April 26, 1978
Page 11535
Mr. HARRY F. BYRD, JR. I thank the able Senator from Arkansas (Mr. HODGES) for his excellent speech to the Senate today on this vitally important matter. As the Senator from Virginia sees it, the Senator from Arkansas put the matter in appropriate perspective; that is, in considering the concurrent resolution as to how much in tax funds will be spent during the upcoming year, this is the place to register our views as to whether we shall continue to permit waste, mismanagement, and fraud on such a gigantic scale and not attempt to do anything about it.
This is not a reduction. The proposal offered by the Senator from Arkansas and the Senator from Virginia is not a reduction in the amount of funds being spent by HEW this year. The Inspector General's report dealt with fiscal year 1977. This budget provides for a $43 billion increase in just the three items of the budget, three functions of the budget that the Senator from Arkansas and the Senator from Virginia are attempting to direct the Senate's attention to. Since the fraud, waste, and mismanagement were discovered and reported by the Inspector General, if the new figures in the budget are adopted, that will be $43 billion more in just these three functions than the Inspector General found in the fraud of $3 billion to $7 billion in the past fiscal year.
So it is not a reduction in what they have now. It is a reduction of the increase in the Budget Committee proposes to give to this Department in just these three functions.
The able Senator from Arkansas mentioned the legislative budget for each of the Senate offices. It so happens that the $6 billion which the Inspector General of HEW says was misspent by that Department, that $6 billion is almost exactly six times the total amount of all funds spent by the entire legislative branch of our Government, including the GAO. The entire legislative budget funds — the Senate, the House, all of the Senate attaches, all the Senators, all the Congressmen, all the staffs, all the other facilities that Congress has — amount to a little over $1 billion. If we do nothing about it, if we do nothing in this concurrent resolution about the amendment offered by the Senator from Arkansas and the Senator from Virginia, the Senate is closing its eyes to the fact that one Department of Government misspent, through waste, mismanagement, and fraud, six times the amount of money spent on the entire legislative process.
I happen to think that the $1.1 billion that is spent by the legislative branch is too much. We do not need all these funds. It is too much. But, regardless of that, the total amount spent is a little over $1 billion, $1.1 billion and this one Department is misspending, has misspent, six times that amount in just 1 year.
The Senator from Arkansas mentioned that in his State, $6 billion is a lot of money. I agree. I happened to check the figures as to how much income tax the 5 million people in the State of Virginia pay to the Federal Government. This $6 billion of waste, mismanagement, and fraud is twice the total amount of all the income taxes paid by all of the people of Virginia into the Federal Treasury.
To look at it another way, to obtain that $6 billion, it takes the total income tax payments of 4 million families with a family income of $15,000 each. Those 4 million families with a family income of $15,000 each paid into the Treasury just about enough money to take care of the waste, the mismanagement, and the fraud of that one department of Government.
I am grateful to my distinguished colleague from Arkansas for his strong support.
Mr. MUSKIE. Mr. President, I hesitate to say anything on this amendment in the light of the observation of the Senator from Arkansas that my arguments the other day, apparently, fired up his indignation about this problem and prompted him to support this amendment. Obviously, I was not persuasive with him then and I do not expect I will be now.
I must say, Mr. President, I reject the assumption of both my distinguished colleagues that unless we support their amendment, No. 1, we do not care about the problem; and, No. 2, we do not think anything can be done about it. I do not think anything I have said on this subject supports that kind of conclusion or that kind of implication. Nor am I prepared to concede that my two colleagues have found the magic answer for dealing with this problem. I certainly would not join in the chorus of their hallelujahs that their amendment, if adopted, will eliminate fraud and abuse in these programs. If we can get that kind of guarantee from these two gentlemen, it would be a valuable addition to the record.
The amendment would include reductions in the health function, 550, of $1.8 billion in budget authority and $1.8 billion in outlays.
Now, I wonder whether these Senators have read the report. The report discloses that 42 percent of the overspending in Medicare and Medicaid, that is a total of $1.9 billion, is due to, what? Excessive hospital beds, unnecessary surgery, and unnecessary hospital stays.
Mr. HARRY F. BYRD, JR. Will the Senator yield for just a moment?
Mr. MUSKIE. I will when I finish this. I am trying to straighten out the record that has been made by the distinguished Senator from Virginia and the distinguished Senator from Arkansas. I sat here listening to their implications about my own motivations and my own objectives, my own reasons for the position I have taken.
Unnecessary surgery. Who orders it? Do the Senators tell me the Secretary of HEW orders it?
Unnecessary hospital stays. Who orders them?
Excessive hospital beds. Where are they? Do the communities involved concede they are excessive?
I have two communities in my State whose hospitals were ordered .closed by HEW. Rural towns, far removed from any city. But to HEW standards, and I assume, the Inspector General who put this report together, those beds were excessive and part of the misspending of which my two colleagues complain.
HEW standards said they were excessive. The communities did not agree. When I went up there, I did not agree, and we saved some of those hospitals. But they were part of the misspending.
Would these two Senators somehow impose their judgment from afar on whether excessive hospital beds are excessive, in fact? Can the Congress do that?
And now are we going to get at that unnecessary surgery?
Mr. HODGES. Will the Senator yield?
Mr. MUSKIE. Monitor the office calls of all the doctors of this country, and the surgeons?
I mean, how are we going to pay the medicare bills of perfectly innocent beneficiaries when they apply? Should we wait until we get some of those doctors who ordered unnecessary surgery to identify their bills?
We will not pay their bills, we will pay yours with the money. How in heaven's name are we going to prevent fraud by this kind of an amendment to a budget resolution?
After we eliminate the fraud and abuse of unnecessary surgery and unnecessary hospital stays what are we going to do about people who apply for benefits who are not eligible? Who draws out their applications? They do. Who are they? They are not employees of HEW. They are citizens, walking the streets of your communities and mine. Many of them are innocent, applying because they think they may be eligible. Some of them may be fraudulent, applying when they know they are not eligible. But that kind of abuse has been disclosed, after the fact.
But how does HEW pay the medicare bills of perfectly innocent beneficiaries? Does it suspend them while it goes hunting around our countryside to identify these abuses by private citizens?
Congressional hearings upon which the Inspector General relied for much of his report disclosed there has been abuse by doctors, by hospitals in the private sector, overcharging, charging for services never rendered, over-prescribing medicines.
Do we put the Secretary of HEW in jail for that? Do we deny benefits to people that Congress has declared are eligible for these entitlement programs because there is this abuse, some of it criminal, in the private sector?
Of course, we care about this problem, and I do not yield to the Senator from Arkansas or the Senator from Virginia in that respect.
Of course, I think we need to do something about it, and any implications that the other day I suggested to the contrary, I reject. If somebody will point to the RECORD in which I could be said to imply that, I will correct it.
But could any piece of legislation offered in an emotional response to a problem automatically become the effective instrument for solving that problem?
We know where the legislative responsibility for this problem rests, in the committee that has jurisdiction over these entitlement programs, and that is the Committee on Finance. The Senator from Virginia is a member of that committee.
Three times in the last 3 years, including this year, we in the Budget Committee have made assumptions about savings that could be achieved in these entitlement programs for one reason or another, and the current budget includes an assumption of $1 billion of assumptions as to savings that can be achieved by better management and eliminating abuses.
What is a reasonable figure for it? We have a billion in it. The other day Senator BYRD thought $5.6 billion was reasonable. I assume he still thinks that is reasonable. I have not heard him concede his first amendment was a mistake.
Mr. HARRY F. BYRD, JR. It was a good amendment. I approve it.
Mr. MUSKIE. All right. He thinks. $5.6 billion is reasonable.
I would like these Senators, instead of belaboring me and the Budget Committee with their rhetoric that we do not care, to specify how and when, how much and how soon, savings of that magnitude can be achieved.
If they can make a case, I will buy it.
One of Senator BYRD's arguments is that some of us believe in deficit spending and that is why we are for fraud and abuse.
How do we answer a non sequitur like that?
My economic philosophy and the economic philosophy of no Senator in this Chamber is based upon an acceptance of fraud and abuse. I reject that argument.
I say to the Senator, if he does not have a case on the merits, if he does not have a concept of management and how it is to be implemented, what forces are to be used, what personnel, what procedures are to be used, investigative, management, otherwise, I do not regard it as responsible to argue that we can pick up $5.6 billion in fiscal year 1979 by eliminating unnecessary surgery, eliminating unnecessary hospital stays, eliminating excessive hospital beds.
We are going to achieve those results and get cash for it that we can apply to pay the benefits of perfectly innocent Americans who are entitled to benefits, who are not guilty of fraud, who are not guilty of abuse? What are we going to do, hold their benefits hostage and the Budget Committee unreasonable because we care about them?
I care about getting the guilty. I also care about protecting the innocent.
What do they want to do, declare a moratorium on these entitlement programs? That is carrying logic to the extreme.
Are we to declare a moratorium on all these entitlement programs until we have all those who have abused them and recovered their ill-gotten gains, so that we can apply those ill-gotten gains to the budget?
Why do we not do that?
Senator LONG is the chairman of the Finance Committee. He was not here the other day. I have sent word that this debate is going on, because I would like to ask him a question: "Senator, these two Senators believe that if Congress discharges its responsibility properly, we can realize as much as $5.6 billion in savings from these documented abuses, which we can apply to the 1979 budget, making it possible for us to reduce your functional totals by that amount.. Can you do it?"
That is the question I would like to put to Senator LONG. If Senator LONG tells me — and that is the oversight committee — that we can do it, bless you gentlemen; I will cosponsor your amendment, gladly, and raise the same hallelujahs I have heard here this morning.
Mr. HODGES. Mr. President, will the Senator yield?
Mr. MUSKIE. I yield.
Mr. HODGES. I think the amendment calls for approximately $1 billion, not $5.6 billion, as the Senator contends.
Mr. MUSKIE. I understand that, but Senator BYRD just mentioned, and still sticks by, his figure of the other day.
Mr. HODGES. Mr. President, will the Senator yield for a further observation?
Mr. MUSKIE. If the Budget Committee is wrong, not to buy either of these amendments, then Senator BYRD is wrong to reduce his amendment, by the strained kind of logic I have been hearing around here.
Mr. HARRY F. BYRD, JR. Mr. President, if the Senator will yield, the Senator reduced his amendment only because there are not enough votes to approve it.
Mr. MUSKIE. The Senator is doing exactly what I said.
Mr. HARRY F. BYRD, JR. I hope there will be enough votes to take the view that at least we want to take steps to reduce one-third of the misuse through waste, mismanagement, and fraud, even though apparently we are not willing to reduce the total amount.
One other comment, and I will not say any more. I am sure the Senator wants to be accurate in his assertions.
Mr. MUSKIE. I hope we are both accurate.
Mr. HARRY F. BYRD, JR. I hope we are both accurate.
The Senator mentioned an abundance of hospital beds. I referred to this in my opening statement, and I will refer to it again.
In calculating the reductions in the three budget categories which are affected by this amendment, we — the Senator from Arkansas and the Senator from Virginia — disregarded what the Inspector General attributed to excess hospital beds, as it could be argued that basically that is a statement of local problems.
So that is not involved in any way in this amendment. We specifically eliminated that item from consideration.
Mr. MUSKIE. Well, that is nice; that is really nice. In other words, if the Secretary managed to eliminate some excess hospital beds and achieved some savings, the Senator would not give him any credit against the total that the Senator is mandating. Is that what the Senator is saying?
Mr. HARRY F. BYRD, JR. That is right, because the Senator from Maine has just made the argument that he could not be expected to have control over those hospital beds.
Mr. MUSKIE. How about the remainder of the argument of the Senator from Maine? What kind of legislative amendment is this? The Senator from Virginia uses this report, which makes no distinction. In the first place, it is a very rough thing, as described by its authors.
Second, the Senator's amendment does not say where the saving is to be achieved. He says orally and in the record that he excludes any savings that might be achieved by eliminating excess hospital beds, even though that is an important part of the record — a $1.2 billion part of the record.
Mr. HARRY F. BYRD, JR. The fact is that I am taking the figures submitted by the Inspector General of the Department of HEW. It may not be an accurate report. The Inspector General's report says that between $6.4 billion and $7.3 billion was misspent last year.
Mr. MUSKIE. The Senator charges me to be accurate. The report says "fraud, abuse, misspending." Fraud and abuse have been committed by citizens; and the Senator, when he shorthands his remarks, puts them all under misspending. There is a distinction.
Mr. HARRY F. BYRD, JR. I think the Senator will find that the report stated that the $6.3 billion to $7.4 billion which was misspent was spent through waste, mismanagement, and fraud.
Mr. MUSKIE. I know, but the Senator said that the word "misspending" implies—
Mr. HARRY F. BYRD, JR. I know.
Mr. MUSKIE. Why can the Senator not be accurate? He uses "misspending" to imply that somehow the Secretary, with his own hands, has misspent, when a lot of this is fraud committed by citizens, abuse committed by citizens, and beyond the Secretary's control in any direct way that he can cash in for the benefit—
Mr. HARRY F. BYRD, JR. Will the Senator—
Mr. MUSKIE. It is my time. I have listened to the Senator's arguments, and he is repeating them, and I would like to respond to them.
How do you fund the budget of HEW out of the ill-gotten gains of citizens out in the countryside who have abused these particular programs? I do not know how you do it.
This year, the President has proposed a hospital cost control measure to save $2.9 billion by curbing excessive hospital costs. The President also asked for savings from improved management amounting to $400 million.
The Finance Committee rejected both of these savings as unrealistic, in its March 15 letter to the Budget Committee.
Speaking of that, we have assumed $1billion in savings in the health function, attributable to quality control and cost control, both of them related to the objective of my two friends; and for our pains we are told that we do not care about the problem or we do not think anything can be done about it. When we suggest to the Senators that the Finance Committee, of which one of the Senators is a member, has the direct responsibility, the Senators brush it off onto the Budget Committee. If this is responsible legislation, I fail to see it.
Express concern, of course; Senators should express concern. If the Senator submits a resolution to that effect, he will get 100 votes.
I have been in government for some 30 years, and I have seen attempts to get at abuses in AFDC programs and in social security programs. It is a never ending task, because individual citizens, whether they are doctors or applicants or beneficiaries, seem to have an almost unlimited source of ingenuity to get around 'the regulations and to get around the rules and to get around the administrators.
When you try to take that out of those who are obeying the law and are applying only for what the law provides and who are not abusing it, by cutting their appropriations, I do not see the equity, frankly. Maybe I am blind; maybe I am stupid; but I think that getting at these abuses is a much more sophisticated kind of problem than cutting back the budget resolution for health, education, and income security in this way.
I suppose I am no more persuasive today than I was the other day. What is frustrating about it all is that it is not really my problem, whatever the Senators say. I have no way and no authority to oversee the administration of these departments and agencies.
That is in the Finance Committee. My two friends refused to put the pressure on the Finance Committee. They want to put it on me. That is fine.
Mr. HODGES. Mr. President, will the Senator yield the floor?
The PRESIDING OFFICER. Who yields time?
Mr. NELSON addressed the Chair.
Mr. HODGES. Go ahead.
The PRESIDING OFFICER. The time is under the control of the managers of the resolution and the Senator from Virginia has time.
Mr. HARRY F. BYRD, JR. Mr. President, I yield such time as he may need to the Senator from Arkansas.
The PRESIDING OFFICER. The Senator from Virginia yields time to the Senator from Arkansas.
(At this point Mr. HODGES yielded to Mr. NELSON who called up amendment No. 1801, a colloquy thereon ensued, and the amendment was withdrawn. Pursuant to unanimous consent request the proceedings are printed later in today's RECORD.)
Mr. HODGES. Mr. President, a parliamentary inquiry.
The PRESIDING OFFICER. The Senator will state it.
Mr. HODGES. Is there to be a vote at 12:30?
The PRESIDING OFFICER. There is to be a vote at 12:30 on the unprinted amendment of the Senator from New Mexico.
Mr. HODGES. Mr. President, I wish to respond, within the limited time available, to the argument of the distinguished Senator from Maine.
There was certainly nothing in my remarks that could be construed as personal or attacking his concern. As a matter of fact, I think that if he had listened, he would have heard me say at the very beginning of my remarks that I realized he had previously stated he also was concerned about fraud, abuse, and waste.
I think the issue, though, is very simple: When and in what forum are we going to begin to do something about it? I say that the proper forum is today, on the budget resolution.
As we look at the broad outlines of the budget, I am reminded of a second story, a famous Jerry Clowers story, of a man who went coon hunting one night.
If you are not familiar with coon hunting, the coon is in the treetop, and someone has to go up in the tree and knock the coon out. This man took a stick and climbed the tree, and got involved with something a lot larger than a coon. It was snarling, and growling, and screaming, and hollering, and the man down below had a gun. The man in the tree kept yelling, "Shoot, shoot, shoot the coon!" Well, because the man in the tree was turning around in the top of the tree so much, the man down below could not get a clear shot, and he yelled back, "I can't get a clear shot."
Finally the man in the tree said, "Just shoot up amongst us, then, because one of us has got to have some relief."
Mr. President, that is the way the American taxpayer has become. I am able to say that because I recently came from among them, and I will return to them shortly. If we cannot cut out one-third of the mismanagement, fraud, and waste out of this budget — we are not cutting specific line items. The Senator fromMaine certainly understands that. He must have been a lawyer, and probably a defense lawyer, because he excels in dragging that red herring across the track. He says, "Oh, we are going to hurt those people by drawing down this line or that line." Mr. President, that is not what it is about at all. That is an emotional response to the issue.
The question is, what are we going to do about the $6.3 billion of fraud, abuse, and waste that has been admitted in their own report? Moreover, they say it is recognized that additional sources of fraud and waste are missing, so this is not even all of it.
The Senator asks the usual question, "How can we do it and where do we cut?" I say that an agency that has 1,217,000 employees, more than our Army and Marine Corps combined, can surely find someone to institute a management system to cut out some of this fraud, abuse, and waste. I think ours is a reasonable amendment; it is not one that is going to deprive people of these things. It is a cut by function, not by line item, and it does not cut specific programs.
Mr. CHILES. Mr. President, will the Senator yield?
Mr. HODGES. Yes.
Mr. CHILES. I just wanted to take thisopportunity to compliment the Senator from Arkansas and the Senator from Virginia for the amendment they are proposing. I am going to vote against it, since I am on the Budget Committee, but I think this is the way these issues should be brought up on the Senate floor. You have specified the functions that are to be cut; it is not a 5-percent cut or a $3 billion cut. I think that is the thing Senators like to write letters back home about, and say, "I attempted to cut the budget by 5 percent or $5 billion," and I think this is a much more reasonable way.
I think every Member of the Senate has a right to propose such cuts when the budget comes to the floor. We are talking about a national debate on priorities, and if this is where you think some priorities should be cut, you have a right to try to do that, and I compliment you for attempting to do it and to do it in that way.
On the Budget Committee, as we go through all the items and go through that process a couple of times, what we attempt to do is to set the whole pie.
I have never been one of those who said, "You can only have this part of government but you cannot have that part."
We have to have an adequate defense and at the same time we have to do something for the people. We have to have something in those areas.
What we have attempted to do is to make a rational determination. We obviously think we have made a good one. We have reduced the budget. I think the Senator's amendment is very important and I compliment him for it.