Service Members Home Ownership Tax Act Of 2009--Resumed

Floor Speech

SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009--Resumed -- (Senate - December 19, 2009)

BREAK IN TRANSCRIPT

Mr. THUNE. Before the Senator from Oklahoma leaves--and I understand the staff needs to get out of here, and the weather is not cooperating in Washington today--I am interested in his discussion and the points he was making about the liabilities we continue to rack up and how that is going to impact future generations.

I wonder if the Senator from Oklahoma might respond to a question with regard to the current debate. Because it strikes me, in light of all the spending and borrowing the country is doing, the concerns it is now creating about not only the economy in the near term but also the impact this could have on our country's strength in the long term, the way some of our creditors, the people who actually buy our debt, are viewing the debate about health care--in fact, when the President was in Asia recently, the discussion with the Chinese was more about, their interest was about what is going to happen with health care in this country, not because they cared about whether there was a public option in the bill, not because they cared about whether it was universal coverage, but because they were interested in what it was going to do to the debt, what it was going to do to the deficit. They were worried about their investments.

I think it is fair to say having this last fiscal year rack up a $1.5 trillion deficit--and looking to be somewhere in that ballpark again this year--that we cannot sustain over time this pace we are on of borrowing, spending, and continuing just to mortgage the future of future generations, and that bears on the debate we are having today. Because under the best case scenario, this health care expansion, when it is fully implemented, is going to be a $2.5 trillion expansion. And the managers' amendment, which was laid down today, actually increases the cost.

I do not know if the Senator from Oklahoma has--I am sure he has
looked at this, but it was $848 billion, and now it is $871 billion. That is their first 10-year number, which I suspect means the fully implemented number, the $2.5 trillion number --

Mr. COBURN. It is $2.73 trillion.

Mr. THUNE.--is equally larger. The tax increases went up as well. The taxes that were in the original bill were $493 billion. It is now $518 billion. The Medicare payroll tax, which was going to be a half a point increase is now nine-tenths of a point. That, of course, impacts the Medicare trust fund, for which this will be the first time I think that a payroll tax will be levied that does not go to the trust fund; it actually goes to create a new entitlement program.

But I just wonder what the Senator from Oklahoma thinks about how the health care debate and the spending that is going to be associated with that is going to impact the scenario he was describing, the fiscal condition of our country as we head into the future, and whether we will be able to really keep the cost at the $2.5 trillion, and whether the tax and the Medicare cuts--which the CMS Actuary says it is unlikely, on a permanent basis, that those cuts will be sustainable--how does this thing get paid for? It seems to me it gets paid for by putting more on the debt, by putting more on future generations.

I am interested in the reaction of the Senator from Oklahoma to that.

Mr. COBURN. I think it gets paid for by rationing health care to Americans. That is how I think it gets paid for. You have three different programs within this bill, three different panels that are going to mandate what I as a physician can do with my patients. Once it gets applied, there is not going to be an exception to it. For 80 percent of Americans that is going to be fine. The real key is to ratchet it down by rationing care.

What do we know? We know $1 out of every $3 that is spent on health care today does not help anybody. Do we fix that in this bill? No. We know that $1 out of every $3 does not prevent anybody from getting sick and does not treat anybody's illness. Did we fix that in this bill? No. We did not do anything about it.

I will tell the Senator from South Dakota, the tenent of medicine is you do not treat symptoms. You find the disease and you treat the disease. The bill we have before us is a bill that treats the symptoms. It does not attack the disease. Because that $600 billion a year, at a minimum, that does not help anybody get well and does not prevent them from getting sick--if we just took half of it, we could cover everybody who is not covered in this country today. We could cover everybody and not spend a penny more on health care. But we have not attacked the disease. We are treating symptoms. We are not working to solve the real problems underlying health care.

The problem in America for health care is access to services. The access limitation is because of cost. If you cut costs 15 percent tomorrow, you would increase the same number of people who are increased in the bill in terms of availability. If you had real transparency in the insurance industry, where people could see and actually compete and buy all across this country what they wanted, and we hammered the insurance industry in terms of transparency of outcomes--the same for doctors--you would cut the cost even further. In other words, you put the patient in charge. We have a government-in-charge bill that we are going to be voting on instead of the patients.

So we are treating symptoms. We are not treating the disease. We are treating those who are screaming the loudest, but we are not fixing the problem. We are just making the problem worse and bigger.

Mr. THUNE. If the Senator from Oklahoma would yield for another question, does the CMS Actuary and the Congressional Budget Office conclude, when it is all said and done, that the overall cost of health care goes up, not down? It seems to me, at least, that as to the points the Senator mentioned, if we were sincere about reforming health care in this country, what most small businesses, what most individuals, what most families want to see is health care costs going down. This actually bends the cost curve up, according to the CMS Actuary, with a $234 billion increase in health care costs over 10 years.

According to the Congressional Budget Office, it is a $160 billion increase in health care over 10 years. So there is a slight difference in terms of their analyses, but both conclude that health care costs will go up. The amount we spend on health care as a part of our total economy in this country----

Mr. COBURN. Will rise to 21 percent.

Mr. THUNE.--will be 21 percent. It is currently about 17 percent or in that ballpark. So it seems to me, at least, we have done very little----

Mr. COBURN. You are not fixing the disease.

Mr. THUNE. If anything, to address that problem.

So I simply would ask the Senator from Oklahoma, some of the things the Senator talks about in terms of actually attacking the disease could be the basis upon which we could put together a consensus bill around here that actually does reform health care in a way that drives down the cost rather than raise it and does not rely on all these tax increases, does not rely on the $1 trillion in Medicare cuts, which the CMS Actuary says are unlikely to be substained on a permanent basis, therefore, again putting more and more of the burden of the cost of this new expansion on future generations.

I just see this as a very dangerous path to be on when you are running $1.5 trillion deficits, when you have an economy in recession, and unemployment is about 10 percent. We are talking about tax increases that are going to be passed on in the form of higher premiums for most Americans.

To be fair, there will be some Americans who will benefit. Most will not. Most will see their premiums go up. We are going to see Medicare cuts. The program will be cut, but not to reform it or make it more sustainable or extend its life but, rather, to create a new entitlement program.

How can we move forward with legislation such as this and call it reform? Wouldn't it be fair to suggest that if our colleagues on the other side were serious about reforming health care, they would sit down with us in a way that is constructive that would actually represent the common ground we could find and not write these bills, as they have, behind closed doors and then spring it on us today on a Saturday morning, and try to push this thing through to passage before Thursday of next week or Friday on Christmas Day?

Mr. COBURN. The Senator has asked a lot of questions. There is an organization that is based out in Oklahoma. It is called Safeway. Safeway has 200,000 employees. They have had a zero percent increase in their health care costs in the last 5 years, doing the things that we talk about in the Patients' Choice Act: using market forces, getting patient participation.

What have they found out? Their workers are healthier. Their absenteeism rate has gone down. They have lost cumulatively thousands and thousands of pounds. Their work product is better and their company is healthier because they are not spending more.

What has happened to their wages? Their wages are going up. One of the statistics most people do not understand is that for every 3.5 percent rise in health care costs, you lose 2.5 percent in real wages. In other words, if health care costs would stay flat, you would get a 2.5-percent increase. If they go up 3.5 percent, you are going to lose that 2.5 percent. If they go up 7 percent, you are going to lose 5 percent. So controlling the costs, when we have a third of it wasted anyway, should be our goal, and that is not where we are headed.

So the disappointment is not that we do not need to fix health care. We do. The disappointment is that--which I think I have outlined here today--the government is highly inefficient at everything it does, and effective only on a limited basis on the things we do fund, and then we are going to move another 20 percent of health care under the control of an organization that has proven itself ineffective at what it does.

That is insanity. The direction of the bill is one that treats the symptoms so we will feel better for a while, but we still die. If we practiced medicine that way, we would be run out of town on a rail. You do not treat symptoms. Symptoms cover up worsening disease. You treat the real disease, and the real disease is lack of transparency, lack of accountability, lack of reform, lack of tort reform, and lack of a competitive nature, both in the health insurance industry as well as in providers like myself.

Make me compete based on quality and price, and make sure my patients can see it, so that a consumer can make a real choice. If we were to do that--which this bill does none of that--if we were to do that, American consumers could get a much better deal.

I thank the Senator.

Mr. THUNE. Mr. President, if I might say, the Senator from Oklahoma has put forward a comprehensive approach to health care reform. It has been argued here many times on the floor that Republicans do not have their own ideas. We have argued throughout the course of this debate that we ought to be approaching this not in sort of a radical overhaul of an expansion of the Federal Government's role in our health care delivery system, which this legislation would do, but, rather, look at ways we can provide more competition and create a more robust private sector health care delivery system. Instead, this approach relies heavily on growing the government footprint with regard to health care, as is evidenced by the $2.5 trillion cost of the legislation.

But the Senator from Oklahoma and our colleague from North Carolina have come up with a comprehensive solution, which is very, in my view, bold and does represent true reform that moves us away from the system we have today, which has demonstrated, as the Senator from Oklahoma has pointed out, that it continues to increase in cost and continues to probably--I think it will be argued--deliver less in terms of quality and makes the failures in the current system even bigger and worse, without doing anything to address the fundamental underlying problem or disease.

So I would say that inasmuch as the Senator from Oklahoma has a comprehensive solution, we also support what I would call more step-by-step approaches. One, of course, is interstate competition, allowing people to buy insurance across States lines. One would allow pooling, allowing small businesses to join a larger group, thereby getting the benefit of group purchasing power.

As the Senator from Oklahoma mentioned, medical malpractice reform is something we all believe needs to be done. The Congressional Budget Office, by the way, has said all these various solutions bend the cost curve down, not up. But those are all things we could be doing to improve upon the system we have today.

Frankly, I think we need to have a fair debate of the proposal of the Senator from Oklahoma, which is a comprehensive approach, which does take us away from the employer-based system, which empowers individuals through the form of tax credits to buy their own health insurance to make them more informed consumers. We always talk about a consumer-driven model. That is exactly the approach that his legislation and his reform proposal would employ.

So I would like to see us have an opportunity to debate that. We are not going to get that chance, I do not think, because it sounds as if the amendment tree has been filled. The bill that is before us now with the managers' amendment will prevent other alternatives, other amendments from being offered. That is unfortunate because I think the direction we are headed is a train wreck, as has been described by many, because it leads to more spending, more taxing, Medicare cuts, and I would argue, in the end, more borrowing, frankly, does little to solve the underlying problems that exist in our health care system today.

Mr. COBURN. Would the Senator yield for a moment?

Mr. THUNE. I am happy to yield.

Mr. COBURN. There is one area I needed to cover that I didn't, and I will do so rather quickly.

Since 1977, this country has said we are not going to take Federal taxpayer dollars to pay for abortions. That is a divisive issue. The only way we change that issue is to change people's hearts in this country. So we are going to have to all agree to disagree on abortion in this country, and it is about a 50-50 split. What is about a 70-30 split is that the vast majority of Americans don't think their tax dollars, whether they are pro-choice or not, should be used to pay for somebody else's abortion.

What we saw come through the Senate this morning is something that every significant pro-life group in this country, including the Catholic Bishops, including Right to Life, including this doctor who has delivered thousands of babies and understands the issues of life, is going to abhor. What we have done is ultimately eliminate the Hyde amendment, and come next September 30, throughout the Federal Government as well as in this bill, the Federal Government is now going to allow taxpayer dollars to be used to pay for abortion.

Congressman Stupak, who is a friend of mine, who made sure the House did not allow that to happen, has recently been quoted today saying this is absolutely unacceptable, and it should be. We should not be using Federal funds for that procedure to end the life of an unborn human being.

With that, I yield the floor and yield back my time.

Mr. THUNE. I appreciate that. I appreciate and share the Senator's view with regard to the changes or proposal that was unveiled this morning and how it treats the issue of abortion.

As was noted, the House of Representatives and Congressman Stupak came up with a clear, unequivocal policy position that extends the policy, essentially, that has been in place now for the past 30 years in this country regarding the use of taxpayer funds for abortions. The language that supposedly was negotiated between the Senator from Nebraska and the Democratic majority does not follow through or maintain that policy and, in fact, opens the door to allowing Federal funding to be used for abortions.

Irrespective of which side you come down on, on this issue, there has been widespread and broad American support for a very long time. I think it is something both Republicans and Democrats have agreed upon, and we should not deviate from that. The American people have made it very plain that they believe--60 to 70 percent, in most surveys--the Federal Government should not be using taxpayer funds to finance abortions. The funding is clearly in the Senate version that now has been negotiated. As the Senator from Oklahoma mentioned, the opposition comes from the Catholic Bishops, the opposition comes from the National Right to Life. It is very clear that this provision that is now included in the managers' amendment does not maintain the long-held policy we have had in this country supported by so many Americans that we not use taxpayer funds for abortions. So that, too, is something this bill falls short on, along with all of the other many things I have mentioned.

I think we are going to have many opportunities over the course of the next several days to continue to discuss this issue. We just received the managers' amendment this morning, and I think it is important, as the debate over the managers' amendment begins and we have some votes that are going to be coming up in the next few days, that we continue to talk about why this is the wrong approach for America, why it is the wrong approach for health care, why it is the wrong approach for our economy, and why it is the wrong approach for jobs. We can do so much better by the American people. This needs to be done in a step-by-step way. It needs to be done right. This legislation takes us in the wrong direction for the future of this country.

Mr. President, I yield the floor.

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