May I ask unanimous consent that the doctor be afforded another 10 minutes. Mr. President, I have a parliamentary inquiry, if I may. I have no objection; I can stay 10 minutes, 20 minutes. I would…
May I ask unanimous consent that the doctor be afforded another 10 minutes.
Mr. President, I have a parliamentary inquiry, if I may.
I have no objection; I can stay 10 minutes, 20 minutes. I would like for the Senator from Oklahoma Dr. Coburn to have a chance to explain what he wanted to say. I don't mean to interrupt.
Mr. President, Dr. Coburn is a tough act to follow, and I am not going to try to do that. But I am happy to serve with him. We come from different parts of the country, different kinds of training, upbringing, and careers, but we have ended up here together in the Senate for the last 9 years and have had an opportunity to lead, first, the subcommittee on Federal financial management--it is a subcommittee of the Homeland Security and Governmental Affairs Committee--and this year to be the Democratic and Republican leaders of the committee. I enjoy working with him. I find that we have the opportunity to do some really good for our country, and I thank him for letting me be his wingman.
I want to just follow on with what Dr. Coburn has said, by asking us to think of how we spend money and what we spend it for in this government of ours. Then I actually have an op-ed that I read recently in our local paper in Delaware that I would like to read into the Record from Dr. Bob Laskowski, who is the CEO and the president of Christiana Care Health System, one of the largest hospital systems not just in our State but one of the largest in our part of the country.
Before I do that, I want to follow on to some of Dr. Coburn's comments by talking about our spending in the Federal Government. I would like to think of it as a pie. It is a big pie. A little more than half of the spending pie goes for something we call entitlements-- things we are entitled to by virtue of our age, our station in life, or we might
be entitled to Medicare if we are 65 or older, or Medicare if we are disabled and unable to work, or we may be entitled to early Social Security benefits at age 62, full retirement Medicare benefits 5 or so years after that. We may be entitled to benefits because we served in the military or we are a veteran or somebody with a disability. Those are all programs that are called entitlement programs. A lot of people say they are uncontrollable, we cannot do anything to control them, and they have grown like Topsy.
Today, if you think of the spending pie, over half of it is for entitlement. Roughly, closer to another 5 to 10 percent of spending today is for interest on the debt. If interest rates were not so low, it would be a lot more than 5 or 10 percent. Fortunately, we are blessed to have very low interest rates, but still our interest as a percentage of that pie is somewhere, I think, between 5 and 10 percent.
The whole rest of the Federal government is called discretionary spending, which means we actually have some discretion on how that money is spent. It is not an entitlement program, but we actually have to pass spending bills. We call them, usually, appropriations bills. There are about a dozen of them that cover everything from agriculture to defense, to housing, to the environment, to education, to transportation--you name it. That part of the budget--roughly, close to 40 percent, 35 to 40 percent--is called discretionary spending. More than half of that discretionary spending is for defense--I would say roughly 20 percent of the whole pie, maybe a little more than 20 percent. About 15 percent of the whole pie--a little less than half of the discretionary spending--is for nondefense matters.
So if you think about it, it goes something like this: For the spending pie, over half of it is entitlements. Allegedly, those are things we cannot reduce, control. I do not agree with that. Another 5 or 10 percent is for interest. Then we have roughly 40 percent for discretionary spending, the lion's share of which is for defense, and a little less than half of it is for nondefense spending. Think about that--entitlements, interest, defense spending. You set that aside, and for the whole rest of the government you have about 15 percent. That is domestic or nondefense discretionary spending.
We could actually eliminate domestic discretionary spending in its entirety--get rid of everything, everything we do in government other than entitlement programs, interest, and defense--and we would still have a deficit.
For people who say we can only focus on domestic discretionary spending or squeeze that to reduce the deficit further, the deficit is down from about $1.4 trillion about 4 years ago to about half that today. So we have made progress. It is still way too big, but we cannot get from here to where we want to go in terms of a balanced budget by just focusing on domestic discretionary spending.
I would like to say there are three things we need to do. Dr. Coburn has heard me say this more times than he wants to remember. The Presiding Officer has heard me say it a time or two as well.
There are three things we need to do if we are serious about deficit reduction, facing the reality of today.
No. 1, entitlement reform. These are the President's words: entitlement reform that saves money, entitlement reform that saves these programs for our kids and our grandchildren, and entitlement reform--these are my words--entitlement reform that does not savage old people or poor people, but it is sensitive to the least of these in our society.
The second thing we need to do is to focus on revenues. We need some more revenues. If you look at our country last year, when our deficit was about $700 billion--the year we just finished--as I recall, revenue as a percentage of gross domestic product was somewhere in the area of 17 percent, maybe 18 percent--revenue as a percentage of GDP. Spending as a percentage of GDP was over 20 percent, maybe around 21, 22, 23 percent.
The difference between revenues as a percentage of GDP down here at 17, 18, 19 percent of GDP and spending at 21, 22, or 23 percent, that difference right there is about a $700 billion deficit from the last year.
At the end of the day we need to make the revenues come closer to, actually, the spending. I suggest that we need to take a page out of the book they did in the second term of President Bill Clinton when we had run chronic deficits since 1968. President Clinton asked Erskine Bowles, who was then his Chief of Staff, to work with a Republican Senate and Republican House--a Republican Congress--to see if we could come up with a budget plan that included revenues, included spending, to actually balance the budget.
As we all know the story, famously it worked. A Democratic President, working with a Republican House and Senate, with the help of Erskine Bowles and Sylvia Mathews--now Sylvia Mathews Burwell, who was Erskine's Deputy Chief of Staff, later Deputy OMB Director--they got the job done. They reached across the aisle and worked it out. The deficit reduction plan was a 50-50 deal--50 percent on the revenue side and 50 percent on the spending side. They grew the heck out of the economy. As a result, we had four balanced budgets in a row--I think 1998, 1999, 2000, and 2001.
Harry Truman used to say: The only thing that is new in the world is the history we forgot and never learned. I think as we try to figure out what to do with today's deficits and how to get on an even more fiscally responsible track, it would be smart to look back about 15 years and see how it worked then.
For folks who might be watching this around the country, we actually have a budget law. I think our budget law was adopted in 1974. There is an expectation in our Nation's budget law for the President to present us in the Congress with a budget--one budget, not a capital budget and an operating budget but one budget. It is different from the States. It is different from my State, where I was Governor of Delaware for 8 years, where we have a capital budget and an operating budget. But we have one budget.
The President usually submits a budget in January, maybe February. This year it was a little late. The expectation here in the Congress, under the law, is that by, say, the end of April--a couple months later--the House and the Senate would have passed something called a budget resolution.
A budget resolution--what is that? It is not a budget. A budget resolution is a framework for a budget. It includes not nitty-gritty line-item spending plans for everything--defense and nondefense--but it says, roughly, we will spend this much in these programs, and generally, we will raise this much money in these ways from these revenue sources. It is not very specific, but it is a framework for the budget. I like to think of it as the skeleton, and later on, when we pass appropriations bills, when we pass revenue measures, we put the meat on the bones. That is where the real specificity comes along.
For a number of years we have not been able to pass in the Senate, in the House, a budget resolution--they are usually different--and then go to conference, create a conference committee to create a compromise. We have found it difficult to actually come up with a compromise budget resolution--a compromise, a spending plan, a framework for the appropriations bills and revenue measures.
This year started more promising because in the Senate here, in April, under the leadership of our Senate Budget Committee chairman Patty Murray of Washington, we actually passed a budget resolution-- sadly, without Republican support. We passed one, and it was one of those like the Clinton years, a 50-50 deficit reduction deal. It did not eliminate the deficit, but it kept it going in the right track. Half of the deficit reduction was on the spending side, half on the revenue side.
Over in the House, they passed a different kind of budget resolution. The budget resolution they passed did a little entitlement reform. But that 15 percent of the spending pie I was talking about--the 15 percent that is domestic discretionary spending--was reduced, as I recall, from 15 percent to like 5 percent. Think about that. We would be talking about--aside from entitlement spending, interest on the debt, and defense spending--having about the whole rest of the government be like 5 percent of our spending. That is not my vision of what our government
should be about. That is not my vision. And I do not think that is the vision of a lot of people in this body and in this country.
So the three things we need to do: No. 1, entitlement reform. It saves money, saves the programs. It does not savage old people, poor people. The second thing, we need some additional revenues.
I remember Kent Conrad, when he was our Budget Committee chairman, gave a presentation at a meeting a year or so ago. He talked about revenues. He talked about tax expenditures. As to the tax expenditures that he talked about, he said over the next 10 years we will see about $12 to $15 trillion go out of the Treasury because of tax breaks--tax credits, tax deductions, tax loopholes, the tax gap--$12 to $15 trillion go out of the Treasury for those tax expenditures. He said more money will come out of the Treasury for those tax expenditures-- tax breaks, tax credits, tax deductions, tax loopholes--than all the appropriations bills we are going to pass. Think about that.
He said we have a new way to appropriate money, we just do it through the Tax Code. I would say to our Republican and Democratic friends, this is where I think Senator Conrad was coming from. If we cannot figure out how out of $12 or $15 trillion of tax expenditures a year, maybe 5 percent of those that could be reduced or could be eliminated because they serve no useful purpose, something is wrong with us. If we can do 5 percent of, say, just $12 trillion in those tax expenditures, 5 percent would be about $600 billion over the next 10 years. Match that with entitlement spending reductions, that is about $1.2 trillion. That is a pretty good next step to take in narrowing our deficit on top of what we have already done.
The third piece, in addition to entitlement reform that saves money, saves the programs for the long haul, and does not savage old people or poor people, some additional revenue, generally from eliminating or reducing tax expenditures, the third piece--and Dr. Coburn was talking a little bit about this. He was talking about the way we spend money. We have a culture in the Federal Government. We have had it for a long time. Big companies have this culture too, and some States as well as counties and cities. I call it a culture of spend thrifts as opposed to a culture of thrift. What Dr. Coburn and I attempt to do with the folks on our committee is look at everything we do in the Federal Government to the extent that one committee can. We like to work with the Office of Management and Budget, OMB, with the General Accountability Office, GAO, the Office of Personnel Management, with the General Services Administration, all of the inspector generals across the agencies, throughout the Federal Government. We like to work with nonprofit groups such as Citizens Against Government Waste and others.
We do this in order to figure out what we are doing. How are we spending the taxpayers' money? Are there ways we can do those things, realize the goals we are trying to achieve, by spending less money or getting better results for the same amount of money? We need to do that in everything.
One of my colleagues said to me, when I said I was coming over to speak tonight: What are you going to talk about?
I said I think I will talk about regular order. We talk a fair amount about regular order around this place. We do not always follow it. Regular order, for the people watching who are tuned in wondering what is regular order, means following the rules. In this case, we have a Budget Act that says the President submits a budget the early part of the calendar year. Congress adopts a budget resolution. We do that about the beginning of May. Then we do our work on preparing appropriations bills and revenue measures. In order to go to a conference on a budget resolution, we have to get agreement. The majority leader will come or the Budget Committee chair will come to the floor and say: I ask unanimous consent to go to conference with the House and to name conferees and begin working out a compromise between the House and the Senate.
For many years it was perfunctory. The unanimous consent request was made. We would go to conference with the House. We would go to work on a budget resolution between the two bodies. This year, every time that request has been made--and it has been made dozens of times by Democrats and by at least one Republican--dozens of times--there has always been an objection to keep us from going to conference to work out this compromise.
As much as anything, we need to create an environment where we can focus on doing the three things I talked about: entitlement reform, tax reform that raises some revenues through deficit reduction, and try to focus on everything we do and say how do we get a better result, how do we get a better result for less money or the same amount of money.
I would say to my Republican colleagues who continue to object: Stop. Please stop. Let us actually have a chance to gather in a room in this building and see what we can hammer out to address, not a short-term continuing resolution but actually a thoughtful, comprehensive spending plan as we did 15, 16 years ago when the Republicans were in the majority here, House and Senate, and we had a Democratic President. We got the job done and helped to continue the longest running economic expansion in the history of this country.
I mentioned Bob Laskowski, president and CEO of Christiana Care Health System, a large regional health care system. He did a great job. We are very proud of him in our State. They provide care to a lot of people. He is a doctor and a health system leader. I thought his perspectives on health care reform and the Affordable Care Act were important enough to share on the floor.
This comes from an op-ed that appeared in one of our local statewide papers called the News Journal, a Gannett publication. His op-ed was in the News Journal this past week. I am going to read it. It is not that long. It goes like this:
With some in Washington promising to speak out against
implementation of the Affordable Care Act until they ``can no
longer stand,'' it might be a useful reality check to visit
an emergency room in any town or city across America.
He goes on to say:
There you will find thousands of Americans each day that
really cannot stand. It is not just because an injury,
illness or disease has put them on their backs.
Too often, it is because an eminently treatable ailment has
been allowed to turn into something much worse--for the
simple reason that the patient doesn't have health insurance
and couldn't afford to see a doctor until things became so
bad that the emergency room was their only option.
In the continuing cacophony of criticism around so-called
ObamaCare, this crucial fact keeps being lost: Our health
care system remains badly broken--and in the absence of
reform, it will continue to get a lot worse.
I see this--as a physician and as a health care executive;
but more importantly, I experience this as the friend of too
many neighbors with no health insurance.
He goes on to say:
I think that might be the reason why 3 in 4 Americans
surveyed in a recent Pew Research poll say they oppose
efforts to sabotage the law: because they know that the
people threatening to derail and defund the Affordable Care
Act are not offering a better solution.
Ironically, the part of the Affordable Care Act that we are attempting to implement and stand up across the country right now, the health exchanges or marketplaces, is a Republican idea. It was first offered as an alternative to HillaryCare back in the first term of President Clinton. It is a Republican idea, a business idea.
But I do not care whether it is a Democratic or Republican idea. It is a smart idea to use large purchasing pools, enable people who otherwise would buy health insurance for one person or five people or for a small business--it is a way for them to bring down the cost of their care, use competition to get better options. It is a smart idea.
The idea of another criticism, the individual mandates, people being individually mandated to get health care and if they did not they would maybe face some kind of fine--modest at first, it grows in time--that is not a Democratic idea. Ironically, that is an idea we got out of Massachusetts. The author, the Governor who signed it into law, was the Republican nominee for President last year, Mitt Romney.
So what we have tried to do is take some Republican ideas and some Democratic ideas and, frankly, some good ideas.
And over half of those who ``oppose'' the law today, say
they want it fixed, not scrapped.
I agree with that--fixed, not scrapped.
They know that in the absence of reform, there are still
too many people who use the emergency room as their only
source of medical care; too many families and businesses who
cannot keep up with the ever-rising cost of health care
premiums; and too many Americans who find nothing but
frustration when navigating our health care system--who still
fill out too many forms, are prescribed too many tests that
do not help them and get passed from office to office without
anyone guiding them overall care.
Beginning [last week], millions of uninsured Americans
began to shop for quality, affordable health care through the
health insurance marketplaces. These marketplaces are a key
element of the Affordable Care Act and represent an important
step toward putting quality health care within reach of all
Americans.
Just as Medicare has enabled seniors to get the care they
need to live longer and healthier lives, increasing access to
health insurance is vital to unlocking a healthier country,
by ensuring something that millions of Americans do not have
today: The opportunity to stay healthy through regular doctor
visits rather than seeking help only when they get sick.
In some cases very sick.
It is worth remembering: Health care reform is not about
special interests. It is about people like us, our families
and our neighbors. It is about fellow parishioners and Little
League coaches. It is about a neighbor who cuts himself
making dinner and a spouse who finds a worrisome lump.
Everyone we know and everyone we love--will need our health
care system at some point. Three years after America debated
the need for health care reform, millions of Americans who
work hard, pay taxes, and raise families still cannot afford
to see a doctor. That is wrong.
And even though the resistance of some states to fully
adopt the Affordable Care Act will tragically still leave
some families in those states in the lurch, we now at long
last have the unprecedented opportunity to create a system
that will work better for us all.
We should also remember: Over time, the Affordable Care Act
promises to improve the system as much for the shrinking
majority of Americans who have health insurance as for those
who do not.
Access is just the first step. The act provides a blueprint
for a new model of care, one that rewards doctors for more
coordinated care. Here at Christiana Care [and throughout
Delaware] we have seen what happens when we provide that kind
of care through reengineered medical practices, known as
``medical homes,'' where doctors are enabled to not only
efficiently meet patients' needs but to anticipate them as
well.
This coordinated approach makes getting care simpler and
makes the lives of those getting care easier. It makes
quality better; and, by making care simpler, better, and more
accessible, it saves money.
No law as big or ambitious as the ACA can possibly get it
all right on the first try. But let us not forget: When
Medicare was signed into law, critics warned seniors would
languish in long lines, and that we would all long for the
good old days before reform took place.
Today, Medicare has helped hundreds of millions of
Americans live longer, healthier lives--while reducing the
poverty rate among seniors by 75 percent.
Dr. Laskowski goes on to write:
I believe if these historic changes are given a chance, we
will collectively create a system that is defined not by
volume, but by value. Over the next several years, I know we
can make health care in America more ``people focused'' and
less transactional by realizing the best way to provide
better outcomes at lower cost is by partnering with patients.
As we in health care listen to our patients, we will learn
what our patients truly value. Then we will be able to free
up resources to help patients get healthy faster and stay
well.
The Affordable Care Act is a map toward that future.
History is being made.
I will close by saying: While many of our colleagues argue that the Affordable Care Act will lead to rising insurance costs and lost jobs, the truth is that in Delaware and throughout the rest of the country, millions of Americans are already learning they will be able to find quality health care, insurance plans for a more affordable price.
In Delaware and much of the country, millions of Americans will be able to find quality insurance plans for less than $100 a month. I have told my constituents and my colleagues since this debate over health care reform began, this law is not written in stone. We want to make the law better wherever we can, just as we have made the Medicare prescription drug program better, which was largely supported by Republicans. But we actually made it better in the Affordable Care Act.
I would urge my Republican colleagues to enable us to reopen our government, to reassure Americans and our creditors in this country and around the world that we will honor our debts. Then let's get to work right away to improve the Affordable Care Act and these insurance marketplaces and come to a consensus on a bipartisan budget resolution that lays out a spending plan that will get us from where we are to where we need to be.
Last word. I spent some time in the Navy, and the Presiding Officer spent some time in the military. One of the Presiding Officer's sons may be on Active Duty today. Some of the time we used to fly in and out of Japan in Navy P-3 airplanes.
I learned not long ago that in Japan they spend about 8 percent of GDP for health care. In this country, we spend about 17 or 18 percent. Think about that. They spend 8 percent of GDP for health care. We spend 17 or 18 percent. They get better results. For the most part they have lower rates of infant mortality and higher rates of life expectancy than we do.
The other thing is they cover everybody. Tonight when folks go to bed in this country, this evening some 40 million will go to bed without health care coverage. The Japanese, smart as they are, cannot be that smart. We cannot be that dumb. We cannot be that dumb.
There are ways to get better results for less money, including in the provision of health care. We can work together. If we work together, we can make that a reality.
The last thing I will say is I think the Presiding Officer has heard me tell how I love to ask people who have been married a long time what the secret is for being married 40, 50, 60, 70 years. People give me very funny answers. Some are actually hysterical. But every now and then some of them are serious, almost poignant. And I will close with one of them tonight.
A couple of years ago I met a couple who had been married over 50 years.
I said to them: What is the secret for being married 55 years?
They said: The two Cs.
The two Cs.
I said: What is that?
They said: Communicate and compromise.
Think about that. Communicate and compromise. I said: That is pretty good advice.
I got to thinking about it later, and I thought that is also some pretty good advice and maybe the secret for a vibrant democracy--to communicate and to compromise. We think we were willing to compromise on the short-term spending resolution that is the continuing resolution by agreeing to the numbers set by the Republican House leaders. They do not regard that as a compromise, but I think it was an attempt to compromise.
We need to find compromises in a conference on the budget resolution. That is where we should put our money, that is where we should put our efforts in the weeks to come.
I would add one more C. Communicate and compromise, as important as they are, maybe a third C would be collaborate. That would be a good one to add. So three Cs: Communicate, compromise and collaborate. It is what the American people sent us here to do.
I know the Presiding Officer feels that way, and so do I, as does Dr. Coburn. There are a bunch of us who feel that way. So let's do that.
Mr. President, I suggest the absence of a quorum.
