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Public Statements

Medicare Improvement for Patients and Providers Act

Floor Speech

By:
Date:
Location: Washington, DC


MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT -- (Senate - June 11, 2008)

Mr. COBURN. We heard some reasons we should support the Baucus doctor fix. I happen to have been practicing in 2004 when the Senate did exactly what they are doing right now. This bill is going to guarantee the doctor fix is not done by July 1. That is what is going to happen with this bill.

Let me tell you, we are eventually going to fix the problem for the doctors for 18 months. There is no question. Everybody agrees to that. But what we are doing is, we are making sure we are going to add hundreds of thousands if not millions of dollars of cost in every State for every private physician that is practicing.

And the reason is because the bill is not going to get changed by July 1, and they are going to be under the 10.9-percent cut. Then they are going to come back, whenever we finally get it done. They are going to have to refile all of that, and Medicare is going to have to repay all of this.

So this exercise in political gamesmanship, of working only with one side of the aisle, not working with Senator Grassley, to truly get this done in a way that the President will not veto it and accomplish the purposes for which we all say we want, to eliminate the 10.9-percent cut for physicians, that is something we are going to lose grasp of, and we are going to create a hardship on every physician in this country because we are playing a political game with this rather than fixing the problem.

That brings me to my next point. Why is it every 18 months the physicians in this country have to come and beg Congress not to cut their fees when we are not cutting the fees for the rest of the providers throughout the Medicare Program?

What we have decided is that doctors make too much money. We have decided that when they work 80 hours a week, one and a half to two times what everybody else works in this country, they spend their time away from their families making great sacrifices, that we are going to fund increases in the care for our elderly and seniors in this country on the backs of physicians.

Now, I will not dispute the fact that there are some disparities in physician pay in this country, with some physicians making too much and far too many making too little, especially primary care pediatricians, psychiatrists, and the like, those who are on the front lines. But this idea that we are going to fix temporarily, again, for 18 months, a problem that we have to fix, which is the other problem with the Baucus bill, the only thing great about Medicare that will get us out of the long-term costs is this idea of creating markets associated with choice and responsibility to give greater health care, greater choice, and greater benefits to Medicare beneficiaries through competition.

I am the first to say that the Medicare Advantage Program has lots of problems. But to get the Medicare Advantage Program, which is the one thing that tries to go toward market-oriented reform in Medicare, to pay for this is ludicrous.

Senator Grassley has a competing bill--we just heard the second reading objected to by the Senator from Michigan so we cannot have a side-by-side vote on it--does all of the things that the Baucus bill does except it does not gut Medicare Advantage.

Well, why do we want to take the one factor in Medicare that is based on markets, that is based on transparency, that is based on some personal responsibility, and throw it out and have another program that right now every family in this country is on the hook for over $300,000 in unfunded Medicare obligations, and the Baucus bill guts the only thing that helps us solve that?

So the President is right to veto this bill. Even if it passes, this bill will not be overridden. So we are ensuring the fact that doctors will experience, on July 1, a 10.9-percent cut. We do not have to do that. They know we cannot do this and have it go to the President and get it vetoed and come back and get everything else down before July 1.

So by voting for the Baucus bill, what you are actually doing is ensuring that every physician in this country that cares for Medicare patients is going to spend thousands and thousands of extra dollars, and that CMS is going to spend thousands and thousands and millions, perhaps $100 million, to come back and deal with the paperwork once this is finally fixed.

Nobody thinks about that around here. We are playing political games. How can you make Republicans look bad as they vote against a Baucus Medicare doctor fix? Everybody in this body wants to fix this payment system for doctors. There is one real reason we do; we want our seniors to be able to have physicians. And we know if an 11-percent cut goes through, many doctors will no longer be able to afford to care for Medicare patients, they will not be able to afford to. They cannot do it.

So if you cut 11 percent of their fees on Medicare, which are already almost as low as Medicaid everywhere, which is about 40 percent less than they get paid for anything else, you are asking them to serve Medicare at half price. And what they are going to do is they are going to make a choice. They are going to say: I cannot take care of Medicare patients.

So what we are going to ensure with the Baucus bill is that doctors are going to get a pay cut, maybe for a short period of time, but the inconvenience of that, the cost of that for political gamesmanship, we ought to be ashamed of what we are doing. And it is exactly the reason we have a low rating with the American people.

We know Senator Grassley and Senator Baucus can work this out. We know it can happen. But the fact is, it was chosen to make it an issue, not work in a bipartisan fashion, not come up with something that the President can sign, but instead to slow down the works. And what they will do is markedly decrease availability of Medicare for seniors in this country because the doctors, when they first see this, if they see a 10.9-percent cut, some of them are going to abandon the Medicare Program, and you are ensuring, if you vote for the Baucus bill, that doctors will get a 10.9-percent cut for a short period of time.

You are ensuring that, in fact, what they are going to do is, they are going to have a whole lot more overhead because they are going to get a bill from the time it starts to the time it ends and finally gets corrected, they are going to bill it twice, once for the primary at a 10.9-percent cost, then they are going to get a bill again because it is going to be retroactively fixed. They are going to have to bill it all again. That is pure waste. That is typical government.

Why would we do that? What are we thinking? What we are thinking is short-term partisanship. And we ought to be ashamed of ourselves.

GLOBAL WARMING

Now I want to spend a few minutes talking about the climate bill. I have been listening for 10 days on this issue. And I want to share some observations.

It was said on the Senate floor that nobody has scientifically disputed the underlying facts associated with climate change.

We cannot dispute underlying facts on climate change because climate changes. It always changes. We have a history of knowing it changes. We know that every 1,500 years we have global warming, whether we like it or not. It happens.

What we do not have is common sense and scientific methods looked at. I hear my friends, even on my side of the aisle, talk about anecdotal observations that things are different. Sure they are different.

As a matter of fact, we heard the leading German scientists on climate change saying we are going to have a 10-year break on global warming. So I guess that means for the next 10 years CO2 input is not going to have any effect on global warming. So we have conveniently changed the terms from global warming to climate change.

Well, I want Americans to ask themselves, what is climate change? The climate changes all the time. Last week, the majority leader, on the Senate floor, said the tornados that were in this area were related to climate change.

Like saying anecdotally we can prove there must be climate change because we saw tornadoes in the Washington, DC, area last week--do you know how many times there have been tornadoes in this month in Washington, DC, throughout the years? Hundreds. But now we are anecdotally, because we see something new to our experience, associating it with some phenomena. That is not science. That is ignorance. That is using science in a way that bastardizes it.

The second point is, if we really want to know how we affect climate, it takes a lot of years to find that out. There are retrospective studies we can do. As a matter of fact, they have been done. We have ice core drilling that goes back about 3,500 years. We know exactly what the temperatures were in the north and in the south based on both ice core drillings and ocean sediment drillings. We know that because we know that isotopes of both oxygen and nitrogen decay at different rates. When those are measured, we can have a pattern of what the Earth's temperatures were and what the cycles of climate were. Nobody wants to embrace that. That is real science. But we ignore that. That doesn't fit with the emotion that allows us to relate a policy that we want to enact in a way that disproves it.

There is so much yet to be known about climate. We can't even predict what the weather is going to be tomorrow. Yet we have this supposed settled science. The science isn't settled. The rhetoric is settled, but the science is far from settled.

What do we know? Here is what we know. The most recent examples of 1,500-year cycles are these: The Roman warming started in 200 B.C. Pared with its other half, the Dark Ages, it ended in 900 A.D. We know that historically. We know there was this warming cycle that came and went. The medieval warming period, the little ice age period cycle, lasted that period of time from A.D. 900 to 1850. The modern warming cycle, which started about 1850 to present, is probably the first half of the change. What happened during the medieval warming period? The Norse populated Greenland. They fished from its coast. They had over 60,000 cattle. They raised hay on what is now majority covered with ice.

So we have been there before. We don't like to look at the historical fact because it doesn't fit either our populace viewpoint or give us a reason to enact a bill which, in my estimation, is the greatest--will be, if we pass it--loss of freedom this country has ever experienced.

Freedom is directly related to the level and the amount of government we have. Under the climate bill Senator Boxer has put out, you can guarantee a loss of your liberty. Anybody with any common sense knows that. We are going to put all sorts of decisionmaking in the hands of bureaucrats. They are going to be deciding for you. So when bureaucrats start deciding for you, that means you don't. If you don't like the results, you have to prove your innocence. The onus becomes on you.

The unique thing about the American experience is that freedom is our basic model. Liberty is ours. When we grow the Government, through $6.4 to $6.9, all the way up to supposedly $10 trillion in a tax structure that is implemented through a great number of Government programs, Government boards, Government regulations, you can bet your freedom is going to be markedly limited.

The last thing I want to talk about is the very fact that we are talking about not using resources we have. Even if you buy everything that the alarmists with climate change and global warming would have you, and let's assume they are all right, everybody agrees it is going to take us 20 to 30 years to get off of hydrocarbons as a method of energy production, as a source of energy. We know that. If we were to start building nuclear plants today, we would have every alternative energy that we had, and it would still take us 15 to 20 years to start to begin to do that. So what is it that we fear about utilizing our own energy resources?

My senior Senator sitting on the floor--and I can tell you that both of us, coming from Oklahoma, love our land. We love our streams. We love our lakes. We love the wildlife that is everywhere you turn in Oklahoma. We drill all over the place. We don't contaminate our environment at all. But we have a level of ignorance about what exploration is for energy in this country. It is done in a fabulous, sophisticated way. We now drill 1 hole and create 8 to 20 wells out of 1 hole because the technology allows you to drill any direction you want at almost any depth you want. So what happens is, we allow people who are not aware of the technology of exploration to create a picture that says exploration can't be done in an environmentally friendly way. That is not true. We do it all the time in Oklahoma. Come visit.

Behind my home is a gas well. It was drilled 25 years ago. When they plugged it, everything about that was remediated. Do you know what is growing there right now is the most fabulous wild blackberries you ever tasted in your life. That is exactly the opposite picture that the alarmists want you to have about energy exploration.

The point I am making is, we have a hundred years, at a minimum, of hydrocarbons available to us that we could utilize in the next 5 to 10 years and not utilize foreign imported oil from people who have vowed to take away our freedoms. The fact is, that gets blocked all the time on the Senate floor on the basis of an irrationality that says you can't do it.

We have two of the largest domestic natural gas producers in the world in Oklahoma. In the Gulf of Mexico, you can't even see the rigs. In 8,500 feet of water, 20,000 feet below the surface of the ocean, they are drilling oil in a platform that is floating that moves less than 8 inches based on gyroscopes. They have not once in all the years had an environmental spill when they were doing that. That is how great the technology is. Yet we have this fear that you can't do something.

At the same time that we have this fear, what we are doing is embracing $4.35 gasoline. We are embracing the funding of terrorists by our purchase of oil moneys that then go to fund terrorists. We have become schizophrenic. We have lost it. When we would deny the ability to use resources in this country that would stop the upward trend on the price of oil, that would utilize oil shale to conversion for jet aviation fuel, that would utilize oil shale for heating oil, that we would not allow that, we will not allow the utilization of our own resources at our own negative benefit, what is the purpose of that?

I get written to all the time by constituents from Oklahoma about gas prices. Do you know what I tell them? I say: You should blame us. You should blame the Congress. It is absolutely our fault we are in the position we are in. We didn't act. From 1995 up through this year, every time we have had a chance to increase exploration in a safe, environmentally friendly way in this country, it has been blocked. So now we sit with the hardest of the hardest hit, the poor and less fortunate, trying to make a choice of whether they can even get to work, let alone buy their groceries, because gas now and their energy needs are such a large component of their family budget.

It is our fault, and we are going to sit around. We are going to dither, and gasoline is going to be $5.50 a gallon. The American public is going to react to that, and they are going to say: Maybe we ought to take another look at these good energy companies that do it environmentally well and supply us power and energy and do not fund the very people who want to take away our freedoms.

It is coming. This is part of the same rumble from the American public that says we do not get it on spending. I was enlightened today on a new bill that is getting ready to be introduced that I am going to try to keep from coming to the floor that is a yearly authorization for the Coast Guard. There is a 25-percent increase in it, but of that 25 percent, 80 percent is earmarks. We almost doubled the Coast Guard when we created the Department of Homeland Security. Yet this year we are going to come close to a trillion-dollar deficit--$3,000 for every man, woman, and child--and we still do not get it.

So the idea that Congress will not act to raise the level of supplies, that Congress will not take off the tariff on imported ethanol, refuses to take off the tariff on imported ethanol to protect a false economy associated with corn ethanol--when, in fact, we have a shortage, as manifested by the price of the fuels that drive our energy and yet we will not act--the American people have a right to be disgusted.

We are the reason gasoline is over $4. It is not the oil companies. It is not the Middle East. It is us. Because we could have done something. We still can do something. But we heard political speeches all today because what we want to do is sue OPEC and create an excess profits tax, and eventually a Btu tax, rather than increase the supply. What we should do is increase supplies. The American people get it. Somehow we do not.

My hope is that America will let us know. I think they are going to. My hope is we will listen.

With that, Madam President, I yield the floor.

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