The Public Option
Floor Speech
THE PUBLIC OPTION -- (Senate - October 26, 2009)
Mr. CORNYN. Mr. President, I listened to the majority leader, Senator Reid, talk about his melded bill, the combination of the Finance Committee bill and the HELP Committee bill that he has now completed merging behind closed doors. He said he is going to send it to the Congressional Budget Office to get a score or a cost estimate. My hope is we will all be able to see it soon. We have not been able to participate in the process since it has been a process taking place between the majority leader and presumably Senators DODD and BAUCUS, the chairmen of the two committees, without Republicans being present. So we don't know what is in it, and we don't know how much it costs. Certainly those are two critical questions the American people are asking and those of us who will be required to vote on this legislation at some point would like the answers to. When will we be able to see it? When will the American people be able to see it? How much will the bill cost?
Today, I wish to focus on another question: Why is it that some people in this country think another government-run health care plan is the answer? A government-run plan goes by a lot of different names. It is an attempt, in part, to obfuscate what people are trying to do. Sometimes people like to call it the public option because it sounds innocuous. Who could be against a choice, an option, if it is not mandatory? Others say they are not for a public option unless it has a trigger. Others talk about opting in, and we heard the majority leader talk about a bill he intends to introduce that provides an opt out for the States. The reality remains the same. We are talking about a brandnew entitlement program, a brandnew government-run health care program run out of Washington, DC, based on the fundamental and misguided belief that one size fits all for a nation of 300 million people.
Some of my colleagues believe a government plan is gaining momentum. I appeared yesterday on a Sunday television show with Senator Schumer, the distinguished Senator from New York, who said he thought Congress was right on the cusp of a public option or government-run plan. The more the American people find out about what is meant by the public option, the less they like it.
Last week, we saw the Washington Post-ABC News poll that supposedly said that support for a government-run plan was growing. In fact, support has fallen by 5 points since June. These numbers can be misleading. As the Presiding Officer knows, in politics and public opinion polling, he or she who gets to ask the questions or frame the questions, he or she who gets to decide what the sample is can have a dramatic impact on the answers given to a poll. It is absolutely the case that support for the so-called public option drops dramatically when we explain to people what it would actually do.
ABC News polling director Gary Langer wrote about this dynamic in June. He noted that while 62 percent initially favored a so-called public option, that number dropped from 62 percent to 37 percent once it was explained to people that it would put many private insurers out of business because they couldn't compete with the Federal Government and the so-called government plan.
In other words, support dropped when people realized they would not be able to keep what they have now--which is one of the President's promises--because many insurers would simply be driven out of business. Thus that promise President Obama has made time and time again would not be possible under the public option or government plan.
Today in the Washington Post, Fred Hiatt explained why a government plan would end up breaking President Obama's promise: A government plan would work like Medicare and Medicaid--those are two government plans--and they would, as Medicare and Medicaid do, pay providers at low rates.
As a matter of fact, last week we had a vote on a bill--actually, on a cloture motion on a motion to proceed--a technical vote but one that would have taken us to a bill to basically reverse the cuts in Medicare reimbursement rates to Medicare providers. But it was not paid for. It would have added $300 billion to the national debt. So 13 Democrats joined with Republicans to defeat that. Hopefully, we will go back to the drawing board and come up with a bill that will be paid for.
But the point is, any new government plan, as Fred Hiatt pointed out, would work like Medicare and Medicaid and pay providers much less than they could get under private insurers. So providers would, as they do now, make up the difference by charging private plans more for the same services. This is a so-called cost-shifting phenomenon. Then private insurance premiums--if you have private coverage now--would increase for people who have health insurance coverage now. Ultimately, some of them would be forced to drop their private insurance because it would be more expensive, not less, which is what I thought the object of this exercise was about: how to bring down costs, not how to drive them up, and the cycle would continue until all private insurers would go out of business, and all Americans would find themselves on a single-payer, government-run health care plan. So much for the option in the public option.
So the fact is, the government plan would not be just a competitor; it would, in fact, act as a predator by calling the shots. Even as it takes the field, the government plan would undercut the private market and create another Washington monopoly.
Some people have described the so-called public option as a Trojan horse. I have used that phrase myself. But the person who actually devised the public option said this--his name is Jacob Hacker, and he is a professor at Berkeley--he put it this way last year:
Someone once said to me, ``This is a Trojan horse for single payer,'' and I said, ``Well, it's not a Trojan horse, right? It's just right there.''
Professor Hacker said:
I'm telling you, we're going to get there, over time, slowly.
The truth is, we should not be creating another government plan when the ones we have now are not working very well at all.
As Robert Samuelson wrote in today's Washington Post:
Why would a plan tied to Medicare control health [care] spending, when Medicare hasn't?
He noted that from 1970 until 2007, Medicare spending had risen by 9.2 percent annually. Let me say that again. From 1970 to 2007, Medicare spending had risen by 9.2 percent annually. He says this is just one reason the so-called public option is what he called a ``mirage.''
We know there are current entitlement programs that have major unfunded liabilities. Medicare has a $38 trillion unfunded liability and will effectively go bankrupt in 2017. Yet this bill, at least the Finance Committee bill--I presume the bill coming out of Senator Reid's office will do the same--takes $500 billion from Medicare to create a new entitlement plan, a new government-run health care plan, when Medicare itself has $38 trillion in unfunded liabilities. It just does not seem to make any sense.
Medicaid, which, of course, primarily helps pay health care costs for the poor, reduces access to health care in many communities because reimbursement rates are so low that many providers simply cannot take new patients. As ``60 Minutes'' reported just last night, fraud and abuse in government health care programs cost taxpayers about $90 billion a year. Does this sound like a model we want to hold out--a new government-run plan--when the ones we have now are broken and need fixing?
On the Medicare fraud and abuse, according to FBI special agent Brian Waterman, Medicare fraud is a bigger problem in South Florida than the drug trade. He said:
There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare.
One former Federal judge looked at his Medicare statement and found that someone had billed the government for two artificial limbs on his behalf even though he still has the ones God gave him. In other words, he did not need any artificial limbs, but somebody charged them to Medicare on his bill without his knowledge.
I agree with our colleague, Senator Landrieu from Louisiana, that a government plan would just replicate the same kinds of problems we have seen in Medicare and Medicaid. As she said:
Why don't we fix the two public options we have now instead of creating a [new] one?
Well, supporters of a government plan say we need to have more competition and give consumers more choice. I could not agree more. But this
is not--this is not--the way to do it. Competition occurs when we have more private insurance companies competing in marketplaces, which would happen under some proposals made by our side of the aisle--if we would simply create a system where individuals could buy health insurance in any State across the Nation and were not just confined to buying health insurance in their own State. Competition increases when we get more insurance carriers to enter the market, not by creating a government plan that will drive them out of it.
We have proposed ways, as I have said, to increase the number of private insurance options in every State. We think if that is the goal, certainly we ought to be able to come together in a bipartisan way to accomplish that goal. But I do not know why in the world we would settle for a health care proposal that would ultimately drive people to a single-payer, government-run health care plan, would raise taxes on the middle class, raise premiums on those who have insurance now and depress the wages of those who have that health insurance now, and would cut, as I mentioned a moment ago, $500 billion from a Medicare Program that is scheduled to go bankrupt in 2017. Why would we settle for something that would make things worse instead of better for more than 100 million Americans? Why would we vote to spend $1 trillion or more on a new entitlement program without fixing the ones we have now?
Well, it is not just me saying that this so-called public option with the opt-out the majority leader has now proposed--which he admits does not have 60 votes, and the one Republican, Senator Snowe, who said she would vote for the bill said she would not vote for a bill with a public option. So I am not sure why, with one Republican supporting the Finance Committee bill, they have now apparently rejected Senator Snowe's support and opted for a strictly partisan proposal coming out of Senator Reid's conference room.
But I also checked, and another health care expert whom I respect shares some of my views about the dangers of the so-called public option.
Secretary Mike Leavitt, who is the former Secretary of the Department of Health and Human Services, said:
Advocates for a public health-care plan continue to look for a way to give political cover to moderates while advancing their goal of implementing a government-run health-care system.
He said:
[Ultimately,] it is designed to undercut private insurance.
He said it is ``dangerous for three reasons.'' He said:
One, it would be cheaper for employers to stop offering private [coverage to their employees and to] funnel their employees into the government-run plan. Employers, not employees, would get to make that choice.
Secondly, he said:
[A] government-run plan would use the coercive force of government to dictate the prices that [are going to be] charged by others--by doctors, nurses, and hospitals--in a way that private entities cannot.
Third, he said this proposal is dangerous because a ``government-run plan would be subsidized by American taxpayers, while private plans are not.'' In other words, he says, if, in fact, States will be given a chance to opt out of the so-called public option, they would not have a chance to opt out of the tax dollars their taxpayers would spend in order to subsidize the so-called public plan.
As he concludes, he says:
The state ``opt-in'' is a transparently false choice. It is just another gimmick to try to find votes for an unwise policy that would increase the federal government's control over health care.
We can do better. We must do better. I urge my colleagues not to take the bait on this so-called public option, whether it has an opt-out or not, because it is just another disguised way to try to end up with a single-payer, government-run health care system out of Washington, DC.
Mr. President, I yield the floor.
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