BREAK IN TRANSCRIPT
Mr. COBURN. Madam President, this is my 10th year in the Senate. Every time we come to a close of the session for a summer break or for a holiday break all of a sudden we start hearing all these unanimous consent requests--they come to the Senate. For those of you who are listening to this and to my colleagues, these are requests that bills be passed without a vote. I am fine with that, as long as they meet certain characteristics and considerations.
But what the American public does not know is that about 70 percent of the work the Senate does happens by unanimous consent, with no recorded vote on the back of any one Senator. Today is no different. I have heard of five or six requests for unanimous consent. They are fine with a couple of provisions. The first provision is they ought to be within the powers of Congress as enumerated by the Constitution in the enumerated powers. The tendency is: Oh, we have to do this; it has to happen now. For some of the things that is true, but the reason it has to happen now is because we had not done it before now because we failed to do it. We utilize the end of the session to force people to give on positions they would never give on otherwise because they do not want to take the heat for being responsible for stopping something from happening, even though it might not fit within the enumerated powers, it might not be under our constitutional authority.
But the most egregious of all of this is the fact that we are going to be asked today, probably 7 or 10 times, to pass pieces of legislation the very cost of which will fall on the backs of our children and our grandchildren--not us. With over $400 billion in waste per year in the Federal Government--waste, fraud, duplication--to ask us to spend $200 million here or $2 billion here or in the case of the veterans bill, $17 billion, of which $5 billion of it is actually paid for, without doing the hard work of not transferring more debt to our children is not acceptable to me.
So my rights as an individual Senator are going to be utilized today--until we go home--to make sure we do not transfer another penny, if I can stop it, onto the backs of our children. It would be different if we were efficient, if we did not have any waste, if we did not have any fraud, if we did not have any duplication. But you see, it is an excuse to not do the hard work we were sent to do.
So I am putting my colleagues on notice that if they want to pass any bill that is going to go by unanimous consent, they better find some waste somewhere to offset it with or I will object. I do not mind taking the heat, no matter what the issue. I have done it before, I will do it again. Our children and our grandchildren are worth any amount of heat that creates a future opportunity for them that is at least as equal to what we have had.
I wanted to say that before I start talking about the veterans bill. I voted for the veterans bill that went out of the Senate. My background as a physician and businessman--businessman first, a physician second, regrettably a politician third--but I voted for that because I thought in conference we would actually fix it. What is wrong with the VA? Leadership, a culture of corruption, a culture of not caring. That does not apply to all of the VA employees, it does not apply to all of the VA hospitals, but it certainly does apply to a number of them.
How did we get there? I would note for the record that VA spending is up 60 percent since 2009. Let's start in 2010, 2011, 2012, 2013, and 2014. It is up 60 percent. Patient demand is up only 17 percent in that same period of time. The number of providers has increased by 40 percent. So it surely cannot be a problem of money.
If we look at the increased utilization of those services over the next progressive 10 years, it will be less than 20 percent. We did some good things in the bill in the Senate, most of which are capped, but we did not do enough. If we are going to manage the VA, we have to give the head of that organization the ability to be able to manage it. Senior Executive Service, the Secretary of the VA is going to have that capability to hire and fire. For a very limited number of title 38 employees--those are hospital managers, physicians--for a very limited number, he will have that as well. But for where we have seen a lot of the problems, he will not be able to fire people who have directly harmed our veterans.
So we have not given him the tools to create the environment and the change that has to happen and a cultural change that has to happen in the veterans organization.
The other thing I would note is that if we look at the requirement for primary care physicians and physician extenders--nurse practitioners and PAs--their load is about one-fourth of the load of private practitioners in this country. That is not true clinic to clinic, but on average that is true. In Oklahoma we have some great physicians who work every night until 10:00 taking care of veterans. We have great caregivers in lots of instances. But we have a lot of stinkers, and on average we are not demanding of them what the private sector routinely does.
One of the good things in the bill is we are going to finally have VA hospitals and clinics reporting outcomes, just as every other hospital in this country has to report. If they take Medicare or Medicaid dollars, they have to report to CMS their outcomes--their readmissions, their death rates, their infection rates, their quality of care. They have to be reported.
Also, physicians have to be credentialed. Not true in the VA. So if they are not credentialed, the VA patient is going to know what their credentials are--if they have lost their medical license.
Those are positive aspects of this bill. What is not positive is the fact that we won't fix the real problem, and we are going to say we did and we are going to spend our grandkids' moneysaying we did over a very short period of time, and we are still not going to hold the organization accountable.
It is unconscionable to me, after a 60-percent increase in funding over the last 4 years, that we would borrow against our children's future an additional $12 billion when we have all this waste throughout the Federal Government and in the VA and say that is the best Congress could do. I think that is an incrimination upon Congress, and it is a dereliction of our duty--to our Republic but also our future.
So I will be doing a couple things:
No. 1, I will be raising a point of order against this bill; and No. 2, I will be voting against it.
Let me say a little bit about why I am voting against it. Yesterday I talked to a Vietnam veteran who is 100 percent disabled and presented to the emergency room of a major VA hospital in this country with chest pain. This patient was observed for 2 hours. She had no acute changes on her EKG, but she had--as any doctor would know--unstable angina. Her pain never went away. She was sent home. In less than 48 hours she presented to an emergency room in her local community and an hour after that had three stents placed in her left coronary artery. She was ignored medically. That is happening today as we have had this discussion.
Another wonderful retired veteran in Oklahoma had to have a knee replaced. She was service-connected. She went to the VA and had her knee replaced. It was a failure. She had to have it done again. A couple years later her other knee needed to be replaced. They replaced her knee. It failed. As they replaced the second knee, as can happen, they fractured her femur. Today she has a replaced knee, and she walks with a terrible limp because her left leg is 1 1/2 inches shorter than her right one. The likelihood of that happening to one individual is about 1 in 10 billion, but the outcomes never get reported. A femur can break while doing a knee prosthesis, there is no question about it. But five major surgeries? That means outcomes don't compare.
When this VA episode started soaking in, as a physician I went to the medical literature and looked at all the studies that have been published on VA care. I did a LexisNexis. I looked at them all. What did they show? VA care is better than anyplace in America. That is what the studies show. Except when we drill down on it, what we find is the way they were cheating on appointments is the way they were cheating on outcomes. In other words, the outcomes weren't accurate. So the culture is one of looking good, protecting those within the VA, and not protecting our veterans. Again, I would say that does not apply to all VA employees. The vast majority of them are great. But the leadership has stunk. We have to have a bill that fixes that. I don't believe this is going to do it.
I also wish to talk about whistleblowers because I have had a multitude of whistleblowers whose complaints I have investigated and found to be truthful. The culture at the VA against whistleblowers has been a channel in the past from whistleblowers back to management. And what happens to them? They get fired. They get demoted. They get harassed. They end up ultimately leaving. These are the people who care, who want to make it better.
There is a big job ahead of Secretary McDonald. He has the capability and he
has the experience to fix this but only if we give him the tools. My fear is that we will not give him the tools with this bill.
The final point I would make, and I think we all ought to think about it--every American ought to think about it. Remember, we are an All-Volunteer Army right now. If somebody has served this country in combat, putting their life on the line to protect us, to protect our way of life, to protect the very freedoms we cherish, should that same individual ever be at the back of the line on anything related to health care that is associated with their service? They should be in the front. They should be ahead of every Senator, every President, every doctor. They should get the first care, not the last. They should get the best care, not the worst. That is how it ought to be. It is the veterans VA system, not ours. It is for them. And when they no longer are the object of service by this country, for them, for their sacrifice, then we are in a whole lot more trouble than any of us realize. We have turned things upside down. Union representation at the VA is more important than the VA patient. Benefits for VA managers are more important than the VA patient.
The one critical thing that really needs to happen to clean up the VA is to give veterans the absolute choice to go wherever they want, their freedom to choose whatever care they want based on what they have done for us. By doing that, the VA will either have to become competitive and just as good or they should die. We have not done that in this bill. We need to do that in this bill.
We have centers of excellence in the VA that beat all the private industry, all the private health care. When it comes to prosthetics, when it comes to closed-head injuries, when it comes to traumatic brain injury, when it comes to post-traumatic stress disorder and depression, we are great. The VA is great, but in too many areas it is not. Tell me this bill will change all that, and I will vote for it even if it does sacrifice our children. But it won't.
I won't be here when the results are assessed, but I can predict what they will be--more of the same, too much money and not enough leadership.
With that, I yield the floor.