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Public Statements

Stimulus Package

Floor Speech

Location: Washington, DC


Mr. COBURN. Mr. President, I wanted to spend a few minutes this evening talking about what we think, what we think--I am going to emphasize that--because nobody has seen the bill that I understand we are supposed to vote on tomorrow morning, that spends almost $700 plus billion. We have not seen the bill. We have not seen the report language. And I can assure you that this Senator is not about to vote on this bill until he has read the bill and we will do due diligence to do that, if we ever get a copy of the bill.

But I wanted to talk about a couple of things that are important that we think are in the bill, and it has to do with health care. I have a little bit of experience in that. I have practiced medicine now for 28, 29 years. I find parts of this bill that I know when it is explained to the American public, they will agree with me, it is ludicrous.

Let me tell you the first part of the bill. There is $20 billion in this bill to pay hospitals and doctors to buy health IT. Now, at the beginning you would say, well, what is wrong with that? We want electronic medical records. We want to see the benefits that come from the economy of scale, the increased productivity that comes from IT to help us in health care.

Where this bill does not understand what is happening out there is doctors will buy health IT, and hospitals will improve--they all have health IT right now, by the way--will improve their health IT once there is a program out there that is interoperable with the rest of the program. The reason doctors are not buying programs for electronic medical records has nothing to do with a lack of money, it is this very simple reason: They know if they buy it now they get to buy it again, because none of the computers in health IT talk to each other. They will not talk.

The way to make them talk is called an interoperable standard. And a good example for you to compare, think about where we had ATMs. How did we make an ATM, where you can go anywhere in the country if you have a credit card that allows you to get cash and go into any ATM in this country and get cash. How did we do that? How did ATMs come about? They came about because the private sector, the banking industry, created an interoperable standard first. Because they had the interoperability standard, where every bank could make sure that they could talk to every other bank, they put in ATMs.

All of a sudden, voila, anywhere in the world today, if you have money in the bank and you have an ATM card, you can get money out of the bank. They did not build the ATMs first, they did not have the Government buy the ATMs before they had the standard set.

People say, well, we have taken care of that in this bill. We are going to have the Government decide what the interoperable standard is. Well, the Government has been working for 6 years to develop an interoperability standard. They are at least doing it through a private consortium now, and 80 percent of that standard has been accomplished. It will be completed in 2011. But it will not be completed the way this bill is written, because we are going to pull it all back from this public-private consortium and we are going to have some bureaucrats at HHS decide what the standard is going to be.

There are a lot of problems with that. One is nobody at HHS knows that information. No. 2 is, everything that is out there in the market today is now put at risk, so you are going to absolutely stop private investment in this area that is so much needed.

So what we are going to do is we are going to allow bureaucrats to decide what is it going to be. We are going to eliminate companies that have great ideas, because they are not going to be in the mix, and we are going to accept a standard that is not going to be the best standard.

The way HHS has it set up now with a public-private consortium was a poor way to do it, but at least it has got it 80 percent of the way there. We are going to backtrack on it. Just so you know, we are so good at spending money. We have spent $780 million already of your money trying to get this, that we are going to now throw down the toilet so we can start over and have bureaucrats exactly decide what the standard is going to be.

Well, I will predict to you, everything else we do in IT in the Federal Government, 50 percent of the money we waste. That is what our studies show. We waste $32 billion a year on IT programs that never work, out of a $64 billion budget for IT programs alone. So we are going to waste a ton of money.

But that is not the important thing in this bill. We are going to give every doctor in the country, no matter how much money they make, if they do not have electronic medical records, we are going to give them $60,000 to buy an electronic medical record.

Now, it would seem to me that with the incomes of the average physician being over $200,000, the last place we want to give $60,000 to buy a piece of software that is not going to work, that is going to have to be replaced anyway, is to those who are in the upper income in this country.

But that is probably not as important as we are going to give for-profit hospitals and the profitable non-profit hospitals $11 million each to buy electronic medical record software that still will not talk to the doctors who bought it and we gave $60,000.

The total cost of this, and what we are doing, is going to be in excess, by the time all of the problems are solved and all of the defects are figured out, and all of the wasted money, of $100 billion. This bill is going to waste $100 billion.

Now, tell me for a minute why we would give some of the most profitable companies in the country, the for-profit hospitals and the not-for-profit hospitals who last year made in excess of $6 billion--that is the not-for-profit hospitals made in excess of $6 billion besides doing the charity care that they did--why are we going to give them $11 million each to accomplish something that cannot be accomplished?

I will tell you why we are going to do it. Because some Congressman or some Senator said the way you solve this problem is to throw money at it. They haven't thought it through. There has been no development on or recognition of what is needed, which is an interoperable standard. What should we have done? Seven years ago when we started down this process, there were three great programs out there: one at Mayo--I am talking big programs--one at Cleveland Clinic, and one at Kaiser Permanente. What should we have done? We should have bought all three of those, created the ability for those three programs to talk to each other and given it away. We would have spent about $20 or $30 million, maybe $100 million, maybe $200 million, but not $100 billion. So again, Washington has messed it up. The very thing we are hoping to fix we are going to ruin. As we do it, we are going to waste $100 billion, and $30 billion of that total is in this bill.

The other interesting thing is none of this money starts rolling out until the middle of next year.

I am told I have 1 minute remaining. I ask unanimous consent for 2 additional minutes.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. COBURN. That is one of the problems with this bill.

Let's talk about the big problem. As a practicing physician, I know what physicians are taught. First, do no harm. Second, listen to your patient, and they will tell you what is wrong with them. Third, if it has already been done, don't do it again. That is what they are taught. With that comes years of experience, clinical judgment, and in-depth knowledge about people and their disease. In this bill is a statement that says: We are going to develop, through a large slush fund at Health and Human Services, a model called comparative effectiveness. There is nothing wrong with comparing effective outcomes. There is nothing wrong with trying to use clinical data to move us in a better direction. But that is not what this is about. This is comparative effectiveness to control cost.

I warn the American people tonight, if this bill goes through, we are well on the way to absolute government control of the patient-doctor relationship, because we are going to assume that there is no way that a doctor can make a better decision than a computer. I will give two examples that happened in the last 5 years in my practice, two people who came in who had no clinical signs, had no indications other than my knowing them for years and developing a suspicion that something was wrong. They didn't come with a complaint. Their complaint was something else. I ordered MRIs on both patients. They were both denied by their insurance company. I arranged for both of them to get MRIs. Both had deadly brain tumors. They never would have fit in the comparative effectiveness or the cost control mechanism that we are setting up with this so we can control Medicare costs. This is the first step for the government to start rationing the very care it says it wants to give to the American people.

The PRESIDING OFFICER. The time of the Senator has expired.

Mr. COBURN. I ask unanimous consent for 1 additional minute.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. COBURN. The American people better pay very close attention to this bill. If you are on Medicare today or if you are 55 years of age, you better be plenty afraid of the language in this bill, because it is setting up the basis with which the Government will decide what kind of care you get. We are going to use a chart. If you don't fit in the chart, you are out of luck. You are going to lose the ability for clinical skills to make a difference in your life. Talk to the people of Great Britain where cancer cure rates are lower than ours because they don't have access to treatments Americans have today.

I yield the floor.


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