Health Care Reform
Floor Speech
HEALTH CARE REFORM -- (Senate - October 19, 2009)
BREAK IN TRANSCRIPT
Mr. THUNE. Mr. President, as my friend from Arizona noted, there are many things about the current debate that I think raise questions with the American people. He was discussing what he had heard back in his State of Arizona regarding the current debate that is before the Congress and the concerns people have, the anxiety, the frustration, and, frankly, the fear that I think a lot of Americans have about what happens and what the ultimate result may be. For instance, will this health care reform effort lead to higher costs for them? Will it lead to questions about whether they will be able to retain that fundamental, essential relationship between the patient and the doctor?
Those are, I think, very valid questions. Frankly, we don't have answers to them because, one, we don't have a bill. We haven't seen a bill. That bill is being written, we are told, in the majority leader's office. There will be a handful of people in that room. There will not be input from our side, let alone from many Democrats in the Senate. It is going to be basically cranked out and at some point we will have a bill that will be put on the floor before the entire Senate. Having said that, it is interesting to me that this week we are going to have a vote in the Senate on an issue which, frankly, is very much a part of the debate over health care reform and yet that vote is being separated out. I think there is a reason for that, which I will come back to in a moment.
I think it is important and telling that the first vote on health care reform here in the Senate is going to be to add a quarter of a trillion dollars to the Federal debt. That is right, $250 billion--or $247 billion, to be precise--is going to be added to the Federal debt because what the majority leader has decided to do is to bring legislation to the floor this week that would address the physician reimbursement issue. We all believe that needs to be addressed. There is no one on our side of the aisle who doesn't believe we need to address the challenge that we will face in January of this coming year. Physicians across this country, if we don't take steps, are going to be subjected to a 21 1/2 percent pay cut. That is not something anybody I know of in this Chamber is willing to abide.
But we have a fundamental difference about whether that ought to be addressed in a way that is paid for, that actually doesn't borrow $250 billion from future generations. The reason I say it should have been in the health care reform bill, but wasn't, is because it is a part of that debate. In fact, the House of Representatives included the physician reimbursement issue in their version of health care reform and put it out of balance, but at least they were honest. They dealt with it in the context of health care reform, because it is fundamental to addressing the health care issues we have in this country. The reason I think it was left out of the Finance Committee bill, the Baucus bill, is because they knew if they put that in the bill, it would put their bill out of balance, and we had the big proclamation that had come out about how this is deficit neutral, that it is going to add $81 billion in surplus, that it is actually going to save money in the long run.
Obviously, if you back out $250 billion, you can make your books balance in the near term. But what you are doing is adding a quarter of a trillion dollars to the debt, which this year was $1.4 trillion--three times what we have ever seen here in the last 40 years or so. The last time we have seen debt of this magnitude in terms of a percentage of our gross domestic product was right after World War II. But the debt this year is three times what we have seen in recent history--at least in this last decade.
I think the first point I would make is that the first vote out of the gate on health care reform should not be to add a quarter of a trillion dollars to the Federal debt and to pile this burden on future generations of Americans. In fact, there is a bumper sticker going around right now, which I think is perhaps pretty descriptive of what is happening in Washington, and it says something to the effect: ``Don't tell those people out in Washington, DC what comes after a trillion dollars.'' I think the American people are sitting out there wondering, when we talk about billions and billions and billions, and now we are talking trillions and trillions and trillions, what comes after that? And yet we continue to spend and borrow as if there is no tomorrow. I think the American people are picking up on that, and obviously they want to see a government that lives within its means just as they have to every single day in their personal lives, in their businesses, and most people who have to live within balanced budgets.
It is a lesson I think Washington could learn. It is essential that we don't continue to pile this burden of debt on future generations of Americans. The deficit last year was $1.4 trillion. It is estimated if we stay on the current trajectory that we will double the Federal debt in 5 years, triple it in 10 years, and at the end of the 10-year period, the average part that each household in this country will own of that entire Federal debt obligation is $188,000. So if you are a family in America today or say you are a young couple who has just gotten married, and looking at your life ahead of you and planning for your future, you are going to get a wedding gift from the Federal Government--a big old IOU for $188,000. That will be everyone's share of the Federal debt.
What we do here with the first vote out of the gate on health care reform is add a quarter of a trillion dollars to that Federal debt. A quarter of a trillion dollars used to be a lot of money in this town. When you start talking about $1.4 trillion deficits, maybe it doesn't seem like that anymore. I think that is why the American people are asking, and probably fairly so, what comes after a trillion dollars. When you add a quarter of a trillion dollars to the debt, the total interest payment on that amount over the 10-year period, if you can believe this, is $136 billion. So we are adding $136 billion in additional interest payments that we are going to have to make over the course of the next 10 years by borrowing an additional quarter of a trillion dollars to address the physician reimbursement issue.
I say all that because I think it bears on the bigger question of health care reform and the fact that right now we have competing bills: One in the House, called the tricommittee bill, if you will, which does spend, over a 10-year period, about $2.4 trillion; the Senate HELP Committee bill, which over a 10-year period spends $2.2 trillion; and the Senate Finance Committee bill, which over a 10-year time period spends $1.8 trillion--until now. When we add in this $250 billion for physician reimbursements, that now pushes the number on that particular bill up to about $2 trillion as well.
So what we have is a whole new expansion, a whole bunch of new spending on health care by the taxpayers in this country. Obviously, it has to be paid for somehow. Most of it is paid for by cuts to Medicare reimbursements that providers in this country would receive, paid for in the form of higher taxes that would be borne by small businesses, by individuals, and would ultimately lead to the final outcome of this big debate, which is higher premiums. The whole purpose of this was to reduce the cost of health care for people in this country by reducing and driving down what they paid for health insurance. But as has been pointed out, I think over and over now in response to questions posed by members of the Senate Finance Committee in answers from the CBO Director, these tax increases--roughly dollar for dollar--will be passed on in the form of higher taxes. In fact, some of the taxes in the House bill hit squarely at small businesses and hit squarely at individuals. The CBO and the Joint Tax Committee, which looked at the Finance Committee bill, concluded that 90 percent--87 percent, I should say, as far as the Joint Tax Committee and 89 percent was the CBO estimate--of the tax burden would fall on taxpayers--on wage earners--making less than $250,000 a year. In fact, the Joint Tax Committee went so far as to say a little over 50 percent of that tax burden would fall on wage earners making less than $100,000 a year.
So the tax burden is going to be borne by people who were promised they wouldn't pay higher taxes in the health care reform proposals, and it was stated by the President and others that we wouldn't tax people who make less than $250,000 a year. That is clearly not the case. There is a 5.4 percent surcharge on high-income earners in the House bill which would be borne largely by small businesses, many of whom file, because of the way they are organized, on their individual tax returns. So you are going to have higher taxes on small businesses, higher taxes on middle-class Americans, and this explosion and expansion of Federal Government here in Washington to the tune of $2 trillion.
You would hope then that you would see that would have some positive impact on health insurance premiums. The reality is, as I said earlier, it does not. I think as the debate broadens and we become engaged on health care reform, the American people are going to come to that conclusion, which is why I think they are very concerned about what is happening here in Washington.
The other point I will make is that one of the objectives of health care reform--in fact, to me, health care reform ought to be about driving health care costs down, not increasing them, which is what all these bills do--was that it was designed to cover people who aren't currently covered, to provide access to more Americans. What we are seeing now with all these various bills is there are lots of people who get left out. Under what they call the House bill--the tricommittee bill--17 million Americans still would not have
health insurance. Under the Senate HELP Committee bill, that number is much higher. It is 34 million who would still not be covered. But there is an assumption there, although it wasn't included in the bill, that Medicaid would be expanded. That would cover more people. So that number may be overstated. But the Senate Finance Committee assumes 25 million people will be without health insurance.
So you will have higher taxes, a tremendous amount of higher spending--up to about $2 trillion under any of these bills--and an expansion of government here in Washington, DC, cuts to Medicare reimbursements--to seniors--across this country, and all for what? Higher premiums for most Americans, for people who currently have insurance, to hopefully cover some Americans. When you are spending $2 trillion, there ought to be some advantage to that, but clearly a lot of Americans are still going to be without health insurance when this is all said and done.
I am concerned. I think a lot of our colleagues here in the Senate--and not just on our side of the aisle, but I think a number on the other side too--have expressed concerns about starting the debate a quarter of a trillion dollars in the hole by putting a bill on the floor that is going to spend a quarter of a trillion dollars--$250 billion--over the next 10 years that is not paid for. That puts any bill that is considered later completely out of balance, and it is a gimmick that is designed to allow the President and the Democratic majority to say our health care reform bill is deficit neutral. Well, sure, if you take the $250 billion and back it out, it is easy to say it is deficit neutral, when in fact now it is going to be $200 billion. They have about an $80 billion overage on the bill in the Finance Committee, but it is still going to be $200 billion out of balance when you do this, again, to be financed with more debt and more borrowing, which is exactly what I think we want to avoid, and particularly when you are running deficits as far the eye can see.
This last year, about 43 cents out of every dollar that was spent here at the Federal level--in Washington, DC--was borrowed. There isn't anyplace in America where you can function like that and still be in business. If you are a person doing that in your personal household finances, you would be forced into bankruptcy. If you were a small business, you would be forced into bankruptcy. Frankly, were it not for the fact that other countries around the world are financing America's debt, we would be in bankruptcy. Because you can't borrow 43 cents of everything you spend, as we are doing here in Washington, DC. In fact, to put it in perspective--and a lot of Americans understand this--if you are a family with an annual income of $62,000, it would be the equivalent of spending $108,000. That is what we are doing here in Washington, DC.
Of all the money we spend in a given year, 43 percent of that is borrowed. We cannot continue to sustain that.
I hope that before this bill comes to the floor, we can reach an agreement about amendments that might be offered. I would say our side, the Republican side, has amendments it would like to offer to this bill that would help pay for it, help reduce the amount or perhaps entirely reduce the amount that would be borrowed in order to finance the physician reimbursement fix, on which we all agree. As I said, there is not anybody on this side who does not agree that needs to be done. In fact, Senator Cornyn offered an amendment to the bill that would provide a 2-year fix, a 2-year solution to the problem for physician reimbursement. It was voted down. It was defeated, that amendment, in the Senate Finance Committee.
We are looking. We are proactive. We have to address this issue. This issue was created by the Balanced Budget Act back in 1987. I was a Member of the House of Representatives at the time. I voted for that balanced budget agreement, but it included what was called a sustainable growth rate formula by which physicians are reimbursed. As I said earlier, in January of this year, based upon that formula, physicians would receive a 21.5-percent reduction in their fees, in their reimbursements.
Everybody here--I should not say everybody. I can't speak for everybody. But I think most Senators on both sides of the aisle acknowledge that issue has to be addressed. We need to fix that, but we have to do it in a way that is fiscally responsible. We want an opportunity to offer amendments that would allow us to do that.
As of last week, that request was being rejected. There was going to be a cloture vote today, which I understand now has been vitiated, which means perhaps the leaders are working together on an agreement that would allow Senators on both sides to offer amendments to this legislation that would help pay for it.
I think it is telling that there are Democrats who are uncomfortable with the idea of adding $ 1/4 trillion to the Federal debt with the very first vote we will cast on health care in the Senate Chamber.
I hope we can reach an agreement. I hope the leaders will be able to do that and this will be an open process, that we debate, and there will not be any mad rush to try to cut off debate. Rather, Senators on our side would have an opportunity to fix the issue that is going to put a lot of physicians in a very uncomfortable position if we do not address it but do it in a way that also is fair to the American taxpayer and make sure we, as a nation, are honoring the responsibility we have, not just to fix this issue for today but to provide a better and brighter and more secure future for future generations of Americans. It is a future which, I would add, is very much in jeopardy and in peril if we continue to spend and borrow and tax at the rate that is contemplated in the health care reform bill but, more important, with the very first vote on that health care proposal, which is to add $250 billion to the Federal debt.
I yield the floor.
BREAK IN TRANSCRIPT
Source