Speeches & Floor Statements

Floor Remarks of U.S. Senator Lamar Alexander (R-Tenn.) -- Health Care Reform

Posted on November 18, 2009

I would like to say a word about health care. The Democratic leader, Senator Reid, today announced that he has completed work on a health care bill. We have been waiting for that. It has been written behind closed doors in Senator Reid's office for the last several weeks, so we have not known exactly what might be in it.

We have had two pieces of legislation from the Senate, one written by the HELP Committee, upon which I serve, another one from the Finance Committee. And now a bill has come from the House of Representatives. It has actually been passed there. And now the Democratic majority leader will be bringing forward his version of the bill. The bill seems to grow each time we have a new one -- a little faster than the Federal debt even grows. This one seems to be another 2,000-page, trillion-dollar bill.

But the point I want to make tonight is that the American people's response to this work, I think, will be what all of ours should be: We want to read the bill. We want to know what it costs. And we want to make sure we have time to understand exactly how it affects the health of each American.

This is the most personal kind of debate we could have about the health of every single American. It affects 17 percent of our economy. It is dramatic proposal, an enormous amount of money, at a time when our debt has reached twelve trillion dollars. A great many Americans are concerned about Washington, DC, because we do not seem to have a check and a balance on the various proposals for Washington takeovers, more debt, more spending, more taxes.

Tonight I would like to do a simple thing; which is not to make a Republican speech but to read a letter, or parts of a letter, and insert it in the Record, that was written by eight Democratic Senators on October 6 to Senator Reid. I think their words say a great deal about this bill and about how we should proceed on it.

The letter is dated October 6, from eight Democratic Senators. It says, in part: Dear Leader Reid: ....Whether or not our constituents agree with the direction of the debate, many are frustrated and lacking accurate information on the emerging [health care] proposals in Congress. Without a doubt, --Say these eight Democratic Senators -- reforming health care in America is one of the most monumental and far-reaching undertakings considered by this body in decades. We believe the American public's participation in this process is critical to our overall success of creating a bill that lowers health care costs and offers access to quality and affordable health care for all Americans. And then, if I may read a couple more paragraphs from the letter from these eight Democratic Senators to the Democratic leader: Every step of the process needs to be transparent, and information regarding the bill needs to be readily available to our constituents before the Senate starts to vote -- "to vote" -- on legislation that will affect the lives of every American.

The eight Democratic Senators continue: The legislative text and complete budget scores from the Congressional Budget Office of the health care legislation considered on the Senate floor should be made available on a website the public can access for at least 72 hours prior to the first vote to proceed to the legislation. Let me read that again. That is not 40 Republicans -- although all 40 of us agree with it -- this is eight Democratic Senators to the Democratic leader: "The legislative text," No. 1, the "complete budget scores," No. 2, "from the Congressional Budget Office," posted on "a website," No. 3, for "72 hours" before "the first vote to proceed on the legislation."

The distinguished Democratic leader's announcement was only made a few minutes ago, but my understanding is we do not yet have a complete legislative text. Hopefully, that will come tonight or in the morning. Second, I understand the estimates from the Congressional Budget Office are preliminary estimates. This letter says: "complete budget scores." We know what a "complete budget score" is around here. It was talked about in the Finance Committee debate. The Director of the Congressional Budget Office said a complete estimate of the health care bill would take about 2 weeks to do. So the question is, Do they have it? And then: "72 hours" before "the first vote to proceed."

So I think the eight Democratic Senators, along with all 40 Republican Senators, have a bipartisan agreement here on how we should start this debate. We want to be able to read it, we want to know what it costs, and we want to see how it affects every American. That means, No. 1, a complete text. No holes, no "We will get back to you later." A complete text. No. 2, a complete estimate. Those are these words here: A complete estimate of the cost and how it affects every American. And third, for 72 hours on the Web site so not only we in the Senate but our constituents, the people who expect us to weigh in on this, have a chance to read it before we have our first vote, which I don't think is scheduled.

There is other language here, but I ask unanimous consent that this letter from the eight Democratic Senators of October 6 to the Honorable Harry Reid be included in the Record following my remarks.

The last thing I would say is this: I think it is pretty obvious why we want to read the bill and know what it costs and understand how it affects the health care of every American, which it will, but in case anyone is wondering why we want to read the bill, it is because the bills we have already seen increase insurance premiums, raise taxes, and cut Medicare. That is what we have seen from the two Senate bills and the House bill. We on the Republican side think this ought to be about reducing costs, reducing premiums, but the Democrats’ proposals increase premiums, increase taxes, and cut Medicare. Not only does it cut Medicare in the bills we have seen so far by $400 billion or $500 billion; it doesn't spend it on grandma, it spends it on somebody else, even though the Medicare Program, the trustees tell us, will begin to go broke by 2015.

There are some other problems with the bills we have seen before, so we would want to be able to ask these same questions about the new bill we haven't yet seen but we are about to see. On Medicare, how big are the cuts? Then we hear in this new bill there are Medicare taxes, new Medicare payroll taxes. On which employees, or which employers? And if their taxes are raised, are they spent to make Medicare solvent, or are they spent on a new program? It is inconceivable to me that we could be even thinking about having savings in Medicare and spending it on something else when Medicare is about to go broke.

Then there are some other questions. The Democratic leader said it doesn't add to the debt. I hope he is right, but we have questions to ask about that. Does his proposal include a full dealing with the issue of physician reimbursement? What we mean by that is when we create these big government programs, then some agency in Washington tells how much we can pay doctors for different services and how much we pay hospitals. Right now, in the government programs we have -- Medicare, for example -- doctors are only paid about 80 percent of what physicians are paid for serving the roughly 200 million of us who have private plans.

And for those who are in Medicaid -- low income; that is the largest government program -- it is about 60 percent. Doctors are paid about 60 percent of what they were paid if they saw private physicians. Then, as a result, 50 percent of doctors won't see new people in that Medicaid Program, which is why so many people think: I am not so sure a new government-run program of insurance is such a good idea, because I might end up in it and it might be like Medicaid and 50 percent of the doctors won't see new Medicaid patients. Why might you end up in a government program if you are not there now? Well, in the other bills we have seen -- and this would be a question we have about Senator Reid's bill -- the combination of sections means that a great many employers are going to look at the bill and the requirements that are placed on them and they are going to write a letter to their employees and say: Congratulations, there is a new government plan. I have sent a check to the government, and instead of having employer insurance, you are in the government plan. Well, you may not have been thinking that was the kind of health reform you wanted.

There is the matter of the States. I will admit that as a former Governor I may be more worried about this than some people, but I see a former mayor in the Presiding Officer's chair today. I won't speak for him, but I know I used to sit back there in Nashville and nothing would make me madder than some Member of Congress coming up with a big idea, pass it into law, issue a press release, take credit for it, and send me the bill when I was Governor. So all of the other bills we have seen say, It is a great idea to expand Medicaid. We are going to dump about 14 million more Americans in this program for low-income Americans and we are going to send the bill for part of it to the State. Well, our Democratic Governor thinks that is a bad idea, because our State, which is fiscally well managed -- Tennessee -- and virtually every other State is having the worst time they have had since the Great Depression in managing their resources. Here they have the Medicaid Program going up at 8 percent a year, and they are cutting higher education and other programs. That is what is going on in the States. So we will have to ask the question: How much does this new bill transfer costs to the States?

There are a great many questions we will need to ask, and they are appropriate questions. The Republican leader pointed out that when we did the farm bill, we talked for 4 weeks. We debated, we had amendments, we came to a conclusion, and we had a bipartisan result. When we did No Child Left Behind, it was 7 weeks. I remember on the Energy bill of 2005, which put us on a new direction, Senator Bingaman and Senator Domenici and others worked very hard on it, but on the floor, it took 8 or 9 weeks. We need to have a full discussion of whatever bill finally comes to the floor, and this may be the bill. It is at least 2,000 pages. It is at least $1 trillion. Maybe it is a good bill. But the American people will have a lot of questions about whether their premiums are going up instead of down, their taxes are going up instead of down; how much are the Medicare cuts -- why are they being spent on somebody else instead of the people in Medicare? What about these Medicare payroll taxes? What about new State taxes? Will I lose my insurance?

These are big questions and they deserve to be answered. A good way to start is to take the advice of the eight Democratic Senators who wrote the Democratic leader and said: Before we have our first vote, Mr. Leader, No. 1, we want to see the complete text which we don't yet have; we want to see a complete estimate by the Congressional Budget Office; and we want it to be on the Internet for at least 72 hours -- the words were very strong -- because we have a duty to the American people that they know how this affects them, because it is a very personal matter.