Speeches & Floor Statements

Floor Remarks of U.S. Senator Lamar Alexander (R-Tenn.) -- Colloquy on Health Care with Sen. McCain

Posted on July 8, 2009

Mr. ALEXANDER. Mr. President, I heard the majority leader talk about denying care, and that is the issue before us -- one of the major issues. The vision of the Republicans is that there will not be someone in between a patient and a doctor who would get in the way of a treatment you need or the care you need or have you stand in line or wait too long. Our great fear is the Democratic proposal so far, in which we have not had a chance to participate, would put the government between you and the doctor and the government doing the rationing. Republican proposals, such as those of Senator Gregg and Senator Burr and Senator Coburn and even the bipartisan proposal by Senator Wyden, a Democrat, and Senator Bennett, a Republican -- of which I am a cosponsor of all -- envision a system where those of us, the 250 million of us who already have health care insurance, would be permitted to keep it and that we would find a way to reform the Tax Code to give to individuals who do not have good health care the money they need to buy the health care and to choose it for themselves. Our concern is, the Government might become too much involved, and we might create a program that is filled with more debt, on top of the debt we already have, that our children and grandchildren simply couldn't afford it. Mr. McCain, the Senator from Arizona, has been, I guess, in more town meetings about health care than any other American, at least any other American who serves today in the Senate. He was in Texas last week and home last week in Phoenix, at some of our leading institutions, to hear what people had to say about it. I wonder if I could ask the Senator from Arizona if he heard concern from those in his home State of Arizona, or those at MD Anderson in Texas, about the government getting in between the patient and the doctor. Mr. McCAIN. Mr. President, if I could say, first of all, I would like to thank the Senator from Tennessee for his leadership on this issue. It is a privilege to serve on the HELP Committee with him, and his continued involvement in the ongoing discussion and debate about one-sixth of America's gross national product has been vital. Mr. McCAIN. I thank my friend from Tennessee. Could I also pick up on what you were just saying, that the majority leader criticized the Republican leader in the House who said America has the best health care system in the world? What the Republican leader in the House was saying was the obvious: America has the highest quality health care in the world. And as the Senator from Tennessee just mentioned, I was in Houston at M.D. Anderson with Republican leaders, the Senator from Kentucky and Senator Cornyn from Texas. There were people there from 90 countries around the world -- 90 countries, most of them wealthy people who could have gone anywhere in the world for health care. But they went to the best place in the world, M.D. Anderson, one of the best, I would argue. We have some facilities in Arizona and probably in Tennessee that are of equal quality. But is there any doubt, when people come from all over the world to the United States of America, that the highest quality health care is not in America? It is. The problem is, and I am afraid some of my colleagues do not get it, it is not the quality of health care, it is the affordability and the availability of health care. Our effort has been to try to make health care affordable and available. The latest proposal of the Democrats is that it only covers 40 percent of the uninsured and costs trillions of dollars. So why not, I would ask my friend from Tennessee, why not let people go across State lines to get the insurance policy they want? Why could not a citizen of Arizona who does not like the insurance policies that are available there find one in Tennessee? Why not have meaningful malpractice reform? We all know where 10, 15, 20 percent, sometimes, of health care costs come from. They come from the practice of defensive medicine. Everybody knows it. It is the elephant -- it is one of the elephants in the room. So, therefore, we do not have -- and consistently in the HELP Committee, amendments that have been proposed by the Senator from Tennessee and me and others to reform medical malpractice have been voted down. The State of California some years ago enacted meaningful and significant medical malpractice reform. Guess what. It has decreased health care costs. So we are not getting -- and I say to my friend from Tennessee, I hope he agrees that we are going at the wrong problem. The problem is not the quality of health care. We want to keep the quality of health care. It is the cost and affordability of health care. We have not gotten affordable and available health care for all Americans. Mr. ALEXANDER. I agree with my friend from Arizona. I think of the pregnant women in rural counties in Tennessee who have to drive all the way to Memphis, or all the way to Nashville to get prenatal health care because there are no OB-GYN doctors after their medical malpractice cases have driven up their insurance. So there is no way for them to get health care. If I am not mistaken, I listened to the majority leader talking about the tragic case in Nevada of someone unable to get health care because of a preexisting condition. The Senator from Arizona knows all of the proposals. I believe all of the Republican proposals would say, everyone would be covered, that preexisting conditions would not disqualify you. The issue before us is whether we are going to address trillions to the debt or put the government in between the patient and the doctor. Mr. McCAIN. I totally agree. Could I mention, since the Senator from Tennessee and I are going up to another meeting in the HELP Committee, the Roll Call article this morning says: Senate Majority Leader Harry Reid on Tuesday strongly urged Finance Chairman Max Baucus to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill. Reid, whose leadership is considered crucial if President Barack Obama is to deliver on his promise of enacting health care reform this year, offered the directive to Baucus through an intermediary after consulting with Senate Democratic leaders during Tuesday morning's regularly scheduled leadership meeting. In other words, according to this article, any shred or semblance of bipartisanship is now out the window. So I think the Senator from Tennessee would agree with me. One of the very disappointing aspects of this whole debate is we have not changed the climate in Washington. Has there ever been, to the Senator's knowledge, a call to sit down at a table in a room with leading Republicans and Democrats and say: Hey, can't we work this out? What is your proposal? Here is ours. Can't we sit down and agree to save health care in America and preserve its quality and make it affordable and available? The same way back in the 1980s when Ronald Reagan and Tip O'Neill sat down together, they saved Social Security. This is unfortunate that even the last shreds of attempts at bipartisanship are now gone. Now maybe it is because the 60th Democratic vote was sworn in yesterday. Maybe they figured they had the votes. Maybe they do. But anybody who alleges that this administration and the other side of the aisle are changing the climate in Washington, that is simply false. Mr. ALEXANDER. There is probably no one in the Senate who has been in the midst of bipartisan negotiations more times than the Senator from Arizona. This is not just for the purpose of feeling good, it is the way to actually get a broad base of support for an energy bill or an immigration bill or a Supreme Court nominee. Usually it involves, if I am not mistaken, sitting down with several members of each side and coming to a consensus, sharing insurance ideas, fighting off the left and right and producing 60 or 70 votes. If I am not mistaken, that is the way we do bipartisan bills around here. Mr. McCAIN. I say to my friend, indeed. One of the issues I think we ought to continue to understand is one of the key elements of this debate as to whether we will have the so-called government option. I know the Senator from Tennessee is going to talk about that. I think it is important for us to look overseas at other countries that are highly industrialized, highly sophisticated, strong economies, countries that have government-run health care. To say the government option would be just another competitor clearly is not the case, otherwise we would just have 1,501 new insurance companies in America. If you had the government option, it will lead to a government takeover of health care, and we ought to look at what other countries do. I am sure the Senator from Tennessee knows this, but it is health care rationing and a level of health care that will not be acceptable in the United States of America. I say that with great respect to our friends in Canada, the British, and other countries that have government-run health care systems. I think that is going to be one of the two major issues: the government run health care and the employee mandate. Those are what this health care debate will come down to. It is of great concern, I know, to the Senator from Tennessee. Mr. ALEXANDER. I thank the Senator from Arizona. I know he is on his way to work on the health care bill, to take the leadership, to the extent we can, in making it a better bill. I thank him for coming to the floor to discuss that today, and to help us reemphasize that we do not have any disagreement with our friends on the other side about the need to reform health care. I do not think we have any disagreement. At least we want to make sure our principal goal is to make health care affordable for every American. We want your family and you to be able to buy health insurance at a price you can afford and to take care of tragic cases such as the one the majority leader talked about. I think there is a consensus on both sides of the aisle to make sure if you have a preexisting condition you can be insured, and it will not matter where you live. The Wyden-Bennett proposal, for example, and others, actually also say that you may carry your insurance from one job to the other, so that if you lose your job, or if you change your job, you still have your insurance because it is your insurance, and it does not just depend upon your employer. What we are concerned about is the fact that President Obama's administration has already proposed adding, over the next 10 years, more new debt, three times as much new debt actually, as was spent in all of World War II in today's dollars. That is the first thing. The second thing is this idea of the so-called government option. Someone says: What is so bad about that? Think of it this way. Let's say you put some elephants and some mice in one room. You 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. That is your only choice. We have 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 the State government. Every Governor -- and this has been true for 25 years, from the time I was Governor -- has struggled with finding money to both fund the State's share of it and still have money for higher education and for other State needs. It is filled with waste. The Congressional Budget Office says 1 out of every 10 taxpayer dollars that are spent for Medicaid is fraud, waste, or abuse. That is $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. The problem for the taxpayer is how expensive that is. I have a letter from the Congressional Budget Office dated July 7 to Senator Gregg, the ranking member of the Budget Committee, which I ask unanimous consent to have printed in the Record. Mr. ALEXANDER. That letter was from Douglas W. Elmendorf, the Director of the Congressional Budget Office, with whom I am about to meet, along with other members of the HELP Committee. It says: The proposal envisions that Medicaid -- that is the Democratic proposal -- would be expanded to cover individuals and families with an income below 150 percent of the Federal poverty level. That sounds good, but the draft legislation does not include provisions to accomplish the goal. About three-quarters of the people who would remain uninsured under this version of the legislation would have income -- in other words, even though we are spending trillions more under this proposal, a lot of people are uninsured and three-quarters of them are going to be dumped into Medicaid. For the Federal Government, that is hundreds of billions of new dollars we would have to borrow, and the thought is over time it would be shifted to the States. In the State of Tennessee, based upon conversations we have had with the State Medicaid director, it might add an amount of money to the State's annual budget that would be equal to the amount that a new 10-percent State income tax would take. 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 we say: Congratulations, we are going to run up the Federal debt and add a big State 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 Republican proposals are completely different. They focus first on the 250 million of us who already have health insurance to try to make sure it is affordable to us, that we can afford it. Then we say let's take the money that is available and give it to the low-income Americans and let them buy, choose, a private health insurance policy more like the policies most of us have. We offer this instead of stuffing them into the Medicaid proposals which are filled with inefficiencies, cannot be managed, and which many doctors will not work with. That is a better course forward. But, unfortunately, our voices are not being heard on that subject. But we are going to continue to make our case. We have the Burr proposal, the Gregg proposal, the Coburn proposal, the Wyden-Bennett proposal. All are different from the government option, and all do not run up the debt. In fact, the Wyden-Bennett proposal, which is the only bipartisan proposal before this body today, with several Republican Senators and several Democratic Senators, adds zero to the debt according to the Congressional Budget Office. Maybe as we go through, if we were seriously considering it, we would find a need to add some costs. But at least we start with the idea that instead of adding $1, $2, or $3 trillion over the next 10 years to the Federal deficit and dumping a new program onto the States after a few years, which the States in their bankrupt condition, in some cases, cannot afford, at least we would start out with an increased deficit of zero. We are almost working at the wrong end. Our biggest problem facing the country is the cost of health insurance to every American, not just the uninsured Americans but the 250 million who already have insurance. The other big issue is the cost of government, caused by rising health care costs, and we have gotten away from thinking of ways to bring that under control. There are even proposals floating around to take savings, to cut Medicare and Medicaid and use those dollars to help pay for the Democratic plan. If we reduce the growth of spending in Medicaid, we should spend it on Medicare, which is increasing at a rate that is going to cause our children and grandchildren never to be able to pay off the national debt. Republicans stand ready to work with Democrats to produce health care reform this year, despite the majority leader's statement that it is time for Senator Baucus to stop chasing Republican votes. We are glad he is chasing Republican votes, and we hope he gets some. But the way we do things around here usually is a group of 15 or 20 Senators, such as Senator McCain and others, sit around and say: OK, let's put our ideas together and come up with a consensus bill, not to operate from a procedure that we won the election, we have 60 votes, and we will write the bill. It is more complicated than that. It needs a broad base of support in the Senate to have a broad base of support in the country. Without that base of support, it will not be successful. We have made our proposals -- the Burr proposal, the Gregg proposal, the Coburn proposal, the Wyden-Bennett proposal. Senator Hatch and Senator Cornyn have a slightly different idea that would give the money to the Governors and let them find a way to cover low-income individuals. As a former Governor, I like that idea. We have an imaginative Democratic Governor in Tennessee who has brought the Medicaid Program there under some control and has come up with several innovative ideas. The difficulty he and other Governors have is that it takes them a year to get permission from Washington to try their innovative ideas to offer the kind of health care to low-income individuals they might need which could be different in Tennessee and different in California. This is the biggest issue before our country today. It is certainly the biggest issue before Congress. Republicans have our proposals on the table. We are ready to go to work. We want to make sure there are no preexisting conditions left out that disqualify people. We want to make sure that everyone is covered and that we have access to health care at a cost the family budget can afford. We are resolute in our determination not to add trillions more to the national debt and not to dump new debt on the States. We are resolute in our determination not to dump low-income people into a failing government program called Medicaid when a much better alternative is to give them the credits and the vouchers and the cash so they can purchase private health insurance and have coverage more like the rest of Americans have. ###