Max Baucus

Mr. BAUCUS

Mr. BAUCUS. Madam President, I yield myself 2\1/2\ minutes from the time under the control of the managers. For the benefit of all Senators I want to take a moment to lay out today's program. The time between now and 11:45 is for debate on the amendment by the Senator from Maryland, Ms. Mikulski, the chairwoman of the Subcommittee on Retirement and Aging of the Health, Education, Labor and Pensions Committee. And at the same time, we will debate the side-by-side amendment by the Senator from Alaska, Ms. Murkowski. At 11:45, the Senate will conduct two back-to-back rollcall votes on the two amendments, first on the amendment by the Senator from Maryland, and second on the amendment by the Senator from Alaska. Thereafter, we will conduct approximately 2 hours of debate on the McCain motion to commit on Medicare and the side-by-side amendment by the Senator from Colorado, Mr. Bennet. At 2:45, the Senate will conduct two back-to-back votes on the amendment by the Senator from Colorado, followed by a vote on the motion to commit by the Senator from Arizona. Thereafter, we expect to turn to another Democratic first-degree amendment and another Republican first- degree amendment. This is the fourth day on this bill, and we are only late this morning coming to our first vote. Even for the U.S. Senate, this is a slow pace. I note that some have made plans for delaying this bill in even more extreme fashion. As the majority leader noted, on Tuesday, one Senator circulated a list of delaying tactics available under the Senate rules. I presume all Senators know the Senate's rules already. So to send the letter leaves the impression that that Senator would like to urge Senators to use some of the delaying tactics stated in the memo. But I urge a more cooperative course. Out of courtesy to other Senators who desire to offer amendments. I urge my colleagues to allow us to reach unanimous consent agreements to order the voting of future amendments in a more timely fashion. That is simply the only way that we can ensure that more colleagues will have the time and opportunity to offer and debate their amendments. I thank all Senators.

Mr. BAUCUS. I ask unanimous consent that the order of December 2 be modified to delete all after the word ``table.''

Mr. BAUCUS. I ask unanimous consent that the debate time from 2 to 2:45 this afternoon be divided as follows in the order listed: the first 17\1/2\ minutes under the control of Senator McCain or his designee; the next 17 minutes under the control of Senator Baucus or his designee; and the final 10 minutes, 5 minutes each for Senator McCain and Senator Bennet of Colorado.

Mr. BAUCUS. Madam President, I think it is perfectly understood.

Mr. BAUCUS. Madam President, will the Senator yield for a quick inquiry to my friend from Wyoming?

Mr. BAUCUS. Madam President, I might inquire of my colleague from Wyoming if that item the Senator was quoting from about costs in the Wall Street Journal was a news article or an editorial.

Mr. BAUCUS. Mr. President, I am going to speak very briefly on the pending subject and then let the sponsor of the amendment, that is the Mikulski amendment, finish up here. I think it is very telling--I know this point has been made before but I think it bears repeating--the American Heart Association, American Stroke Association has written and released to the Senate this letter. I will read the most important part here. Basically they say they strongly support requiring health plans and Medicare providing first dollar coverage for clinical preventive services that are evidence based and necessary for the prevention or early detection of an illness or disability. We all agree with that. They go on then to comment on the Murkowski amendment, saying they appreciate the Murkowski amendment recognized the value of the guidance and recommendations but they go on to say that even these guidelines must be held to a standard of being evidence based. I might say, I run across this over and over again in the medical profession--medical experts. We need to keep moving more and more toward evidence-based medicine. This statement from the American Heart Association, American Stroke Association, goes on to say: In addition, we are concerned that Senator Murkowski's preventive health services amendment would take a step backwards by substituting the judgment of the independent U.S. Preventive Services Task Force with the judgment of private health insurance companies. Frankly, it is a point I very much agree with. I don't think we want the judgment of private health insurance companies making these decisions. I think it is appropriate the sponsor of the amendment finish. She is doing a very good job.

Mr. BAUCUS. Mr. President, I wonder if the Senator from Wyoming would be available to answer a question.

Mr. BAUCUS. I am thankful to my good friend and neighbor to my State. Is it true the CBO letters say the Senate bill will extend the life-- extend the solvency of the Medicare trust fund? Is that true?

Mr. BAUCUS. I don't have the letter in front of me, but in all deference and respect to my good friend from Wyoming, the CBO says the exact opposite. It is the conclusion of the Congressional Budget Office that this legislation will help seniors by extending the solvency of the Medicare trust fund by, I guess, 4 to 5 years. That is black and white. If I had the letter in front of me, I could read it to him, but that is a fact. This legislation will extend the solvency of the Medicare trust fund by another 5 years. So instead of being insolvent in the year 2017, under this legislation, that is extended to the year 2022. That is a fact. At least the fact is that is what CBO concludes in their letter. That is a fact. Second, as a caring physician, does the Senator think that we as a country should try to find a way to provide health insurance for so many Americans--some of them lower income--who don't have health insurance in our country? Because, after all, we are the only industrialized country in the world that doesn't find a way to make sure its citizens have health insurance. As a physician who sees patients, many of whom can't pay their bills and defer medical treatment because they do not have health insurance, I am wondering if the Senator believes this country should try to find a way where its citizens have health insurance.

Mr. BAUCUS. I will ask this question, and then I will finish because I know my colleagues want to speak. One of the basic underpinnings of this legislation is that we should change the way we reimburse providers, moving away from quantity and volume and more toward quality. I am curious--and this is not an antagonistic question. I am just trying to get a physician's point of view because so many doctors I talk to think that although it creates a little uncertainty, probably that is the right thing to do--to move our reimbursing based on quality, coordinated care, and focusing on the patient rather than our current system, which reimburses more on quantity and the number of services provided, et cetera. Is that something the Senator thinks we should pursue in this country?

Mr. BAUCUS. I agree.

Mr. BAUCUS. Mr. President, I have to address that one. My colleagues want to speak, but I think it is worth repeating over and over again: This legislation is designed to retain the uniquely American solution to health care--roughly half public, half private. It is designed to make sure patients can still, as they should, choose their own doctor, any doctor they want--primary care doc, specialist, no gatekeepers and all that stuff. The doctors are totally free and should be free to make their own decisions, after consultation with their patients, as to what procedure makes sense or doesn't make sense. In addition to that, frankly, more competition with the exchanges. This legislation, frankly, is rooted almost entirely on maintaining the current free market system in health care. There is some insurance market reform, which I think everybody agrees with, which is denying preexisting conditions as a basis for denying coverage, and there is a modest expansion of Medicaid for lower income people who just can't get health care, but otherwise this is legislation which is rooted in the current American system. We have a good system. It works. This is just designed to make it work a little better by making sure it reimburses, as the Senator from Wyoming wants, based more on quality. He didn't mention this, but I know he agrees, also insurance market reform so those patients who come to him don't have to wait until the end of the year in the future as they have in the past. But I want to get it very clear, this is no ``government takeover.'' That is a scare tactic. It is not accurate. It is basically maintaining our current system. I would now like to yield 10 minutes to my good friend from Vermont.

Mr. BAUCUS. Mr. President, I ask how much time is remaining on each side?

Mr. BAUCUS. Mr. President, I yield 9 minutes--how many seconds?

Mr. BAUCUS. I yield 9 minutes 11 seconds to the Senator from Iowa.

Mr. BAUCUS. Mr. President, I do not think I have any time, but I ask unanimous consent that as to the time I do have after 2 o'clock, I can take 2 minutes of that so I can ask a question of my good friend from Iowa.

Mr. BAUCUS. Mr. President, I might ask my friend from Iowa, Senator Grassley, a question, if he is available for a question. I am taking time.

Mr. BAUCUS. I understand. I do not want to cut into that time at all.

Mr. BAUCUS. I am taking it off my time, not your time.

Mr. BAUCUS. Is it true the Congressional Budget Office said this bill, over 10 years, is not only deficit neutral but actually decreases the budget deficit by about $130 billion? Is that true? Is that what the Congressional Budget Office said?

Mr. BAUCUS. Well, I do not know--to be totally fair and respectful to one of my very best friends in the Senate--to cover that point, isn't it also true the Congressional Budget Office said in the second 10 years this bill will reduce the budget by one-quarter percent of GDP? Isn't that also true, according to the Congressional Budget Office?

Mr. BAUCUS. We trust each other. We both trust each other. That is what the letter says. Thank you.

Max Baucus

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