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Public Statements

Health Care And Education Reconciliation Act Of 2010

Floor Speech

By:
Date:
Location: Washington, DC

BREAK IN TRANSCRIPT

Mr. GREGG. Well, I would like to ask the Senator from Tennessee a question on the substance of his proposal.

Mr. ALEXANDER. I will be glad to take the Senator's question.

Mr. GREGG. Because I do think it is an important proposal. As I understand it, what the Senator is saying is that they put this baggage on the train, which is the nationalization of all student loans in this country, the government is going to take them all over, which will be the fourth major nationalization event this administration has undertaken.

First, they nationalized the auto industry. Now, they are in the process of quasi-nationalizing the health care industry. Now they are going to nationalize the educational industry. If the House final reform bill passes, they will essentially be nationalizing the financial industry--or having the capacity to--because they can break up any company, whether they are healthy or not, under the Kanjorski amendment.

So my question is: They threw this proposal on the train, nationalizing the student loan industry, in order to use student loan money to finance the health care bill because this bill would have violated the budget rules if it did not have the student loan money basically paying for it?

Mr. ALEXANDER. Mr. President, I am afraid the Senator from New Hampshire is exactly right. According to the Congressional Budget Office's updated estimate, $8.7 billion of this money that is being overcharged to students will be used to help pay for the health care bill.

The other money, except for a small part, will be used for other government programs. So you are right on both counts--one Washington takeover after another. That is why I am saying, I think we ought to hide the Yellow Pages from these fellows because if they find something in there that is being done in the private sector, they are going to say: Oh, we can cut out the profit, we can cut out the business; why does not the government do it?

Then, second, I mean this is astonishing to me. These are not Wall Street financiers going to community colleges in New Hampshire and Tennessee, these are people with jobs who are trying to improve their lot. Their student loan levels are already too high. We are worried about that. So we are going to take another $1,700 or $1,800 on a $25,000 average loan over 10 years. We are just going to say: Well, we will overcharge you. We are going to use that in government. The answer is, yes, to your question, Senator; $8.7 billion of the money taken from students by overcharging them on their student loans will go to help pay for the health care bill.

Mr. GREGG. If I can ask a further question of the Senator. If they did not have that $8.7 billion of student loan money being used to finance the health care bill, this reconciliation bill would fall; would it not? Because it would not meet the budget instructions of having $1 billion of savings.

Mr. ALEXANDER. The Senator is correct.

Mr. GREGG. The Senator had a further question about whether the floor could be yielded. We are in the process of seeking a unanimous consent agreement.

Mr. BAUCUS. I was going to ask the Senator from Tennessee a question.

Mr. ALEXANDER. I will be glad to have a question.

Mr. BAUCUS. Is it not true that the Congressional Budget Office stated in a letter, dated March 20, commented on the bill in a letter to the Speaker on page 13, where it states: The title as a whole--that is referring to the education title--states that the title as a whole would reduce budget deficits in both the 10-year projection period and in subsequent years.

Is it not true that the Congressional Budget Office reached that conclusion and so states in their letter of March 20?

Mr. ALEXANDER. Mr. President, I do not have that letter in front of me, and I do not know what that has to do with my amendment.

What I am saying is, the Democratic majority is deliberately overcharging 19 million students to help pay for the health care bill. Those are the Congressional Budget Office's figures, not mine.

I would ask, through the Chair, to the Senator from New Hampshire, whether I should at this point yield the floor.

Mr. GREGG. I appreciate the Senator from Tennessee's courtesy. At this time, we are ready to go forward with a unanimous consent request.

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Mr. GREGG. Mr. President, a couple comments need to be responded to because they are so patently inconsistent with the facts that they should be clearly rejected. It is almost as if somebody spent too much time at the movie ``Alice in Wonderland.'' The idea that by their own score, when you cut Medicare by $521 billion--$ 1/2 trillion cut out of Medicare by their own score, which is inaccurate, of course, because it doesn't count the full 10 years--if you count the full 10 years, it is $1 trillion taken out of Medicare--the idea that seniors are not going to be affected by that type of a cut is absurd on its face.

The claim is, we don't affect senior benefits. That is nice. That is like telling somebody they can have a car, but there is no engine in it. I mean, the simple fact is, when you cut the providers of seniors by as much as this bill cuts them, clearly it is going to be harder for a senior citizen to see a provider, a doctor, a hospital group. Or when you reduce the spending on Medicare Advantage, which is an insurance program that many seniors appreciate--CBO scores the reduction as being so large that over 11 million seniors will be thrown off that system--that affects seniors.

If they genuinely believe their language, ``we don't do anything about Medicare; we don't do anything about seniors,'' even though the score says they cut Medicare by $500 billion, their own score, and the CBO has said over 11 million people will be knocked off of Medicare Advantage--if they believe that, if they believe their language, then they have to vote for my amendment. They have to vote for my amendment which makes it clear that we protect Medicare.

Then there was some other comment made that somebody was going to vote against our amendments, not because they don't make sense but because they are dilatory. This is from a leadership on the other side of the aisle that produced the largest piece of social engineering in our history: 2,500 pages, $2.6 trillion of spending, $1 trillion of cuts in Medicare when fully implemented. They produced that bill in a closed room behind a secret door somewhere on that side of the Capitol, never open to the public, brought it to the floor of the Senate on a Saturday afternoon, filled up the tree, wouldn't allow any amendments, and within 3 days forced us to vote on it on Christmas Eve. Then they took it over to the House, where they rewrote this trailer bill, again, in a secret room, behind a closed door, and brought that bill to the floor and didn't allow anybody to amend that. But amendments are dilatory.

Why have an opposition party? Maybe we should just go with the Cuban system. That seems to be the attitude of the other side of the aisle. The American people are an unfortunate inconvenience. The fact that they have elected a Republican membership to this Senate and to the House, they are an unfortunate inconvenience that should be ignored and not allowed to participate in the process.

When they come up with ideas such as protecting the Medicare system or such as taking out the sweetheart deals or such as suggesting that the President and his people and the staff of the majority leader should be under the laws we are about to pass or suggest that we should live by the terms of the rhetoric which is, if your premiums go up, you won't be impacted by this bill, or that says that there won't be any taxes on people under $200,000 of income, amendments which just fulfill the statements of the other side of the aisle on issues--they are going to keep the bill clean, they are not going to tax people under $200,000 of incomes, people's premiums won't go up, Medicare won't be affected, and everybody will be subject to this new law of the land, including the President of the United States and his people and the staff of the majority leader--when we offer amendments like that, they are dilatory. They are an inconvenience. They should not be allowed. They should not be voted on, not because they don't make sense but get rid of them; they are the opposition.

They are the American people speaking through their elected representatives and they ought to have a voice and they ought to be voted on and they ought to be given a vote based on the substance of the amendments, not on the fact that the other side of the aisle doesn't like opposition.

It is so arrogant, this attitude which pervades Washington now that says: The American people, we know better than you do how to live your lives. Why do you get in our way? We in Washington know how you should live. Just stand back. Let us make your decisions as to what you should do with your life, especially relative to health care. We will do a much better job. Certainly, don't countenance any opposition. Don't countenance any dissent, and, certainly, don't hold us to our word, for example, when we say people with incomes under $200,000 won't be taxed or when we say premiums won't go up or when we say everybody will be covered by the bill or when we say Medicare recipients won't be impacted. Don't make us hold to those words by voting on amendments because those amendments are dilatory.

The arrogance is palpable and inexcusable.

Now we will hear from the Senator from Oklahoma who has another amendment that I am sure the other side will say is dilatory and inappropriate, even though it makes a heck of a lot of sense to me.

I yield the floor.

BREAK IN TRANSCRIPT

Mr. GREGG. The Senator from Tennessee is going to offer an amendment in a second, and I will follow him with an amendment. I wish to highlight what my amendment will do as we are waiting.

One of the extraordinary shell games that is played under this bill in the ``Alice in Wonderland'' claim that this bill is paid for is the fact that the doctors will receive a $285 billion cut in their reimbursements if this bill goes forward in its present form. We all know that is not going to happen. So at some point there is going to have to be a doctors fix, which means $285 billion not accounted for in this bill will have to be spent over the next 10 years. Of course, if they had included this in the bill--this fact that doctors are being underreimbursed and that we are going to correct this; this is called the doctor fix, and we do it every year on an annual basis--if they had included it in the bill, as they should have because this is, after all, called health care reform, then the bill would have been in deficit even under the gamesmanship played by the Democratic Party on this bill.

Remember, the way they got a surplus in this bill in the first 10 years was they took 10 years of spending cuts, 10 years of revenues, and matched them against 6 years--6 years--of programmatic expenditures. So they were able to get a surplus, and CBO has to score what is given to them. If you are given phony ideas, you have to score them. In any event, what CBO was not asked to score as part of this health care, because there was no attempt to correct it, and even though it is the essence of health care, is how do you correct the reimbursed doctors.

So after the Senator from Tennessee proceeds, and I think he may be ready to proceed at this time, I am going to offer an amendment for a doctors fix so that this bill will address that issue which is, obviously, one of the core issues on the question of health care reform around here.

So I will reserve now on that issue and turn to the Senator from Tennessee who I see is ready to proceed.

BREAK IN TRANSCRIPT

Mr. GREGG. The States don't have the elasticity the Federal Government has, which we will not have much longer, by the way, as a result of passing this bill specifically because our debt is growing so fast that it is going to be very hard for us 5 or 6 years from now to be able to sell our debt at a reasonable price, in my opinion, and we are going to find that maybe some people don't even want to buy our debt.

There was a very significant event this week when it was determined that the debt issued by Warren Buffett was going out at a lower cost than the debt issued by the United States of America. That is the first time that anybody can remember something like that, and that is a very clear statement by the markets that they are getting very worried about how much deficit and debt this government is running up.

Now we pass this bill which adds $2.6 trillion to the spending of the U.S. Government and alleges it is paid for, but we know it is not going to be, and creates new entitlement programs which we know would not be fully funded. Even if it were paid for, it takes resources which should be used to reduce the debt, especially in the area of making Medicare more solvent, and uses them to expand new programs.

This event, as I have described it, is an astroid of debt headed at our country. The simple fact is, it is going to have an effect. The effect will be that we will have more difficulty selling our debt, the deficits and debt we pass on to our children will be extraordinary, and their ability to have a higher standard of living will be reduced as a result of that.

But the point, of course, is this bill, on top of all of the other egregious things it does in the area of fiscal policy--of running up debt and creating a massive government that we can't afford, being intrusive in everybody's health care delivery system, undermining the ability of small businesses to offer insurance, raising premiums, raising taxes on people not only earning more than $200,000 but earning less than $200,000, replete with special deals--on top of all of that, this bill, as Senator Corker said, puts pressure on the States and local communities.

It asks them to spend money which they did not want to spend and which is not reimbursed. That is not fair. It is called unfunded mandates. It is inappropriate. We actually have a law around here that this bill basically runs over that says we will not do that.

As I said earlier, another thing this bill does, which I find extraordinary, is it does not address one of the elephants in the room relative to the cost of health care in this country, which is the fact that we are not adequately reimbursing our doctors; that our doctors are going to receive a $285 billion cut over the next 10 years, a $65 billion cut over the next 3 years unless we correct that. This is from basically a freeze level of reimbursement.

Every year we adjust that payment so doctors do get their money they deserve or at least some portion of it in that we do not keep up with inflation. But this bill, which is supposed to be a comprehensive resolution of health care, leaves the doctors out in the cold. It means every year they are going to have to come hat in hand, one more time, asking for something they should not have to ask for, which is a fair reimbursement for their services.

We will every year, hopefully, address it. But it is not right that we have a bill that does not even account for that.

Why was it not put in? It was not put in because if it had been put in, this bill could not meet the budgetary rules that give it the special protection that allows it to come to the floor of the Senate, and it would have been in deficit, at least over the first 10 years, by $100 billion, even using the gamesmanship scoring the other side of the aisle has used relative to the big bill.

This is not fair to the doctors. The doctors deserve better than this. We should correct this right now as part of this process. This trailer bill has the title ``fix-it bill'' on it. One thing we should definitely fix is the fact the doctors are getting shortchanged. So let's fix it. That is what my amendment does.

My amendment says: OK, this bill alleges it generates a surplus. Let's use part of that surplus to make the doctors whole for the next 3 years. It is a paid-for amendment. I cannot imagine anybody would want to oppose this amendment. After all, after we complete this bill--immediately after we complete this bill--we are going to do, I believe it is a 1-month extension to try to correct the doctor problem. How inconsistent, how fundamentally hypocritical is it for us to pass a major health care reform bill, and then in the next breath--literally the next breath--within the next 24 hours, this body will take up a bill to give a 1-month extension to the doctors fix. I think it is 1 month. That is not right. Let's do it now. Let's do it in this bill. Let's do the doctors fix. I have come up with a proposal that will take care of the doctors in a fair and forthright manner for 3 years.

That is my amendment. I am not sure if it is at the desk or whether I have to send it to the desk.

I send my amendment to the desk.

BREAK IN TRANSCRIPT

Mr. GREGG. Mr. President, let me summarize it again. We know the doctors are being shortchanged. They deserve fair treatment. It is pretty obvious that if we are going to do a health care reform bill, the proper place to correct the doctor issue of reimbursement is in that bill, not the next day in a short-term extension.

This is a forthright and fully paid-for attempt--and if it is passed it will occur--to reimburse the doctors at a fair rate for the next 3 years and correct what is known as the SGR problem relative to doctor reimbursement.

I cannot understand why we would not want to do something such as this.

I see the Senator from North Carolina. I will be happy to yield to him for any thoughts he may have on this amendment or the Senator from Oklahoma.

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Mr. GREGG. Mr. President, I wish to ask the Senator from Oklahoma, who is obviously a physician and has an indepth knowledge of this issue, I heard the other side of the aisle say: There are no cuts to the benefits of people on Medicare. If you reduce doctor payments under Medicare 21 percent, don't you think that is going to affect what they receive? Technically, there will be no cut because they will still have the right to see a doctor. Is it not going to be hard to see a doctor because doctors will stop seeing them?

Mr. COBURN. They are not going to find a doctor, and that is the whole problem. Whatever we see in the urban areas now, multiply it tenfold in the rural areas. We are going to increase eligibility for Medicaid to 133 percent of the poverty level, we are going to add 16 million people to a system that is not handling the people who are in it today, so we are going to promise them: Here is your Medicaid.

Now where is the care? It is not going to be there. There is not the available physicians in this country to care for 16 million new Medicaid patients.

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Mr. GREGG. I thought we were told insurance rates were not going to go up.

Mr. COBURN. All I will tell you is, the best guess of CBO--wonderful people, but they can only make decisions within the parameters they are given. There is no question private insurance, individual and family insurance, is going to go up, but everybody else's is because we are going to increase the trend of cost shifting from government programs to the private sector.

You are going to end up with three taxes. You will pay income taxes, you will pay a Medicare tax, and then you will pay a tax on your insurance--actually, you will pay four--and then you are going to pay higher health insurance premiums because the government does not cover the cost.

Mr. GREGG. I assume that is not just going to be people with incomes over $200,000.

Mr. COBURN. That is everybody in this country who has private insurance, either through their employer or the individual market.

Mr. GREGG. Isn't it equally likely that a large number of small employers will get frustrated with the rate increases they are getting in order to support people on Medicaid that they will simply drop that and push their membership, their employees over into this new exchange?

Mr. COBURN. Yes, they will pay the fee. They will pay the tax and say it is easier. Consequently, the young people in our country, because we do not have a big enough payment under the ``individual mandate,'' are going to say it is smarter for me to save my money, pay the fine, and not get insurance because when I get sick, I can get it. You are going to get what is called adverse selection, which is even going to drive the rates up further. Anybody 40 or older, watch out, your health insurance rates are getting ready to bloom.

Mr. GREGG. We have basically a multiplier effect----

Mr. COBURN. That is correct.

Mr. GREGG. In the area of costs being driven up as a result of this new policy of adding a huge number of people to an uninsured system that cannot afford it right now, Medicaid. The costs are going to multiply on people in the private sector. The effect will be higher premiums, less opportunity for your employer to give you insurance and, in the end, a higher tax rate for you, Americans who are just working Americans, not people with high incomes.

Mr. COBURN. And people who are not necessarily getting a subsidy.

Mr. GREGG. Then they do not even take care of the doctors. They cut the doctors 21 percent on top of all this.

Mr. COBURN. What happens to all this? What is the ultimate? The ultimate is failure of the insurance market.

Mr. GREGG. That is the goal, isn't it?

Mr. COBURN. That is the goal, so the government can control it all. I yield back.

Mr. BURR. Let me add, if I may, to my good friend, Senator Gregg, even though some would choose not to have coverage and pay the fine, we have an emergency room system that is obligated to see those individuals when they have traumatic care. For those who claim we have sorted out the system where the high-cost delivery of care does not exist, no, we have again exacerbated the problem.

I think Senator Coburn hit on the key. As you try to handle the health care of individuals by limiting the reimbursement, whether that is the way we are limited in the problem you are trying to fix, whether we do it by shoving them into Medicaid, you have now cost shifted more money to the side causing greater inflation for the health care in this country.

Mr. GREGG. The Senator is absolutely right. Isn't it true one of the ultimate cost shifts is to claim that the health care bill is fiscally responsible when it ignores the fact that the doctors are being cut by 21 percent and does not even attempt to address that huge problem which represents $65 billion over 3 years?

Mr. BURR. I have learned throughout this whole process to never try to figure out what promises have been made. But I know the promise we have made to physicians--to reimburse them fairly for the services they provide--and anything less than that jeopardizes the pool of health care professionals we have and eventually will affect the quality of care simply because if the pool is not big enough to handle the patients, the quality will suffer.

Mr. GREGG. So I guess I would get on to the next question because it is pretty obvious we have to correct this problem with the physicians. In fact, as I understand it, the next bill immediately that we will consider will correct it for 30 days. Why wouldn't we correct it right now for 3 years, get that 3-year consistency in the system so physicians can have some confidence in their reimbursement rates, fully paid for? What possible, conceivable reason would there be not to vote for this type of amendment?

Mr. BURR. Because the Senator from New Hampshire remembers this body did pass a bill that partially paid for an extension of this through September of this year. The problem was, when they passed the health care bill, they used the pay-fors out of that extension bill to be included in this health care bill. Now they have gone to a point that they just seek the 30-day renewals and claim it is an emergency. One, I don't think that passes the threshold of emergency. I think it should be paid for. And there is a legitimate way to pay for it and extend it for 3 years, where this Congress can fully understand the implications of the current health care bill as it is implemented and put back the comfort of physicians around this country and their trust back in the system.

Mr. GREGG. Well, I think the Senator is absolutely right, but I would also suggest that maybe there is another reason they haven't paid for it in this bill or put the correction in this bill, which is that if they did that, the bill would fall because it would be out of compliance with the budget because it is a $285 billion cost over 10 years. Therefore, aren't they sort of trying to pull the wool over somebody's eyes here? Aren't they trying to act as if this bill that we know exists for our doctors, that we are never going to pay for it? We are not going to pay; we are just going to act as if it doesn't exist? We know as soon as this bill is over, we will have to do something about it, at least for the next 30 days.

Mr. BURR. You are absolutely right, it will be the first order of business when this bill is finished if we miss the opportunity to fix it in this bill and fix it for 3 years and actually fix it in a way that it is paid for.

Mr. GREGG. I see the Senator from Arizona has arrived.

Mr. McCAIN. Mr. President, I ask unanimous consent to be included in the colloquy.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. McCAIN. I would say to the Senator from New Hampshire that there is some recent information that I find hard to believe, but apparently it may be the case. As we go through this 2,733-page piece of legislation, the IRS may need up to $10 billion to administer the new health care program this decade, and it may need to hire as many as 16,500 additional auditors, agents, and other employees to investigate and collect billions of new taxes from Americans. Is that possible, in this legislation, I would ask the Senator from New Hampshire?

Mr. GREGG. The Senator is absolutely correct, and that does call into question the representation that this bill is not a tax increase on Americans that we need 16,000 new IRS agents to enforce it.

Mr. McCAIN. At $10 billion to administer. That is probably believable, given what is in 2,733 pages.

Mr. GREGG. Well, you are going to need one IRS person for everybody in America who doesn't have insurance, I guess, or however the ratio works out. Everybody has to buy insurance under this bill, and your local IRS agent is going to show up at your door to tell you that you better do it or else you will have to answer to the IRS.

We know there are no new taxes in this bill because that has been represented to us a number of times.

Mr. BURR. If I could add, it also adds some insight into how many people will choose not to have insurance and make themselves susceptible to the fine. The anticipation is the IRS is going to chase a lot of people to recover the fine.

Mr. McCAIN. I would also finally add that perhaps we could get some indication--I think we should before we vote on passage of this bill--as to how many new bureaucrats and bureaucracies there are going to be with 193 new boards and commissions and other layers of bureaucracy. I think the American people are owed at least a round figure as to how many new bureaucrats there are going to be to administer this program.

I see the Senator from Montana, and I don't want to impede on what has been the agreed-upon rule here, but I did want to continue and say to my friends very quickly that I think there are several myths here that have to be refuted by the facts.

One is that this legislation will result in a tax cut for the American people. I would say to my friend from New Hampshire, we have to rebut that in the next hour.

The next myth is that the health care bill won't increase taxes on individuals with incomes under $250,000. The fact is, millions of Americans with incomes below $250,000 will pay higher taxes.

Another myth: The legislation will reduce the growth of health costs--President Obama's stated goal for health reform--and premiums will go down. The fact is, national health expenditures and premiums will increase.

Another myth: The legislation is deficit neutral. The fact is, commitment to health care spending under existing obligations increases the deficit.

Myth: ``If you like the plan you have, you can keep it.'' Fact: Millions of Americans with coverage will lose their current coverage, including 330,000 citizens of my State who have the Medicare Advantage Program.

Finally, the myth is that the law will provide immediate coverage for children with preexisting conditions. The fact is, children are not necessarily protected against discrimination for preexisting conditions.

So I hope we have a chance, I would say to my friend from New Hampshire, to address the allegations about this legislation, and perhaps the first one is that legislation will result in a tax cut for the American people when the fact is that taxes will increase for millions of Americans.

I would yield to my colleague from New Hampshire.

Mr. GREGG. I thank the Senator from Arizona, who has been one of the most cogent and thoughtful speakers on the issue of what this bill really does. He has hit the nail on the head time and time again with his points. They are all absolutely accurate.

Has the Senator completed his statement?

Mr. McCAIN. Well, I just wanted to throw in here that perhaps one of the most egregious statements, and it is worth repeating, is this so-called doc fix. They are using an assumption that we will cut physicians' fees by 21 percent sometime this fall in order to make up--and please correct me if I am wrong--some $281 billion over 10 years, which we know is not going to happen. And the reason it is not going to happen is because doctors would refuse to take Medicare patients if they cut their reimbursement by some 21 percent.

So this is one of the fundamental assumptions they are selling this on, is that it is deficit neutral when it is not.

Mr. COBURN. If I may, I would like to add one other thing here. Think about it. We are talking about the cuts that are set to go. But since there is no tort reform in this bill, we spend $250 billion on defensive medicine and liability costs continue to rise. You could bring them back whole, but if you give them no increase, they are still going to quit seeing Medicare patients.

One other point I would like to make is with the student loan program being totally taken over by the government, 31,800 people in this country this July will lose their jobs. So we are going to lose 31,800 jobs in the private sector, but we will add 16,500 jobs at the IRS. I don't think anybody in America would like to see that happen.

Mr. McCAIN. The CEO of Caterpillar wrote a letter saying that the taxes for Caterpillar would go up by $100 million next year. What does that do to Caterpillar? It obviously makes them either not hire or lay off individuals as they pay an additional $100 million. And I might point out, as we all know, Caterpillar's headquarters is in Peoria, IL.

So, again, I would ask the Senator from New Hampshire, is this legislation deficit neutral?

Mr. GREGG. No, it is not deficit neutral if you actually score the number of years of income against the number of years of expenditures or you include the doctors fix. Either one would throw this into a deficit-negative situation.

Mr. McCAIN. Isn't that another of the great scams, that for 4 years the benefits are cut and the taxes are increased, and for most--not all but most--of this bill, none of the benefits really kick in until after 4 years?

Mr. GREGG. That is right.

Mr. McCAIN. So when you score it, that is the way you make it deficit neutral over 10 years?

Mr. GREGG. That is correct. And it is a bit of a scam, as you say.

BREAK IN TRANSCRIPT

Mr. GREGG. Let me make two quick points. The only way CBO gets to the conclusions they reach, and they had to get to those conclusions, is because of the facts put before them. One of those facts, they have to presume Medicare is going to be cut $500 billion in the first years before full implementation, $1 trillion in the second 10 years during full implementation, and $3 trillion during the first 20 years of full implementation--$3 trillion.

All that money is going to be taken out of Medicare and moved over to start new programs, new entitlements to benefit people who are not senior citizens and who, for the most part, have never paid into Medicare. That is a serious problem.

You can score that positively if you wish, but first off I do not think it will happen. I think what will end up happening is, it will get put on our children's backs as debt. But second, if it does happen, it is wrong because Medicare has to be fixed and you are taking the money that should be used to fix it, if you believe in these types of cuts in Medicare, and you are spending them on a new entitlement.

Mr. BAUCUS. Mr. President, may I ask my colleague a friendly question?

Mr. GREGG. On your time you may ask a question, including my answer, which may take 24 minutes.

Mr. BAUCUS. I trust in the good faith of the Senator from New Hampshire not to abuse the situation.

As I understand it, basically the Senator does not question the professionalism of CBO. Clearly, CBO had all the facts. All Senators have them, all Senators, House Members, the whole world has. CBO has all the facts. You are not questioning their professionalism. You do question their conclusions.

Mr. GREGG. I certainly don't question their professionalism. They are an extraordinarily good organization with a wonderful leader who is fair and unbiased. I don't question their conclusions because what they have to score is a fact pattern that was given them and the fact pattern given them by this bill is, on its face, not believable relative to what is going to happen in the outyears, even though they have to score it as believable. It is a fantasy.

Mr. McCAIN. I ask the Senator from New Hampshire, while the Senator from Montana is here, maybe it is a legitimate question. Does the Senator from Montana believe that the assumption given to the Congressional Budget Office that the so-called doc fix, reimbursement for physicians who treat Medicare patients, will be cut by 21 percent? The Senator from Montana knows full well the AMA has been told in no uncertain terms it will be fixed between now and when it is supposed to take effect because the fact is, as the Senator from Montana knows, you can cut Medicare physician reimbursement. Then doctors will not treat Medicare patients. So maybe the Senator from Montana would tell us if that was a valid assumption given to the CBO, that there would be some $281 billion that would be accrued because physicians' payments would be reduced by some 21 percent?

Mr. GREGG. I simply ask the time of the Senator from Arizona come off ours and the time of the Senator from Montana for his answer come off his.

Mr. BAUCUS. Mr. President, that sounds fair.

Let me say to my good friend from Arizona, first of all, clearly this body, the Senate and the Congress, is going to not let the SGR problem expire; that is, doctors are not going to be cut 21 percent, whatever the rate is the first year or more and so on. That is not going to happen. First, from the seniors' point of view, second from the doctors' point of view, that is not going to happen. I do not want to take too much time on the subject, but the long and short of it simply is we are going to have to find a way, this Congress, to address that problem. If I might finish, it is not part of health care reform, and we will find a way. A question is going to be how much will be paid for. That is a judgment this body is going to have to make in the pretty near future.

Mr. McCAIN. I appreciate very much the acknowledgment, on the part of the manager of the bill, that the assumption that provides us with deficit neutrality is not valid. That is the point we have been trying to make. It is based on false assumptions. The assumption that doctors--I am very happy to hear the Senator from Montana state unequivocally what was given and assumed by the CBO when they gave us our numbers is not true. So we will be voting, in a short period of time, on a piece of legislation which is based on false assumptions. I think that is an unfortunate circumstance.

Mr. GREGG. I simply note the Senator from Montana made the case for my amendment rather eloquently because my amendment does address the doctors fix and it is paid for. Therefore, I certainly hope the Senator might consider voting for it.

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Mr. GREGG. Mr. President, a lot has been talked about here. A lot has been discussed. I don't want to get in an expansive discussion of the issue of the underlying bill. It has been fully aired. But this concept to vote down every amendment, that you have to do that in order to save this bill, seems to reject the concept of a constitutional process.

Think about this for a moment. The whole series of amendments here are being offered to fulfill the statements made by the President of the United States. For example, Senator McCain has offered an amendment to take out the sweetheart deals. The President said the sweetheart deals would be taken out. Senator Barrasso has offered an amendment which says that if premiums go up, certain parts of this bill will not go into force. The President said premiums will not go up on working Americans. Senator Crapo has offered an amendment which says that if there are taxes on people earning less than $200,000, those taxes won't go into force. That is what the President promised. I have offered an amendment which says that if there are Medicare cuts in this bill, the cuts should go to Medicare and make Medicare more solvent--a promise also made from the other side of the aisle.

All of these are amendments which are substantive and the purpose of which is to put forward the policies which the other side of the aisle represented they were going to have in their original bill. This is called the fix-it bill. Well, we are suggesting you fix it so it meets the conditions set out by the President and by the Democratic leadership. Yet now we hear that every amendment should be voted down. Why? Because the idea of sending the bill back to the House is anathema to the Democratic Party. Did I miss something? Isn't the House of Representatives controlled by the Democratic Party with a supermajority? You mean they couldn't survive the idea of knocking out the sweetheart deals, sending it back to the House, and coming back here? That is going to somehow fundamentally undermine this bill? That argument is absurd on its face. It is absurd on its face.

I think the only answer is that the other side of the aisle has decided to proceed on this bill in a most arrogant process. From the beginning of the core of this bill being put together in a hidden room behind a hidden room behind a hidden door of the majority leader's office suite, brought to this floor on a Saturday afternoon, the tree was filled and we were told we had to vote on it on Christmas Eve. No amendments were allowed. Then it was taken over to the House, and the Speaker worked out the deals in the back rooms of her offices behind hidden doors without any public input, without C-SPAN there, as was represented it would be. And what happened? It passed the House without any amendments being allowed.

Now, for the first time, we have a chance to offer amendments, and the position on the other side of the aisle is no amendments allowed even if they are good amendments.

So, I guess, obviously, they consider their promises to be an inconvenience. Obviously, they presume the Republican Party is an inconvenience. The Democratic process is an inconvenience. It also appears, considering the opposition to this out in America, that the American people are an inconvenience and that amendments which make sense aren't going to be allowed to be passed because they don't want to send it back to the House of Representatives. It makes no sense to me, and I don't think it is going to make much sense to the American people.

This bill is fundamentally flawed. It needs to be repealed and it needs to be replaced. We have suggested a whole series of amendments which will significantly improve this bill, and I hope some will be supported by the other side of the aisle since they are the policies of the other side of the aisle.

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Mr. GREGG. Mr. President, this amendment fulfills the obligation to our senior citizens. This bill reduces on its face $520 billion in Medicare by cutting Medicare beneficiaries through reducing providers and by eliminating or significantly reducing the Medicare Advantage Program. That number actually, when fully implemented, is $1 trillion over the first 10 years. That is $1 trillion of reductions in Medicare.

That money is then taken and used to create new entitlements for people who are not seniors and who have, for the most part, not paid into the Medicare trust fund. That is wrong. Medicare is in serious trouble. We should use the Medicare savings in this bill for the purposes of making Medicare more solvent.

That is exactly what this amendment does. It keeps Medicare savings in the Medicare trust fund and uses them to make Medicare more solvent.

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Mr. GREGG. Mr. President, this amendment addresses what is a core problem we have with our health care system, which is the fact that every year we cut our doctors' pay--those doctors who deliver Medicare services. This year, it will be cut 21 percent. This amendment restores that pay so that those cuts don't occur for a period of 3 years. This is known as the doctors fix.

It should have been in the bill to begin with. The reason it wasn't in the bill was because the other side wanted to not put it in the bill because of its cost, because it scores at $280 billion over 10 years. The other side didn't want to absorb that score because it would have thrown the entire bill out of whack relative to the budget.

We have come up with a way to address this doctor problem that pays for it for 3 years. Let's do it. Let's take care of these doctors who are delivering these services so they can continue to deliver services to Medicare recipients.

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