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[Congressional Record Volume 141, Number 72 (Wednesday, May 3, 1995)]
[House]
[Pages H4528-H4529]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                            MORE ON MEDICARE

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Illinois [Mr. Durbin] is recognized for 5 minutes.
  Mr. DURBIN. Mr. Speaker, I would like to follow up on the earlier 
discussion by the gentleman and the gentlewoman from California about 
Medicare.
  I think it is critically important for us to focus on the fact that 
when we are talking about Medicare, we are not necessarily just 
confining our interest to the health care of our parents and 
grandparents. Some of us who are advancing in age look to Medicare just 
a few years down the line to take care of them, too.
  But the bottom line is that Medicare and Medicaid, the other 
Government health care program, are major sources of funding for 
hospitals across the United States. In my small-town district in 
Illinois, I have many, many hospitals, and I find that 60 percent to 80 
percent of the revenue coming into those hospitals comes from those two 
Government programs, Medicare and Medicaid.
  So when I hear suggestions made, as I have from some Republican 
leaders who are trying to come up with a budget, that they want to make 
cuts of billions of dollars in Medicare funds in out years, it not only 
should cause concern among seniors and people soon to be seniors as to 
whether they will have to pay more out of pocket, it also raises a 
serious question as to whether or not these hospitals will receive 
enough revenue to keep their doors open.
  Those who visit with the hospital administrators and boards know that 
there have been dramatic changes in these hospitals in rural and small 
town America over the last 10 years. Most of them have downsized, there 
are fewer patient beds, there is more outpatient service, and they 
depend dramatically on Medicare and Medicaid to continue to keep their 
doors open.
  We just finished last week in Ames, IA, a rural conference with 
President Clinton and Vice President Gore talking about the future of 
small-town America. A lot of concentration was put on bringing new jobs 
and keeping businesses in rural America. What we found is that when the 
Chamber of Commerce or the local boosters want to bring in a business 
or keep one, they have to answer some basic questions. The first 
question is: Do you have a hospital? How many doctors do you have?
  So when we talk about changing a Federal program for medical care, 
reducing the expenditure and literally threatening the bottom line of 
rural and small-town hospitals, the ripple effect goes far beyond the 
jobs at that hospital. It goes far beyond whether or not that ambulance 
has to drive 5 minutes or 50 minutes with a patient who is in critical 
need. It goes to the question of whether or not the community survives.
  Members of Congress fight battles day in and day out to keep Federal 
facilities open in small towns. We know how important they are. There 
is nothing more important than a hospital. Absolutely nothing. In rural 
America, it is critically important because we have an older 
population. Many of them are in farming, the most dangerous occupation 
in America, and a lot of them get involved in automobile accidents in 
rural areas at higher speeds with more injuries.
  So all these debates that we hear on Capitol Hill about budget 
resolutions and the future of Medicare have dramatic importance to 
people living in small town America. They had better tune in.
  Let me tell you, also, as I listen to this debate, I am really 
troubled. The Republicans yesterday, Mr. Dole, Mr. Gingrich, tossed 
down the gauntlet and said, ``President Clinton, why haven't you told 
us anything about health care reform?''
  Excuse me? This President was here 2 years ago with a proposal on 
health care reform. It was one that was detailed. Perhaps it was overly 
bureaucratic, maybe it was too large in its scope, but he accepted the 
challenge long before they issued it. He came to us and said, ``Let's 
look at the integrated health care system of America and how we can 
help Medicare, Medicaid, uninsured people, and the private sector,'' 
and it fell on deaf ears.
  The insurance industry ran over him like a steamroller, and that was 
the end of the debate. Now the Republican leaders have discovered the 
issue again because the problem is still there. The problem is there in 
terms of human terms and in terms of budget terms.
  I sincerely hope that we can come to some sort of bipartisan dialog 
on this. But I think honestly before that occurs that the Republican 
leaders, particularly those in the House, are going to have to 
basically admit the reality that they cannot have a tax cut package 
which adds more to our Nation's deficit at the time that they are 
talking about cutting a program as critical as Medicare.
  I think if they drop that whole Republican tax bill and then say, 
``Let's come to the table,'' we have got a real opportunity for 
bipartisanship. But why in the world should my senior citizens, should 
my small towns and should my neighbors lose a community hospital 
critical for the future of that community in order to give tax breaks 
to the wealthiest people in America under the Republican Contract With 
America? That does not compute. You cannot give a tax credit large 
enough to a family to make up for the loss of a hospital when there is 
serious need, when that family needs that medical care.
  I yield to the gentlewoman from California.
  [[Page H4529]] Ms. PELOSI. I appreciate the gentleman's comments 
about what it means to hospitals, both rural and urban, and why we need 
to address the budget seriously without taking out all these hundreds 
of billions of dollars for tax cuts for the wealthiest.
  I wanted to point out that distinction again, though, between tax 
cuts for the wealthiest and who is paying the price, out-of-pocket cost 
to senior citizens.
  Right now the Urban Institute says that seniors
   spend a staggering 21 percent of their incomes to pay for out-of-
pocket health care costs. That is now. If the Republicans go through 
with their tax cuts and take it out of Medicare, as we said earlier in 
the special order of the gentleman from California, this will again 
take it out of the pockets of seniors, a back door way of reducing 
their Social Security benefits by having them pay in some cases 100 
percent of the cost-of-living adjustment and in many cases a majority 
of the cost-of-living adjustment.

  So we absolutely must recognize who is paying for whose benefit. The 
senior citizens, the most vulnerable in our country, their health care 
benefits, out-of-pocket costs, will be used to pay for tax breaks for 
the wealthiest Americans. That just cannot be right.
  Let's all be of good faith in this. Eliminate the tax break from this 
equation. Let's get down to talking about making Medicare solvent and 
doing it in a way that is respectful of the limitations of income of 
our senior citizens.
  Mr. DURBIN. I thank the gentlewoman for her comments. I want to add 
something.
  We are in a period of sacrifice. We will have to cut back on Federal 
spending. We are asking people to accept that reality. But think about 
some of the people affected by this debate. Some of the people 
literally dependent on Medicare and Medicaid are in nursing homes, 
totally unable to take care of themselves. They have exhausted all of 
their savings. They are dependent on Government programs and what their 
families can come up with. As we increase their expenses, there is 
nowhere for them to turn to make up the difference.

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