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Mr. COBURN. Mr. President, I wish to ask the Senator from Pennsylvania a couple questions, if he might be so kind as to respond.
Your earlier statement was without this, children will not develop, children will not become productive members of our society.
Having taken care of 4,000 infants and done well child exams on them, what is the number of children out there who are not getting vision and hearing screens right now?
Mr. CASEY. Well, I don't have a number on them.
Mr. COBURN. The number is zero because every one of them is tested.
Mr. CASEY. Let me finish.
Mr. COBURN. I control the time.
Mr. CASEY. Let me finish the answer. If we do not pass this--if we don't pass this, those children won't get that preventive care. It is as simple as that.
Mr. COBURN. That is simply not true.
Mr. CASEY. How are they going to get preventive care?
Mr. COBURN. They are going to get preventive care, and let me tell my colleagues how. What is the number of children who are not getting preventive care in the first 6 months of life right now? We don't know that number, and that is exactly the problem.
Here is the point: Every one of us wants children to get health care. It is not about wanting children to get health care.
Mr. CASEY. This is the way to do it.
Mr. COBURN. The fact is, we have an SCHIP program now and a Medicaid Program right now where we have 5.4 million kids who are eligible and who are not enrolled.
What we are doing is exactly the opposite of what President Obama stated we should be doing. He stated that we should be being responsible. I would contend that one of the areas of being responsible is to make sure programs work. When we have a program where last year, on average, 5.5 million kids were covered and another 5.4 million kids who were eligible weren't covered, I would tell my colleagues that program isn't working very well. It is not working. So what have we done? We have expanded the eligibility with this bill.
The debate over how we cover all the rest of Americans--we will have that debate, and I am sure we are going to have that debate this year. But the fact that 51 percent of the eligible children under the programs we have now, under the requirements we have now, are covered means 49 percent aren't. In this bill is a measly little $100 million to try to expand the enrollment of those kids who are already eligible.
I would think the average American out there who does have insurance or who may not have insurance might say: Well, why don't you make the program you have today work? We would have more kids covered than this bill will totally cover if we just made the requirements that the States and Medicaid directors throughout do the outreach to get the kids who are eligible.
The fact is, most of the poor women in this country--up to 300 percent right now--deliver under either title XIX or Medicaid. Their children are covered the first year of life. They are not going to miss the first well child visit. As a matter of fact, they are the ones--the biggest problem we have is getting the people who have coverage to be responsible and to bring their kids in. It is not about coverage; it is about responsibility--the very thing our new President said we need to reach up to and grab.
The other point that has to be brought forward in this debate is there is a lack of integrity with this bill. Let me tell my colleagues what it is. I do not doubt this Senator's integrity whatsoever. He is a friend of mine. When he speaks, he speaks from the heart. But when we manipulate the numbers and we drop a program from $13 billion to $8 billion in the last year of the first 5 years of its authorization so we don't have to meet the requirements of living within our means, and then we transfer $13.2 billion so we lower the baseline--this is all inside baseball--what, in fact, we are doing is we are lying to the American people to the tune of $41.3 billion. That is what CBO says. That is what CBO says in a letter to PAUL RYAN, the ranking member on the Budget Committee in the House, that, in fact, because we manipulated the numbers, because we cheated with the numbers, that it is actually going to cost $41.2 billion or $41.3 billion more than what we are saying it is going to cost.
Why is that important? Because we have decided to pay for this with one of the most regressive taxes toward poor people that we can. The consequence is that we are going to tax them and then we are going to wink and nod to the rest of the American public to say: This $41.2 billion, oh, don't worry about it; we are going to fudge the rules; we are not going to play the game honestly and with integrity. There is not going to be change you can believe in because the Senate's bill winks and nods at $41 billion. We all know that is there. We all know that is the only way they can do it to where it is scored in terms of pay-go.
So what we did is we paid attention to the numbers but not to the integrity behind the numbers. So the American taxpayer in some way or another will take on, from 2014 to 2019, an additional $41 billion. That is not change, folks, regardless of how good our goal is, regardless that every Member of this body wants to see kids who don't have care covered. Every Member wants to see that. We don't want the first child, we want every American covered--every American covered. But to do that under the guise of ``integrity in our numbers'' puts us right back into the same problems that got us into the deep financial problems we have today.
Let's be honest. Let's talk about what this bill really costs, what we know it would cost if we didn't play a game with the numbers, and what we could do to offset some of the programs President Obama says need to be eliminated so we can do the things that are good. There is not one attempt in this bill to do that. As a matter of fact, there is an attempt to cover non-U.S. citizens at the expense of U.S. citizens in this bill.
So basically we are going to keep a 9-percent approval rating because we are not going to earn the trust of the American people about being honest about what something really costs. I want to tell my colleagues, that undermines the whole debate. It sends us on a track to where we are going to be a Third World country because we won't even be honest about what things really cost. There is nothing wrong with having an honest debate about what this bill really costs, but to deceive the American people on what this bill actually costs--actually costs and will actually cost them--it is not going to cost us; it is going to actually cost them. It is going to cost them in terms of a lower standard of living and less opportunity.
Let's get honest about what it really costs, and it really costs $41.2 billion more than what we say it is going to cost. Let's do the hard work. If the bill is such that the Senator from Pennsylvania thinks it is absolutely necessary so children will develop, so children will become productive, isn't it worth getting rid of things that don't make kids develop and don't make them productive? Isn't it worth us taking the heat to get rid of programs that aren't effective so we can actually pay for this? Instead, we are in essence lying to the American public about the true cost of this bill. That is what has to stop.
The integrity of those who want to do this is fine. The integrity of the numbers stinks. For us to say we are for children and have that honorable position that we are for children, but at the same time we want to undermine the faith in this place so they can't believe us in the future because we are going to charge them $41.2 billion more than it actually costs says a whole lot about us.
Every child should have an opportunity for health care. Every child should have prevention. Every child should get a hearing screen and a vision screen as we do now at every newborn nursery in this country. Every child should get their immunizations at every opportunity when they encounter--first at 2 months, 3 months, 6 months, 9 months, and a year, their first year of life. The whole purpose for that screening is to see if development is not normal.
The Senator from Maryland talked about the mandated oral health care in this bill. The mandated oral health care in this bill is a direct consequence of one of our other programs to help people. It is called food stamps. When we look at the mix of food stamps, what do we see? We see a high predilection for high-fructose corn syrup in the foods that we use food stamps to buy which causes the very dental caries we are fighting. So do we fix the real problem or do we treat the symptoms? We ought to be about fixing the real problems. So if we want to do and mandate oral health care in this bill, why don't we put a limitation on the high-fructose corn syrup products and high-glucose products that are the No. 1 cause of the dental caries the kids are having? An ounce of prevention is worth a pound of cure. But we didn't do that.
We didn't come forward with a total plan on health care, which is the whole problem as we try to expand this bill to meet a need. What we need to do--and I think the Senator from Pennsylvania agrees--is we need to reform all of health care. It needs to be based on prevention. It needs to be based on prevention. It needs to be based on teaching and preventing disease rather than treating disease.
My hope is that when we come through this, whatever we do, win or lose--whether my side wins or the other side wins--what should happen is Americans should win. The American people should win. What that means is an honest debate about the numbers--not a game with the numbers, an honest debate about the numbers--and what it really means is an honest debate about what the real problems are and not about things that aren't the real problems.
We have plenty of money in health care. We don't need to increase spending in health care. What we need to do is redirect the spending that is there. We spent $2.28 trillion last year on health care. Thirty percent of that money didn't go to help anybody get well or prevent anybody from getting sick. That is $600 billion. If we would look at it and say prevention is going to be No. 1, and No. 2 is going to be every American insured, we could go a long way toward solving this problem.
Unfortunately, however, we have chosen to start off the new SCHIP by trying to pull the wool over the eyes of the American taxpayer, by playing funny numbers. Why would we leave that out there? Why would we do that? It lessens the integrity of the debate. It lessens the quality of the work product we put forward. It undermines the very thing we need most from the American people, which is their confidence that we are doing what is in the best long-term interests of the country. This bill isn't in the best long-term interests of the country. The bill doesn't address the needs of the Medicaid populations out there today who aren't served who could be served if, in fact, we should mandate that the States go and do it. But we have chosen not to do that. We have chosen to expand up the chain before we fix the problems down the chain. We have chosen to take dollars and give them to those who are more fortunate instead of spending dollars on the people who are the least fortunate in this country, all in the name of a movement to close in ultimately on a single-payer health system. Let's have the debate about single-payer health system.
One final point I will make before I yield to my friend from North Carolina, and that is this: The most important thing after access is choice. We know what. Medicaid offers little choice. SCHIP offers little choice. The reason is because we have a payment system that rewards specialty and doesn't reward primary care. It started with Medicare, and it has worked its way through Medicaid. So our average pediatrician in this country makes about a fourth of what the average surgeon does or about a fourth of what the average gastroenterologist makes, and we ask ourselves: Why can't we get more pediatricians? Our average family practitioner makes a little bit more than that, but not much, and we ask ourselves: Why can't we get people out there into primary care? Our average internist makes just a little bit more but still about a fourth of what the specialists make because we have decided to pay it. Who is going to take care of them? Let me tell you who is going to take care of them: PAs and nurse practitioners.
Some are excellent, some are great, but none of them have the training of a physician. We are slowly walking to a health care area where we are going to tell people you have coverage, but the coverage is you do not have choice and you do not have the same level of care because we have not chosen the priorities of compensating primary care, compensating pediatricians, compensating pediatric dentistry, compensating internists to care for these kids.
Choice is the most important thing, and the reason is because if a mother is taking her child to a health care professional in which she does not have confidence, do you know what happens? She does do what they say.
As we eliminate choice, which is what happens in SCHIP and Medicaid because so few physicians take it because the reimbursement rate is so low, we eliminate the doctor-patient relationship in establishing the confidence necessary to make sure, as the Senator from Pennsylvania said, that these kids will develop, that they will become productive.
The idea behind this whole program is we have taken away the most important attribute of consequences of care, and that is confidence in the provider.
I yield to my colleague from North Carolina.
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Mr. COBURN. I will make this short because I know we have a swearing in.
I wanted to make a few points. When President Obama talks about being responsible, if you sign an affidavit that you will cover and be the sponsor for a legal immigrant in this country, you ought to do that. That is what he is talking about. He is not talking about: I will do it until I can get someone else to take care of my responsibility, talking about it, if you sign an affidavit that you will do it.
The idea that 22 States already do this is great. If States want to do it, that is what makes our Union so great, that 22 States can, except now they cannot afford to do it, and we are going to be bailing them out to the tune of about $300 billion on Medicaid and SCHIP programs in the supplemental or the spending package or the stimulus package that is coming through.
What this bill is going to do is make permanent that people do not have to be responsible when they, in fact, sign an affidavit that they will sponsor a legal immigrant.
One final point I would make is, the Senator from Pennsylvania listed all of those premium assistance programs that Pennsylvania has because that is what they are, premium assistance rather than a regular SCHIP program. Well, in this bill you have extremely limited any new premium assistance programs without an absolute mandate and an absolute mandate on what kind of program you have. You will be in an HMO. You will not have the doctor of choice, and you will not go where you want; you will go where you are sent.
So great points, great need in our country, great debate, but integrity first. Be honest with the numbers about what they really mean. Everybody in this Chamber knows they are not, but we are not going to change that. Even if we offer an amendment, it is not going to go anywhere because nobody knows what to get rid of to be able to afford to pay for that.
I yield the floor.
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