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Mr. President, I come to the floor again to talk about--it is my understanding we are not going to be allowed to offer any amendments again on a significant bill that spends billions, tens of billions of dollars--to talk about a couple of amendments I have.
My staff recently talked with some veterans from Oklahoma, and I want to give you an anecdote that just happened. This is about VA care. This is a lady, a 100-percent disabled veteran, who has had knee replacements at a VA hospital. She did not have one knee replacement, she had two knee replacements. And then she had two knee replacements on the other knee.
If you look at the statistics of a knee replacement having to be replaced, it is a very rare occurrence. But the fact that you would have two knee replacements, and both of them would have to be replaced is unheard of.
The story does not end there. The story ends with the fact that during her second knee replacement, they broke her femur. So they had to put a rod into her femur. When they put the implant in, she ended up with one leg an inch longer than the other leg.
The fact is that this all occurred at a VA hospital. And it is unheard of that somebody who has a knee replacement on one side would have to have another one done because of complications, and then have the other knee done, and have to have that knee redone because of a complication. But then on top of it, as to the skill of the surgeon in terms of doing a second replacement and having a rod, and then putting the wrong rod in, it creates a leg length discrepancy that can only be corrected now by her spending a significant amount of money on an orthotic shoe on the shorter leg which, if you know anything about medicine, changes the alignment of the spine, which causes tremendous arthritis in the spine of that patient.
So here is a patient that if you look across the world in the private sector 99.9 percent of the time would not have had to have either of them replaced, would not have had to have a rod put in her femur, and would not have a leg-length discrepancy.
I agree that is an anecdote. But those are the kinds of things that we are not holding the VA to account for.
One of the amendments I was going to offer to this bill was a very straightforward amendment requiring every 6 months that the VA publish, in both their hospitals--outpatient--and nursing homes the quality of their care, the mortality rates, the complication rates, the infection rates, the wait times in their emergency rooms, the wait times for a screening examination, the wait times for an endoscopy, the complications associated with those, so veterans could actually see and compare it to the private sector--every other hospital knows all this stuff and publishes it--so they can see and compare the quality of care. Because we have an honor-bound commitment to offer care to those who have offered to sacrifice their life and their future for our freedom.
But we are not going to be able to offer the first step in terms of accountability to the VA health system because we get to offer no amendments.
What if you knew--and this does not apply and I do not mean to denigrate the whole VA system because there are some great VA hospitals, but in your area, where you have to go, if you knew the quality was 20 or 25 percent less than what you could get in your own hometown, would you still go to a VA hospital? Should veterans not know whether they are getting a standard of care that equates to what they could get in the private sector? They are not going to know because that is nowhere in terms of the accountability of the VA system I talked about yesterday.
One of the other amendments I was going to offer would be to strike section 301. The chairman of the committee yesterday referenced section 302. He was actually talking about section 308 of his bill, not section 302 of his bill. But when you expand VA health care to Priority Group 8--these are people who do not meet the income, have no service-connected disability, and have no limited resources--to put them into the VA health care system, when we are not adequately treating the veterans who are eligible for service today in the VA health care system, what you are really doing is taking away our commitment to care for those to whom we have already promised care. So it is somewhat cynical that we would expand from 6 million to a potential of 22 million people in a system that is behind the curve already.
The other thing that is important for that is the care for these veterans with nonservice-connected disabilities was excluded from the VA's priority group so the VA could focus--focus--its limited resources on our veterans with service-connected disabilities. In other words, they have a health complication because they served our country.
As former Secretary Anthony Principi said: Remember, when everyone is a priority, no one is. That is exactly what this bill will do. It will take the priority away from our veterans with service-connected disabilities to where they will fall further through the cracks.
The other thing in this section is--the only thing worse than them being in the Affordable Care Act, which is what this is really specifically designed to do, is to take them out of the exchanges and put them into the VA. So what we are saying under this bill is, if you are a high-income, nondisabled veteran, and the only health care coverage you have available to you is an ObamaCare exchange, then you now qualify for VA services.
What is that about? What that is about is moving to a single-payer, government-run, totally government-run health care system. And this is about moving 16 million veterans--or the potential of up to 16 million veterans--to that position. So the only thing worse than being covered by the VA, where veterans are waiting for weeks to see a doctor and literally dying because of medical deficiencies, is being in an Affordable Care Act exchange.
This amendment would strike the expansion from the legislation, which would ensure that the VA remains focused on the service-connected disabled and increasing the quality of care for more than 6 million veterans currently in the VA system.
I want to talk a minute about why we did that. We created the VA health care system for those who have a complication of their service--a complication of their service.
Do we have a commitment, one, to ensure that those who have a complication from their service get the care we have promised them?
I believe we do. Section 301 would markedly minimize that commitment to those who have a complication from their service. So how is it that we have come about, that we have this great big VA bill on the floor, without any oversight, aggressive oversight, on holding the VA accountable to do what it is supposed to be doing now--with a 59-percent increase in budget since October 1 of 2009, and expand it and blow it to an area where we are going to offer these same services, where we are not meeting quality outcomes, we are not meeting timeliness outcomes, we are not meeting care outcomes, and we are going to put that on the VA system?
I would say the better way to honor our veterans who have a complication associated with their service is to hold the VA accountable through transparency of their quality.
Here is the other thing that has not been studied, and we do not know the answer to this. I certainly do not know it. I cannot find it anywhere. It is this. What does it cost to do an ``X'' procedure in a VA hospital, totally absorbed, versus doing it in a nonVA hospital? Let's assume quality is the same. Would the American taxpayer be better off if, in fact, we delivered that service at a cost that is much less?
But nobody has asked for those numbers. The VA cannot give those numbers. The VA does not know those numbers. So we are driving blind. We do not know what it costs to do a total knee in a VA hospital. We do know what it costs in Oklahoma City from every hospital. As a matter of fact, there is a wonderful hospital in Oklahoma City that advertises every price, all their complications, everything else out there. They have people from all across the country coming because they are so much cheaper and so much better than what people in the private market can get done where they live.
Let's see how VA cost and quality and outcomes compare to that. If you really want to drive quality for our veterans, we have to have accountability in terms of how we spend money, accountability in terms of the outcomes, accountability in terms of the quality, and accountability in terms of the service.
The other amendment that I have would allow service-connected veterans who are driving hundreds of miles--in my State--to get care with a pilot program which would allow them to go anywhere they wanted, to their home town, to the next town over if it is bigger and has higher quality, rather than drive 200 miles to get their care at a VA hospital. We would cover it under Medicare rates, since we do not know the cost ramifications of what we do at VA clinics and VA hospitals, in terms of the total absorbed cost, but we do know what the price would be if we had Medicare paying. My learned opinion is that, No. 1, veterans would have access to care closer to home, probably improved quality, and most probably a decreased cost for the Federal Government, i.e., the American taxpayers in terms of meeting this honor-bound commitment to our veterans.
If, in fact, you served this country, and one of the benefits of serving this country--and you have a service-connected disability associated with that--is a promise of quality health care, why do we say you can only get it in a VA clinic or a VA hospital? If you served our country, why can't you get it wherever you want? I mean, you served our country to preserve our freedom of choice, our freedom to do and select what is best for us and our interests. Why can't a veteran have that privilege that he or she fought for and put their rear ends on the line for? Why do we not avail them of the freedom that they sacrificed for?
Nobody will answer that question. Nobody will come down and answer that question. Those are knowable answers. They are moral questions. If you sacrifice, should you not have the benefits of the freedom for which you sacrificed?
The other problem with this bill is it has a false pay-for, money that we might have spent on a war in Afghanistan. Because we are not going to spend it, we are going to spend it here and call that a pay-for. That is not a pay-for. It does not pass muster. It does not pass the budget point of order on it. Everybody knows that.
So what we ought to be doing, instead of having this bill on the floor, we ought to have a bill on the floor that holds the VA accountable, that creates transparency in the VA so that everybody in the country, including the veterans can see outcomes, quality, and cost. Finally, we ought to give the veterans the freedom that they fought for; that if they are deserving of this benefit, they ought to be able to get the benefit anywhere they choose, because they are the ones who preserved the rights and the abilities and the capabilities for us to experience the freedoms to make choices for ourselves.
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