GRASSLEY: Good morning, everybody. This is Chuck Grassley.
Obviously, you know, our Committee on Finance yesterday had a
second roundtable discussion on health care reform focusing on making
coverage more affordable and accessible. It had a round table two
weeks ago, we did, on delivery systems. And then the third and what I
think will be the final round table is on financing health care which
is probably the most difficult issue before us.
Today, if these votes don't interfere -- they're starting seven
or eight votes at 10:30 -- and if they don't stop for the hour from
12:00 to 1:00, this won't happen. But if they stop voting, Senator
Baucus and I are lunching with President Obama at the White House on
-- not just on health care reform -- although I guess it would
probably be the most important discussion -- but the work of our
committee.
My message for the meeting on health care is that it needs to be
bipartisan despite the margins by which Democrats control Congress.
The health care system is 16 percent of the economy. That makes it a
massive undertaking to impact and change that much of the economy. So
all the more reason it ought to be bipartisan.
And few issues touch every household in such a person way as
health care. Health care decisions need to stay between patients and
doctors. I'm going to be a crusader for not having government
interference in a doctor's decision for the patient. I'm also working
to make sure that rural America isn't short changed as we bring about
reform because if we do, it will be left without benefits that people
in Florida have.
And some of that is a controversial issue of Medicare Advantage.
You know, you hear about, well, it's subsidized. Well, why is it
subsidized? You know, Medicare Advantage has been around for 20 years
but only five years have we had it in Iowa.
Prior to that period of time, one county, Potawatomi, had managed
care because they're across the river from Dodge County, Nebraska.
And that one had a plan. But the other 98 counties didn't. And most
of the states of the Upper Midwest and upper mountain areas did not
have it.
And so we wanted to make it a national program because why?
Medicare, generally, has been a -- a national program for 44 years.
So Medicare Advantage is set up 20 years ago, and so the first 15
years, it was a regional program. California, Texas, Louisiana,
Florida, New York, Chicago, Massachusetts, a few places like that, and
also very expensive places.
So if -- if Floridians can have the choice between traditional
Medicare and Medicare Advantage, then, obviously, Iowans are entitled
to that same choice or else you don't have a national program. And
there's inequity.
So we bring about it so that Iowans have that choice now. And
about 20 percent of the -- of the senior citizens have chosen Medicare
Advantage. So they're complaining about subsidy, well, let me remind
you of what the subsidies are. Why do you think Florida had Medicare
Advantage for so many years? Because they pay so much more. So it's
$1,100 a year -- or a month -- in Florida, $700 in Iowa, and people
here in Washington are complaining because we're subsidizing it.
Who's getting subsidized? It's being subsidized in Florida because of
the reimbursement rate down there is so much higher than it is in
Iowa.
And this is what we're fighting for generally, not just
Medicare Advantage but that's one of the issues that's coming up in
health care reform. Just one of the dozens of issues coming up that
it won't be easy to deal with.
There aren't too many people that are on here today, so this may
go very fast, but I've got plenty of time.
Kerry Cathcart?
QUESTION: Thank you, Senator.
As the Republicans are thinking through how to get back at least
on parity with the Democrats, if not back in the majority, have
you given any thought to trying to get Jim Leach on board into that
discussion to offer the more moderate voice and a low-key voice to
attract those Republicans that have left the party and independents
and even some Democrats?
GRASSLEY: Well, I don't -- if you were looking for a person of
Jim Leach's caliber, you wouldn't be working just to get him back into
the discussion; you'd want him to be national chairman or some sort of
task force on rebuilding. You know, you'd want him to have a very
important leadership position not just being a part of the discussion.
QUESTION: Have you discussed that at all with anybody?
GRASSLEY: The national chairman is doing that now. And I think
he's got a reputation for bringing more people into the party and a
broader base of the party. But one reason why Jim Leach might not be
able to do that in the future is, you know, he's being considered to
be ambassador to -- to China. So if he gets that position, he will
have to be nonpolitical.
QUESTION: Right.
GRASSLEY: Tom Beaumont?
QUESTION: Just to be clear, do you expect votes to conflict with
that White House lunch today? Or are you planning to go?
GRASSLEY: Well, I'm planning to go, but not if they have votes.
QUESTION: Right.
GRASSLEY: So here's -- here's what we've done, hopefully, to
preempt voting at that time. Baucus talked to his leader last night.
I talk to my leader. We're -- I'm having my staff this morning follow
up to make sure what's going to happen. But we need -- if we're going
to have -- let's say we're going to have an hour with the president,
maybe it won't be an hour, but I better plan on an hour. So I need
11:30 to 1:20 for a window.
QUESTION: Did the White House discuss an agenda, or did they
leave it open?
GRASSLEY: Very much open, but I assume, since it's both Baucus
and me, it's a little broader than just health care reform, although I
bet that'll take most of the time. But we've got trade issues to come
up, and we've tax issues as well.
But there's no agenda that I'm aware of.
QUESTION: Has the White House reached out to you as a member of
the Judiciary Committee to talk at all about judges yet?
GRASSLEY: No. I've been asked that by the national press people
here twice in the last two days, and the answer is no, and it's still
no.
QUESTION: Thanks.
GRASSLEY: Mike Glover?
Jim Boyd?
QUESTION: Senator, this may be repetitive because I missed your
opening statement, but with regards to health care coverage and that
sort of thing, we've been talking a lot about this for years and years
and years. What is your sense as far as actually getting something
done in the next 12 to 18 months, maybe 24 months?
GRASSLEY: Well, I've said it this way. In it's not done this
year, it might not be done for your years because next year is an
election year, and then you and back in January of 2011, you're
already into the presidential election cycle. And so, you know,
there's so many things that I can point back to, including health care
reform that Clinton proposed. It was so late getting to the Hill that
it just got bogged down in election-year politics. So it's got to be
done.
Now, we set a very ambitious agenda in January, and we're on
calendar yet. And that was to have a bill through the committee in
June and have a bill on the floor of the Senate in July. Now, that
could slip some. It could slip because we maybe don't get it there.
But I don't think that's the biggest problem.
I think there's two other problems. One, Congressional Budget
Office has a very big job trying to score health care reform. And
from that standpoint, we're very dependent upon -- before we move
ahead -- on getting final action by Congressional Budget Office. So
that's one.
The second one is everything else that the Senate has to do. And
Baucus and I are not in the driver's seat on that. That's Reid going
to determine that. So we have to -- we're -- you know, we have to do
our work, but if we do our work, it still might not be on the floor in
July but not because of our fault.
So we -- we -- we could slip up. It could take longer than we
think in committee. But our -- presently, we're on calendar to get it
done.
Tim Rohwer?
QUESTION: Yes, Senator.
There's been a lot of talk over the past few years about a
shortage of doctors, particularly, in rural areas. Are there any new
incentives in this health care reform that could, you know, encourage
more doctors to set up practice in rural areas?
GRASSLEY: Well, there will be but not -- no decision has been
made on this. But the white paper we put out last week on delivery
system would have 5 percent bonus above present formula for
reimbursement to doctors of primary care. And those are the people we
need in rural America, and that's where there's a dearth of that
specialty to do that.
Now, for two reasons, one of them is to get them in areas of
country where maybe you don't have enough of them. But the other one
and more important reason is, through a process of coordinated care,
we want to have the family physician or primary care physician --
because it's not just family physicians that are primary care --
primary care physicians right at the focal point of coordinated care.
We do that because such a person is going to cut down
tremendously on the cost of care, and it's also it's going to enhance
the role of a family physician in the hierarchy of medicine. And in
the process of doing that, we would do away from the perverse
incentives that have encouraged people to go into specialists.
And let me say in the words of Dr. Coburn, a Senator from
Oklahoma, he says, well, what do you expect that we don't have very
many family physicians when you pay -- he says "specialists," but it
would be like heart specialists, neurologists, et cetera, et cetera.
You pay them three times what congressmen get paid and you don't pay a
family physician even what a congressman gets paid. Now, that's on
average, you know, around the country.
And so there's perverse incentives under the reimbursement system
that gets everybody into specialty. Now, I'm saying like is this a
new phenomenon? Not really. I can take you back to the 1960s when I
was a legislator and I was working with a much older member of the
legislature then by the name of Elmer Van Herter (ph) from Sioux
Center.
He was very concerned that we had some counties at that time
didn't have family doctors. And so we started looking into why we
don't have them. Well, we looked in and found out that, at the
University of Iowa in the 1960's, the people that were talking to new
medical students coming in said, well, you need to specialize; don't
go into what then they called general practice. Today, it's called
family practice. Don't go into that; go into some specialty because
that's where the money is and go practice in California because that's
where the money was.
So we were spending the taxpayer's dollars of Iowa to educate
people at the University of Iowa with all of their professors telling
them to specialize and go to California. So what we did at that
particular time was set up a department of family practice at the
University of Iowa so that there was a specialty -- that it wasn't
just everybody that wasn't specialized in anything else tended to be a
general practitioner. You actually had a specialty of family
practice.
And then my last year in the state legislature, I got money
appropriated to set up six more family practice -- family practice
residency programs in Iowa because we only had Broadlawn and the
University of Iowa at that time. So with the idea -- because
statistics show that where you did resident work, you were apt to
practice.
So we did all those things. Now, of course, you know, 25 years
later, you know, the good you did in the 1970's is probably wearing
off a little bit. So we're back where we started because there's a
bunch of perverse incentives that's developed in Medicare that gets
people back going into specialties and away from general
practitioners.
So, you know, what you asked about is new and a problem today,
but it's been a problem in the past as well. Did I answer your
question, Tim?
QUESTION: Yes. Uh-huh.
GRASSLEY: OK. Now, I've gone through the list. Anybody else
jump in that I forgot about?
QUESTION: Senator, could I jump in and ask a question if there's
nobody new? As you're waiting for a nominee for the Supreme Court,
would you be interested in seeing somebody out of a background other
than the traditional court of appeals? Maybe somebody with a business
background or even a political background like out of the Senate?
GRASSLEY: Well, the answer is yes, but not as enthusiastically
as has been be expressed by some of my fellow senators and by people
that are advising the president for this reason. I'd like to know
what a guy is going to do when he's on the Supreme Court, and a record
from previous courts help us do that.
But I think that overriding everything that you say or I say in
this area has to be qualifications judicial temperament, which means
they're going to leave their personal views out of it. Well, from
that standpoint, you know, you know a little bit more whether they let
their personal views out if they've written for the appeals court or
district court than somebody that's just coming out of -- well, maybe
if you come out of law school -- I mean, as a professor at a college
of law, you probably have written some things, so we've got some idea.
But if you were just a famous lawyer out of practice, then about
all of you've got to go to is how he handled his cases, and that's not
a very good basis because, you know, you've got to represent who you
hire out to represent even if you disagree with them.
So it's better, for me, as a non-lawyer, if they come from the
courts.
QUESTION: Senator, based on how you've seen the confirmation
process of Eric Holder and the way the Senate is working right now,
can you sort of talk about how you expect the confirmation environment
to be? Do you think it's going to be contentious? Do you expect to
be in the role of consensus building? Give us an insight into how
that might go.
GRASSLEY: Nothing to do with recent confirmations and the
controversy of them. It's got more to do with the precedent set by
Democrats in 2002 because prior to that, you could -- you could have,
on one hand, the number of filibusters that there were. And some of
the ones that are most famous, you couldn't say that they were really
filibusters because, in the case of -- was it Fortis? -- I think, in
the case of Fortis, he didn't even -- he only had 49 votes to begin
with and yet they say there was a filibuster against him, but he
didn't have the votes to get through anyway and, eventually withdrew.
So, you know, four or five filibusters in 230-year history of our
country and probably most of those in the last half century until
2002. And then Schumer promoted this process that what people think
and believe ought to have something to do with whether they're
confirmed regardless of how judicious they've been in just reading the
law or the Constitution and their views on the law and the
Constitution and how be they would be impartial.
No, that wasn't good enough for Schumer. Their personal views
and their backgrounds ought to be a factor. And so they started just
a significant amount of filibustering against it. So that has set a
precedent where Republicans will probably do the same thing based on
the precedent that the Democrats set because if you go back prior to
2002, there were some Republicans that wanted to filibuster Clinton
nominees, but Senator Hatch, the chairman of the committee said you
better not do that because if you start down to road, the Democrats
will do it to us.
So they warded off a lot of antagonism of Republican senators
towards Clinton nominees, but what Hatch advised Republicans not to do
because Democrats would do it in turn, the Democrats did it anyway.
So you have a very sound precedent for Republicans to be very -- very
careful on making sure that people that get appointed to the Supreme
Court are really qualified to be on the Supreme Court and to take
things into consideration other than qualification of whether or not
they ought to be nominated.
So I think the bottom-line answer to your question is I would
expect it to be contentious. I hope it's not. And one thing that can
keep it from being contentious is the extent to which Obama follows
what Schumer was advising Bush to do that you ought to appoint people
in the mainstream.
If Obama does that, then I think not. But if he appoints people
like Souter or worse than Souter, then, you know, I think you've got
problems.
QUESTION: Based on the news that you're going to, you know, if
you're reelected next year, be the ranking member on Judiciary, tell
us what you, you know, kind of -- what you want to -- what hope to get
out of it, what you hope to put into it, if you project what you
expect that agenda might be. I know we're a year -- we're years off,
but...
GRASSLEY: Yes. I wouldn't even try to project that, but I could
give you a generic answer. I intend to bring common sense to the
committee in a greater sense than I have thus far being a non-lawyer.
And I think -- I think my colleagues would say, you know, every time I
say I'm not a lawyer, they say, well, even the lawyers say it's a good
thing you aren't a lawyer; we need that point of view to some extent.
Anybody else?
QUESTION: Senator, a quick question.
GRASSLEY: Yes?
QUESTION: Could you comment on the Chinese pork ban?
GRASSLEY: It's a -- it's the same irrational approach that even
Americans have taken when they hear the word "swine" with "flu," they
think you eat the meat, you're going to get flu. And there's nothing
to it. So we're trying to get people to understand in China, and
we're trying to do it through our government, the same thing we're
trying to convince Americans of; that you eat pork and not get swine
flu.
And the other thing is the contrariness of it to what trade is
all about -- safety of food has got to be based on sound science and
not political science. And so we need to -- we need to -- we just
need to push that it's not legitimate and a violation of international
trade agreements.
OK. Goodbye, everybody.