Mr. President, I am honored to follow my distinguished colleague from Maryland in this discussion about our priorities as we address the debt limit we are approaching. I think Leader Reid was wise to…
Mr. President, I am honored to follow my distinguished colleague from Maryland in this discussion about our priorities as we address the debt limit we are approaching. I think Leader Reid was wise to choose to cancel the scheduled Fourth of July recess so we could continue to work toward an agreement to prevent defaulting by the United States on our government debt and the financial consequences that would ensue here in America and around the world.
As we negotiate an end to this debt limit standoff, we also, obviously, have to address our looming budget deficits and our looming debt, which threaten to cripple our potential for economic growth in years to come. Where we are on this, of course, is that President Clinton put our budget on course to permanent surpluses. We would be a debt-free nation right now if the predictions the nonpartisan Congressional Budget Office had put in place when President Clinton left office had been kept. In fact, there were changes. President Bush and a Republican Congress squandered away those surpluses with unnecessary tax cuts and unwise spending increases. Our multitrillion- dollar deficits have resulted. We must now fix the budget and bring it back into balance.
So where are we in this standoff? Well, we need to cut spending. Democrats and Republicans agree on that. We need to protect ordinary families who enjoy ordinary levels of income from tax increases. Democrats and Republicans agree on that. The disagreement is whether we also need to raise some revenues in other areas to help balance the budget, areas such as oil and gas and ethanol subsidies, closing corporate tax loopholes, and putting an end to high-income tax-dodge schemes.
On that front, I rise in support of Leader Reid's resolution calling for a deficit reduction package that includes a ``more meaningful contribution'' from millionaires and billionaires.
The Republicans are threatening that they would rather let this government default on its obligations than to what they call ``raise revenues'' by requiring the wealthy to pay their fair share. Just last week, Senate Republican leader Mitch McConnell called on President Obama to take any raised revenues ``off the table'' and to balance the budget solely on spending cuts that affect the middle class and lower income families. In an opinion piece on cnn.com, Senator McConnell proclaimed that ``tax hikes can't pass the Congress.''
Well, let's pull the curtain back and take a little glimpse behind it as to whom the Republicans are fighting so hard to protect.
As shown in this picture I have in the Chamber, here is a building in New York City on Park Avenue, the Helmsley Building. Because this building is large enough to have its very own ZIP Code, we know from actual IRS information--not projections, not guesses, not conclusions drawn from rates; from actual paid-in IRS information--that the wealthy and successful individuals and corporations that call this building home paid a 14.7-percent total Federal tax rate in the last year they have done the calculation, 2007. That is lower than the actual tax rate, on average, of the New York City janitor or doorman or security guard who would work in this building. It is upside down. The people who serve the occupants of this building pay a higher tax rate than the occupants of this majestic building. The tax gimmicks that let those occupants pay a lower rate than the people who take care of the doors and the cleaning and the security for them--that is what the Republicans are fighting to protect.
This problem is not just a fluke in the Helmsley Building. Each year, the Internal Revenue Service publishes a report that adds up all the taxes paid by the 400 highest income earning Americans. I spoke earlier this year--several times, actually--on last year's report, which included data from 2007, like the same year as for the Helmsley Building. In that year, these super-high-income earners, making, on average, $\1/3\ billion, approximately--billion with a ``b''--paid a lower tax rate in 2007--the 400 of them did, on average--than an average hospital orderly who is a single payer pushing a cart down the halls of a Rhode Island hospital at night.
In May, the IRS published updated data on the top 400 income earners for 2008. Let's take a look at the status of the top 400 earners in that more recent year. Well, they are down from $\1/3\ billion, on average, to over $\1/4\ billion each. Certainly we can applaud that kind of success in America. That is definitely the American dream come true. But, on average, they paid an average tax rate of 18.2 percent. That is what they actually paid. That is what they put into the IRS. Once you get through all the tax dodges, all the different schemes, all the different deductions, all the different rates, when you actually put the pen to the paper at the bottom line, it is 18.2 percent.
We spent a lot of time around here debating whether the top income tax rate should be 35 percent or 39.6 percent. Folks, that is not what they are paying. The Tax Code is so filled with special provisions that tend to exclusively or disproportionately benefit the wealthy that the highest 400 income earners, earning more than $\1/4\ billion in 1 year, paid an average tax rate of 18.2 percent.
This means that the 400 highest earning individuals in the Nation, in 2008, paid the same effective tax rate as a truckdriver in Rhode Island. According to the Bureau of Labor Statistics, on average, an ordinary truckdriver earns $40,200, which is about the place in the Tax Code, on the way up, where you first hit paying 18.2 percent of your income in taxes.
So what the Republicans are asking as part of the debt limit compromise is that we cut employment and job training support now, at a time of record joblessness, while they continue to fight to make sure that people making a quarter of a billion dollars a year pay lower Federal tax rates than average middle-class families.
Here is another building that has a little story to tell. This is a building called Ugland House. It is over in the Cayman Islands. This building does not look like much. It is pretty nondescript. But over 18,000 corporations claim to be doing business out of this building-- 18,000 out of that little building. Clearly what is going on is that those corporations are hiding through shell companies, phony corporate identities that they and wealthy taxpayers use to hide assets and play tax games with the IRS.
This kind of mischief down in the Cayman Islands and elsewhere through these tax dodges is estimated to cost us as much as $100 billion every year. As part of a debt limit compromise, the Republicans are asking us to cut America's investments in science, cut America's investments in technology at the same time they are fighting to protect corporations that hide in offshore tax havens so that the honest American taxpayer has to pick up the burden for them. That is what they are fighting for when you pull back the curtain.
When all is said and done, everyone, Democrat and Republican, agrees that there needs to be cuts. And everyone, Republican and Democrat, agrees there should be no tax increases on ordinary middle-class families. Those concerns are not at issue. Where is the dispute? What is the blockade? Again, pull back the curtain and you will see that the Republicans are willing to let us as a nation default for the first time in our history on our debt, which would devastate our economy, all to defend tax rates for millionaires and billionaires that are lower than those paid by regular hardworking Americans; all to defend offshore tax havens that are used to evade taxes while ordinary families are expected to pay their taxes; all to defend corporate and special interest tax loopholes, earmarks for the wealthy and well- connected. That is where they have chosen to stand their ground. That is where they have chosen to pick a fight.
As our Nation rushes toward the August 2 deadline and the agreement deadline before August 2 when we must have something in place in order to get the President's signature on a bill by August 2--as we rush toward that, as the world's economy and America's economy are imperiled by the threat of our debt limit not being lifted, what are they fighting for? That is what they are fighting for, for the superprivileged, for the super well-connected, for the tax dodges they take
advantage of, and for the lower rates the superrich pay compared to the rest of all of us. Those are the interests that Republicans are protecting when they reject any revenue increases to bring down our unsustainable deficit. They say it is tax increases they are against. Well, the answer to that should be Americans asking the question back: Tax increases for who? Because if it is tax increases for the guy who is making a quarter of a billion dollars, and is paying a lower tax rate than a truckdriver, that is okay with me. That is a tax dodge we can get rid of. If it is a tax increase for a company that is going to hide in this building in the Cayman Islands to shelter its incomes so that Rhode Island corporations and Oregon corporations, American corporations have to make up the difference--American taxpayers have to make up the difference, and they cannot hide their income down there any longer, that is a tax increase I can live with. I do not think that is what ordinary Americans have in mind when they say we do not want tax increases. They mean we do not want our rates to go up. But ordinary Americans know that our Tax Code is filled, riddled with gimmicks and tricks and loopholes and deductions that have been put in it over the years by lobbyists. They are earmarks, they just happen to be earmarks in the Tax Code. They spend America's money through the Tax Code just as much as if it were an appropriation.
But what is the big difference? The big difference is it takes being a very wealthy individual or a very big corporation to be able to take advantage of those tricks, to be able to hire a lobbyist who can build that trick into the Tax Code, and to have the revenues and the resources to be able to maneuver through the Tax Code in that way. Ordinary Americans do not do that.
You can ask pretty much anybody in Rhode Island, show them the thousands of pages of the Internal Revenue Code and ask them: Who has a special provision in it for you? Nobody does. They are regular Americans. They pay regular taxes. They do things the way they are supposed to be done. The gimmicks and the tricks are all at the upper end, and it is time to clean house, particularly now when we so badly need the revenues to balance our budget.
It is simply inexcusable that our tax system permits billionaires to pay lower tax rates than truckdrivers, that it allows the wealthy to avoid taxes by hiding assets in phony offshore corporations. Even if we had no budget deficit, just being fair, honoring the principle of equality would demand that we address these inexcusable discrepancies that favor the wealthy and the well-connected. Our budget crisis, however, brings real urgency to the problem. So as we continue to work to avoid a debt default by the United States of America and to bring down our budget deficits and to reduce our crippling national debt, I hope Senator McConnell and the Republican Conference will revisit the potential to significantly cut the deficit by addressing tax loopholes, tax gimmicks and, frankly, outright injustice to the ordinary American taxpayer that they are now defending here in the Senate.
I see the distinguished Senator from Alabama arriving.
I yield the floor.
Would the Senator yield for a question?
I don't want to step on your colleagues' time.
One of the things I have been tracking is the share of wealth, income, and taxes at various percentages toward the top. The Senator was good enough to mention that the top 1 percent pays about 28 percent of the taxes, the top 5 percent pays a little over 44 percent of the taxes, and the top 10 percent pays 55.4 percent of the taxes.
But I think in order to get a complete picture, it is also important to note that the top 1 percent controls 24 percent of the income, the top 5 percent controls 39 percent of the income, and the top 10 percent controls 50 percent of the income. If you go to wealth, the top 1 percent controls 33.8 percent of the wealth, the top 5 percent controls 60.4 percent of the wealth, and the top 10 percent controls 71.5 percent of the Nation's wealth.
So if you are in the top 10 percent and you control 71.5 percent of the Nation's wealth, it doesn't seem to be unreasonable that you should be paying 55 percent of the Nation's taxes, particularly if you are taxing based on dollars and not on just number of people.
I don't know if those numbers are wrong. We got them from the Federal Reserve Board, from the IRS, and from the Congressional Budget Office. I think they are accurate. It would appear to show that at the very high end, although these individuals are paying considerable taxes toward our Nation's economy, they are paying considerably less than the amount of wealth they control and not much more than the amount of income they control. In a graduated system of progressive taxation, which we are supposed to have, that is not surprising. In fact, what is surprising is that the top 24 percent of the income only pays 28.3 of the taxes.
I would be delighted to do that. And I might actually throw in the data from the IRS that shows that the top 400 income earners in the country in the most recent period that they have actually gone back and done the calculation paid 18.2 percent total taxes, which is less than I think the average American, certainly the average middle-class American family pays. So there is this reversal at the high end where people actually end up paying less.
Indeed, in one building in New York, the payment for the most recent year was 14.7 percent from the occupants, whereas janitors and doormen and security guards are paying up in the 20-percent ranges. It is not progressive in that sense. It is regressive at the high ends, according to those things. So let's get the information together, and we will have that discussion.
That is why I think the loopholes need to be closed, and I thank the distinguished Senator for the colloquy.
Exhibit 1
[From the National Review Online, July 5, 2011]
Politics vs. Reality
(By Thomas Sowell)
It is hard to understand politics if you are hung up on
reality. Politicians leave reality to others. What matters in
politics is what you can get the voters to believe, whether
it bears any resemblance to reality or not.
Not only among politicians, but also among much of the
media, and even among some of the public, the quest is not
for truth about reality but for talking points that fit a
vision or advance an agenda. Some seem to see it as a
personal contest about who is best at fencing with words.
The current controversy over whether to deal with our
massive national debt by cutting spending, or whether instead
to raise tax rates on ``the rich,'' is a classic example of
talking points versus reality.
Most of those who favor simply raising tax rates on ``the
rich''--or who say that we cannot afford to allow the Bush
``tax cuts for the rich'' to continue--show not the slightest
interest in the history of what has actually happened when
tax rates were raised to high levels on ``the rich,'' as
compared with what has actually happened when there have been
``tax cuts for the rich.''
As far as such people are concerned, those questions have
already been settled by their talking points. Why confuse the
issue by digging into empirical evidence about what has
actually happened when one policy or the other was followed?
The political battles about whether to have high tax rates
on people in high income brackets or to instead have ``tax
cuts for the rich'' have been fought out in at least four
different administrations in the 20th century--under
Presidents Calvin Coolidge, John F. Kennedy, Ronald Reagan,
and George W. Bush.
The empirical facts are there, but they mean nothing if
people don't look at them, and instead rely on talking
points.
The first time this political battle was fought, during the
Coolidge administration,
the tax-cutters won. The data show that ``the rich'' supplied
less tax revenue to the government when the top income tax
rate was 73 percent in 1921 than they supplied after the
income tax rate was reduced to 24 percent in 1925.
Because high tax rates can easily be avoided, both then and
now, ``the rich'' were much less affected by high tax rates
than was the economy and the people who were looking for
jobs. After the Coolidge tax cuts, the increased economic
activity led to unemployment rates that ranged from a high of
4.2 percent to a low of 1.8 percent.
But that is only a fact about reality--and, for many,
reality lacks the appeal of talking points.
The same preference for talking points, and the same lack
of interest in digging into the facts about realities,
prevails today in discussions of whether to have a
government-controlled medical system.
Since there are various countries, such as Canada and
Britain, that have the kind of government-controlled medical
systems that some Americans advocate, you might think that
there would be great interest in the quality of medical care
in these countries.
The data are readily available as to how many weeks or
months people have to wait to see a primary-care physician in
such countries, and how many additional weeks or months they
have to wait after they are referred to a surgeon or other
specialist. There are data on how often their governments
allow patients to receive the latest pharmaceutical drugs, as
compared with how often Americans use such advanced
medications.
But supporters of government medical care show virtually no
interest in such realities. Their big talking point is that
the life expectancy in the United States is not as long as in
those other countries. End of discussion, as far as they are
concerned.
They have no interest in the reality that medical care has
much less effect on death rates from homicide, obesity, and
narcotics addiction than it has on death rates from cancer or
other conditions that doctors can do something about.
Americans survive various cancers better than people anywhere
else. Americans also get to see doctors much sooner for
medical treatment in general.
Talking points trump reality in political discussions of
many other issues, from gun control to rent control. Reality
simply does not have the pizzazz of clever talking points.
Exhibit 2
[From the National Review Online, July 4, 2011]
Entitlement Bandits
(By Michael F. Cannon)
The budget blueprint crafted by Paul Ryan, passed by the
House of Representatives, and voted down by the Senate would
essentially give Medicare enrollees a voucher to purchase
private coverage, and would change the federal government's
contribution to each state's Medicaid program from an
unlimited ``matching'' grant to a fixed ``block'' grant.
These reforms deserve to come back from defeat, because the
only alternatives for saving Medicare or Medicaid would
either dramatically raise tax rates or have the government
ration care to the elderly and disabled. What may be less
widely appreciated, however, is that the Ryan proposal is our
only hope of reducing the crushing levels of fraud in
Medicare and Medicaid.
The three most salient characteristics of Medicare and
Medicaid fraud are: It's brazen, it's ubiquitous, and it's
other people's money, so nobody cares.
Consider some of the fraud schemes discovered in recent
years. In Brooklyn, a dentist billed taxpayers for nearly
1,000 procedures in a single day. A Houston doctor with a
criminal record took her Medicare billings from zero to $11.6
million in one year; federal agents shut down her clinic but
did not charge her with a crime. A high-school dropout, armed
with only a laptop computer, submitted more than 140,000
bogus Medicare claims, collecting $105 million. A health plan
settled a Medicaid-fraud case in Florida for $138 million.
The giant hospital chain Columbia/HCA paid $1.7 billion in
fines and pled guilty to more than a dozen felonies related
to bribing doctors to help it tap Medicare funds and
exaggerating the amount of care delivered to Medicare
patients. In New York, Medicaid spending on the human-growth
hormone Serostim leapt from $7 million to $50 million in
2001; but it turned out that drug traffickers were getting
the drug prescribed as a treatment for AIDS wasting syndrome,
then selling it to bodybuilders. And a study of ten states
uncovered $27 million in Medicare payments to dead patients.
These anecdotes barely scratch the surface. Judging by
official estimates, Medicare and Medicaid lose at least $87
billion per year to fraudulent and otherwise improper
payments, and about 10.5 percent of Medicare spending and 8.4
percent of Medicaid spending was improper in 2009. Fraud
experts say the official numbers are too low. ``Loss rates
due to fraud and abuse could be 10 percent, or 20 percent, or
even 30 percent in some segments,'' explained Malcolm
Sparrow, a mathematician, Harvard professor, and former
police inspector, in congressional testimony. ``The
overpayment-rate studies the government has relied on. .
.have been sadly lacking in rigor, and have therefore
produced comfortingly low and quite misleading estimates.''
In 2005, the New York Times reported that ``James Mehmet, who
retired in 2001 as chief state investigator of Medicaid fraud
and abuse in New York City, said he and his colleagues
believed that at least 10 percent of state Medicaid dollars
were spent on fraudulent claims, while 20 or 30 percent more
were siphoned off by what they termed abuse, meaning
unnecessary spending that might not be criminal.'' And even
these experts ignore other, perfectly legal ways of
exploiting Medicare and Medicaid, such as when a senior hides
and otherwise adjusts his finances so as to appear eligible
for Medicaid, or when a state abuses the fact that the
federal government matches state Medicaid outlays.
Government watchdogs are well aware of the problem. Every
year since 1990, the U.S. Government Accountability Office
has released a list of federal programs it considers at a
high risk for fraud. Medicare appeared on the very first list
and has remained there for 22 straight years. Medicaid
assumed its perch eight years ago.
How can there possibly be so much fraud in Medicare and
Medicaid that even the ``comfortingly low'' estimates have
ten zeros? How can this much fraud persist decade after
decade? How can it be that no one has even tried to measure
the problem accurately, much less take it seriously? The
answers are in the nature of the beast. Medicare and
Medicaid, the two great pillars of Pres. Lyndon Johnson's
``Great Society'' agenda, are monuments to the left-wing
ideals of coerced charity and centralized economic planning.
The staggering levels of fraud in these programs can be
explained by the fact that the politicians, bureaucrats,
patients, and health-care providers who administer and
participate in them are spending other people's money--and
nobody spends other people's money as carefully as he spends
his own. What's more, Medicare and Medicaid are spending
other people's money in vast quantities. Medicare, for
example, is the largest purchaser of medical goods and
services in the world. It will spend $572 billion in 2011.
Each year, it pays 1.2 billion claims to 1.2 million health-
care providers on behalf of 47 million enrollees.
For providers, Medicare is like an ATM: So long as they
punch in the right numbers, out comes the cash. To get an
idea of the potential for fraud, imagine 1.2 million
providers punching 1,000 codes each into their own personal
ATMs. Now imagine trying to monitor all those ATMs.
For example, if a medical-equipment supplier punches in a
code for a power wheelchair, how can the government be sure
the company didn't actually provide a manual wheelchair and
pocket the difference? About $400 million of the
aforementioned fines paid by Columbia/HCA hospitals were for
a similar practice, known as ``upcoding.''
And how does the government know that providers are
withdrawing no more than the law allows? Medicaid sets the
prices it pays for prescription drugs based on the ``average
wholesale price.'' But as the Congressional Budget Office has
explained, the average wholesale price ``is based on
information provided by the manufacturers. Like the sticker
price on a car, it is a price that few purchasers actually
pay.'' Pharmaceutical companies often inflate the average
wholesale price so they can charge Medicaid more. Teva
Pharmaceuticals recently paid $27 million to settle
allegations that it had overcharged Florida's Medicaid
program by inflating its average wholesale prices, and the
Department of Justice has accused Wyeth of doing the same.
Merck recently settled a similar case.
Most ominously, how does the government know that people
punching numbers into the ATMs are health-care providers at
all? In his testimony, Malcolm Sparrow explained how a
hypothetical criminal can make a quick million: ``In order to
bill Medicare, Billy doesn't need to see any patients. He
only needs a computer, some billing software to help match
diagnoses to procedures, and some lists. He buys on the black
market lists of Medicare or Medicaid patient IDs.'' With this
information in hand, Billy strides right up to the ATM, or
several at a time, and starts punching in numbers. ``The rule
for criminals is simple: If you want to steal from Medicare,
or Medicaid, or any other health-care-insurance program,
learn to bill your lies correctly. Then, for the most part,
your claims will be paid in full and on time, without a
hiccup, by a computer, and with no human involvement at
all.'' These schemes are sophisticated, so Billy might hire
people within Medicare and at his bank to help him avoid
detection.
Last year, the feds indicted 44 members of an Armenian
crime syndicate for operating a sprawling Medicare-fraud
scheme. The syndicate had set up 118 phony clinics and billed
Medicare for $35 million. They transferred at least some of
their booty overseas. Who knows what LBJ's Great Society is
funding?
And there are other forms of fraud. An entire cottage
industry of elder-law attorneys has emerged, for instance, to
help well-to-do seniors appear poor on paper so that Medicaid
will pay their nursing-home bills. Medicaid even encourages
the elderly to get sham divorces for the same reason. It's
all perfectly legal. It's still fraud.
Medicaid's matching-grant system also invites fraud. When a
high-income state such as New York spends an additional
dollar on its Medicaid program, it receives a matching dollar
from the federal government--that is, from taxpayers in other
states. Low-income states can receive as much as $3 for every
additional dollar they devote to Medicaid, and without limit.
If they're clever, states can get this money without putting
any of their own on the line. In a ``provider tax'' scam, a
state passes a law to increase Medicaid payments to
hospitals, which triggers matching money from the federal
government. Yet in the very same law, the state increases
taxes on hospitals. If the tax recoups the state's original
outlay, the state has obtained new federal Medicaid funds at
no cost. If the tax recoups more than the original outlay,
the state can use federal Medicaid dollars to pay for bridges
to nowhere. As Vermont began preparations for its Obamacare-
sanctioned single-payer system this year, it used a provider-
tax scam to bilk taxpayers in other states out of $5.2
million. In his book Stop Paying the Crooks, consultant Jim
Frogue chronicles more than half a dozen ways that states
game Medicaid's matching-grant system to defraud the federal
government.
Since 1986, the GAO has published at least 158 reports
about Medicare and Medicaid fraud, and there have been
similar reports by the HHS inspector general and other
government agencies. In 1993, Attorney General Janet Reno
declared health-care fraud America's No 2 crime problem,
after violent crime. Since then, Congress has enacted 194
pages of statutes to combat fraud in these programs, and
countless pages of regulations.
Yet federal and state anti-fraud efforts remain uniformly
lame. Medicare does almost nothing to detect or fight fraud
until the fraudulent payments are already out the door, a
strategy experts deride as ``pay and chase.'' Even then,
Medicare reviews fewer than 5 percent of all claims filed.
Congress doesn't integrate Medicare's myriad databases, which
might help prevent fraud, nor does it regularly review the
efficacy of most of the anti-fraud spending it authorizes.
Many of the abuses noted above, such as those of the Brooklyn
dentist, were discovered not by the government but by curious
reporters poking through Medicaid records. The amateurs at
the New York Times found ``numerous indications of [Medicaid]
fraud and abuse that the state had never looked into,'' but
``only a thin, overburdened security force standing between
[New York's] enormous program and the unending attempts to
steal from it.
The federal government's approach to fraud is sometimes so
inept as to be counterproductive. Sparrow testified that a
defect in the strategy of Billy, our hypothetical criminal,
is that he doesn't know which providers and patients on his
stolen lists are ``dead, deported, or incarcerated.'' But
Medicare's anti-fraud protocols help him solve this problem.
When Medicare catches those claims, it sends Billy a notice
that they have been rejected. ``From Billy's viewpoint,''
Sparrow explained, ``life could not be better. Medicare helps
him `scrub' his lists, making his fake billing scam more
robust and less detectable over time; and meanwhile Medicare
pays all his other claims without blinking an eye or becoming
the least bit suspicious.''
Efforts to prevent fraud typically fail because they impose
costs on legitimate beneficiaries and providers, who, as
voters and campaign donors respectively, have immense sway
over politicians. At a recent congressional hearing, the
Department of Health and Human Services' deputy inspector
general, Gerald T. Roy, recommended that Congress beef up
efforts to prevent illegitimate providers and suppliers from
enrolling in Medicare. But even if Congress took Roy's
advice, it would rescind the new requirements in a heartbeat
when legitimate doctors--who are already threatening to leave
Medicare over its low payment rates--threatened to bolt
because of the additional administrative costs (paperwork,
site visits, etc.).
Politicians routinely subvert anti-fraud measures to
protect their constituents. When the federal government began
poking around a Buffalo school district that billed Medicaid
for speech therapy for 4,434 kids, the New York Times
reported, ``the Justice Department suspended its civil
inquiry after complaints from Senator Charles E. Schumer,
Democrat of New York, and other politicians.'' Medicare
officials, no doubt expressing a sentiment shared by members
of Congress, admit they avoid aggressive anti-fraud measures
that might reduce access to treatment for seniors.
It's not just the politicians. The Legal Aid Society is
pushing back against a federal lawsuit charging that New York
City overbilled Medicaid. Even conservatives fight anti-fraud
measures, albeit in the name of preventing frivolous
litigation, when they oppose expanding whistle-blower
lawsuits, where private citizens who help the government win
a case get to keep some of the penalty.
Sparrow argued that when Medicare receives ``obviously
implausible claims,'' such as from a dead doctor, ``the
system should bite back. . . . A proper fraud response would
do whatever was necessary to rip open and expose the business
practices that produce such fictitious claims. Relevant
methods include surveillance, arrest, or dawn raids.'' Also:
``All other claims from the same source should immediately be
put on hold.''
Some of the implausible claims will be honest mistakes,
such as when a clerk mistakenly punches the wrong patient
number into the ATM. And sometimes the SWAT team will get the
address wrong, or will take action that looks like overkill,
as when the Department of Education raided a California home
because it suspected one of the occupants of financial-aid
fraud. How many times would federal agents have to march a
handcuffed doctor past a stunned waiting room full of
Medicare enrollees before Congress prohibited those measures?
``It seems extraordinary,'' Sparrow said, that the HHS
Office of Inspector General recommends ``weak and inadequate
response[s] . . . to false claims and fake billings'' and
that Medicare ``fail[s] . . . to properly distinguish between
the imperatives of process management and the imperatives of
crime control.'' Extraordinary? How could it be any other
way? Anti-fraud efforts will always be inadequate when
politicians spend other people's money. Apologists for
Medicare and Medicaid will retort that fraud against private
health plans is prevalent as well, but this only drives home
the point: Since employers purchase health insurance for 90
percent of insured non-elderly Americans, workers care less
about health-care fraud, and have a lower tolerance for anti-
fraud measures, than they would if they paid the fraud-laden
premiums themselves.
The fact that Medicare and Medicaid spend other people's
money is why the number of fraud investigators in New York's
Medicaid program can fall by 50 percent even as spending on
the program more than triples. That is why, as Sparrow
explained in an interview with The Nation, ``The stories are
legion of people getting a Medicare explanation of benefits
statement saying, `We've paid for this operation you had in
Colorado,' when those people have never been in Colorado. And
when you complain [to Medicare] about it, nobody seems to
care.''
The Ryan plan offers the only serious hope of reducing
fraud in Medicare and Medicaid. Its Medicare reforms,
especially if they were expanded later, would make it easier
for the federal government to police the program, and its
Medicaid reforms would increase each state's incentive to
curb fraud.
To see how the Ryan plan would reduce Medicare fraud,
imagine that the proposal really were what its critics claim
it is: a full-blown voucher program, with each enrollee
receiving a chunk of cash to spend on medical care, apply
toward health-insurance premiums, or save for the future.
Instead of processing 1.2 billion claims, Medicare would hand
out just 50 million vouchers, with sick and low-income
enrollees receiving larger ones. The number of transactions
Medicare would have to monitor each year would fall by more
than 1 billion.
Social Security offers reason to believe that a program
engaging in fewer (and more uniform) transactions could
dramatically reduce fraud and other improper payments. As a
Medicare-voucher program would, Social Security adjusts the
checks it sends to enrollees according to such variables as
lifetime earnings and disability status. The Social Security
Administration estimates that overpayments account for just
0.37 percent of Social Security spending. Overpayments are
higher in the Supplemental Security Income (SSI) program
(8.4 percent), a much smaller, means-tested program also
administered by the Social Security Administration. But
total overpayments across both programs still come to less
than 1 percent of outlays.
In reality, the Ryan ``voucher'' is much closer to the
current Medicare Advantage program, through which one in four
Medicare enrollees selects a private health plan and the
government makes risk-adjusted payments directly to insurers.
Skeptics will rightly note that, judging by the official
improper-payment rates, Medicare Advantage (14.1 percent) is
in the same ballpark as traditional Medicare (10.5 percent).
Therefore, the Ryan plan should be seen not as a solution to
Medicare fraud in itself, but as a step toward a vastly
simplified, Social Security-like program in which the task of
policing fraud is less daunting.
The Ryan plan would also vastly increase the states'
incentive to curb Medicaid fraud. Just as a state that
increases funding for Medicaid gets matching federal funds, a
state that reduces Medicaid fraud gets to keep only (at most)
half of the money saved. As much as 75 percent of recovered
funds revert back to the federal government. In a report for
the left-wing Center for American Progress, former Obama
adviser Marsha Simon noted that ``states are required to
repay the federal share . . . of any payment errors
identified, even if the money is never collected.'' The fact
that Albany splits New York's 50 percent share of the
spending with municipal governments may explain why the
Empire State is such a hot spot for fraud: No level of
government is responsible for a large enough share of the
cost to do anything about it. The result is that states'
fraud-prevention efforts are only a tiny fraction of what
Washington spends to fight Medicare fraud.
Ryan would replace Medicaid's federal matching grants with
a system of block grants. Under a block-grant system, states
would keep 100 percent of the money they saved by eliminating
fraud. In many states, the incentive to prevent fraud would
quadruple or more. Block grants performed beautifully when
Congress used them to reform welfare in 1996. They can do so
again.
The Ryan plan would not reduce Medicare and Medicaid fraud
to tolerable levels, but neither would any plan that retains
a role for government in providing medical care to the
elderly and disabled. What the Ryan plan would do is reduce
how much the fraudsters--many of whom sport congressional
lapel pins--fleece the American taxpayer. And that is no
small thing.