Service Members Home Ownership Tax Act Of 2009
Floor Speech
Service Members Home Ownership Tax Act Of 2009
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Mr. GRASSLEY. Mr. President, opponents of the Gregg amendment claim the Reid bill doesn't technically change the law on guaranteed benefits for beneficiaries. But they are ignoring the fact that while those benefits may be ``technically guaranteed,'' if the cuts put health care providers out of business, then those guarantees will be nothing more than useless words in the Medicare Act. Guaranteed benefits are not worth much without health care providers that can treat patients, provide home health services, and run hospitals and hospice agencies. These claims are not good enough to assure seniors who have paid into the Medicare Program for all these years. It is not good enough for protecting access to health care services and the benefits that our seniors have been promised.
My colleague from New Hampshire in his amendment would back up those claims with very real enforceable mechanisms to ensure that Medicare savings are not being used to fund a whole new program at a time when the trust fund is just about broke. The Gregg amendment is needed to protect the Medicare Program. After all, if you knew the Medicare Program already had $37 trillion in unfunded obligations, would you be assured without an enforcement mechanism to back up those promises? No guarantee is worth the paper it is written on without an enforcement mechanism to back it up. That is what the Gregg amendment is all about; otherwise, it is just a meaningless guarantee that our friends on the other side of the aisle are talking about. It is not real without an enforcement mechanism.
Let me say for a third time, the Gregg amendment provides that enforcement mechanism. It makes guarantees real. It then goes much further than just the words we get from the other side of the aisle to make sure that what seniors have they will actually get when needed.
Opposition to the Gregg amendment shines light on this issue. If the Gregg amendment is not approved, it should be clear to everyone watching that all the guarantees that are made from the other side of the aisle that Medicare is protected in the Reid bill are worthless. As a result, I hope everyone will be watching carefully how the other side votes on the Gregg amendment. The Gregg amendment is essential for protecting the Medicare Program. It is essential for making guarantees real.
The way the Gregg amendment works to enforce those guarantees is quite simple. The Gregg amendment would make sure the Medicare Program is not used as a piggy bank to spend for other purposes. It would make sure the Medicare Program is not being raided to fund this new program, as the other side claims. Under this important amendment, the Director of the White House Office of Management and Budget and Medicare's Chief Actuary would both be required to add up non-Medicare savings in the bill and compare that total to the total of new spending and revenues in this bill. The Gregg amendment works then that if the non-Medicare savings don't offset all the new costs, then the Treasury Secretary and the Health and Human Services Secretary would be prohibited from implementing the new spending or revenue provisions in the bill. By doing so, the Gregg amendment would ensure that non-Medicare savings are, in fact, paying for the new spending in this bill. It would ensure at the same time that Medicare itself is not being used to pay for new spending in the bill.
It is very simple, very straightforward. It brings common sense to this whole argument that has been full of a lot of nonsense before now. The amendment, therefore, would prevent massive government expansion at the expense of Medicare beneficiaries. Massive expansion of government is one thing, if it is paid for, but it is quite another thing if you take the money out of a trust fund that is on its way to being broke and use it to set up a brandnew entitlement program to the tune of $464 billion.
As opposed to the mere nonbinding sense-of-the-Senate resolution the other side has offered to pretend to protect Medicare, this Gregg amendment requires action, action that has to be taken to protect the Medicare Program. The Gregg amendment is the enforcement mechanism for the guarantees the other side says they are making to protect Medicare. Slashing Medicare payments to start up another new and, in fact, unsustainable government entitlement program is not the way to address big and unsustainable budgets.
AMENDMENT NO. 2939
I would like to take a little bit of time to discuss the Pryor amendment. I have always been a strong supporter of transparency. In order to have a successful free market, consumers need to have information. I can't think of any reason, besides my strong objection to the underlying 2,074-page bill, to oppose the Pryor amendment. It is pretty straightforward. It requires that the Secretary of Health and Human Services have a rating system for private health plans. That sounds OK to me. An informed consumer makes better decisions. So I don't object to the Pryor amendment. But I do object to the fact that the Pryor amendment is more proof that this bill is not being crafted out in the open on the Senate floor.
The Associated Press has confirmed, based on an e-mail circulated by Democratic staff, that the Bennet amendment of last week to protect Medicare was simply ``a message amendment.''
The New York Times went on to call the Bennet amendment ``meaningless.'' Now we have a Pryor amendment that requires a level of transparency that, in fact, is already required by the bill. If you look at page 134, the bill already describes a rating system developed by the Secretary that consumers can use to choose the right health insurance plan. So if the underlying bill is already doing this, I can only assume this amendment by my friend from Arkansas is specifically designed to buy time so the White House and Democratic leadership can cut deals and twist arms behind closed doors.
That is right. The American people need to know this bill is not being written on the Senate floor. In fact, we have a 2,074-page bill before us that took since October 2, until we took it up, for one Senator, the majority leader, to put together. Somehow the other 99 Senators shouldn't have 3 weeks to look at a bill that took well over a month to put together.
Then we had the President here yesterday speaking to his caucus. That kind of obviates any efforts to get bipartisan support for this bill. I think it gives further proof that it is not only partisan but that what this final 2,074-page bill is, we don't know yet. They are trying to put together some sort of a group that can get 60 votes to get a bill passed.
Do we really know what sort of a Christmas present we are giving to the American people with this health reform bill? I don't think so.
I yield the floor.
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Mr. GRASSLEY. Madam President, for the benefit of my colleagues waiting to speak, I don't think I will speak much more than 10 minutes. Before I speak on my purpose for coming to the floor to support Senator McCain's amendment, I want to take a couple of minutes to go over a source of information that is no longer credible, which has been used in debate on the floor several times, used throughout the year--information that has been in letters to the editor of Iowa newspapers.
The most recent hearing of this was when the Senator from California rose to talk about the quality of our health care and the reference to the fact that the United States is 37th out of all of the nations of the world in quality of health care.
I don't deny we have to do a lot to improve the quality of health care in America. I even admit that in this legislation, though I oppose the bulk of this 2,074-page bill, there is a lot in the bill that has to do with the enhancing of the quality of care.
We keep hearing about the United States being 37th in quality. That comes from a World Health Organization analysis that was made back in the year 2000, ranking the United States among all the other nations. It is a 10-year-old report that was flawed in its analysis at the very outset. Yet it is repeated as if gospel truth by almost anybody who wants to denigrate America's health care system and build a case for this monstrosity of a bill we have before us. When I call it a monstrosity, I will say it has some very good provisions in it that would enhance the quality of care. The World Health Organization no longer produces such a ranking table because of the complexities of the task. The rankings were flawed because they judged health care systems for problems--cultural, behavioral, and economic--that are not controlled by health care. There is no differentiation between the quality of medical systems and other factors, such as diet, exercise, and violent crime rates, which ought to be taken into consideration when considering a nation's delivering quality of health care.
The editor in chief of this 2000 report of the World Health Organization, Philip Musgrove, called the figures `` ..... many made-up numbers,'' and the result a ``nonsense ranking.'' Dr. Musgrove, an economist who is now deputy editor of the journal Health Affairs, said he was hired to edit the report's text but didn't fully understand the methodology until after the report was released. Once he left the World Health Organization, he wrote an article in 2003 for the medical journal Lancet criticizing the rankings as ``meaningless.''
The U.S. health system spends more than any other country per capita and was ranked 37th out of 191 due to that spending alone. Prior to considering how much we spend, the United States was ranked 15th, not 37th.
The Dominican Republic, Costa Rica, and Morocco ranked 42nd, 45th, and 94th before adjusting for spending levels. After the adjustment for spending levels, can you believe it? They ranked above the United States--35th, 36th, and 29th, respectively.
The United States ranked first in responsiveness. That means respect for persons and prompt attention. Americans understand and appreciate this quality care. This will be lost in this massive health care reform bill when the government takes more control.
Experts in the field of health, such as Mark Pearson, head of health for the
Organization of Economic Cooperation and Development, OECD, was quoted as saying:
It's a very notorious ranking. Health analysts don't like to talk about it in polite company. It's one of those things that we wish would go away.
I hope my colleagues will take that into consideration when they bring up the rationale for this bill, that it is because of that World Health Organization study, which I think what I said and a lot of other things you can say about it ought to put it into proper perspective.
For my support of the McCain motion to bring equalization among the 50 States for the Medicare Advantage portions of this bill, I have spent the past 28 years in Congress working to make sure that rural Iowans have access to the same quality of health care as people living in more urban areas.
Medicare, since 1965, has been a national program. Well, it is a national program with traditional Medicare. But before we brought equity to Medicare Advantage, it wasn't a national program. It was a program for California, Arizona, Texas, New York, Florida, Chicago, or near the Midwest, maybe Omaha. Since Medicare Advantage was not a national program, and since Medicare since 1965 has been a national program, I set out in the Medicare Modernization Act to bring equity to rural America just as we have in urban America. I fought to make sure that seniors living in rural areas would have the same choices as seniors living in Miami, New York City, or Los Angeles.
That is simply saying that wherever you live in the United States, you have Medicare--traditional Medicare. Before then, wherever you lived in the United States, in most rural areas you didn't have Medicare Advantage. Since Medicare is a national program, people living in rural America ought to have the same choice as those in urban America.
Today that is the case. Seniors in every county in Iowa have a choice between traditional Medicare and Medicare Advantage. That is a big improvement, since prior to the Medicare Modernization Act not all Iowans had that choice. I can narrow it down to 1 out of 99 counties--Pottawattamie County, across from Omaha, had Medicare Advantage. The other 98 counties didn't have it. I want to tell you, there are still inequities, because Iowa providers offer high-quality care that leads to less utilization. Iowans get approximately $1,500 less per year in Medicare Advantage benefits than seniors living in Florida. Under this bill, Iowans will see even less in Medicare Advantage benefits. It looks like that won't be the case for some lucky Floridians.
In another one of those backroom deals--a backroom deal that seemed to be needed to get 60 votes, backroom deals that are still being attempted to get 60 votes--the Senator from Florida, in one of these backroom deals, was able to secure a provision in the Finance Committee bill that would make sure that seniors in certain Florida counties are able to maintain their current benefits. I am not talking about the so-called guaranteed benefits that Democrats say they are protecting. The provision secured by the Senator from Florida will also protect additional and extra benefits for Floridians. In pushing for this amendment, the senior Senator from Florida said:
It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare.
I guess Floridians weren't satisfied with the promise that has been made throughout the last 2 weeks of debate on this bill to protect the so-called guaranteed benefits. Seniors in Florida still wanted the lower cost sharing, wellness programs and vision, hearing and dental benefits they have come to rely on. Now we have the Senator from Pennsylvania filing an amendment to help Medicare beneficiaries in Pennsylvania protect their extra benefits, to get these extra benefits that people on Medicare Advantage have.
I am guessing that seniors in Pennsylvania must have also picked up on the Democrats' hollow promises to protect guaranteed benefits but not worry about other benefits. In fact, the presence of these special deals is proof that this bill is cutting Medicare benefits.
It is even proof that some Senators are worried about going back to their constituents and trying to explain the difference between cutting guaranteed and additional benefits, and explaining why they voted to cut Medicare Advantage benefits by 64 percent. Why else would these special deals be necessary?
I am here to ask my colleagues, why should seniors in Florida or Pennsylvania get to keep their extra benefits, while more than 9 million seniors in other parts of the country see an average cut of 64 percent? To quote the Senator from Florida, isn't this also intolerable?
My colleagues on the other side talk about efficiency and fairness, but they are supporting a bill that maintains the highest Medicare Advantage payments in the country, while slashing benefits in higher quality rural areas. One of those higher quality rural areas is the State of Iowa, where we are fifth in quality but near the bottom of 50 States in reimbursement on Medicare, whereas other States are fiftieth in quality and No. 1 in reimbursement on health care.
All of this doesn't sound very efficient or fair to me. Senator McCain's motion is pretty straightforward. It goes State by State. I am not going to read all 50 States, but it says here that 1 million--it is going to benefit the 70,000 Medicare Advantage enrollees in Arkansas. It is going to benefit the 198,000 Medicare Advantage enrollees in Colorado. In Iowa, it is probably something in the neighborhood of 63,902. It will make sure that seniors in every other State in the country--red States and blue States--get the same deal Senator Nelson got for Florida.
A vote for the McCain amendment is simply a vote for equity. But a vote against the amendment is a vote to favor backroom deals that put the interest of a handful of Floridians above 10 million seniors across the country.
I urge my colleagues to support all seniors and vote for the McCain motion.
I yield the floor.
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