Speeches & Floor Statements

Colloquy Remarks of U.S. Sen. Lamar Alexander and Republican Colleagues on Health Care Reform

Posted on March 11, 2010

Mr. ALEXANDER. Madam President, the Senator from Arizona and I and Senator Barrasso, who will be here in a few minutes, had the privilege of being invited by the President to a lengthy health care summit a couple weeks ago at the Blair House, a historic location right across from the White House.  

Over the 7 1/2-hour discussion, there were some obvious differences of opinion. In fact, my friend, the majority leader, said: Lamar, you are not entitled to your own facts. I think he is right about that. We want to use the real facts. But the American people, once again, seem to have understood the real facts.  

In the Wall Street Journal yesterday, March 10, there was an article by Scott Rasmussen and Doug Schoen. Mr. Rasmussen is an independent pollster, and Mr. Schoen was President Clinton's pollster. Here is one of the things they said. We were saying, with respect to the President: Mr. President, your plan will increase the deficit. This is a time when many people in America believe the deficit is growing at an alarming rate and will bring the country to its knees in a few years if we do not do something about it. The President and his Democratic colleagues said: No, the Congressional Budget Office says we do not increase the deficit.  

The American people do not believe that, according to Mr. Rasmussen and Mr. Schoen. They say: ...66 percent of voters believe passage of the President's plan will lead to higher deficits.

They are right about that. Why do I say that? Because not included in the comprehensive health care plan that the President has yet to send up -- we do not have a bill yet. We have an 11-page memo which is suggested recommendations in a 2,700-page Senate bill. We do not have a bill. But the plan does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients over the next 10 years. According to the President's own budget -- and Paul Ryan, the Congressman from Wisconsin, brought this up at the summit -- that costs $371 billion over 10 years. 

Let me say that once more. What we are being asked to believe is, here is a comprehensive health care plan that does not add to the debt, but it does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients. That is akin to asking you to come to a horse race without a horse. Does anybody believe a comprehensive health care plan is complete and comprehensive if it does not include what you actually are going to pay doctors to see Medicare patients? Of course not. You have to include that in there. That adds $371 billion to the President's proposal, and that, by itself, makes it clear the proposal adds to the deficit.

The Senator from Arizona is here, and I say this to the Senator. Also in the article in the Wall Street Journal it said: Fifty-nine percent of the voters say that the biggest problem with the health care system is the cost....That is what we have been saying over and over again. Let's don't expand a program that costs too much. Let's fix the program by reducing costs.  

According to the survey -- remember this is an independent pollster and a Democratic pollster:

Fifty-nine percent of voters say that the biggest problem with the health care system is the cost: They want reform that will bring down the cost of care. For these voters, the notion that you need to spend an additional trillion dollars doesn't make sense. If the program is supposed to save money, why does it cost anything at all? Asked the pollsters.  

I ask the Senator from Arizona that question. If this program is supposed to save money, reduce costs, why does it cost anything at all?  

Mr. McCAIN. Madam President, I say to my friend, obviously, the answer to that question is, we continue to go back to the Congressional Budget Office with different assumptions in order to get the answers they want when the American people have figured it out.  

Again, I know my friend from Tennessee saw yesterday's news, which has to be considered in the context of the cost of this bill, which Congressman Ryan estimates as around $2.5 trillion with true budgeting over 10 years. But we cannot ignore the fundamental fact that "the government ran up" -- this is an AP article yesterday:  

The government ran up the largest monthly deficit in history in February, keeping the flood of red ink on track to top last year's record for the full year.

 The Treasury Department said Wednesday that the February deficit totaled $220.9 billion, 14 percent higher than the previous record set in February of last year.  

The deficit through the first 5 months of this budget year totals $651.6 billion, 10.5 percent higher than a year ago.  

The Obama administration is projecting that the deficit for the 2010 budget year will hit an all-time high of $1.56 trillion, surpassing last year's of $1.4 trillion total.  

I say to my friend from Tennessee, these are numbers that in our younger years we would not believe. We would not believe we could be running up these kinds of deficits. Yet we hear from the President and from the administration that things are getting better -- certainly not from the debt we are laying onto future generations of Americans.  

May I mention also in this context -- I wonder if my friend from Tennessee will agree with me that there is so much anger out there over porkbarrel spending and earmark spending that the Speaker of the House said they are going to ban earmarks in the other body for for-profit companies. I think that is a step forward. Why not ban them all? Immediately they would set up shadow outfits.

Chairman Obey says that would be 1,000 earmarks. In one bill last year, there were 9,000 earmarks. So why don't we take the final step and put a moratorium on earmarks until we have a balanced budget, until there is no more deficit? I think that is what the American people wanted to get rid of -- this corruption that continues there.  

But I would also mention to my friend from Tennessee very briefly that the President, when he and I sat next to each other at Blair House, and I talked about the special deals for the special interests and the unsavory deal that was cut with PhRMA and how the American people are as angry about the process as the product, the President's response to me was -- and there is a certain accuracy associated with it -- the campaign is over.  

Well, I would remind my friend that before the campaign -- even before the campaign -- when the President was still a Senator, he said this about reconciliation: 

You know, the Founders designed this system, as frustrating [as] it is, to make sure that there's a broad consensus before the country moves forward....And what we have now is a president who -- And there he was referring to President Bush -- hasn't gotten his way. And that is now prompting, you know, a change in the Senate rules that really I think would change the character of the Senate forever....And what I worry about would be you essentially have still two chambers -- the House and the Senate -- but you have simply majoritarian absolute power on either side, and that's just not what the founders intended.

That was a statement by then-Senator Barack Obama. Then he went on to say:

I would try to get a unified effort saying this is a national emergency to do something about this. We need the Republicans, we need the Democrats.  

Just yesterday, of course, at rallies around the country, he said: It is time to vote.  

It is time to vote, is his message, which certainly is attractive. We will be glad to vote. But we want to vote preserving the institution of the Senate and the 60-vote rule.  

In the interest of full disclosure, Republicans, when they were in the majority, tried to change it, as the Senator from Tennessee remembers. But the fact is, if we take away the 60-vote majority that has characterized the way this body has proceeded, we would then have just what then- 

Senator Obama said:You essentially have still two Chambers -- the House and the Senate -- but you have simply majoritarian absolute power on either side, and that's just not what the founders intended.

I wonder if my colleague from Tennessee would like to comment on whether the President still believes that is not what the Founders intended.  

Mr. ALEXANDER. Madam President, I appreciate the Senator from Arizona bringing this up, and I think it is important for the American people to be reminded that the Senator from Arizona has a certain amount of credibility on this matter because about 4 years ago -- when we were in the majority and we became frustrated because Democrats were blocking President Bush's judicial appointments -- it was the Republicans who said -- I didn't, but some Republicans said -- well, let's just jam it through. We won the election, let's get it with 51 votes. Let's change the rules.  

But Senator McCain and a group of others said: Wait just a minute. He said then what he has said just today. He said the U.S. Founders set up the Senate to be a protector of minority rights. As Senator Byrd, the senior Democratic Senator, has said: Sometimes the minority is right. And it was Alexis de Tocqueville who said, when he wrote his observations about our country in the 1830s, that potentially the greatest threat to American democracy is the tyranny of the majority.  

This is supposed to be a place where decisions are made based upon consensus, not just a majority. As Senator Byrd has said: Running the health care bill through the Senate like a freight train is an outrage. It would be an outrage.  

I would ask the Senator from Arizona whether he believes it is not just the higher premiums and the higher taxes and the extra costs to States; that, in the end, the reason this health care bill is so deeply unpopular is because of the process because, first, there were 25 days of secret meetings, and now they are jamming it through by a partisan vote. Something this big, this important ought to be decided by consensus in the Senate.  

Mr. McCAIN. I would also remind my friend from Tennessee of Senator Byrd's comments regarding reconciliation and health care reform. 

Madam President, I ask unanimous consent to have printed in the Record Senator Robert Byrd's statement on the floor of the Senate from April of 2001. 

Mr. McCAIN. Let me explain his objection to using reconciliation to pass controversial health care legislation by quoting from Senator Robert Byrd:  

The Democratic leadership pleaded with me at length to agree to support the idea that the Clinton health care bill should be included in that year's reconciliation package. President Clinton got on the phone and called me also and pressed me to allow his massive health care bill to be insulated by reconciliation's protection. I felt that changes as dramatic as the Clinton health care package, which would affect every man, woman child in the United States would be subject to scrutiny.

I said, Mr. President, I cannot in good conscience turn my face the other way. That's why we have a Senate. To amend and debate freely. And that health bill, as important as it is, is so complex, so far-reaching that the people of this country need to know what's in it.  

Let me note here what the Speaker of the House said on March 9:  

We have to pass the bill so that you can find out what is in it.  

Now, continuing to quote from Senator Robert Byrd: 

And, moreover, Mr. President, we Senators need to know what's in it before we vote. And he accepted that. He accepted that. Thanked me and said good bye.  

I could not, I would not, and I did not allow that package to be handled in such a cavalier manner. It was the threat of the use of the Byrd rule. Reconciliation was never, never, never intended to be a shield, to be used as a shield for controversial legislation.  

I might also point out that the Senator from Tennessee mentioned the process. I don't think the American people understand that if the House passes the Senate bill, every one of these sweetheart deals that were included behind closed-door negotiations in the majority leader's office and in the White House will remain in that bill. We Republicans have all signed a letter, 41 votes, that we will not accept any change or amendment, whether it is good or bad, because we oppose the use of reconciliation, as Robert Byrd did so eloquently back in 2001.  

Mr. ALEXANDER. I wonder if the Senator from Arizona would agree with me that what is happening is the President is inviting the House Democrats to join hands and jump off a cliff and hope Senator Reid catches them.  

Mr. McCAIN. Will the C-SPAN cameras be in those meetings, I would ask my friend?  

Mr. ALEXANDER. Well, when they jump, they may be. But Senator Reid and his Democratic colleagues, I would say to my friend from Arizona, are not going to have any incentive to catch these House Members who vote for the bill because the President will have already signed it into law, and he will be well on his way to Indonesia, as the Senator from Arizona has just said. We have 41 Republican Senators who have signed a letter saying that you are not going to make new deals and send them over here and change them by reconciliation. 

Mr. McCAIN. Madam President, I ask unanimous consent to have printed in the Record an article entitled "Health-Care Reform's Sickeningly Sweet Deals" by Kathleen Parker, which appeared in the Washington Post on Wednesday, March 10. 

Mr. McCAIN. I think Kathleen Parker says it best, and let me quote from her article:

Skipping through the Candy Land of the health-care bill, one is tempted to hum a few bars of "Let Me Call You Sweetheart." What a deal. For dealmakers, that is. Not so much for American taxpayers, who have been misled into thinking the sweetheart deals have been excised.  

That is why I say to my friend from Tennessee, it is important the American people understand that the Senate bill cannot be changed without coming back to the Senate. Therefore, all these deals they have pledged to remove will be in the bill that will be voted on by the other body -- the "Cornhusker kickback," which, by the way, had to secure 100 percent Federal funding for Nebraska's Medicaid expansion in perpetuity, among other hidden prizes to benefit locally based insurance companies. When other States complained about the unfair treatment, President Obama and Congress fixed it by increasing the Federal share of Medicaid to all States through 2017, after which all amounts are supposed to decrease. But they didn't fix it.  

Anyway, I think it is important for us to understand that these sweetheart deals have not been removed and that we are in opposition to this entire reconciliation which would lead to the erosion and eventual destruction of the 60-vote procedure that has characterized the way the Senate has operated.  

I have been in the majority, and I have been in the minority, and when I have been in the majority, we have been frustrated by the 60-vote rule and vice versa. Some of the people who are doing the greatest complaining and arguing about the fact that we have a 60-vote rule are the same ones who were the most steadfast defenders of it in past years when they were in the minority. That alone is enough argument for us to leave the process alone.  

I believe historians will show that there are times where the 60-vote rule, because of the exigency of the moment, averted us from taking actions; and later on, in perhaps calmer times, we were glad that we did not act at that time. 

Mr. ALEXANDER. Madam President, I congratulate the Senator from Arizona for his consistency, for 5 years ago saying to members of his own party that the Senate is a place where minority rights are protected. As Senator Byrd has said, sometimes the minority is right. It slows things down, yes; but it forces us to get it right.  

I ask unanimous consent to have printed in the Record the editorial from the Wall Street Journal to which I referred a little earlier. 

Mr. ALEXANDER. Madam President, I ask unanimous consent that the Senator from Wyoming be allowed to lead the colloquy in our remaining time. 

The ACTING PRESIDENT pro tempore. Without objection, it is so ordered.  

Mr. McCAIN. Madam President, may I ask the Senator from Wyoming if is he aware of a letter written to House leadership, representing, I believe, 85,000 physicians who oppose this legislation? 

Mr. BARRASSO. I am not aware of that article, but I look forward to hearing about it from my colleague from Arizona. 

Mr. McCAIN. Let me quote a little for my colleague, Dr. Barrasso: The undersigned state and national specialty medical societies -- representing more than 85,000 physicians and the millions of patients they serve -- are writing to oppose passage of the "Patient Protection and Affordable Care Act." The changes that were recently proposed by President Obama do not address our many concerns with this legislation, and we therefore urge you to draft a more patient-centered bill that will reform the country's flawed system for financing healthcare, while preserving the best healthcare in the world.  

At this point, I want to ask my friend, the doctor, isn't it true that included in this legislation remains the so-called doc fix, and that there will be a 21-percent cut in doctors payments for treatment of Medicare enrollees?  

There is no one in America who believes that cut will actually be enacted, which then makes the comments by supporters of this bill false on their face -- just that alone. I believe that is $371 billion; is that correct?  

Mr. BARRASSO. My colleague is absolutely correct. That is exactly what is happening. They call this a health care bill. It doesn't seem to address the major issues that patients across the country are concerned about. My colleague is absolutely right, we need a patient-centered approach. It doesn't address the issue that doctors are concerned about, which is the issue of making sure a doctor and a patient can work together toward the best health for that patient.

Doctors and patients alike are very much opposed to this bill. When Senator McCain talks about the doctor fix to make this bill work, they say they are going to cut doctors across the country 21 percent in what they get paid for taking care of patients who depend upon Medicare for their health care, and then keep that price frozen for the next 10 years. That is the only way the Democrats can say, well, this actually saves money. In reality, in terms of health care in the country, it does not. 

This bill, if it passes, is going to end up costing patients more. It is going to interfere with the doctor-patient relationship. It is going to result in an America where people truly believe their personal care -- and that is what people care about: What is in it for me? How will this bill affect me and my life and my children? If they are providing for adult care, how is it going to affect their parents? They believe the care they receive, in terms of the quality of care and the available care they receive, it is going to be worse. 

They believe it is going to end up costing more. That is why, in a recent poll this week, 57 percent of Americans say this plan, if it passes, will hurt the economy. We are at a time where we are at 9.7 percent unemployment in this country. People are looking for work, and the place people find jobs in this economy right now seems to be working for the government. 

For decades and decades, the engine that drives the economy of our Nation has been small businesses. That is who we rely upon to stimulate the economy and get job growth. That is who we should be relying on, not Washington, not the Federal Government. That is why 57 percent of Americans who are focused on the economy say we believe this economy will be hurt if this bill passes.

People are focused on the debt and the cost, and 81 percent of Americans say it is going to cost more than estimated because of the fact, as Senator McCain has said, that doctors are going to be cut 21 percent across the board and continue for the next 10 years with their Medicare fees. The people of America realize that is not going to work for health care. People are going to say how am I going to get to see a doctor? I am on Medicare. I want to see a doctor. That is why people believe Medicare in their own personal care is going to get worse if this bill passes.

Then the President promised we are not going to raise taxes on anyone. Seventy-eight percent of Americans believe there will be middle-class tax hikes if this passes. That is why people are opposed to a bill that cuts $500 billion from Medicare for our seniors who depend on Medicare for their health care. It is not just cutting payments to doctors; it is to hospitals, to nursing homes where we have so many seniors across the country. It affects home health agencies, which is a lifeline for people who are at home, and keeps them out of the hospitals. They are even going to cut payments for people who are in hospice care, who are at the terminal point, who are in the final days of their life. They are cutting that out. 

All of these are reasons the American people say I am not for this bill and it is time to stop. Half of America says stop and start over. One in four says stop completely. Only one in four actually believes this is going to help. That is not a way to pass legislation in this country. That is not a way to find something the American people agree with. That is not the way to get successful implementation of a program. I spent 5 years in the Wyoming State Senate. On major pieces of legislation, we always sought broad bipartisan support because if you have broad bipartisan support, then people all around the community and the country would say this must be the right solution to a significant problem we are facing.

We are facing a problem with health care in this country and we need health care reform. We just do not need this bill that cuts Medicare, raises taxes, and for the most part most Americans will tell you they believe their own personal care will suffer as a result of this bill becoming law. For whatever means or mechanism or parliamentary tricks are used to try to cram this bill through and cram it down the throats of the American people, the American people want to say no, thank you. They are saying it in a less polite way than just saying no, thank you. They are calling, they are showing up, they are turning out to tell their elected representatives that we do not want this bill under any circumstances. Let's get to the things we can agree upon and isolate those and pass those immediately. Not an over-2,000-page bill that is loaded with new government rules and new government regulations and new government agencies and new government employees at a time when 10 percent of Americans are unemployed and people are looking for work in communities around the country.

One of the things I found so interesting and also distressing when the President says everyone will have coverage, is he wants to do it by putting 15 million Americans on Medicare. Having practiced medicine for 25 years and seen all patients, regardless of ability to pay, I can tell you there are many doctors across the country who do not see Medicaid patients because what they receive in payment from the Government for seeing those patients is so little. Even the people at the Congressional Budget Office -- who look at this health care bill with the cuts in Medicare and with so many people put on Medicaid -- say one in five hospitals is going to be unable to stay open 10 years from now if this gets passed because they are not going to be able to even cover the expenses of staying open. The same applies to doctors' offices and to nursing homes.

We need a program approach that is sustainable, not something like this, that we know is irresponsible and unsustainable. That is what we are going to do if we put 15 million more people on Medicaid by sending them a Medicaid card. But, as Senator Alexander has said, that is like giving somebody a bus ticket when a bus is not coming -- because coverage does not always equal care.

As a surgeon in Wyoming, I took care of people who came from Canada. They came to Wyoming from Canada for health care. They had coverage in Canada because Canada covers all the people, but they do not get care in Canada. That is why 33,000 Canadians last year came to the United States for surgery. Why? Because the waiting lines were so long in Canada. Even a Member of Parliament had cancer -- and my wife is a breast cancer survivor -- a Member of Parliament in Canada came to the United States for her cancer care because the survival rates for people treated in the United States are so much better. Why are they better? It is more timely care. 

People come for artificial hip replacements because they do not want to wait in Canada. In Canada, come Halloween -- it is called trick-or-treat medicine -- they have spent the amount of money they are going to spend on a procedure, whether it is cataract surgery or total joint replacement, and they say: OK, we are done. Wait until next year. Go get in line again.

I hear it time and time again in patients who come from Canada to the United States because they have coverage but they do not have care.

Then we look at Medicaid and Medicare and we look at the model the President has lifted up as the one that is a good model for health care in America, and he pointed to the Mayo Clinic, which is a wonderful place with wonderful care. Yet the Mayo Clinic in Arizona said we can't take more Medicare patients. They said we have to limit the number of Medicaid patients we take. Why? Because, by taking care are of those patients in the past, the Mayo Clinic has said they have lost hundreds and hundreds of millions of dollars because Washington is the biggest deadbeat payer of all for health care. 

When it comes to actually rejecting patients' claims, the No. 1 rejecter of claims in this country is Medicare. The highest percentage of claims rejected is Medicare, over other insurance companies. Having practiced medicine for 25 years, I have fought with Medicare and I fought with insurance companies, all on behalf of patients. When you are fighting with an insurance company you can always actually appeal that if they reject it. It is very hard to fight with Washington.

This health care bill we have been debating in the Senate and is now before the House is the one where the American people say don't make me live under this. Don't cut my Medicare. Don't raise my taxes. Don't interfere with my relationship with my doctor. Don't make it tougher for me to get care. Don't lessen the quality of that care. 

I ask how much time I have remaining. 

The ACTING PRESIDENT pro tempore. The Senator's time has expired. 

Mr. BARRASSO. Madam President, I yield the floor and suggest the absence of a quorum.  

The PRESIDING OFFICER. The clerk will call the roll. 

The legislative clerk proceeded to call the roll.  

Mr. BARRASSO. Madam President, I ask unanimous consent the order for the quorum call be rescinded. 

The ACTING PRESIDENT pro tempore. Without objection, it is so ordered.  

Mr. BARRASSO. Madam President, I ask unanimous consent to have printed in the Record the letter that Senator McCain referenced from the 85,000 doctors across the country opposing the bill.