Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I agree with the Senator. That is why we have 22 minutes on the Republican side to clear up some misconceptions. The Democratic health care bill does cost $2.5 trillion over 10 years when it is fully implemented. If I may say so, it is arrogant to think the American people couldn't figure out the difference between the first 10 years, when the bill wasn't implemented in 4 of those years, and they would like to know that it costs $2.5 trillion.

Mr. ALEXANDER. I hope the Parliamentarian is keeping track of the Republican time. I am enjoying the questioning, and I thank the Senator for his question. One of the things--in fact, a great compliment has been paid to the Senator from Arizona. It is rare that a Senator can have something he said actually begin to break through the fog. Dana Milbank, a columnist for the Washington Post, wrote a column about it being all about grandma and wondering why we never mention grandpa. Maybe Mr. Milbank hasn't seen the movie ``My Big Fat Greek Wedding,'' where the man said, ``I'm the head of the house,'' and the woman said, ``I'm the neck, because I can turn the head any way I want.'' We are talking about grandma because she can help persuade grandpa. If we take $465 billion out of Medicare over 10 years, grandma and grandpa and those who are younger and looking forward to Medicare will be affected. If I may say to the Senator from Arizona--and I see the Senator from Oklahoma and the Senator from Nebraska--it wasn't long ago, in response to the question--in fact, in 2005, when we sought to restrain the growth of Medicare by $10 billion over 5 years, and this is what they said--remember, they are ``restraining'' the growth of Medicare by $465 billion and spending it on a new program, and Republicans were, at that time, trying to save $10 billion over 5 years. ``An immoral document,'' said Senator Reid and Senator Dodd. The Senator from Connecticut said that funding for Medicare would be cut. Senator Rockefeller: ``A moral disaster of monumental proportion.'' Senator Boxer, in the same way, compared it to Katrina. Senator Kerry said we are ``passing the costs on to seniors.'' Senator Levin said people are ``going to be hurt by this bill.'' ``Irresponsible and cruel,'' said Senator Kohl. Senator Reed and Senator Hillary Clinton also made similar comments. That was for $10 billion of restraining the growth of Medicare to spend it on the existing program. Yet this proposal by the Democrats would take $465 billion and spend it on a new program.

Mr. ALEXANDER. I would say no to that, Mr. President, because the Director of the Congressional Budget Office made it clear there would be specific cuts in benefits for those who have Medicare Advantage, which is about one out of four seniors.

Mr. ALEXANDER. Didn't I hear the words ``providers overpaid''?

Mr. ALEXANDER. Mr. President, we have enjoyed our discussion with the distinguished chairman of the Finance Committee and thank him for his questions. Senator Coburn, who is a physician--the Senator from Montana talked about doctors being overpaid. He talked about----

Mr. ALEXANDER. I mean whatever time the Senator uses should be on Democratic time.

Mr. ALEXANDER. As long as it is on Democratic time.

Mr. ALEXANDER. Mr. President, I am happy to see a debate actually break out on the Senate floor on this issue.

Mr. ALEXANDER. I must have misunderstood. Normally when we talk about providers, we talk about hospitals and physicians. We have a physician on the Senate floor, the Senator from Oklahoma. I wonder if he, having heard this debate, might want to comment. I might say, isn't it true that the McCain motion, which we have on the floor, would send this back to the Finance Committee and say: If there are savings, let's spend it on Medicare to actually strengthen it?

Mr. ALEXANDER. I will concede to the Senator from Montana that the attempt of the Democrats to pay for this $2.5 trillion bill consists of Medicare cuts, tax increases, and additions to the deficit by not including the physician reimbursement, which is an essential part of any 10-year health care plan. There may be other problems, but those are the three things I know about.

Mr. ALEXANDER. Mr. President, it is clear there are $465 billion in cuts in Medicare. The Chair and the Senator from Montana and the Senator from Connecticut have all agreed that is a big part of how the bill is supposedly paid for. It is specific enough to say that $135 billion comes from hospitals; $120 billion from Medicare Advantage, which 11 million seniors have; nearly $15 billion from nursing homes; $40 billion from home health agencies; $8 billion from hospices. The Director of the CBO testified that provisions like that would result in specific cuts to benefits for Medicare Advantage. He said that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear. The changes would reduce the extra benefits, such as dental, vision, and hearing coverage, that currently are made available to beneficiaries.

Mr. ALEXANDER. I would like to finish responding to Senator McCain, if I might.

Mr. ALEXANDER. I say to the Senator from Arizona that he is exactly right. Another way to describe it, the Senator from Kansas said it was like writing a big check on an overdrawn bank account and buying a big new car. Maybe another way, if I may respond to the Senator from Arizona--I ask unanimous consent that Republican Senators, on our time, be allowed to engage in a colloquy.

Mr. ALEXANDER. Yes.

Mr. ALEXANDER. I wholeheartedly disagree with that. The Medicare trustees have said that between 2015 and 2017 Medicare will be approaching insolvency. They have asked that we take urgent action. The urgent action recommended by the Democratic majority is that we take $465 billion out of the Medicare Program over 10 years and spend it on a new entitlement. It is hard for me to understand how that can make Medicare more solvent, when you take money out of grandma's Medicare and spend it on someone else.

Mr. ALEXANDER

Mr. ALEXANDER. Would the Chair let me know when 4 minutes remain. The Senator from Idaho will conclude our remarks at that time. The Senator from Idaho has made an important point, anticipating our Democratic friends will have the next 30 minutes and some other things they may be saying the rest of the day. There was a lot of talk yesterday about the CBO report about the effect of this $2.5 trillion proposal on premiums. Rather than take my word for it, let's go to the news section of the Wall Street Journal of today which has the headline: ``Some Health Premiums to Rise.'' That means going up. That means the cost of your insurance is going up for some Americans. So my question is, why would we spend $2.5 trillion over 10 years, cut Medicare, raise taxes, and run up the debt to raise some health premiums? I thought the whole exercise was to lower the cost of health care premiums. The article says: The analysis released Monday by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation-- We are supposed to pay some attention to these outfits as nonpartisan-- painted a more complicated and uncertain picture. It said people who pay for their own insurance would see a higher bill, albeit for more generous benefits-- That is the government-approved insurance you are going to be forced to buy. unless they are lower earners who qualify for a new government tax credit. Where is the money going to come from for those subsidies? It is going to come from grandma. It is going to come from Medicare. It is going to come from taxes. And it is going to come from increasing the debt. Those are facts. Employees of small firms-- Says the Wall Street Journal-- would effectively see their insurance premiums unchanged-- So for small firms, we are going to spend $2.5 trillion over 10 years, cut Medicare, cut taxes, and run up premiums for millions of Americans, so your insurance will continue to go up at about the rate it already was. Why should we be doing that? while workers at large firms would see something between unchanged and slightly lower premiums under the bill-- Compared to what would already happen-- according to the analysis. We need to change the debate. We need to start over. Instead of this comprehensive 2,000-page bill that is full of taxes, mandates and, as a general effect, raises premiums and taxes and cuts Medicare, we should set a clear goal, reducing costs, and begin to go step by step toward that goal--reducing junk lawsuits against doctors, allowing health care to be purchased across State lines to increase competition, allowing small businesses to combine in health plans so they can offer more insurance to employees at a lower cost. These three bills I mentioned have been offered and rejected so far by the Democratic majority. We should have more flexibility in health savings accounts, efforts at waste, fraud, and abuse, which are, in effect, Medicaid--the largest government program--and Medicare--the second largest--and more aggressive steps to encourage wellness and prevention. One approach, the comprehensive 2,000-page bill, Washington-takeover approach, Americans are very leery of. In my respectful opinion, this bill is historic in its arrogance for thinking we could take a system that affects almost all 300 million Americans, 16 percent of the economy, and change it all at once. Instead, why don't we go step by step to re-earn the trust of the American people? Republicans will be making those proposals on the floor this month and next month and as long as it takes to try to see that we get real health care reform. Cutting grandma's Medicare by $\1/ 2\ trillion and spending it on a new program at a time when Medicare is going broke is not real health care reform.

Mr. ALEXANDER. I see the Senator from Idaho here. I wish to hear his observations. If there is any issue in this entire health care debate that symbolizes why we on the Republican side want to change the debate to a step-by-step approach to reducing the cost of premiums, it would be the Medicare issue. As the Senator from Arizona said, what we need to do about Medicare is make it solvent as quickly as we can, as effectively as we can. The Senator from Kansas said the other day that the proposal to take $465 billion from grandma's Medicare and spend on it some new program is like writing a check on an overdrawn account in a bank to buy a big, new car. There is a lot of truth to that. The President said earlier this year something I agree with. He said this health care debate is not just about health care. It is about the role of the Federal Government in the everyday life of Americans. He is exactly right about that. This health care debate, which we are beginning this week, is not just about health care. It is about the stimulus package, about the takeover of General Motors. It is about the trillion dollar debt. It is about the Washington takeovers. It is about too much spending, too much taxes, too much debt. The Medicare provisions in this bill are a perfect symbol of that. That is why Senator McCain is right. What he is saying is, don't cut grandma's Medicare and spend it on some new program. If you can find some savings in the waste, fraud, and abuse of grandma's Medicare, spend on it grandma. Make sure those of us who are older and those of us who are younger and looking forward to Medicare can count on its solvency. Later this week we will talk more about premiums going up. There was a lot of discussion yesterday because, according to the Wall Street Journal, some health premiums would rise. For people who get their insurance from large employers, this bill won't make much difference. And for small employers, if you get your insurance from a small employer, it won't make much difference. If you are going to the individual market to buy insurance yourself, your premiums will go up, except we are going to get some money from somewhere to help pay part of your premiums, at least for about half of Americans who are in the individual market. Where are we going to get that money? From grandma. We are going to get it from Medicare. So that is what is wrong with this bill. And what is right about the McCain amendment is, it says simply, don't cut Medicare. If we find savings, which we hope we can in Medicare, we should spend it on making Medicare solvent. I wonder if the Senator from Idaho is hearing from seniors in his State about the proposed $465 billion cuts to Medicare and how they feel about taking that money and spending it to create a new program?

Mr. ALEXANDER. I think the Senator from Arizona is right. The President of the United States, in his address to us about health care, and the New York Times, the Wall Street Journal--everyone who has reported on the Congressional Budget Office figures said the same thing. We are going to pay for this bill, which is $2.5 trillion over 10 years when fully implemented, by $465 billion cuts in Medicare. What Senator McCain in his amendment that we are in support of is saying is, don't cut grandma's Medicare to pay for someone else's insurance. He goes on to say, if you are going to find some savings in waste, fraud, and abuse in grandma's Medicare, spend it on grandma. The reason for that is that the Medicare trustees have said to us that there is $38 trillion in unfunded liabilities for the Medicare Program and that the program will start going bankrupt between 2015 and 2017. According to the Medicare trustees, they say, ``We need timely and effective action to address Medicare's financial challenges,'' and the proposal, if I may say to the Senator from Arizona, who is on the Finance Committee and deeply involved in what we need to do about our Nation's finances, I don't think the Medicare trustees were thinking that the timely and effective action we could take to keep Medicare from going broke was to take $465 billion out of it and spend it on some new program.

Mr. ALEXANDER. I congratulate the Senator from Arizona on his analysis of the Medicare cuts. I heard the Democratic leader talk about figures and how we have some figures and the Democrats have other figures. I agree with him. I think someone watching this must think we are on two different planets sometimes, so let me focus in on the figures. I believe I heard my colleague say to pay for this health care bill over 10 years there would be $465 billion in the Medicare cuts. Where does that figure come from?

Mr. ALEXANDER. In discussing the Medicare cuts, another provision of the bill which we will be talking about this month and next month as we go through the health care debate is what about the problem of paying doctors and hospitals who see Medicare patients. They get paid about 83 percent of the rate they would be paid if they were seeing a private care patient. Every year Congress has to make an adjustment in something we did a few years ago which automatically cuts the amount of money that we pay doctors who are seeing Medicare patients. That is a big problem for Medicare patients. Because if the doctors can't be paid, they won't see the patients, and Medicare patients may find themselves increasingly in the condition that Medicaid patients do, low-income Americans who are covered through the State program-- that is our largest government-run program--where they are paid about 60 percent of what doctors who see private patients are paid and about half of Medicaid doctors won't see new patients. I ask the Senator, does he see anywhere in this bill a provision for the $\1/4\ trillion that will be needed to pay doctors 10 years from now what they are making today? If it is not in the bill, where is that $\1/4\ trillion going to come from? Is it going to come from Medicare cuts, or will it come from adding to the deficit?

Mr. ALEXANDER. Mr. President, how much time remains on the Republican side?

Mr. ALEXANDER

Mr. ALEXANDER. The Senator from Arizona is exactly right. There is no Senator in the Chamber who has a better record of working across party lines on bipartisan steps in the right direction than the Senator from Arizona. But going to Mr. Samuelson's comment--I was talking to a businessman this morning. I said: If you had a problem in your company, would the first thing you would do is to tear the whole company down and start over again? Or if the football team had lost two or three games, would you blow up the stadium and run everybody off? No, that is not the way you do it. The person I was talking to said: What I would do, I would identify the problem, I would test the solution, I would phase it in, and I would make sure we can afford it. The American people know that. I think they are sitting up there looking at us saying: What are these guys doing? Two-hundred-fifty million of us have health care policies, 85 percent. We would like for the rest of America to have that opportunity too. But we know we can't afford that until we get the costs down. Why don't we do as the Senator from Arizona suggested, let's move step by step in the right direction to re-earn the trust of the American people by reducing costs? He said: Why haven't we done that? One of those steps is to allow small businesses to pool their resources and purchase a health plan, which the Congressional Budget Office has said would allow nearly 1 million more employees of small businesses to be covered. Their rates would be lower than they are paying today. It would save $1.4 million of Medicaid. This is what the Congressional Budget Office said. So it would reduce costs, increase insurance coverage, and lower premiums. The reason we are not considering it is because when we brought it up, the Democrats said no. They filibustered it. They didn't come across the aisle and say that is a pretty good idea; let's put that together with two or three of ours, and we will reduce costs. I say to Senator Bennett of Utah, you have founded a company. You have run a company. If you were having a problem with the cost of a product or some other fundamental problem, is the first thing you would do, is to think you were wise enough to tear the whole thing down and start over again? Or if you called in a consultant and he recommended that to you, what would you say to him?

Mr. ALEXANDER. It sounds right to me. It is another part of the arrogance of this bill, which is to say we are not smart enough to figure it out. The majority is saying the 10-year cost of the bill is $849 billion, but it doesn't start counting until the fifth year, and Senator Reid thinks the American people are not smart enough to figure that out. That is part of the arrogance of the bill.

Mr. ALEXANDER. That is $2.5 trillion, right?

Mr. ALEXANDER. Mr. President, I would say to the Senator from Arizona, that is a part of the problem. But I think of it a little different way. There has been a lot of talk this week about medical care availability for women in America. In Tennessee, in 45 of our 95 counties, there are no OB/GYN doctors. So pregnant women in Tennessee in those counties have to drive 50, 60, 70 or 80 miles for prenatal health care. They might have to check into a hotel for a few days in a big city in order to have their baby.