Search Bills

Browse Bills

93rd (26222)
94th (23756)
95th (21548)
96th (14332)
97th (20134)
98th (19990)
99th (15984)
100th (15557)
101st (15547)
102nd (16113)
103rd (13166)
104th (11290)
105th (11312)
106th (13919)
113th (9767)
112th (15911)
111th (19293)
110th (7009)
109th (19491)
108th (15530)
107th (16380)

ANNOUNCEMENT BY THE CHAIRMAN


Sponsor:

Summary:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples to apples

Major Actions:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples

Amendments:

Cosponsors:

Search Bills

Browse Bills

93rd (26222)
94th (23756)
95th (21548)
96th (14332)
97th (20134)
98th (19990)
99th (15984)
100th (15557)
101st (15547)
102nd (16113)
103rd (13166)
104th (11290)
105th (11312)
106th (13919)
113th (9767)
112th (15911)
111th (19293)
110th (7009)
109th (19491)
108th (15530)
107th (16380)

ANNOUNCEMENT BY THE CHAIRMAN


Sponsor:

Summary:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples to apples

Major Actions:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples

Amendments:

Cosponsors:


bill

Search Bills

ANNOUNCEMENT BY THE CHAIRMAN


Sponsor:

Summary:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples to apples

Major Actions:

All articles in House section

ANNOUNCEMENT BY THE CHAIRMAN
(House of Representatives - October 19, 1995)

Text of this article available as: TXT PDF [Pages H10333-H10455] ANNOUNCEMENT BY THE CHAIRMAN The CHAIRMAN. The Chair would like to take the time to remind Members that it is not appropriate to wear or display badges while engaging in debate. Mr. ARCHER. Mr. Chairman, I yield 3 minutes to the gentleman from Louisiana [Mr. McCrery], a valuable member of the Subcommittee on Health. Mr. McCRERY. Mr. Chairman, as this chart shows, spending on the Medicare system has skyrocketed since 1970. Here we are today and Members can see, if nothing is done, it goes off the chart. In 1970, Medicare spent about $8 billion; in 1994, Medicare spending was about $165 billion. That is an increase of almost 2,100 percent in just 14 years. In the part B side alone, growth rates have been so rapid that outlays of the program have increased 40 percent per enrollee just in the past 5 years. More alarming is that Medicare spending is projected to explode to over $350 billion in 2002. Clearly, this is an unsustainable trend and one that neither seniors nor younger Americans working to support themselves and their families can be asked to underwrite. The financial crisis in the Medicare program is not a short-term cash flow problem, as the Democrats would like the American people to believe. The trustees of the Medicare trust fund, three of whom are President Clinton's own Cabinet members, said in their report on the HI, or part A, trust fund, ``The trust fund fails to meet the trustee's test of long range close actuarial balance by an extremely wide margin.'' Further, the same trustees said in their report on the SMI trust fund, the part B trust fund, ``while in balance on an annual basis, shows a rate of growth of costs which is clearly unsustainable.'' The public trustees of the Medicare program were very clear when they said, ``The Medicare Program is clearly unsustainable in its present form.'' The Democrats in the past have ignored the long-range spending problem of the Medicare Program. Their solution has been to continually raise taxes on working Americans, and that is still their solution. In the years since the enactment of Medicare, the maximum taxable amount has been raised 23 times. Two years ago, the Congress, then controlled by Democrats, raised taxes, Medicare taxes again. All that did was just put another financial burden on the taxpayers and put off the financial crisis in the trust fund for just a few months. Clearly, raising taxes yet again on the American people is not the answer. The Medicare Preservation Act, on the other hand, addresses the out- of-control spending in the Medicare Program by opening up the private health care market to the senior population. By harnessing some of the innovative cost effective and high quality private sector health care delivery options, Medicare beneficiaries will not only have a choice in their health care coverage for the first time, but the Government will also be able to rein in out-of-control Medicare spending. It is a win/ win situation. The Republican plan provides security for not only today's seniors but also lays the groundwork for the retirement of my generation, and it does it without increasing the tax burden on working people. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Pennsylvania [Mr. Klink]. Mr. KLINK. Mr. Chairman, I thank the gentleman for yielding time to me. I would like to begin by yielding to the gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, the previous speaker, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from Louisiana [Mr. McCrery], will lose $158 million over the next 7 years under the Gingrich Medicare cut plan. [[Page H 10334]] Mr. KLINK. Mr. Chairman, I thank the gentleman for that input. Here is the chart which actually shows the reduction in Medicare spending per beneficiary under the House Republican plan. I have to get this straight. When is a cut not a cut? Last year when we were trying to do health care, every Republican on the Committee on Ways and Means signed a letter which said, ``the additional massive cuts in reimbursement to providers proposed in this bill''--the Clinton bill--``will reduce the quality of care for the Nation's elderly.'' That was $168 billion versus $70 billion now. The current chairman of the Committee on Ways and Means made the statement, ``I just don't believe that the quality of care and availability of care can survive these additional cuts.'' Now they are saying that these are not cuts. It is cuts in the rate of growth. Were you lying to us now or are you lying to us then? Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. I resent the fact that the gentleman implied that I have lied. No. 1, that does not belong on this floor. But the gentleman, as usual, has not given the factual information. The plan that I made those comments on cut $490 billion out of Medicare and Medicaid. Without transforming Medicare, without giving other options, without including true savings in the cost drivers. That was a totally different time, a totally different program. But it cuts $490 billion out of Medicare and Medicaid. Mr. Chairman, I reserve the balance of my time. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia [Mr. Lewis]. Mr. LEWIS of Georgia. Mr. Chairman, I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in strong opposition to the Republican Medicare plan. I rise to tell you there is another way, a better way. We Democrats have a plan. We save the Medicare trust fund, and we do it without hurting the poor, the sick, and the elderly. How can we do it? We can do it because we do not pay for tax breaks for the rich. There is only so much money--you can either use it to help the sick and the elderly or you can give it to the rich. My Republican colleagues may say whatever they wish, but the truth is that these very large--these huge Medicare cuts are needed to pay for their tax breaks for the rich. The Republicans say they want to help Medicare. But what they do is different. Thirty years ago, the Democrats created Medicare and the Republicans voted against it. Two years ago, Democrats passed a bill that helped the Medicare trust fund. Every Republican voted no. Earlier this year. the Republicans took $87 billion from the Medicare trust fund. Today, they want to cut an additional $270 billion. They voted against Medicare 30 years ago, and they are voting against it again today. My colleagues, actions speak louder than words, and the Republican actions are loud and clear. The Republicans did not want Medicare 30 years ago and they want to dismantle it now. I do not believe that we must destroy Medicare to save it. Democrats do not raise premiums for seniors. Democrats ensure that Medicare is there for our families, for our children, for our grandchildren, and their children. Under their plan, the Republicans eliminate nursing home standards. Poor seniors lose help for copayments and deductibles. Under the Republican plan, the rich get tax cuts, and our Nation's elderly and hard-working families get higher Medicare bills. It's a scam, a sham, and a shame. I know it. You know it. Now the American people know it. Mr. Chairman, on this day, October 19, let the word go forth from this place into every State, every city, every town, every village, every hamlet that it was the Republicans who voted to cut Medicare-- they voted to cut Medicare by $270 billion in order to give a $245 billion tax break to the wealthy. The Republican plan is too much, too radical, too extreme. We have more than a legislative responsibility to oppose this Republican plan. We have a mandate, a mission, and a moral obligation to protect Medicare. This vote--this debate is about something much bigger than one vote. It is bigger than one bill. It is about two contracts, the Republican contact with the rich, and the Democratic contract with the American people--Medicare. Medicare is a contract--a sacred trust with our Nation's seniors and our Nation's hard-working families. My fellow Americans, remember--it was the Democrats who found the courage and the strength to provide health care to our seniors, and it is the Democrats who will preserve it for unborn generations. We must not and will not break the contract with America's seniors and families. I urge my colleagues to support the Democratic alternative and oppose the Republican plan to cut Medicare. Mr. ARCHER. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the facts have already been presented to this committee. Medicare increases per beneficiary go from $4,800 to $6,700 per year. The total aggregate increase in medical expenditures increases $1.4 trillion under our plan over the next 7 years. But only in Washington can an increase be called a cut. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, earlier this year we got some very bad news for Americans and senior citizens. The trustees of the Medicare funds told us that under all sets of assumptions the fund goes bankrupt, and it goes bankrupt in 7 years. Taking our responsibility very seriously, we Republicans went to work. We gathered with senior citizens, with experts from around the country, and we said, what can we do? Is there any good news? Can we fix the situation? We found good news. We found that health insurance costs for working people, not retired people, were going down. Inflation rates at 10.5 percent in Medicare are killing it. {time} 1230 The private sector using intelligent new programs have brought the inflation rate down below to virtually zero. We said the good news is this. We can preserve Medicare, we can preserve fee-for-service options for everyone who wants to stay that way, but we have new and exciting options. Mr. Chairman, my mother and father have chosen the managed-care option. They love it. They save $1,000 a year each because they no longer buy MediGap insurance. They have new prescription drug benefits. They get all of the referrals they want. They are delighted. This plan is very straightforward. We preserve fee-for-service, we increase the per beneficiary expenditure from $4,800 a year to $6,700 a year, and for those seniors who want new choices, we have excellent new choices in managed care. This is a spectacular bill. Americans will be proud of it. Senior citizens love it. Vote ``yes.'' Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentleman from Oregon [Mr. Wyden]. (Mr. WYDEN asked and was given permission to revise and extend his remarks.) Mr. WYDEN. Mr. Chairman, our Nation needs---- Mr. STARK. Mr. Chairman, will the gentleman yield? Mr. WYDEN. I yield to the gentleman from California. Mr. STARK. Mr. Chairman, I wish to inform the gentleman that in the district of the gentleman from Pennsylvania [Mr. Greenwood] there will be $128 cut from hospitals over the next 7 years. Mr. WYDEN. Mr. Chairman, our Nation needs bipartisan reform of Medicare, but instead today's bill will deliver a nationwide Medicare migraine. Instead of listening to our seniors, and our families, and to the inspector general, this is a cut first, ask questions later Medicare initiative, and the fraud section is a metaphor for the whole bill. Instead of legislation to protect seniors and taxpayers, it protects the crooks and the thieves. Instead of improving access to health care, it provides a freeway to fraud, and, my colleagues, think of the words of the nonpartisan fraud-buster at the Office of the Inspector General who said that this bill will cripple, it will cripple, efforts to bring justice. [[Page H 10335]] Let me tell my colleagues it is possible to develop 21st century Medicare that works for seniors and taxpayers. Reject this bill and come with me to Oregon because I will show each of you programs that protect seniors, hold down costs, and insure that we have a path to the 21st century. We can do this job right. We can do it in a bipartisan way. But let us listen to our seniors and our taxpayers. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Oregon [Ms. Furse]. Ms. FURSE. Mr. Chairman, I thank the gentleman for yielding this time to me. I have here a list of words that I am told the Republicans were asked to use in this debate, words like historic, successful, saves. Well, there was a historic event 30 years ago. The Democrats in this House passed Medicare. Not one Republican voted for it. Successful? Well, yes. This bill successfully guts Medicare. Saves? Well, yes. This bill saves the promised tax breaks for the rich. Mr. Chairman, also on this list it says we should say the Democrats are scaring 85-year-olds. Mr. Chairman, as a member of the committee, I know that it was the Republicans who ordered the arrest of 85-year-olds who came to the committee. They came there. They came to ask the committee what is going to happen to our Medicare protection. They were Americans. It is a disgrace that they were arrested. I think there is a word that is not on this list, Mr. Chairman, and that word is shame. Mr. BLILEY. Mr. Chairman, I yield myself 30 seconds to respond. Mr. Chairman, the rules of this House are explicit. The chairman of any committee is required to preserve order, and when citizens of any persuasion, any age, come in, refuse to obey the orders of this House, the chairman has no choice but to have them escorted out of the room. Mr. Chairman, that is exactly what happened in the Committee on Commerce, and that is what we had to do regrettably, but that is the truth. Mr. DINGELL. Mr. Chairman, I yield myself 15 seconds. Mr. Chairman, I love my dear friend from Virginia, but I notice he did nothing when a bunch of people came in and dumped bags of mail from dead men, from people who were not supporting the legislation in question, and some of which were addressed ``contributor.'' Our Republican colleagues have a great sensitivity about the senior citizens, but none whatsoever about rascality by high-paid lobbyists. Mr. BLILEY. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, the organization that disrupted that meeting, I would like the Record to show, 96 percent of those funds come from the public treasury. The person who was the ringleader was a paid staff person. Mr. Chairman, I yield 2 minutes to the gentleman from Florida [Mr. Bilirakis]. (Mr. BILIRAKIS asked and was given permission to revise and extend his remarks.) Mr. BILIRAKIS. Mr. Chairman, I will use the word ``shame.'' Shame on those politicians who over the years, not just now, use scare tactics and misinformation to frighten our senior citizens all in the interests of getting votes through fear. These actions are unconscionable. Only the most affluent retirees are having their part B premiums raised substantially. We are not raising Medicare copayments or deductibles. We will not be reducing services or benefits--our legislation ensures that the core services in the current Medicare Program will be retained and must be offered to all beneficiaries. I also want to make it clear that no one will be forced into HMO's. If Medicare beneficiaries wish to keep the current fee-for-service benefit where they have complete choice of their doctor, they will be permitted to do so. If beneficiaries want to enroll in an HMO which might include additional health benefits, or some other Medicare-plus plan, they can do so. It will be their choice. Under our proposal, coverage will be assured to all senior citizens, regardless of prior health history or age. From the beginning of this effort, I have insisted that protecting beneficiaries was an essential part of any Medicare report effort. I represent a congressional district that has one of the highest percentages of senior citizens in the country. I also worked for years as an attorney and a community volunteer with many retirees. Recently, I myself, reached Medicare age. This bill is the product of listening and learning. It is a product of many discussions with people who had real life, day to day experiences with the Medicare Program. It protects our current beneficiaries while ensuring that Medicare will exist for future beneficiaries. In a recent Washington Post article, Robert Samuelson said it well when he stated that ``Republicans occupy the high moral ground and the low political ground. They have raised critical questions at the risk of political suicide.'' And, knowing that, Republicans still believe it is our responsibility to show pure guts and courage to save Medicare for our seniors, their children, and grandchildren. We have taken on the task of protecting and preserving Medicare because it is our moral responsibility, not because of political necessity. We have taken the higher ground and this is ground that I am proud to stand on. Mr. WAXMAN. Mr. Chairman, I yield 2 minutes to the gentleman from Texas [Mr. Bryant] and I ask him if he would yield back to me 15 seconds. Mr. BRYANT of Texas. I yield to the gentleman from California. Mr. WAXMAN. Mr. Chairman, I just want to comment on the statement made by the previous gentleman. He claimed we are not cutting benefits, we are not going to make people pay for benefits for their health care. How are we getting $270 billion in Medicare cuts and the AMA supports the bill? Something just does not add up. Mr. BRYANT of Texas. Mr. Chairman, the gentleman's logic is impeccable. I would point out that the losses to hospitals in and around the district of the gentleman from Florida [Mr. Bilirakis] are going to be $210 million over the next 7 years, and my colleague says there are no cuts. His folks are going to feel them. The fact of the matter is, Mr. Bilirakis, as chairman of the Subcommittee on Health, my colleague and his Republican friends ought to be working on the fact that health care costs are rising. Instead my colleague is working on cutting health care insurance that elderly people use to cope with health care costs. That is the problem. The fact of the matter is it is not a secret that my colleague's party philosophically does not believe Medicare is the appropriate role of government, and yet he comes in here and tells us they are not cutting it. Mr. Chairman, my colleague has gotten power, and now he is cutting it. He boasts throughout the land he is cutting government, but today, as he takes $270 billion out of the program that insures the health needs of seniors, he says he is not cutting it. Only in Washington would anybody believe that, Mr. Archer. I would point out that with regard to these cuts, Mr. Chairman, the gentleman from Texas [Mr. Archer] and I are pretty much both in the same situation. In Harris County, TX, we are talking about $2.4 billion in cuts between 1996 and the year 2002 according to the Health Care Finance Administration. Now my colleagues asked for facts, There is facts. Dallas County, $1.6 billion in cuts between 1996 and the year 2002. Why? To pay for tax cuts for wealthy people out of the hides of elderly people who are not going to be able to pay their medical bills because they have cut their insurance. Mr. ARCHER. Mr. Chairman, I yield myself such times as I may consume very simply to say that once again we are back into the same rhetoric. There will be increases for hospitals across this country. Those increases have already been demonstrated by the facts. Only in Washington can a Member of Congress stand up and call increases a cut. Mr. Chairman, I yield 2 minutes to the gentleman from Michigan [Mr. Camp], a respected member of the committee. (Mr. CAMP asked and was given permission to revise and extend his remarks.) Mr. CAMP. Mr. Chairman, I thank the distinguished gentleman from [[Page H 10336]] Texas [Mr. Archer] for yielding this time to me, and I rise today in support of the Medicare Preservation Act because it officially ends the policy of just raise taxes. Mr. Chairman, some who oppose our program have called it extreme. What is extreme is that year after year the Democrat's answer to the Medicare crisis has been to raise taxes. Almost every year, Democrats dug deeper into the pockets of working Americans just to get through the next election. And in 1993, they even raised taxes on seniors citizens. Nine times, since 1965, the Medicare Board of Trustees has stated that Medicare was in severe financial trouble and needed reform. What was the Democrats answer? Raise taxes. Just throw more money at it to get through the next election. Since 1965, Democrats raised the payroll tax on working Americans eight times, over 450 percent. They raised the earnings subject to tax for Medicare 10 times, an increase of over 2000 percent. Then they raised taxes on Federal and State employees, and, when they still needed more, in 1993, they raised taxes on American seniors who had already paid their fair share into the program. Now, a senior earning just $34,000 pays not half of their Social Security in taxes but 85 percent. And now even the President admits taxes were raised too much in 1993. Mr. Chairman, that is extreme. Could we put the Medicare crisis off a few years if we raise taxes again? Sure we could. Could we avoid the vicious attacks by special interest groups if we didn't reform the system? Sure. But we are not going to do that. We are going to preserve, protect and strengthen Medicare not to get through the next election, but for the next generation. We will ensure the solvency of this program. We will increase benefits. We will maintain the current premium rate and for the first time in the history of Medicare, we will give seniors the right to choose the health care plan that best suits their health needs. Mr. BLILEY. Mr. Chairman, I yield 5 minutes to the gentleman from Florida [Mr. Stearns]. Mr. STEARNS. Mr. Chairman, I would like to have a colloquy, if I could, with the gentleman from Pennsylvania. Both he and I have worked hard in our districts getting the message out how important it is to look at this program because it is going bankrupt, and we want to offer them choices, much like the choices that the gentleman and I have. Perhaps many Members do not know that a large number of the Federal employees are retired and they have choices, HMO's, PPO's, and all these other things. Let us talk, for example, about a widow whose $600- a-month pension is too low to pay for this expensive part C medigap insurance and whose biggest problem is that she cannot afford the deductible portion of her doctor's bill. {time} 1245 So what happens, she does not go to take care of herself. Now, what would we have under this program with our HMO's and PPO's and the PSN's? I mean, even a $5 doctor bill is something that she would be concerned about. You might want to amplify on that. Mr. GREENWOOD. If the gentleman will yield, the option that would be very attractive for the constituent in your district that you just have described would be a managed care option. Most of the managed care companies have told us that, and they are already doing this in many areas of the country, that they will offer managed care plans in which there is no requirement whatsoever to pay Medigap insurance. So that $1,000 a year that she may be paying now toward her Medigap insurance would disappear. Suddenly she would gain new benefits. She would probably gain a prescription drug benefit. She may get an improved dental or vision benefit. She would no longer have that out-of-pocket cost at all and still be able to go to her doctors within her network whenever she chooses. She would, I think, would welcome this change very much and be far better off and have more money left over in her budget at the end of each month. Mr. STEARNS. Is it not a point of fact that all the people in this room have the Federal employee health benefit program, and is it not a point of fact that people on this side are in HMO's, in fact, there are Members of Congress who have retired who are in health management organizations and they are not picketing and screaming and worried? Because actually what we are trying to do is develop a program for Medicare that is much like the First Lady and the President has and all of us have, which basically says that health management organizations might work for some people. It should be a choice, and surely if it is good enough for Members of Congress, these same choices should be available for the seniors. So I think that is what you are saying for this particular woman in Florida who is on a very small pension every month. This would be a possible choice for her. You might want to just amplify on that, because I know you have toured, like I have, many health maintenance organizations, talked to the seniors, and for some of them they are very happy. There are people that have high monthly drug costs, and the HMO is paying for that, and it is paying for their deductible. So that surely that is an approach we should not rule out by keeping the one warehouse, one-size-fits-all program we now have. Surely moving it to what we have in the Federal employee health benefits program is a step forward. Mr. GREENWOOD. The fact of the matter is 9 percent of seniors in this country already have chosen the option of receiving their Medicare benefits through managed care. That number is growing rapidly because you know how seniors will get together and talk and compare notes, and when one learns from the other that they have a new prescription drug program benefit, they say, ``How do I get that,'' and they make the choice. One of the things about this debate that has been interesting to me is you and I and Members of this side of the aisle know our friends on the other side of the aisle will spend all day, as they have spent the last 6 or 7 months, scaring senior citizens that all of these terrible things are going to befall them. The fact of the matter is that we are confident today, we are confident because we know when the political dust settles, when this plan is finally signed into law, that the senior citizens will then, beginning in January, have these new options. They will see, my goodness, their copays did not go up, deductibles did not go up, their Social Security check, even with part B deduction, is bigger than it was this year. They will then thank us. Once this debate is over, we think we will be able to say we told you so. Mr. STEARNS. Is it not also true, if they want to remain in Medicare as it is right now, they can still do that? They still have that choice? Mr. GREENWOOD. Absolutely. That is the beauty part. We have made certain from day one there is the fee-for-service option will always be available to every single senior citizen in America that wants to keep it. Those that may be a little too old for change, do not like to change, can keep their fee-for-service and enjoy the kind of Medicare that they have grown to enjoy these past years. Mr. GIBBONS. Mr. Chairman, I yield myself 30 seconds. I know the two gentlemen who just had this colloquy on the floor are sincere. But last year I checked all of the Medicare policies of every Member in Congress here. Ninety-nine percent of us have fee-for- service. Ninety-nine percent of us have fee-for-service, and all of those, all of those that have fee-for-service have abortion benefits in our medical care policies. You know, those are in the records of the House. Go check them. parliamentary inquiry Mr. THOMAS. Mr. Chairman, I have a parliamentary inquiry. The CHAIRMAN. The gentleman will state his parliamentary inquiry. Mr. THOMAS. Mr. Chairman, is it against the rules to wear slogans, buttons, while addressing the Committee of the Whole, and did the Chairman not already indicate what the rules are? The CHAIRMAN. The gentleman is correct. Mr. STUPAK. Mr. Chairman, I yield 90 seconds to the gentleman from New York [Mr. Manton]. Mr. MANTON. Mr. Chairman, at the outset, I yield to the gentleman from Michigan [Mr. Stupak]. Mr. STUPAK. Mr. Chairman, I just wanted to point out the last speaker in [[Page H 10337]] the well down here, the gentleman from Florida [Mr. Stearns], his district will lose $154 million over the next 7 years if this Republican plan goes through, just to give a tax break to the rich. I am more concerned about the State of Michigan where the gentleman from Michigan [Mr. Camp] spoke in which in his district the hospitals will lose $125 million between now and 2002 just to pay for this tax break for the rich. Being from Michigan, I am very concerned about that. Mr. MANTON. Mr. Chairman, I rise in strong opposition to this draconian plan to slash $270 billion from Medicare. This so-called Medicare preservation plan will seriously threaten the integrity of the program and inflict undue pain on America's elderly. Under this bill, the elderly will suffer an increase in their premiums and a decrease in the quality of their health care services. Quite simply, you are asking seniors to pay a lot more, but expect a lot less. And last night, Mr. Chairman, in one final act of cruelty, the majority included a provision to deny anti-nausea drugs for chemotherapy patients. How can you possibly justify denying basic dignity and comfort to those in the twilight of their life, who are fighting for that very life. Speaking out against this outrageous proposal is not a matter of demagoguery, its a matter of duty. Duty to the senior citizens we represent. Oppose this legislation. Mr. ARCHER. Mr. Chairman, I yield 30 seconds to the gentleman from Louisiana [Mr. McCrery]. Mr. McCRERY. Mr. Chairman, the gentleman stated something that is just incorrect, and it has been stated in the media some. We are not denying payments for anti-nausea drugs for cancer patients. The fact is that we will continue to pay for the intravenous drug that people, the cancer patients, use to fight nausea. Mr. BLILEY. Mr. Chairman, I yield 4 minutes to the gentleman from Pennsylvania [Mr. Greenwood]. Mr. GREENWOOD. Mr. Chairman, I yield to the gentleman from New York [Mr. Paxon] for a question. Mr. PAXON. Mr. Chairman, I have many constituents back in western New York, in the Buffalo and Rochester, Finger Lakes areas, that are concerned about catastrophic costs in health care. How would medical savings accounts help those with recurring health problems pay for these catastrophic expenses? Mr. GREENWOOD. The medical savings account is a new component of Medicare that we have included in this reform. Those seniors who choose it would have deposited into their medical savings account a number of dollars that would average about $5,000 across the Nation; the first portion of that deposit would be used to buy catastrophic or major medical insurance that would cover them above he deductible. Then the senior gets to use what is left in the account for his or her medical benefits, go to whatever doctor or hospital he or she wants. Once the deductible is reached, then in a year in which that particular individual has high costs, then the medical, the catastrophic, coverage would kick in and they would have no more out-of-pocket costs whatsoever. In a year in which she was particularly healthy, managed her costs and did not go to a doctor very often, she would be able to keep the balance in the medical savings account. It is a good opportunity for savings for those seniors. Mr. PAXON. I would make a comment. My parents are both retired. Both have had catastrophic health care concerns. Of course, this would be very important to them. I also want to make the point Medicare is important to them today, too. They want to see Medicare protected and strengthened. It is their health care needs. It concerns me deeply. If their Medicare is not safe and secure, they have to turn to the family to help. We want to make certain for them and all of the constituents this plan is preserved and protected for the coming years. Mr. FRISA. Mr. Chairman, will the gentleman yield? Mr. GREENWOOD. I yield to the gentleman from New York. Mr. FRISA. Mr. Chairman, I just wanted to, if we could, because this is such a serious issue, it is an important one for our senior citizens. My folks are both retired and are counting on Medicare being there throughout their retirement, and they are happy that we are taking the opportunity to make Medicare safe and sound and better for all of us. So I would like to ask the gentleman, are there going to be increased funds for seniors under the Republican plan? Mr. GREENWOOD. Well, of course, there are. Despite all of the rhetoric to the contrary, we are actually taking, right now, we are spending on average $4,800 per each beneficiary in the Medicare Program. Our plan increases that about 5 percent each year for a 40- percent increase over the next 7 years. So 7 years from now we will be spending $6,700 for beneficiaries. It is a huge increase. What we are doing is bringing down the unsustainable inflation rate which is bankrupting the system. Mr. FRISA. In other words, and I think this is very important, despite the rhetoric, it is really not truthful. We are saying the average senior citizen will be getting an extra 100 $20-bills spent on their medical behalf. So there is more money being spent for senior citizens under the Republican plan. It is absolutely incredible, I think you would agree, that my colleagues on the other side of the aisle are trying to say that 100 additional $20-bills for our senior citizens is a cut. It is absolutely incredible. I thank the gentleman for explaining that and making it clear to the American people and, most importantly, to our senior citizens that the Republicans, by providing a $2,000-per-beneficiary increase is what is going to save Medicare for our seniors so they can feel that it is safe and sound and better for them. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Florida [Mr. Deutsch]. Mr. DEUTSCH. Mr. Chairman, you know, sometimes we can make complicated issues simple. If we are saving $270 billion and there are 37.6 million beneficiaries, this is what it is going to cost each Medicare beneficiary in America, whether in terms of direct out-of- pocket expenses or not. There is another chart which I think is probably the best chart and the clearest and most factual, and if we can focus in on this so people watching can see, my Republican colleagues have said we have to do something, there is this incredible crisis, the trust fund is gong to go bankrupt in 7 years. Well, the Medicare Program has existed for 30 years. Twelve of those thirty years there was a shorter life expectancy than 7 years that exists today, and we did incremental changes. We fixed it. It is a flat-out lie that this is unprecedented. It is a flat-out lie that $270 billion needs to be cut. It is a flat-out lie that choice will be available for Medicare beneficiaries. Mr. GIBBONS. Mr. Chairman, I yield such time as he may consume to the gentleman from Tennessee [Mr. Clement]. (Mr. CLEMENT asked and was given permission to revise and extend his remarks.) Mr. CLEMENT. Mr. Chairman, I rise in opposition to the Republican Medicare reform plan and ask my colleagues to support the Dingell- Gibbons substitute. Mr. Chairman, when President Lyndon Johnson began the Medicare Program in 1965, less than half of all seniors had health insurance. It was understood that the elderly had declining resources, costly health care needs, and few insurers willing to sell them coverage. Since its creation, the Medicare Program has been a great success. Today, 99 percent of senior citizens and a substantial proportion of the disabled are covered by Medicare. It has contributed to reducing poverty among the elderly and causing the life expectancy rate in America to exceed that of every country in the world except Japan. Medicare is fulfilling its mission. Let me review briefly the two areas of the Medicare Program. Part A of Medicare is financed by the hospital insurance trust fund, which comes primarily from the hospital insurance or Medicare payroll tax contributions paid by employers, employees, and self-employed individuals. Medicare part A will pay for inpatient hospital care, skilled nursing facilities, home health care, and hospice services. It is the trust fund of part A which the Medicare trustees say is ``severely out of financial balance'' and must receive ``prompt, effective, [[Page H 10338]] and decisive action'' from Congress to restore the stability of the program. The second aspect of the Medicare Program is part B, the supplementary medical insurance trust fund. Part B is optional, and primarily finances physician and hospital outpatient services. Part B is financed by premium payments from enrollees and by general revenue funds from the Federal Government. The part B premium is currently $46.10 monthly or 31.5 percent of total costs of Medicare, and the budget of 1993 would bring the premium down to 25 percent of total costs from 1996 to 1998. Beneficiaries are responsible for an annual deductible of $100 and coinsurance, usually a 20-percent copayment. The part B trust fund is not in financial crisis, though only because it is financed partially by the general fund which is experiencing runaway health care costs and driving up the deficit of the U.S. Government. Let me be clear that I do not believe Medicare is out of control or too generous as some have stated. In truth, Medicare pays only 45 percent of the Nation's health care bill for the elderly, and it is less generous than 85 percent of private health insurance plans. The problems we are facing with Medicare today are primarily external, not internal. Though some problems do exist internally such as fraud and abuse, most of the factors which bring us to the present crisis are external. Let me share a few with you. First, the primary threat to Medicare is its rising costs which are consequently driving up the Federal deficit at alarming rates. The ability of any reform proposal must be measured by the following yardstick if we are to balance the budget and get our financial house in order: Does the reform measure control the costs of Medicare? Over the past 20 years the cost of the Medicare Program has increased an average of 15 percent a year. In this year alone, Medicare will account for 11.6 percent of all Federal spending. This will rise to 18.5 percent by 2005 if costs are not controlled. Another factor which threatens the future of Medicare is the growing number of senior citizens in America. The Baby Boomers will begin retiring shortly after 2010, and recent years have seen a dramatic increase in life expectancy. During the 30-year period from 1990 to 2020, the growth rate of the senior citizen population will be double the growth rate of the total U.S. population. This means that those receiving Medicare benefits will outnumber those employees and employers paying into Medicare. Among other contributors to the rising cost of Medicare are the high cost of advanced medical technologies, the rapid increase in procedures by doctors after a fee schedule was imposed by Medicare, the fee-for- service arrangement which gives no cost-saving incentives to providers or patients, and the rise of Medicare fraud and abuse. All these factors, some of which I applaud such as life expectancy and miraculous technology, have brought us to this present moment of crisis. Before looking at the specific proposals to reform Medicare, I wish to suggest the values which I believe should drive any attempt at reform. I believe you will agree with me. These values are: First, ensuring that every dollar saved from Medicare goes directly toward strengthening the part A trust fund and eliminating the Federal deficit; Second, making the trust fund sound for the short term and the long term; Third, protecting beneficiaries from dramatically increased costs and reduced access to care; Fourth, improving patient choice without coercion or compromising the quality of care; Fifth, reasonable sacrifice by all while ensuring the quality and viability of provider services for all Americans. Let us now turn to a quick overview of the two major proposals now before the Congress, one from each party. First, let's look at the Republican plan to reform Medicare. The Republicans, in their noble effort to balance the Federal budget and reduce the deficit, agreed to a fiscal year 1996 budget resolution which would reduce the rate of increase in Medicare spending by $270 billion by the year 2002, bringing its rate of growth down from its current 10 percent a year to about 6 percent a year. The most important innovation in the Republican proposal is a feature which would allow Medicare beneficiaries to opt for a wide range of privately run health plans, with the Government paying the premium. The plan would provide an incentive for beneficiaries to choose an option that is less costly, such as managed care or preferred provider groups, while allowing those who want to stay in the traditional fee-for- service style Medicare Program to do so. However, the Republican plan would force many low-income seniors out of the traditional program because of the high cost of staying in the fee-for-service as compared to other options. The Dingell-Gibbons substitute, which I will support today, allows seniors to move into managed care and rewards this cost- saving sacrifice without punishing those who wish to stay in traditional fee-for-service programs. Another set of cost-saving provisions in the Republican plan would reduce the growth of fees paid to hospitals, doctors, and other care providers by an estimated $110 billion over 7 years. The Democratic and Republican plans both rely heavily on reductions in the increase of payments to providers, but the Republican plan also contains a look back provision which I oppose that would balance the budget on the backs of providers if the projected cost savings are not realized. This will only mean that doctors and hospitals will begin turning down Medicare patients, leading to a national health care travesty. Both Democratic and Republican plans also contain provisions to eliminate excessive fraud and abuse within the Medicare Program. The Congressional Budget Office estimates that at least $20 billion could be saved over 7 years by reducing fraud and abuse in the Medicare Program. I believe it is wrong to raise premiums for seniors until the cheats and ripoff artists are weeded out of Medicare. The Democratic plan makes significant headway toward reducing fraud, but the Republican plan will repeal existing statutes that keep doctors from preying on their patients for their own financial self-interests. These measures, and others, are slated to ensure the viability of the Medicare part A trust fund. Let us turn to part B for a moment. I remind you that the primary reason to reform part B is to reduce the growth in the Federal deficit, not to build up the part A trust fund which receives its revenues from elsewhere. The Republicans choose to deal with the rising cost of part B by keeping the part B premium at 31.5 percent of total cost rather than at 25 percent as now planned. This means a doubling of Medicare part B premiums by 2002, increasing from $46.10 now to approximately $104 in 2002. While I do not oppose a sensible increase in premiums, I believe this increase is out of reach for many low-income seniors. I support the Democratic plan which would permanently maintain premiums at 25 percent of total cost. As you can see, many of the aims and methods are the same in the two plans. But the details differ at significant points, particularly with regard to how much of the burden seniors are asked to bear. I would like to sum up the Medicare debate as I see it. First, I support many of the reforms both sides support including incentives for entering managed care, slowing the increase in provider payments, and eliminating fraud and abuse. These are all contained in the Democratic substitute which I am supporting. Let me share with you my disagreements with both plans, Democratic and Republican. Too often Democrats have sat on the sidelines this year while the Super Bowl is being played on the field--we have offered more critique than solutions. While this may be a good political stunt, it is not responsible nor respectful of our Nation's senior citizens or our children who will bear the cost of the Medicare Program if we do nothing. But I have not been content to sit on the sidelines. Before this debate even began, I stepped out in support of health care reform bill this year that would have made many of the adjustments we are now discussing. Even today, I would have preferred to have voted for the coalition substitute which would have dealt with part A and part B. But the Republicans in the Rules Committee would not allow this bill to come to the House floor for a vote. So, today I will choose between the better of two evils and support the Democratic substitute. I sharply disagree with Republicans at one major point. Earlier this year, the Republicans voted for a $245 billion tax cut which gives over 50 percent of the cut to those who make over $100,000 a year. It is any wonder then that Republicans now need to save $270 billion from the Medicare Program to pay for these tax cuts. I believe a tax cut of this magnitude at this time is irresponsible, especially when the majority of the tax cut goes to wealthy Americans. This translates into the outrageous premium and deductible increases Republicans now propose. The seniors in my district are telling me, ``Congressman, I don't mind sacrificing some benefits and bearing some of the financial burden of the Medicare Program to ensure the viability of the trust fund. But it seems to me that the Republicans are asking us to bear most of the burden for this reform, and it is not fair.'' I've been hearing a lot of people at home saying that they are beginning to think that GOP stands for Get the Old People party. I am not so sure they are wrong. The Greek word for crisis is krisis. The Greeks used this word to point to a critical moment in time when the road ahead would either mean a time of devastation or a time of great opportunity. This is a time of krisis. The decisions Congress make at this time will mean a future of prosperity and health security for all Americans, or it will mean a bleak future [[Page H 10339]] of prosperity and health care for only the privileged few. I believe this is the time of great opportunity, and together we will forge out a Medicare Program that will provide the best health care for our Nation's elderly for decades to come. Mr. GIBBONS. Mr. Chairman, I yield 30 seconds to the gentleman from Wisconsin [Mr. Kleczka]. Mr. KLECZKA. Mr. Chairman, the previous speaker indicated we are going to be giving all of this cash to senior citizens under the Republican plan. What he did not tell the seniors that are watching today is we are going to double your premiums in part B; all right. The Senate provisions provides more copays, more out-of-pocket-expenses. Seniors, this is what you are getting: Nothing. Mr. GIBBONS. Mr. Chairman, I yield 2 minutes to the gentleman from Massachusetts [Mr. Neal]. Mr. NEAL of Massachusetts. Mr. Chairman, the Massachusetts Hospital Association and the gentleman from Massachusetts [Mr. Torkildsen] have rejected the Republican Medicare bill. The MHA says the spending reductions in these proposals are too fast, too deep, and would jeopardize the ability of Massachusetts hospitals to provide quality health care to patients and communities. Health care in Massachusetts is world-class. When Raisa Gorbachev and Elizabeth Dole, and as I learned yesterday, when Chairman Solomon, of the Committee on Rules, all were ill, they came to Massachusetts. {time} 1300 If the Medicare bill was a good bill, would not the Massachusetts teaching hospitals, with the renowned reputation that they have earned over many years, take the lead and endorse the bill? We trust these hospitals with our lives. We should also trust their assessment of the Republican Medicare bill. The Gingrich Medicare cuts are simply too large for hospitals to absorb. Cuts of this magnitude will damage the quality of health care in America, especially for senior citizens and future generations. We should be investing, and not cutting research and education. These outlandish cuts to hospitals will cause massive job loss across this country. The people hurt most by these cuts will be the hard working men and women of America, all so that a tax cut can be given to wealthy Americans who have not even asked for it. It is just not right. Mr. DINGELL. Mr. Chairman, I yield 1\1/2\ minutes to the distinguished gentleman from New Mexico [Mr. Richardson]. (Mr. RICHARDSON asked and was given permission to revise and extend his remarks.) Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. RICHARDSON. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, under the Gingrich Medicare plan, the hospitals in and around the district of the gentleman from New York [Mr. Paxon] will lose $64 million over the next several years to give tax breaks to the wealthy. Under the Gingrich Medicare plan, the district of the gentleman from New York [Mr. Frisa] will lose $262 million, again to give tax breaks to the wealthiest people in this country that do not need it. Mr. RICHARDSON. Mr. Chairman, reclaiming my time, I want to talk about the effect of this plan on rural hospitals. That is what I represent. On Indian reservations throughout the State of New Mexico and many States in this country, rural health care will be devastated. Rural hospitals will close under this plan. In no way are they going to get more funds and resources. Now, this is according to the American Hospital Association. The typical rural hospital will lose $5 million in Medicare funding over 7 years, and that means many of them are going to close. In my own district, the average senior lives on $800 a month, and paying $92 a month in premiums and unlimited out-of-pocket expenses is going to be devastating. Rural Medicare patients are going to lose access to doctors. America's rural areas are going to need at least 5,000 more primary care physicians to have the same access to those that accept Medicare. The American Medical Association says cuts in Medicare are so severe they will unquestionably cause some rural physicians to leave Medicare. Mr. DINGELL. Mr. Chairman, I yield 1 minute to the distinguished gentleman from Ohio [Mr. Brown]. Mr. BROWN of Ohio. Mr. Chairman, I appreciate the gentleman yielding time. Mr. Chairman, we have listened to the Republicans talk over and over about what a great plan this is, how it expands choice. The fact is senior citizens in this country now have full choice with Medicare. Yes, under the Gingrich plan seniors will have their choice of a plan, but they lose their choice of doctor. The Gingrich plan gives physicians financial incentives, the New York Times calls it ``bribes for doctors,'' to move out of traditional fee- for-service into HMO's. Medicare beneficiaries therefore will be pushed out of traditional fee-for-service and forced into HMO's, forced into managed care. This is purely and simply a political payoff to big insurance companies. We know it, Newt Gingrich knows it, the Republicans know it, and the American people know it. Mr. ARCHER. Mr. Chairman, I yield 2 minutes to the gentleman from New York [Mr. Houghton], a respected member of the Committee on Ways and Means. (Mr. HOUGHTON asked and was given permission to revise and extend his remarks.) Mr. HOUGHTON. Mr. Chairman, there is a lot of emotion in this issue, and I can understand it. It is a very important issue. I always think of what Wilbur Mills said, that there are probably more votes changed in the House Chapel than there are on the House floor. I am not going to try to convince anybody, but I am just going to tell you where I am coming from. The gentleman from Ohio [Mr. Brown] has thrown around a lot of numbers is terms of how many cuts will be in people's hospitals. I would question those numbers. I have seen those numbers myself as far as my own district is concerned and I question the authenticity of them. Second, I think the issue is are we going to face up to this thing or not? Everybody agrees we should. The President agrees, the Democrats agree, the Republicans agree. How are we going to do it? It is a matter in terms of timing and numbers. Also, there always is a better way. I can devise a better way. I am not sure this plan is exactly the way I want, but it is a good plan. The next point is that there are no eternal fixes for the Medicare problem. We never can go asleep. We are always going to have to be on top of this thing. The question is are we going to have a short-term or longer term approach to this thing. Let me talk a little bit about cuts. If I spend $1 today and I spend 90 cents 7 years from now, that is a cut. If I spend $1 today and I spend $1.45 7 years from now, that is not a cut. Those are the relationships we are talking about. Let me talk a little bit about taxes. I did not vote for a tax cut. I did not think it was appropriate, I did not think it was the right timing. However, the Republican Party has felt that is important, the President has felt that is important, the gentleman from Missouri [Mr. Gephardt], the minority leader, has felt that is important. It is a fact we deal with everyday. Why can we not get together; why can we not, if our philosophy is the same, do something which is important as far as this overall Medicare issue is concerned? Mr. GIBBONS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Indiana [Mr. Jacobs]. Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield? Mr. JACOBS. I yield to the gentleman from Ohio. Mr. BROWN of Ohio. Mr. Chairman, the gentleman from New York [Mr. Houghton] mentioned he has other figures and he did not believe these figures. Under the Gingrich Medicare plan, the hospitals in and around the gentleman's district, my friend from New York, will lose $167 million over the next 7 years. I would ask if he would come back in the well and perhaps tell us what the numbers he has that are different from [[Page H 10340]] the numbers that we have been recounting, because we have heard no debate or no questioning of those numbers. Mr. JACOBS. Mr. Chairman, reclaiming my time, speaking of numbers, the proponents of this measure cite approvingly the trustees' report that there will be a shortfall in the next 7 years in Medicare part A, and that is the truth. But it is not all the truth. The rest of the trustees' report states how much that shortfall is, $90 billion. So if you accept approvingly the one part, you should accept approvingly the other; $90 billion is considerably less than $270 billion. I wonder anyone remembers the city of Bentre in Vietnam. That is the one that was wiped out, every lock, stock, horse carriage, human being, and building, the Army major declaring it became necessary to destroy it in order to save it. My father used to say that in politics you can get people to eat the pudding, but you cannot get them to read the recipe. Today we are talking the recipe. We will see how the pudding tastes. Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished gentlewoman from California [Ms. Eshoo]. Ms. ESHOO. Mr. Chairman, today the Gingrich Republicans are being encouraged to use certain words, probably put together by some PR agency or PR person, to describe their Medicare plan, words like ``historic, serious, and long-term.'' Well, in some ways, I could not agree with them more. Their plan is historic because it marks the end of a 30-year commitment to provide our seniors with health care. It is serious. It is radical surgery, because it places the lives and well-being of 37 million Americans at risk. And it is long-term because it will tear holes in our social safety net that will remain for many years to come. It ``saves, preserves, and protects,'' not Medicare, but $245 billion in tax breaks that no one is asking for. It ``protects the right to stay with your doctor,'' but only if you are able to pay more for the privilege. It ``protects the right to choose,'' only if your choices are slim and none. It is ``responsible,'' but only if you are a member of the AMA. It is ``innovative and bold,'' inasmuch as it breaks new ground for being cruel to seniors. It is ``the right thing to do,'' but only if your parents did not raise you to know any better. Mr. Chairman, the Republican Medicare plan is all these words and one more, disgraceful, and I urge my colleagues to defeat it so that we can go on and make America a stronger, better, and more gentle Nation. Mr. GIBBONS. Mr. Chairman, I yield 3 minutes to the gentleman from Washington [Mr. McDermott]. Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that. Mr. BLILEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Washington [Mr. White]. Mr. WHITE. Mr. Chairman, I would like to say, first of all, that the explanation we just heard from my colleague from the Seattle area, who I have a great deal of affection and respect for, is exactly the kind of thinking that got us in this mess in the first place. We have been doing this for 30 years, and the fact is it is a self-fulfilling prophecy. If the Government tells you the cost of medical care is going to go up 10 percent every year, you can be sure that it will, because people who are buying health care or selling health care to the Government are going to spend every nickel their customer tells them they are going to spend the next year. The fact is we have to exercise some control at the Federal Government level to control these costs. Otherwise, they will be out of control forever and that is the reason we find ourselves in this situation. We have to fix this program. Otherwise, it is going to go bankrupt. {time} 1315 I want to say one other word about the Seattle area because it is very important. Seattle is an urban community and yet it is one of the healthiest communities in the Nation. It is also one where we have one of the most efficient health care systems in the Nation. Why is that, Mr. Chairman? It is because in Seattle we essentially invented the managed care program. Under managed care individuals get to sign up in a program that looks out for your health over the long- term basis. Instead of trying to cure diseases as they come up, it actually prevents individuals from getting sick in the first place. A lot of people in the Seattle area have found that to be a good idea. One of the great things about this bill is that it tries to do for the rest of the Nation what we have done very successfully in Seattle by having the option to take managed care instead of the fee-for- service program. We have been able to keep the costs down across the board, and that is what this bill will do for the entire country. Mr. ARCHER. Mr. Chairman, I yield 2 minutes and 30 seconds to the gentleman from Ohio [Mr. Portman], another respected member of the Committee on Ways and Means. Mr. PORTMAN. Mr. Chairman, I thank the gentleman for yielding time to me. We have heard a lot today from the other side of the aisle about how the increases in spending in our Medicare plan will not keep up with the private sector growth. We just heard from the gentleman from Washington [Mr. McDermott]. I wish his chart were still up. Maybe it can be put up again. It might be useful to have it. It is just not accurate. It is not accurate. The charts we just saw from the gentleman compares apples to oranges. It is full of unknowns. It is full of false assumptions. Let me give Members a couple. First of all, the Medicare figures are per beneficiary. The private sector figures are not per beneficiary. How can we compare those two? The private sector figures are, thus, inflated. Second, the Medicare figures the Democrats use do not include a lot of other costs, including administrative costs. It is comparing apples to oranges. Here is a better chart that illustrates clearly what the gentleman from New [[Page H 10341]] York [Mr. Houghton] and others have been trying to explain, which is that under this bill before us Medicare spending actually goes up. Guess what? It actually keeps pace with the private sector. It will be higher than the private sector 7 years from now as it is today. This chart compares apples

Amendments:

Cosponsors: