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Public Statements

Fiscal Choices: House of Representatives

Floor Speech

Location: Washington, DC


Ms. BASS of California. Thank you very much, Mr. Yarmuth, for your leadership in this effort.

You know, as a new member on the Budget Committee, we had an interesting week last week. We really just completed a week where we saw the far right of the Republican Party take their party off the ledge and way out of the mainstream. They've declared war on seniors, on the disabled, on the sick, on children, and on the underserved by proposing to end Medicare and Medicaid as we know it. They've championed the budget, entitled the Path to Prosperity.

This is a plan that simultaneously ends Medicare while giving billions in tax breaks to Big Oil and the wealthiest Americans. Mr. Tonko called it the ``path to ruin''; I thought about the ``Ryan-to-ruin'' plan.

It generously gives senior citizens a gift, and that gift is a voucher to purchase health care. The senior citizen then has to identify an insurance carrier that will take the voucher; and if the person is lucky, the voucher will cover all the cost. I do think that this would be rare. And I don't know what happens in this plan if after a couple of years or a couple of illnesses the insurance company decides to drop the person or raise the rates. You know, under the Affordable Care Act, of course, they couldn't do that, but if the Ryan plan does what he wants, he wants to repeal the Affordable Care Act, so all of that would come back into play. The person would have to pick up the rest of the cost under the Ryan plan.

Now, I believe that we are simply foolish and we are fooling ourselves if we think all seniors will be able to just write a check and pay the difference. That's what is said, they will just pay the difference, they will just have to absorb more cost. A more likely scenario is that seniors will simply not have medical coverage, and we will be sent back in time to when seniors did not have coverage because insurance companies didn't want to cover them. I often say to people that you can judge a society by how it treats its elderly and its children. The ``path-to-ruin'' plan hurts both populations.

What I wanted to do today was to share a story, but just talk for a moment a little bit about the Ryan plan. When it takes effect in 2022--that's only 11 years from now--the average senior would receive an $8,000 voucher to buy insurance. What I wanted to share with you was the years that I spent working in the emergency room. I worked in Los Angeles County, USC--one of the largest emergency rooms in the United States. And the emergency room is so large, it is divided into different sections. One section that I spent a couple of years working in is called ambulatory care, but we used to call it the ``walking wounded'' because, frankly, the people that came to that section of the emergency room shouldn't have even been in an emergency room, but the reason why they were there was because they didn't have health insurance, they didn't have access to care. And what typically happens is that if you don't have access to care, by the time you eventually see someone, you are much sicker than you would have been.

So I remember a case where a diabetic patient, who was not 65 and, therefore, he couldn't access Medicare, he came into the walking wounded area or the ambulatory care area with a sore on the heel of his foot. He told me in the history that he was a diabetic. But he had tried a series of home remedies and he finally came to the ER when his heel started turning purple. Well, as I interviewed the patient and I asked about his medical history, he told me that he had been diagnosed with diabetes years ago, but he couldn't afford his medication. So he was trying to watch his diet and do the best he could. Well, for those of you who don't know, a patient with a history of poorly controlled diabetes who presents to an emergency room is likely to have a series of complications. Well, this man ended up as an amputee because the sore on his heel--that he didn't realize--had developed into gangrene, and that's why his foot was turning colors.

So just thinking about the cost of this, the total cost of this visit was $12,000 and his leg. That bill included a $2,000 charge for his emergency room visit and lab tests, a $6,000 charge for an amputation, and a daily charge of $1,400 for aftercare. If this patient had had access to routine preventive care, he would still have his leg, and $12,000 would be saved.

So why do I share this story with you? Well, we're fooling ourselves if we don't understand that turning Medicare into a voucher and leaving seniors to fend for themselves is simply denying adequate health care that in the end will cost us so much more in suffering and in hospital costs that will ultimately be borne by taxpayers.

Today in my office I met with representatives from several hospitals who were describing the challenges that they face now. So there is an area of Los Angeles County where 600,000 people live--and the last time I checked that was around the entire population of the State of Vermont, 600,000 people--where there is not one trauma center, there is not one emergency room because all of the four hospitals in that area have closed. Now that's today.

Under the Ryan plan, vouchers for seniors and vouchers for States--because that's the bottom line as to what a block grant is, it's a voucher; instead of a voucher for an individual, it's a voucher for a State. The hospitals they represent that all border this area--that has no trauma center in it and has no emergency room and has no hospital because they're all closed up--they would essentially have to absorb--and they have been absorbing--the population, these 600,000 people. So they were concerned, and they came into my office today concerned that they could potentially face closure now, given the situation.

If we were to adopt the Ryan plan--the ``pathway to ruin,'' however you want to describe it--I think we would be setting the stage for hospital closures to continue, for more patients to come into the walking wounded area of emergency rooms, for there to be more amputations, for people to be sicker and eventually come to the emergency room--which is so incredibly short-sighted because in the end it winds up costing taxpayers so much more money because these people are going to be cared for. So we are fooling ourselves if we think that seniors are just going to be able to meet what the voucher doesn't cover.

Thank you very much for your leadership in this.


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