John McCain

Mr. McCAIN

Mr. McCAIN. Will the majority leader yield for a question?

Mr. McCAIN. And the disposition of the pending Dorgan amendment, could we have some idea about that?

Mr. McCAIN. Will the Senator yield for a question?

Mr. McCAIN. The answer is, obviously, that I don't know. I would like to say to the Senator from Tennessee--and Dr. Barrasso is here as well--a lot of Americans have heard of the Congressional Budget Office. I am not sure many have heard of the Centers for Medicare and Medicaid Services, which is part of the Department of Health and Human Services. Are they not the people whose entire focus is not on the entire budget, as CBO's is, but just on Medicare and Medicaid, so that they can make determinations as to the future and the impact of various pieces of legislation on specifically Medicare and Medicaid? Is that a correct assessment?

Mr. McCAIN. I thank my friend. Because the findings as of December 10, 2009, which is entitled ``Estimated Financial Effects of the `Patient Protection and Affordable Care Act of 2009,' as Proposed by the Senate Majority Leader on November 18, 2009,'' have some incredibly, almost shocking results, I say to my friend from Tennessee. We know the bill before us does not bring costs under control. But as I understand this--and it is pretty, may I say, Talmudic in some ways to understand some of the language that is in this report, but is it not true that the Reid bill, according to this report--this is not the Republican policy committee but the Centers for Medicare and Medicaid Services--doesn't it say: The Reid bill creates a new long-term insurance program-- Called the CLASS Act-- that the CMS actuaries found faces ``a very serious risk'' of becoming unsustainable as a result of adverse selection by participants. The actuary found that such programs face a significant risk of failure and expects that the program will result in ``net Federal cost in the long term.'' I would like to mention two other provisions to my friend from Tennessee and Dr. Barrasso, who is very familiar not only with this center but with Medicare and Medicaid services. The Reid bill funds $930 billion in new Federal spending by relying on Medicare payment cuts which are unlikely to be sustainable on a permanent basis. As a result-- According to CMS-- providers could ``find it difficult to remain profitable and, absent legislative intervention, might end their participation in the Medicare program.'' The Reid bill is especially likely to result in providers being unwilling to treat Medicare and Medicaid patients, meaning that a significant portion of the increased demand for Medicaid services would be difficult to meet. They go on to say: The CMS actuary noted that the Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. He also found that roughly 20 percent of all Part A providers (hospitals, nursing homes, etc.) would become unprofitable within the next 10 years as a result of these cuts. Finally, he goes on to say: The CMS actuary found that further reductions in Medicare growth rates through the actions of the Independent Medicare Advisory Board-- Which is one of the most controversial parts of this legislation-- which advocates have pointed to as a central lynchpin in reducing health care spending, ``may be difficult to achieve in practice.'' This is a remarkable study, I say to my friend from Tennessee.

Mr. McCAIN. May I also ask, in addition to that question, has Dr. Barrasso ever heard of the CMS being biased or slanted in one way or another? Isn't it one of the most respectable and admired objective observers of the health care situation as far as Medicare and Medicaid are concerned?

Mr. McCAIN. This is the information on the bill as it is; correct-- the original bill? This is without the expansion of Medicare taken into this study, which already, as the Senator quoted from the New York Times and other health care experts, is going to increase costs even more. As you expand Medicare, among other things, you run the risk of adverse selection, which means the people who are the sickest immediately enroll, which then increases the cost, and then who would be paying the increased Medicare payments? The young and the healthy. I ask my friend from Wyoming, should we do that to the next generations of Americans?

Mr. McCAIN

Mr. McCAIN. Mr. President, I ask unanimous consent the Senator from Montana be given 2 additional minutes.

Mr. McCAIN. I ask unanimous consent to enter into a colloquy with the Senators from Oklahoma, Tennessee, and Tennessee, both of them.

Mr. McCAIN. Mr. President, we are here, obviously, as we are on a daily basis, to discuss the issue of health care reform. But we are in a rather unusual situation this morning because we don't know what we are discussing or debating. We find ourselves in an interesting situation. After almost a year of consideration of health care reform, with a measure that has been--at least a couple of the outlines of it we know but, frankly, we have had no details except that Medicare is going to be extended, eligibility for Medicare is going to be extended to age 55. I just would quote: There was a meeting yesterday amongst Senate Democrats. Many Senate Democrats emerged from yesterday's caucus meeting saying they had learned little about the public option agreement and there were many outstanding concerns. Senator Mary Landrieu called the agreement ``a very good idea.'' Senator Blanche Lincoln said, ``More information is needed.'' And Senator Ben Nelson said, ``I just want to know what the costs are.'' So do the rest of us. So do the rest of us. Here we have a proposal after nearly a year that is being assessed by the Congressional Budget Office, and here we are with no knowledge of what that bill is about, with the exception of some bare essentials that have been leaked. What did this have to do with change? What does this have to do with bipartisanship? What does this have to do with anything? Frankly, we have an editorial in the Washington Post this morning that calls it ``Medicare Sausage?'' I ask unanimous consent the editorial from the Washington Post be printed in the Record.

Mr. McCAIN. ``The emerging buy-in proposal could have costly unintended consequences.'' But we don't know what it is. But we know that never before in this entire year--I ask my colleagues--have we seen a proposal that would change eligibility for Medicare down to age 55, never before. The majority leader came to the floor this morning and said if we accept an omnibus, a multitrillion-dollar bill by unanimous consent--by the way, the Omnibus appropriations bill is six bills totaling $450 billion, 1,351 pages long, with 4,752 earmarks totaling $3.7 billion. And, by the way, spending on domestic programs is increased by 14 percent except for veterans, which is increased by only 5 percent. The majority leader wants us to go out for the weekend, after keeping us in all last weekend. Here we have an unspecified proposal--none of us know the details or the cost--so I am supposed to go home to Arizona this weekend and say: My friends, we have been working on health care reform for a year. And guess what. I can tell you nothing. We need to stay in, we need to know what the proposals are, we need to have votes on it, and we need to tell the American people what is going on behind closed doors.

Mr. McCAIN. Gladly.

Mr. McCAIN. And vote.

Mr. McCAIN. If we are not going to have a vote, maybe we ought to have a vote to table the pending amendments, at least to have the Senate on record. Could I finally say, I know New Orleans is very nice this time of year, but perhaps we ought to stay here and get this job done?

Mr. McCAIN. Not only are there questions--not only is there opposition from the Mayo Clinic but the American Hospital Association and the AMA. They have all come up steadfastly against this. Could I ask my colleague from Oklahoma--and I quote from this editorial. Here we are supposedly going out for the weekend and the editorial from the Washington Post says: Presumably, the expanded Medicare program would pay Medicare rates to providers raising the question of the spillover effects on a health-care system already stressed by a dramatic expansion of Medicaid. Will providers cut costs-- or will they shift them to private insurers, driving up premiums? Will they stop taking Medicare patients or go to Congress demanding higher rates? Once 55-year-olds are in, they are not likely to be kicked out and the pressure will be on to expand the program to make more people eligible. The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market.

Mr. McCAIN. There are many who believe the Senator from Oklahoma could not have a heart attack.

Mr. McCAIN. Apparently, I would ask my colleague from Tennessee, we do not know what we would be voting on because there has been a whole rewrite of this health care reform here after a year. We do not even know what the provisions of that bill are except what has been leaked. Apparently, my colleagues on the other side of the aisle, with the exception of the majority leader, don't know what it is either.

Mr. McCAIN. I thank the Senator. May I ask the Republican leader, again, to be very clear that it is his view and that of all Republican Members that we will stay in for as long as it takes to get this issue resolved and we are prepared to vote throughout the entire weekend. If the majority leader moves to the Omnibus appropriations bills, we will have a conference report, and we will certainly have discussion about a bill that has 4,752 earmarks totaling $3.7 billion. But we should not get off this, should we?

Mr. McCAIN. May I point out, again, as the Senator from Maine, Ms. Snowe, pointed out--and it was highlighted in the Wall Street Journal-- no major reform in the modern history of this Senate has been enacted without bipartisan support, a reason for us to go back to the drawing board. I know the Senator from Texas has been heavily involved in the issue of hospitalization and the American Hospital Association's reaction to what appears to be an expansion of Medicare.

Mr. McCAIN. May I say, having stood fifth from the bottom of my class at the Naval Academy, I cannot explain it. But perhaps before I turn to the Senator from South Dakota, maybe we could get a response from Dr. Coburn to that question.

Mr. McCAIN. I yield to the Senator from South Dakota.

Mr. McCAIN. I thank the Senator from South Dakota. I have to say I have never, in the years I have been here, seen a process such as this. It is incredibly bizarre that after a year, after hundreds of hours in the HELP Committee, after how many hundreds of hours in the Finance Committee, products are here on our desks. Yet there is a meeting yesterday of the Democrats. They come out, and they don't know what the proposal is either. Apparently, there is only one Senator who knows what the proposal is and that is the majority leader. Also, then it is OK to go home for the weekend. I honestly say to my colleague from South Dakota, I have never seen anything quite like this, especially when we are talking about one-sixth of the gross national product. Of course, already from what they know, the hospitals and doctors and others have come out in strong opposition to expansion of a program, as the Senator points out, that is going broke.

Mr. McCAIN. Mr. President, I ask unanimous consent that a list of physician organizations that oppose this act, representing nearly one- half million physicians, be printed in the Record.

Mr. McCAIN. Mr. President, I thank the Senator from Montana for his courtesy.

Mr. McCAIN

Mr. McCAIN. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.