Transcription of Senator Grassley's Conference Call with Iowa Reporters


  

     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.