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GOP Doctors Caucus: Save Medicare

Floor Speech

Location: Washington, DC


Mr. CASSIDY. Thank you, Dr. Fleming. I always tell people hepatologist--no, I don't do snakes. I do liver disease. We have to make that correction.

I just want to kind of pick up where Dr. Roe left off. A lot of folks say, heck, how did we end up with Medicare going bankrupt when they've paid into it their whole life? Well, if you work backwards, it began, if you will, or maybe the most recent insult, was the fact that the President's health care plan, the Affordable Care Act, took $500 billion from Medicare. Instead of putting it back into Medicare to support the program, it used it to create their new entitlement.

Now, that's important because as the graph you had earlier showed, at our current rate of going forward, by 2030, I think it is, Dr. Fleming, you have it right there, roughly 2040, 2045, Social Security, Medicaid, and Medicare will take up the entirety of our Federal budget. Whatever tax dollars we receive by 2045 will be entirely consumed by those three entitlement programs.

Do you have that graph where there is the debt on there as well?


Mr. CASSIDY. So by 2030, I think it is, if nothing changes, Social Security, Medicaid, Medicare, and the national debt will consume 100 percent of our tax revenue. Clearly, we have to preserve this important program.

The other thing I'd like to point out to people is, in 1964, when Medicare was conceived, people were having, on average, four kids per family. So the folks that came up with Medicare said, Well, people are having four kids per family now, most likely they'll continue to have four kids per family going forward. Let's make this a pay-as-you-go. There will always be four people paying for the two people ahead of them. It turns out families have shrunk.

Now I'd point out in most crowds, most people have more brothers and sisters than they do children. Families have decreased in size. Instead of on average four kids per family, now there's about 2.5. That demographic shift has made all of the difference. Instead of a pay-as-you-go program where there is always as much money coming in as we needed to pay out, what has happened is families have shrunk, you have a large number of baby boomers, and then their parents, and beneath it, you have kind of a tree, if you will, where it goes straight down. Instead of the pyramid originally thought that would occur, we now have something that looks like that and then goes straight down.

There is no longer this broader base of people paying in.

We're not the first to recognize this. John Breaux, the former Democratic Senator from Louisiana, was appointed by President Bill Clinton to say, Listen, the demographics are changing. How do we preserve Medicare? It was actually John Breaux, a Democrat, who first came up with the premium support model.

Now, we speak of it sometimes as a Republican plan. No. It was originally a Democratic plan, and it was a bipartisan commission. It came up with this premium support model as a thing that would save Medicare. As it turns out, President Clinton became distracted with the Monica Lewinsky affair, if you will, and it kind of got pushed to the wayside.

This same Breaux carry model conceived of in the nineties is the basis for what is now the bipartisan Wyden-Ryan plan.

Now, although Dr. Roe spoke of it earlier, it's worth going back over. If you're 55 and above, nothing changes from the Medicare program you've always known. If you're 55 and above, if you're already on Medicare because you're disabled, nothing changes. If you're 54 and below, like I am, the program changes to premium support.

Now, in the premium support model, it works kind of like Medicare Part D. I find the program that best fits my need. I choose the program that I want. If I'm very wealthy, I pay a little bit more. If I am poor, I pay nothing at all. But if I'm middle class, I pick the program I like. If it's a frugal program, then I pay less out of pocket. If it's a bells and whistles program, I may pay a little bit more out of pocket--much like the Medicare Part D program that seniors now get their drug benefit from. By the way, a Medicare Part D program that has an 80 percent approval among seniors.


Mr. CASSIDY. If I may reclaim my time, because of market forces, not only is Medicare Part D incredibly popular among seniors, but its costs are 40 percent cheaper than originally conceived. That is the power of giving the patient the ability to go from plan to plan. If she doesn't like that plan, next year she chooses another, and the bad plan goes out of business if enough seniors do that. That's the same concept behind Medicare Part D.

We have other colleagues to speak. I'll add one more thing. I'm always struck when our Democratic friends say they want the American people to have the same type of plan that Members of Congress do. The premium support model is the same type of plan you and I have. We pick among an array of programs. We pick the one that works best for us that matches our pocketbook.

If we're poor, we pay nothing at all. If we're rich, we pay a little bit more. But most of us in Congress are in this middle range, we get the plan that most fits our needs. That is the Wyden-Ryan plan totally. We actually give the American people the same sort of deal that Members of Congress get.

So that said, thank you for allowing me to join you, Dr. Fleming.


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