Speeches & Floor Statements
Colloquy Remarks of U.S. Senator Lamar Alexander (R-Tenn.) and John McCain (R-AZ) -- Health Care Reform
Posted on December 2, 2009
Mr. ALEXANDER. Mr. President, I agree with the Senator. That is why we have 22 minutes on the Republican side to clear up some misconceptions. The Democratic health care bill does cost $2.5 trillion over 10 years when it is fully implemented. If I may say so, it is arrogant to think the American people couldn't figure out the difference between the first 10 years, when the bill wasn't implemented in 4 of those years, and they would like to know that it costs $2.5 trillion. Mr. BAUCUS. Will the Senator yield for a question? Mr. ALEXANDER. If it is on your time. Mr. BAUCUS. Is it paid for? Mr. ALEXANDER. The Senator is right. It is paid for by cutting grandma's Medicare. It is paid for by cutting grandma's Medicare by $465 billion over a 10-year period of time, and about $500 billion in taxes -- Mr. BAUCUS. That is a second question I would love to debate with the Senator. But on the first question only, the Senator admits it is paid for? Mr. ALEXANDER. No. I admit it costs $2.5 trillion, and the attempt to pay for it is through Medicare cuts, tax increases, and increases to the deficit by not including the physicians reimbursement in the health care bill. Mr. BAUCUS. One more question. I think we all know the House has taken action on physician reimbursement, and the Senate will also do so before we adjourn. That is the so-called doc fix. That is a separate issue. That will be paid for. Putting the doctor issue aside, health care reform -- and I say that because we take up the doc fix virtually every year. We don't take up health care reform every year. That is an entirely separate proposition, separate legislative endeavor. If the Senator will bear with me and take the doc fix off the table for a second -- we can address that later -- health care reform -- to use a 10-year number, or when you start in 2010 or in 2014, wherever you are starting -- either there is $1 trillion or $2.5 trillion, depending where you start, not getting into how it is paid for. Is it paid for and therefore it is not deficit; am I not correct? Mr. ALEXANDER. I will concede to the Senator from Montana that the attempt of the Democrats to pay for this $2.5 trillion bill consists of Medicare cuts, tax increases, and additions to the deficit by not including the physician reimbursement, which is an essential part of any 10-year health care plan. There may be other problems, but those are the three things I know about. Mr. BAUCUS. One more question on my time. Is it true there are no cuts in guaranteed beneficiary payments -- none whatsoever -- in this legislation -- in guaranteed benefits? Mr. ALEXANDER. I would say no to that, Mr. President, because the Director of the Congressional Budget Office made it clear there would be specific cuts in benefits for those who have Medicare Advantage, which is about one out of four seniors. Mr. BAUCUS. Is it true those provisions are not guaranteed provisions? I am talking about guaranteed benefits that seniors expect to get when they go to the doctor, fee for service, expected benefits, under ordinary Medicare, not benefits that a private plan may pay in addition. Mr. ALEXANDER. Mr. President, it is clear there are $465 billion in cuts in Medicare. The Chair and the Senator from Montana and the Senator from Connecticut have all agreed that is a big part of how the bill is supposedly paid for. It is specific enough to say that $135 billion comes from hospitals; $120 billion from Medicare Advantage, which 11 million seniors have; nearly $15 billion from nursing homes; $40 billion from home health agencies; $8 billion from hospices. The Director of the CBO testified that provisions like that would result in specific cuts to benefits for Medicare Advantage. He said that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear. The changes would reduce the extra benefits, such as dental, vision, and hearing coverage, that currently are made available to beneficiaries. Mr. BAUCUS. One more question. Does the Senator agree this legislation will extend the solvency of the Medicare trust fund for 5 years, and failure to pass this would mean the solvency of the Medicare trust fund would not be extended for 5 years? Mr. ALEXANDER. I wholeheartedly disagree with that. The Medicare trustees have said that between 2015 and 2017 Medicare will be approaching insolvency. They have asked that we take urgent action. The urgent action recommended by the Democratic majority is that we take $465 billion out of the Medicare Program over 10 years and spend it on a new entitlement. It is hard for me to understand how that can make Medicare more solvent, when you take money out of grandma's Medicare and spend it on someone else. Mr. McCAIN. Will the Senator yield? Mr. ALEXANDER. Yes. Mr. McCAIN. Isn't it, shall we say, Enron accounting when you have a proposal that, as soon as the bill becomes law, you begin to raise taxes and cut benefits, and then you wait 4 years before any of the benefits are then extended to the beneficiaries? That, on its face, is a remarkable piece of legislation. My experience, which has only been 20-some years, is that we haven't passed legislation that says we are going to collect taxes on it for 4 years, and then we are going to give you whatever benefits that may accrue from this legislation. Again, there has been no time in history where we have taken money from an already failing system to create a new entitlement program. Mr. BAUCUS. Which colleague is the Senator asking that? Mr. McCAIN. I believe the Senator from Tennessee has the floor. Mr. BAUCUS. He does. Mr. McCAIN. I was addressing the person who has the floor, which I am sure the Senator from Montana should understand by now. Mr. ALEXANDER. I say to the Senator from Arizona that he is exactly right. Another way to describe it, the Senator from Kansas said it was like writing a big check on an overdrawn bank account and buying a big new car. Maybe another way, if I may respond to the Senator from Arizona -- I ask unanimous consent that Republican Senators, on our time, be allowed to engage in a colloquy. The PRESIDING OFFICER. Is there objection? Without objection, it is so ordered. Mr. BAUCUS. May I ask the Senator another question? Mr. ALEXANDER. I would like to finish responding to Senator McCain, if I might. Mr. BAUCUS. Then I have a question on the same subject. Mr. ALEXANDER. I hope the Parliamentarian is keeping track of the Republican time. I am enjoying the questioning, and I thank the Senator for his question. One of the things -- in fact, a great compliment has been paid to the Senator from Arizona. It is rare that a Senator can have something he said actually begin to break through the fog. Dana Milbank, a columnist for the Washington Post, wrote a column about it being all about grandma and wondering why we never mention grandpa. Maybe Mr. Milbank hasn't seen the movie "My Big Fat Greek Wedding," where the man said, "I'm the head of the house," and the woman said, "I'm the neck, because I can turn the head any way I want." We are talking about grandma because she can help persuade grandpa. If we take $465 billion out of Medicare over 10 years, grandma and grandpa and those who are younger and looking forward to Medicare will be affected. If I may say to the Senator from Arizona -- and I see the Senator from Oklahoma and the Senator from Nebraska. It wasn't long ago, in response to the question -- in fact, in 2005, when we sought to restrain the growth of Medicare by $10 billion over 5 years, and this is what they said -- remember, they are "restraining" the growth of Medicare by $465 billion and spending it on a new program, and Republicans were, at that time, trying to save $10 billion over 5 years. "An immoral document," said Senator Reid and Senator Dodd. The Senator from Connecticut said that funding for Medicare would be cut. Senator Rockefeller: "A moral disaster of monumental proportion." Senator Boxer, in the same way, compared it to Katrina. Senator Kerry said we are "passing the costs on to seniors." Senator Levin said people are "going to be hurt by this bill." "Irresponsible and cruel," said Senator Kohl. Senator Reed and Senator Hillary Clinton also made similar comments. That was for $10 billion of restraining the growth of Medicare to spend it on the existing program. Yet this proposal by the Democrats would take $465 billion and spend it on a new program. Mr. McCAIN. Isn't it true -- and the Senator from Montana is on the Senate floor and wants to enter into this, maybe he can respond to his comments of 14 years ago. We weren't trying to create a new entitlement program, which is the object of the Senator's bill. We were just trying to enact some savings in the Medicare system. What did Senator Baucus say? He said: And above all, we must not use Medicare as a piggy bank. What are we using the $483 billion in cuts in Medicare for? Then he said: That is disgraceful. Perhaps some changes lie ahead. But if they do, they should be made for the single purpose of keeping Medicare services for senior citizens and people with disabilities. Isn't it true that now that we are taking $483 billion out of a failing system the Medicare trustees say is going to go bankrupt, and the Senator from Montana, 14 years ago, said: Seniors could easily be forced to give up their doctor, as doctors begin to refuse Medicare patients and hospitals -- especially rural hospitals -- close. Isn't that the effect of taking $483 billion in cuts in Medicare? Then the Senator from Montana went on to say: Equivalent to blowing up the house and erecting a pup tent where it used to be. Instead of blowing up a pup tent, I would say what they are doing is like a hydrogen bomb. Finally, Senator Baucus said: Staggering. The leadership now proposes something like $250 billion in Medicare cuts. It is staggering. It is a reduction of nearly a quarter in Medicare services by the year 2002. All of us here learn about the issues. Apparently, the Senator from Montana didn't learn much, because he was deeply concerned 14 years ago about a very small savings in Medicare. Now he wants to spend $2.5 trillion and taking $483 billion out of Medicare to create a new entitlement system. Mr. BAUCUS. Might I respond to the Senator? Mr. ALEXANDER. Mr. President, I am happy to see a debate actually break out on the Senate floor on this issue. Mr. BAUCUS. Here is your opportunity; here is your chance. Mr. ALEXANDER. As long as it is on Democratic time. Mr. BAUCUS. It is on both sides. We have even time. Mr. ALEXANDER. I mean whatever time the Senator uses should be on Democratic time. Mr. BAUCUS. Yes. The basic question, obviously, is how to protect Medicare benefits. I think most of us would say how do we protect Medicare benefits and extend the solvency of the Medicare trust fund. I think we would all agree that excessive payments to providers would cause insolvency of the trust funds to come earlier rather than later. We all agree with that proposition. The next question is, What would excessive payments to providers be? Do providers get paid excessively? I think that is an honest question we should ask ourselves in a way to help extend the solvency of the Medicare trust fund. In fact, in 1995, many Senators, especially on the other side of the aisle, did say just that, that we have to cut Medicare in order to save benefits. That was made by many Senators. I have them right in front of me, if anybody wants to hear them. I am not going to go through all of that, but it is the truth. That is exactly what we are doing in this bill. We are trying to help extend the solvency of the Medicare trust fund by cutting down on excessive provider payments from the Medicare trust fund. How do we decide whether payments are excessive? That is the basic question here. All we can do is just give it our best shot, make our best judgment. I think it makes sense to look at the recommendations by outside independent groups, what they think. One is MedPAC, the Medicare Payment Advisory Commission. That is an outside group, as we all know, that advises Congress on Medicare payments. As Members of Congress, we are not totally competent to know exactly what dollars should go to which industry group. We have too many other obligations to think about. As Senators, we must be responsible to do the best we can. MedPAC has said these groups have been overpaid. And Wall Street analysts tend to agree. In fact, MedPAC said, with respect to Medicare Advantage, that they have been overpaid -- I forget the exact amount but much less than the $118 billion reduction in this bill. In fact, I totaled up and looked at the projected growth rate of providers -- hospitals, nursing homes, home health, hospice, PhRMA, you name it -- and on average their growth rate over the next decades is going to be 6 1/2 percent. That is the growth rate of providers. We decided to trim that a little bit by 1.5 percent. So it is 5 percent. It is a 5-percent growth rate in an attempt to try to find the right levels of reimbursement to providers, which will also help extend the solvency of the Medicare trust fund. When we talk to providers, they basically agree with those cuts. They basically agree. Why do they basically agree? They basically agree because they know that with much more coverage, with many more people having health insurance, they could spread out their business. They may lose a little on margin, but they can pick it up on volume. That is exactly what their business plan is under this bill. Wall Street analysts say -- I quote them -- these industries are doing great, they are doing well under this bill. They are not getting hurt. So we do achieve a win-win -- I don't like that phrase, by the way, but I will use it here -- where the solvency of the trust fund is being extended and where reimbursement rates to providers are fair -- not being hurt; it is fair. And that is why they want this bill, by and large. Most groups tend to want this bill enacted because they know it is good for the country, it is good for the seniors, and it is good for them too. Mr. McCAIN. Mr. President, may I just mention again, $70 billion in fraud, abuse, and waste, and Senator Coburn, the doctor, can tell you, that is nowhere in this bill. The fact is, maybe some of the providers have been bought off, jawboned, or had their arms twisted or given a good deal, like PhRMA has. Recipients have not. Medicare recipients know you cannot cut $483 billion without ultimately affecting their benefits, and that is a fact. Again, conspicuous by its absence, I say to the Senator from Montana, totally conspicuous by its absence is any meaningful malpractice reform, which has been proven in the State of Texas and other States to reduce costs and to increase the supply of physicians and caregivers. There is nothing in this bill that is meaningful about medical malpractice reform. I had a townhall meeting with doctors in my State, and everyone stood up and said: I practice defensive medicine because I fear being sued. If you are really serious, I say to the Senator from Montana, if you are really serious about this, medical malpractice should be a key and integral part of it. Even the CBO costed it out at about $54 billion a year. When you count in all the defensive medicine, it could be as much as $200 billion over 10 years. That is conspicuous by its absence. I think it brings into question the dedication of really reducing health care costs across America. Mr. ALEXANDER. Mr. President, we have enjoyed our discussion with the distinguished chairman of the Finance Committee and thank him for his questions. Senator Coburn, who is a physician -- the Senator from Montana talked about doctors being overpaid. He talked about -- Mr. BAUCUS. No, no, no, I did not. With all due respect, I did not say that. Mr. ALEXANDER. Didn't I hear the words "providers overpaid"? Mr. BAUCUS. I talked about hospitals. I did not talk about doctors overpaid. If I may say to my friend from Tennessee, this legislation pays more to primary care doctors, 10 percent increase in Medicare reimbursement for each of the next 5 years. I did not say "doctors." Mr. ALEXANDER. I must have misunderstood. Normally when we talk about providers, we talk about hospitals and physicians. We have a physician on the Senate floor, the Senator from Oklahoma. I wonder if he, having heard this debate, might want to comment. I might say, isn't it true that the McCain motion, which we have on the floor, would send this back to the Finance Committee and say: If there are savings, let's spend it on Medicare to actually strengthen it? Mr. COBURN. Mr. President, I thank the Senator. The first comment I have is about relying on what Wall Street analysts say today. They have about this much credibility in this country today. Look at the economic situation we find ourselves in because of what Wall Street analysts have said. That is the first point I would make. The second point is that the majority whip yesterday said we should cut Medicare Advantage because of the 14 percent. Senator Dodd just recently went after the Patients' Choice Act because we actually make it be competitively bid without any reduction in benefits. Your bill, for every Medicare Advantage, cuts 50 percent of the benefits out. It cuts the benefits. The difference is -- and I agree with the majority whip -- we do need to have the savings in Medicare Advantage, but the way you get that is through competitively bidding it while at the same time maintaining the requirements for the benefits that are offered. There is a big difference in those two. Ours ends up being pure savings to save Medicare. The savings in this bill are to create a new entitlement. The other point I wish to make is, if you are a senior out there listening and if you are going to be subject to the new increase in Medicare tax, for the first time in history, we are going to take the Medicare tax and not use it for Medicare, we are going to use it for something else under this bill. This one-half of 1 percent is now going to be consumed in something outside of Medicare. So no longer do we have a Medicare tax for the Medicare trust fund. We have a Medicare tax that funds the Medicare trust fund plus other programs. I say to my colleagues, I think we want a lot of the same things. How we go about it -- the Senator from Montana recognized the fact that we are going to increase payments to primary care physicians. Ask yourself the question why only 1 in 50 doctors last year who graduated from medical school is going into primary care. Why do you think that is? Could it be that the government that is setting the payment rates created a maldistribution in remuneration to primary care physicians; therefore, they choose to go where they can make 200 percent more over their lifetime by spending 1 additional year in residency rather than doing primary care? What this bill does, and what the Senator from Arizona is trying to do by sending this bill back, is to refocus it on the fact that Medicare money ought to be used for Medicare. If, in fact, we are going to slow the growth of Medicare, can we do that without cutting benefits? To slow the growth in this bill for 11 million Americans who now have Medicare Advantage will diminish their benefits. That is out of the $120 billion that is going to come. You cannot tell a senior who is in a rural area today, who is on the economic lower rungs of the ladder, who uses Medicare Advantage to equalize their care with somebody who can afford a Medicare supplemental policy, you cannot tell them this is not going to decrease their benefits and their care, because it is. And in the bill, it actually states that it is going to decrease their benefits. Mr. McCAIN. Will the Senator yield? Very briefly, the Senator from Montana talked about the support the bill gets. AARP makes more money from Medigap plans they sell to seniors. AARP should be opposing the bill, but other groups such as 60 Plus are educating seniors. The AMA endorsement of the bill -- shocking. The bill puts the government in charge, but AMA cut a deal to get their Medicare payments addressed by increasing the deficit by $250 billion. Mr. COBURN. Mr. President, will the Senator yield for a minute? Mr. McCAIN. PhRMA -- my God, if there ever was an obscene alliance made that will harm seniors because it has the administration against drug reimportation from Canada and competition for treatment of Medicare patients. So now we understand a little bit better why these special interest groups, 500-some of them, have visited the White House in recent months, according to White House logs. Mr. COBURN. The Senator would probably be interested to know -- and, I know, my colleagues on the other side -- that the American Medical Association now represents less than 10 percent of the actively practicing physicians in this country. The physicians as a whole in this country are adamantly opposed to this bill. The reason they are opposed to this bill is because you are inserting the government between them and their patient. That is why they are opposed to this bill. So you have the endorsement of the AMA which represents less than 10 percent of the practicing doctors -- actively practicing doctors -- in this country because not only will it increase payments, but CPT code revenue is protected. That is the revenue AMA gathers from the payment system that continues to be fostered in this bill, which is their main source of revenue. Mr. McCAIN. May I ask my colleague's indulgence for just a moment because, as you know, the majority leader seems to appear more and more frantic as he, perhaps, is reading the same polls we are that more and more Americans, when they figure out this legislation, are becoming more and more opposed to it. Yesterday, the majority leader came out and directly addressed me, saying: This man talks about earmarks, but his amendment is one big earmark to the insurance industry. And in addition to that, the sponsor of the amendment -- Talking about me -- during his Presidential campaign talked about cutting these moneys. Mr. President, I hate, I say to my colleagues, to take a trip back down memory lane, but at the time -- of course, this was echoed by a DNC spokesperson, who then echoed it throughout the blogosphere and leftwing liberal blogs. The fact is, on October 20, FactCheck.org says: He accuses McCain of proposing to cut benefits. Not true. This is from FactCheck. In a TV ad and in speeches, Obama is making bogus claims that McCain plans to cut $880 billion from Medicare spending and to reduce benefits. A TV spot says -- A very well-funded campaign, I might add -- McCain's plan requires "cuts in benefits, eligibility, or both." Obama said in a speech that McCain plans "cuts" that would force seniors to "pay more for your drugs, receive fewer services, and get lower quality care." A second ad claims that McCain's plan would bring about a 22 percent cut in benefits. FactCheck.org says: These claims are false, and based on a single newspaper report that says no such thing. McCain's policy director states unequivocally that no benefit cuts are envisioned. Mr. President, I ask unanimous consent to have printed in the Record the entire FactCheck.org article. Mr. McCAIN. Mr. President, I hope the Senator from Nevada will stop making false claims -- repeating the false claims that were in attack ads on me throughout the campaign, funded by tens of millions of dollars, about my positions on health care in America which the fact checkers found to be totally false. As the narrator says that McCain's plan "means a 22 percent cut in benefits," the ad displays a footnote citing an Oct. 6 Wall Street Journal story as its authority. FactCheck: But, in fact, the Journal story makes no mention of any 22 percent reduction, or any reduction at all. I hope, among other things, in his, may I describe, frustration, that the Senate majority leader would at least not repeat false accusations about what I wanted to do in the Presidential campaign. It is unfortunate.