Speeches & Floor Statements

Colloquy Remarks of U.S. Senator Lamar Alexander (R-Tenn.) and Republican Colleagues -- Health Care Reform

Posted on December 15, 2009

As I recall, one of the things the Senator from Arizona told us after he came back following his campaign was, what the American people are concerned about is the cost of health care -- the cost. Of course, we are also concerned about government spending -- the cost to consumers of health care and the cost to government spending. Dr. Christina Romer, a part of the White House's economic team, said on one of the shows yesterday:

We are going to be expanding coverage to some 30 million Americans and, of course, that's going to up the level of health care spending. You can't do that and not spend more.

Maybe she didn't get the talking points for yesterday's appearances. But we have conflicting messages out of the White House on this very measure.

In short, it is safe to say this is a confused mess, a 2,100-page monstrosity of confusion and unintended consequences. Yet they are in this rush to enact a bill -- the benefits of which don't kick in until 2014 -- before Christmas Day this year. I am astonished at the irresponsibility of it.

Mr. McCAIN. Madam President, it is a remarkable process we are going through. I see that my friend from Tennessee is here. I know he, being the head of our policy committee and a major contributor to keeping us all informed and up to date, would also like to say something.

First, I will say something I had not planned on saying; that is, this has been a vigorous debate. I think we have been able to act in an effective way, which has been reflected in the polls of the American people who are largely opposed to this measure and greatly supportive of a process where we can all sit down together -- with the American people in the room, to be honest -- when we are talking about one-sixth of the GDP. The Republican leader's job has been compared by one of his predecessors to herding cats -- I agree with that -- or keeping frogs in a wheelbarrow. I have not seen the Republican Members on this side of the aisle as much together and as cohesive and working in the most cooperative and supportive fashion of each other since I have been in the Senate. For that, I congratulate the Republican leader.

Mr. McCONNELL. I thank my friend.

Mr. ALEXANDER. I congratulate the Senator from Arizona for his comments and his own leadership on this issue. I want to add my commendations to the Republican leader.

My thought is that the reason we are working so well together is because we are afraid our country is about to make a historic mistake. There is a lot of talk about making history. There are a lot of ways to make history. Put aside all of the laws about race -- don't talk about them. When we talk about race, that is often misunderstood. We didn't fail to make a historic mistake on laws about race until the 1960s, when we began to correct those laws. Let's put aside all the historic mistakes we might have made in failing to stop aggression before World War II. We know about those mistakes. We can remember historic mistakes.

I ask the Republican leader if the Smoot-Hawley tariff sounded like a good idea when President Hoover pushed it in the late 1920s. We were going to raise tariffs on 20,000 imported goods, create more American jobs, and it created the Great Depression. The Alien and Sedition Act sounded like a great idea. That made a little history. Shortly after our country was founded, we made it a crime to publish false and scandalous comments about the government. It has never been repealed. Our Supreme Court said it was a historic mistake. Then there was the Medicare Catastrophic Coverage Act of 1988. I wonder if the Senators might have been here then.

So we are capable of making historic mistakes. As the Senator from Arizona has said very well, most Americans, if presented with a problem, would not try to turn the whole world upside down to solve it. They would say: What is the issue? The issue is reducing costs. We can all talk to family members and others -- we know what they are paying monthly for premiums, and we would like that to be less, and we would like for the government's costs to be less.

Why don't we, as we have proposed day after day, and as the Senator from Arizona has said -- why don't we go step by step in the direction of reducing costs.

I will not go into a long litany of proposals we have made. We can take five or six steps on small business health plans, reducing junk lawsuits against doctors, or buying health insurance across State lines. We should be able to agree on that instead of a 2,000-page bill that raises premiums, raises taxes, and seems to have a new problem every day.

I think the cohesion on the Republican side is not so partisan. I like to work across party lines to get results. That is why I am here. I am just afraid that our country is about to make a historic mistake, and we are trying to help and let the American people know what this bill does -- what it does to them and their health care.

Mr. McCONNELL. The fear is palpable. In addition to the public opinion polls we have all seen, we are each having experiences with individuals. I will cite three.

I ran into a police officer -- a long-term police officer, an African American. He came up to me and said: Senator, you have to stop this health care bill.

Then there are the health care providers. I see Dr. Barrasso from Wyoming. Within the last week, I spoke to one of the Nation's fine cardiovascular surgeons. He said: Please stop the health care bill. This is going to destroy the quality of our profession. He told me of a friend of his, a neurosurgeon, who called him with the same concern.

I get the sense that there are an enormous number of health care providers -- physicians, hospitals, everybody involved in the health care provider business -- apparently, with the exception of the pharmaceutical industry, which seems to have cut a special deal -- who are just apoplectic about the possibility that the finest health care in the world is going to be destroyed by this -- as the Senator from Tennessee points out -- "historic mistake."

Mr. McCAIN. I will mention, also, on the issue of PhRMA, again, here we are in the direst of economic times, with a Consumer Price Index that has declined by 1.3 percent this year, and they have orchestrated a 9-percent increase in the cost of prescription drugs -- that is remarkable -- laying on an additional burden, which naturally falls more on seniors than anybody else since they are the greatest users of pharmaceutical drugs. I don't blame them for fighting for their industry. But the point is, what they are doing is harming millions and millions of Americans.
Again, about contributing to the cynicism of the American people, whether you are for or against the issue of drug reimportation, to cut a deal behind closed doors and then, apparently, because of support of an amendment by Senator Dorgan, go down and negotiate another deal -- how do you describe a process like that?

Mr. ALEXANDER. Well, "unsavory" would be a minimum word that comes to my mind. The problem I have is that Americans have a perfect right to their view, and the pharmaceutical industry has a perfect right to advocate its point of view. As I hear the Senator describe what has been going on, am I hearing correctly? I mean, the pharmaceutical industry is saying we don't like drug reimportation. The White House says: OK, we will cut a deal with you behind closed doors -- as far as we can tell -- and we will change the law this way, and then –

Mr. McCAIN. The original deal was published in every newspaper, and it was that they would close the so-called doughnut hole by some $80 billion. CBO said their profits would be reduced by some $100 billion if we allow reimportation. They had a $20 billion cushion.

Mr. ALEXANDER. So it is a negotiation between the White House, the President, and big industry about profits: I will do this, you do that, and then you go out -- and my understanding is that you write in as part of the deal that the industry spends $150 million on television advertisements in support of the deal. Is that the deal?

Mr. McCAIN. But then, incredibly, they counted the votes. The votes were there to pass the Dorgan amendment. According to published reports, the pharmaceutical industry is negotiating with the White House and lawmakers on a revised health care deal under which the industry would ante up cuts beyond the $80 billion it agreed to this summer.

In other words, because that wasn't sufficient to get votes to kill the Dorgan amendment that would allow reimportation of drugs, they went down and renegotiated. What is that called?

Mr. ALEXANDER. Well, if I am remembering right, earlier this year the Republican leader made a talk on the Senate floor. The attitude of the White House toward a large company in Kentucky, as I remember, was: If you don't agree with us on health care, we will tax you. That was the attitude, it seems, to come out. If you don't agree with us, we will tax you, or we will make it difficult for you to do business. If you do agree with us, we will make a deal with you that affects your profits.

Mr. McCONNELL. I say to my friends, beyond that, the administration basically told this company to shut up. They issued a gag order that was so offensive, even an editorial in the New York Times said it should not have been done. They could not communicate with their customers the impact of various parts of this bill on a product they buy, Medicare Advantage. The tactics have been highly questionable, it strikes me, from the beginning of the year up to the present. What Senator McCain is talking about is just the most recent example.

Mr. McCAIN. Can I also give you this to illustrate it graphically? In this news report, several lobbyists told Inside Health Policy -- that is the organization that is reporting this -- they have heard that the Pharmaceutical Research and Manufacturers of America may have already reached a deal with the White House and AARP to close the Senate bill's coverage gap by 75 percent versus the 50 percent under the current bill. PhRMA declined to confirm the reports that it may be agreeable to reforms that would further close the doughnut hole but signaled discussions were underway, and AARP said no agreement has been reached. We haven't seen a deal.
Here are our old friends at AARP at it again. They are at it again.

Mr. McCONNELL. Will the Senator yield for this point?

Mr. McCAIN. Yes.

Mr. McCONNELL. Is that the same AARP that would, I am told, actually benefit from the decline of Medicare Advantage because they sell policies themselves that would be more likely to be purchased by seniors? Is that the same AARP?

Mr. McCAIN. When you lose Medicare Advantage, as Dr. Barrasso will fully attest, then you are almost forced into the so-called Medigap policies, which then cover the things that are no longer covered under Medicare Advantage, such as dental, vision, fitness, and other aspects of Medicare Advantage.

So if you destroy Medicare Advantage, then people will be forced into the Medigap policies. Who makes their money off Medigap policies? AARP.

Mr. SESSIONS. If the Senator will yield for a question about this deal with big PhRMA, a few days ago I made reference to and quoted from a scathing editorial by Robert Reich, who served as Secretary of Labor in the Clinton administration, who is a leading intellectual liberal Democrat who criticized these deals in the most scathing terms. He used words I was reluctant to use on the floor -- as my colleague said, "unseemly," whatever. I would say it goes beyond that. He used the word "extortion." I don't think he used that word lightly.

I think it is the kind of process -- the Senator has been here and many who are on the floor now have been here for a long time -- but it seems to me this is pushing the envelope on dealmaking to the point that really is a dangerous step. It goes beyond anything we should countenance, in my view.

Mr. McCAIN. I agree with the Senator. Again, I would like to ask Dr. Barrasso because he has treated patients who are under Medicare Advantage. Before I do, I want to say again that the whole process has been wrong. The process of going behind closed doors; the process where, after nearly a year of addressing this issue, the distinguished -- and he is a fine person, a fine Senator from Illinois -- the No. 2 leader in the majority, in a colloquy I had with him just 2 days ago, said no one knows what is in the bill. He said no one knows what is in the bill. This is after a year. It is wrong. What it does is -- this issue is vital, but it destroys the confidence of the American people to be truly represented here to have their interests overridden by the special interests, of which PhRMA and this deal that is going on right now is a classic example. I ask Senator Barrasso.

Mr. ALEXANDER. Before Dr. Barrasso speaks, just listening to the Senator from Arizona, it seems to me it puts the Democratic leadership in the extremely awkward position of even its leadership -- proposing a bill that affects 17 percent of our economy and the leadership of the Democratic Senate doesn't yet know what is in the bill, we certainly don't know what is in the bill, and they are in the awkward position -- at least they have been the last few days -- of filibustering their own bill at a time when they are insisting that we pass the bill before Christmas, which we can hear the sleigh bells ringing. It is just a few days before that happens.

Mr. BARRASSO. It seems, as we are on the Senate floor talking –

Mr. McCAIN. May I interrupt? I ask unanimous consent that the Senator from Tennessee take over this colloquy.

The PRESIDING OFFICER (Mrs. SHAHEEN). Without objection, it is so ordered.

Mr. McCAIN. Go ahead. I am sorry.

Mr. BARRASSO. It seems to me, as we are on the Senate floor discussing the issue wide open -- any American can come in here and listen to us -- hidden behind closed doors is the other party, maybe sharing what is in the secret negotiations, maybe not, because it sounds as if a number of their members don't know.

What I do know from practicing medicine for 25 years and taking care of families around the State of Wyoming is that people depend on Medicare for their coverage. There are seniors who depend on Medicare and Medicare Advantage. The reason they call it Medicare Advantage is because there are advantages to being in it. It coordinates care. It helps with preventative care, which is not part of the regular Medicare Program.

Yesterday, I heard my colleague from Arizona say there are those who want to shut down Medicare Advantage -- AARP, he said -- because they are the ones to benefit and profit if, in fact, Medicare Advantage is lost to the seniors in this country. Madam President, 11 million Americans depend on Medicare Advantage. Yet they are losing because of a vote this body took. This body voted to strip $120 billion away from our folks who depend on Medicare Advantage.
I know the Senator from Arizona has another important point he wants to make.

Mr. McCAIN. The point I want to make is this process has turned into something, again, like I have never seen before. I was just handed this FOX News, just-reported breaking news that Harkin said -- I guess referring to the Senator from Iowa -- Harkin said that Medicare buy-in and public option are now dead. I don't know what to say except it seems to me they are just throwing everything against the wall and seeing what sticks and what doesn't stick. This is really, again, one of the most astounding kinds of situations I have observed in the years I have been in the Senate. Medicare buy-in is dead; public option is now dead.

What I would like to see is that Harkin would report that now Republicans and Democrats will sit down together and try to work out something of which the American people would heartily approve.

Mr. BARRASSO. I have great concerns about the health care availability for the people of our great country. This is a front-page story in the Wyoming Tribune Eagle on the 13th: "Doctor shortage will worsen." That is what I am worried about. I am worried about the patients at home. I am worried about the folks in Arizona, Alabama, and Tennessee. "Doctor shortage will worsen." "It is estimated that as many as one-third of today's practicing physicians will retire by 2020" and provider shortages will continue to increase. It says that based on health care so-called reforms they are proposing, the strain on certainly Wyoming's physician shortage will even possibly lead to longer wait time for appointments as patients travel even farther for care.

As I look at this bill that raises taxes $500 billion, cuts Medicare $500 billion, and causes people who already have insurance -- insurance they like but they are concerned about the cost -- they will see the cost of their premiums going up. There is very little in this bill that I think the American people would be interested in having for themselves.

The President has made a number of promises. He said: I won't add a dime to the deficit. Eighty percent of Americans do not believe him. Recent poll, CNN, 80 percent of Americans don't believe the President on that point. How about taxes? With taxes, he said he won't add a dime to your taxes. Eighty-five percent of Americans don't believe him there. They believe their taxes are going to go up. Yet they don't believe the quality of their care will be better.

So when we talk about a bipartisan solution, we want to improve access to care, we want to get costs under control. This bill raises costs.

Mr. ALEXANDER. I see the Senator from Idaho is here. We both had the experience of being Governors, as did the Presiding Officer in her State of New Hampshire. We were talking the other day -- and I hope he doesn't mind me repeating that -- I worked with a Democratic legislature the whole time I was Governor. But what we always did on anything important was we sat down together. We had our different positions, we fought during elections, but we worked things out. We didn't go forward unless we found a way to agree. That meant I usually didn't get my way. I got some of my way, but I had to take into account that someone else -- in this case, the Democratic legislature in Tennessee -- might have a different idea. Sometimes it was a better idea.
I ask the Senator from Idaho, we talk a lot about bipartisanship around here. The reason for bipartisanship is that these big bills are tough bills. We are expected to make difficult decisions: Are we going to reduce the growth of Medicare? Are we going to expand Medicaid? Are people going to be required to buy insurance? What are we going to do about health care premiums?

Many of these decisions are controversial.

When the American people look at Washington and they see that just one side of the political spectrum is pushing a bill through and the other side says: Absolutely not, what kind of confidence is that going to give the American people? On the other hand, if they look at Washington as they did with the civil rights legislation we talked about in the 1960s when Lyndon Johnson, a Democrat, was President and Everett Dirksen was the Republican leader, they saw the Republican leader and the Democratic President saying: OK, this is a tough problem, but we have a solution with which we both agree. Then the American people had some confidence in that.

Bipartisanship is not just a nice thing; it is a signal to the American people that people of different points of view think a controversial decision is in the country's interest. Isn't that totally lacking here? Isn't that bipartisanship signal lacking across the country?

Mr. RISCH. I thank the Senator. I am astonished at the process that is involved here. If one steps back and has a look at this from 30,000 feet and you look at what we are doing here, what we are doing here is -- and I say "we"; it is actually the other side of the aisle -- what the other side of the aisle is doing here is they are attempting to entirely revamp the health care system of this country and they are doing it all in one bill, which we think is a mistake. It should be broken into its component parts. The bill contains and attempts to address quality, cost, accessibility, and the insurance industry all put into one bucket and stirred and expected to resolve all of these problems at one time.

If you look at what has happened here, the House produced three bills, a multithousand-page bill. Those bills were stirred around over there, and eventually in the dead of night they finally got one of them passed with one or two votes to spare. Then it came over here. There were already two bills over here.

The two bills were produced through the committee process. The committee process is a very good process by which we produce bills. Admittedly, both of those bills were heavily skewed to the Democratic side, and all of the Republican amendments -- or virtually all of the Republican amendments, certainly all the significant amendments -- were voted down on a party-line basis.
Those two bills came out of those committees. One would expect that then they came to the floor and would go through the process. But, no, the two bills were taken over to the majority leader's office, doors shut, curtains closed, and various people were brought in. We don't know who, we don't know how, we don't know what the negotiations were, but at the end of the day, a third bill over here was produced, and it is 2,074 pages long. It is usually kicking around here on the desks. I see they removed most of them. I suspect they removed most of them because most people were afraid they were going to fall over and hurt somebody. These were 2,074 pages that were put together. Nobody really knows exactly what is in them. There are some generalities that we know, but we don't know all the specifics.

Then what happened is a week ago, they decide they will put 10 people in a room, leave the rest of the 90 of us out, and they will try to come up with some type of compromise. And they did. The next day, I got calls from home: I guess it is over; they put out an announcement; they have a compromise. I said: That is news to me. I don't know what is in it. I started to make some calls. Nobody will release the details of what this supposed compromise is.
Remember, in the last election we were promised things would be changed. Change we could believe in. These things would be done out in the open, without lobbyists coming and getting their input in the bill behind closed doors. That is exactly what has been produced. You have a secret document that has been produced that we have not even seen.

In spite of all this, the other side is saying: By golly, we are going to produce a bill before Christmastime. Christmas is coming, and Christmas is very close.

I can tell you, after looking at these 2,074 pages -- not looking at the compromise because we are told we cannot see it -- it would be reckless, absolutely reckless to shove down the throat of the American people something that has been put together in secret, something that has been put together in the dead of night, something they will not let us look at and examine, and to say: We are going to take this now and shove it down the American people's throats before Christmastime.

This is not a Christmas present the American people want. If you don't believe me, all you have to do is look at the polling. The polling shows every single day support for this bill deteriorates. It deteriorates amongst Republicans, amongst Democrats, and amongst Independents. The last poll, I think, was up to 61 percent of the American people said: Don't do this to us.

We need health care reform in this country. We want health care reform in this country. But this monstrosity that has been produced, and whatever it is they are going to drag out of the alley tomorrow and say: This is what we are going to vote on now, is not what the American people want.

I have a message for those on the other side from the American people: Don't do this to us. Stop. Bring some sanity into this. Do it right.