December 21, 2009 CONGRESSIONAL RECORD — SENATE S13661 Service located at 116 North West that side who has a comprehensive pro- Your mother was right, you know: Street in Somerville, Tennessee, as the posal, it is hard to do that. We have Prevention is worth a pound of cure. ‘‘John S. Wilder Post Office Building’’, had to kind of plow ahead as best we We have fallen far short of that in this was ordered to a third reading, read the can. We have not done this alone. In country. There is a remarkable array third time, and passed. our committee, we met for 13 days. We of provisions in this bill that promote f had 54 hours of markup. No amendment wellness, disease prevention, and public was denied. Republicans offered over health. Together they will move us SERVICE MEMBERS HOME 200 amendments. We adopted 161 of from a sick care society into a genuine OWNERSHIP TAX ACT OF 2009 them. That is pretty good. Yet in the wellness society, into a true health The PRESIDING OFFICER. The Sen- end, every Republican voted against it. care system, not just sick care. What ator from Montana. So it is not as if we didn’t try and we better way to reform our health care Mr. BAUCUS. I yield 20 minutes to didn’t hold out an olive branch to work system than to restrain health care the chairman of the HELP Committee, with people to get a bill that was truly costs by helping Americans to prevent Senator HARKIN, and 18 minutes to the bipartisan. We did in our committees, chronic diseases, stay healthy and out Senator from Colorado, Senator BEN- both the Finance and HELP Commit- of the hospital in the first place. Right NET. tees. Now it has come down to fear and now, as we have heard so many times, The PRESIDING OFFICER. The Sen- anger on the other side and some we spend more than $2 trillion each ator from Iowa. nitpicking. year on sick care. But 4 cents of every Mr. HARKIN. Mr. President, I guess I My friend from Iowa—and he is truly dollar is invested in prevention and can say we crossed the Rubicon last my friend—was talking about some public health. I submit this is a major night at 1 o’clock. Reading some of the provisions put in the bill for special reason why Americans spend twice as press reports, of course, most of the reasons and so forth. I admit fully and much per capita on health care as Eu- news didn’t have it because it occurred openly that I was part of that. Did I ropean countries, but we are twice as at 1 a.m. Some of the different reports put something in the bill that was sort sick with chronic disease. We spend have been online this morning. It oc- of particular to my State of Iowa? Yes, twice as much as Europe on health curred to me that a lot of people are I did. But it doesn’t just affect Iowa. care, but we are twice as sick with missing the overall importance of what There are several States in which we chronic diseases. happened last night. We can get into have hospitals that are not as big as The good news is that by ramping up the fine tuning and the nitpicking and the big hospitals with the volume. the emphasis on wellness and preven- sort of the fear and the anger I hear They are not so small that they are tion, we have tremendous opportuni- from the other side. Every time I listen low-volume hospitals that get help. ties to both improve the health of the to speeches over there, with the excep- They are kind of in between. They call American people and to restrain health tion of the last speaker, almost all the them tweener hospitals. We have eight care spending. That is the aim of this speeches I hear from the other side, it of them in Iowa: at Grinnell, Keokuck, bill which makes significant new in- is fear, be afraid, be afraid. It is some Spencer Municipal, in Carroll, St. An- vestments in prevention. For example, built-up anger over there. I think what thony Regional; Muscatine; Fort Madi- our bill would ensure that seniors have happened last night is, we crossed a de- son; and Lake Regional Hospital at access to free annual wellness visits marcation line, the demarcation line of Spirit Lake. There are a number of and personalized prevention plans which on one side health care is a these in the United States. I forget the under Medicare. We have never had privilege. We have been on that side of total number; not a large number, they that. For the first time seniors will the line for a long time. On the other just fall in a place where they are too have access to free annual wellness vis- side of that line, health care is a right. small for the big and too big for the its and personalized prevention plans We stepped across that line last night. small. As a result, they have been get- under Medicare. That is a big deal. So We are now in the process of saying ting a bad deal from Medicare reim- many seniors today, if they get sick, go health care is a right, an inalienable bursement. There is a fix in this bill to the doctor and get more pills. Now right of every American citizen. that will allow them to get adequate they will be able to go in, have their Is that what so upsets my friends on reimbursement. I don’t see anything annualized checkup, see what is wrong, the Republican side? I don’t know. wrong with that. It is fixing a specific and have a personalized prevention Something is upsetting them. Because problem that the bureaucracy can’t plan for each person under Medicare. this is a momentous change we are seem to quite get fixed. That is in the It will also encourage States to im- doing. bill. I make no bones about having put prove coverage and access to rec- I keep hearing from Republicans they that in there. I think it is a good deal. ommended preventative services and want us to deal in a bipartisan way. We It is something that is going to help a immunizations under Medicaid. At a tried all this year, both in the HELP lot of hospitals, not only in Iowa but a minimum, States will provide Medicaid Committee and in the Finance Com- few other States. coverage for comprehensive tobacco mittee. Senator BAUCUS bent over One of the things I wish to talk about cessation services for pregnant women. backward to accommodate. But at today is something I have been on for That is just the start. Right away, at a every turn, Republicans said no, no, no, many years, and that is the huge minimum, they have to do that. In ad- no, no—all year long. How can you be amount in this bill on prevention and dition, the bill requires insurance com- bipartisan when the other side has wellness. It has not been written about panies to cover recommended preven- nothing to offer? There is no bill on the a lot. People have been focused on the tive services with no copayments or Republican side. There is a bill. It has public option and the abortion issue deductibles. This is critical because we about nine cosponsors—Senator and a few other items such as that. know that all too often people forgo COBURN, Senator BURR, maybe seven Perhaps one of the most profound parts their yearly checkups or essential others, but not every Republican is on of this bill and the one I believe will do screenings because either their insur- that. I hear bits and pieces of this and more to bend the cost curve, as they ance companies don’t cover them or be- that every time I hear these speeches. say, than any other single thing is the cause they have high copays and Most of it is attacking what we have provisions dealing with prevention and deductibles. done. I hear nothing positive from wellness. In the past I have said many Another critical element in the bill their side. It is very hard to deal with times that we don’t have a health care essential to a sustainable push for a party that is in total disarray as the system in America. We have a sick care wellness is the creation of a prevention Republicans are. If they had a bill they system. When you think about it, if and public health trust fund. Typically were supporting and that was sup- you get sick, you get care. But pre- prevention and public health initia- ported by all of them, such as the bill cious little is spent out there to keep tives are subject to unpredictable and we have here which is supported by 60 one healthy in the first place. So peo- unstable funding. This means that im- Democrats, I think then you could find ple get sick. You go to the doctor, the portant interventions, things such as some reason for meeting and working hospital. We patch and fix and mend education about nutrition and assist- things out. But since there is no one on and try to make them well. ance for smokers who want to quit,

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\A21DE6.004 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13662 CONGRESSIONAL RECORD — SENATE December 21, 2009 often go unfunded from one year to the bill. That deals with school lunches But Dr. Wilson, in his statement, next. They get funded a little bit one and school breakfasts. We need a major made particular note of the wellness year or cut the next; funded a little bit effort there to make our lunches and and prevention programs we have in the next year, cut the next. The pre- our breakfasts more nutritious for our this bill. He did not say this, but I was vention and public health fund in this kids in school. thinking, when he was talking, that it bill will provide an expanded and sus- Next year, in the committee I chair, made sense. Doctors want to keep peo- tained national investment in pro- the HELP Committee, we are going to ple healthy. They do not want to see grams that promote physical activity, reauthorize the Elementary and Sec- people go to the hospital. They would improve nutrition, and reduce tobacco ondary Education Act, the so-called No rather be working with their patients use. We all appreciate that checkups Child Left Behind Act. There are a lot one on one. How can they structure a and immunizations and other clinical of things we are going to be doing on patient’s profile so the patient stays services are important. But this bill that. I see one of our committee mem- healthy, does not get sick so often? also recognizes that where Americans bers, the Senator from Colorado, Mr. That is what Dr. Wilson was talking live and work and go to school also has BENNET, in the Chamber, a former su- about: letting doctors practice medi- a profound impact on our health. That perintendent of schools, who is going cine in a way that focuses on a person’s is why a number of provisions in the to play a key role in helping get that health and keeping them healthy. bill focus on creating healthier com- Elementary and Secondary Education As President Obama said in his munities with better access to nutri- Act through and refined and brought speech to Congress early this year: tious foods as well as safe places to en- up to date where we will make some [It is time] to make the largest investment gage in physical activity. changes. ever in preventive care, because that’s one of A 2007 study by the Trust for Amer- But there is one other part of that the best ways to keep our people healthy and ica’s Health found major savings from bill we have to focus on; that is, the our costs under control. community-based prevention programs amount of physical activity kids get in That was the President of the United designed to increase levels of physical school. I talked many times both to States in his State of the Union mes- Secretary Duncan and, before him, to activity, improve nutrition, and reduce sage. Well, President Obama has it Secretary Spellings about this idea of smoking rates. This study concluded right. It is one of the best ways to keep No Child Left Behind. If we are not that a national investment of $10 per our people healthy and our costs under going to leave kids behind in terms of person per year in these kinds of com- control, and that is a big part of this their writing and their math and their munity-based programs could yield net bill. I do not know—I have not listened English, how about not leaving them savings of more than $2.8 billion annu- to every speech made by the Repub- behind in terms of their health? Yet re- ally in health care costs in the first 1 licans on the other side—but I hardly cess is gone. I saw a statistic this year and 2 years, more than $16 billion sav- ever hear them talk about this, but it that said 80 percent of elementary ings within 5 years, and nearly $18 bil- is a very important part of the bill. school kids in America today get less So, Mr. President, we are changing lion savings annually within 10 to 20 than 1 hour of physical exercise a week years, starting at $10 per person per the paradigm. We are going to extend in school—80 percent get less than 1 quality, affordable health coverage to year. hour a week. nearly every American. We are going More generally, this bill aims to give Mr. President, I do not know about to transform ourselves into a genuine Americans the tools and information you, but I remember when I was in they need to take charge of their own school, in elementary school, we had wellness society, and we are going to health. For example, it requires large an hour a day for recess. We had 15 give our citizens access to a 21st-cen- chain restaurants to post basic nutri- minutes in the morning, 15 minutes in tury health care system, one that is fo- tion information on the menu so con- the afternoon, and a half hour at lunch. cused on helping us to live healthy, ac- sumers can make healthy choices. That So there was 1 hour every day, and we tive, and happy lives. is in this bill. It will start next year. had to go out and do stuff. We couldn’t Mr. President, I yield the floor. The PRESIDING OFFICER. The Sen- The bill also focuses on prevention sit around and play with Game Boys ator from Colorado. and public health needs of a number of and things like that. So we got an hour Mr. BENNET. Mr. President, I would generally overlooked populations, in- a day of physical exercise. Well, we like to first thank the Senator from cluding children, individuals with dis- need to reinvigorate our schools to Iowa for his leadership over many abilities, Americans living in rural make sure they get that physical exer- years, especially on prevention and communities, and certain ethnic mi- cise. norities. For many months I have made So we have done a lot in this bill to wellness, and to see so much of this bill the case that it is not enough to talk move this paradigm toward a health devoted to that is a real testament to about how to expand insurance cov- care society rather than a sick care so- his efforts. So I thank the Senator for erage, how to pay the bills—those are ciety. There is more to do, as I said, in that. important—but it makes no sense to both the Education bill next year and Mr. President, a number of years ago, figure out a better way to pay the bills in the Agriculture Committee in terms I left a rewarding job in business be- for a system that is dysfunctional, in- of the child nutrition reauthorization. cause I had a chance to lend a hand to effective, and broken. But in this bill we have made a great my community during a very difficult We have to change the health care start. We have laid a great foundation. time in Denver. The economy was slow system itself, beginning with a sharp I am just thrilled so many of the and the city was facing a record budget new emphasis on prevention and public wellness and prevention initiatives I deficit. Our great mayor, John health. We also have to realize that have championed for so many years are Hickenlooper, asked me to come be his wellness and prevention must be truly included in this bill. chief of staff. It was not a glamorous comprehensive. It is not only about As I look forward to going to con- job, but it was rewarding because we what just goes on in the doctor’s office; ference, we look forward to working got results—not by seeking out what it also encompasses community-wide with the House to strengthen it even divided the people of Denver, who were wellness programs, about which I just more and to put more emphasis on going through a very rough time, but spoke, things such as building bike wellness and prevention. by reaching out time and time again to paths, walking trails, getting junk food Just about an hour ago or so, we had what the mayor called ‘‘our alignment out of our schools, out of the vending a press conference with the president- of self-interest.’’ machines, making our school break- elect of the American Medical Associa- We fixed the city’s budget, and then fasts and lunches more nutritious, in- tion, Dr. Wilson. I am proud of the fact I had the chance of a lifetime to be- creasing the amount of physical activ- that the American Medical Association come the superintendent of public ity our children get, and so much more. has now endorsed our bill. As I said at schools and serve our children and the Some of this is going to be addressed the time, I said the doctors of America people who work so hard every day to in other bills. For example, next year, have examined this bill, and they have support them. I came away from that in the Agriculture Committee, we will made the right prescription: Pass it. experience believing that much of the be reauthorizing the child nutrition Pass the health care reform bill. Republican and Democratic

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.036 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13663 doxies relating to public education are happy that the public option was held forced out of business. So they dropped essentially useless to our children—and hostage by people in our own party. I coverage for the 12 employees to keep maybe worse—and that Washington as do not support rewarding delay with their doors open. a whole has absolutely no clue about special deals. I will let others justify Hollis Berendt owns a small business what is going on in America’s class- their vote and their tactics. in Greeley and told me about her rooms. As for me, I am voting to provide daughter Abby who graduated from So it is fair to say I did not come to coverage to 840,000 uninsured Colo- Colorado State University in 2004 and Washington with a partisan ax to radans, voting to extend Medicare for found a job in New York with a large grind. As is probably obvious to every- our seniors and provide free preventive company. Her daughter’s company one around here—for good or for ill—I care for everyone, voting to close the made her wait a year before she was el- am not a career politician. I did not prescription drug loophole and provide igible for health insurance, and during come here to win political points so tax cuts to small business, voting to that time Abby was diagnosed with that someone else could lose. I am not make health care more affordable and ovarian cancer. Hollis took out a sec- interested in that. I am here as the fa- eliminate exclusions based on pre- ond mortgage to pay for her daughter’s ther of three little girls with an abid- existing conditions, voting for health bills and told me: ing concern we are at risk of being the care reform that is fully paid for. This experience brought to light, all too first generation of Americans to leave The people in my State and in our clearly, how close we all are to losing every- less opportunity to our kids and our country deserve better than a politics thing due to a health issue. grandkids than our parents and grand- that cares more about lobbyists and I have spoken here before about a parents left us. That prospect is shame- talk show hosts than the people we rep- young boy named Alex Lange. Alex’s ful. resent. I am committed to delivering parents’ insurance company refused to We are not the only Americans who on that despite what the political ex- cover Alex because he was 4 months old have been working weekends and late perts have to say. And, in the end, and 17 pounds. They said he had a pre- into the night recently. There are peo- when the dust settles and the stories existing condition, at 4 months, of obe- ple in small towns and big cities all focus more on substance and process, I sity. across America doing jobs much harder am confident Coloradans will see it the Then there was 2-year-old Aislin than ours, who are taking an extra same way. Bates, whose parents’ insurance com- shift before Christmas so they can af- I also commit to the people of Colo- pany denied her coverage because she ford that extra gift beneath the tree— rado and the people of this Chamber was underweight. One child too big, the Americans who are unemployed in this that I will do everything I can to make other too small. Today in America, you savage economy and still trying to sure this bill is fully paid for. That is have to be just right to get insurance. make sure the kids know Santa re- why I submitted an amendment that There was Peggy Robertson of Gold- membered them. will ensure that health care will help en, CO, who was told she could not re- These same people are reading their pay down the deficit by forcing Con- ceive coverage unless she was steri- papers and watching their televisions gress to make adjustments if reform lized, Mr. President. She came and wondering what in the world we are does not meet the cost estimates we bravely testified in Washington about doing here in Washington. All they see have projected. the need for reform. There was Mat- are talking heads yelling at each other I urge my colleagues and the leader- thew Temme of Castle Rock, who could on cable news, needless partisanship ship in the Senate to see to it that this not receive coverage because his wife paralyzing their government, and even amendment is included in the con- was pregnant, even though she had her people praying that Senators will not ference report. If not, I will fight to get own health insurance. be able to make votes. it passed on its own. I believe so The sad thing is, there is nothing un- I am not naive about politics, but I strongly in this because everyone here usual about these stories. None of expected more. I will vote for health knows that keeping things the way these people were trying to cheat or care reform because it is a step in the they are is no longer acceptable. game the system. They were trying to right direction. But I will not go home When I first started in the Senate, gain some peace of mind, some sta- and defend the actions of a Washington 800,000 Coloradans were without health bility in their lives and, instead, they that is out of touch, a Washington that insurance. That number has grown by wasted weeks of their lives fighting is more interested in scoring political 40,000 in the months we have debated against insurance company bureauc- points, more interested in the 278 this bill. On average, 111 Coloradans racy and mounting bills. health care lobbyists who used to work have lost their health insurance every We have debated health care reform for Members of Congress than it is in single day. This number will only get for over a year. Some have been work- what our constituents have to say, a worse if we do nothing. Our State has ing on these issues for decades. Killing Washington that is more concerned spent $600 million in the last year health care reform under the disguise with the millions being spent by big in- alone on uncompensated care. of starting over is not an option. We surance companies than the thousands Colorado’s working families suffered cannot wait until after the next elec- of dollars being lost by working fami- double-digit health insurance cost in- tion. We cannot wait until our econ- lies who are struggling to pay for cov- creases year after year for the last dec- omy recovers or until we have come erage. ade. Many families have made terrible home from Afghanistan to deal with Columnists opposed to reform have sacrifices—no longer investing in their our broken health care system. criticized me for saying that I am will- children’s futures, saving for a home, Now standing so close to the finish ing to lose my seat to enact meaning- or carrying crushing credit card bal- line, it is completely understandable ful health care reform. Now I am being ances—all to pay for health care. that some Americans doubt whether asked why I did not negotiate a special Small businesses pay 20 percent more this bill will improve their situation. deal with leadership. In fact, there was for health insurance than large busi- They understand we cannot live with a report this morning criticizing me nesses do just because they are small. the current system. But they are also because the National Republican Sen- I think back to the Coloradans who deeply concerned about our capacity to atorial Committee was rejoicing that I shared their stories with me during make it worse. did not ask for special favors. Only in this debate. The special interests are using tried- Washington would someone be at- I remember Bob and Deb Montoya of and-true tactics that have been em- tacked for not negotiating a backroom Pueblo. They were torn between pro- ployed over and over across the decades deal. Just because others choose to en- viding health care for their small busi- to prevent reform: phone calls to scare gage in the same tired Washington rit- ness employees and keeping their busi- seniors, direct mail to scare those al- uals does not mean I have to. ness afloat. Last year, their business ready covered, television ads to scare So I have a message for the col- paid out $36,000 to cover two families just about everyone else, and oppo- umnists, the political professionals, and one employee. They could not af- nents of this reform in this body are and those back home: I am not happy ford to give their other 12 employees trying every delay tactic permitted by about the backroom deals. I am not health care or they would be literally the Senate rules.

VerDate Nov 24 2008 02:47 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.037 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13664 CONGRESSIONAL RECORD — SENATE December 21, 2009 Amidst all this, there is still a reason tended tax credits for small businesses, who told me repeatedly all they wanted to hope. After almost a century of try- allowing more than 68,000 small busi- to do was work with patients, while all ing, the Senate is very close to finally nesses in Colorado to buy health insur- the government was doing was making passing a meaningful health care re- ance. them fill out one form after another. form bill, a piece of legislation that This bill makes a significant invest- When I came back, I was determined to while not perfect, represents a substan- ment in Medicare payments to rural do something to help cut the red tape tial step forward from business as areas. When I first joined the Senate, and bureaucracy for these people so usual. We have a bill that does three my first piece of legislation called for a they could spend more time with their important things: It saves money, it deficit-neutral reserve to address the patients. That is why, as part of the saves lives, and it gives families a differences in Medicare payments be- freshman package, I introduced an fighting chance in their relentless tween urban and rural areas. This Sen- amendment to put an end to multiple struggle with health insurance compa- ate bill recognizes the geographic dif- forms, confusing codes, and unneces- nies. ferences between rural and urban areas sary paperwork that burden providers. This bill will save money. It reduces and makes sure providers in rural Colo- If health plans don’t follow the rules, the deficit by $130 billion over the first rado that provide higher quality at they will suffer financial penalties. Our 10 years, according to the nonpartisan lower cost receive higher Medicare health care workers deserve better, and Congressional Budget Office, and is payments. this amendment gives them back time projected to reduce the deficit by 10 This bill also delivers on its promise to spend with their patients. times that—up to $1.3 trillion—in the to seniors. It doesn’t use a dime of the Our freshman package rewards and emphasizes efficiency: one form to fill second decade. We will save $1⁄2 trillion Medicare trust fund to pay for reform by improving the way we deliver serv- and does not cut guaranteed benefits. out, not 10; less red tape; fewer bureau- ices to our seniors. These savings will That is why, on the first day of the crats; a system that makes sense. prevent Medicare from going broke in 7 health care reform debate, I introduced Thanks to the leadership of the Pre- years by extending the life of the Medi- an amendment that would make sure siding Officer, that package was en- dorsed by the Business Roundtable, the care trust fund. seniors will still see their guaranteed This bill will save lives. It will ex- benefits, such as hospital stays and AFL–CIO, and the Consumers Union— tend health insurance coverage to 31 prescription drug coverage, no matter proof that at least off this floor, there million Americans who don’t have it what changes we make in health re- are still people from all different points of view who are willing to work today. Over 90 percent of Americans form. It was the most bipartisan piece of legislation we have had this year, together. will have health insurance coverage, This bill also makes progress in the with 100 Senators agreeing health re- the highest percentage in the history area of tort reform. It includes lan- of the United States. For Colorado, form would not take away guaranteed guage I worked on with Senators BAU- that means over 840,000 people who Medicare benefits for seniors. For Colo- CUS, CARPER, and LINCOLN to create a rado, that means half a million Medi- don’t have insurance will now have ac- State grant program for States to de- care beneficiaries will continue to have cess and another 300,000 people who velop, implement, and evaluate alter- have insurance in the unstable indi- their guaranteed benefits protected and natives to tort litigation for medical vidual market will be able to get af- preventive services free of charge malpractice claims. The purpose of fordable coverage through the new through health reform. these grants is to limit litigation while I am very pleased Majority Leader health insurance exchange. preserving access to courts for patients REID included a version of a piece of The Senate bill makes preventive and promoting strategies to reduce legislation I wrote based on the work services, such as breast cancer and medical errors. colorectal cancer screening, available in Mesa County, home of Grand Junc- I know many in this Chamber take without copayments. Now mammo- tion, CO. Currently, one out of every issue with one particular part of this grams and colonoscopies, which can five Medicare patients who is released bill or another. I have my own issues cost between $150 and $200, on average, from the hospital in this country winds with the bill. I am one of many who will be free as well for seniors—half a up back in the hospital in the same have expressed their strong preference million seniors in my home State month they were released but not in for a public option. But I urge my col- alone. This means catching diseases Mesa County. They have reduced the leagues to consider how much good this earlier, promoting wellness, and saving readmission rates at the hospital to bill can do for the American people— millions of lives. about 2 percent, compared to the na- those with skyrocketing health care For our Nation’s working families, tional average of 20 percent. That is 12 costs, small businesses forced with the this bill will also rein in the worst million patients who aren’t receiving impossible choice of helping workers practices of private insurance compa- the care they need. In Mesa County, keep their coverage or even just main- nies. They will have to commit to cov- they have lowered readmissions by cre- taining their business. To have the ering patients instead of gouging them ating a transitional model that makes nonpartisan experts at the Congres- for excessive profits and overhead. sure that when patients leave the hos- sional Budget Office validate that in Starting in 2011, if an insurance com- pital, they do so with a coach. That the second decade we will have cut pany doesn’t give you value for your coach helps them go from the emer- health care costs by up to $1.3 trillion dollar, they will have to refund you gency room to their primary care phy- and that we will reduce the rise in back the difference. They will not be sician, their mental health provider, costs of Medicare from 8 percent in the able to impose arbitrary lifetime limits making sure they get the care they next two decades to 6 percent in the on consumers and punish you just for need over a period of time, making sure next two decades, while covering 31 getting sick or deny you insurance be- they don’t forget their prescriptions, million insured Americans, is truly cause of a preexisting condition. The and making sure they have the guid- groundbreaking. newest Senate bill does more to con- ance they need to take responsibility We know what more time elapsing tain costs, more to demand account- for their own care. I am pleased the without fixing this system means for ability and transparency from insur- Senate bill compensates and reim- Colorado’s working families and small ance companies, and more to give con- burses hospitals and providers that set businesses. It means more double-digit sumers a better choice. up models such as the one in Mesa premium increases, less time to fix For my home State, in particular, I County that actually saves money. Medicare before it goes bankrupt in am glad the bill addresses other crit- On another note, I wish to thank the 2017, and more names added to the rolls ical areas. This reform does more for Presiding Officer and my fellow fresh- of the uninsured. It means another big small business and small business men. Together, we worked hard to in- win for the special interests, more peo- workers than ever before. Small busi- troduce a package of amendments to ple denied coverage for preexisting con- ness tax credits will begin next year, further contain costs and make our ditions, and more small business em- giving eligible businesses a tax credit system more efficient. As I traveled ployers will have to make impossible for 6 years to purchase health insur- throughout Colorado on the August decisions about covering their workers ance for their employees. We have ex- break, I heard from doctors and nurses or keeping their doors open.

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.039 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13665 So let’s reject business as usual. cluded that came from their side—and company. They now have 15 employees. Let’s look at the promise of this Sen- the Finance Committee as well. They are making backpacks for our ate bill as a whole. Let’s put the petti- I remember the first bipartisan meet- Nation’s soldiers because they make ness, scare tactics, and obstruction ing we had on health care reform was such high-quality backpacks. Do you aside. Reform is what is needed to con- something called Ready to Launch that know what the man who started that trol costs, give people more choice, and the Finance Committee put together. I company told me? That if he had provide support for our small busi- remember Senator WHITEHOUSE and I known how much his health care would nesses. This package will reduce our were there. It was literally a year and cost with his family of four—he did not deficit, and it does so by reforming the a half ago. So many of the ideas that have kids when he started the busi- way we provide health care. are now incorporated in this bill that ness—he would not have started it We have much to do. Even before we Senator BENNET from Colorado just so today. He is paying $24,000 in Two Har- were in the worst recession since the eloquently went through are in this bors, MN, for a family of four. Great Depression, during the last pe- bill, so many of the bipartisan ideas to This is what it really means when riod of economic recovery, working kick off cost reform, to start rewarding you look at the numbers. Inflation usu- families’ incomes in this country actu- high-quality care, to start bringing ally raises the cost of most goods and ally declined, the first time in the his- down those costs in a way that gives us services between 2 and 3 percent a year. tory of the United States, the first the high-quality care. What have health care premiums been time our economy grew and left the We all know that rising costs are not doing? Health care premiums have been middle class behind. At the same time, sustainable. If we don’t act, these costs going up close to 8 percent a year, and in my State of Colorado and in all are going to continue to skyrocket. that is an increase Americans simply States across the country, the cost of So what was the vote about last cannot afford. health insurance rose by 97 percent and night? The vote last night was to say What does this bill do? I was listen- the cost of higher education in my we are not going to put our heads in ing to some of the commentary and State went up by 50 percent. Finally, the sand anymore. We are not going to taking part in it myself over the week- because of the short-term politics prac- keep letting these costs go up. end. There seems to have been a lot of ticed around here, we now have an an- Ten years ago, the average family talk about these delayed benefits. Why nual deficit and long-term debt that is was paying $6,000 a year for their don’t we talk about the benefits that cheating our children and constraining health insurance. Now they are paying are taking place right when the Presi- our choices. $12,000 a year. Well, 10 years from now, dent signs this bill, within the first We still have a lot to do to live up to if we don’t do anything about this, year of this bill? the legacy that our parents and grand- they are going to be paying $24,000 to The first thing is, if your kid loses parents left us. It has taken me less $36,000 a year for their health insur- their coverage because something goes than a year to understand that Wash- ance. Just look at these numbers. Look wrong—if they get diabetes or if they ington still doesn’t get it. I know we at where we are. In 1999, a single person have some childhood disease—guess can do better, and despite so much evi- was paying about $2,100 for their health what. They are going to be able to get dence to the contrary, I believe we will. care. They were paying for a family, health care. There is no longer a ban I believe we will because, in the end, $5,790 for their health care. Where are on preexisting conditions immediately, the national creed that each genera- we now? Last year, in 2008, a single per- and then in later years that applies for tion of Americans has fought for and son was paying $4,700 for their health adults as well but immediately for fulfilled—the idea expressed in our care and then a family was paying kids. Constitution that our responsibility $12,680. Especially during this difficult Immediately, by 2011, within the first lies not just with ourselves but to our economic time when wages haven’t year of the bill, our seniors are going posterity—is so much more powerful been going up, people have been losing to be covered in that doughnut hole for than the trivial politics that animate their jobs, cutting back on their hours, their prescription drugs. So many of so many of the charges and counter- and look what their health care costs them for so long—I know my own charges that ricochet around this have been. It has been a higher and mother would complain about this building. higher percentage of their family budg- doughnut hole where they fall off a It is for this reason I urge my col- et, a higher and higher percentage. cliff and are not able to pay for their leagues to come together and support At the same time, health care ex- drugs because they do not have enough this meaningful improvement in our penditures are going up and up and up. money. That will be covered. health care system. In 1995, we were spending something A number of the small business tax I yield the floor. like $12 billion and now it is way up to credits take effect by 2011. These are The PRESIDING OFFICER. The Sen- $2.5 trillion. This is the kind of money real benefits for the people of this ator from Minnesota. we are talking about when we look at country—real benefits. Ms. KLOBUCHAR. I ask unanimous why we have to do something to bend The thing I care most about in this consent to yield myself 10 minutes. the cost curve. When people at home bill which Senator BENNET discussed is The PRESIDING OFFICER. The Sen- hear this term ‘‘cost curve’’ and they this idea of getting our money’s worth ator is recognized. don’t know what it means—well, this is for our health care dollars. What does Ms. KLOBUCHAR. Mr. President, exactly what it is: The cost curve has this bill do? This new bill—we have late last night, as my colleagues are been going up and up and up for health taken a lot of the good from the origi- aware, the Senate took the important care in America. nal bill and made things even better: step to move forward on health care re- So $1 out of every $6 spent in our $132 billion off the deficit in the first 10 form. After all the work, the debate economy is on health care. Over 20 per- years and in the next 10 years, $1.3 tril- that has gone on for this entire year, cent of our economy, by 2018, we be- lion off the deficit. That was the most we owe the American people a vote on lieve, will be spent on health care. important thing to people in my State this issue. We can’t afford to ignore American families can no longer afford when I went around. They said: We this situation anymore. it. want to get rid of these preexisting I know some of my colleagues on the Who has been taking it the worst? conditions, we want to make things other side of the aisle have been talk- Small businesses. They are paying 20 better so we have better health care, ing about a lack of debate. I think any- percent more than large businesses for but we want to make sure we do some- one who has turned on C–SPAN for the their health care. In a recent survey, thing about the deficit, start doing last few months will tell you there has nearly three-quarters of small busi- something about costs. been a lot of debate—not only that, a nesses that did not offer benefits cited As you know, Mr. President, Min- number of Republican amendments high premiums as the reason. nesota is a mecca for health care. We were actually included in the original These are little companies such as have one of the high-quality, cost-effi- bill, the HELP Committee bill. When it Granite Gear up in northern Minnesota cient, low-cost States in the country. came out, I believe it was something and Two Harbors. I went up there and In fact, when we look at some of the like 130 amendments that were in- visited them. They are a thriving little numbers, one of my favorite ones—and

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.040 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13666 CONGRESSIONAL RECORD — SENATE December 21, 2009 maybe this will be the last time I will municate one-on-one with the nurse. health care they and their families say this before the end of the year—is The doctors were able to handle the need. So what is it to them if another Mayo Clinic. They did a study out of most difficult cases and monitor the 14,000 people lose their insurance every Dartmouth, and they looked at what other cases. They saved $200 a month day? Mr. President, 390 people every Mayo did with chronically ill patients. per patient with this kind of system. single day in my State lose their insur- What they found was this: If other hos- Higher quality care and better patient ance. What is it to them if people with pitals in the country simply use the outcomes. preexisting conditions cannot get cov- same high-quality care Mayo uses— What does our system do when they erage, if women are overcharged for in- bring the family in, talk to them about see this kind of smart, cost-effective surance, if the self-employed cannot af- what the care should be for the pa- result for the doctors and for the sys- ford the outrageous premiums they are tient—they talk to the patient and tem and for the taxpayers? They actu- charged, if too often American small then figure out what is the best course. ally are told: You get punished for this businesses pay more for health cov- They work as a team, like a quarter- under our system. You are going to get erage than they earn in profits? What back with a team working with that a lot less money if you do something is it to them? quarterback. They do not have 20 spe- like this. That is what I am talking I have listened as Republican Sen- cialists falling all over each other; about. ators have come to the Senate floor they work as a team. What this study On hospital readmissions, we could day after day to tell tales about health showed was this kind of health care for save $18 billion a year. If you go in the care reform and try to manipulate pub- that subset of chronically ill patients hospital and you are treated, you want lic opinion by any means possible. I in the last 4 years of their lives, the to go home. You don’t want to go back hear them mostly stalling: Slow down, quality ratings were sky high for the into the hospital because someone not yet. They have done it since the Mayo Clinic. The families felt good made a mistake or they gave you an in- Gang of 6 in the Finance Committee about how their loved ones were treat- fection. Let’s provide incentives—that met in June. No, actually they had ed. is what this bill does—so that we re- begun to stall even before that when What Dartmouth found is if all the duce those hospital readmissions, make the Finance Committee and the HELP hospitals in the country followed the life better for the patient and at the Committee began their deliberations, same time reduce taxpayer money. same protocol, we would save, for this informal deliberations. That is what this bill is about. subset alone, $50 billion every 5 years What they forget or what they do not Right now, fraud is $60 billion. I don’t in taxpayer money, giving patients think anyone would believe this. A sen- want to think about, perhaps, is that that Mayo health care, giving them ior who just depends on Medicare, every day they stall, 390 people from high-quality health care. It is counter- right—we have to tell our seniors Galion to Gallipolis, from Buckeye intuitive to people. If you go to a hotel today that $60 billion a year is wasted Lake to Avon Lake, from Ashtabula to and you pay the most, you are going to on Medicare fraud, going to con men, Cincinnati, 390 people in my State lose get the best room with the best view. going to people who set up storefronts their insurance every day. Every day, That has not been the same in Amer- and they get fake checks and they are we see 14,000 Americans lose their in- ican health care. In fact, there is an in- not even real. That is where the money surance, and 1,000 Americans die every verse relationship. is going right now—down the tube, si- week because they do not have insur- I see my friend from Ohio. Ohio has phoned off by fraudsters. What this bill ance. One thousand Americans die the Cleveland Clinic, and there is does is give the tools to improve that every week because they do not have Geisinger. Those places that offer high- situation so that will not happen any- insurance, and on the other side of the quality care also tend to have some of more. aisle they say: Slow down. What is the the lowest costs. That is what we are doing with this rush? Why do we have to move into Those are the incentives we are put- bill. It is about reducing costs, it is this? ting in this bill—incentives for ac- about raising quality, and it is about They forget or maybe they just do countable care organizations, incen- saving Medicare so it does not go in the not want to hear that a woman with tives for that integrated care I talked red by 2017, giving it 10 more years and breast cancer is 40 percent more likely about instead of people running around beyond because of the delivery system to die if she is uninsured than if she with x rays to 20 specialists, getting changes. has insurance. Women with breast can- charged every single time, but then one I am proud to support this bill. We cer are 40 percent more likely to die if specialist does not know what the continue to work for reform. As you uninsured than if they have insurance. other specialist is doing. They don’t know, this is not just an end, this is a Yet they continue to say: Slow down. know what kind of drugs you are aller- beginning. There will be more work to I wish my friends on the other side of gic to when you go in for surgery. This do in the future, but we cannot put our the aisle would actually meet some of is because there is no communication. heads in the sand. We have to vote on these people who do not have insur- This bill promotes that integrated care this bill. We have to get this done. ance. Let me put a human face on this, where you put the patient in the driv- I yield the floor. if I can. Let me share three letters er’s seat so they have their pick of a The PRESIDING OFFICER. The Sen- from Ohioans. I have come to the floor doctor. That is what we want—bun- ator from Ohio. since July day after day reading letters dling of payment so you start reward- Mr. BROWN. Mr. President, it has from people directly affected by this ing outcomes instead of the number of been said that a cynic knows the price health insurance situation, if you will. tests and procedures. of everything and the value of nothing. In most cases, these are people who My favorite example of this came out I spent, as we all have, as the Senator were happy with their health insurance of the Geisinger Clinic in Pennsyl- from Minnesota has, as the Presiding a year ago, and something happened in vania, where they said: We are not that Officer has, the last 4 weeks listening their lives—they got laid off and lost happy with how we are treating diabe- to my colleagues come to the Senate their insurance; had a child with a pre- tes patients. So instead of having ev- floor to describe health reform legisla- existing condition for whom they could eryone wait to see an endocrinologist, tion that bears no resemblance to what not get insurance; maybe they got sick a doctor, we are going to have some of is actually before us. They take lib- and the cost of their health care was so the routine cases see nurses, and the erties with the cost of the bill. They high that the insurance industry cut nurses will report to the doctors, and seem to have no concept of the value of them off, simply eliminated their cov- the patients will be happier because health care to a family who has it and erage. Let me read a couple of these. they will be able to see a nurse more to a family who does not have it. I Marie from Hancock County, OH: often. The most difficult cases will be guess they believe it is not important My husband and I both have preexisting treated by endocrinologists. for us to get this done, it is not impor- conditions and are stuck paying $1,300 a They did that for about a year and tant for other Americans to have af- month for health insurance. He has been out looked to see what the results were. fordable health insurance. of work for 2 years and we are living off the Guess what. The patients were much My colleagues are not at risk of los- money that we got when we sold our house. happier because they were able to com- ing their coverage. They can afford the We are afraid to go without insurance. We

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.042 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13667 are in a fix and in our late middle ages and strengthen Medicare. It is going to bill that was brought to the Senate find ourselves watching our retirement sav- lengthen the lifespan of Medicare. It is floor—with the government knowing ings go down the drain. Please fight for us going to give free physicals, once-a- better than the rest of America, know- and others like us. year checkups, colonoscopies, and ing what health care ought to be given Think about that. Does anyone in mammograms for people on Medicare, and shouldn’t be given—all of a sudden this Chamber, does anyone who comes and it is going to close the doughnut what we see is the government knows to work as a Senator or down the hall hole so fewer people will have to pay so best, people don’t know—her life would as a Congressman—can any of us really much out of pocket. have been lost because she is one of understand what this couple is all Last letter. Raymond from Delaware those 1,900. about, this couple from rural, County: So I understand, having practiced smalltown Ohio paying $1,300 a month? medicine, having lived that life as a How are they paying for their insur- My wife and I had to drop our coverage be- cause it cost us $30,000. The country needs re- physician—taken care of people with- ance? They sold their house so they form that bars insurance companies from de- out health insurance and on Medicaid could pay for their health insurance. nying coverage or charging higher premiums and Medicare and those worrying about They are in their late middle ages. I on the basis of preexisting conditions. Health losing their insurance when they lose am guessing they are probably in their reform is the right solution for the people of their job—the implications. Yet I took late fifties, early sixties. They are not Ohio. care of all of them, as did all my part- eligible for Medicare. The PRESIDING OFFICER. The Sen- ners. We dealt with all these people, So many people say to me through ator’s time has expired. trying to help each and every one of these letters and through my meetings Mr. BROWN. I yield the floor. them, regardless of their ability to pay. and discussions and when I am trav- The PRESIDING OFFICER. The Sen- It is why we need health reform in this eling around my State: I am 63. I only ator from Wyoming is recognized. country that actually works on avail- have 2 years before Medicare because I Mr. BARRASSO. Mr. President, I just ability of care, affordability of care, trust Medicare. It is stable, predict- heard my colleague, the Senator from access to care, and quality care. This able. It will be there for me, and it will Ohio, say: I wish some of my colleagues bill that I voted against last night help. on the other side of the aisle would un- doesn’t address the needs of the coun- Instead, Republicans in this body, all derstand families who don’t have insur- try. It fails time and time again. 40 of whom even voted against the bill ance. The President made a number of last night—40 said: Stop. Don’t even I practiced medicine for 25 years, promises—a number of promises—to move forward on this bill. Do any of taking care of families in the State of the people of this country. He said peo- those 40 really understand people such Wyoming. During that time, I took ple would see their insurance premiums as Marie from Hancock County? Do care of all patients, regardless of their drop by $2,500. Instead, the budget offi- any of them understand? Do any of ability to pay. I will tell you, I believe, cers say: Oh, no, it is going to go up them understand that 390 people are as a physician who practiced medicine $2,100 for a family. Has the President losing their insurance every day in just for 25 years—and as someone whom the not read the bill, not read the re- one State? Do any of them understand Obama administration has decided to sponses that have come from the Con- that 1,000 people a week are dying in completely ignore, as he did the other gressional Budget Office? Does he not this country because they do not have Senator of this Chamber who is a phy- see the difference there of $4,600 per insurance? Do any of them understand, sician—that I know specifically and family? any of the Members of Congress, the personally about what happens to fami- The President said this wouldn’t add House of Representatives or the Sen- a dime to the deficit. Well, it is going ators, the 40 Senators who said no and lies who lose their insurance. My col- league and I know specifically what to add a lot of dimes to the deficit. stall and stall, saying: Not yet; can’t This is going to add $1 trillion to the do this yet; have to slow it down. Do happens to families who are on Med- icaid, a health care program which my deficit. He said: Oh no, will not at all. any of them understand that a woman Yet they didn’t do the doctor fix—the with breast cancer is 40 percent more colleague who is now leaving the Chamber after asking if anyone in this Medicare doctor fix. Now the Speaker likely to die if she does not have insur- of the House says: Oh, we will handle body understands people without insur- ance than if she does? that in January or February for $250 ance but not staying to hear the dis- Charles from Cuyahoga County, the billion, since they are not going to pay cussion for the next hour—making Cleveland area, writes me: for it here. The hands-off-health-care people claim statements and then leaving—I under- The President said: Taxes will not go that many Americans are very satisfied with stand those families. I understand the up on anybody making under $250,000 their own health insurance. I am one of families on Medicare, I understand the for a family. There are a dozen taxes in those. I have Medicare. But I don’t believe families on Medicaid, I understand the the bill that will be passed on to the their implication that health care reform is families without insurance, I under- not needed. I think if you were to really ask American people. Now any teenager stand the families worried about losing who goes to a tanning salon is going to those lucky people who were somewhat satis- their insurance, I understand about the fied with their plan—a great majority would get taxed 10 percent. I don’t think any say they support reform that would benefit families worried about disease. of those people are making over everyone. My colleague from Ohio said: Do peo- $250,000 apiece. Charles understands. He is on Medi- ple understand women with breast can- The President said: People will not care. He understands the stability and cer? Well, my wife is a— lose their coverage. Oh, they are going predictability of the Medicare system. Mr. BROWN. Will the Senator from to lose their coverage. Many will lose I might add parenthetically that my Wyoming yield? the coverage they have, coverage they Republican friends, all 40 of whom last Mr. BARRASSO. Regular order, Mr. like, because they have cut 11 million night said: Stop, slow down, stop, slow President. people on Medicare Advantage—a pro- down, all 40 of them understand that Mr. BROWN. I just wished to let the gram people like, a program my pa- their party overwhelmingly opposed Member know I am still in the Senate. tients like. People whom I have taken the creation of Medicare. When they Mr. BARRASSO. My wife was a care of like it because there is actually had a chance, they tried to cut it and breast cancer survivor, and her breast an advantage to the program. It is a privatize it in the nineties. Then when cancer was discovered in her forties by program that deals specifically with President Bush was sworn in, with Re- a screening mammogram. It was that preventive care. It is coordinated care. publican leadership in the House and screening mammogram that saved her That is what happens with Medicare Senate, they moved forward on their life because the cancer had already Advantage. The President doesn’t like. giveaway to the drug companies and spread. It had already spread to a They will lose their coverage. insurance companies in their attempts lymph node. She had three operations, Of course, the President said we to privatize Medicare. Now they say two bouts of full chemotherapy, radi- wouldn’t see any cuts to Medicare. Yet they are all for Medicare. ation—35 treatments and all—all—be- the bill says $500 billion of cuts to Understand, Charles knows what this cause of the screening mammogram Medicare for the seniors who depend bill is going to do. It is going to that saved her life. Yet because of this upon Medicare.

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.043 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13668 CONGRESSIONAL RECORD — SENATE December 21, 2009 The President said we would have an 40 million seniors depend on. We all mean, they are suggesting we believe if open, honest debate. He said C–SPAN pay into it, and then when we get to be you take $135 billion from hospitals would be there covering the debates. of a certain age we depend upon it for and $120 billion from the 11 million sen- Those of us with the most experience— our medical care. For many Americans, iors who participate in Medicare Ad- the two physicians, with 50 years in the it is very important. It was established vantage and $15 billion from nursing practice of medicine and taking care of with broad bipartisan support in the homes and $40 billion from home health families in this country—were com- 1960s. agencies and $7 billion from hospices, pletely excluded—completely ex- What are the proposals that have to that somehow that is good for seniors. cluded—even though we offered to go do with Medicare? Well, basically half Perhaps it could be, if all that money to the White House and read the bill this health care bill is paid for by re- were put back into Medicare; if the with the President. ductions in the growth of Federal money were taken from grandma and So what do we have? What is the ver- spending for Medicare. Those are Medi- spent on grandma. But no, this money dict of the American people on the vote care cuts. Who says they are? Well, the is taken out and spent on a new pro- that was taken in the dark of night—at President of the United States, for one, gram. The Director of the Congres- 1 a.m. in the morning—a Monday says we will have no deficit from this sional Budget Office—not a Republican, morning vote, taken at 1 a.m. so the bill. So the way we are going to do not a Democrat, the nonpartisan Direc- American people, hopefully, according that, for this bill, which the Congres- tor said, for the 11 million on Medicare to the Democrats, would be asleep and sional Budget Office figures show us Advantage that one-half of their bene- not see what they were doing to the will cost $2.5 trillion over 10 years fits will be diminished. That is what he American people? The verdict is the when fully implemented, is basically said about these cuts. American people are overwhelmingly paid for one-half by Medicare cuts and Even when it is all said and done, we opposed—opposed—to the bill the Sen- one-half by new taxes. Give the Demo- completely leave out the $1⁄4 trillion ate last night voted 60 to 40 on cloture crats credit for that, that helps to that we need to appropriate to pay the and decided to move ahead on. avoid a large part of the deficit. The physicians to serve Medicare patients. The deals in the bill are absolutely rest is done by sending a huge bill to Because if we don’t, their payments are astonishing: $100 million for a hospital States to help pay for another big gov- going to be cut by 21 percent next year in a State we still can’t identify and no ernment program called Medicaid, but and fewer of them will see Medicare pa- one is claiming, a payoff to one State, I will leave that to the side for a mo- tients. We have already heard the a payoff to another State, and then the ment. Mayo Clinic, for example, is beginning cuts in Medicare for our seniors who The Medicare cuts which are reduc- to restrict some patients on Medicare depend on Medicare, a program that is tions in the spending for Medicare, are because they lost $840 million serving going to go broke in the year 2017—not $466 billion over the first 10 years and Medicare patients last year. to save Medicare. Instead of saving over a fully implemented 10 years it is I have taken a few moments to talk Medicare, to start a whole new govern- about $1 trillion in Medicare cuts. That about Medicare. That is just one thing ment program. is money coming out of the Medicare wrong with this bill. But when you I see my colleague from the State of Program and going somewhere. Where hear the other side say they are help- Tennessee is standing, and he has does it go? Well, it goes to start a new ing Medicare, and if you listen to what worked closely with people on Medi- program. I said about how can you take $1 tril- care in his home State. He is familiar What is wrong with that? Well, one lion out of the Medicare Program— with that and with Medicaid and he thing wrong with it is the trustees of which is going broke—when it is fully knows how difficult it is for patients to Medicare say that there is already implemented over 10 years and claim get to see a doctor. With the cuts in more money coming out of Medicare you are helping Medicare by starting a Medicare, it is going to make it harder than is being paid in, and by the year new program, I don’t think that is pos- for those hospitals to stay alive and 2015 or 2017 it will be insolvent. That sible. That is the source of the great open in your community, and for pa- means going broke. These aren’t Re- concern on our side of the aisle about tients to get the kind of care they publican trustees or Democratic trust- this bill on that one issue. need. ees, these are the men and women I see the assistant Republican leader, So I would ask my friend from Ten- whose job it is to report to the Nation the whip. I have heard a number of peo- nessee: Are there concerns you have on the condition of this program that ple say, and I will just propound this about the cuts to Medicare and how takes care of 40 million people and question and then I will yield the floor, they are going to impact on the care of their medical care. if I may, to the Senator from Arizona. people in your home State? Already we see that the Medicare But I have heard them say: Why are Mr. ALEXANDER. I thank the Sen- Program is under some stress. The doc- Republicans keeping everybody in here ator from Wyoming and appreciate his tors, for example, who serve Medicare this week? We want to go home and see leadership on this bill. It is of tremen- are only paid about 83 or 84 percent as our families. dous value to have within our body two much as doctors who serve patients We all want to see our families. But practicing medical doctors to help us with private health care. As a result of there is a reason this bill was suddenly interpret the effect of this bill, which that, we have to come along year after presented to us in the middle of the affects all 300 million Americans so year and appropriate more money to greatest snowstorm in the history of dramatically. reimburse doctors who serve Medicare Washington in the month of December, We find, when we discuss this bill patients. If we do not do that, they will and we were asked to start voting on it with our colleagues on the other side of not be serving Medicare patients, and in the middle of the night on the same the aisle, we sometimes become exas- Medicare will become similar to Med- day, and to finish the work by Christ- perated with one another because it icaid, the program for low-income mas. If I am not mistaken, and this is seems like they are talking about one Americans, where about 50 percent of my question to the distinguished as- set of facts and we are talking about doctors will not take a new Medicaid sistant Republican leader who has been another set of facts. So what I would patient. It is akin to telling somebody: here a number of years, who is in the like to do is take a moment and talk I am going to give you a ticket to a bus leadership and whose job is to help about Medicare. line where the bus only runs about half manage the floor: Is it not entirely the If anyone is watching our debate, you the time. prerogative of the majority leader of hear the Democrats talk about three So what the Democrats are saying to the Senate to schedule what comes up things: We are saving Medicare, we are us is that by taking $1 trillion out of on the floor? Is that not his job? Isn’t extending its length, and you hear Re- Medicare over 10 years when fully im- it true that if Senator REID wanted to publicans say they are cutting Medi- plemented, and there is no dispute say let’s take this bill down, let’s go care. So who is right? about that amount of money, and home, let’s let the people hear about it, Well, let me tell you why we talk spending it to pay for this new program let’s come back and vote on it after about Medicare cuts. Medicare, of that is somehow good for Medicare and Christmas, after New Year, after Val- course, is a government program which for the seniors who depend upon it. I entine’s Day, could he not do that and

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.044 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13669 isn’t that peculiarly his power and not jority leader made the decision that help themselves was to hurt their com- our power? this has to be done by Christmas, then petition. At that point I said no. Their Mr. KYL. Mr. President, I would say the time is pretty well set by the Sen- competition is the physician-owned, to our colleague, as a general rule that ate rules, absent a unanimous consent self-referral hospitals. These are gen- is correct. The majority leader has two by the body that would either extend erally specialty hospitals in a commu- great powers that no one else in the the time or shorten that amount of nity that provide very good care. While Senate has. One is the right of first time. they do in one sense provide competi- recognition by the Presiding Officer I would like to make another point, tion to the community hospitals, they and the other is the power to set the off that subject if I could, but if my are all in the same boat in terms of the schedule. That power is limited by Sen- colleague has another question in that kind of reimbursement that Congress ate rules, and it can be altered by regard I would be happy to try to re- provides. What I have said is you unanimous consent. I can go on and ex- spond it. should not solve your problem by hurt- plain a little bit to folks who are won- Mr. ALEXANDER. No, I thank the ing your competition but having Con- dering why we would be in this predica- Senator. I yield the floor. gress solve the problems that affect ment of voting on Christmas Eve based Mr. KYL. I talked to the Senator you both. I have been willing to try to upon the majority leader’s decision. If from Wyoming. Of course, Arizona is a help on that. I can just proceed, I will do that. State that has a lot of Medicare pa- In this legislation what they have All of these rather odd times for de- tients. Our State is hurt as much as done, they struck a deal with the Hos- bates, 1 o’clock in the morning, 7:20 any by the cuts to Medicare and par- pital Association to stop the competi- a.m. in the morning, and so on, are as ticularly the Medicare Advantage cuts. tors, the physician self-referred hos- a result of the majority leader’s deci- We do not have the benefit that was ex- pitals, from building any more hos- sion to make sure that this bill is com- tended to residents of other States, pri- pitals. You have to be under construc- pleted by Christmas. That is the pre- marily the State of Florida, by a spe- tion by a certain date under the bill— cipitating cause for everything else cial provision that was inserted into it is February 10, 2010. You have to that follows because once he says the the bill. As a result, our constituents have a provider agreement in oper- bill has to be completed by Christmas, are going to suffer more than those of ation—that is the technical term—or then he has to, in effect, count back- some other States. else you cannot go any further with wards on how long it takes to do the But the more we read this bill—and your new physician self-referred hos- various things the Senate rules say we one of the reasons Republicans have pital. That is going to hurt a lot of have to do. not been willing to truncate this de- communities. It turns out that some of If there are three cloture motions bate is that the more we read it the the communities hurt were in a par- filed—which is what the majority lead- more we find in it that is troublesome. ticular State, the State of Nebraska. er did; he filed three cloture motions We found yesterday that the Congres- Again, I have an affinity for Ne- simultaneously—under Senate rules sional Budget Office—actually the Con- braska because I was born there, and I certain timeframes then attach. gressional Budget Office brought to our know a lot of people there. The Senator You have to take the vote with 1 day attention the fact that they had made from Nebraska, Mr. JOHANNS, a little intervening between the filing of the a little mistake. I think it was a quar- bit earlier today said he didn’t think cloture motion and the vote. If cloture ter of 1 percent in one of their calcula- the special deals that were created for is invoked, then 30 hours for debate is tions. That quarter of 1 percent the State of Nebraska were appreciated permitted after which there can be ad- amounted to $600 billion. So a small by Nebraskans who stand more on prin- ditional action by the Senate. So when error by the Congressional Budget Of- ciple and have the view that if some- the majority leader takes all that into fice can make a huge difference to the thing is bad for Nebraskans and it is account, he finds that he has to vote at people of America. That is $600 billion. bad for the folks in other States, there- 1 a.m. in the morning, 7:20 a.m, and so We also saw there were special provi- fore it ought to be solved for all of the on. sions in the bill for residents of one States, not just for the State of Ne- He could change that, of course. He particular State, and that has gotten braska. could change that by saying we do not quite a bit of attention lately. There It turns out that is the case with this actually have to have the whole thing has also been a dental/vision clinic in a particular provision on page 332 of the completed by Christmas. That is strict- State that has benefited. I am still not Reid so-called managers’ amendment, ly an arbitrary date he set. sure we have figured out exactly what which would extend the date on which There have been some who said: Why that State is, but I understand one of a hospital may have physician invest- don’t we have a unanimous consent re- the Senators from Connecticut has ment and a provider agreement in quest to not put us through all of this taken credit for it. I don’t know if that place for the purpose of being grand- and try to complete the debate a cou- is true. It is hearsay. If that is incor- fathered. That date was extended until ple of days earlier? rect, I can be corrected. But the more August 1, 2010. Republicans have said: Now wait a we see about it, the more we realize It turns out that helps, at least ac- minute. You are telling us on the one that support for it was garnered, not on cording to staff, at least three hos- hand that the majority leader is saying the merits but on the basis of special pitals in the State of Nebraska—one in we have to have this completed by favors done to certain Members. Omaha, one in Kearney, and one in Christmas, but since that is kind of My staff has indicated there is yet Bellevue. In fact, I will just quote tough on all of us, now you are saying another one of these in the bill, and it briefly from an article that Robert let’s move that up a couple of days. has to do with so-called specialty hos- Pear of the New York Times did on Republicans are saying: We have had pitals or, as they are referred to in the this. barely enough time to consider this bill legislation, physician self-referral hos- The Senate health bill, would impose as it is. We are not going to agree to pitals, that have physician ownership. tough restrictions like the one passed by the move it up any more than that. We House last month, would impose tough new Just a little bit of background on restrictions on referrals of Medicare patients don’t like voting on Christmas Eve any this. The Hospital Association that is by doctors to hospitals in which the doctors more than you do, but the answer to it primarily representative of the com- have financial interests. The package assem- is not making the time even shorter munity hospitals has been pleading for bled by Mr. Reid would provide exemptions but, rather, taking our time and doing a long time that they are not ade- to a small number of such hospitals, includ- it right. As the Senator from Maine quately reimbursed, and we need to try ing one in Nebraska. has pointed out, let’s go home for the to help them. I have been an advocate He goes on to describe this and then Christmas recess, stop and listen to for that. I have tried to help them, for quotes Molly Sandvig, executive direc- what our constituents are telling us example, for reimbursement in the care tor of Physician Hospitals of America, they would like to have us do, and then provided to illegal immigrants, and we which represents doctor-owned hos- come back and complete it. That could were successful in that. pitals, who said the change would ben- all be done by unanimous consent. My But one area I departed from that is efit Bellevue Medical Center, scheduled colleague is correct that once the ma- when they concluded the best way to to open next year in Bellevue, NE.

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.046 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13670 CONGRESSIONAL RECORD — SENATE December 21, 2009 Under the proposal Ms. Sandvig said, ‘‘doc- allow the bill to be amended. So some- urday had seen. In fact, many of the tor-owners can continue to refer Medicare thing that affects one-sixth of the Democrats hadn’t seen it either, in- patients to the hospital’’ in eastern Ne- economy, which we have had a day and cluding members of the Democratic braska. ‘‘Senator Nelson has always been a friend a half to read, which is part of an over- leadership. There was a discussion on to our industry,’’ she said. ‘‘But doctor- all bill that will raise taxes, cut Medi- the floor last week between Senator owned hospitals in other states were not so care, and send big bills to States could MCCAIN and Senator DURBIN in which fortunate. They would not meet the August be improved with amendments but can- Senator MCCAIN said: They are writing 1 deadline.’’ not be amended under the current pro- this amendment behind closed doors. I would like to help all the physician- cedure. We don’t have any idea what is in it. owned hospitals. I agree that all of Mr. BARRASSO. Another amend- The Senator from Illinois, the No. 2 them should have the same kind of sup- ment—I see my colleague from South person in the Democratic leadership, port that was gained by the Senator Dakota is here—is an amendment I of- said: I am in the dark just like you are. from Nebraska for three specific hos- fered on the floor of the Senate yester- You had a handful of people who were pitals in Nebraska. I understand, by day to protect individuals from sky- adding 400 pages of content to the 2,100 the way, that three or four hospitals in rocketing insurance premiums. You pages we already have. Arizona would also benefit from that. I may recall the President of the United In addition, there is another amend- think that is a great thing. States said premiums—families in Wy- ment that adds another 300. We are But instead of just benefiting the oming and other States, families across talking about 2,700 pages that will re- hospitals in a few States by moving the the country—health insurance pre- order and restructure literally one- date back to where you catch the ones miums would go down $2,500 per family. sixth of the entire American economy. in the State of Nebraska, we ought to Yet what I read and studied, and as I Right now what we are being told is eliminate this requirement altogether look at this, it says to me it looks like that we are not going to be allowed to because what you are going to do is premiums will go up instead of going offer amendments to that humongous prevent more competition from very down. Instead of going down $2,500, piece of legislation. When you get this high-quality hospitals in communities they will go up $2,100. I think for 90 much legislation coming at you and re- that can provide a real service to con- percent of the families in this country, ceiving this on Saturday, not having stituents in all of our States, not just their insurance premiums will either the opportunity to read it for the first one State. stay the same or go up more because time, is why we have been saying we It is just one more example, I say to the bill is passed than if we did noth- need to push this back and not try to my friend from Tennessee, that the ing. jam it through before the Christmas more we read the bill and learn what is I ask my friend from South Dakota— holiday. You find all kinds of things in in it, the more we find that the 60 votes I know he has been bringing forth in- these bills. Sometimes people take for it were obtained less by persuasion formation; I know he put a chart to- credit for those being there. Some- and on the merits of the bill than by gether on it—would there not be some times they don’t. We have had a debate special provisions that were inserted to value in allowing the Senate to discuss about some of the provisions that ben- assist folks in particular States. an amendment because this amend- efit specifically Nebraska. You have As I said, I think if something is good ment basically said let the State insur- this Medicaid provision that requires for one State, it ought to be good for ance commissioners—because every the taxpayers of the other 49 States to all States. If it is not good for one State has an insurance commissioner— subsidize and pay the Medicaid match- State, it ought not be a requirement on let the State insurance commissioner ing share for the State of Nebraska the other States as well. take a look at what happens to insur- which will cost millions and millions of Mr. BARRASSO. Mr. President, what ance premiums in their State. If the in- dollars. The Senator from Arizona you are hearing is what we are noticing surance commissioner finds that the mentioned this late add, a $100 million as Republicans take a look at the bill. premiums have gone up faster than the item for construction of a university I saw the majority whip come onto the Consumer Price Index, then in that hospital which, again, is being reported Senate floor a few minutes ago. Yester- State where those premiums have gone as being inserted by the Senator from day he was on the floor and said the up faster than the Consumer Price Connecticut. You have all these sorts Republicans have not offered amend- Index, all of these laws and regulations of deals that get made to try and get ments to this bill, so I brought four and rules would no longer apply. The that elusive sixtieth vote that are now amendments yesterday. The chairman mandates, the rating rules, the benefit coming to light. The American people of the Finance Committee objected. mandate, all of those included in the have a right to know it. Frankly, Mem- One had to do with letting people on Reid bill would not apply. bers of the Senate who have to vote on Medicare keep their own doctors or Wouldn’t that make sense, I ask my this have a right to know what is in choose who they want to go to see for colleague from South Dakota? What is these volumes of pages, 2,700 pages, a doctor. The purpose of this what was the Senator’s understanding of this and that will spend $2.5 trillion. The origi- called ‘‘Medicare Patient Freedom to should not we be allowed to at least nal 2,100-page bill spent $1.2 billion per Contract’’ is it ‘‘allows Medicare pa- discuss and debate that as a Senate page, $6.8 million per word. It creates tients the right to privately contract when we have been promised as citizens 70 new government programs. This is a for medical services with the physician of this country that premiums would massive overhaul of health care deliv- of their choice.’’ go down? ery. I ask my friend from Tennessee, who (Mrs. HAGAN assumed the Chair.) What it ought to be about is driving has just spoken about Medicare, Mr. THUNE. Madam President, the down the cost of health care for people. wouldn’t he think that patients who Senator from Wyoming is correct. Of In fact, we have heard a lot of discus- have been promised that they can keep course, we would like to offer amend- sion from the other side about how this the health care they want should be ments. I know the Senator from Wyo- drives down the cost of health care. able, or at least this Senate ought to ming has deep experience in this field, This bends the cost curve down. They be able to debate an amendment about being a practicing physician, someone can say that, but the experts we rely allowing Medicare patients the right to who brings great knowledge and back- on, the referees or the umpires, say privately contract for medical services ground to the debate and obviously has otherwise. In fact, what the CBO has with the physician of their choice? great insight about how this 2,100-page said is that the cost curve would be Wouldn’t that seem fair? bill could be improved upon. What we bent up by this bill. The blue line on Mr. ALEXANDER. Mr. President, I have here is the 2,100 pages that we this chart represents the increasing agree with the Senator from Wyoming. started with, and this represents one- health care costs year over year if we I think it is important for the Amer- sixth of our entire economy. We are do nothing. The blue line represents ican people to know, the 400-page talking about reordering one-sixth of what we would be looking at if we con- amendment that was added to the un- the entire economy. Saturday we re- tinue on the current course which ev- derlying bill over the weekend is being ceived an amendment, a 400-page erybody here acknowledges is unac- presented to us in way that will not amendment which nobody up until Sat- ceptable. We all want to see the cost

VerDate Nov 24 2008 01:32 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.047 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13671 curve go down and see overall health or buy or however you want to charac- The other night I did the phone call care costs go down. But the ironic terize it that sixtieth vote is essen- between 7:30 and 8:30. I called to about thing is, according to the CBO, the red tially what we are talking about. These 18 west Tennessee counties, including line represents what happens if the bill are special goodies packed into this bill Shelby, which is Memphis, and as re- proposed by the Democratic majority essentially because the majority de- ported to me by the service, about actually becomes law. The cost curve is cided that rather than trying to in- 30,000 people were on the telephone bent up. We will actually spend more clude Republicans and pass it with Re- sometime during that hour, with a on health care than we are spending publican votes, they had to pass it with maximum number of 3,016 on the call today, even the year-by-year twice the all Democrats which meant that every at any one time. Someone might pick rate of inflation increases in health one of the Democrats had tremendous up the phone and say: Senator care premiums today. leverage. Clearly, they decided to use BARRASSO is on the phone. They might The Senator from Wyoming is abso- it. There are lots of carve-outs, lots of tune in for 15 or 20 minutes and then lutely right to be offering amendments special deals in this that cost the hang up. Maybe they have to cook din- to address the issue of premiums. This American taxpayers hundreds of mil- ner or the ball game comes on. Maybe bill does not do anything to reduce pre- lions of dollars in additional spending they get tired of talking to you, but miums for most Americans. About 10 simply because they wanted to get this they are on for 15 or 20 minutes. During percent of Americans, because of the done by an artificial deadline and that time, I was able to take a number subsidies in the bill, would get their wanted to do it with all Democratic of questions. After it was over, 563 mes- premium costs reduced, but 90 per- votes. sages from constituents were sent to I say to my colleagues, this process cent—we are told by the CBO—would my Web site. see their premiums stay the same or go itself, when the American people find It was interesting to me. People who up. When I say stay the same, it means out about particularly this latest deal, know my history, know that to be smells. I don’t think they are going to go up at the current rate of twice the elected Governor 30 years ago, I walked like it. I don’t think they are going to rate of inflation. Worst-case scenario, across the State of Tennessee. Instead like the end product when they find if you are buying your insurance in the of going to a Republican meeting or a individual marketplace, you will see out it will raise insurance premiums. Mr. BARRASSO. I try to stay in rotary club, I would visit with random your insurance premiums go up above close touch with the people of Wyo- people during my walk. It took me 6 and beyond this by 10 to 13 percent. ming. I go home every weekend. We months and I would see 1,000 people a Health care costs for 90 percent of have not been able to do that the last day. These random phone calls kind of Americans, the best they can hope for, couple of weekends so I have had tele- reminded me of that. It was as if the is the status quo which is year-over- phone townhall meetings. I know the people were randomly selected. They year increases that are twice the rate Senator from Tennessee has done the were not on any Republican list or of inflation. If you are one of the un- same. There is a way people can push a Democratic list or list of doctors or pa- lucky who buys their insurance in the button to indicate whether they are in tients. They were just in the individual marketplace, your pre- favor or against. Ninety-three percent phonebook. They talked and acted like miums go up by another 10 to 13 per- of the people of Wyoming are opposed they were normal citizens who I had in- cent. This ought to be about driving to the bill the Democrats are trying to terrupted after dinner, probably be- down health care costs and getting pre- jam through in the middle of the night. cause it was 6:30 to 7:30 in that part of miums under control. I know the Senator from Tennessee has Tennessee. I was able to ask those citi- The overall cost of health care in this recently had telephone townhall meet- zens three questions. I am not about to country represents about one-sixth of ings with his constituents because he say this is a Gallup poll of Tennessee, our entire economy. If this bill passes, was not able to be home personally because I know that surveys like that according to the Congressional Budget with them. Maybe the Senator wants have to be done in a scientific way, but Office, according to the Actuary of to share with us some of the experi- after being here for 21 straight days, CMS, health care spending will no ences he has had and some of the mes- not able to go home because we have longer be one-sixth of the economy; it sages he has heard from the fine folks been debating this bill, these opinions will be more than one-fifth. Because if of Tennessee. are straws in the wind. this bill passes, health care spending Mr. ALEXANDER. Madam President, The first question was: Do you be- will go up to about 21 percent of our the telephone townhalls are inter- lieve the Senate should rush to pass gross domestic product. esting. This is the 21st consecutive day this health care bill before Christmas? Tell me, what does this bill do then and the third weekend we have been de- In this case, 943 people, 83 percent, said to get costs under control? If we are bating this bill. One would think we no, and 108 said yes; that is 9 percent. driving up the cost of health care for could probably do a better job of it, if Second question: Do you support the individuals in the form of higher pre- we were going back home every week- health care bill moving through the miums, if we are driving up the overall end to hear what people thought about Senate? On this one, 1,496 said no, or 75 cost of health care as a percentage of what we were doing. But maybe the percent. 352 said I don’t know, which is our economy, why would we be jam- strategy has been to keep us here talk- 18 percent, and 154 said yes, that is 8 ming this thing through before the ing to each other, bring the bill up in percent. Christmas holiday, these 2,700 pages, a snowstorm, pass it in the middle of No. 3: Do you agree that Congress spending $2.5 trillion of taxpayer the night and go home for Christmas, doesn’t do comprehensive legislation money, raising taxes on small busi- and the people won’t find out what we well and ought to go step by step to nesses, which obviously have weighed are doing until it is too late. One way bring health care costs under control? in on this, and the National Federation to find out is tele-townhalls. I was On this question, 1,285 said yes, that is of Independent Business, which rep- skeptical before I did one but it is a 80 percent, 14 percent said I don’t know resents a lot of small businesses around pretty interesting way to stay in touch and 7 percent disagreed. the country, has said, if enacted, this with people from Tennessee. You get I have often heard our friends on the bill would cost us 1.6 million jobs be- on the telephone and an automated other side say: Where is the Republican cause of all the new taxes it imposes— system calls thousands of people and bill? My response has been, day after you are raising taxes, when fully im- says: The Senator from Wyoming or Il- day, if you are looking forward to see- plemented, by about $1 trillion, cutting linois or North Carolina or Tennessee ing the Republican leader role a wheel- Medicare by about $1 trillion. After all wants to talk with you about health barrow in here with a 2,700-page Repub- that, what do you have? You have the care. People can either stay on the lican comprehensive bill, you will be same or worse insurance premiums for phone when they get the call or they waiting forever. We have a different ap- 90 percent of Americans. I argue that is can hang up. What normally happens is proach. Our approach is to set a clear a bad deal for the American people. a person stays on the call, this time a goal—reducing cost. The bill we are Coming back to the special deals, surprisingly large number of people voting on increases costs. Our goal is this is not the way to legislate. To stayed on the call, because of their to find five or six steps to go in the di- carve out deals, to go and try and find strong interest in this issue. rection to reducing costs.

VerDate Nov 24 2008 02:33 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.048 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13672 CONGRESSIONAL RECORD — SENATE December 21, 2009 Without going into detail, although that we are all well acquainted with— majority support is here in the U.S. the Senators from South Dakota or National Federation of Independent Congress because maybe it makes too Wyoming may want to, we focus on Business, the Chamber of Commerce, much sense. five or six steps that would clearly re- the National Association of Manufac- But it seems to me there are sugges- duce health care costs. By that, I mean turers, the National Association of tions and solutions out there which do your premium, the cost of your govern- Wholesalers and Distributors, builders not require $1⁄2 trillion of tax increases ment. And once we do those five or six and contractors, electric contractors, on small businesses, which every small steps, we could go on. We could do that franchise associations—I can go right business organization has come out and without taxes, without mandates, down the list—all say this does nothing said: It is going to drive up our cost of without running up the debt, without a to lower their costs. In fact, it in- doing business, and at the end of the big bill with lots of surprises. Just to creases the cost of doing business, in- day, it is going to raise our health care take one example—and then I will yield creases the cost of doing health care. costs—and does not require these steep to my friends from Wyoming and South What they have argued repeatedly is Medicare cuts that the Senator from Dakota—one of those examples is the one of the suggestions the Senator Wyoming has alluded to over and over small business health care plan. The from Tennessee mentioned, that small again and the impacts those will have current bill, the Democratic bill, has in business health plans would drive their on the delivery of health care to sen- it a credit for small businesses, but we health care costs down, which is why iors across this country but, rather, it would argue that by the time small they have been such strong advocates would bend the cost curve down with- business men and women get through for this over the years. out tax increases and Medicare cuts. paying the mandates and the taxes the I guess the other question I would bill also imposes, it is not going to be ask of my colleague from Tennessee is, Another example of that, I would much help to them. would an approach, a suggestion like argue, would be allowing for interstate What we have is a bill that would small business health plans require tax competition, allowing people to buy allow small businesses to pool their re- increases that would hit small busi- their insurance across State lines, sources. In other words, if you are a nesses? which is a suggestion we have made small business man or woman and you Incidentally, the latest version with over and over on our side of the aisle. have 60 employees and 2 get cancer, the managers’ amendment, which we According to the Congressional Budget suddenly the costs of those 2 employees just received Saturday, increases the Office, both small business health plans prohibit you from providing insurance tax increases in the bill that were pre- and buying insurance across State to the other employees. But if you viously $493 billion and are now $518 lines actually would reduce health care could pool your resources with small billion. As the Senator mentioned, costs and would do it without raising businesses all around the country, then with the tax credit businesses get, they taxes or cutting Medicare, which, to the pool would be large enough that up that a little bit but not enough to me, would make a lot of sense, espe- you could offer insurance. help most small businesses in light of cially when you have an economy in re- That proposal has been made by Sen- the $518 billion in tax increases in the cession, 10-percent unemployment, a ator ENZI. It has been through the first 10 years, and when it is fully im- $1.5 trillion deficit last year and an- HELP Committee. The Congressional plemented it will be about $1 trillion. other $1.5 trillion deficit this coming Budget Office said it did not add to the But the payroll tax that is going to hit year, and when you are talking about a deficit. In fact, it reduces the deficit, a lot of small businesses was increased $2.5 trillion cost in the growth of gov- and it would permit 750,000 more em- dramatically in the managers’ amend- ernment here in Washington, DC, to ployees of small businesses to be in- ment. The individual mandate was al- implement these 2,700 pages. sured and their premiums would be most doubled in the managers’ amend- Some suggestions along the lines of lower than they otherwise would be. ment. So the taxes in the bill go up the one mentioned by the Senator from That is a single step to moving toward with this proposal. Tennessee and some of these others reducing health care costs, but if we I guess my question is, with all these would make a lot of sense, and I think took that step and the other steps we tax increases that are going to have a they would enjoy tremendous support have proposed, that would be a good crushing impact on small businesses, among small businesses, which create way to start. We could do that to- does a suggestion such as the one made the jobs in this country, as well as gether, and we would not have this par- by the Senator from Tennessee for among the American public. tisan bill with so many questions and small business health plans require tax So I thank the Senator from Ten- so many concerns. increases or Medicare cuts, which is nessee for pointing out one of the many So I wonder if my friends from South what is going to be necessary to fi- things Republicans are for and which Dakota and Wyoming—I know they nance this 2,700-page behemoth? we have tried to get in the debate. have thought a good deal about this Mr. ALEXANDER. I thank the Sen- step-by-step approach toward actually ator from South Dakota. The answer is I know the Senator from Wyoming solving the real problem of health care no. The difficulty with a big, com- has advocated for many of these same costs. prehensive plan is it sounds good but types of initiatives and solutions. As Mr. THUNE. If the Senator will yield has lots of unintended consequences. If he mentioned earlier, he was prepared on that suggestion of small business our real concern right now is reducing to offer an amendment to address the health plans, doesn’t that enjoy wide costs in health care, then the idea of a issue of premiums, but it looks as if we support among small businesses in this small business health care plan that are going to be prevented from doing country? has no new taxes and no new mandates that. Mr. ALEXANDER. It clearly does. It but creates opportunities for small Mr. BARRASSO. Our friends at the enjoys widespread support everywhere, businesses to pool their resources and University of Minnesota said that if except the Senate. When Senator ENZI offer more insurance at a lower cost to people were allowed to shop across brought it up, it was rejected by our their employees would seem a logical State lines, shop around for insurance friends on the other side. place to start. that is better for them and their family Mr. THUNE. If I might continue, the Mr. THUNE. I appreciate the Senator and their personal situation, we would one thing that strikes me about this for his work on that issue. It is a view have 12 million more Americans in- proposal that, as I said before, now is, I share, a proposal I have been a big ad- sured today than we have now, without in totality, 2,700 pages, is that it does vocate of going back to my days in the a single page of legislation. That is all not enjoy any support from any small House of Representatives and one we need to do: allow people to shop business organization that I know of. which, as the Senator from Tennessee across State lines. But when we talk Maybe there are some out there I can- noted, has tremendous support among about and look at this bill, which has not speak to. But I do know the organi- small businesses across the country. mandates, there is going to be a man- zations that represent small businesses About the only place it does not have date for people to buy insurance.

VerDate Nov 24 2008 03:36 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.050 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13673 One of the amendments I tried to through the cracks, which we all know what has happened. Half the doctors in offer yesterday that I thought made a examples exist—all of us have dealt the country do not take care of pa- lot of sense for young people was that with those in our individual States— tients on Medicaid because the reim- for individuals under the age of 30 or and then proceeds to attack Repub- bursement is so low that they cannot for those making less than $30,000 a licans for not having their own ideas, afford to continue to care for those year, they would be exempted from the which we have just mentioned there people. Five million people will lose mandate, the individual mandate that are lots of good Republican ideas which the insurance they get through work, they have to buy insurance. do not raise taxes, which do not cut and health care costs will go up. The I was involved in a discussion on a Medicare, and actually do something to cost curve will go up instead of going college campus in a debate on this reduce premiums. But that seems to be down. But the whole purpose of this topic, and in talking to the students, the strategy employed and the pattern was to help drive the cost down. they were astonished to learn—because that emerges in the rhetoric day after Then, additionally, they said that 20 they were not focused on this; they day down here from the other side. percent of providers—20 percent of the were focused on their studies and work- The one thing I do not hear is them providers—of health care in this coun- ing—they were astonished that they coming down here and talking about try—and that includes physicians, are all going to have to buy, as a mat- what this 2,700-page bill is going to do nurse practitioners, medical clinics, ter of law, if this passes, health insur- to reduce health care costs, because if hospitals—20 percent of the providers ance immediately, and if they do not, we all submit to the experts on this— in this country, under this plan, 10 they are going to have to start paying which, as I said earlier, the Congres- years from now, will be unprofitable, a tax or a fine, depending on how you sional Budget Office is sort of the ref- unable to keep their doors open. describe it. eree. They do not have a political agen- So we have heard about sweetheart So in my amendment, I said, for da, or at least they are not supposed to. deals. We have heard about taxes going those up to the age of 30 and making The Actuary at the Centers for Medi- up. We have heard about Medicare cuts. under $30,000 a year, let’s exempt them care and Medicaid Services does not And what we have seen is one promise from the mandate. That amendment have a political agenda, or at least after another made by the President was rejected. they are not supposed to. They are sort that has been unfulfilled and actually Then I said, well, if they are going to of considered to be an umpire on this. reversed by the bill we see ahead of us. do this and force these people to buy The Joint Committee on Taxation, So I ask my friend from Tennessee, insurance, and if they do not buy insur- which looks at the distributional im- wouldn’t he agree that in the next 2 ance, they have to pay these excessive pacts of tax policy, is a referee and is days, the best thing for the country fines or taxes—or however you want to not supposed to have a political agenda would be to have this bill not pass the define it—I said, how about that the in all this. They all come to the same Senate and instead go back in a step- penalties these people would have to conclusions with regard to premium in- by-step way and regain the trust of the pay, if they choose not to buy insur- creases in this bill. American people? ance—because it is going to be a lot So if the overall objective is to re- Mr. ALEXANDER. I certainly do cheaper to not buy insurance and to duce the cost of health care, and if, in agree with that. just pay the tax—what if that money fact, your legislation, according to all I think most Americans, when pre- could go into a personal account so the referees, all the umpires, all the ex- sented with a problem, would not try that person can then use the money to perts, not only increases premiums for to change it all at once but would say: then buy insurance? So it would be most Americans but increases the over- Let’s identify the goal which is reduc- kind of like a savings account, so the all cost of health care, which is what ing costs and go step by step. money would be there for them to buy they all conclude, it is pretty hard to Madam President, I ask unanimous insurance. So individual mandate pen- come down and defend this product. consent to have printed in the RECORD alties would accrue not to the govern- That is why I think day after day they a column by David Brooks in the New ment but in a personal account, so try to create distractions and counter- York Times on December 18. There being no objection, the mate- they could purchase health insurance attacks as opposed to actually coming rial was ordered to be printed in the within a 3-year period. The money down and talking about the substance RECORD, as follows: would accumulate. That amendment of the bill because the substance of the was rejected as well. bill does not accomplish the stated ob- [From the New York Times, Dec. 18, 2009] So we have lots of ideas, good ideas, jective, which is to reduce the overall THE HARDEST CALL to help people with affordable care, cost of health care and get premiums The first reason to support the Senate available care, and yet one after an- health care bill is that it would provide in- under control for families and small surance to 30 million more Americans. other they have been rejected in a step- businesses in this country. The second reason to support the bill is by-step process to try to find ways to It is also hard, I would argue, because that its authors took the deficit issue seri- solve the health care crisis we know of the $518 billion of tax increases that ously. Compared with, say, the prescription faces the country. All 100 Members of are in here and the unified opposition drug benefit from a few years ago, this bill is the Senate know we need to find ways of the entire small business commu- a model of fiscal rectitude. It spends a lot of to make health care more affordable nity, which creates 70 percent of the money to cover the uninsured, but to help and to work on high-quality care. jobs in this country, to talk about how pay for it, it also includes serious Medicare It has been fascinating to see the cuts and whopping tax increases—the tax on this can be anything but detrimental high-cost insurance plans alone will raise dean of the Johns Hopkins Medical to job creation. This is going to cost us $1.1 trillion in the second decade. Center and the dean of Harvard and jobs. I think every business organiza- The bill is not really deficit-neutral. It’s those who have looked at this bill tion has made that abundantly clear. politically inconceivable that Congress will closely say that the people who are And all the analysis of this legislation really make all the spending cuts that are supporting this are living in collective that has been done comes to the same there on paper. But the bill won’t explode denial, that this bill is doomed to fail, conclusion. the deficit, and that’s an accomplishment. Mr. BARRASSO. When you take a The third reason to support the bill is that that it will raise the cost of care, not the authors have thrown in a million little lower the cost of care, and will do look at what the Centers for Medicare ideas in an effort to reduce health care infla- nothing to improve quality. and Medicaid Services has done, which tion. The fact is, nobody knows how to re- Mr. THUNE. If the Senator from Wy- is the group that oversees Medicare, duce cost growth within the current system. oming would yield on that point, that they have said that 10 years from now, The authors of this bill are willing to try is why I think day after day after day— if this goes through, you are still going anything. You might even call this a and I have said—there is a pattern to have 24 million uninsured, you are Burkean approach. They are not fundamen- emerging here in the Senate where the going to have 18 million more on Med- tally disrupting the status quo, but they are majority comes down and establishes icaid, the program the Senator from experimenting with dozens of gradual pro- grams that might bend the cost curve. the need for health care reform, which Tennessee appropriately referred to as If you’ve ever heard about it, it’s in there— we all acknowledge, and illustrates ex- having a bus ticket for a bus that is improved insurance exchanges, payment in- amples of those who have fallen not going to come, because that is novations, an independent commission to

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.051 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13674 CONGRESSIONAL RECORD — SENATE December 21, 2009 cap Medicare payment rates, an innovation Mr. ALEXANDER. I thank the Pre- 24th in life expectancy in the world— center, comparative effectiveness research. siding Officer and I yield the floor. 24th. We must do better. There’s at least a pilot program for every The PRESIDING OFFICER. The Sen- I wish to share with my colleagues promising idea. The fourth reason to support the bill is ator from California. some of the letters and e-mails that that if this fails, it will take a long time to Mrs. BOXER. Madam President, we have been sent to me from Californians get back to health reform. Clinton failed. heard our Republican friends say it is that personalize the statistics I spoke Obama will have failed. No one will touch very hard to defend our bill. Maybe it about. this. Meanwhile, health costs will continue is hard for them, but it is not hard for Mr. William Robinson wrote: their inexorable march upward, strangling the American Medical Association, the I am about to be laid off from the job I the nation. AMA, which has endorsed our bill. It is have had for 19 years. My biggest fear is not The first reason to oppose this bill is that being employed, but being able to find and it does not fundamentally reform health not hard for the American Heart Asso- ciation, which has endorsed our bill. It get affordable health care. I am 60 years old. care. The current system is rotten to the I have a preexisting condition that will for bone with opaque pricing and insane incen- is not hard for the American Cancer certain make it impossible for me to buy tives. Consumers are insulated from the Society Action Network, which has en- health insurance. costs of their decisions and providers are dorsed our bill. The American Hospital punished for efficiency. Burkean gradualism Association has endorsed our bill. Fam- Mr. and Mrs. Gilbert De La Cruz is fine if you’ve got a cold. But if you’ve got ilies USA, the Business Roundtable, wrote: cancer, you want surgery, not nasal spray. We are at the point of losing our home be- If this bill passes, you’ll have 500 experts in the Small Business Majority—we hear colleagues say small business opposes cause we have spent our savings on medical Washington trying to hold down costs and and prescription drugs. I am 67, retired, and 300 million Americans with the same old in- our bill. The Small Business Majority my wife is 62. Because of the Medicare gap in centives to get more and more care. The Organization supports it. And how prescription drug coverage, we have had to Congressional Budget Office and most of the about the AARP, which represents our pay $600 a month on prescription drugs. It’s experts I talk to (including many who sup- seniors, millions of seniors. Those are a a huge portion of our monthly income. We port the bill) do not believe it will seriously few. They not only defend our bill, they will be selling our home shortly and perhaps bend the cost curve. moving in with one of our children because The second reason to oppose this bill is support our bill. there doesn’t seem to be any option. that, according to the chief actuary for This is indeed an important moment Medicare, it will cause national health care in our Nation’s history as we approach Well, I want to say to Mr. De La spending to increase faster. Health care a final vote on major health care re- Cruz: Help is on the way. If we get the spending is already zooming past 17 percent form legislation. I think whenever you 60 votes we are forced to get—not 51, a of G.D.R. to 22 percent and beyond. If these are trying to change something, you majority, but 60 votes because of a Re- pressures mount even faster, health care will have to take a look at how things are publican filibuster—if we get those 60 squeeze out everything else, especially on votes each time, there is hope for you the state level. We’ll shovel more money at the moment. So why is it we voted into insurance companies and you can kiss to change our current system? There because we are going to fix that entire goodbye programs like expanded preschool are certain numbers that I think ex- problem. that would have a bigger social impact. plain it. The first number is 14,000. We Mr. Ronald Kim says: Third, if passed, the bill sets up a politi- know that every single day 14,000 of our I am in the construction industry and my cally unsustainable situation. Over its first neighbors lose their health insurance work is very slow. several years, the demand for health care through no fault of their own. They ei- He says he is in the design industry. will rise sharply. The supply will not. Pro- ther lose their job, they can’t afford to viders will have the same perverse incen- I am in danger of becoming financially ill tives. As a result, prices will skyrocket while keep up the health insurance or they and I am looking for ways to stay healthy, efficiencies will not. There will be a bipar- have a condition and the insurance and one way may be to eliminate my medical tisan rush to gut reform. company walks away from them or insurance. It is a significant part of my This country has reduced health inflation they are priced out of the market. budget. This may, heaven forbid, lead me to in short bursts, but it has not sustained cost Fourteen thousand a day. That is financial ruin if I get injured or sick. This is my situation. control over the long term because the deep cruel, and we need to change it. flaws in the system produce horrific political Sixty-two percent of bankruptcies I want to say to Mr. Kim: Help is on pressures that gut restraint. the way. Fourth, you can’t centrally regulate 17 are linked to health care crises. We are the only nation in the world where peo- Ms. Madeleine Foot wrote—these are percent of the U.S. economy without a raft all Californians, my constituents: of unintended consequences. ple go broke because they get sick. Fifth, it will slow innovation. Government If we do nothing, 45 percent of an av- I recently turned 25 and I lost my health regulators don’t do well with disruptive new erage family’s income will go for pre- coverage under my parents. I attempted to technologies. miums in 2016. I ask everyone to think get coverage under a Blue Cross plan created Sixth, if this passes, we will never get back for young people my age, but because I had to cost control. The basic political deal was, about it, paying 45 percent of your in- taken medications, I was denied. I applied we get to have dessert (expanding coverage) come for premiums. It is not sustain- again for another plan, was offered a plan but we have to eat our spinach (cost con- able. What about food? What about with a $3,000 deductible, and it was $300 a trol), too. If we eat dessert now, we’ll never clothing? What about shelter? Can’t do month on top of that. As a young person come back to the spinach. it. working in a restaurant, repaying student So what’s my verdict? I have to confess, I We are 29th in the world in infant loans and trying to make it on my own, this flip-flop week to week and day to day. It’s a mortality. We come in behind Cuba. We is a huge financial burden. I cannot afford an guess. Does this put us on a path toward the come in behind Singapore. We come in insurance that charges me so much and real reform, or does it head us down a valley won’t be any benefit for me until I have in which real reform will be less likely? behind South Korea. We are 29th in the shelled out a huge portion of my income. world on infant mortality because peo- If I were a senator forced to vote today, I’d To Madeleine Foot I say: Help is on vote no. If you pass a health care bill with- ple don’t have good insurance or they out systemic incentives reform, you set up a don’t have any insurance. the way, if we can break the Repub- political vortex in which the few good parts Fifty-two percent of women—fifty- lican filibuster. of the bill will get stripped out and the ex- two percent of women—don’t seek the Mr. John Higdon wrote: pensive and wasteful parts will be en- health care they need. They either put As a self-employed person, I had a pace- trenched. it off or they never get it because they maker implanted. The cost was borne en- Defenders say we can’t do real reform be- tirely by me at prices much higher than any cause the politics won’t allow it. The truth may not be insured or they are afraid insurance company would have had to pay. is the reverse. Unless you get the funda- of the copays. They are afraid of what That was a wakeup call to get health insur- mental incentives right, the politics will be it would cost. They may have limits on ance. I am told by every health insurance terrible forever and ever. their policies. We need to change that. company I have contacted that no one will Mr. ALEXANDER. Most of us—we The United States spends twice as offer me health insurance at any price with are pretty split up here: 60 there, 40 much on health care as most other in- a ‘‘preexisting heart condition.’’ here. They are for it, and we are dustrialized nations. So what is the I wish to say to Mr. Higdon: Help is against it, this bill anyway. message here? We spend a huge on the way. The PRESIDING OFFICER. The mi- amount. We are not doing very well in Dr. Robert Meagher, a pediatrician nority time has expired. outcomes. By the way, I think we are with Kaiser Permanente for over 30

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\A21DE6.005 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13675 years, do you know what he wrote and Senator COBURN: I have a message for I was there in 1965 fighting the fight, vot- told me? That he has to fake—he is you. You are going to die soon. ing against Medicare, because we knew it pressured to fake a diagnosis because If you want to know what wouldn’t work in 1965. when a parent comes in with a young fearmongering is, that is the best ex- So when you hear our Republican child with asthma, they beg him not to ample I can give you. friends say, Oh, my goodness, they are write down asthma but write down I decided to go back and look at the making a lot of savings in Medicare; bronchitis, because if he writes down past CONGRESSIONAL RECORDs. I this is bad for the seniors, please, asthma, that child will have a pre- thought: Have Republicans spoken like please, which party has stood for pro- this over the years every time we have existing condition and when she turns tecting our seniors? It is not a matter tried to do some health care, every 21 she won’t be able to get insurance. of being partisan; it is just the fact. Imagine, in America, a physician being time we have tried to make life better for people, such as Social Security? I The echoes of the past fill this Cham- pressured to lie on a form because of a ber. health care system that is so cruel. will let you be the judge. So, Dr. Meagher, we are going to In 1935, on the floor of the House of I am convinced now in 2009 that hope change things here if we can break this Representatives during the debate on and reason and determination and good Social Security, Republican Congress- filibuster. policy will triumph over fear and ob- Mr. Douglas Ingoldsby wrote: man Jenkins of Ohio said—a Social Se- struction and the status quo. curity bill, remember, which hadn’t I own a small business. I employ 11 people. Let’s look at the immediate and I have been in business in California since passed: near-term changes for the better that 1972. This is compulsion of the rankest kind. Do people are going to have, because our not be misled by the title. The title says He says: ‘‘Old-Age Benefits.’’ Shame on you for put- colleagues say: Oh, we are raising reve- I used to provide health care for all my em- ting such a misleading and unfair title on nues but there are no benefits right ployees and all the members of their fami- such a nefarious bill. Old age benefits? Think away. lies, and if I want to remain profitable of it. Oh, what a travesty! . . . Mr. Chair- Let’s talk about what the benefits enough to stay in business now, I can’t do it man, what is the hurry? Nobody is going to are. There will be a $5 billion high-risk anymore. get a dime out of this until 1942 . . . what is pool immediately for people with pre- the hurry about crowding an unconstitu- He can only cover the employees, not existing conditions who cannot find in- their families. He feels terrible about tional proposition like this through the House today? surance. There will be reinsurance for it, and he says he may have to cut off retirees, so if you are retired and you his employees if prices keep going up. If you listen to some of my col- leagues, you will hear the same thing. are getting your health care benefit I want to say to this fine small busi- and something happens to your com- ness owner: Douglas, help is on the What is the rush? As a matter of fact, they had four or five amendments to pany, there will be reinsurance so you way. can still get your benefits. We close Mrs. Linda Schumacher wrote—and send it back to committee. What is the that doughnut hole for the Medicare this is the one I will close with in this rush? recipients who fall into it and suddenly series of stories: The rush is that 14,000 people are los- ing their health care every day. The they cannot afford their prescription I am a Republican. rush is that 62 percent of bankruptcies drugs. There will be billions of tax Let me repeat what she writes: are linked to a health care crisis, and credits—billions—up to 50 percent tax I am a Republican, and my husband and I in 2016 our people will be paying almost credits for small businesses. That is are small business owners. The Senators and half of their income for premiums. Yes. why we have the support of so many Congressmen of both parties who are against small businesses. For new policies, no President Obama’s plan have their own in- We have to do this, and we started it 7 surance, and it is my understanding that it months ago, and 100 years ago Teddy discrimination against children with does not cost what we pay. They do not un- Roosevelt, a Republican President, put preexisting conditions, and children derstand what a huge expense this is. Please it in his platform. What is the rush? can stay on their family’s policy until listen to the middle class who are in our po- What is the rush? they are 26 years of age. sition or who no longer have insurance. It I wish to tell my colleagues about an- What else are the immediate and keeps me up at night worrying. This time other Republican Congressman, J. Wil- near-term changes for the better? For the Republicans have it wrong, and they liam Ditter of Pennsylvania. This is need to know. Please push the health plan. new policies, no lifetime limits, no what he said during the debate on So- more rescissions. They cannot walk The insurance companies only care about the cial Security: bottom line, not people. away from you when you get sick. . . . security for the individual, whether I wish to say to Mrs. Schumacher: They are required to cover essential worker or aged, will be a mockery and a preventive health benefits such as Thank you for putting aside party poli- sham. tics, because this isn’t about Repub- mammograms. It prohibits discrimina- This is what he said about Social Se- tion by employers based on salary of licans and it isn’t about Democrats and curity. it isn’t about Independents. It is about their employees. An employer cannot And it will allot to our people the role of say: If you earn over $250,000, you get all of us together. puppets in a socialistic State. What happens now? We are hearing these great benefits, but if you earn That is what he said back then. I tell under $50,000, you get a worse array. the polls, and the polls show Americans you, if you ask Republicans who are don’t want us to act. I understand why. getting Social Security, Democrats By 2011, standards for insurance over- There has been so much misinforma- who are getting Social Security, Inde- head costs go into place. If your insur- tion. Senator DURBIN, our assistant pendents who are getting Social Secu- ance company spends too much on majority leader, and I were talking rity, they will all tell you the same overhead and too much on executive about the misinformation that is on thing: Keep your hands off it. It works. pay, let me tell you what happens. this floor from the other side day in It is good. It is fair. It is insurance. They have to rebate to you, the policy- and day out, and I believe much of it, It is what we did way back then. holder. We also see increased funding if I might say, is purposeful. If you lis- In 1965, when Medicare passed, health for community health care centers. tened to my Republican colleagues care for those 65 and up, Republican This is going to make a huge dif- over the past few days and weeks, they Senator Carl Curtis said: ference. There will be a national Web have trashed this bill and they have It is socialism. It moves the country in a site to shop for affordable insurance. trashed the process. Over the weekend direction which is not good for anyone. There will be a long-term care program the Republican leader said health re- Years later, we know Newt Gingrich that is voluntary into which you can form is a legislative train wreck of his- when he was Speaker of the House said buy. Insurance companies with unrea- toric proportions. That is a direct he wanted to see Medicare ‘‘wither on sonable premium increases can be quote. the vine,’’ his words. barred from the exchanges that will be Earlier this month Senator COBURN In 1995, while seeking the Republican set up in 2014. So they will be making used more inflammatory language nomination for President, Senator Bob sure they do not increase your pre- when he said to seniors—I am quoting Dole said: miums beyond a reasonable amount.

VerDate Nov 24 2008 03:36 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.057 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13676 CONGRESSIONAL RECORD — SENATE December 21, 2009 This bill will benefit the insured in the reason is, we invest in prevention, tened to her over here. She laid out in one way—I do not think people under- and that pays off. We finally will be a very careful, deliberate, and thought- stand this—by 2014; 62 percent of fami- able to say to the insurance companies: ful way the realities about this legisla- lies will no longer face unsustainable Stop your gouging. And that pays off. tion before us. I thank her for a terrific premium costs. If you are a family of We do have competition now because presentation. four and make less than $88,000 a year, we will have that special plan run by I wish to pick up a little bit where you will never have to pay more than OPM, the State option MARIA CANT- she has left off. But let me inquire so I 9.8 percent of your income on health WELL put in there. This is why we see understand where we are. How much insurance premiums. This is an amaz- the reduction, including taking the time is remaining on the majority ing thing most people do not focus on. fraud and the waste out of Medicare. side? I just explained that the nonpartisan We do not need fraud and waste. The PRESIDING OFFICER. The ma- studies show—and this is important— Here is how I want to close. Health jority side has 341⁄2 minutes remaining. that they will be paying, the average care coverage for all Americans has Mr. KERRY. I thank the Chair. family, 45 percent of their income for been such an elusive goal for nearly a Let me begin by saying I also lis- health care. In 2014, people in this century. If you look at Republican tened to our colleagues on the other country will not have to pay more than Presidents, Democratic Presidents, Re- side of the aisle, particularly the Sen- 9.8 percent of their income on health publican Congresses, and Democratic ator from South Dakota, just a little insurance; otherwise, they will get tax Congresses, we have tried it over and while ago. I was really struck by the credits. That is very important. over again, and the status quo has al- chart they put up showing Medicare This bill is going to benefit our sen- ways prevailed. going up and up and up, and then they iors. That is why it is endorsed by the Our beloved friend, Senator Ted Ken- talk to Americans, basically scaring AARP. We eliminate the prescription nedy, whom we miss so much, particu- them, trying to say: If you pass this drug coverage gap. That is the dough- larly during a time such as this, fought bill, it is not going to do anything to nut hole. We extend the life of the for health care right here on the floor reduce the crisis in Medicare down the Medicare trust fund by 9 years. We re- from the moment he became a Senator road. duce waste and fraud in Medicare. We in 1962 to the moment he died. In an The reality is, that is all they provide for free yearly wellness visits op-ed in the Washington Post this past present, is the scary picture of a future for seniors. This bill saves Medicare. Friday, Ted Kennedy’s wife Vicki which they are not even describing ac- This bill makes our seniors stronger. wrote: curately. They have had a year and a They will have more benefits, and they Ted often said that we can’t let the perfect half—a year and a half—that we have can never lose their guaranteed bene- be the enemy of the good. been working on this legislation, since fits. I want to say to Vicki, she is exactly it was announced in the Finance Com- Small businesses will be able to re- right. Each of us could write this bill mittee, on which I serve, and we held a duce their costs, again, by getting im- our way. Believe me, if I wrote a bill, day-long—I think a 2-day long con- mediate tax credits. In 2014, they will to me it would be perfect. But to my ference over at the Library of Congress be able to access the exchange, as will friend in the chair, she would say: I can and within the committee where we self-employed people. They will have make it better. And all of us could. began the work, laying the groundwork the power of big business behind them This is the legislative process. This is a and foundation for a new Presidency as they go into those exchanges. good bill. and for the work that has gone on this I want to talk about public interest Vicki goes on to say: year. Many of their Members took part provisions. I wanted a public option, in that. So there is no secret here as to The bill before the Senate, while imper- let me be clear, because I felt it would fect, would achieve many of the goals Ted where we are. keep the insurance companies honest. fought for during the 40 years he championed This is a debate that has gone on in But let me tell you what we have in access to quality, affordable health care for the United States of America since here that are definitely public interest all Americans. Harry Truman was President of the provisions. We expand Medicaid. That He is not here to urge us not to let United States and before. We all know is a public plan to cover an additional this chance slip through our fingers. that President Teddy Roosevelt, a Re- 14 million people, and that starts in And she says: publican, put before the country the 2014. That is 1.5 million Californians. In So I humbly ask his colleagues to finish notion that every American should be my State, the Federal Government will the work of his life, the work of generations, able to have their sickness dealt with. pay the full fare for those added people to allow the vote to go forward and to pass Nobody has ever contemplated that for 3 years, and after that, far more health-care reform now. As Ted always said, you ought to go bankrupt in order to than we get paid now. HHS will set the when it’s finally done, the people will wonder have health care. But, as we know, we initial rules for the State exchanges. what took so long. have more bankruptcies in America— So those getting into the exchanges I thank Vicki, not only for writing health care bankruptcies—every year have to be fair. The OPM plan—that is that wonderful editorial but for actu- than any other nation on the planet. I the plan that will be part of the ex- ally being in the Chamber when we think we are the only nation that real- change—will be set up by the govern- took that first vote to break down this ly knows health care bankruptcy. The ment, the Office of Personnel Manage- filibuster. stories we have heard—countless sto- ment. I say to my colleagues, I am so proud ries. Again, community health centers. A that today we are moving closer to ful- Earlier this morning—I guess to get basic plan can be created by the States, filling the promise of health care for my times correct—when we were here which I think is very important. I all Americans, including the 40 million at 1 in the morning, we heard the ma- thank MARIA CANTWELL for working so Californians I am so privileged to rep- jority leader talk about those very hard on that issue. resent. I thank my colleagues for all poignant, moving situations of individ- If people tell you we do not have any- the work they put into this bill. I spent uals in Nevada. We heard the Senator thing to do with public options, they a lot of time on it myself, and this mo- from California. There are stories from are really not right. You have to look ment is very poignant. I hope we pass every Senator, from every State. Yet it carefully at this bill. it. is only this dividing line, right here I want to talk about the deficit. We I yield the floor. down the center of this Chamber—it is reduce the deficit between 2010 and 2019 The PRESIDING OFFICER. The Sen- only the Senators on this side of that by $132 billion, and between 2020 and ator from Massachusetts. dividing line who seem to be prepared 2029, there is up to a $1.3 trillion deficit Mr. KERRY. Madam President, let to try to address this issue. The fact is, reduction, according to the Congres- me begin by commending the Senator the managers’ amendment, which is sional Budget Office. That is a non- from California for an outstanding now the pending business before the partisan office. This bill reduces the presentation regarding this legislation. Senate, brings us even closer to being deficit. I am going to say it one more I was listening to her in my office be- able to address many of the major con- time. This bill reduces the deficit. And fore I came over to the Chamber. I lis- cerns we have.

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.059 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13677 Senator after Senator has come to crimination or other discrimination have to decide how to provide you the floor and described the way in within the systems. We have gotten lit- those services in a cost-effective way which this bill does not do everything tle pieces done. But all the time, the based on the whole universe of money we want it to do. I have been a pas- basics of the system have been without that has been put on the table. It is dif- sionate supporter, as was Ted Kennedy the reform necessary to bring down ferent from what we do today, where and a lot of our colleagues, of a public costs and make health care more acces- we don’t bundle it and say: Take care component of this plan. Why? Because sible to more Americans. of this patient, and all of your various I believe that is the best way to create So I have no doubt we are reaching a parts have to fit into a whole. Today, the kind of competitive pressure that moment of historic importance here. we pay each of the separate parts with- will restrain a group of insurance com- This is a moment where we are going out relationship to what their connec- panies that have shown no predilection to finally provide access to almost all tion is to the total care of a patient. It to restraining themselves over these Americans. Thirty-one million Ameri- is unbelievably wasteful, ineffective, past years. cans are going to gain health care cov- sometimes redundant, it is noncommu- If you are for the status quo, then erage through this legislation when we nicative, and that is one of the reasons you will vote no, the way our col- pass it, and that will bring us up to 94 why in America we don’t get the same leagues have voted. But the American percent. outcomes for less money that people people are not satisfied with the status To give an example, in Massachu- get in Europe or in some other coun- quo. People in America understand setts, where we passed health care re- tries. that health care costs are breaking the form a couple of years ago, we man- But we have learned from the New backs of families. They are breaking dated that everybody be covered and England Journal of Medicine, which is the backs of businesses. They are a we created a penalty for companies a highly respected medical journal, huge albatross around the neck of that don’t offer the insurance, but we that the bundled payments for chronic American competitiveness. have a pool that helps provide coverage diseases and for elective surgeries Many of our companies have a harder to people who can’t afford it. We now could reduce health care spending by as time competing because there is a have 97.6 percent of all our citizens much as 5.4 percent from 2010 to 2019. health care premium tax, if you will, covered in the State of Massachusetts. Yet we don’t credit for that savings. for the uneven distribution of being The fact is the premiums in the indi- They do not talk about it. But common sick in America. Obviously, if you are vidual market, which is where it is sense tells us, because we have seen it sick in America, you get care at some most expensive for Americans to go out where they have done these bundled point in time. It may well be that point and buy health insurance, went down payments, that you are going to reduce in time is when you are on your death- by 40 percent. The premiums went the costs. In addition, even if such savings only bed or when you are so sick that you fi- down by 40 percent in Massachusetts applied to half of the spending in the nally go into the hospital, into an for a quality of care that people love. health care sector, the result would be emergency room, and the emergency The premiums in the rest of the coun- more than $900 billion of savings over room becomes your first contact with try went up 14 percent. That is a 54-per- the next 10 years. If bundled payments the medical system or it becomes your cent spread in the cost of premiums be- get expanded beyond the post-acute primary care facility. We have almost tween those who got health care re- care, and even half of the potential sav- 50 million Americans for whom that is form and those who did not. ings from bundled payments were real- That is precisely what we are going true—50 million Americans who don’t ized in the Medicare Program during to be able to provide Americans—be- have health care. So they do not get an the upcoming decade, these savings ginning to provide Americans with early screening, they do not get an would translate to an additional .2 per- this. One of the reasons we can’t pro- early determination of what may be cent of savings per year or reduction in wrong with them. They do not get what vide it as effectively as in Massachu- program expenditures, and that would somebody who has a health care plan setts is because there are certain be more than $190 billion between 2010 gets, which may be a mammogram or a things we do in Massachusetts that the and 2019. Pap smear or a PSA test for prostate other side, or some folks, have pre- I have talked about $1 trillion—$1 cancer, or any number of evaluations, vented us from being able to do here. trillion—of savings that does not even perhaps early detection of diabetes. Let me sort of lay it out here. There get formally presented to the American We spend almost $100 billion in the are a couple of things that bother me people as part of this process because United States for unnecessary dialysis about this. We keep hearing from our of bureaucratic technical rules about and/or amputations that take place be- colleagues—and I heard this from the what the budget applies to. Everybody cause people weren’t able to go to a Senator from South Dakota—that we on the other side of this aisle knows, as doctor earlier and learn that they had are not going to be able to save money a matter of common sense, if you look a type of diabetes that might have been in the legislation we are going to pass. at the experience, the way it has al- able to be treated in a far less expen- In fact, nothing could be farther from ready been proven in the marketplace, sive and dramatic and personally cost- the truth. All of us know, as a matter and if you apply your thinking to this, ly way. of common sense, that many of the we are going to reduce the cost of The word ‘‘history’’ gets thrown measures in this legislation are going health care. around in the Senate probably more to reduce the cost of health care, and Similarly, large reductions in Fed- than it ought to. We often refer to one of the reasons is that the CBO eral health care expenditures are plau- something as being historic, where analysis is generally limited to the sible from the combination of other de- sometimes it is a reach. There is no Federal budget. It doesn’t attempt to livery system reforms. A lot of Ameri- question that we are on the threshold account for savings in the health care cans aren’t aware of this, but here is of an unbelievably historic moment in system that come from policies that what we have. Accountable care orga- the Senate. This is history we are liv- are implemented through reforms. nizations. We don’t have that today. ing here now. For example: The CBO found only $19 Suddenly, we are going to have an ac- When I think of what we tried to do billion in government savings from countability in the care organizations in 1993 and 1994, when President Clin- transitioning toward post-acute bun- delivering service. That is going to pro- ton was in office and we tried to pass dled payments in Medicare. But recent vide savings. health care—we got beaten back by research in the New England Journal of We have incentives to reduce hos- false advertisements—Harry and Lou- Medicine suggests that bundled pay- pital-acquired infections. One of the ise—scare tactics, and I might add a ments—bundled payment, for some- biggest single fears people have today plan that didn’t quite pull the pieces body listening who doesn’t understand, in America when they go to the hos- together as effectively as we have. We is when you take all the payments that pital is that they are actually going to have learned a lot of lessons since then. come to a hospital or to the providers get an infection in the hospital, and We have had many fits and starts, with who provide the care, and the pay- the chances of coming up with a staph children’s health care, portability, and ments are all put together for the var- infection or some other kind of infec- trying to deal with certain gender dis- ious services that you get and they tion are very real and very high. There

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.060 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13678 CONGRESSIONAL RECORD — SENATE December 21, 2009 are actually different practices be- We keep hearing about the secrecy poverty. They said no. The insurance tween different hospital operations. I and how this legislation has been hid- industry survived Medicare and Med- happen to know this on a personal den from folks for a long period of icaid. They are doing very well. basis because my wife recently had an time. Again, that is not true. There is According to CBO, the gross cost of operation in one hospital system and nothing in this legislation that we the managers’ amendment is, over the they had a certain procedure to try to haven’t been working on or talking next 10 years, $871 billion—less than deal with the MRSA infection, and a about or wrestling with in committee, the $1 trillion we started with in our certain washing and disinfection proc- out of committee, in hearings, in the committee. But it buys a lot. I will ess you went through, and I know other public debate for over a year now. If talk at some time, perhaps tomorrow hospitals where they do not do the the minority had taken a little less or afterward, about what this bill pro- same thing. time to have press conferences and vides in addition. But I think it is crit- In addition, we are going to have spending their time doing news con- ical for people to follow the truth, to health information technology reform ferences denouncing what they hadn’t look for the facts, and to measure the adoption. There is going to be adminis- analyzed, they would have a better reality of the positive ways in which trative simplification that would sense they might have been able to this legislation will provide additional standardize and streamline insurance read the managers’ amendment on the help to seniors, will reduce premiums paperwork. I mean, if you go to the Internet for over a month—excuse me, for many Americans, will help people ATM machine and pull out some the managers’ amendment was on the afford coverage who do not have it money, it is about a penny or half a Internet on Saturday, and many of us today, will spread risks throughout the penny per transaction. If you go to the looked at it, because many of us have system more effectively, will improve hospital, where they do not have tech- worked on provisions and we wanted to care and delivery within the hospitals, nology managing the records and peo- make sure they were in there. It wasn’t will prevent people from being denied ple are doing it, it is about $20 to $25 hard to read it to see what was and insurance if they have a preexisting per transaction to pull the records. In wasn’t included in it. In addition, the condition, will prevent them from the age of computerization and infor- underlying bill has been posted on the being kicked off insurance they paid mation technology, it doesn’t make Web for over 1 month. for and thought they had when they sense, and all of us know that. But we But the fact is the minority has get sick and they suddenly get that let- also know that because we are putting made a fundamental political calcula- ter that says: Sorry, you are not cov- money on the table and incentives in tion here. They do not want to work ered anymore, and families go bank- place to help do that, we are going to with us. In all the time we were in the rupt—that is over. That alone is an be able to get additional savings; all of Finance Committee trying to mark it enormous step forward for this coun- the savings that are on top of the $1 up, we never had people come to us—as try. CBO has underestimated savings be- trillion of savings I have already I often have here in the 25 years I have fore. talked about, and none of which gets been here when you are legislating se- According to the Generic Pharma- measured when our colleagues come to riously—and say, hey, if you include ceutical Association . . . ‘‘In 1984, it the floor to say what a terrible bill this this or if you work this a little or if was predicted that the Hatch-Waxman is. you tweak this, I think I could support Act would save our country $1 billion CBO has also grossly underestimated this bill. There is just a fundamental in the first decade. Now, generic medi- savings in the past. I am not picking political divide, a fundamental philo- cines save more than that every three on CBO. They have had an incredibly sophical divide. We are looking at a days.’’ hard job, and they have done an incred- party whose opposition to health care In the mid 1990s, the Congressional ible job. They have been completely for Americans is not new. My colleague Budget Office released an analysis overworked on any number of efforts, from California talked about it a few showing that in 1994, the 10th anniver- where we have been asking for models minutes ago. In 1935, they tried to kill sary of the enactment of Hatch-Wax- and analyses. But it is automatic in a Social Security and succeeded in pre- man, annual savings from generics had process that you are going to lose some venting health care from being in- reached approximately $8 billion to $10 things. cluded in the bill at that time. They billion. According to the Generic Pharma- argued in 1935 the same thing they The new data released showed that ceutical Association: argue now. by 1999—15 years after Hatch-Waxman In 1984, it was predicted that the Hatch- Madam President, may I ask how became law—generics were generating Waxman Act would save our country $1 bil- much time we have? $49 billion in annual savings. lion in the first decade. Now, generic medi- The PRESIDING OFFICER. The Sen- In the last decade alone, generics cines save more than that every three days. ator has consumed 20 minutes. have saved consumers, businesses, and Every 3 days we do what was pre- Mr. KERRY. How much time do I State and Federal Governments $734 dicted to happen in savings every 10 have? billion. years. In the mid 1990s, the Congres- The PRESIDING OFFICER. The ma- According to a December 14 report by sional Budget Office released an anal- jority has 15 minutes remaining. the President’s Council of Economic ysis showing that in 1994—the tenth an- Mr. KERRY. And is that Advisors: CBO’s analysis is generally niversary of the Hatch-Waxman Act— predesignated? Is the 15 minutes re- limited to the Federal budget, and does annual savings of generics had reached maining predesignated, Madam Presi- not attempt to account for savings in approximately $8 billion to $10 billion. dent? the health care system more broadly The new data released showed that by The PRESIDING OFFICER. Not by from policies implemented through re- 1999—15 years after Hatch-Waxman be- order. form. For example, the CBO found only came law—generics were generating $49 Mr. KERRY. Madam President, in $19 billion in Federal Government sav- billion in annual savings. In the last fairness, I was not aware; I thought I ings from transitioning toward post- decade alone, generics have saved con- had the full amount of time, but I do acute bundled payments in Medicare. sumers, businesses, State and Federal not. I want the Senator from Con- However, recent research published in governments $734 billion. necticut to be able to share his the New England Journal of Medicine I haven’t even talked about the thoughts also. Let me just say, and I suggests that bundled payments for wellness provisions or the prevention will wrap it up here, that the insurance chronic diseases and elective surgeries provisions that are in here. When we industry, which they sought to protect, could reduce health care spending by as start getting all of America more survived the passage of the Social Se- much as 5.4 percent from 2010 to 2019. tuned in to the things we can do to pre- curity Act. In 1965, we passed Medicare. Even if such savings applied to only vent diseases by taking actions in our Medicaid came afterward. They op- half of spending in the health care sec- lives, our lifestyles, in our diet, and posed it. They opposed Medicare, one of tor, the result would be more than $900 any other number of things, we can the most important programs in the billion of savings over the decade. If bring the cost of health care down in United States of America, that lifted bundled payments were expanded be- America. countless numbers of seniors out of yond post-acute care and even half of

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.061 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13679 the potential savings from bundled First, most of us have wanted to stop KERRY said, will not only not be able to payments were realized in the Medi- the continuous increases in the cost of deny coverage if an individual has a care program during the upcoming dec- health care that burden every indi- preexisting condition, they will not be ade, these savings would translate to vidual, family, business, our Govern- allowed to rescind coverage if you be- an additional 0.2 percent per year re- ment, and our economy. Second, we come sick, which is the outrageous re- duction in program expenditures, or have wanted to regulate insurance ality today. Thanks to changes made more than $190 billion between 2010 and companies to provide better protec- by the managers’ amendment, insur- 2019. tions for consumers and patients. ance companies will also be required to Similarly large reductions in Federal Third, we have wanted to find a way to spend more of the premiums they col- health care expenditures are plausible make it easier for millions of Ameri- lect on medical expenses for patients from the combination of other delivery cans who cannot afford health insur- rather than on administrative costs system reforms, including: Account- ance today to be able to buy it tomor- and profits. That is real progress on able care organizations, incentives to row. I believe this bill makes real the second goal I mentioned. reduce hospital-acquired infections, progress in achieving each of these As for the third goal, the fact is at- health information technology adop- three goals. Most importantly, it does tested to by the CMS Actuary and tion, and administrative simplification so in a fiscally responsible way. CBO, 31 million more Americans will that would standardize and streamline The Patient Protection and Afford- be able to have health insurance as a insurance paperwork. This will help able Care Act not only does not add to result of this legislation. We say that cut down on the $23–$31 billion time our national debt, through new health so often I think we forget the power of cost to medical practices of interacting care delivery reforms it will help re- it—31 million people who do not have with health plans and their administra- duce the debt by $130 billion over the health insurance today will have it tors. first 10 years, according to the inde- after this bill passes. That is a giant Another potentially significant cost pendent Congressional Budget Office. step forward for our society. It is not saver within the Senate bill is the That figure could multiply many times only the right thing to do, but it will Independent Medicare Advisory over during the second 10 years, also eliminate the so-called hidden tax Board—IMAB. The IMAB would rec- thanks, in part, to the managers’ that each of us who has health insur- ommend changes to the Medicare pro- amendment that incorporated stronger ance today pays in higher premiums gram that would both improve the cost-containment proposals that sev- when someone who has no health insur- quality of care and also reduce the eral of us, across party lines, made to ance gets sick and goes to the hospital growth rate of program spending. The Senator REID. to be treated. That is real progress on CBO score of the Senate bill estimates In addition, it is very significant the third fundamental goal of health that the IMAB would reduce Medicare that, according to the Actuary at the care reform that I mentioned. spending by $23 billion from 2015 to Center for Medicare & Medicaid Serv- Is there anything in the bill that 2019, with the savings likely to con- ices, this bill will extend the solvency worries me? Of course, there is. I would tinue in the subsequent decade. The of the Medicare trust fund for an addi- say, most of all, I worry that we, and IMAB has the potential to increase the tional 9 years. This act will also take future Congresses, will not have the savings from many of the delivery sys- substantial steps toward creating a discipline to keep many of the prom- tem reforms described above, which health care delivery system that pays ises we have made in this bill to con- may not be fully captured by the CBO for the quality of the care patients re- trol costs by transforming the way estimates for the reasons previously ceive rather than the quantity of care. health care is delivered because some mentioned. I am proud to have worked with Mem- of these reforms are controversial and Taken together, the combination of bers of both sides of the aisle to include they are going to be opposed by some Medicare- and Medicaid-related provi- amendments that would do that. health care providers and health care sions in the Senate’s Patient Protec- For instance, Senator COLLINS and I beneficiaries. Without the kind of dis- tion and Affordable Care Act are esti- introduced an amendment, parts of cipline I have just mentioned, this bill mated to reduce the annual growth which were included in the managers’ will add to our national debt or in- rate of Federal spending on both pro- package, that will enhance trans- crease taxes. Neither of those results is grams by 1.0 percentage point in the parency for consumers so they can acceptable. If we stick to the contents upcoming decade and by an even great- make more informed decisions in of the bill, this bill will cut health care er amount in the subsequent decade. choosing their health care providers costs and it will reduce our national These savings would increase national and insurers. In fact, our amendment debt. savings and improve the long-run per- will create Physician Compare, a new In my opinion, our exploding na- formance of the U.S. economy. Web site where physician quality meas- tional debt is the biggest domestic The PRESIDING OFFICER. The Sen- ures that exist now but are not known threat to our country’s future. That is ator from Connecticut is recognized. by the rest of us will be posted for ev- why I have said this bill must reduce Mr. LIEBERMAN. Madam President, eryone to see and to use in the choice that debt, not increase it. Accumulated I rise to declare and explain my sup- of physicians. This will also create in- debt is currently over $12 trillion, with port for the Patient Protection and Af- centives, we believe, for doctors to pro- our budget office estimating an addi- fordable Care Act. First, I commend vide high-quality, more efficient care. tional $9 trillion added in the next 10 Senator REID and all those who worked I also cosponsored an amendment in- years. That is unprecedented in our so long and hard, including my friend troduced by Senator WARNER and some history. We are running up to the time and colleague from Connecticut, Sen- other freshman Senators that will con- when we can see a moment possible ator DODD, for all they have achieved tain costs even more. This amendment that we never thought would be pos- in this legislation. The truth is, no creates prevention programs to help us sible, when our capacity as a nation to piece of legislation, as significant and understand how to effectively manage borrow will be imperiled, when we will complicated as this is, could possibly chronic diseases such as diabetes, and have to raise interest rates so high it be totally satisfying to every one of us. it requires prescription drug plans will constrict our economy and send us In the end, each one of us has to ask under Medicare Part D to offer medica- back into a recession, worse than the ourselves: Do the positives in this leg- tion therapy management services to one we are coming out of now. islation substantially outweigh the beneficiaries so they can better adhere We cannot bring the fiscal books of negatives? Are the things we like in to their prescription treatments. All our Government back into balance by the bill greater than the things that that is progress on the first goal that I only making the health care system worry us? For me, the answer to both and most others had, which is to re- more cost efficient, but we will never these questions is yes, because this bill duce the cost of health care without control our national debt without makes real progress on the three im- compromising—in fact, improving—its doing so. Medicare is in a particularly portant goals I have had, and I think quality. perilous condition today. Without re- most people have had, for health care The second goal. If this bill passes, form, the Medicare trust fund will be reform. insurance companies, as Senator broke in 8 years—broke. With tens of

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\CR\FM\A21DE6.006 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13680 CONGRESSIONAL RECORD — SENATE December 21, 2009 millions of baby boomers reaching the ening of Medicare. This bill, as it ap- Mr. ENZI. I ask unanimous consent age of eligibility, we simply must pro- pears it will emerge from the Senate, is that our time be extended in the same tect Medicare so it remains a viable delicately balanced. I understand the amount as their time was extended. program for both current and future normal inclination in a conference The PRESIDING OFFICER. Without generations. committee with our colleagues in the objection, it is so ordered. This leads me to my firm opposition House is to split the difference. But Mr. ENZI. I yield myself 15 minutes. to the creation of a new government- splitting the difference on this bill runs The PRESIDING OFFICER. The Sen- run insurance program and to lowering a real risk of breaking the fragile 60- ator from Wyoming. the age of eligibility for Medicare to 55 vote Senate consensus we have now Mr. ENZI. Mr. President, the major- years. That opposition was rooted in and preventing us from adopting health ity has voted to cut off further amend- my very serious concerns about our care reform in this Congress. ments to this bill. Senator REID has long-term national debt and the fragile That would be a very sad ending. used a procedural tool that prevents fiscal condition of Medicare. For any Rather than splitting our differences, I Republicans from offering amend- new government-run insurance pro- hope the conferees will adopt our ments. Several of my Democratic col- gram, including the Medicare exten- agreements so we can enact health care leagues have come to the floor to argue sion-expansion idea, the moment pre- reform this year. The rules of the Sen- that Republicans don’t have any ideas miums do not cover costs the Federal ate require 60 votes to end debate on a on how to improve the bill. Nothing Government—that is Federal tax- conference report. could be further from the truth. Repub- licans have filed over 200 separate payers, the American people—would The PRESIDING OFFICER. The time amendments. Yet the majority is refus- have to pay the difference. That could of the Senator has expired. ing to allow us to vote on any. On a bill easily put our Federal Government and Mr. LIEBERMAN. I ask unanimous that will affect the health care of every the taxpayers on the hook for billions consent for an additional moment, American and one sixth of the Nation’s and billions of dollars in future liabil- maybe 2 moments, to complete my re- economy, the majority has not allowed ities and further jeopardize the sol- marks. us to have more than 10 votes to try to vency of Medicare. The PRESIDING OFFICER. Without Because of the insurance market re- improve the bill. objection, it is so ordered. forms in this bill and other measures— This bill needs to be fixed. We know Mr. LIEBERMAN. Each Member of the creation of a new system of tax this bill currently will cut Medicare, the Senate will have to decide once credits and subsidies for people making raise taxes, and increase insurance pre- again when this bill emerges from the up to 400 percent of poverty—the cre- miums. If we had the chance to offer conference whether he or she wants to ation of a new government-run health amendments, I believe we could make be one of the 60 votes necessary to take care, the so-called public option or the changes to fix the problems. I filed nine up and pass the conference report. In expansion of Medicare to people under amendments, but I have not been al- this case my own sense of the Senate is 65 is not necessary. Neither proposal lowed to offer any. I believe any reform the same as that expressed in the last would extend coverage to one person should reflect the following core prin- few days by Senators CONRAD, NELSON, who will not be benefited by the new ciples: reducing health care costs so and others. If significant changes are provisions of this bill, neither the pub- that all Americans get the quality, af- made to the Senate bill in conference, lic option nor the expansion of Medi- fordable care they need, ending dis- it will be difficult to hold the 60 votes care. Yet both proposals would, in my crimination based on preexisting con- we now have. I have two priorities that opinion, lead to higher premiums for ditions, ensuring everyone has access will matter a lot to me. The first is to the 180 million people who have insur- to at least catastrophic care, pre- continue and maintain the health care ance today and are struggling to afford serving the right of patients to choose reforms that will improve the cost-ef- the health insurance they have now be- the doctors and health insurance plans fectiveness of our health care system cause of cost shifting. that meet their needs, eliminating According to studies by the CBO, a and help reduce the national debt. Sec- junk lawsuits and reforming our med- new government-run insurance pro- ond, I hope there will be no attempt to ical liability system, reducing health gram, a public option, would actually reinsert a so-called public option in care costs for all Americans, improving likely charge higher premiums than any form in the conference report. patient safety, encouraging incentives competing private plans on the ex- That would mean I will not be able to for healthy behaviors by allowing in- change, and expanding Medicare to support the report. surers to charge low premiums to peo- cover people 55 years or older would I want to support it. I believe I am ple who eat healthy, exercise regularly, lead to additional cost shifting. not alone in that opinion among the 60 and abstain from tobacco use, pro- I know the removal of the public op- who supported the bill last night. Our tecting Medicare for seniors by ensur- tion from the bill in the Senate dis- exploding national debt is the biggest ing that any savings found in Medicare, appointed and angered many Members threat to our Nation’s future. That a program that is going broke, are used of the Senate and the House, while I means we must begin to make politi- to strengthen that program, not to cre- know it pleased and reassured others. I cally difficult decisions to reduce our ate new entitlements, and helping all wish to say to those who were not debt. That means saying no to some Americans afford health care coverage happy about the removal of the public groups and some ideas, including some by fixing the flawed Tax Code so that option from this bill that I believe we would otherwise support, because all Americans can get tax benefits for President Obama never said a public we simply cannot afford them. purchasing health insurance. option was essential to the reform A final hope about the conference re- Unfortunately, the bill fails to do goals he set out to achieve and that port. Perhaps some will say it is naive. these things. I know most Members most of us have. When the President I hope the conferees will find a way to agree on those principles for reform. spoke earlier this year to the Joint produce a report that can be supported The hard part is making the principles Session of Congress, he said a public by some Republican Members of the come to life by translating them into option is ‘‘an additional step we can Senate and House. It is a sad com- bill language. I did that a few years ago take.’’ An additional step, he said, but mentary on this moment in our polit- when I introduced 10 steps to transform not an essential one. Then, he added, ical history that so major a reform will health care. Once the bill was intro- ‘‘The public option is only a means to be adopted with no bipartisan support. duced, I went on a tour of Wyoming in that end.’’ He concluded that we should Hopefully the conference will find a March of 2008 and hosted town meet- remain ‘‘open to other ideas that ac- way, difficult as I know it might be, to ings to talk about health care to my complish our ultimate goal.’’ conclude this long legislative journey constituents. Some of the ideas I in- I am confident this bill accomplishes with a bill that is not only worth sup- cluded in my 10 steps plan I also filed the goal the President and most of us porting, as I believe the Senate bill as amendments to the Reid bill. We set out to achieve without the creation now surely is, but also engages the sup- need to end discrimination based on of a brand-new government-run insur- port of Members of both parties. preexisting conditions. No one that has ance company or the further weak- I yield the floor. at least catastrophic coverage should

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.066 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13681 be denied coverage for a preexisting and employers. We know this because CBO says the Reid bill will drive up in- condition. Everyone should have cata- 70 percent of all health care costs are surance costs for small businesses. I strophic coverage, but no one should be driven by behaviors. If you provide in- have proposed a bill that CBO scored as forced to buy anything. If someone centives to change those behaviors, saving small businesses money by low- does not at least have catastrophic you have a potential decrease in cost of ering their health insurance premiums coverage, then they should have to pay 70 percent of all of the health care by up to 6 percent. more if they want coverage in the fu- costs for an organization. Small business health plans allow ture. Companies such as Safeway have de- businesses to join together through Everyone should get the choices for signed plans that focus on personal re- their trade association across State health care that Senators get. Senators sponsibility and provide targeted in- lines even nationwide so they can form get to choose between competing pri- centives that lead to behavior changes big enough purchasing pools to effec- vate plans. So should all Americans. that can reduce the risk of developing tively negotiate with the insurance Senators get the same choices as any four of the most costly chronic condi- companies and providers. Ohio has other Federal employee. No more, no tions. Safeway’s model, focused on four enough people they were able to do this less. The janitor in the building, the chronic conditions, can be attributed within their State. It is effective. It mailman, the forest ranger, we all get to 75 percent of all health care costs: brought down the cost of health care. the same choices. All choices are from Cardiovascular disease, which is 80 per- They were able to save 23 percent just private insurance. The Federal Govern- cent preventable; cancer, some types on administrative costs. They were ment does not have its own plan. Like are 60 percent preventable; type 2 dia- sure if I could get my bill through, other employers, the Federal Govern- betes, which is 80 percent preventable; they would save even more by going ment does pay part of our health care, and obesity. As a result, Safeway has across State borders. That is one that but not all of it. Our choices allow us seen their health care costs remain flat has been in the lab. It has been proven to pick a plan with a higher premium over the past 4 years, while other em- to work. Not in the bill. at a lower deductible or a plan with a ployers experience annual cost in- Small Business Health Plans, which lower premium and a higher deduct- creases as high as 6.3 percent. This is a was S. 1955, drafted by myself and Sen- ible. Everyone should have these same huge accomplishment for Safeway and ator NELSON of Nebraska, former Gov- choices, but they would have to work its employees, and the employee satis- ernor and insurance commissioner, was for a company willing to make a con- faction is fantastic. Senator HARKIN voted out of the committee in March tribution to be personally willing to and I had an amendment that would do 2006. On May 2006, cloture on the bill make that contribution and pay the re- that. It was inserted into the HELP was not allowed in the Senate by a maining premium and deductible. Committee bill and then pulled out vote of 55 to 43. I know how tough No matter how the health care re- without talking to us before it was health care reform is to pass. I had a form bill comes out, there will not be printed in September. Never heard of majority of the votes but not enough free insurance. Everyone will pay that being done to Senators before. to begin debate. At the same time, Sen- something. The amount we pay should Health care reform legislation should ator SNOWE was poised to do a single have a relationship to the choices we include the necessary provisions to en- amendment that would have solved the make. Insurance costs will only come sure that companies can continue to objection for 80 percent of those who down if we are encouraged to make the provide successful prevention programs voted against it. Without cloture, that best choices. that lead to better health and lower amendment could not be offered. The Speaking of choices, there is no rea- costs but also allow those programs to Snowe amendment would have solved son shopping for health insurance be replicated across public and private the question of what health plan man- should be any more complicated than health programs. We should encourage dates would be required. The desire for purchasing an airline ticket. Everyone these programs and allow people to mandate clarification was the objec- should be able to fire up their com- reap the benefits of better health out- tion that had the disease groups work- puter and look up health insurance op- comes and lower health costs. Addi- ing against the bill. The insurance tions as they look up airline flights. tionally, people who smoke should companies worked against the bill and Each State should set up a Web site or have to pay more. People who don’t successfully defeated other versions an exchange where consumers can find smoke should pay less. People should called associated health plans for over the listing of all the health insurance be encouraged to quit smoking, start a decade. I was able to neutralize much plans sold in their State. The public exercising, and eat healthy. To put it of the insurance lobby. should be able to pick their health in- simply, allow folks who follow healthy By creating Small Business Health surance using the information on the practices to pay less for their health Plans, we can put small business own- Web site. Each health plan would list insurance. ers in the driver’s seat instead of the what is covered, the premium, the de- People should be able to buy insur- Federal Government or insurance com- ductible, and the copay, not what ance across State lines. Companies panies. Through their associations, Washington says they have to put on should be able to sell insurance any- small business owners will have the there. Every insurance company should where in the United States. Policies kind of clout in the marketplace need- be allowed to list their plan on any ex- should be listed on the State exchanges ed to negotiate high-value and high- change, and the State could certify with a disclaimer stating the policy is quality health insurance for their whether the plans meet the minimum an out-of-State policy. The exchanges members on a regional or even national requirements and whether subsidies would also say whether the policy basis. could be used for those plans. There meets minimum credible standards ac- Additionally, throughout the health could also be ratings for how well the cording to Washington and the State. care debate, we have heard Democrats company provides for its insured cus- Insurance commissioners in both the say we need a public option in order to tomers, but people could buy from any insurance company’s State and con- keep insurers honest and to have more company, having been warned. sumer’s State, each get their usual choices for Americans. However, the Everyone could use the trans- amount for the sale—originators, be- only place where we don’t currently parencies of the exchange to find the cause they can be consulted, and pur- have competition is for the millions of insurance that best suits them. Trans- chaser State, as they have to handle Americans who are currently trapped parency would also bring the costs complaints. in the Medicaid Program. Democrats down. Another thing that will bring We need to help small businesses. I believe it is OK to lock 54 million poor down cost is changing the system from have been working on health care re- American people into Medicaid and one that provides sick care to one that form for some time. Small business have them languish in a system that is provides health care. One way to do owners are seeing their insurance pre- broken and they are unwilling fix. this is to focus more on preventing pre- miums go up and up every year. They Their solution is to keep adding more ventable diseases. We know that incen- need real help. What they don’t need is Americans to this broken system. A tives to encourage changes in behavior for the Federal Government to make 2007 Wall Street Journal article stated can result in lower costs for patients their insurance even more expensive. that Medicaid beneficiaries have poorer

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.067 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13682 CONGRESSIONAL RECORD — SENATE December 21, 2009 health than their peers with private in- cuts in order to keep the system this type of strategy, what I call the surance. A study published in the Jour- going—doesn’t that seem counter- 80-percent rule, would likely mean nal of the American College of Cardi- productive—after limiting where the broad support from both sides. This ology found that Medicaid patients cuts can come from because of hidden would mean that the rigid ideologies of were almost 50 percent more likely to deals to get support for the bill. both sides would oppose such a bill, but die after coronary artery bypass sur- Whatever we do has to reduce costs I am confident that majority of the gery than patients with private for all individuals and be deficit neu- American people would support a bill coverage. Merritt Hawkins found that tral. It has to truly be paid for. Why like this. in 15 major metropolitan areas and in does it have to be paid for? Because We need health care reform, but it seven particular cities, including America is going broke. We have has to be done the right way. The best Washington, DC, Medicaid acceptance maxed out the credit cards, and now we way to reform our health care system was below 50 percent. are driving down the value of our is to do it step by step. We need to A 2002 MedPAC report stated that 40 money. We have to use honest cost, not start by focusing on the issues where percent of physicians—let me repeat gimmicks such as the doc fix delay or we already have broad, bipartisan that: 40 percent of physicians—will not collecting revenues before the benefits agreement. treat Medicaid patients because of kick in and showing years of revenue I know how to pass bipartisan legis- their concerns about reimbursement for a shorter time benefit. lation. Since I came to the Senate 13 and the time and added cost of com- What ways can the government pay years ago, I have worked with both pleting the billing paperwork. Even the for anything? Unfortunately, they can Democrats and Republicans to reform Office of the Actuary at the Centers for cut benefits, cut payments to doctors our Nation’s health care system. Over Medicare and Medicaid Services has and other providers, increase taxes, or my years in the Senate, there have stated that providers will accept more cut waste, fraud, and abuse—which been several times when I have worked patients with private insurance than government seldom does and even more across the aisle to get health care bills government-run health care due to the seldom does effectively—or, more hon- signed into law. When I joined the Senate, the Health, more attractive private physician pay- estly, allow a checkoff for donations to Education, Labor, and Pensions Com- ment rates. If you cannot see a doctor, other people’s insurance—perhaps even mittee was one of the more contentious a tax-free donation—so people who you do not have insurance, no matter committees. I believe that people can want a bigger role in seeing that every- what the special name. agree on 80 percent of the issues 80 per- As we increase dramatically the body has insurance could directly par- cent of the time and, if they leave the number of people eligible, we should ticipate. People who argue that it is other 20 percent out, they can get a lot find a way to offer them regular insur- imperative we extend health benefits done. With that in mind, Senator Ken- ance so they do not have the stigma of to everyone should put their money nedy and I worked to make it one of being on Medicaid. They should be able where their mouth is. People should the most productive and bipartisan to choose between the usual Medicaid have an opportunity on their income committees, with a substantial number and a private policy with a subsidy. taxes to make an instantly deductible of bipartisan bills signed into law each Unfortunately, the Reid bill expands gift to the health care of others. If the year. Medicaid, and the reason is because it deductible size of the gift is a refund, Whether it is the reauthorization of is cheap. According to the Congres- then they would not have to include a the National Institutes of Health or sional Budget Office, it costs 20 percent check. the renewal of the Ryan White and more to cover a person in the ex- On the subject of taxes, taxes have to PEPFAR programs for people with change, funded by Federal dollars, than be fair to everyone. Right now, big HIV/AIDS here and abroad, I am com- through Medicaid, which is shared be- companies can write off the health care mitted to working across the aisle on tween Federal and State governments. they provide their employees, so those issues of importance. Working to- One of my amendments would change employees are getting health care with gether, we got patient safety, mental all of this. Senators and their staffs all zero income tax. Individuals who buy health parity, and genetic non- have the ability to choose between insurance pay income tax on all the discrimination legislation over the fin- competing private plans, and I believe money they use to buy insurance. That ish line. These proposals had been we should give that same kind of is not fair. pending for years. We were also able to choice to low-income Americans. In- I have covered just a few of the ideas have a strong bipartisan bill to over- stead of trapping people in a broken I have. I have several more ideas I have haul the drug safety functions at the Medicaid Program, my amendment been talking about time and time FDA. By working together, instead of would provide individuals who would again, none of which show up in the against each other, we can achieve pas- otherwise be enrolled in Medicaid bill. These meet the promises that were sage of many more pieces of critical through the expansion in this bill the made. The bill does not meet the prom- legislation. right to choose to be covered by Med- ises that were made. Everyone agrees we need real icaid or a qualified private health plan Health care is too complicated and changes that will allow every Amer- offered through their State exchange. encompassing to be done by a single ican to purchase high-quality, afford- Every American should be able to bill. I have never worked on a bill that able health insurance. Not a single one choose to enroll in private insurance, affects 100 percent of America. Ade- of my Senate colleagues on either side and my amendment would provide real quately done, rather than assigning de- of the aisle supports the status quo. choice access to a network of physi- tails to agencies, a comprehensive bill The argument that Republicans sup- cians and fix this problem. It would has to contain details. Assigning the port the status quo is simply false. We also assure them they would have cov- tough parts to the Secretary of Health understand that the current system erage for an entire year, not just while and Human Services makes it easier to fails too many Americans. We want to their income fluctuates. legislate, but you don’t know what the support reforms that will provide real On the topic of expanding govern- final outcome will be. Done in smaller insurance options to all Americans and ment programs, I would also like to incremental steps, the bill would be help lower the cost of that insurance. mention that if you save money in more understandable. More impor- But I have said from the start of this Medicare, it should only be used to tantly, with the huge, more com- year, and frankly throughout my 13 help Medicare because it is already prehensive bill, the more people who years in the Senate, true reform should going broke. The current bill takes each don’t like a particular part will be developed on a bipartisan basis, so money from Medicare and uses it for defeat the whole bill over a few parts. that the legislation will incorporate other government programs. This bill We need to start over. We need to the best ideas from both sides and will takes $466 billion from Medicare and pursue a step by step, bipartisan, ap- have the broad support of the America. uses it to start new entitlements that proach. We need to match up a Repub- That should be a prerequisite for any have nothing to do with Medicare. Yet lican idea with a Democrat idea. We proposal that will affect the nearly 20 they start a new commission to figure need to leave out a Republican idea and percent of our Nation’s economy and out where to make additional Medicare leave out a Democrat idea. Pursing the health care of every American.

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.068 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13683 We have only had 10 votes on Repub- But this wasn’t the worst I saw that day. Bingham is a ‘‘termination engineer.’’ He lican amendments. It is not because The worst came in a news report of the year- fires people for companies that want to Republicans agree the status quo is ac- end news conference by House Speaker outsource the awkward, and occasionally ceptable or because we think the Nancy Pelosi. Asked how she would deal dangerous, unpleasantness of downsizing. His with next year’s looming tests of congres- pitter-patter for the fired—‘‘Anybody who health care system works fantas- sional Democratic support for Obama’s deci- ever built an empire, or changed the world, tically; quite the opposite. Republican sion to send 30,000 more U.S. troops into the sat where you are now’’—rarely consoles. Members have filed 223 amendments to Afghanistan struggle, she said, ‘‘the presi- But with his surgeon’s detachment, he is this bill. Unfortunately the majority dent’s going to have to make his case’’ him- more humane than Natalie, who says this: leader has blocked us from offering our self. Reminding reporters that she had told ‘‘This is the first step of a process that will amendments. lawmakers in June, when funding was ap- end with you in a new job that fulfills you. This bill is too important to get proved for 17,000 additional troops, that it I’d appreciate it if you didn’t spread the wrong. We need the opportunity to im- would be the last time she would ever lobby news just yet. Panic doesn’t help anybody.’’ prove this bill, and I would urge my her members to back such a step, she made A confident young cost-cutter from Cor- nell, her brainstorm is to fire people by colleagues in the Democrat leadership it absolutely clear she felt no obligation of party loyalty to support Obama on the most videoconferencing. She tells one desolated to allow us the opportunity to do so. important national security decision he has man: Madam President, I ask unanimous made. ‘‘Perhaps you’re underestimating the posi- consent that an editorial by David The liberal legislator from San Francisco tive effect your career transition may have Broder, ‘‘One Is the Loneliest Number could not have been plainer if she had added, on your children. Tests have shown that for President Obama,’’ be printed in ‘‘You’re on your own, buster.’’ children under moderate trauma have a the RECORD. It mentions some of the With this as an example from the No. 1 tendency to apply themselves academically editorials and key points of editorials Democrat on Capitol Hill, one has to wonder as a method of coping.’’ why liberal Democrats are so furious about Bingham considers his low emotional me- that I put in my speech last night. tabolism an achievement, and in motiva- There being no objection, the mate- senators such as Joe Lieberman and Ben Nel- son negotiating their own deals with the tional speeches he urges his audiences to cul- rial was ordered to be printed in the White House on the health care bill. tivate it: ‘‘Your relationships are the heavi- RECORD, as follows: I think Obama deserves more help than he est components of your life. The slower we ONE IS THE LONELIEST NUMBER FOR is getting from his fellow Democrats in Con- move, the faster we die. We are not swans. PRESIDENT OBAMA gress, given the boost he provided them in We’re sharks.’’ (By David Broder) the last election, the difficulty of the prob- The movie begins and ends with everyday In the last year or so of George W. Bush’s lems he inherited, and the stiff-arm he has people talking to the camera, making re- second term, commentators used to talk a received from the Republicans. markably sensitive statements about the lot about the conspicuous scarcity of other But the reality is that, the closer the mid- trauma of being declared dispensable. Some, Republicans willing to stand up and defend term election comes, when they will be on however, recall that the consequences in- him. I never thought we’d see Barack Obama the ballot and he will not, the more members cluded being reminded that things they re- face the same problem before his first year of Congress—and not just Pelosi—will judge tained, such as their human connections, are was over. what is best for themselves and the less truly indispensable. But as Obama’s approval scores (50 percent they’ll be swayed by Obama. The opening soundtrack is a weird version in the latest Washington Post-ABC News He may feel lonely now, but he ain’t seen of Woody Guthrie’s ‘‘This Land Is Your poll) sink, it is getting harder and harder to nothing yet. Land.’’ This hymn to Depression-era radi- find a full-throated supporter of the presi- Mr. ENZI. Madam President, I also calism is catnip for people eager to tickle a dent. political manifesto from any movie that has ask unanimous consent that an edi- a contemporary social setting. You need go no further from here than the torial by George Will from the Wash- op-ed page of Thursday’s Washington Post to But although ‘‘Up in the Air’’ might look see what I mean. Time was, and not all that ington Post titled ‘‘The Indispensable like a meditation on the Great Recession, it long ago, when the Post was thought of as Dispenser Opens Up’’ be printed in the is based on a novel published in 2001, during the ‘‘liberal paper’’ in Washington, a reliable RECORD. It shows how Medicare is left the mildest recession since the Depression, advocate for the kind of policies pursued by up in the air after the Reid bill. and written before that. Democratic presidents. There being no objection, the mate- You must remember: In 2006, the last full Well, in the lead article on the op-ed page, rial was ordered to be printed in the year before this downturn, when the econ- a well-known member of the president’s omy grew 2.7 percent and the unemployment RECORD, as follows: party said that Obama’s prize piece of do- rate was just 4.6 percent, 3.3 million people mestic legislation, the health care reform THE INDISPENSABLE DISPENSER OPENS UP lost their jobs to the normal churning of a bill, has been so compromised that as it (By George Will) dynamic economy. This ‘‘creative destruc- stands, ‘‘this bill would do more harm than Ryan Bingham has a unique way of de- tion’’ has human costs, but no longer is op- good to the future of America.’’ scribing his life. tional. ‘‘If I were a senator,’’ wrote Howard Dean, ‘‘Last year,’’ he says, ‘‘I spent 322 days on America has an aging population, and has former governor of Vermont and the chair- the road, which means that I had to spend 43 chosen to have a welfare state that siphons man of the Democratic National Committee miserable days at home.’’ Home is an Omaha increasing amounts of wealth from the econ- during Obama’s run for the White House, ‘‘I rental unit less furnished than a hotel room. omy to give to the elderly. Having willed would not vote for the current health-care He likes it that way. this end, America must will the means to bill.’’ Today he is where he feels at home, in an it—sometimes severe economic efficiency to Dean, who had been signaling his apostasy airport—glass walls and glistening steel, generate revenues to finance the entitlement for some time, was far from alone in clob- synthetic sincerity and antiseptic hospi- culture. So ‘‘Up in the Air’’ is sobering en- bering Obama, just as the president and Sen- tality. Today he is showing Natalie, a fero- tertainment for a nation contemplating a ate leaders were struggling to line up the 60 cious young colleague, how an expert road giant addition to the entitlement menu. votes needed to pass the ever-changing legis- warrior deals with lines at security screen- ‘‘Up in the Air’’ is two mature themes sub- lation. ing: tly braided and nuanced for grown-ups. One Across the Post’s prized real estate, con- Avoid, he says, getting behind travelers is the sometimes shattering sense of failure, servative columnist George F. Will gloated with infants (‘‘I’ve never seen a stroller col- desperation and worthlessness that over- that the more Obama argued for the bill, the lapse in less than 20 minutes’’). Or behind el- whelms middle-aged people who lose their less the public supported it. And from across derly people (‘‘Their bodies are littered with livelihoods. The other is that such shocks the aisle, Matthew Dowd, a former Democrat hidden metal and they never seem to appre- can be reminders that there is more to life who served as chief strategist for the young- ciate how little time they have left on than livelihoods. er President Bush, offered congressional earth’’). Do get behind Asians: ‘‘They’re But not for Bingham. He is, in his fashion, Democrats the free advice that they would light packers, treasure efficiency, and have a content. In E.M. Forster’s novel ‘‘Howards be better off themselves if the Republicans thing for slip-on shoes.’’ End,’’ Margaret famously exhorted, ‘‘Only managed to block Obama’s bill. Natalie: ‘‘That’s racist.’’ connect!’’ Bingham would rather not. It was left to my friend, E.J. Dionne, Jr., Bingham: ‘‘I stereotype. It’s faster.’’ Mr. ENZI. Madam President, I yield one of Obama’s most passionate journalistic Played with seemingly effortless perfec- the floor and reserve the remainder of advocates, to tell the Democrats that they tion by the preternaturally smooth George our time. ought to mind their manners—and their Clooney, Bingham is the cool porcelain heart words. The increasing flak between moderate of the movie ‘‘Up in the Air.’’ It is a roman- The PRESIDING OFFICER (Mrs. and liberal Democrats ‘‘is a recipe for polit- tic comedy, although Bingham begins im- SHAHEEN). The Senator from South ical catastrophe,’’ Dionne warned, his tone mune to romance. And the comedy is about Carolina. suggesting that he thinks the Democrats are pain—about administering it somewhat hu- Mr. DEMINT. Madam President, we too far gone to heed him. manely to people who are losing their jobs. have heard a lot about the

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\CR\FM\A21DE6.007 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13684 CONGRESSIONAL RECORD — SENATE December 21, 2009 unsustainable mountain of government care, this debate is about much more in the Halls of Congress to lead us out debt, bureaucracy, and spending the than health care. It is about how we of the woods. Democratic majority intends to create find ourselves in a situation where we There is not a word in the Constitu- in rushing their health care proposal are debating the best way to give the tion about the government deciding through this Chamber. We have also government control over another big what medical test private health insur- heard a lot about how much of this part of our lives and our economy. ers should pay for, nothing about the they inherited. We need to remember In the children’s story of ‘‘Hansel and government deciding how much execu- that this Congress—both Houses of Gretel,’’ the children drop a trail of tives on Wall Street should earn or Congress—has been controlled by the breadcrumbs as they walk through the what kind of lightbulbs or cars we Democratic Party for 3 years now. The forest so they will be able to find their should buy. There is nothing about the President does not write legislation or way out of the woods. But when the thousands of parochial earmarks that spend money; the Congress does. The birds eat the breadcrumbs, the children fund local bridges to nowhere, golf only thing the Democratic majority find they are lost in the dark and courses, bike paths, sewer plants, and has inherited is its own irresponsible frightening woods. teapot museums. There is nothing spending. Well, lost in the woods is exactly about these or many other things in Saturday’s release of the final Demo- where we find ourselves as a country the Constitution because they have cratic bill only increases America’s right now. We know we are in trouble, nothing to do with the proper role of concern with this Congress, its shadow but there is no clearly marked path to the Federal Government in a free soci- negotiations, and our growing debt. get us back to where we were, and it is ety. But these are exactly the kinds of Early this morning, all 60 Democrats plenty frightening. things our government spends its time voted to force all the taxpayers of this In the past year alone, this Federal and money on, and we do not even country to pay for bailouts and special Government has taken over two of our question anymore why that is. favors for several States. Rather than largest automakers, our largest insur- Instead, it has gotten to the point actually taking the time to put forth ance companies, the largest mortgage where if we oppose the government real health care reform proposals that company, and hundreds of banks. It has doing anything, we are accused of would increase Americans’ ability to bailed out Wall Street and attempted being opposed to getting it done. That buy and own health care plans they to stimulate the economy by taking $1 is patently absurd. If you really want could really afford, this plan forces trillion out of the private sector and to get something done and get it done over 15 million Americans onto yet an- spending it on wasteful government right, the government is absolutely the other bankrupt entitlement program, programs. It has thrown taxpayer last place we should turn. Medicaid. money at people to encourage them to The tea parties, townhalls, and ral- While Medicaid is a State and Fed- buy new cars and houses. And it is lies affirm that the American people eral shared program, the Democratic looking at imposing massive new job- are rethinking the appropriate role of majority saw fit for the Federal Gov- killing taxes on businesses in the name the government in a free society. Hope- ernment to pay 100 percent of the Med- of reducing global warming—all in the fully, their discontent will be dem- icaid Program in the State of Nebraska middle of a snowstorm. onstrated in the 2010 elections. Only under this legislation at the expense of One of the problems we have now in the American people can hold our taxpayers in the other 49 States, who this country is, instead of asking if we elected Federal representatives ac- will now be forced not only to deal should solve it, we are asking, how countable for fulfilling their oath of of- with the loss of their freedoms under should we solve it? It is now considered fice. In the health care debate, this this huge government takeover but to a sign of admirable restraint to occa- means deciding exactly what role the pay for special favors in other States. sionally ask here in this Senate and in government should play to help people This State bailout is not the only this Congress, how much should we in the private sector find solutions, in- downside of the majority’s health care spend? And somehow we started think- stead of creating a monstrous new bu- proposal; there is a laundry list we ing that anything less than $1 trillion reaucracy that puts the government in could go through. Just a few include is a good deal. There is not a pothole in charge of every decision. that the working American taxpayers America that most Members of the But this debate is about much more and their employers will be taxed $500 Congress do not believe should be filled than health care. It is a battle for the billion over the next 10 years, and the with an earmark from the Federal Gov- heart and soul of America. It is a Congressional Budget Office has con- ernment. There is not a bridge to no- struggle between freedom and social- firmed that nothing in this bill de- where, a flat tire, a skinned knee— ism, between free markets and a cen- creases the premiums for Main Street there is nothing off limits for this Con- trally planned economy, and between Americans. gress today. ‘‘we the people’’ and an entrenched Seniors will see their Medicare bene- This matters not just because of our class of elite politicians. fits changed as a result of the $500 bil- unsustainable debt and the huge The current debate over health care lion in Medicare cuts included in this amount of money we waste; it matters reform is a symptom of a bigger prob- bill, not to mention that this bill turns because every time we give a job to the lem in Washington. But it can be the a blind eye to the physician payment government, we take away some con- catalyst for a wider debate about the system that is woefully underfunded trol people have over their own lives, proper role of government in our lives. and vitally necessary to maintain the and we take away a little bit more of The same debate can lead us to a mo- Medicare Program and physician ac- their freedom. In return for letting ment when Americans finally take a cess for seniors. It does not matter how government try its hand at solving a stand to return government to its prop- good the insurance is we give our sen- problem, we as citizens cede our ability er place—and we can all start finding iors if they cannot find a doctor who to try for ourselves to find a better our way out of the woods. will see them. way. Madam President, I yield the floor. Another alarming part of this bill is It is awkward to admit it, but my The PRESIDING OFFICER. The Sen- it will, for the first time in decades, colleagues in Congress have led this ator from North Carolina. force every American taxpayer to pay country into the woods, despite our Mr. BURR. Madam President, I am for abortion services. oath of office. We swore to protect and going to be joined by a number of my Frankly, after reading this bill, it defend the Constitution of the United colleagues, so I ask unanimous consent seems the only Americans who are not States and to bear true and faithful al- that we be able to have a colloquy dur- going to be affected by the bill are legiance to it. The Constitution pre- ing the remainder of our time. Members of Congress, pharmaceutical scribes a very limited role for the Fed- The PRESIDING OFFICER. Without companies, and insurance companies. eral Government. There is not a word objection, it is so ordered. Madam President, for all the mind- in our oath or in the Constitution Mr. BURR. Madam President, I think boggling numbers and devastating about most of what we do. As we have many Members have to ask: Why are facts we have heard about the major- wandered off the path of liberty, there we here? We are here because at 1 a.m. ity’s government takeover of health are few crumbs left of the Constitution this morning, there was a cloture vote

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.072 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13685 on the consideration of the Reid man- in Nevada. I think maybe there is even not real pretty, and when you look at agers’ amendment. I think it is impor- a deal that affects them to some de- the $2.3 trillion that health care costs, tant that we discuss what that means. gree. you have to ask yourself, where is the It means there are going to be no more Is it fair? No, it is not fair. The fact beef? Where is the value in this? amendments, no opportunity for any that it wasn’t fair was called: ‘‘That is As hospitals close, as nursing homes Senator from any State to propose a compromise.’’ close, as providers don’t see Medicare change to the bill. At some point, we That is not compromise. We are here and Medicaid, ask yourself, have we will have an up-or-down vote on ex- under an obligation to make this fair really done something good? Chances actly what Senator REID has presented to all of the American people. But in are, you will find out if we do nothing, to us. this case, it is not. if we do nothing, we will actually save But here is what we do know. We are Yes, there are 31 million Americans money in the health care system. going to steal $466 billion from Medi- who are going to have health insur- The last fact: The Chief Actuary of care. We are going to take that $466 bil- ance, 15 million of whom are delegated Medicare said: If you pass this bill, the lion away from hospitals, from hospice, into Medicaid, the most dysfunctional cost of health care will be $1⁄4 trillion from nursing homes, from home care, delivery system that exists in the more than if we did nothing. and, yes, a popular target up here—the American health care system. The President talked about bending insurance product many Americans Yes, there is, for many States, an un- the cost curve down. We are bending have chosen, 20 percent of the seniors, funded mandate to those States be- that cost curve up in this bill. We are Medicare Advantage. We are going to cause after 5 years, for most States, ex- bankrupting hospitals and nursing eliminate that option. So this is one cept for those who got these special homes. We are chasing providers from case where if you like your health care, deals, the States are going to be re- seeing Medicare and Medicaid patients. you are going to lose it. sponsible for some portion, an average There are not too many things we The bill that we are considering and of 10 percent of the cost of Medicaid. can point to that are great about this that will be voted on later this week Let me tell you what my Governor, bill. That is every reason we should raises $519 billion in new taxes and Governor Bev Perdue of North Caro- start over. fees—$519 billion in new taxes. I might lina, said earlier: I know my colleagues are here to join add for my colleagues, we are taxing The absolute dealbreaker for me as gov- in and to offer some perspectives, and I tanning salons at 10 percent. What in ernor is a Federal plan that shifts costs to would ask them to chime in. the hell does that have to do with the States. Mr. ENSIGN. Madam President, let health care? Well, the reason it is in Well, we are shifting costs to the me just summarize a few problems I see there is because we dropped taxing States, and she is nowhere to be found in the bill, and maybe even offer a few Botox. Hollywood saw this was not ad- now. But the people in North Carolina, suggestions about what I think we can vantageous to have Botox taxed, so the taxpayers of North Carolina are do in a bipartisan fashion—kind of this when they dropped that, they had to going to continue to be charged for this step-by-step approach many of us have find something else: poor tanning sa- expansion of Medicaid when that is the been talking about—instead of this lons, small businesses in every commu- most inefficient place for us to have massive government takeover of our nity across this country. We are going put these 15 million Americans who health care system. to actually tax the majority of Ameri- were promised health care. This is a—I have lost track—I think cans the President said he would never While we do all this, according to the somewhere around a 2,700-page bill tax: those under $200,000, the ones who Chief Actuary of the Centers for Medi- with incredibly complex legal lan- can’t afford to go to the beach every care and Medicaid Services, CMS, 20 guage. In the 400-page amendment of- weekend; the ones who don’t have a percent of our hospitals and nursing fered the other day, when I was sitting beach house. They are going to pay a homes are going to go bankrupt. They there listening to the reading of it, I 10-percent tax when they go to get a are going to go out of business because can’t tell my colleagues how many little bit of a tan. Well, when they do as the Chief Actuary said: times I was listening to this and I that, how far off are we from fining They would be unprofitable within the thought: When the regulations are parents because we don’t put a high next 10 years as a result of these cuts. written to that particular small part of enough SPF on our children, or are we Hospitals, nursing homes, at a time the amendment, it could be incredibly going to start charging when we go to that our senior population is getting complex with all kinds of unintended the beach because we get exposure to ready to explode as the baby boomers consequences. I thought about the bur- the Sun? That is what happens when hit it, we are cutting $466 billion from dens on small business and the record the government becomes a more domi- Medicare, and we are starving the in- keeping that small businesses are nant role in health care. frastructure of hospitals and nursing going to have in this bill. I might add: No doctor fix, something homes and hospice and home care. I think what is going to also happen many of us have highlighted. In the What is going to happen to the pro- with small business, there is going to bill, there was a 1-year fix. Doctors are viders? The Chief Actuary, again, said be a great incentive—if you are a small going to be faced with a 21-percent cut if we pass this plan, the result is pro- business owner, the complexities are so in their reimbursements after this next viders will be unwilling to see Medicare much and you can get yourself in so 2 months. There was a 1-year fix to it. and Medicaid patients. much trouble, you know what, I am It didn’t do away with the problem. It Today, 40 percent of providers don’t just going to pay the fine. I will write didn’t fix the whole problem. But now see Medicaid patients. Does that mean a check to each one of my employees, there is no 1-year fix. We have said in it is going to be 50 percent or 60 per- but I am getting out of the health care 60 days doctors will be on their own. cent or 70 percent? We are ballooning a business. I am going to let them go out Yes, there were some special deals— system that today is having a hard and find their own health care, whether the cornhusker kickback, the windfall time finding providers. To most of us through the government exchanges or for Nebraska. I have to admit that I that doesn’t make sense, but that is whatever it is, but I am getting out. was proud of my colleague, Senator what the Senate is going to do. That is one of those unintended con- JOHANNS, who came to the floor and I might also add that the attempt sequences that a lot of people haven’t said: Let me assure you, the people in was to expand coverage; and, yes, sure, focused on. Nebraska have never asked for some- in numbers, we are expanding coverage. We talked a lot about this $500 bil- thing different than everybody else. But, if passed, the Congressional Budg- lion-plus cut in Medicare. My colleague They are willing to pay their share of et Office says 8 million to 9 million in- from North Carolina mentioned that. the way there. They haven’t asked for dividuals who currently have em- Some of the biggest places—I had two it to be free for them and cost every- ployer-based health care will lose that grandmothers who were in hospice. body else. health care. Eight million to nine mil- Hospice care is the most compassionate Yes, it will cost my constituents in lion who currently have their health care we have today, and we are going North Carolina, and it will cost the care will lose their health care with to cut hospice care. That actually puts constituents in Nevada—well, it won’t the passage of this bill. The net-net is dignity back into dying. That is just

VerDate Nov 24 2008 02:31 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00047 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.073 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13686 CONGRESSIONAL RECORD — SENATE December 21, 2009 unconscionable. The Congressional share of something; my State is suf- healthcare reform. What it is, it’s allowing Budget Office says these cuts actually fering because the whole economy is in more people, 30 million people, to buy into will be cuts in service because you the doldrums and because we are such the existing broken system. It’s very impor- can’t just take money out of the sys- a tourist economy, construction ori- tant to keep in mind that healthcare insur- ance is not the same as health care. Insur- tem unless you make them more effi- ented, the housing industry, all of ance, not the same as care, if you go up to cient. These cuts don’t make the sys- those things, and because the general Massachusetts, they have a mandate as well, tem more efficient, they just take economy went down, my State is suf- and last year 21 percent of people in Massa- money out of the system, whether it is fering. chusetts could not get health care because out of hospice or nursing homes or the So the Senator is exactly right. We they could not afford it. Even though they home care, but also out of Medicare should be looking at what is best for had insurance, the premiums—not the pre- cuts. the entire country. As John F. Ken- miums, the deductibles, copays and out-of- We know there is $120 billion in cuts nedy said: A rising tide raises all boats. pocket expenses were too high. So really, to Medicare Advantage. The Congres- this isn’t reform. It’s expanding the system, Well, if the whole country is doing bet- it’s almost rewarding the existing system. sional Budget Office said by 2016, 64 ter, whether it is on health care or Now, what is important about this is that it percent of the extra benefits, whether whatever it is, instead of looking for actually puts the federal government, plus those are prescription drugs or dental something individual for our States, America on the place to say health care is a coverage or vision coverage, the sen- you are exactly right. I think our indi- right, it’s not a privilege to just those who iors covered under Medicare Advantage vidual States will do better if the are—who can afford it or who are lucky are going to be cut 64 percent because whole country does well. enough to have a good job that has good ben- of this legislation. Mr. COBURN. Madam President, I efits. But as far as reform goes, I think this We also know there is around $500 is a long battle that we have ahead of us. ask unanimous consent to have printed Mr. MOULITSAS: Well, you can’t talk about billion in new taxes, and this is a com- in the RECORD an article that appeared health care and Afghanistan being distrac- plete violation of the President’s prom- today. It is a quotation from the found- tions. They’re the reasons that Obama won ise during the campaign when he said er from the Daily Kos Web site. I will the White House and Democrats won control not one dime in new taxes will be give it to the clerk in a moment. I wish of Congress, including big, massive support raised on those individuals making less to read a quote from it: from independents. Independents know what they were voting for when they voted for than $200,000 or families making less I don’t think this is a reform bill. I mean, Obama and the Democrats. I think the prob- than $250,000. Yet in this bill, of the I think it is very clear this is not insurance lem with Obama’s numbers and, and Con- $500 billion, 84 percent is paid by those or health care reform. What it is is allowing gress’ numbers is that people voted for a more people, 30 million people, to buy into people the President said wouldn’t Congress and a president that was going to an existing broken system. It is very impor- have their taxes raised by one dime. take on entrenched interests. Now, Repub- tant to keep in mind that health insurance is We also know, because the Senator licans had jumped off the Obama bandwagon not the same as health care. If you go up to from North Carolina talked about it, from day one. They were never on board. Massachusetts, they have a mandate as well. Independents have sort of been unhappy be- this massive Medicaid expansion—I Last year, in Massachusetts, 21 percent of cause I think independents really want re- think it was the Democratic Governor the people who are insured could not get sults, and we haven’t seen a lot of results. from Tennessee who said it was the health care because they could not afford it. mother of all unfunded mandates. Well, We’ve seen a log of bickering, and most of it That is somebody who is very well re- has been internally within the Democratic we have to look at this one way. If the spected on the majority side, and it is Party, and I think that’s why they’re turn- sweetheart deal that was made by the something we have been saying, and ing off. And a lot of Democrats are becoming Senator from Nebraska—and, by the they are saying the same thing. The disenchanted. way, I agree with you. Senator fact is, what we are going to do is put Mr. GREGORY: . . . What does the president JOHANNS, who came to the floor, it 15 million people into Medicaid that we need to address to keep his own party in line? Should there be personnel changes in takes a lot of courage to say it isn’t know has worse outcomes, we know is about just helping my State; it is the White House? What do you think the left an unfunded mandate on the States, is going to demand? about thinking about the whole coun- and we know 40 percent of the doctors Mr. MOULITSAS: Well, 2006 is going to be a try as well. He isn’t asking for some- refuse to see them. So you are not base year. It’s going to be a base election. thing—which most Senators do around going to get to choose the doctor you MR. GREGORY: 2010, you mean. here, ask for something just special for want to see. You are going to have Mr. COBURN. Madam President, I the State that the rest of the States State mandates in terms of what is wish to also quote from what I think is have to pay for—but he stood up with available to you and what is not. So we a brilliant letter by a Dr. Robert Geist courage, and I think he deserves a lot have violated two of the key promises from St. Paul, MN, that was written as of credit for that. with which to reform health care. a letter to the editor in the Wall Street But if all the other States now come There being no objection, the mate- Journal today. The title of his letter to back and say: We want the Federal rial was ordered to be printed in the the editor is, ‘‘The First Cost Con- Government to pay for our States and RECORD, as follows: troller Will Be Your Own Doctor.’’ It is Medicaid, this bill is going to do one MOULITSAS: WE’LL GET KILLED IN 2010 something I have been talking about thing. It is either going to be a massive since we started this. The last thing we unfunded mandate on our States or Markos Moulitsas, founder of the Daily Kos and an influential leader of the Web- want to do in health care in America is this bill is going to massively balloon based political left, said Sunday that Demo- to make it where the doctor is not a the Federal debt. crats are facing huge defeats in the 2010 elec- 100-percent advocate for the patient’s Mr. COBURN. Madam President, I tions because the Obama administration has best interest. have a question for both the Senator alienated the Democratic Party’s liberal po- He quotes very directly the transfer. from North Carolina and the Senator litical base with its escalating involvement He said a previous article written: in Afghanistan, and its failure to push for from Nevada. Can the State of Nevada . . . doesn’t emphasize a potential stealth universal healthcare. or the State of North Carolina or the cost-control aspect proposed in the bill. It State of Nebraska or the State of Okla- Speaking on NBC’s ‘‘Meet the Press,’’ Moulitsas offered a bleak scenario for House will start pilot programs that would transfer homa be healthy if our country doesn’t and Senate races next year. the gatekeeper role to doctors at the bedside, flourish? So no matter what we do for Excerpts: a role currently held by ‘‘payers’’ (HMOs and government-agency insurers, including Medi- our own States, if, in fact, we are not Mr. GREGORY: Markos Moulitsas, I want to thinking about the country as a whole, start with you. You heard David Axelrod say care and Medicaid). The transfer will be via capitation fee pay- this in keeping with the president’s prin- the best right thing for the country as ments, making clinics ‘‘responsible’’ for the ciples; it is in keeping, the compromise on a whole, none of our States can flour- cost of care of ‘‘insured lives’’ for one year. health care, with the way the president cam- ish. . . . The illusion of many pundits and policy paigned on this. And this is the bill, essen- Mr. ENSIGN. I think the Senator makers is that mini provider gatekeepers tially, the reform that Americans deserve. can control costs after the very powerful from Oklahoma has made a wonderful What do you say? payer gatekeepers— point. Right now, my State is suffering Mr. MARKOS MOULITSAS: Yeah, I don’t terribly, not because of anything indi- think this is a reform bill. I mean, I think That is, Medicare, Medicaid, and the vidually, such as we didn’t get our fair it’s very clear, this is not insurance or large insurance companies—

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00048 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.074 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13687 have failed for decades. The problem for pa- What Dr. COBURN and I found out, as care costs actually, according to Presi- tients is the dilemma of all managed-care many other Members have, is if you dent Obama’s CMS, go up $234 billion if gatekeepers: cost, quality, access; pick any look at the successful companies across nothing is done. If nothing is done, we two. It is not pleasant to think that one’s gatekeeper doctor will have to decide wheth- this country that have held down their actually save money on total health er to order surgery for your painful [worn health care costs through doing real re- care spending. But with this bill, it ac- out] hip or only to increase the dose of— form—paying for prevention and tually goes up by $234 billion. Anti-inflammatories because they wellness in work, changing the life- Mr. COBURN. What we also know are worried about costs. styles of the employees—we saw com- from the Congressional Budget Office That is the key point. We are going panies that, for 4 years, had a 45-per- is that between 9 and 10 million people to now separate physicians in this cent increase in their health care. who today have insurance through country for doing what is best for the Where is any of that in this bill? Out of their employer will actually lose it. patient to meet the demands of the 2,700-plus pages, there is no attempt to They are going to lose their insurance. government. do that. There is no attempt to try to That may be good or bad for them. But Mr. ENSIGN. If the Senator will affect the lifestyles through supporting if you look at the incentives, the sub- yield. chronic disease management, preven- sidy for people who do not get insur- Mr. COBURN. I will be happy to tion, and wellness, but we set up a lot ance through their employer, if you yield. of independent advisory boards. make $42,000 a year, today with your Mr. ENSIGN. As a practicing physi- As a matter of fact, they were so health insurance through your em- cian, isn’t this what the Senator saw in scared that in the managers’ amend- ployer you get a benefit of about $5,749 his practice with HMOs? ment, it is no longer called the Medi- from the tax system. But under this Mr. COBURN. That is exactly why I care independent advisory board. It is bill, you will be eligible for $12,500 am not a member of any HMOs. called the independent advisory board. worth of subsidy. Mr. ENSIGN. Because we have kind So the word ‘‘Medicare’’ was dropped, What do you think an employer is of an insurance center system today, to not to signify that they are going to going to do? They are going to look at a large degree, and now we are going to cut Medicare, but that is exactly what their employees and they are going to make that worse. Instead of going CBO and CMS have said. These will say: I have to pay this penalty if I more toward a patient center, we are kick in. The question is, Are they sus- don’t offer this, but it is a significantly going to go from an insurance center to tainable or will Congress legislatively smaller amount than what I am paying a government center to where these override their authority to cut the today. Therefore, I am going to make a government bureaucrats now start spending? decision to no longer offer health in- being in control of eventually what Mr. ENSIGN. If my friend will yield, surance, give my employees a small kind of care you are going to get, what there is one part—actually one of the raise because the government is going is paid for, and all that. We need to put best parts in this bill—but there are so to come in with $12,500 worth of sub- the doctor and the patient back at the many other bad parts of this bill and sidies to put them in a ‘‘private’’ plan center of our health care system. the Senator from North Carolina men- inside the parameters of what is in the Mr. COBURN. Let me finish this for a tioned them, and we have talked about exchange. How many people do you minute, if I might. Here is the summa- a lot of them. The one place they actu- think it is going to shift? rizing paragraph: ally have improved our health care sys- What we are going to get is adverse The economic reality is that no rationing tem is the part that allows people to selection. So the individual—let’s say I of care supply will ever control costs, when have larger discounts for healthier be- am working and I am making $42,000 a the problem is demand inflation driven by haviors. Safeway was the model for year and my employer decides to do popular insurance tax subsidies too sacred to that and let’s say I am 35 years old and repeal. Consider that when federal fiscal ‘‘ne- this. They have done the most work on cessity’’ overwhelms empty slogans,— this in the last 4 years. Today, they I know available to me is $12,500. Even Our empty slogans— can discount up to 20 percent of their though my earnings may go up, I am health care premiums for people who still 21⁄2 times better off. scores of new bureaucracies created in [this I also know I will have to pay $3,000 bill] would be able to implement Draconian engage in healthier behaviors—for not rationing in collusion with subservient in- smoking, for being the proper body or $4,000 of my own money to get that surance and ‘‘provider’’ corporations. The weight compared to their height, doing benefit. I will not cover myself because high costs, as well as the rationing powers things such as that. If they are a non- I know I can cover my little included in the more than 2,000 pages of the smoker, they get a lower premium, and incidentals. If I get sick, they have to ObamaCare Senate legislation are very real. if they even quit smoking, Safeway cover me in the exchange. Which is the point I have been mak- pays for the cessation products. To be So we are going to see adverse selec- ing all along. I am going to spend 30 fair, that is in the bill. Senator CARPER tion in the insurance market, people minutes tomorrow talking about the and I got that in the Finance Com- who are between 40 and 64 who are sick rationing aspects of what we are about mittee. We were able to get that are going to pay far more for their to do as we pass this bill. amendment drafted. health insurance and people who are Mr. BURR. If I can comment to my The problem is, that is a tiny part of sick who are younger than 40 are going good friend, who started on a quest this bill. That should be a major focus to pay far more for their health insur- with me several years ago to try to put of the bill. We should be able to buy in- ance and everybody who is healthy together a health care reform bill, I surance across State lines. Many of us under 40 is going to say: This is an eco- might say it was the first one intro- have supported that—small business nomic bonanza for me. I am not going duced in the Congress in May of this health plans, where small businesses to buy insurance. year on comprehensive health care re- can join together and take advantage Mr. ENSIGN. I see our friend from form—not that it is better than any- of purchasing power. We all, on this South Carolina has joined us. He has body else’s, but I can honestly say side, almost everybody on this side of spoken eloquently about some of the today it was true reform. I think that the aisle agrees with medical liability sweetheart deals that have been made is what Dr. COBURN is trying to say. reform. The Congressional Budget Of- in this plan to ‘‘buy’’ votes. Could the In this bill, it lacks reform. What do fice said that would save $100 billion. Senator from South Carolina address I mean by that? Their reform is to set The bottom line is, what we have those? up an advisory panel that if we exceed been focused on—and I appreciate the Mr. GRAHAM. I don’t know if you the costs we have designated for health efforts Senator BURR and Senator could call it a sweetheart deal more care, they are going to cut the scope of COBURN made in their bill last year—is than it is just repugnant. The cam- coverage or the reimbursement. So ei- trying to address the No. 1 problem we paign in 2008 was about change we ther the array of coverage for a senior have in health care in the United could believe in. I do believe one of the or for an American is ‘‘skinnied down’’ States, which is costs. This bill does reasons President Obama won is be- or we cut the reimbursement to the not address costs. cause he convinced young people in doctor or the hospital, and they call As a matter of fact, you said it in this country that if he got to be Presi- that reform. your opening remarks. Total health dent, this country was going to change

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00049 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.077 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13688 CONGRESSIONAL RECORD — SENATE December 21, 2009 for the better; we were going to do What I hope will happen, I say to my expenses, what you see is a $1 trillion things differently, and that resonated good friend, the Senator from Nevada, tax increase, a $1 trillion cut in Medi- with people. is that the people will take their gov- care, and an increasing cost to the Quite frankly, when we were in ernment back. If you think this deal economy. charge, as Republicans, we let people from Nebraska is unacceptable, speak But because there is not the sustain- down. We let things get out of control up and speak out and let the House able growth rate—the doctor fix in the on our watch. Some of our people Members know you want it changed. bill—that is $247 billion not accounted wound up going to jail. The Iraq war Mr. BURR. I thank our colleague for, and that is if you keep physician was not popular. So you had this new, from South Carolina. I know we are wages frozen over the next 10 years. young, exciting, articulate figure come about to run out of time, but I wanted That is $247 billion, probably closer to along and promise a new way of doing to go back to the Chief Actuary at $300 billion. So that is $300 billion. The business. That is what hurts so much Medicare because I think the way they fact is we know the taxes that are about this bill. The special deals the analyzed the bill is absolutely essential going to be collected, people are going Senator just mentioned remind us all for the American people to understand to pull down the cost, which is one of why Congress is in such low standing. what is in it. their hopes, and they are going to pay The 60th vote—how did they get it? The Chief Actuary, the President’s for it out of their pocket. Did they negotiate the 60th vote on C– Actuary, said: So we are going to see that insurance SPAN in a transparent manner prom- The Reid bill funds $930 billion in new ised in the campaign that we would spending by relying on Medicare payment plans not reach the Cadillac level, and have negotiations on C–SPAN so that cuts which are unlikely to be sustainable on we are counting on revenues from that you, the American people, could watch a permanent basis. in terms of billions and billions and what was being given and what was It gets to what Dr. COBURN said. By billions of dollars. But what they will being taken and there will be no more design, maybe this could work, but do is change the deductibles—and that backroom deals? there is not a will because there is not is a hidden tax. Because if your deduct- Here is what happened. They took reform. We have spent a lot of money, ible goes up to keep your insurance one Senator who was the key guy and and at the end of the day, it looks as if from going too high, your tax goes up they put him in a room. We had no ac- the only thing we have done is tried to in actual expenditures. So your ability cess to that room and no Democrat did address waste, fraud, and abuse. For to invest and create additional jobs—in either. After it is all said and done, $2.3 trillion, it seems as if you could other words, it cascades. The honest here is what resulted from those nego- bring more bacon to the table. It seems accounting for this is that there is no tiations that were not on C–SPAN. as if there would be a little more meat. way this saves any money. It will cost Nebraska is going to be the only It seems as if there would be some money. State in the Union, ladies and gentle- substance there we could look at and The final point I will make is they men, that new Medicaid enrollees will say: Look at the improvements our won’t put forward the cuts in Medicare be covered by the Federal Government. health care system makes. that they are claiming in this bill. Be- Every other State in the Union, when I know Dr. COBURN has said many cause they know if they truly do put you sign up a new person on Medicaid, times: If we do this wrong, what we do forth the cuts, and patients feel it, because you are expanding the number is we chase innovation out of this they won’t be back here. So it won’t of people eligible for Medicaid, your country, out of our system, the break- happen. State is going to have to make a throughs that go from maintenance to I will go back to what Senator BURR matching contribution. cure, the research on a bench that finds started this out with. If you are going In my State of South Carolina, with us new ways to address diabetes where to start tomorrow and fix health care, 12 percent unemployment, there is amputation and blindness are not in what would you do? You would attack going to be one-half million more peo- somebody’s future. If we go backward, costs. Why are things so costly? One is ple eligible for Medicaid under this bill if we chase that innovation out, we because there is no transparency in than exists today. It will cost my State lock ourselves into not only the most markets. There is no real connected- of South Carolina $1 billion. But if you costly health care but health care that ness to your pocket. No. 3, there is no live in Nebraska, it doesn’t cost you a achieves the least amount of quality incentive for prevention of chronic dis- damn dime because that is what it for future generations. ease or the management of it. In other took to get a vote. Mr. ENSIGN. I wish to ask Senator words, we don’t pay people to have less If that is change we can believe in, COBURN to address, in the last couple of expensive outcomes. We won’t count me out. If that is OK with the minutes here—because he has spoken incentivize better care in that way. We American people, I can tell you our so eloquently about debt and the Con- won’t incentivize prevention. best days are behind us. The insurance gressional Budget Office saying this companies in Nebraska got a deal that helps the deficit by some $100 billion— We have done a lot of this on Medi- no other insurance company in the Na- how the taxes go into effect right away care—and I will talk about it tomor- tion got. Physician-owned hospitals in and that the spending doesn’t go into row—but they have three different Nebraska got a deal that nobody else effect, and how that kind of smoke and agencies within this bill that are going got. Louisiana got $300 million to help mirrors happens all the time around to ration care. They are going to make with their Medicaid problems that no- here; how they try to hide various ex- the decisions for you, and not just on body else got. penses, and what this is going to do to Medicare and Medicaid. Everybody If you want your country to be run in our debt. needs to understand that. It doesn’t a more businesslike fashion, then you Mr. COBURN. Well, the disappointing just apply to Medicare and Medicaid, it need to speak up. You have a chance thing—and I have worked on this for 5 applies to your choice of your private between now and sometime in January, years, since I have been here—is we are insurance. The government is going to when this goes back to the House, to not honest with the American people ration your care. let your voice be heard. about how we account for things, and We know that is true because they To my good friend from Nevada, the this bill is another example of that. wouldn’t allow an amendment to pro- special deals in this bill are not spe- Let me give you the quantifications. hibit rationing. They all voted against cial. They are the same old crap we If you read the CBO report on this the amendments in committees when have been putting up with for decades bill, they talk about it is highly un- we offered amendments to limit ration- up here and that people thought was likely we will ever actually make the ing. So we know the intention is to ra- going to come to an end. It is going to Medicare cuts, because they have never tion care. If that is how we are going to hurt your children’s ability to have seen it done, and every time we have control costs, then Bernie Sanders is half of what you have because they said it in the past, we haven’t done it, right—go to a single-payer, govern- cannot make it because you are about like the sustainable growth rate for- ment-run system. Bernie Sanders’ sys- to pass on a bill to them they cannot mula in the Balanced Budget Act of tem is far better than this one—far bet- pay. 1997. So if you match up revenues and ter than this one—if that is what we

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.078 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13689 are going to do. If we are going to ra- their conscience. They were not driven generation, despite Congressional tion care, let everybody know it up- by the far rightwing of their party or Budget Office estimates to the con- front. Let’s be absolutely honest about by radio talk show hosts who demand trary. We say: You can’t pick and it. ideological purity and see any attempt choose when to believe the Congres- If you are 75 years of age and need a to support health care reform as an sional Budget Office and stand by their hip replacement but the quality of abandonment of principle. numbers only when it is convenient to your life is not all that great, we are Each of us is rarely called to act on your cause. going to say you can’t have it. That is such significant legislation, and when For instance, my friend Senator what we are going to do, because that we are, it is our solemn duty to put GREGG, the ranking member on the is exactly what they do in England. aside our idealogy—turn off Rush Budget Committee, touts CBO numbers They have the National Institute of Limbaugh—and leave politics in the even on his specific bill, when they Comparative Effectiveness which cloakroom. Our vote on this ground- benefit his arguments, for example, on makes an evaluation of what your breaking legislation—comparable to malpractice provisions. But now my worth is. And no matter what your his- Social Security and Medicare—will be friends on the other side conveniently tory, no matter what your family situ- one of the most significant votes in dismiss the Congressional Budget Of- ation, no matter your income, you American history. It should not be fice numbers showing our health care can’t have it. driven by the hope of failure that the plan reduces the deficit. So you can’t Canada is getting around that, be- other side prays for, rather by the will have it both ways. cause they have said you get the right to succeed for the American people. They bring along their partisan to buy what you want. Their Supreme This Congress will be remembered for straw man, accusing us of drafting a Court ruled on that 21⁄2 years ago. So this vote for generations to come, and bill or having votes in the middle of we are seeing a two-tiered system de- our friends across the aisle will once the night. We say: How quickly you veloping in Canada, which ultimately again be on the wrong side of history. forget the 4 months that we waited for will happen in this country—worse We have heard the same tired argu- Republicans in the bipartisan Gang of than what we have today. ments over and over. We heard those 6, three Democratic Members, three Mr. ENSIGN. If the Senator will arguments in 1935 against Social Secu- Republican Members, working, sup- yield, though, if America does this rity. We heard them again in 1965 posedly, to achieve a bipartisan effort with our health care system, where against Medicare—the same arguments in health care reform. Four months. will the Canadians come for their we hear today. History has a way of re- Four months we waited for them to health care when they need it? When peating itself. If past is prologue, his- work with us in a constructive way, they get it rationed up there, they usu- toric health care reform legislation and then they all walked away. So ally come to the United States. will be signed into law despite the don’t come back now and say you had Mr. COBURN. They will go to Thai- naysayers, the fearmongers, the pan- no input in the process when you chose land or India. derers to those who see any attempt at that course. Mr. ENSIGN. But where will Ameri- compromise as defeat. And, by the way, these votes that cans go? To our friends on the other side, this take place at the time they take place Mr. COBURN. I thank the Senator for is no longer about legislating, it is sim- are because the Republicans insist on holding this colloquy, and I will make ply about obstructing. It is no longer stopping the process and delaying it one final point before I stop. about doing what is right for the Amer- and drawing it out. So under the proce- I don’t doubt the motivation of our ican people but about stopping us from dures, once we start the process to fin- colleagues on the other side of the doing anything. It is not about finding ish that delay, it ends up at certain aisle. They want us to fix this prob- common ground but drawing lines in hours—30 hours each time from the lem—the problem in health care. But the sand. moment we file a motion to say that is the problem is cost. If you don’t fix My friends on the other side have set enough of the delay, let us move for- cost, and you expand the same broken up an army of straw men, as they did ward. Whenever those 30 hours end, system, you haven’t fixed anything. on Social Security and Medicare, ma- that is when we have to have the vote. You have added to the cost. nipulating the facts to create the illu- But they could consent to have that Mr. BURR. I thank the good doctor, sion of refuting the false claims they vote in the fullness of the day and and I thank the Presiding Officer, and created in an attempt to score political light. But no, they want to have the I yield the floor. points. vote as late as possible, hoping that 60 The PRESIDING OFFICER (Mr. They stand up the socialist straw Members who want to see progress on MERKLEY). The Senator from New Jer- man, call the bill a government take- this reform don’t come to this Chamber sey is recognized. over of health care, and make Ameri- and, therefore, cannot stop the fili- Mr. MENENDEZ. Mr. President, I cans fear it. Well, we say: Let’s make buster. They want failure, and then rise to speak to the great debate we are sure the Bernie Madoffs of the world, they clamor about the time these votes having on historic health care reform, and people like him, are not selling take place. and I am reminded of the words of a health insurance. Straw man after straw man. They great Republican, President Abraham They wave the flag, stand up the un- have done nothing but block this legis- Lincoln. He said: American straw man, saying the bill is lation, as they have throughout the We cannot escape history. The fiery trial against old-fashioned American values year on other legislation. They will do through which we pass will light us down in and denounce it. We say: Don’t you anything, say anything to delay, deny, honor or dishonor of the latest generation. dare question our patriotism. Do not and defeat health care reform. The occasion is piled high with difficulty and dare question our commitment to They are on the wrong side of history we must rise with the occasion. doing what is right for the American now, as they were in 1935 and 1965. But That is what Abraham Lincoln said. people. the difference between 1935 and Social It is time to rise to the occasion be- They stand up the death panel straw Security and 1965 and Medicare and cause our friends on the other side of man, claiming the legislation would today is that when the debates ended the aisle have chosen to sit on their kill grandma, and denounce it as inhu- in 1935 and 1965, when the legislation hands and do nothing. They have no mane. We say: Stop the outrageous was weighed on its merits, there were plan. They have chosen to delay and misinformation and tell the truth to those few Republicans who voted their obfuscate. the American people. conscience, those who did not march in If you look back in history, during They stand up the taxing straw man, lockstep to the demands of rightwing the great debates on Social Security in and say health care reform will in- talk show hosts or in fear of tea party 1935 and Medicare in 1965, our friends crease taxes. We say: We are making anarchists. across the aisle were on the wrong side health care entities, such as insurance In 1935 and 1965, there were a few on of history. But in the end, there was a companies, pay their fair share. the other side, a few who voted for So- minority that chose to stand up for They set up the spending straw man, cial Security and Medicare because historic social legislation and vote and say the bill will indebt the next they knew it was right for America.

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.079 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13690 CONGRESSIONAL RECORD — SENATE December 21, 2009 But in 2009 it appears there will be no tween doctors and patients. The dif- tients. They are wrong, those who are votes for health care reform—not one, ference is when the debate ended on So- saying that. not a single vote from the other side of cial Security in 1935, when the shouts They called Medicare unpatriotic and the aisle. of socialism and un-Americanism had un-American. They were wrong again. The ideological differences were as faded, a few, a minority on the other They said it would mean the rationing intense then as they are now but pure side, had the political courage to cross of health care. They were wrong. They obstinate ideology did not prevail then the line and vote yes. made the same argument they have as it will in this Chamber when we But there will not be a single vote been making for 74 years, and they are vote. Before Social Security was de- from the Republicans in favor of this still wrong. bated, President Roosevelt laid out the bill, not a single vote. Our colleagues In 1965, the champion of my conserv- changes in society and the reasons why on the other side want nothing more ative friends, Ronald Reagan, issued a we needed Social Security legislation than to stop this bill, period, pure and 19-minute-long LP, for those of us who before the Congress. He said then: simple. It is their intention to stand en still remember that, a long-playing vinyl recording at the time. It is past— Security was attained in the early days bloc for insurance companies and gone. They are like antiques now. But through the interdependence of members of against any health reform that would it was entitled ‘‘Ronald Reagan Speaks families upon each other and of the families protect American families from losing Out Against Socialized Medicine.’’ within a small community upon each other. everything if they get sick. Their plan It featured an impassioned 2,000-word ... is just to say no; and once again they The complexities of great communities and speech intended to get people to write of organized industry make less real the sim- will squarely be on the wrong side of to their Congressman against the idea ple means of security. Therefore, we are history. of Medicare that was beginning to compelled to employ the active interests of When President Kennedy and later make its way through the Congress. the nation as a whole, through government, Lyndon Johnson fought for Medicare, That was 1965. It was referred to as Op- in order to encourage a greater security for those on the other side raised the same each individual who composes it. eration Coffee Cup, something of a pre- army of straw men they raised 30 years cursor to today’s tea parties. In his That is what he said about Social Se- earlier. They played the same game record message, Ronald Reagan said: curity. That is why we needed Social they are playing again now. Senator One of the traditional methods of imposing Security and why we realize today that Curtis of Nebraska at that time voiced socialism on people has been by way of medi- without Social Security more than half opposition in this Chamber saying, cine. . . . of our seniors in this country would be ‘‘Medicare is not needed.’’ He was a Re- Does it sound familiar, in the year living in poverty—more than half—if publican Senator of the time, Mr. Cur- 2009, in the debates we have heard here the voices then in opposition had suc- tis of Nebraska, who said: on the floor? When he became Presi- ceeded. [Medicare] is not needed. It is socialism. It dent, one of the pillars of his health Then the debate began. There is no moves the country in a direction which is policy was cutting benefits, in par- mention of death panels but there were not good for anyone, whether they be young ticular through increased cost sharing those Republicans who raised similar or old. It charts a course from which there for Medicare and Medicaid recipients. straw men to the voices we hear today. will be no turning back. It is not only social- ism, it is brazen socialism. He was wrong then, just as our conserv- A member of the New York delegation, ative friends are wrong now. a Republican, Daniel Reed said: In the other body, Congressman Hall In the face of yet another landmark The lash of the dictator will be felt, and 25 of Missouri called it ‘‘an ill-conceived piece of legislation, is it possible there million Americans will for the first time adventure in government medicine.’’ is not one of my friends on the other submit themselves to a fingerprint test. Those were the Republican voices of side who does not in their heart believe Another said: the past on Medicare. What senior in we need to pass this legislation for the The bill . . . invites the entrance into the this country today—which one of our good of the American people, regard- political field of a power so vast, so powerful parents or grandparents—believes less of ideology? Is there not one of my as to threaten the integrity of our institu- those words of the past as they relate friends on the other side who will vote tions and pull the pillars of the temple down to their health care today? More straw yes to help Americans who have lost upon the heads of our descendants. men, more fear, more naysaying—all of their jobs and their health care and John Taber, another member of the it wrong then, all of it wrong now. stand to lose everything if they or a New York delegation, a Republican, They said bureaucrats would come member of their family becomes ill? raised the antibusiness straw man, say- between doctors and patients. They are My friends, saying no to accessible, ing: wrong. That is why it is interesting to affordable health care for the Amer- Never in the history of the world has any see that today the American Medical ican people is too big a price to pay for measure been brought here so insidiously de- Association, the Nation’s doctors—the ideological purity. When I think of signed as to prevent business recovery, to en- people who take care of you when you what this legislation will do, I cannot slave workers. are ill, the ones who follow your believe there will not be one vote on In this Chamber, in the Senate, Sen- progress when you have, maybe, a de- the other side to provide competition ator Daniel Hastings of Delaware, a Re- bilitating disease or a lifetime health and affordable choices for every Amer- publican, raised the death-of-a-nation challenge, your doctor, the voice of ican, as this bill does; not one vote for straw man, saying that Social Security your doctor, not any Members of the greater accountability for health insur- would ‘‘end the progress of a great Senate, the voice of your doctor in sup- ance companies; not a vote for more country.’’ port of this historic reform—said: choice and competition for consumers, In this debate we have seen the same This is a time of great opportunity for the for programs that will rein in health army of straw men standing against us. American health care system. We have the costs and make policies more afford- They have claimed that health care re- chance to substantially expand health insur- able. form is a government takeover that ance coverage, implement insurance market Is this bill perfect? No. But it is a will threaten the integrity of our insti- reforms that promote greater choice, afford- great and historic foundation of re- tutions, when in fact we create an ex- ability and security, improve [this is the form. Yet there will not be one vote on change of private insurance companies doctors speaking] the quality of the care and the other side to improve access to help Americans live longer, healthier, that people will be able to pursue. happier and more productive lives. To that quality care for children, as this bill They say it will ‘‘pull down the pil- end [the doctors of the nation say] we urge provides for, and the most vulnerable lars of the temple on our descendants’’ all Senators to support passage of the Pa- among us, which the bill does. Not a and leave them in debt, that it will tient Protection and Affordable Care Act as single vote for tougher accountability drive private health insurers out of amended. policies, for health insurance compa- business and put a bureaucrat between This is the Nation’s doctors. This is nies that are included in this legisla- doctors and patients. your doctor who is telling the Members tion? Not one vote to require insurers We already have bureaucrats between of the Senate: Vote for it. They do not to spend more of the premium revenues doctors and patients. They are health believe the line that bureaucrats are on health care rather than on adminis- insurance company bureaucrats be- going to come between doctors and pa- trative costs, executive compensation,

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.081 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13691 and boosting the bottom line? Not a million New Jersey residents who pres- legislation and will be remembered as vote to hold health insurers account- ently do not have any health insurance such. Yet every one of my colleagues able for excessive rate increases? Not a whatsoever. It will increase the num- on the other side will vote no. They single vote on the other side to imme- ber of doctors, nurses, and dentists for will stand against all of it, all I have diately ban insurance companies from the 150,000 New Jerseyans, 2 percent of talked about, firmly, once again, on denying children—we hear a lot about the population who live in areas where the wrong side of history. the sanctity of life—coverage for a pre- they do not have access to primary Let me conclude by saying, as I have existing condition? Not one vote for ex- care because of a shortage of health said before, and I will say again, his- panding eligibility for tax credits for care providers in their communities, tory calls on us to stand up on rare oc- small businesses and starting the yet there will not be one single vote for casions for what is fair and just and health insurance tax credit next year? this legislation on the other side, not a right for the American people. This is That is why it is interesting to note single vote for any of these health re- one of those occasions. This is a time that among the many supporters of forms to help hard-working families in to look into your heart, a time to see this, the Business Roundtable, they are my State and in States across the beyond your own political interests, quoted as saying: country. your own hard ideology, and look at The proposed legislation is a step towards This is the politics of no, pure and the lives of millions of Americans. our shared goal of providing high quality, af- simple. I suppose it is nice to say no to Think about the millions of families on fordable health care for all Americans. health care reform when you have the Main Street, in every community, It is why the Small Business Major- full protection of health care yourself. where a child wakes up in the middle of ity says the managers’ amendment, But it is wrong to say you are unwill- the night to a parent who cannot afford Senator REID’s amendment, ‘‘includes ing to afford the same protections to to get them the basic care they need. new provisions essential for small busi- others. It is nice to say no to health Ask yourself: What is the right thing ness protection and survival.’’ That is care reform when you and your family to do? the voice of business. will not be denied coverage because of This is a time to do what is right for Not one vote for a bill that promotes the privileged position you hold but America. It requires more than par- competition for insurers and choice for wrong to let even one mother, one fa- liamentary maneuvers to slow the workers? Or to test alternatives to ther hear that their child has been de- process. It requires more than shrill civil tort legislation that emphasize nied the medical treatment they des- voices raised under the banner of free patient safety, disclosure of health perately need. market values at the expense of funda- care errors, and resolutions of dis- I say to my friends, how dare you mental human values. It requires doing putes? Not one vote. stand in unison on the other side of the what is right for the millions of Amer- Not one vote for people in my home aisle and deny to others that which you ican families who have lost their jobs State of New Jersey and every State so fully enjoy yourselves. How can you and their health care, those who have who will see direct and immediate ben- deny to others that which you so fully suffered from the economic policies of efits from this legislation? Not a vote enjoy yourselves. It is inconceivable to the last 8 years and now find them- for every uninsured Jerseyan who has a me that when all is said and done, selves hurting. This is a time to re- preexisting condition and has been un- when our differences have been aired member them, a time to remember able to find affordable health insurance and debate has ended, that not one of every mother who cries herself to sleep in the marketplace? The health of our my colleagues on the other side will at night because she lost her job, lost families is not a commodity. It is not a see the historic nature of this legisla- her health care for herself and her in- privilege for the wealthy. It is some- tion. We can be proud of this legisla- fant and could lose everything she thing everyone should be able to be tion. I know when the dust settles and struggled for in her life, if she gets protected from without going broke. the provisions of the bill become clear, sick. Under this legislation, 1.3 million America will be proud of it as well. I say again to my friends, how dare seniors in my home State will be eligi- This landmark reform legislation in- you deny to her the protections that ble for free preventive care for rec- cludes State-based insurance ex- you so fully enjoy yourself. How dare ommended services. Seniors will also changes, creating a fair, open, competi- you turn this into a parliamentary be eligible for free annual wellness vis- tive marketplace for affordable cov- game of delay, deny, and defeat. Those its to their doctors, and will be pro- erage. It includes an amendment I pro- who have continuously said no to any vided with a personalized prevention posed for long overdue consumer pro- attempt at health care reform and yes plan so they can stay healthy. tections for emergency services. When to the needs of the insurance industry When this legislation is signed, we you are getting sent to a hospital, you believe that the business of govern- will have lived up to our promise to fill are not thinking about calling your ment is business. But for all of us who the doughnut hole, that gap in cov- company and saying: Is this the right know the business of government, what erage under Medicare Part D, to pro- hospital? Am I going to be covered it really is, it is about people. It is vide affordable prescription drugs to without regard to prior authorization? about those who send us here. It is over 227,000 seniors in New Jersey and It requires insurance plans to provide their lives, their hopes, their dreams millions across the country so they behavioral health treatments, such as for a better life for themselves and will no longer have to choose between those for children who are autistic, as their families. This is an opportunity paying their bills and taking the medi- part of the minimum benefits standard. to stand up for them. This is an oppor- cation. It encourages investments in new ther- tunity to take care of their health When this legislation is signed, over apy to prevent, diagnose, and treat care. This is an opportunity to show 850,000 New Jerseyans will qualify for acute and chronic disease with a tax whose side you are on. tax credits to help them pay for health credit for innovative biotechnology re- Are you on the side of those families insurance, easing the burdens, pre- search. It ensures that minor children or are you on the side of the special in- miums, deductibles, and copayments. qualify as exchange-eligible and pro- terests that would have you vote no, or It will make tax credits for up to 50 vides for the availability of child-only the ideological interests that would percent of health care premiums avail- health insurance coverage in the ex- have you vote no against these fami- able to over 100,000 small businesses in changes. It stops insurance companies lies? This is historic legislation. I am New Jersey. It will also put an end to from denying coverage for preexisting afraid our friends on the other side will the hidden tax that is passed along to conditions, health status, or gender, once again, as they did in Social Secu- everyone in my State through in- and it ends the medical benefits shell rity and Medicare, find themselves on creased premiums and costs to pay for game that insurers have played with the wrong side of history. the over $1 billion spent on uncompen- people’s lives. I intend to be on the right side of his- sated care in New Jersey. The bottom line is this legislation tory and to vote yes on this legislation. This legislation includes a health in- helps New Jersey and America. It is I yield the floor. surance exchange that would provide fair, balanced, and fixes a badly broken Mr. JOHNSON. Mr. President, I wish portability, security, and choice for 1.3 system. It is truly a historic piece of today to recognize the progress made

VerDate Nov 24 2008 02:40 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.082 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13692 CONGRESSIONAL RECORD — SENATE December 21, 2009 on health care reform, as well as stress Despite a commitment by some to tried to demonize the plan, and have the fact that we must press forward. kill reform and defend the status quo, claimed it will never work. We have Americans face out-of-control health I am confident the strong consensus on overcome weeks of delay tactics em- care costs, great inequalities in access the urgent need for reform will prevail. ployed by the minority—inexplicably, to care, eroding benefits, and the ever- The cost of inaction is too great. the most recent delay due to a fili- increasing threat of losing their health Mr. LEVIN. Mr. President, the health buster against a bill to provide funding insurance. While it has not been an insurance provider annual fee in the so- for our troops. These are the tactics of easy task to reach a consensus, we find called merged Senate health care re- obstruction, and further demonstrate ourselves very close to fixing our form bill did not distinguish between Republicans’ efforts to maintain the health care system and extending ac- nonprofits and for-profit insurance status quo. cess to health insurance to over 31 mil- companies in this country, although Is this the exact bill that any one of lion Americans. our current tax law properly does make us would have written? Probably not. I I have heard from countless South the distinction. remain disappointed that the man- Dakotans whose stories illustrate the I urged that the managers’ package agers’ amendment before us today urgent need for reform. Just as the dis- modify the fee to continue to recognize strips the bill of a public insurance op- eases and health care emergencies they the distinction. tion to compete with private plans and face cannot be postponed, it is impera- Imposing the annual fee on true non- does not include a provision I have tive we forge ahead and deliver reforms profits, particularly those with high sponsored to repeal the antitrust ex- that will improve their health and se- pay-out rates to beneficiaries, would emption for health insurers and med- curity. have pushed many of those true non- ical malpractice insurers. I believe I would like to share the story of profits into deep financial difficulties both of these provisions would go far in Susan from Rapid City, SD, a 57-year- and would have caused significant old woman who has nearly depleted her providing fair competition into the hardships on the families who rely on savings and plans to sell her home in health insurance market. their services. But in looking at this bill as a whole, order to pay her bills and medical ex- Some nonprofit insurers have not penses. Her husband passed away sev- I believe it stands by the core prin- maximized the amount they pay out in eral years ago and she now survives on ciples I sought at the beginning of this medical expenses to beneficiaries. That his modest pension. After exhausting debate. It gives Americans affordable is why I urged the managers to include COBRA health insurance, she bought access to health care coverage, it re- in the managers’ package a provision the only private health insurance pol- duces costs for families, businesses and exempting from the tax only those icy she could afford. She was forced to government, and it protects con- nonprofits with very high payout rates. accept several riders for her pre- sumers’ ability to choose doctors, hos- existing conditions, arthritis and hay Those good performers are committed pitals and insurance plans. fever, so her insurance ‘‘won’t cover to their policyholders rather than to The managers’ amendment intro- the problems that will soon need atten- profits for stockholders, which is the duced by the majority leader incor- tion.’’ She also has to pay out-of-pock- goal of the for-profits. Those good per- porates many important changes to the et for most her preventative screenings forming nonprofits are unable, as a re- underlying legislation that will im- and primary care because she has not sult, to absorb the fees. prove the bill. It includes several provi- reached her $5,000 deductible. She The managers’ amendment specifies sions that I have long supported and writes, ‘‘I feel I am paying $250 a two ways for nonprofits to be exempt promoted. month for unreliable health insur- from the fee. Vermont has always been a national ance.’’ Until she reaches Medicare age The first way for a nonprofit insurer leader in expanding access to health in- or can qualify for Medicaid, her only to be exempt from the fee: one, it can surance. In coordinating care, offering option is to sell down her assets to pay not refuse to insure anyone in the comprehensive coverage to children, the bills. State and is the State’s insurer of last and developing a system of electronic Like millions of Americans, Susan is resort; two, its premium prices are reg- health records, Vermont has been at vulnerable in the non-group health in- ulated by its State insurance regu- the forefront of reform. It is no sur- surance market, where coverage is lator; and three, it must pay out in prise that for the third year in a row often expensive, inadequate and cer- medical expenses 100 percent or more Vermont has been ranked the health- tainly not guaranteed. ‘‘Without the of its premium revenues in the indi- iest State in the Nation. security of group coverage,’’ she notes, vidual market. Unfortunately, a provision included ‘‘I am very vulnerable and am one ill- The second way for a nonprofit to be in the underlying bill to expand Med- ness away from a catastrophe.’’ Several exempt: the nonprofit insurer must pay icaid coverage nationwide threatened provisions in the Patient Protection out a very high percentage of its pre- to penalize Vermont by excluding the and Affordable Care Act will help mium dollars—at least 90 percent—in State from increased Federal funding, Americans like Susan gain access to medical expenses in each of the three solely because Vermont acted early to quality, affordable health insurance. major market segments: individual do the right thing. We can all share the Under the Senate reform bill, all market, small group market, and the goal of increasing access to essential health insurers will be prohibited from large group market; and it also must medical services by expanding Med- using preexisting conditions to deny have an even higher overall payout icaid coverage nationwide, but we health care and it will be illegal for rate of at least 92 percent. A nonprofit should not penalize States such as them to drop coverage when illness that compresses its margins that far Vermont, which demonstrated the ini- strikes. Health insurance exchanges beyond its peers for the benefit of its tiative to expand its Medicaid Program will create an accessible marketplace policyholders also warrants the exemp- early. for Americans to shop for the best plan tion. Senator REID’s amendment, however, to meet their needs. Health insurers These exemptions continue the dis- remedies the anomaly in the under- will offer national plans to all Ameri- tinction that our tax law has recog- lying bill, and will allow Vermont to cans under the supervision of the Office nized—that true nonprofit insurance access additional Federal funding when of Personnel Management, the same providers should not be treated the the Medicaid expansion goes into ef- entity that oversees health plans for same as their for-profit counterparts. fect. I thank Senators REID and BAUCUS Members of Congress. Tax credits will Mr. LEAHY. Mr. President, after for working with me to ensure that be available to make insurance more months of arduous work, the Senate Vermont’s efforts to expand coverage affordable for those who need assist- will finally take the first significant to low income individuals is not set ance, and the choice of doctor will be step toward bringing needed reforms to back by inequities in the underlying protected. These health insurance mar- health care in this Nation. Opponents legislation. ket reforms demand greater account- of reform have wasted much of the The managers’ amendment also in- ability from insurance companies while public’s time by provoking arguments corporates a vital antifraud amend- creating more choice and competition over their distortions about what ment Senator KAUFMAN and I, as well for consumers. health reform means. Opponents have as Senators SPECTER, KOHL, SCHUMER,

VerDate Nov 24 2008 03:36 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.055 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13693 and KLOBUCHAR, introduced, derived other white-collar criminals. This vision is an important part of that ef- from the Health Care Fraud Enforce- lower risk is one reason criminals are fort. ment Act which we introduced earlier drawn to health care fraud. By increas- I am also very encouraged that the this fall. ing the Federal sentencing guidelines amendment before us includes a meas- This antifraud initiative builds on for health care fraud offenses, we send ure I proposed with Senator BROWN to the impressive steps the administra- a clear message that those who steal expand Federal Tort Claims Act med- tion has already taken to step up from the Nation’s health care system ical malpractice coverage for free med- health care fraud prevention and en- will face swift prosecution and substan- ical clinics. This expanded coverage forcement, and on the real progress tial punishment. will help free clinics across the Nation represented by the antifraud provisions The provision provides for a number continue to provide and improve a crit- adopted by the Finance and HELP of statutory changes to strengthen ical safety net for many Americans. Committees and incorporated into the fraud enforcement. For example, it In 1996, Congress enacted legislation leader’s health care reform bill. I was would expand the definition of a ‘‘Fed- to cover volunteer medical profes- glad to contribute to those efforts, and eral health care fraud offense’’ to in- sionals in free clinics with medical I am glad we are now going even fur- clude violations of the antikickback malpractice liability insurance ther. statute and several other key health through the Federal Tort Claims Act. The Kaufman-Leahy provision will care-related criminal statutes, which This coverage protects volunteer med- provide prosecutors with needed tools will allow for more vigorous enforce- ical staff against liability by sub- for the effective investigation, prosecu- ment of those offenses, including mak- stituting the Federal Government for tion, and punishment of health care ing their proceeds subject to criminal an individual defendant. But without fraud. By making modest but impor- forfeiture. It also clarifies the intent any explanation in the legislative his- tant changes to the law, it ensures that requirement of another key health care tory, the coverage enacted in 1996 those who drain our health care system fraud statute in order to facilitate ef- failed to provide coverage for others of billions of dollars each year, driving fective, fair, and vigorous enforcement. who are essential to the operation of up costs and risking patient lives, will The managers’ amendment also in- free clinics, such as nonmedical staff, go to jail, and that their fraudulent cludes our provision amending the contractors, board members, and the gains will be returned to American tax- antikickback statute to ensure that all clinic itself. As a result, free clinics payers and health care beneficiaries. claims resulting from illegal kickbacks must use scarce funding to purchase in- For more than three decades, I have are considered false claims for the pur- surance on the private market to fill fought in Congress to combat fraud and pose of civil action under the False this gap. This lack of comprehensive protect taxpayer dollars. This spring, I Claims Act, even when the claims are coverage for free clinics is inconsistent introduced with Senator GRASSLEY and not submitted directly by the wrong- with the coverage provided to commu- Senator KAUFMAN the Fraud Enforce- doers themselves. All too often, health nity health centers, which benefit from ment and Recovery Act, the most sig- care providers secure business by pay- coverage for all employees. This provi- nificant antifraud legislation in more ing illegal kickbacks, which needlessly sion will remedy this discrepancy. than a decade. When that legislation increases health care risks and costs. This measure will have no impact on was enacted, it provided law enforce- This change will help ensure that the the legal rights of a patient injured by ment with new tools to detect and government is able to recoup from a medical error; any victim of medical prosecute financial and mortgage wrongdoers the losses resulting from malpractice will still be able to pursue fraud. Now, as health care reform these kickbacks. a remedy for an injury under the Fed- moves through the Senate, I am glad The Kaufman-Leahy measure gives eral Tort Claims Act. Instead, this we are taking steps to do all we can to the Department of Justice limited sub- amendment will free up scarce re- tackle the fraud that has contributed poena authority for civil rights inves- sources that are currently being used greatly to the skyrocketing cost of tigations conducted pursuant to the to purchase liability insurance on the health care. Civil Rights for Institutionalized Per- private market. Informal estimates in- The scale of health care fraud in sons Act. This provision allows the dicate that this amendment could save America today is staggering. According government to more effectively inves- free clinics across the country $15 to to even the most conservative esti- tigate conditions in publicly operated $20 million a year. These are funds that mates, at least 3 percent of the funds institutions, such as nursing homes, will be redirected to providing essen- spent on health care are lost to fraud— mental health institutions, and resi- tial medical services to low-income and more than $60 billion a year. In the dential schools for children with dis- other Americans in need. For example, Medicare Program alone, the General abilities, where there have been allega- as a result of this amendment, the Accountability Office estimates that tions of civil rights violations. Viola Startzman Free Clinic in Woos- more than $10 billon was lost to fraud These changes will strengthen our ter, OH, will save $17,000 a year. The just last year. While Medicare and ability to crack down on fraud and will Americares Clinic in Stamford, CT, Medicaid fraud is significant, it is im- ultimately result in significant savings will save $31,000 each year. Our hard- portant to remember that health care that will make health care more effi- working free clinics in Vermont will fraud does not occur solely in the pub- cient and more affordable. save $12,000 each year and will be able lic sector. Private health insurers also I am also pleased Senator REID’s to put those savings toward helping see billions of dollars lost to fraud. amendment includes a key reform to Vermonters in need of health care serv- That fraud is often harder for the gov- the False Claims Act that Senator ices. For free clinics operating through ernment to track. Private companies SANDERS, Senator GRASSLEY, and I volunteerism and private donations have less incentive to report it, and in have proposed. By fixing the False and in a difficult economy, these are some cases, are responsible for the Claims Act’s public disclosure provi- substantial sums that if devoted to the fraudulent practices themselves. Rein- sion, we can ensure that we fairly and care of Americans in need will have a ing in private sector fraud must be a appropriately empower whistleblowers significant positive impact. part of any comprehensive health care to come forward to expose fraud, which And the savings realized through this reform. is a crucial way to save the govern- amendment will cost the taxpayers lit- The Kaufman-Leahy provision makes ment money and ensure the health and tle if anything. Free clinics do not per- a number of straightforward, impor- well-being of Americans. form high-risk procedures such as ob- tant improvements to existing statutes We all agree that reducing the cost of stetrics or surgeries, and thus are sub- to strengthen prosecutors’ ability to health care for American citizens is a ject to a lesser risk of liability. Since combat health care fraud. The bill critical goal of health care reform. We 2004, when funds were first appro- would increase the Federal sentencing in Congress must do our part by ensur- priated and set aside to cover any guidelines for health care fraud of- ing that, when we pass a health care claims against free clinic doctors, no fenses. Despite the enormous losses in reform bill, it includes all the tools and claims have been filed. The bottom line many health care fraud cases, offenders resources needed to crack down on the is that this amendment represents sig- often receive shorter sentences than scourge of health care fraud. This pro- nificant value to Americans in need of

VerDate Nov 24 2008 03:36 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.024 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE S13694 CONGRESSIONAL RECORD — SENATE December 21, 2009 health care services at little cost to Importantly, however, it does include last Congress, the Rural Hospital As- the government and the taxpayer. specific patient protections that must sistance Act of 2008, S. 3300, which I thank Senator BROWN for his sup- be in place before a State can receive a would improve the low-volume adjust- port as a cosponsor, and I thank the grant for liability reform measures. To ment for hospitals under Medicare’s majority leader, Senator HARKIN, and the extent that States can pass meas- hospital inpatient prospective payment Senator BAUCUS for working with me ures that improve patient safety as system. This improvement would en- to make this amendment part of the well as expedite damages recovery for able tweener hospitals to benefit from historic legislation before the Senate. victims, those reforms will truly im- this adjustment. Over the course of the past month, I prove our health care system. In fact, the low volume adjustment have listened to many of my friends on I am disappointed, however, that the provision in the Finance Committee’s the other side of the aisle. It is not sur- Health Insurance Antitrust Enforce- health reform bill, S. 1796, and the Reid prising that frequently they have ar- ment Act, which I introduced in Sep- substitute to H.R. 3590 is the language gued for one of their pet proposals— tember, was not part of the managers’ that I crafted. This language was craft- medical malpractice reform. For as amendment, and will not be part of the ed with the intention of benefiting all long as I have served in this Chamber, Senate’s health reform legislation. Iowa tweener hospitals. I was assured I have fought against court-stripping That legislation would repeal the anti- by the Iowa Hospital Association that measures that limit American’s access trust exemption for health insurers and this language would do so, and they to their justice system. I have also medical malpractice insurers, and is an supported it. fought to protect the sovereignty of integral part of injecting competition Unfortunately, after the Finance States to make rules for their own jus- into the health insurance market. Committee markup of S. 1796, I learned tice systems. Medical malpractice While there are differing views on the from the Iowa Hospital Association claims are based on State law and for best way to inject competition into the that the language they originally sup- the most part take place in State health insurance market, we can all ported would not benefit all Iowa courts. I find it curious that some of agree that health and medical mal- tweener hospitals. I was informed that the same Senators who pledge loyalty practice insurers should not be allowed several Iowa tweener hospitals had to federalism and the sovereignty of to engage in blatantly anticompetitive Medicare discharges in excess of the the States under the tenth amendment practices, such as colluding to set maximum in the provision, which was are some of the same Senators who are prices and allocating markets. My re- 1,500. so aggressively pushing for a Federal peal would ensure that basic rules of In an attempt to make sure that all ‘‘one-size-fits-all solution’’ for the jus- fair competition will apply to insurers, Iowa tweener hospitals benefit from tice systems in our 50 States. and is nonpartisan. this provision, I filed an amendment The managers’ amendment includes a My amendment was cosponsored by that would increase the maximum provision addressing malpractice li- 23 Senators, and has support from a number of Medicare discharges from ability that has been introduced on a cross-section of consumer rights orga- 1,500 to 1,600. This amendment was also bipartisan basis several times over the nization. I look forward to working to offset. My staff was successful in work- past few years. I support this provision include this repeal when the Senate ing with the majority staff to include because it respects the States’ primary and House conference to reconcile their my amendment in the manager’s role in adjudicating the claims of pa- versions of the legislation. amendment to the Reid substitute. tients injured or killed by medical er- The managers’ amendment will im- Mr. INHOFE. Mr. President, on Mon- rors. I also support this provision be- prove the underlying bill, and I hope day morning at 1 a.m., I voted no on cause it resists the notion that ‘‘one- my fellow Senators will support its the cloture motion to the latest Reid size-fits-all’’ when it comes to litiga- passage so we can move toward final managers’ package, which was only tion issues and it includes the nec- passage of the bill. Each day that made available Saturday, because I am essary safeguards for patients. I note passes without reform, 30 more adamantly opposed to this $2.5 trillion for the RECORD that several States’ ef- Vermonters lose their health insur- government-run health care system forts to reform medical malpractice li- ance. We know our current health sys- with its $1⁄2 trillion increase in taxes on ability have been struck down as un- tem is unsustainable. That threatens Americans and nearly $1⁄2 trillion in constitutional. For example, Alabama, not only our health security, but also cuts to Medicare to help pay for it. I Florida, Georgia, Illinois, Kansas, New our economic security. Doing nothing am opposed to public financing of abor- Hampshire, Ohio, Oregon, South Da- has been seen as an option before, but tion this bill allows. I am opposed to a kota, Washington, and Wisconsin have it simply is not an option now. fac¸ade of health care reform that in no all enacted caps on damages associated I hope now we can work together to way seriously addresses tort reform with medical malpractice claims. And pass a bill that will give millions more and will only increase premiums and all of those State laws were struck Americans access to quality, affordable the cost of health care for all Ameri- down as unconstitutional for good rea- health care. We should reject the tac- cans. I am opposed to the special deals son. I am heartened that no such tics of delay and the efforts to ob- for only certain States in this bill to amendment was seriously considered in struct, and remember that the Senate buy off votes. I am opposed to the spe- this Chamber because such arcane should be the conscience of the Nation. cial deals for only certain States in measures hurt our children, our senior With the Christmas season upon us, our this bill to buy off votes. I am opposed citizens, and stay-at-home moms. The constituents are looking to us to do to the increased burden of at least $26 Wall Street Journal has reported on the right thing. We should adopt this billion on States including Oklahoma this clear fact when it pointed out that amendment, advance this legislation, mandated under this bill. I am opposed these caps deprive these groups of ac- and work to send it to the President to no serious effort at all to include cess to justice. If we create Federal without undue delay. any amendments from Republicans. caps on their ability to recover from Mr. GRASSLEY. Mr. President, one Republican amendments to block tax serious injuries we are telling them longstanding priority of mine has been increases, block cuts to Medicare, im- that they are worth less because they to improve Medicare payments for hos- pose tort reforms, try to impose some are retired or they choose to stay home pitals known as tweeners. They tend to kind of discipline on the government and raise a family or are young chil- have too many beds, so they can’t qual- take-over of health care in this coun- dren. This is not fair. I know that no ify as critical access hospitals, but try, among other amendments and mo- doctor wants to harm a patient, but they do not have sufficient volume to tions have failed by nearly party-line the solution is not to take away the operate viably under Medicare’s pro- votes. I am opposed to this bill, and rights of patients who are seriously in- spective payment systems. There are a most importantly, the American people jured. number of these tweener hospitals in are opposed to this bill. They know The provision in the managers’ Iowa. this bill is a complete disaster. The amendment does not encourage draco- Working closely with the Iowa Hos- next few votes leading up to the final nian damages caps and does not dictate pital Association and individual Iowa vote on this package are all procedural what reforms States must consider. hospitals over the years, I introduced, votes, and I will be opposed to them

VerDate Nov 24 2008 03:36 Dec 22, 2009 Jkt 089060 PO 00000 Frm 00056 Fmt 0637 Sfmt 0634 E:\CR\FM\G21DE6.024 S21DEPT1 smartinez on DSKB9S0YB1PROD with SENATE December 21, 2009 CONGRESSIONAL RECORD — SENATE S13695 all. But all 60 Democrats will vote for after January 1. And the nation will lose a curity charges leveled against activists. them. Democrats do what they are vital link in its effort to reduce our depend- These cases have become a substitute for the told. The votes include accepting this ence on foreign oil. old ‘‘counter-revolutionary’’ crimes. Others new Reid managers’ package, cloture As we continue our important busi- convicted on such grounds include Hu Jia, ness, I implore my colleagues on the the AIDS activist who also criticized abuses on the original Reid substitute, accept- surrounding the staging of the Summer 2008 ing the original Reid substitute, clo- other side of the aisle to work to get Olympic Games and Huang Qi, who posted ture on the underlying bill, and finally the extenders finished this year and to public information on his website about the the final passage of his colossal mis- include the renewal of the biodiesel tax government’s response to the Sichuan earth- take. Since I am opposed to each one of credit. quake. these votes, I will not remain in Wash- f Liu’s prosecution requires a serious re- sponse from the United States. Cooperating ington to vote against these procedural LIU XIAOBO maneuvers since that will have the with China on other issues like the environ- Mr. LEAHY. Mr. President, I want to ment or North Korea does not mean we must same effect as voting no, and will re- silence ourselves when it comes to the rights turn to vote against final passage of speak briefly about the indictment and trial by Chinese authorities of Mr. Liu and freedoms of China’s citizens. Indeed, we this bill. are unlikely to get meaningful cooperation Xiaobo for ‘‘incitement of state subver- f on any issue when we appear weak in defense sion.’’ The evidence cited in support of of our principles, which as President Obama MORNING BUSINESS the charges were Mr. Liu’s essays and has said many times—most recently in his Mr. DURBIN. Mr. President, I ask association with Charter 08, a frame- speech accepting the Nobel Peace Prize—are unanimous consent that the Senate work for democracy, human rights and universal principles. proceed to a period of morning business the rule of law that was made public a I agree, and hope the Chinese au- with Senators permitted to speak for year ago this month. thorities reconsider this case, release up to 10 minutes each. That document was signed by Mr. Mr. Liu, and dismiss the charges The PRESIDING OFFICER. Without Liu and some 300 other intellectuals against him. There are so many issues objection, it is so ordered. and activists. Thousands more people on which we want to expand our co- have since added their names, most of operation with China, but the persecu- f them from inside China. I am told that tion of courageous Chinese citizens THE IMPORTANCE OF RENEWING Charter 08 is widely regarded as the who are guilty of nothing more than THE BIODIESEL TAX CREDIT most significant democratic reform exercising rights guaranteed by the Mr. MCCONNELL. Mr. President, on movement in China in a decade. Universal Declaration of Human Rights December 31, 2009, the current biodiesel The charges against Mr. Liu are very hinders that cooperation and China’s tax credit will expire. This tax credit disappointing. They illustrate how lit- own development. increases domestic demand and pro- tle has improved in China regarding If the charges are not dismissed, and vides an incentive for U.S. producers to tolerance for freedom of expression. I Mr. Liu is brought to trial, his trial increase investment and output. It is am informed that the Chinese Govern- should be attended by outside observ- essential in producing biodiesel and al- ment has decided to bring Mr. Liu to ers including top officials of the U.S. lowing it to compete with petroleum trial, that international observers are Embassy and Governor Thornburgh. I diesel. Without the tax credit, petro- permitted under Chinese law, and this hope the Department of State and our leum marketers will be unwilling to is consistent with international legal diplomats in Beijing will assist Gov- purchase the more expensive biodiesel, standards on the openness and trans- ernor Thornburgh, including in obtain- and demand will be heavily reduced. parency of legal proceedings. I mention ing a visa and access to the trial. It is As all of my colleagues know, the this because I am aware that former important that the Chinese Govern- biodiesel tax credit provides a $1-per- Governor of Pennsylvania and U.S. At- ment, and the Chinese people, know gallon credit for biodiesel made from torney General Richard Thornburgh how strongly we deplore what is being soybean oil or yellow grease and ani- has expressed a strong interest in at- done to Mr. Liu, and what it says about mal fats. The original version of this tending the trial as an observer, to the need for China to meet its own tax credit was passed in 2004 and has show support for Mr. Liu and to convey commitments to respect internation- been extended twice, most recently in the concern that he and others around ally recognized human rights. October 2008. the world have for the larger implica- f As a result, the U.S. biodiesel indus- tions of this case. The arrest of Mr. Liu demonstrates a NATIVE AMERICAN APOLOGY try has grown significantly over the RESOLUTION past several years, providing not just continuing, disturbing trend in China. jobs but also the green jobs this admin- As Governor Thornburgh has written: Mr. AKAKA. Mr. President, today, I istration and many of my friends on in recent years, China’s leaders seemed to want to speak about a matter of sig- the other side of the aisle have so ada- be tolerating changes in the legal system. nificance to our Nation. As part of the The number of private lawyers and law firms Defense appropriations bill, Congress mantly supported. However, the com- has grown exponentially. Lawyers and citi- bination of volatile commodity prices has enacted an apology to our Native zens energetically began pursuing rights in Peoples for the historical wrongs that and weak motor fuel demand caused by court. A ‘‘wei quan,’’ or ‘‘rights defense’’ the current recession has severely af- movement, grew up around lawyers and ac- our Nation has committed against fected the biodiesel industry for the tivists seeking to use the laws on the books, them. I am proud to have served as a worse and therefore increases our ur- and the institutions allowed by law, to as- cosponsor of the stand-alone apology gency to extend the credit today. sert and defend human rights without chal- resolution, S.J. Res 14, and commend In Kentucky, public school districts, lenging the underpinnings of China’s com- Senators BROWNBACK, DORGAN, and munist system. Such efforts were tolerated INOUYE for ensuring this needed apol- universities, National and State parks, at first, and there were even modest signs of local governments, and the Transpor- ogy will be made. greater professionalism in the communist ju- From the beginning, Native peoples tation Cabinet are using biodiesel dicial system. blends. These institutions and many Unfortunately, initial signs of progress welcomed early colonists at Plymouth Kentucky employers, including manu- have given way to serious setbacks. Many Rock and in Virginia, and in my home facturers in Kentucky, will be hurt be- lawyers who take on politically-sensitive State of Hawaii, the Kingdom of Ha- ginning on January 1 if we allow this cases have been subject to a kind of back- waii extended the aloha spirit to our tax credit to expire. One executive of a door disbarment, finding it impossible to visitors. During the American Revolu- renew their licenses. Some lawyers have tion, the United States entered into biofuel manufacturing facility wrote to been the target of surveillance, confined to me to say: military alliances with Indian nations house arrest, the victims of physical attacks, to secure assistance in winning our The $1-per-gallon tax incentive is truly the raids and confiscation of their property. Law difference between the survival and collapse firms and other groups pursuing law in the independence. As a nation, we pledged of this important industry. Without this tax public interest have been shut down. to respect the rights of Indian nations incentive, thousands of jobs will be lost with Moreover, there has been an alarming in- to self-government, self-determination plants closing down almost immediately crease in the use of ‘‘subversion’’ or state se- and territorial integrity.

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