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Mr. COBURN. First of all, let me say my biggest concern for my patients in this whole debate is, will the American consumer still have the power and the ability to select who is going to give them this most personal of all care when this is over? The answer to that is ``no.'' It is not ``no'' for everybody, but it is a ``no'' for half of the American public. That is what it means.
Mr. McCAIN. Would it be ``no'' for the individual who has employer-based health care and that employer then opts for the so-called public option, which would be a government-run health program? Could that employee see the same doctor?
Mr. COBURN. We don't know, but most likely half of them will not. The whole debate ought to be how do we get more value out of the health care system we have today rather than how do we add more money to the cost of health care to cover more people.
The reason my patients have trouble getting care is cost. Right now, they have choice, except if they are in Medicaid, and they have some choice if they are in Medicare because we are seeing a larger and larger percentage of doctors who cannot afford to take the Medicare reimbursements. But can they afford the care? This bill does nothing to lower health care costs. It does nothing to lower health care costs.
Mr. McCAIN. Isn't it true, in fact, that the Congressional Budget Office has said that these increased costs, at least half of them, will be passed on to the individual?
Mr. ALEXANDER. I would say to the Senator from Arizona, that is exactly right. The Congressional Budget Office did an analysis of the impact of Senator Baucus's plan on insurance premiums. It showed the premiums for those in the individual market would go up. So, to the point of the Senator from Oklahoma, one of the effects of the one remaining bill that is being considered here, at a time when we are trying to reduce the cost to Americans of their policies and their government, is that premiums would go up.
Mr. COBURN. Premiums will.
Mr. McCAIN. I have one very important question. There is no one who has led the fight against waste, fraud, and abuse more than Dr. Coburn!.
Dr. Coburn, the President keeps saying we will eliminate all this fraud and abuse and waste. If we can, why don't we start tomorrow?
Mr. COBURN. I agree. We have offered for years a couple of ways to do this. I think it is important for the American people to know how much there is. The Department of Health and Human Services estimated in 2007--that is the last year for which they have numbers--that $62 billion was improperly paid out of Medicare. The GAO, when they looked at that report, said: No, you are way off. It is at least $85 billion, and we think it is higher.
If you look at that, that is almost 20 percent--20 cents out of every dollar--Medicaid pays out is lost to fraud. Why wouldn't we fix that first rather than say that if we fix it, we are going to take it from Medicare and put it somewhere else, when the trust fund, the HI trust fund, the hospital insurance fund, is going to be belly-up in 2017?
Mr. ALEXANDER. Mr. President, I ask Senator Coburn, isn't it true that, under the Baucus plan, about half of it would be paid for by Medicare cuts, which would then be spent on a new program?
Mr. COBURN. That is right. And Medicare is already unsustainable. So what is going to happen? There is another factor, which is we have it fixed that, with this bill, there will not be a big cut to the payments to doctors under Medicare. But in the years that follow that, there will be a 25-percent cut. If access is a problem for Medicare patients today, it is going to get worse. It is part of the lack of truth in this bill that they do not address what we have set in motion to take dollars away from the health care industry.
Mr. McCAIN. May I ask Dr. Coburn again, if we start tomorrow, what can we do?
Mr. COBURN. The first thing is you put uncovered patients in the Medicare system and you put people in jail who are defrauding Medicare. If 30 or 40 doctors went to jail in the next 6 months in this country, you would lower Medicare costs by 10 percent because all of a sudden they would start thinking about: I can't skirt this. I can't play this game. I can't do it. The risk is too high.
As a matter of fact, here is one of the things we know. In Florida, the drug dealers have switched from being drug dealers to Medicare suppliers because they can make more money defrauding the Federal Government. It is harder to get caught and the penalties, when you are caught, are less than when you are dealing drugs. Consequently, we have all these people in the business of defrauding Medicare, and there has not been a plan that has been effective in cutting Medicare fraud because nobody knows--and the government is all about Medicare. So it, by its very design, is designed to be defrauded. We should make structural changes so it is not and with that get better care and lower cost care, like paying for outcomes rather than paying the American Medical Association to use their CPT code.
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