Weekly Column of U.S. Senator Lamar Alexander (R-Tenn.) - We Need Affordable Health Care that Works

Posted on July 12, 2009

As Congress continues to debate proposals for health care reform, I am concerned about the fact that President Obama's administration has already proposed adding, over the next 10 years, three times as much new debt as was spent in all of World War II. I am also concerned about including a so-called government option in health care reform, which is a nice way of saying a government-run health care plan. Some people say, “What is so bad about that?” Well, think of it this way: let's say you put some elephants and some mice in one room and say, “OK, fellows, compete.” What do you think will happen? Pretty soon there are no mice left; they are all squished. You have a big elephant left—the government-run health plan. That could quickly become your only choice. There’s an example of that in the current Medicaid Program, which is one of the worst government programs imaginable. There are 60 million Americans stuffed in it, primarily because they are low-income or disabled. It is run jointly by the federal government and by each state government. TennCare is our Medicaid program in Tennessee. Every governor—and this has been true for 25 years, from the time when I was governor—has struggled with finding money to both fund the state's share of it and still have money for education and for other state needs. Medicaid is filled with waste. The non-partisan Congressional Budget Office says one out of every 10 taxpayer dollars that are spent for Medicaid is fraud, waste, or abuse. That adds up to be about $32 billion a year. That is $320 billion over 10 years, enough to make a real dent in whatever we decide to do on health care. Yet the Democratic proposals that we are seeing involve putting more people into that government program. Not only does that force people into a bad program, but the problem for the taxpayer is how expensive that is. In a July 7th letter, Douglas W. Elmendorf, the Director of the Congressional Budget Office, wrote that the new Kennedy health care bill we are considering in the Senate “ . . . envisions that Medicaid be expanded to cover individuals and families with an income below 150 percent of the federal poverty level.” That sounds good. We all want to help those with lower incomes. But the draft legislation does not include provisions to accomplish the goal. Even though the Kennedy bill would spend trillions, a lot of people would still be uninsured and three-quarters of them are going to be dumped into Medicaid. For the federal government, that means hundreds of billions of new dollars we would have to borrow, and the thought is that over time the cost would be shifted to the states. In the state of Tennessee, based upon estimates we have received from the state Medicaid director, it might add an amount of money to the state's annual budget that would be equal to how much a new 10 percent state income tax would raise each year. That is not even the worst thing about it. The worst thing about it is what it would do to the low-income Americans who are stuffed into the proposal. Some 40 percent of doctors will not see Medicaid patients for all their services—40 percent of doctors. So this is what the Kennedy bill would have us say to lower income Americans: “Congratulations, we are going to run up the federal debt and add a big state income tax, in order to stuff you into a proposal where 40 percent of the doctors today will not see you.” It is like giving out a ticket to a bus system that does not have any buses. What is the alternative? The health care proposals I support are completely different. They focus first on the 250 million of us who already have health insurance to try to make sure that we can afford it. Then we say: let's provide a way for low-income Americans to choose a private health insurance policy more like the policies most of us have. We offer this instead of stuffing them into Medicaid which is filled with inefficiencies, cannot be managed, and which many doctors will not work with. After the economy, health care reform is the biggest issue before our country today. I am ready to go to work. I want to make sure that people aren’t disqualified from getting health coverage because of preexisting conditions. I want to make sure that everyone is covered and that they have access to health care at a cost their family’s budget can afford. I am resolute in my determination not to add trillions more to the national debt and not to dump new debt on American families and taxpayers. And I am resolute in my determination not to dump low-income people into a failing government program called Medicaid when a much better alternative is to give them with the tax credits and the vouchers and the cash they need to purchase private health insurance and have coverage more like the rest of Americans have.