Tom Harkin

Mr. HARKIN

Mr. HARKIN. I am beginning to see.

Mr. HARKIN. Wait a minute. I had been led to believe by the other side that they want to give seniors choices, more choices; that they do not want to shoehorn or force the elderly into managed care systems but leave them their choices and their options. But now what this says is that this BELT, this thing which would have these across-the-board cuts in all these areas, would apply only to fee for service. Again, am I correct, I ask the Senator from West Virginia, in saying that with this BELT provision, it is just another way of taking away more choice for the elderly?

Mr. HARKIN. Again, I want to thank the Senator for pointing this out. I daresay, not too many people know about this hidden in these 2,000 pages. I just received a piece of paper on this which indicates that BELT applies only to Medicare fee for service. So it would hit only those elderly who want to keep their current doctors; is that right?

Mr. HARKIN. Will the Senator yield for another question?

Mr. HARKIN. Will the Senator yield?

Mr. HARKIN. Not only that, if the Senator would yield further, not only that, not only the price increase, but the number of elderly is going to increase. People are living longer. They are healthier so they are living longer. So you will have more people in that bracket in the future. So the belt is going to tighten even harder and faster because of both of those. I am just shocked about this. I am glad that the Senator brought this up. I daresay, there are very few people who understand this. We are indebted to the Senator from West Virginia for pointing this out. I just still find this incredible that this would be buried in this bill.

Mr. HARKIN. I wonder what else is hidden in here. Two thousand pages, and we got it yesterday--2,000 pages. Who knows what is hidden in here--2,000 pages. We have not had 1 day of hearings on it, not 1 day. And now the Senator from West Virginia has brought up something that this Senator was totally unaware of, I will be frank to admit to everyone. Why? We have not had a chance to look at this or have hearings and know what is in it. What the Senator is saying is buried in these 2,000 pages, which no one knows what is in there, is a provision that will allow for services to the elderly, in all the areas the Senator just outlined, to be automatically cut, automatically without any vote of this body or of the Congress of the United States. I find that incredible. I almost cannot believe it.

Mr. HARKIN. Well, what the Senator from West Virginia is talking about, are these BELT provisions, are they in this 2,000-page reconciliation bill? Is that what the Senator is saying? They are in this big thick bill someplace?

Mr. HARKIN. This is startling news to this Senator. I am not on the Finance Committee. Is the Senator saying that this BELT provision, which sounds to me like the old sequestration, whereas, if you do not hit certain targets, there is automatic across-the-board cuts, is that what is going to happen, automatic, in all these services?

Mr. HARKIN. Would the Senator yield?

Mr. HARKIN. Zero. The American people have no idea what is in this.

Mr. HARKIN. How many days of hearings have we had?

Mr. HARKIN. There are 2,000 pages.

Mr. HARKIN. I wanted to clarify a point.

Mr. HARKIN. Will the Senator yield?

Mr. HARKIN. I thank the Senator for yielding. He makes an excellent point to the Senator from Massachusetts. This comes right out of the Social Security checks. That is where it is coming from. It is not coming from some other place when an elderly person gets that Social Security check. The amount that they pay in that monthly premium is going to double under what the Republicans have before us. Mr. President, Halloween is just around the corner. It is trick-or- treat time. This is a trick-or-treat bill. The trick is on American seniors, and the treats are the $245 billion tax cuts for the wealthiest in this country. That is what it is. They are saying we are trying to scare our seniors. It is not a scare. It is an actual assault on the seniors of this country so that we can treat the wealthiest. What is this debate really about? Mr. President, here is what the debate is about right here on this poster. This is what the debate is about. Make no mistake about it. Notice the date on these words. October 24, 1995. That was yesterday. Last night in a speech to the American Conservative Union here in Washington, here is what the majority leader of the Senate said: ``* * * I was there fighting the fight--voting against Medicare--one of 12--because we knew it wouldn't work in 1965. There you have it. The majority leader is saying he is proud of the fact that he voted against Medicare in 1965 because he says, ``We knew it wouldn't work.'' It will not work? Prior to 1965, only 46 percent of our elderly had health care. Today, 99 percent of our seniors have health care coverage. Tell me it has not worked. I want the majority leader to come out here on the Senate floor and tell the American public that Medicare has been a failure, that it has not worked, that he was right in 1965 when he voted against it. I wish he would tell me. I wish he would tell me. I wish he would tell me about my own family. When my father was on Social Security and an ex-coal miner, we had no income. All he had was a Social Security check. We lived in a small town of 150 people. He had black lung disease. He was in his seventies. He had no health care. We had no money. We had no life savings. We had a little house and a half acre of property. Every winter he would get sick and they would have to take him in to Mercy Hospital in Des Moines, and, thank God, the Sisters of Mercy would take care of him, and they would send him home. It happened like clockwork every year. That was the only health care he had when he was sick as a dog and they would have to rush him to the hospital. But before he died, Medicare came into existence in 1965. And the last 2 years of his life was by far the best years he had in his later years because then he could get health care. He got it when he needed it, not later on when he was so sick. But he got it up front, and he got it with his head held high and not coming in the back door to get charity. I often think that if my father had had Medicare during the 1950's and in the early 1960's, he would have lived longer and he would have been a lot healthier. So the majority leader better not try to tell this Senator that Medicare was a mistake and that it has not worked. I have seen too many in my own family. I have seen too many elderly people in Iowa who, before 1965, did not have health care living in those small towns and communities. Their lives were made better and healthier, and their children's lives were made better because Medicare came in and provided health care for the elderly. I delight in talking to young people about Medicare. They think it is just for the elderly. I do this a lot of times with college students. I always ask them. I say, ``How many of you have grandparents that are on Medicare?'' Most of them raise their hands. I say, ``After you get out of school and you start earning money, for every $100 that you earn, how much of that money is going to go into the Medicare trust fund to pay for Medicare? Out of every $100 you earn, how much goes in so that your grandparents get Medicare?'' I tell you, you should hear the answers I get: $20 out of $100, $10 out of $100, and all kinds of wild guesses. When I tell them it is $1.45, for every $100 they earn, they spend $1.45 so their grandparents do not have to live with them, so their grandparents get quality, affordable health care, they are amazed. I asked them. ``Do you think it is worth it? Is it worth $1.45 out of $100 to put into the Medicare trust fund?'' When you put it that way, they think it is a darned good deal. So, yes. We have some problems with the Medicare trust fund, long term, short term, and we can address those. The other side is always talking about the trustees; how the trustees said it is broke and we have to fix it. There is nothing in the trustees' report that says we have to take $270 billion out of Medicare. That is what the Republicans want to do to--give a $245 billion tax break for the wealthiest in our country. What our amendment does is send the bill back to Finance, and come back with an $89 billion cut in Medicare to make it secure but to keep it and to save it for our elderly. Let us not have this trick-or-treat bill that the Republicans have brought out here to trick our elderly and to take away their hard-earned savings and put it in a $245 billion tax break for the wealthiest in our country. That is what this battle is about. Make no mistake about it. I yield back my time. I thank the Senator for yielding me that time. Mr. ROCKEFELLER addressed the Chair.

Mr. HARKIN. Mr. President, I just have to respond to my friend from New Hampshire. He is absolutely wrong. Here is a statement of a managing trustee of the Social Security trustees. Let me just read this paragraph: Simply said, no Member of Congress should vote for $270 billion in Medicare cuts believing that reductions of this size have been recommended by the Medicare trustees or that such reductions are needed now to prevent an imminent funding crisis. That would be factually incorrect. So I say to my friend from New Hampshire, he is incorrect. The trustees never said, and in fact here is a statement just to the contrary, as the managing trustee said, it would be factually incorrect to say that $270 billion in cuts were recommended by the trustees. That was never the case.

Mr. HARKIN. Mr. President, I send an amendment to the desk and ask for its immediate consideration.

Mr. HARKIN. Will the Senator yield just to engage in a 2-minute colloquy?

Mr. HARKIN. This Senator came to the floor in good faith because I thought that when time was through, then there would be an opportunity for an amendment. I was going to offer a second-degree amendment. I wonder why that is not appropriate to do at this time.

Mr. HARKIN. The Senator was very thoughtful. As I said, I do not really have much argument with what is in the bill. I am not trying to undo what is in it, nor the Senator's amendment. But I still think the heart and soul of this is competitive bidding. I hope the Senator will think about that. Maybe we might reach some agreement on this. But I think the time is long past when we should put out competitive bidding just like they do in the Veterans Administration. I hope your side might take a look at that. I thank the Senator.

Mr. HARKIN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, this amendment is an amendment to the amendment offered by the Senator from Michigan, Senator Abraham, and it deals with waste, fraud, and abuse in the Medicare system. I might just say at the outset that while I have no real disagreements with the amendment offered by the Senator from Michigan--it is not a bad amendment--it just does not go very far. There is a lot more that I think needs to be done in the whole area of waste, fraud, and abuse than is encompassed either in the underlying bill or the amendment offered by the Senator from Michigan. Mr. President, for the last several years, I have been privileged to chair the Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. In that capacity, at least once a year, I had a hearing on the issue of waste, fraud, and abuse in Medicare. Just about every year I asked the GAO to do a study on one facet or another of the waste, abuse, or fraud in the Medicare System. We have had several of those, and two or three inspector general reports on that subject also during that period of time. It seems that every year we would uncover something and try to take some action to stop it, and it would only pop up in another place and be even worse. I became convinced over the last couple of years that major changes had to be made in the way we address the issue of waste, fraud, and abuse in the Medicare Program. Mr. President, these GAO reports that we have had done are available to Senators. Here is one that we had on medical supplies that was done over the last year, issued in August 1995. Let me say for the record what the GAO found in their study of the purchase of medical supplies. They went in and did a random sample of supplies that were paid for by Medicare. They went behind the supplies to get an itemized list. When they looked at it, the result was startling. The GAO found that 89 percent of the claims should have been partially or totally denied; 61 percent of the money paid out should never have been paid out. That is a lot of money, Mr. President, because last year Medicare paid out about $6.8 billion for medical supplies. If that sample that GAO took was representative, and I believe it probably was, you are talking somewhere in the neighborhood of $4 billion going for wasteful, duplicative, and fraudulent spending. While we may not get all of that, we certainly ought to be able to get a good share of that money back for our taxpayers who are paying this money in. There are a lot of other programs. The computer system that HCFA used, for Health Care Financing Administration, the computers are outdated. It is as if we were all using manual typewriters, that is how outdated their hardware and software is. Here is another report we had from the GAO outlining that. Very briefly, what the amendment I have offered does is add to the amendment offered by the Senator from Michigan. Basically, it strengthens the sanctions against providers who rip-off Medicare. Those convicted of health care fraud and felonies would be kicked out of Medicare. Maximum fines would be increased. What we also did, Mr. President, I think the heart and soul of the whole thing, is that we have to go to competitive bidding. We found, for example, that Medicare was paying up to 86 cents for a bandage that the Veterans Administration only pays 4 cents for. We found in durable medical equipment that Medicare was paying up to $3,600 a year for an oxygen concentrator that only costs $1,000. The Veterans Administration was reimbursing at only about $1,200 a year-- one-third of what Medicare was reimbursing. Same for oxygen equipment and everything. Time and again, we have found the Veterans Administration was substantially below what Medicare was paying for the same items. The reason for that is because the Veterans Administration competitively bids for durable medical equipment, services, and for supplies; Medicare does not. Usually, when I tell audiences that, they cannot believe it. They cannot believe we would not do something so simple and straightforward and so market-oriented as to require competitive bidding for supplies, services, and durable medical equipment. This started when Medicare first came in 1965--a fee schedule was set up for the items, and it has rolled on year after year after year. Quite frankly, Mr. President, I say in all candor, those entities, those companies involved in this, have had a sweetheart deal. They have opposed efforts in this Congress and in other Congresses to do away with the fee schedule and go to competitive bidding. I can understand why--because they are really ripping off the system. Mr. President, we had a study done on duplicative claims. Case after case where a doctor put in for, say, two X rays; the GAO found out he should have only been paid for one X ray. On and on. Again, this is because GAO's computers could not pick it up. We had testimony from one private insurance carrier who also did the billing for Medicare. They had one set of computers and software for their private side of what they did; they had another set for what they did for Medicare. The examples were astounding about how for the same claims, covering the same items, under the private side the computers and their programs would pick up duplicative claims and spit those out so they would not pay it. On the Medicare side, because of the old software and computers, they would not catch it and out would go the money for two X rays when only one was required. So our amendment, the amendment I offered, requires competitive bid. That, I believe--we can do anything we want to Medicare. Want to cut money, want to save money in Medicare you can do all you want to and jimmy the system, but until we have competitive bidding we are really not going to get to the bottom of the extensive amount of money that goes out. What are we talking about? GAO estimates that up to 10 percent of Medicare spending goes for waste, fraud, and abuse. You figure $170 billion this year in Medicare, if we took 10 percent, that is $17 billion a year. We are talking about 7 years here. Mr. President, $17 billion a year for 7 years, and you have more than enough to take care of fixing up the Medicare system just by clamping down on waste, fraud, and abuse. I realize we cannot get all of that but if we could just get half of it, if we could just get half of it, we would save our taxpayers and we would save the beneficiaries from having to pay more money. Our amendment provides for that competitive bidding. It would specifically prohibit also Medicare payments for a number of items clearly not related to quality patient care. For example, we found, Mr. President, that Medicare was paying for tickets to sporting events, personal use of automobiles, and we even found that they were paying for travel to Italy to examine art to be put into a hospital. Medicare was picking that up. Our amendment expressly prohibits that. Another part of our amendment clamps down on improper payment for ambulance services. Again, another GAO report that we had done shows that ambulance services are charging the highest rate for ambulance services even though they are not using all of the equipment or they are not using the more expensive ambulance services when they go out to pick up a patient. Also, our amendment, as I said, puts funds in there so they can get updated computers, so they can stop the double billing. GAO estimated that if this amendment, this part of the amendment that we offered, to require Medicare to employ the commercial software that is available and to do it within 6 months--and GAO said they could do it within 6 months--that in the first year we could save $600 million just by employing this software. Mr. President, our amendment would strengthen the criminal penalties and also provide rewards up to $10,000 to individuals who report violations of the law which result in criminal convictions for health care fraud. Our amendment also provides for uniform application process for health care providers seeking to participate in Medicare and Medicaid. Right now, there is just too much paperwork. Our amendment says one standardized form for the submission of claims under Medicare and Medicaid. Again, Mr. President, that would save countless millions of dollars. So, in sum, Mr. President, this amendment builds on what the amendment offered by the Senator from Michigan does and what is in the bill. What is in the bill, and even with the amendment offered by the Senator from Michigan, really does not get to the real problem. I repeat for emphasis' sake, the real problem in Medicare is lack of competitive billing. All of those who believe in the market system and who believe the market system gets you the best services and the best prices, you ought to be for this amendment. We ought to, for once and for all, require competitive bidding for Medicare just like we do the Veterans Administration. Mr. President, I yield the floor.

Mr. HARKIN. My question was, I thought under the rules, after the time on the amendment ran out, that it would be open for amendment. I had a second-degree amendment I was going to offer. I was going to do it at this time.

Tom Harkin

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