Service Members Home Ownership Tax Act Of 2009 - Motion To Proceed
Floor Speech
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, in joining my colleague from Wyoming, he and I had a townhall meeting together in Gillette, WY, his hometown, a wonderful community. I was just there last week for a Veterans Day parade. What Senator Enzi knows and I know is when we talk to the people of Wyoming, they want commonsense solutions.
As I am here with the House-passed bill and the Senate bill we are now looking at, people of Wyoming are astonished at the amount of pages in this sort of thing, how to deal with this, how to comprehend it. What does it mean? What if I like something on page 208 but don't like something on page 1,200?
We ought to be using a step-by-step process. My colleague has a wonderful program, a 10-point plan to improve our health care, and any one of those would be a positive step to actually helping American families, helping them get the health care they would like and they need. But not these bills--one through the House, one through the Senate.
I don't know if my colleague wants to join me in discussing the townhall meetings, where people said: We want health care reform; we want things that are going to make life better but to help keep down our premiums, help keep down the cost of our care. Eighty-five percent of Americans have health care coverage. They are just not happy with the cost. What I heard for the last hour from my colleagues on the other side of the aisle is we need to cover more people; we need to cover more people. That is only part of it. We need to keep down the cost of care for the 85 percent of people who like the care they have.
That is what happens when we get together with groups of people from around the State of Wyoming who come out for our townhall meetings to discuss the issues, to listen. We are there mostly to listen; they are there mostly to talk.
I ask my colleague, is that not exactly what we heard: We need changes but not this?
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, there are a lot of flaws in these bills because what Senator Enzi and I both hear when we go to townhall meetings--but also I had a telephone townhall meeting the other day--is: Don't cut my Medicare. Yet when we take a look at the details of these bills, it is going to cut $500 billion--$500 billion--from our seniors who depend on Medicare for their health care.
They also say: Don't raise my taxes. But taxes are going to go up across the board. Every family is going to notice an increase in their costs, whether through taxes, premiums, an increase in the cost of their lives in terms of how it is going to impact the care they are going to receive. They say: Don't make my family pay more for health care. But across the board, people look at this and say they are going to end up having to pay more.
When Senator Reid brought this bill out, he said: Of all the bills I have seen, it is the best. To me, it is the best of the worst bills I could ever see. It raises taxes. It is not just me speaking. If you read what the people who had a chance to read the bill say--the Associated Press, the Washington Post, the New York Times, others throughout the country, our e-mails from home--there are higher payroll taxes, companies would pay a fee, rely primarily on new taxes, new fees, and then cuts in Medicare. It is beyond me that this Senate--that this Senate, the Senate of the United States--is ready to tell the seniors of this country they are going to cut $500 billion from the care these seniors get from Medicare. That is a growing number of people. Year after year, more people are on Medicare but yet the cuts are going to be there.
The gimmicks, the budget gimmicks are astonishing. The advertised pricetag is an astonishingly large number, over $800 billion. To get down to that astonishingly high number, they have used quite a few gimmicks. You get taxes, you get Medicare cuts, and then you get the gimmicks.
I visited with Senator Gregg from the Budget Committee earlier today. He is going to be on the floor to discuss the gimmicks. One of the things they have done is basically hidden the true cost of the bill. The true cost of the bill is going to be close to $2.5 trillion over a 10-year span. They have done it by putting in a whole new program called the Community Living Assistant Services and Support Act. It is a new Federal long-term care program.
What happens in these long-term care programs? They take in the money early on and then they do not spend it until many years later. But in the way they count money around here--they do kind of a 10-year score, they call it. For the first 10 years they are going to be taking in all of this money, and then when it is time to pay the money out, that money is not going to be there anymore because they will have spent it on the increased cost of medical care because these bills do nothing to get the cost of care down.
Kent Conrad, Democratic Senator from North Dakota, do you know what he called this part of the bill, the Democratic bill on which we are going to be asked to vote? He called it a Ponzi scheme of the first order. He said it is the kind of thing that Bernie Madoff would be proud of. That is a Democrat talking about what is in this bill.
What has the Washington Post said? ``It's a gimmick. These are not savings that can honestly be counted on the balance sheet of reform.''
Do we need reform? Yes. Do we need health care reform? Do we need to change the system? Absolutely. But this is not the way to go.
Senator Enzi is here. He has done a remarkable job as a member of both the Finance Committee and the HELP committee, and he has been part of the markups for both of the bills. He has focused relentlessly on trying to get the costs down so the premiums for the American people will not go up, and he has offered amendment after amendment, and they have been rejected time and time again.
Then Senator Reid gets these two bills--one from the HELP committee, one from the Finance Committee--tries to stitch them together behind closed doors, and there is an amendment that Senator Enzi had put into the bill, one of the bills--it was voted on and approved--and then it magically disappeared without the knowledge of any members of the committee. It was something intended to help the American people, but that got taken out and thrown away in the dead of night.
I don't know if Senator Enzi would like to comment on that, but this is a Senator who was working to improve the lives and health and pocketbooks of the American people, and his great idea is thrown away.
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, that is exactly what is going to happen. No. 1, we will get this huge push of an unfunded government mandate onto the States, a mandate that both Republican and Democratic Governors have called the mother of unfunded mandates, and they are across the board opposed. This is the way that Washington, with its wisdom, will say: We keep the price down, but what we will do is make the American people pay for it in a roundabout way. The more people you have on Medicaid, the program to aid the poor--and we have seen this in Massachusetts with their health care plan; there are not enough doctors to take care of everyone so the system is swamped, which is why it is taking now up to 9 weeks to get an appointment to see a doctor in Massachusetts, but also about 40 percent of doctors do not see Medicaid patients because the reimbursement rate is so low.
What you said, 60 percent of the cost, that is exactly right. It doesn't cover the cost of seeing the patient. We are talking about hiring a nurse, turning the lights on, paying the rent on the office, doing all of those things, the medical charts, the liability insurance, the whole list of the costs of having an
office opened. You cannot keep the office open if all of your patients are Medicaid patients. As a result, physicians--and I saw every Medicaid patient who wanted to see me. My partners and I have the same program where anyone can call and get an appointment, regardless of the ability to pay. But we know 40 percent of the doctors don't see patients on Medicaid.
Mr. GREGG. If I may ask a question on that point, this is an important point. As a practicing physician, if all your patients had been Medicaid, would you have been able to pay your bills?
Mr. BARRASSO. The answer is no. Doctors' offices cannot stay open at the rate that Medicaid reimburses, and no hospital in the country can stay open if they are getting paid across the board at Medicaid rates. You have to have other people who are paying more to make up for the underpayment by the government on Medicaid.
Mr. GREGG. If I might follow up, doesn't that inevitably mean that the people who are paying more are in the private sector, which means premiums for people in the private sector go up, which means fewer people are willing to give that type of coverage because the cost is too high for the business to cover; right?
Mr. BARRASSO. The people who have private insurance end up paying more for their insurance premiums to help make up the difference because the government has across the board been the greatest deadbeat payer. Washington is a deadbeat when it comes to paying for health care costs, both for Medicare as well as Medicaid across the board. That has been the long tradition of Washington and health care. The other people who are penalized under this situation are people who have no health insurance, because they are being charged at a higher rate. The person who works hard and says, I will kind of self-insure in case something happens, I get sick and I have to pay the full bill, they pay the full bill to cover themselves as well as more to help for the underpayment done by Washington.
That is how, when you have more and more people on the Medicaid rolls, more and more people forced onto that through Washington's wisdom, it is going to be harder on people who have insurance through their jobs. Insurance premiums, for people who have insurance and like their insurance, those rates are going to go up. It is going to make it harder for American families and for small businesses that want to hire someone, because the rates of insurance will go higher. It will make it harder for small businesses to provide health insurance for their workers, and those who continue to provide health insurance will not be able to give raises because the costs are going to go up.
This whole approach to health care reform was supposed to be designed to help keep the cost of care down. That is what the President and the Senate promised all through the year. But it does not. It drives prices up.
When I hear my colleague from New Hampshire talk about all of the gimmicks being used in an effort to claim this is a good bill, I refer to this morning's column ``Health Bill Hoax.'' Only Bernie Madoff could believe the Senate's health care bill will expand coverage to 31 million while cutting the deficit by $127 billion over 10 years. It would be the first profitable entitlement. Kind of like when the President of the Senate, at an AARP townhall meeting this year, said: We have to spend money to keep from going bankrupt. On its face, we know how absolutely ridiculous that sounds. You can't do that. This is an incredible expense: taxes galore, all over the place. The word ``tax'' is used in the Senate bill 183 times; ``taxable,'' 164 times; ``taxes,'' 17 times; ``fee,'' 152 times; ``penalty,'' 115 times.
For people who believe this will keep down the cost of care, it will not. As my colleague from Wyoming said earlier, I advise Members to take a look at an editorial by the dean of Harvard Medical School, living in a State where they have the Massachusetts health care plan, which is government-forced insurance, government-mandated care, government-run care. According to the dean of Harvard Medical School in an editorial this week, the health debate deserves a failing grade. The plan is wrong and those who support it are living in collective denial. This is what is wrong with this. This will markedly accelerate national health care spending rather than restrain it. It will do nothing or little to improve the quality of care.
That is what we started with at the beginning--to improve quality, improve access, and lessen the cost. What we have is a bill which, if passed into law and signed by the President, will decrease quality, increase cost, and lessen the access of Americans to health care providers.
I appreciate my colleague's comments. The numbers are so high. These are staggering figures. How do you communicate to the folks back home how astonishingly large these numbers are? Because people say: We do want you to fix things, but don't cut Medicare, don't raise our taxes. Drive down the cost of medical care. Improve access to providers. Create more choices. As I look at this, to me this is going to mean higher health insurance costs, higher taxes, Medicare cuts and then, unfortunately, more government control over health care decisions.
Mr. GREGG. I thank the Senator from Wyoming. He has a unique perspective which we should listen to, as a practicing physician for how many years?
Mr. BARRASSO. I have 24 years practicing orthopedic surgery, taking care of the families of Wyoming.
Mr. GREGG. That is impressive. He understands this whole issue and the point on cost. It is very hard to conceptualize that this is a $2.5 trillion bill when honestly scored. When honestly scored, it is a $2.5 trillion bill.
BREAK IN TRANSCRIPT
Mr. BARRASSO. The Senator from North Carolina, who has been a champion of early detection, early treatment, and prevention of disease, did see a preview of rationing this past week when this Preventive Services Task Force made a decision and recommendation about breast cancer.
The Senator talked about our seniors. I worry about rationing of care, delaying care, denying care. They said for women under 50 they should not have mammograms anymore. They should not do a breast self-exam. They said for women over 75, they should not have a mammogram anymore.
I will tell you that my wife is a breast cancer survivor, and she was diagnosed by a mammogram under the age of 50. And they cannot say that mammograms are not helpful. What they are saying is that the number of mammograms done per life saved is not cost effective.
I know both of the Senators who are on the floor, from New Hampshire as well as from North Carolina, have talked about early detection, early treatment, not using cost as the issue on comparative effectiveness research. We say let's use some clinical judgment. Let's see what we can learn. But, no, because for women under 50, they have to do 1,900 mammograms to save a life. For women over 50, it drops down to 1,300 mammograms to save a life. So that is what they are putting the cost of a life at: a 600-mammogram difference.
But for my wife--who is alive today, after three operations, and two full bouts of chemotherapy, and is now 6 years cancer free--having that mammogram under the age of 50 meant the difference between life and death.
That is what this bill has to do with. It is the difference between life and death for people. If you get into rationing care, delayed care--that is why people come to the United States for their care. It is the best care in the world. That is why Canadians and Europeans come here, because they have to wait too long. That is why our techniques and our treatments and our survival for cancer is so much better in the United States than these other countries. Because the Senator from North Carolina knows it is that early treatment that makes a big difference.
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, there are improvements that need to be done to the system. There are simple things we can do to keep down the cost of care, such as allowing people to buy insurance across State lines as well as giving individuals the same tax breaks big companies get, ending lawsuit abuse and dealing with what is needed to be done in terms of incentives to help people stay healthy so they have opportunities to save money themselves, and allowing small businesses to join together.
The bill we are looking at here is going to raise premiums for people who already have insurance. It is going to raise taxes on all Americans. It is going to cut Medicare--cut Medicare--for our seniors who depend upon Medicare for their health care needs. And while they are doing it, they are going to fund a whole new program rather than save Medicare--a system we know is going to go bankrupt.
Thank you, Mr. President. I yield the floor and note the absence of a quorum.
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, I find it fascinating, listening to the comments from the Senator from Maine. Maine and Wyoming are similar in a number of ways. One is that the engine that drives our economy is small businesses. What we heard is that this bill right here, this large bill which is the bill the Senate is considering right now, over 2,000 pages--underneath it is the bill that passed the House--I hear these are actually going to penalize the small businesses of Maine and the small businesses of Wyoming when those businesses try to hire another employee.
We are looking at 10.2 percent unemployment right now. People in our States are well aware of those numbers. I don't know if that number is being neglected by others, but for small businesses trying to hire people, this health care bill makes it much tougher. It will certainly make it tougher for them to provide insurance, and it will make it tougher for those small businesses to give raises to people.
It is, indeed, unfortunate that we are here in the Senate Chamber looking at a bill that is going to raise premiums for the American people who have insurance and who like the insurance they have. Their big concern isn't cost. We are looking at a bill that is going to cut Medicare for seniors who depend on Medicare, and the numbers are huge, almost $500 billion. And we are looking at a bill that is going to raise taxes on the American people.
I heard the Senator from Maine, and she can jump in and correct me if I am wrong. What I heard her say is that it is not just a tax on the rich; it is a tax on people all across the board because the taxes are going to be passed on. I see the Senator nodding her head in the affirmative. When taxes are raised on medical devices or on medication, on one thing after another after another, those are costs that will get passed on to all the consumers of health care.
Right before this party took the floor, we had the senior Senator from Minnesota talking about the Mayo Clinic and the wonderful care that is given there. It is wonderful care. But the Mayo Clinic has also said they don't want any part of this bill, nothing to do with it, to the point that they have sent doctors in my home State and States surrounding the Mayo Clinic who refer patients--and I practiced medicine in Wyoming for 25 years, have taken care of families there as a physician, and we sent patients to the Mayo Clinic--they just said: Stop sending patients on Medicare or Medicaid. We want nothing to do with it because the government is the biggest deadbeat payer. The Mayo Clinic said: Every time we get one of those patients, we have to charge the people who pay their own way, the people who have insurance. We have to charge them more. We don't want to take any more patients on Medicare and Medicaid. Hospitals and the communities in Maine, South Dakota, and Nevada, hospitals in those States have to take all those patients.
So what happens to people who pay their own way because they buy insurance themselves or they get it through work is the hospitals have to charge them more to make up for the biggest deadbeat payer of all time--the Federal Government.
I see the Senator from Nevada rising to his feet. I imagine the exact same thing is happening to hospitals in Nevada. Premiums are going up on the 85 percent of the people who have insurance they like. Yet we in the Senate tomorrow night are going to vote on a bill which, to me, the people of America don't like. Do you know who doesn't like it the most? Seniors. They are concerned. They know Medicare is going broke. And by the year 2017, there will be $500 billion of cuts in Medicare. Yet the money that is being cut from Medicare isn't being used to save Medicare; it is to start a whole new program that will cause Americans who have insurance to pay more. It will cause people who don't have any insurance to make it harder to get or if they go to an emergency room and have to pay a bill, that bill will be higher, all because of what I believe is an irresponsible piece of legislation that is going to be a huge weight on the American economy at a time when we have 10.2 percent unemployment.
I see the Senator from Nevada. He has a similar copy of the bills next to him. He may want to chime in on what he sees in his home State and what he is hearing from people who live in Nevada, from small businesses as well as hospitals and providers.
BREAK IN TRANSCRIPT
Mr. BARRASSO. Plus, when you read this bill, one of their so-called solutions is they will put more people on the Medicaid rolls.
Mr. ENSIGN. How many more people are going to go on the Medicaid rolls?
Mr. BARRASSO. It is millions and millions of people, with the cost to the States. You say we will take it out of here. You won't see it in this bill because they are going to make the States pay over $20 billion in money because it is a matching program, so they get it off the Washington books. But it is still the taxpayers and the States, and we all come from States. That is going to drive up the cost for individuals as well as increase taxes around the country.
Mr. ENSIGN. Because you were in the practice of medicine, I ask the Senator from Wyoming, I have heard numbers as high as 15 million new people on Medicaid, plus we have a new public option, so there will be more people on another government plan. What will happen as far as cost shifting to those of us who have private insurance? For those tens of millions of Americans who have private health insurance, what will happen to their cost of insurance when more people are on government plans?
Mr. BARRASSO. Those costs will have to go up. Premiums will go up for all people who have insurance, private insurance. The Senator from Nevada is correct. Some people think the number is 15 million more who will go onto the Medicaid rolls because there is a difference between the Senate bill and the House bill as to how many more folks they move onto the Medicaid rolls. But either way, we are talking tens and tens of billions of dollars that will come out of the taxpayers' pockets around the States. But that is still for a government-run program that doesn't reimburse, doesn't pay the hospitals, doesn't pay the doctors even what the cost of delivering the care is.
Across the board, hospitals will tell you they cannot keep their doors open if everyone is paid at Medicaid or Medicare rates. The only way they can pay the nurses, keep the lights on, take the food in the trays around to the patients, do all the things a hospital has to do, or keep a doctor's office open, the only way they can do it is because they charge more to people who have private insurance than they get paid for people on Medicare or Medicaid. And Medicaid is worse than Medicare in terms of the payment.
So it is this cost shifting that occurs. Who pays that? The people who have regular insurance. It is the hard-working men and women of America through their jobs who pay for that. We just heard from the Senator from Maine. Anytime we try to help that individual--I see the Senator from South Dakota is in the Chamber as well, and he may want to jump in as well because South Dakota is a State like mine where we have lots of small businesses that are going to be hit specifically hard as they try to continue to provide insurance. This does not even allow small businesses to group together to get better deals.
The Senator from Nevada talked about buying insurance across State lines to help people get the costs down. This bill prevents that. It also prevents small business groups from getting together, which would be a great help.
I know the Senator from South Dakota is interested in getting into the discussion. I invite him to discuss this very aspect and the impact of all these increasing premiums on the folks in his State.
BREAK IN TRANSCRIPT
Mr. BARRASSO. Mr. President, if you do a poll of doctors, with the question: Have you ever ordered a test that was not going to help that person get better, that patient get better, but you were doing it because you did not want to miss something for fear of a malpractice suit, every hand will go up of
every physician. The Massachusetts Medical Society did a poll and 87 percent of doctors said that. Massachusetts has their new health care plan.
As an aside, the dean of the Harvard Medical School had an editorial in one of the major national publications this week, and he gave this whole thing--he said: I give this whole thing a failing grade. He said people who support this--the legislation that is being proposed--are engaged in collective denial. We need to do some things that will help with cost, with access, with quality. All this bill is going to do is drive up the cost, with no improvement at all in quality.
So there are step-by-step things we can do: letting people buy insurance across State lines, getting the same tax breaks as others. The Senator talked about helping people stay healthy--exercising, getting down the cost of their care by getting their cholesterol down.
But also you have to deal with lawsuit abuse. It is out there. You could do a thing as easy as loser pays. Obviously, there are great objections to trying to do that. There are people who would oppose that all the way. But it would help eliminate--eliminate--a lot of the unnecessary tests and certainly a lot of the costs of the system. Because two-thirds of the cost of that whole liability system goes to the system, it does not even go to the injured person. If somebody is injured, you want to take care of them. But this does not do it at all.
One of the things the Senator from South Dakota mentioned, fairly quickly in passing, was age band ratings, which flies in the face of the things we have been talking about: individual responsibility, opportunities for people to stay healthy. The big problem is that we know 50 percent of all the money we spend on health care on this country is on 5 percent of the people--the people who eat too much, exercise too little, and smoke. But yet under this government-forced insurance, where people are going to be forced to buy insurance--and if young people do not buy it, they are going to be listed as either tax cheats or criminals because they are going to get fined or they are going to get taxed an amount for not buying the insurance--they are going to have to buy insurance.
As the Senator from South Dakota talked about a 3-to-1 ratio--and the Senator from Maine mentioned the same thing--what that means is for the youngest, healthiest person buying insurance--that kid out of college who is staying healthy or might be working construction, who is in good shape, going to the gym--what they are doing on a 3-to-1 ratio is that person has to pay a lot of insurance compared to the person who does eat too much, exercises too little, and smokes. The ratio of their insurance premiums--this person can pay no less than one-third of what this person pays, when you might have 100 young people where their total health care bills for a year would be equal to that one person who exercises too little, eats too much, and smokes.
So these young people are going to end up paying the cost. And it is their premiums--and I think we heard that from the Senator from South Dakota--their premiums are going to go up--did I hear 69 percent?
Mr. THUNE. Mr. President, 69 percent. If you are 18 to 34, that is what you are looking at in the form of premium increases, not to mention the fact that future generations are going to deal with all of the debt we continue to pile on them, which I think bears heavily on this debate right now, when you are looking at trillion-dollar deficits as far as the eye can see. This is not a good deal if you are a young person in America.
Mr. BARRASSO. It is the wrong prescription for America.
I am going to continue to speak on the floor about the things that I think are problems with this bill. I think it is the wrong approach. I think it costs way too much. I think it raises taxes on all Americans. It cuts Medicare. What we have heard now, and what we know for sure, is it is going to raise premiums for people who have insurance, who like the insurance they have, who want to keep the insurance they have; and their costs are going to continue to go up if this becomes law, at a rate faster than, as we saw from the graph, if nothing was passed at all.
BREAK IN TRANSCRIPT
Source