Health Care Reform

Floor Speech

HEALTH CARE REFORM -- (Senate - October 19, 2009)

Mr. KYL. Mr. President, I believe my colleague, Senator Thune from South Dakota, will be here in a few minutes. Until he arrives, I thought this might be of interest. I promised my constituents I would tell my colleagues what they told me to tell them. I think it would be of interest to share some of these remarks.

I went to a meeting on Saturday morning that I thought was going to be a rather staid affair with folks who were primarily senior citizens, but not all of them were. It turned out to be a little bit reminiscent of some of those townhall meetings we saw on television during August because the subject most people wanted to talk about was health care. They weren't happy with what they were hearing the Senate was about to do. Among other things, they wanted to get it clear with me right off that I would pass on their concerns about this to my colleagues. I promised that I would. So let me summarize what some of them had to say and what I think the clear consensus of the group was.

First of all, they have a hard time understanding how Senators would pass a bill before we read it or even know how much it costs. I assured them that the procedure we would follow in the Senate was that we would have at least 72 hours after the bill had been finally written and after the Congressional Budget Office had scored the bill--that is to say, told us how much it would cost in all of its component parts and the ways it would be paid for. The reason I can feel fairly certain that will happen is because a number of colleagues on both sides of the aisle have either written to the majority leader or made it clear to him that they will not support a motion to proceed to a bill until we have had an opportunity to, in effect, read it and see how much it costs. That process could take some time, I told my friends. The Congressional Budget Office Director told the members of the Finance Committee, on which I sit, that it can take 2 to 3 weeks after the bill is written to come up with all of these calculations.

You will hear many people say we need to move this process on, even before we have the numbers. But I think that given the fact that most of us are committed to ensuring we have the numbers and can digest them and share them with our constituents before we debate and amend the bill, I assume the process will unfold in the Senate in such a way that we do know what it costs, and that means after the final CBO report is provided to us.

The next thing they wanted me to convey was that they were very worried about--in fact, maybe that would be a euphemism. They were more than concerned about the degree of government involvement in health care once this process is over. They fail to understand why we had to have what amounts to a government takeover of insurance in this country and dictating everything from what kind of insurance policy you have to have, to how doctors and hospitals are paid, in order to solve the two key problems that exist: No. 1, there are some Americans who need help buying insurance; second, that the costs of health care premiums continue to go up every year, and it is especially hard for small businesses to provide coverage for employees.

They asked me: Why do we have to change the entire system, with the government essentially taking it over?

I happen to believe we don't. I provided the two basic alternatives to them. One is a step-by-step approach that targets specific problems we have and matches up specific solutions to the problems, on the one hand, which is the approach I favor; on the other hand, essentially changing the insurance we all have today, creating a new insurance exchange, and all insurance would have to go through there. Even if you like your policy, it will change, and you are not going to be able to keep it.

Estimates are that, as a result of all of this, in an effort to cover 18 or 20 million more people with insurance, it is going to cost us close to a trillion dollars. It will raise taxes, it will raise insurance premiums, and it will require deep cuts in Medicare. They didn't like that. I guess that brings up the third thing.

With regard to Medicare, they were pretty perceptive in asking me the following basic question. One person said: One of two things is going to happen. Either it will be business as usual where we say we will make cuts in Medicare, but the Senate and the House never have the courage to do that, in which case this bill is going to cost a lot of money that is not offset by concomitant savings, or the savings are going to be made, and when they are made, it is going to deeply cut our benefits under Medicare.

That person was right. One of those two things is true, and neither one is a good result.

I remember a few years ago when we tried to reduce the growth in Medicare by about $10 billion. Republicans and President Bush were excoriated; we were going to ruin Medicare, and our colleagues on the Democratic side took great glee in the public reaction to that proposal to decrease the growth in Medicare by $10 billion.

Now we are talking about cutting Medicare by--I said $500 billion. The Finance Committee money is actually $450 billion. So let's be accurate. If that is the way this bill comes out, $450 billion, $120 billion of that is reduction of benefits under Medicare Advantage. So when people say: You would not have your benefits cut, that first $120 billion is a direct cut in benefits, and in my State a lot of seniors have Medicare Advantage policies.

The other way in which Medicare is cut--there are basically two things. One is reducing the amount of money we pay doctors and hospitals, and that cannot help but reduce the care we get. The final mechanism is a Medicare Commission is being established to provide--I think it is every year; maybe every 2 years, but let's say every year--an amount of money that will have to be cut and will automatically be cut from Medicare unless the Congress finds a different way to do it, but Congress would still have to cut the same amount. So we either do it the way we want to do it or we do it the way the commission recommends it. In any event, their recommendation automatically goes into effect if Congress does not act.

I have a couple thoughts about that point. We have never been able to effect these cuts in the past because seniors know that it cuts deeply into their care, and they have told us and we have reacted by saying: OK, we will not do it. We could react that way again, in which case all of the savings, or at least a great deal of the savings, that were supposed to result and offset the costs of the bill would not be there. So now the bill is no longer deficit neutral. Now it is not balanced. Now it does add to the deficit and to the debt. If we do allow those cuts to go into effect, seniors are clobbered by deep reductions in the care they receive all the way from nursing homes to physicians to hospitals to hospice, medical devices--you name it. As I said, neither of these results is a good result.

There were several people who wanted me to convey their thoughts in that regard. I happen to agree with them, so I could do that.

I met, after visiting with this group, with a group of spinal surgeons from all over the country and, in fact, from outside this country. I saw the agenda of their meeting. I was the last speaker. For a layman, such as you and I, Mr. President, it was daunting to read through that agenda--all of the latest techniques in using new laser and stints and all kinds of things that I did not understand, but it was the very latest technology and techniques for treating spinal diseases and conditions.

What they told me was--I was the last person to make a presentation--all of these great things we are doing for our patients we are not going to be able to do under this legislation, first of all, because it will be presumed to cost too much; second, because it will take the FDA and the other government agencies way too long to authorize its use for treating Medicare patients, for example; and, third, because the comparative effectiveness research which has in the past been used by these doctors to help them appreciate the best way, clinically, to treat someone is now going to be used to decide what Medicare can afford to pay. A lot of the more leading-edge techniques and technologies are not going to be approved for that purpose.

Their point was that people in China and Europe are going to be treated with the latest techniques more than Americans will because the American system of health care is going to deny people such as these experts the ability to do what they do.

One way this is being accomplished is by taking money away from specialists and giving it to general practitioners. There is a rationale for paying general practitioners--family doctors--more money. They are not making enough, and they are the first place most of us enter the medical world. If we have something that does not feel right, we go to our doctor. It is usually a family doctor. Frequently, he can help us, but frequently he says: I think there is something about what you have here that tells me I have to send you to a specialist. We go to the specialist then and he orders some specialized tests and he examines them and he may end up having to provide some kind of very specialized treatment and care that is probably going to cost more money.

While the family doctor needs to be paid more, we don't solve that problem by taking money away from the specialists. If we have to add money to the system to ensure that we have enough doctors who can provide quality care, then there is no free lunch and we have to pay for what we get. We should not make it a zero-sum game and take it from Dr. B in order to pay Dr. A. That was another strong message of these specialists.

I also happened to meet on Friday afternoon with a group of physicians in Phoenix from all different practices--from specialists to generalists, hospital physicians to others. To a person, they had this question for me. The way they asked it was, Why isn't anybody talking about medical malpractice reform?

I said: I am talking about medical malpractice reform.

They said: You are not getting through.

I said: The problem is there are a bunch of folks on the other side of the aisle who don't want medical malpractice reform, and you know why. And, yes, they understood the answer why.

I remind friends who might not have remembered, Howard Dean, a former Governor of Vermont and a former Democratic candidate for President and a former Democratic Party chairman was very candid in a townhall meeting in Northern Virginia on August 17 with Representative Moran where he told the group assembled there that the reason medical malpractice reform was not in the legislation is because they did not want to take on the trial lawyers.

That is true, but it does not make it right. Maybe somebody should take on the trial lawyers because there are a lot of estimates of how much money could be saved through meaningful medical malpractice reform. This jackpot justice system of ours that pays trial lawyers and requires physicians to pay as much as $200,000 a year in liability insurance premiums--all of which, of course, have to be passed on to the cost of our care, and perhaps even worse than that, practice what is called defensive medicine--raises the cost of our health care. Defensive medicine is having all kinds of tests performed and maybe putting someone in the hospital an extra day or two all in order to protect from a liability claim that their doctor did not do everything he could to take care of this poor patient and, as a result, the patient got sicker and something bad happened.

There are a lot of estimates. First, one estimate is from a study that says 10 cents on every dollar spent on health care is paid in insurance premiums by physicians. Obviously, some of that will still have to be paid with medical malpractice reform, but it could be reduced as has been the experience in the State of Arizona and the State of Texas, which is the reason Senator Cornyn from Texas and I have introduced legislation that will provide modest reforms to the tort system by putting some modest caps on noneconomic damages awards and providing that expert witnesses who testify have to be really expert witnesses in the area of the alleged malpractice.

These two things have saved enormous amounts of money. In Arizona, we don't even have caps on damages, but the requirement that expert witnesses really be expert has ended up saving millions of dollars and reducing the malpractice premiums for physicians in the State of Arizona.

This is a reform we could accomplish on a bipartisan basis that not only would not cost anything, it would actually reap financial benefits. The Congressional Budget Office says just the savings to the U.S. Government--because we provide care under Medicaid, Medicare, and to our veterans--would save $54 billion. There are a lot of estimates that are higher than that. There is one estimate that is over $100 billion a year.

The Director of CBO acknowledged to people of the Finance Committee when we asked that $54 billion savings would actually be approximately doubled if we take into account the private sector as well. In other words, not only the Federal Government would save that much money, which pays about half of all health care dollars in the United States, the private sector, which pays the other half, could save a like amount of money.

These constituents wanted to know why doesn't anybody ever talk about it. I had to tell them we are talking about it. It is just that nobody is listening.

That kind of brings up the last point I want to pass on. After meeting with these three different groups in Phoenix and talking with people elsewhere I went over the weekend, it is pretty clear to me people are becoming very frustrated with their government, and this is not good. They don't think their government is listening to them. We are elected to be their representatives, to bring their ideas to Washington. Since they can't all study up on the issues as thoroughly as we are supposed to do, they trust us to not just to do what they want, not what they say, but to use our best judgment. But they do want us to listen to what they are saying and translate that into action.

What I hear them saying and what public opinion polls verify is they are very worried about the breadth and the depth of this proposed health care reform. They say it costs too much money; it is going to get us in debt; it will raise taxes which are going to be passed through to them; it is going to raise insurance premiums; and it is going to involve a massive government intrusion into what is primarily a private matter between them and their physician, with their insurance company added into the mix. They see this along the same lines as the government takeover of banks and insurance companies and car companies and everything else, and they don't like it.

One of the reasons they don't like it is because they see their own health care being delayed or denied as a result. They appreciate the fact that if the government gets so involved that it can begin to tell insurance companies what they can pay for and tell doctors what they can do for patients, that the next thing that will happen is their care will be delayed and denied and ultimately rationed.

I read a chapter in a book by our former colleague, former majority leader of the Senate, Dr. Bill Frist, a renowned heart surgeon. I talked with former Senator Frist about it last week. He actually served for about a year in England under their health system. He makes the point in his book that there are some good things about their health system. He said the bad thing is that if someone has a serious condition, unless they are at the top of the list, they run the risk of never having their serious condition dealt with.

He gave an example of a list of 100 patients who needed heart surgery. He said they would do two a day and gradually work down the list. He said what he found was that after a few weeks, peoples' names were being taken off the list. They didn't need the surgery anymore because they had died. He said that would never happen in America. He said if we have 100 people who need heart surgery in America, we would figure out a way to get that heart surgery for them right away, and we wouldn't do two a day until we ran out of time and they ran out of life. He said that is really the difference in a system in which we are controlled by the amount of money the government chooses to put into the system every day versus the kind of system we have that takes care of people and worries about the cost later. That is why it is possible for us to say that even people without insurance get cared for. No one in this country should die because they don't have insurance because we will take care of them.

Obviously, having insurance makes the delivery of care easier, more timely, and much more cost-effective, which is why at the end of the day we want to see that everybody is insured.

The bottom line is that we do not need to throw out the baby with the bathwater, get rid of the system we have that currently takes care of most people very well in order to insure that last group of folks who don't have insurance. We can provide a voucher or subsidy to them and get them coverage.

The other thing we have to do is help to bring down the costs. Republicans have offered numerous solutions on how to do that without having the government take over the system. I mentioned one: Medical malpractice reform. It does not cost a dime, it will save billions of dollars, and it is good policy besides. So why don't we do it? Because there is a vested special interest that does not want it done. It will take money out of their pockets. That is wrong.

My question to all of my colleagues is, When are we going to stand up to the special interests? Everybody likes to whack at the insurance companies. How about taking a good hard look at the trial lawyers? And, by the way, while we are talking about insurance companies, Republicans offered several ideas on how to add more competition for the insurance companies so in those situations where they have it good, if we provide for certain reforms that we have offered, such as association health plans, small business plans, more flexible HSAs, interstate sales of insurance, all these things would provide more competition for the insurance companies and force them to lower their rates.

This would make health care more affordable because it would help small businesses in providing health care for their employees.

All these things came up during these meetings. As I said, I promised my constituents I would be sure to pass their ideas on to my colleagues, and I make these comments in that spirit, hoping that we will listen to our constituents not just in Arizona but in South Dakota and everywhere else around the country. And as a result of listening to a bunch of pretty commonsense folks, perhaps we will make wiser decisions here than we otherwise would have.

I see my colleague from South Dakota is here. He had some very erudite comments to make on one of the television shows on Sunday, and I am happy to yield the floor for Senator Thune.

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