Speeches & Floor Statements

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

Posted on September 29, 2009

Mr. ALEXANDER. Madam President, all of us were home in August. It was a pretty good thing we were, because the people of the United States had a lot to say to us about the health care bill. I think President Obama was very correct when he said the health care reform bill is a proxy for the role of Federal Government in our everyday lives. I think that is what we are debating here. On the one side, we have an effort by the majority and the President to do this massive, comprehensive health care reform with thousand-page bills and White House czars and trillions in spending and debt. That is on the one side. On the other side we have Republicans saying we want health care reform, but let's focus on reducing costs to each American who has a health care policy -- that is 250 million of us -- that is why people are showing up at town meetings; it is not some abstract thing -- and reducing costs to our government, because we know that $9 trillion more in debt is coming. Mr. McCAIN. Will the Senator yield for a question? Mr. ALEXANDER. Yes, I will. Mr. McCAIN. First, concerning the costs, how do we know what the cost is if we don't have legislative text? I think all of us have been around here long enough -- we have talked a lot about the 72 hours that I absolutely think we need. The text should be online so that every American -- not just the 100 of us who are fortunate enough to be here -- can read it. Everybody should have the right to know what a fundamental reform of health care in America is all about, and they should be able to read the legislation if they want to. Just as important, I ask my friend, has he seen any legislative text anywhere? Is it true that the Finance Committee is moving forward with legislation regarding which there is no legislative text? And by the way, we find out now, according to the Wall Street Journal, Mr. Barthold noted in a followup letter that the willful failure to file -- that is, to take the government option -- would be punishable by a $25,000 fine, or jail time, under a section of the bill. I wonder how many Americans are aware of that. In fact, I have to tell my friend from Tennessee, I was unaware of it. So if we are unaware of it -- should we not have legislative text so that Americans know what is being legislated in the Senate Finance Committee; and second, shouldn't it be on line at least 72 years so everybody would know about it? Mr. ALEXANDER. The Senator is right. He and I and the Senator from Georgia are on the HELP Committee. We worked and we spent many hours in June and July marking up that version of the health care bill. We finished our work about July 15. That bill was 839 pages. It wasn't even presented to us until early in September, and we still don't know what it costs. I wonder if the Senator from Georgia heard much about reading the bill and how much it costs. Mr. ISAKSON. The Senator from Arizona and the Senator from Georgia and I all sat through 67 1/2 hours of markup in the HELP Committee on an 839-page bill, which was not scored and had 3 titles blank and they are still blank. We didn't have text during that debate on three titles within that bill, and what they are developing in the Finance Committee today, as I understand it, is concepts. The language is somewhere that we have not yet seen. This is too important for us to guess on and to take a chance on. It is most important that Congress know precisely what it is doing. Mr. ALEXANDER. Maybe the Senator from Georgia and the Senator from Arizona know more about this than I do, and they are debating concepts but they are getting down to specifics. I saw in a morning newspaper that Nevada was somehow miraculously taken care of in the provisions for Medicaid expenses. We have had Governors, both Democrats and Republicans, here saying if you are going to expand on Medicaid in our State, pay for it. What happened in Nevada? Mr. McCAIN. I say to my friend from Tennessee, first, it is clear that the Medicaid cost increases to the States will be incredibly large. The original version of the bill, according to media reports, the State of Nevada would have, along with every other State, a significant Medicaid expense. So somehow now the legislation has been changed, again, according to media because -- excuse me, the concept has been changed because we don't have legislative language -- that 4 States would then have 100 percent of their Medicaid costs assumed by the Federal Government for as long as 4 or 5 years. That is what goes on with the laws and sausages business here. I ask the Senator again, do you -- first, I ask unanimous consent that the editorial entitled "Rhetorical Tax Evasion" in the Wall Street Journal this morning be printed in the Record. Mr. McCAIN. This says: Chairman Max Baucus's bill includes the so-called individual mandate, along with what he calls a $1,900 "excise tax" if you don't buy health insurance. (It had been at much as $3,800.) So American small businesses, who are hurting more than any other group of Americans today -- the creators of jobs -- are now facing a $1,900 excise tax. By the way, the President, in response to George Stephanopolos, said there was no tax engaged here. I wonder how many Americans are aware of that and how many Americans have had the opportunity to know exactly not only what the costs to the Federal Government and the respective States are, but the costs to the individuals who are struggling to make it in America at a time of almost unprecedented unemployment? Mr. ALEXANDER. That is a very good point. The Senator from Georgia was in small business for many years before he came to the senate. Mr. ISAKSON. Yes, I ran a small real estate company for 22 years. We tried -- myself and other distinguished Senators -- on the floor to pass small business health reform 3 years ago which would have made more affordable and accessible health care to those independent contractors, the small business people. It was rejected and we could not get a cloture vote. Mr. ALEXANDER. May I interrupt for a moment? I often hear it said that you Republicans are not for health care too much. The difference is we have a little more humility than to try to take on the whole health care system at once and fix the whole world. We are ready to go step by step, and that is one of the most important steps -- to allow small businesses to pool their resources and offer health care to their employees. I think the estimate is it would add maybe a million new people who could be insured that way. Mr. ISAKSON. Under outside estimates -- not mine -- of the 47 million alleged uninsured, up to 16 million would have access to insurance because of associated health plans and small business reform. That is a third of the uninsured. Mr. McCAIN. My friend from Tennessee brings up a good and an important point about some saying that Republicans have no plan. The fact is that the Republicans have no plan for the government to take over the health care system in America. That is what it is. What are we for? We are for going across State lines so that these small businesses and individuals -- and the Senator from Georgia used to be one of them -- can get the health insurance policy of their choice. Why should they be restricted to the State they are in when perhaps there are minimum requirements for those health insurers residing in that State for coverage, which they neither want or need, and it may be in another State. Why don't we allow small business people to pool their assets together and negotiate with health insurers across America for the best policy they can get? And we are for medical malpractice reform and medical liability reform. We know doctors prescribe time after time, to protect themselves, unneeded and unnecessary procedures and tests. We all know that. That is in tens if not hundreds of billions of dollars. We are for medical malpractice reform. Where is it in any bill that has been proposed by the other side? We want outcome-based treatment. We want an individual who has a certain chronic disease to be treated on the basis of long term. We want Americans who have preexisting conditions to have a risk pool they can go to, or where risk pools would be established so they can get health insurance, and insurers will bid on those people with so-called preexisting conditions, so that every American can have affordable and available health insurance. We are for that. We are for medical malpractice reform. We are for going across State lines to get a policy of your choice. We are for outcome-based care. We are for taking on the drug companies that have cut an unholy deal with the administration, which will give them the obscene profits, and the lobbyists, who make over a million dollars. We want to be able to import drugs from Canada that are cheaper for the American people. We want competition, as there is in Medicare Part D, for these patients who need it, who don't have health insurance. So we are for a number of things, but we are not for a government takeover of the health care system. So the next time we read that the Republican party does not have anything they are for, then they are not paying attention. There is more that we are for, but it has to do with competition and with availability and with affordability of health care in America, not a government takeover. We have seen that movie before in other countries. Mr. ALEXANDER. As I listen to the Senator, I wonder if the Senator from Georgia is having the same impact. Every single step he said Republicans are for, whether it is getting rid of runaway junk lawsuits,going across State lines to buy insurance, whether it is allowing small businesses to pool resources, or incentivizing prevention and wellness, they are all focused on reducing costs. I ask the Senator from Georgia, I thought this was supposed to be about reducing costs for health care premiums and costs to our government; but it seems to me we are talking about more billions and more debt and more spending and taxes. Mr. ISAKSON. Those are the two things Republicans don't want, which is more debt to bankrupt our children and grandchildren and more taxes. Robert from Loganville was on my teletown hall meeting a week ago in Georgia. We were talking about the pay-fors. He said, "Senator, I want to ask you a question. The administration keeps talking about there being a half billion dollars of waste, fraud, and abuse in Medicare. If that's true, why haven't you saved it instead of using it to save against a national health care." That is precisely right. The pay-fors they are talking about to keep us from going into debt are moneys that may or may not be there. They involve taxation and raising taxes on small businesses. Those are the things we don't want to do as Republicans. Mr. McCAIN. I ask the Senator from Georgia, do you believe, one, that small business people in America today are ready for an additional cost laid on them to provide health insurance for themselves and their employees? Should we not make it easier and less costly, rather than imposing a government mandate, which may have types of health care that they neither want nor need, or paying an "excise tax," as is in Chairman Baucus's bill? The second point I want to ask the Senator about, of course, is this whole issue of what should be the government's role in health care in America today. We freely admit -- not only admit, but appreciate, the fact that Medicare is a government program. But we also appreciate that the costs of Medicare have skyrocketed to the point where we now have, by estimates, a $31 trillion unfunded liability. In other words, our kids and grandkids will not have Medicare 7 or 8 years from now unless we fix the issue of costs. Mr. ISAKSON. The Senator is precisely right, because as of right now, Medicare goes broke in 2017. That is only 8 years from now. In this bill, part of the pay-fors is to raise the cost of Medicaid on the States to a level that would take Georgia's Medicaid payments in 2014 by State tax dollars to be from 12 percent to 20 percent of our State budget. That is not the way to run a railroad. Mr. ALEXANDER. Going back to the point of the Senator from Arizona, I hear our friends on the other side say you have used scare tactics, saying there will be Medicare cuts. I ask the Senator, did I not hear the President say he was going to take a half trillion dollars out of Medicare for seniors? There are about 45 million seniors on Medicare and who depend on Medicare, and they will spend it on new programs. Is that not what I heard him say? Mr. McCAIN. That is why there is a rising sentiment, particularly among seniors, against this plan, the one passed through the House and passed through our HELP Committee and is now being formulated. Our seniors and our citizens are a lot smarter than many times we give them credit for. They know you are not going to get $1/2 trillion in "savings" from Medicare without there being reductions in Medicare. There are hundreds of billions of dollars of savings that can be enacted in Medicare, but why don't we start tomorrow or why didn't we start yesterday or why didn't we start at least at the beginning of this debate imposing those savings so we could have a delay in the year when Medicare goes broke? Mr. ALEXANDER. May I ask the Senator, if there are savings in Medicare, shouldn't it be spent on Medicare? Mr. ISAKSON. Absolutely. Mr. McCAIN. That is an excellent point. But also the fact is to root out this waste, fraud, and abuse is going to take time and effort and it is going to require some pretty hard work on our part. But we need to change some of the fundamentals of the Medicare system in providing more competition in the form of prescription drugs, in the form of medical malpractice liability reform, in the form of more competition between drug companies for Medicare and Medicaid patients. These reforms we are advocating have to be enacted in order to bring down the costs of Medicare, Medicaid, and overall health care costs in America. Look, it is obvious. The cost escalations that are bringing Medicare to a crisis are the same cost escalations everybody else in America is experiencing. Mr. ISAKSON. A lot of them are based in defensive medicine, which is practiced because of runaway lawsuits and verdicts. The administration's most recent comment about tort reform, to which the Senator from Arizona referred, was they want to do a study. A study is not what we need. What we need is action. That is one of the biggest contributors to the rising cost of health care we have. Mr. McCAIN. Or a demonstration project conducted by the Secretary of Health and Human Services who knows a lot about this, I admit, because I understand she was head of the Trial Lawyers Association for a number of years.. I am sure that gives significant qualifications to the person who is tasked with this study. Life is full of anecdotes and experiences we have. I was down in Miami at the Palmetto Hospital. I spoke to a surgeon there. By the way, they treat a very large number of people who have come to this country illegally. I asked the surgeon: How are you doing on making your insurance payments, your malpractice or medical liability insurance payments? He said: I don't have a problem. I don't have it. I don't have it because I couldn't afford it and probably I am not going to get sued because if they sue me, they are only going to get everything I have, not what the insurance company has. We are giving physicians and caregivers the untenable option of either paying skyrocketing malpractice insurance premiums -- in some cases $200,000 a year for a neurosurgeon -- or as this surgeon did and others have done: I am not going to have insurance. That is not an acceptable thing to do to physicians in America or anybody in America. Mr. ISAKSON. The other consequence of that is the threat of it, and the cost of becoming a physician is driving young people to go into other professions. We are going to have a shortage of providers, not just in physicians but nurses and caregivers, if we have an overly regulatory system and indefensible tort system. Mr. ALEXANDER. The Senators from Arizona and Georgia have raised a number of questions that need to be answered. How much is the expansion of Medicaid going to cost States in State taxes? How much of the Medicare costs are going to cost people on Medicare? Are individual premiums actually going up instead of down, which is what the Congressional Budget Office said. Why is there not something for getting rid of junk lawsuits in the bill? Why don't we have a small business health insurance pool? The point we made when we first started is if we are taking on 17 or 18 percent of the whole economy in another one of these 1,000-page-plus bills, why then do the Democratic Senators vote down the amendment to say that the bill needs to be online for 72 hours so we and the American people can read it? Shouldn't we read the bill we are voting on, and shouldn't we know how much it costs before we start voting on it? Mr. McCAIN. The Senator is exactly right. Again, wouldn't it be nice for our constituents -- by the way, many of them come to the townhall meetings with a sign that says "Have you read the bill?" -- let them read the bill too. Wouldn't it be nice if every American citizen who wanted to could go online and read the legislation and give us their ideas and thoughts as to how we could make it better? May I mention -- I hate to keep coming back to this issue of medical liability -- but a PricewaterhouseCoopers study says defensive medicine could cost us as much as $200 billion annually. If we are interested in savings, why don't we go right at that? Do we need a demonstration project someplace around America? I don't. May I mention one other point, and I would be interested in my colleagues' views on it. This proposal also levies new taxes on medical devices. Why in the world would we want to do that? Medical devices and the best technology in the world are developed in America, but they are very expensive as they are. Why would we want to levy new taxes on medical devices when we know very well that if the insurance company is paying for them, the insurance company passes on those increased costs to the insured, thereby increasing the cost of health insurance in America. Why would we want to do that? Mr. ISAKSON. It is raising the cost to the consumer because a lot of those types of things that are being taxed are purchased discretionarily and are not covered. They are paid for out of the pocket of the consumer. When you tax the medical device, you are just raising the cost of the medical device to the consumer. Mr. McCAIN. What the other side is trying to do is expand government, expand coverage, and yet, at the same time, reduce costs. You cannot square the circle. That is why they keep bumping into -- every time there is a new proposal and to make things more expansive and more available, they run into escalations in costs and how we are going to pay for it. I believe our constituents, again, have figured it out -- a reestimate of a $7 trillion to $9 trillion deficit over 10 years, a some $700 billion stimulus package that may have stimulated Wall Street but, frankly, in my view from being home a lot, has not stimulated Main Street and is not having an effect on unemployment in America, to say the least. The neighboring State of California now has 12.2 percent unemployment. They cannot get to where they want to go without increasing that deficit and debt burden that we are laying on future generations of Americans. I wish they would sit down with us. I wish we could sit down together, start from the beginning, knowing what we know -- we have all been well educated by this process -- knowing what we know now, knowing what we can do to reduce health care costs in America and make it affordable and available.. Unfortunately, as we watch the machinations going on in the Finance Committee, that has not happened yet. Mr. ISAKSON. I completely concur with the Senator from Arizona and the Senator from Tennessee. There is common ground, but you have to be willing to find it. So far that has not been the case. When we get to that point, we can solve a lot of the American peoples' problems. Just ramming through something we cannot read, we cannot quantify, we cannot score is not the way to go about it. Mr. ALEXANDER. If there is one point we would want to make, it is this.. It is such an ambitious program. The stakes are so high. This is no abstract debate. The reason people are turning up at town meetings is because this is about their health care insurance and also whether your government is going to go broke in the next few years, dumping a lot of burdens on our children and grandchildren. What we are saying is we need to read the bill and know how much it costs before we start voting on it. We need to read the bill. It needs to be online 72 hours. That is a modest request, it seems to me. That is a short period of time. Then we need to know how much it costs. Does it raise our premiums or lower them? Does it cut your Medicare, or does it not cut your Medicare? Does it increase the national debt, or does it not increase the national debt? We need to know the answers to those questions. It would be the height of irresponsibility for us to begin debating a bill that affects 17 percent of the economy at a time when our debt is going up so rapidly without having, one, read the bill and, two, knowing exactly what the nonpartisan Congressional Budget Office tells us every provision costs. Mr. McCAIN. Can I tell my friend, if the American people are able to know the details of this legislation, I think they would be surprised to know that the new taxes -- the medical devices, the prescription drugs and other tax increases -- they begin in the year 2010, 3 years before the provisions in the bill for "reform" are implemented. So for the next 3 years, the cost of health care and health insurance goes up due to the new taxes and fees, but the so-called reforms are not implemented -- why did they do that? -- so that the actual costs, as we cost it out over a 10-year period, are disguised by beginning the taxes and not implementing the reforms, which then the Congressional Budget Office can give a cost estimate which is less than, frankly, what it actually is if you put the reforms in at the same time as the tax increases. That is a little complicated, but I think Americans need to know that. Mr. ISAKSON. My only comment in closing is simply this: The Senator is exactly right. Once this horse is out of the barn, you can never put him back in. We have to get it right to begin with. We need to go back to the drawing board, have a bill we can read, and a bill we can afford. Mr. ALEXANDER. I thank the Senator from Arizona and the Senator from Georgia. They said what we believe. We need to stop, start over, and get it right. Above all, we -- it seems such a basic thing to say it is almost embarrassing to say it on the Senate floor -- we need to make sure we read the bill before we vote on it, and we need to make sure we know what it costs before we vote on it. Those two things are minimum requirements. From the Republican side, we want to reduce health care costs, and rather than try a comprehensive health care reform of the whole system, we would like to work step by step in the direction of reducing costs in order to re-earn the trust of the American people. Senator McCain and Senator Isakson have outlined a series of steps ranging from eliminating junk lawsuits against doctors to allowing small businesses to pool their resources, all of which would help reduce costs. I thank the Senators. I yield the floor. I suggest the absence of a quorum.