The Budget

Mr. COBURN. Mr. President, I wish to spend a few minutes this evening talking about where we are as a nation.

I have to say I am discouraged at the work of the Senate. If we look around and take in the whole picture here, there is nobody here, essentially, and they are not going to be here for 9 or 10 more days. The question I put forward is, If your own personal household was in trouble, financially or otherwise; if you knew you weren't going to be able to pay the bills; if you knew your credit cards were maxed out, would you just sit on the couch and do nothing or would you work to protect your family? Would you go out and do whatever you could? Would you take advantage of every opportunity to secure the future for your family?

Well, we have big problems in our country, and it doesn't matter how we got here. The fact is, we are borrowing $4.3 billion a day. The interest on our debt is $2.8 billion a day. We are at a point where if we don't start making the very difficult decisions for our country despite our fear of the political consequences, we will be like the person who, when his family was in trouble, didn't try to solve the problem.

Mr. President, we don't have a budget. Yesterday we had political votes on budgets, but it was a game. For the last 2-plus years, no budget has come through the Senate. There is a reason for that, and the American people need to know it is not because of our great budget chairman, whose name is Senator Kent Conrad. It is not his fault there is not a budget. It is because of the leadership in the Senate. The leadership does not want the votes that come along with a budget. You see, the political thinking is, we don't want any of our members to have to be recorded on things that might affect the next election. So to hell with the country. What is more important is the next election.

What is happening in the Senate is a complete meltdown of the very purpose the Senate was created. The fact is, we had votes on four separate budgets, and let me tell you, what is most astounding is that nobody voted for President Obama's budget. The President of the United States submits a budget to the Congress, and nobody in the Senate agrees to vote for it. How disconnected could that budget be from the realities of what our country's needs are if even the people of his own party won't vote for it? I was inclined to vote for it just so we could have a debate on his budget. But the fact is, we didn't have a debate on any budget.

So as we sit here, we are borrowing $4.3 billion a day and running a $1.6 trillion deficit and mortgaging the very future of our children. The very reason we work so hard and the reason we live is to nurture and support those who come after us, and to ignore that responsibility is absolutely uncalled for. Congress deserves every recognition from the American people for being a farce. You can't have the kinds of problems we have in front of us and not attempt to address them.

I want to spend a minute talking to every Medicare patient in the country. I have practiced medicine for 25 years. I have cared for thousands of Medicare patients. I understand, at 63 years of age, with three pretty significant disease processes going on in my own body, about worrying about one's health. I worry about the security around that health. It is important enough to me to really take the medicines and to follow the diet my doctor is offering me now that I am 63. I probably wouldn't have paid attention 20 years ago, but today I am doing that.

The health care that is available to me is important to me, as I know it is to every Medicare recipient out there. But the facts are the following: Politicians want to use Medicare as a tactic to scare people into not doing what we as a nation are going to ultimately do anyway. We will have to fix Medicare. And we can fix it in a way that assures every senior who absolutely needs the help of Medicare and is dependent on Medicare will have that health care.

Anybody who says something other than that either cares a whole lot more about themselves and their political career or they are absolutely dishonest, because it is absolutely impossible for us to raise the money to continue to run Medicare the way it is today. It will change in the next 4 or 5 years no matter what the politicians say, no matter what the next election--it has to change. The good news is we can give as good care or better with fewer dollars if we will make the right changes in Medicare.

What most Medicare patients don't understand is that $1 out of every $3 spent on Medicare is not going to help you get better and isn't preventing you from getting sicker. Those are facts. They are backed up by four studies now, four long-term studies. If $1 out of every $3 is going into Medicare and it is not effective in actually helping you with health care, and that $1 out of every $3 we are borrowing from the Chinese this year to keep Medicare afloat--and that is just the hospital system, that is Part A--why would we not want to make the hard choices and fix it?

The reason you are not seeing that come forth is somebody sees an advantage in an election to game Medicare. The fact is, it is not just Medicare that is broken. The whole entire health care system is broken because we do not allow markets to allocate it in an efficient way and we do not hold physicians such as myself accountable to be very frugal with the tests we order and the treatments we order.

As we continue to think about ourselves and say I do not want any change--and that is the other point I want to make. As I get older, I find I resist change more than anything. But the one absolute that is going to happen is that Medicare is going to change and it does not matter what any politician from Washington tells you, it has to change. Otherwise we will be in an absolute depression. We will not be able to accomplish any of the things we are accomplishing now under Medicare. It will change.

If it is going to change, why don't we change it in a way that continues to guarantee the promise of Medicare and puts more of a burden on those who have more dollars with which to do that and takes care of the sickest and poorest the best and puts a greater load on those who have less of a need for Medicare?

Some would say that is not fair. Let me tell you what is not fair. What is not fair is the average American puts $138,000 into Medicare over their working career and takes $450,000 out. That is what is not fair. What is not fair is for a 5-year-old to complain about something not being fair. To quote P.J. O'Rourke: ``You were born in America. That's not fair.'' Life is not fair.

The fact is, we have a system that is getting ready to crash and we have a political dynamic that people are actually saying we do not care because we want to win the next election more than we want to fix the problem. That does not apply to everybody, but people who are gaming this issue, people who are scaring people who are on Medicare, lack the integrity and courage to talk about what the real problems are in this country.

The real problems are we have made promises without creating the revenues to pay for it. We can tax 100 percent of all the income of everybody above $100,000 in income in this country and you will not fix the deficit this year--if you took 100 percent of everything everybody earned over $100,000--that is how great the problem is. We have a $14.3 trillion debt that, if in fact the debt limit is extended, will be past $15 trillion by December. When is it going to stop? When are we going to start thinking about the future of our country and the security of our country instead of the next election and how we can look good as the media plays the game on politics?

It is amazing; today most of the stories in the newspaper were about Medicare and the effect of an election up in New York, a congressional election. I don't think that matters a twit on what is going on in this country. What was not said in the papers is that nobody voted for the President's budget. That was not the headline anywhere. It was not the headline that the Congress does not have a budget. The House has passed a budget. You don't have to agree with it but at least they passed one. But you have all this criticism of a proposed plan that came through the House that actually will solve the problem, make sure everybody on Medicare actually gets the care they want and actually will take $1 of those $3 that we are wasting, one out of every three, and put it into actually taking care of patients. But the people who are critical of that plan have no plan themselves. And, if you have a plan, the plan is the following--it is the plan that passed, what we know as ObamaCare, but what is the health care bill that was passed in the last Congress. Here is the plan, just so we understand.

According to the President's speech at Washington University, the plan is that if we have to, we have two mechanisms. He mentioned one of them. He didn't mention the other. We have the Independent Payment Advisory Board. Under the Affordable Care Act, the Independent Payment Advisory Board is mandated to control the growth of Medicare. Here is how it does it. It makes a recommendation on the cutting of payments for Medicare. That recommendation comes before Congress and we either have to accept that or do something similar to that, in terms of the total dollar amounts, to cut back on the payments for Medicare.

What is the No. 1 problem a new Medicare recipient has today? The No. 1 problem new Medicare recipients have today is finding a doctor who will care for them, who will take their Medicare. That is their No. 1 problem. If you think we can take this tremendous unfunded liability and continue to cut--I am not against, as a physician, physicians taking a 5-percent or 6-percent pay cut under Medicare today. I am not against that. But if you think we can continue to do the savings we are going to have to get out of Medicare by doing that, you will not have anybody taking care of Medicare patients because they will not be able to afford to. Those payments to the physicians are less than 30 percent of the total payments of Medicare.

Then they transfer over to the hospitals, so we are going to cut what we pay to the hospitals. Some hospitals can afford that, some cannot. What happens when the hospitals that cannot afford that close? Where do you get your hospital care? Prescription drugs--we are going to cut the price of prescription drugs. Consequently, no new drugs are coming on line because of the rate of return for the billion dollar cost that it is for any new drug just to get it through the FDA. All of a sudden the things you count on are not there.

Let me mention the second way the President would have us control. That is they have what is called an Innovation Council, under the Affordable Care Act. What is that purpose? The purpose of the Innovation Council is to decide whether Medicare can afford new innovation in medicine to be offered to Medicare patients. That is the same thing as saying: Here is a new drug, it will cure your breast cancer, but we don't think we can afford it so therefore it is not available under Medicare. One is direct rationing; the other is indirect rationing. But the fact is we cannot fix Medicare by rationing. You will not fix it that way. What you will do is limit care and limit access--similar to what we have under Medicaid.

If you look at the trustees' report on Medicare, what they are saying will have to happen is that the reimbursement rates under Medicare will end up being lower than the reimbursement rates under Medicaid. That is the answer they have right now.

That is not a good answer. No American thinks that is a good answer. My colleagues on both sides of the aisle do not think that is a good answer. But that is where we are sitting.

I make the point if we do not address Medicare and if we do not address Medicaid and if we do not fix Social Security--and it is true, if Congress had not stolen the $2.6 trillion from it and it was sitting in an account, we would be in pretty good shape. We would make it another 30 years. But there is a problem in terms of paying back that money. Congress stole the money, spent it, and it is not there. So for us to get the $2.6 trillion to keep it going until 2036 we have to borrow more money. We have to borrow that $2.6 trillion. The problem is we are at a debt limit now and we are getting very close to the time when people are going to quit loaning us money.

We can fix Social Security where it is for sure as available as it is today--actually we can make it better for the poorest Americans. We can actually make it better and we can assure that it is going to be working forever. But that requires change. The political dynamic says don't, you can't touch Social Security.

How fair is that? How fair is not fixing Medicare, not fixing Medicaid, and not fixing Social Security to those who follow us? I am the grandfather of five great-grandkids, wonderful kids; I love them to death. I raised three daughters--actually my wife did most of that hard work and that is why they turned out well. But the fact is, the relationship with your children is a special relationship, but it does not get close to comparing to the relationship to your grandkids. There is not anything I wouldn't do for my grandkids and they kind of know it. They have not taken advantage of it yet, but they know it.

What I would ask is, anybody who is on Medicare today who is listening to this, here is what you need to know. No. 1 is there is nobody in Washington who does not want you to have a secure medical health care system. But the problems with it are so severe that it has to be fixed and it cannot wait. And that requires change. The problems of our country as a whole are so severe that we are not going to be able to borrow the money to pay back what we owe Social Security if we do not fix Medicare and Medicaid because nobody is going to loan it. They are going to say you haven't done what you need to do.

What has to happen is we have to think about our grandkids. I don't like going through change very much but I will tell you there is one group of kids that I will go through change for, I will sacrifice for, I will give something up for me. What we are asking you to give up is the comfort of what you know now, and move to the comfort of something that is going to supply the same thing to you, just in a different way. Anybody who games that will not put forward a solution to the very problems that are in front of us.

To the seniors out there who are on Medicare, nobody is proposing any impact on you today for the next 10 years. Any proposal would be for those people who are 55 and less and we are saying we have to change it so we can keep it. If we do not change it, nobody is going to have it. By the way, we are going to have trouble surviving if we don't change it because we are not going to be able to manage this tremendous amount of debt which is over $55,000 per man, woman, and child in this country today.

We have to think about our grandkids. We have to quit listening to the political shill who says somebody wants to hurt you. Everybody who has put forward ideas on Medicare has a legitimate basis with which to be critical of any other. But any politician in the Senate or the House who has not put forth their solution to get us out of the problems you should give no quarter to. You should not listen to the first word they say because what they are thinking about is the next election. They are thinking how do I take advantage, how do I scare you over the next election? Nobody wants to take away health care for our seniors. What we want to do is ensure it is there in the future, and to put forward the idea that the motivation there is to scare you into thinking that somebody wants to disrupt your care, that is just not true.

There could be a great debate, and I started this talk on the fact that there has not been any debate on the problems that are in front of us. There needs to be a great debate. People need to hear what the options are. We need to put a budget on the floor and have the hard debates on it, and take the hard votes, and then try to mix something with the House; otherwise, here is what is going to happen come September--which is not fair to any Federal employee. We are going to have another continuing resolution. That is what is coming because we refuse to have a budget that allows the people who work for you, through the Federal Government, to plan and efficiently carry out what the Congress directs. We are just going to do a continuing resolution. It is a highly inefficient way to run the Government. As a matter of fact, I will tell you that any family who does not run on a budget is set up for getting in trouble.

We are not running on a budget now. The bills are coming in and we have a continuing resolution until September 30. But we do not have a budget, we have no plan, we don't know what we need to do, what are the changes we need to make. We are not listening to the people running the program. We are not listening to the American people as we do that.

We can fix health care in this country. The problem is the cost of health care. The reason it costs so much is that the vast majority of Americans think somebody else is paying the bill.

I will end with this story. I see my colleague from Alabama is here. I have delivered thousands of babies, but there is a particular group I always enjoyed delivering for because they are unique. They were the best purchasers of health care I have ever encountered. They are from a little town called Inola and another called Chouteau, OK, and they are Amish. When they come to buy health care--they don't have health insurance, by the way. Very few of them have a college education. They work with their hands. They are into dairy or carpentry or farming or something, but they work with their hands. They have lots of good common sense.

I can tell my colleagues without a doubt that of the 500 Amish babies I delivered, they bought that service from the hospital, from me, from the radiologist, and from the labs at 40 percent less than anybody else bought it. Why is that? It is because they were great consumers of health care and the money was coming out of their pockets. They didn't think somebody else was paying for it. They knew they were paying for it, so therefore they asked for a discount. They said: I will pay you cash up front if you give me a discount. By the way, if you want to do this other test, please explain in detail why I should fork out $100 for another ultrasound. And does my wife absolutely have to have this ultrasound?

When you get questioned that way the doctor says: Well, if you understand that we may miss something but basically everything looks good, then I am fine with that as long as you are fine with that.

The average pregnancy today in the United States has four or five ultrasounds. I was trained without doing any ultrasounds, and I had the same outcomes.

So the point is that we can get better value if we reconnect the purchase of health care with some individual responsibility. If we disconnect that--and that is what we do through private insurance and low deductibles, and that is what we do through Medicare and low deductibles and supplemental policies. We do the opposite of that. Once we have met our deductible, there is no cost. So we are not prudent consumers. As we age, we worry a lot about new symptoms, so we access the health care system. Once you access, the costs just start ticking up.

So the point I make is there are a lot of things we can do better in health care if, in fact, we have market forces and transparency helping us do that. I would suggest we can have a Medicare Program that is efficient, that works, and that doesn't have $70 billion worth of fraud in it by the end of the year, by the way--$70 billion, well over 10 percent--and improper payments above 10 percent as well. So $70 billion in fraud and $70 billion in improper payments in Medicare. We could solve the problem right there if Congress would do it. But we don't because we would rather have a political game and game people's fears on health care and Medicare than fix the problem.

What I hope seniors will do over this next year, as they hear the politicians make all these wild claims about people's motivations and the damage to Medicare, is when you hear that, think about that in light of your grandchildren. Think about yourself and what you want versus what you want your grandchildren to have because there is no question that the $14.2 trillion and under the President's budget the $23 trillion we are going to have at least in 9 more years is going to be paid back by them, not you. What that really means is they are going to have a far lower standard of living than you do so you don't have to get out of your comfort zone.

I trust America a whole lot more than I trust the U.S. Congress. We have a $1 trillion deficit of common sense in Washington, and we have an excess of common sense outside of Washington. If you will trust your common sense and look at what we are doing, what you will find is we can solve our problems, we can come together as a nation, we can fix what ails us, and we can do that without destroying the future of our children and grandchildren.

I yield the floor to my colleague from Alabama.

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Mr. COBURN. Well, to my colleague, through the Chair, I would answer, What is our obligation? Is our obligation to win the next election or is our obligation to solve the problems in front of our country? It is not even a matter of having votes. We can't even get bills on the floor for the Members that actually would save some money right now.

Let me give an example. We had the small business bill up--the only thing we have done of significance since we have been back in this session. It took 2 weeks to get a bipartisan amendment that would save $5 billion out of the duplication that was reported by the Government Accountability Office--hundreds of billions of dollars. It took 2 weeks to finally get a vote on that. My colleague from Virginia and I cosponsored that. It won. That is one of the reasons we didn't finish the bill, is because they don't want to do that. They don't want to make the hard

choices. So it is an abrogation of our responsibility to not do the hard part that comes with the job.

The job comes with a whole lot of rasping on your skin. You are going to get criticized. But the ultimate fatal criticism is to make a choice not to get--put yourself in a position to be criticized. So what we are saying is we are going to do nothing. We are not going to do what we are constitutionally supposed to do by April 15 every year; that is, have a budget. We are not going to debate the issues. We are not going to cast our votes because somebody may affect somebody's election outcome. How big of cowards are we that we can't defend the vote we make? I don't have any problem. You throw the hardest vote from the other side at me, and I will make a decision on it, whether I think it is right or wrong, and then I will defend it. But to not vote at all is an absolute abrogation of our oath, and that is the leadership we are experiencing. It is not just Democratic leadership. We have some on our side who don't want to cast hard votes either.

The point is, the American people need us to be casting hard votes now. Our problems are greater than at any time since World War II. The challenge to our country is greater than World War II. The outcome of our Republic depends on us solving the very real and urgent and difficult problems in front of us and doing so in a way that preserves the future of this country and reestablishes and reforms us to where we get our mojo back so we can start believing in ourselves again. To not do it and to not have the courage to sacrifice your own position for the betterment of this country--that is what we ought to be about, and I don't see that.

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Mr. COBURN. Well, I would answer through the Chair that I think we are perplexed. We know intellectually that there is a big problem, and we have this challenge: Do I go down this path and do the best thing for the country or do I go down this path to do the best thing for me?

I look at politics differently than most of our colleagues. To the Senator from Alabama, I would say I don't really care whether I am here; I care whether America is here. But the point ought to be, how do we secure the vote and how do we establish trust with the American people?

If my colleague will go with me--and I know he knows this--look at the confidence in the Congress of the people in this country. Why is there a lack of confidence? Why is it that 80 percent of the people of the United States didn't have any confidence in Congress? I can tell my colleague why. It is because we have milked trust and credibility from those very people.

I get letters all the time from people who disagree with me. They will write me, and I actually--I am involved in every answer to every inquiry that comes into my office. I actually read them because I want to know what the people from Oklahoma say. But even though they disagree with me, they vote for me because they trust me because I am not gaming them as they have seen with the gaming on Medicare.

Our problems are real. The solutions are difficult. But America can overcome that if we come together. If we stay divided as we have seen here with no budget votes, no hard votes, and we try to game it politically, what we are doing is undermining our country's future. It doesn't matter who wins the next election; what we need to do is save America.

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Mr. COBURN. It does not. But it is interesting to note that the President's deficit commission was set up by the President and had six of his nominees on it. It had six Republicans and six Democrats. Five of the six Presidential nominees he nominated agreed with the deficit commission, three of the six Republicans agreed, and three of the Democrats--a pretty good meeting in the middle. Yet the President did not embrace the results of his own commission, did not embrace the results of the people he appointed. So what was the purpose of that exercise? Was it to make political hay or was it to solve the problems?

The fact is, I have five colleagues in the Senate who have been working hard on that over the past 5 months to try to build a bipartisan agreement out of the basis of that. That is what has to happen--except politics.

I go back and just refer to my colleague, if you look at the history of republics, the track record is not very good. The average age of the world's republics is 207 years. That is our average age. We are 27 years past the average. The question is, Can we cheat history? Can we not fall like the rest of the republics over the very same things? They all fell over fiscal issues. They let their spending get out of control, they let their debt get out of control, and then they could not afford the promises they made.

I will say to my colleague, this is not an issue of the budget chairman. This is an issue of the leadership of the Senate that does not want a budget. We ought to be very clear that the American people know that Congress is not doing its job--this body, for sure--because we are not making the hard choices we were sent up here to make. What we are doing is punting. We are going to come to a crisis, and the crisis is going to be painful, and it is going to be much more painful than had we made the hard choices today.

So I want to thank the ranking member of the Budget Committee for his leadership. We can solve any problem in front of us, Mr. Ranking Member, but we have to do it together, and we cannot deny that the problems exist.

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