Hearing of the Oversight of Government Management, The Federal Workforce and the District of Columbia Subcommittee on Pasing the Buck: A Review of...

Hearing of the Oversight of Government Management, The Federal Workforce and the District of Columbia Subcommittee on Pasing the Buck: A Review of the Unfunded Mandates REform Act

Senator Coburn. Mr. Chairman, I don't have a written statement. I would ust, first of all, apologize in advance. We
are in the midst of an executive committee meeting in Judiciary so I'll be in and out and intermit with my attendance. I am
very appreciative that you're holding this hearing. I believe there are still way too many mandates coming out of Washington
for States and local communities, and many of them, although we call them funded, they're not. So there is a difference between an unfunded mandate and an underfunded mandate, and the way we are getting around the law today is underfunding the mandates. So I look forward to studying this report and also the testimony of your witnesses today, and thank you for holding the hearing.

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OPENING STATEMENT OF SENATOR COBURN

Senator Coburn. Well, I would make note that we just passed out of Committee S. 21, which should offer, especially Seattle,
some leverage in terms of homeland security and more of the requirement for it to be on needs-based, risk-based, rather
than just on population-based granting. And I think you are going to be pleased with that. We will see how the
appropriators do with that, but it is our hope that bill will get through both the Senate and the House and get some common
sense into the funding.

My experience from the people I have dealt with in Oklahoma, it is not that there is minimal consultation. Most of
the time there is no consultation from the Federal Government. And when you find out what the rules are, it is when they are
published in the Federal Register, and you have 30 days to try to mobilize and to change those. And I would just tell you that I would tend to agree with what you said. I would apologize for not being here. I am trying to shuffle between three committees today. But common sense is the thing that is lacking. It looks good up here, but you have to remember this is a very small, hollow network that does not rely on common sense and does not see the results of things that are put out.

So I look forward to working with the Chairman on that. I look forward to going through this to see what the GAO has said
and understand that and try to change it.

I think the threshold problem is more difficult than the definitional problem for us in Congress, because I think
Federal agencies can get around the threshold problem, but I do not think they will be able to get around the definitional
problems. And if we can tighten those up, I think they would be great.

With that, I guess I don't really have any questions other than to say I am sorry we have not done our job to make sure
you can do your job.

Mr. Licata. I would like to thank Senator Coburn and others for the S. 21 bill. We really do appreciate the emphasis on
threat regarding homeland security, and I hope there is successful passage of that legislation.

I again want to thank Chairman Voinovich and the other Senators for their concern about this issue. I think we will
take up your challenge to get together and come back to you with some solid proposals that we can all work together on and
do something about this problem.

Senator Coburn. Could I address Medicaid again?

Senator Voinovich. Certainly. I have some more questions, too.

Senator Coburn. I just think the points you raised on Medicaid is the prime example, and we need total reform in
Medicaid. But we do not need to reform it just here. We need the input of the States as we make this a more flexible problem
for the States to decide how they care for the people in their State. It is different in every State; the requirements and the
needs are different. And one of the things I am going to be working on is to try to do that over the next couple of years,
at least build a consensus in terms of reforming Medicaid so that it is more flexible, so that you have the ability to
really do what you want to do in the State to help those that are depending on us.

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Senator Coburn. Mr. Chairman, just to roll on the Medicaid, right now Medicare and Medicaid dictate health care in America.
Health care does not dictate Medicaid and Medicare. It is exactly backwards. We are going to spend $2.3 trillion this
year in our economy--that is close to 18 percent of our GDP--on health care. That is 40 percent more than any Nation in the
world does per capita. And one out of every three dollars we spend does not help one person get well.

Certainly we can do it better, and if we do it better, we are going to free $700 billion a year to use in other areas,
both at the State and the Federal level. And I am committed to see that happens.

Now, that is a big task, but there is no prevention incentive for providers. We do not pay them for prevention. We
pay them to treat acute disease and chronic disease. Prevention will save us tons. Half of Medicare and Medicaid spending in
the year 2050 is going to be on diabetes alone. And diabetes today is a preventable disease, and yet there is no leadership
at the Federal Government level in terms of prevention of that, and colon cancer and all these other diseases that we know are preventable.

So I believe--and I hope through my Subcommittee and your Subcommittee that we are going to be able to discover some of
the areas where we can change this. And it is a burden on the States, but it is not just a burden on the State Governments.
It is a burden on every business in your State.

Last month alone, 15,000 jobs were not created in this country because of the sole cost of health care insurance for
individuals who would have been hired, many in Ohio, because they cannot afford that premium so, therefore, they do not add
another person to the payroll even though they need it.

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Senator Coburn. I would just add one comment. Almost 7 percent of the cost of health care today, 6.8 percent, is $130
billion worth of tests that doctors order every year that patients do not need but doctors need. And that is directly
related to the tort system failure in this country. And we could lower the cost tomorrow by 7 percent, health care across
the board in this country, if we just had malpractice reform in this country.

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