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Commerce, Justice, Science, And Related Agencies Appropriations Act, 2010 - Continued

Floor Speech

Location: Washington, D.C.


Mr. COBURN. Mr. President, I listened very patiently to the last 2 hours about why we need a government-run plan. I want to concur with my colleagues about the problems in the insurance industry. There is no question they are great. But the reason the problems are great is because there is no real competition today. The rhetorical question is, you can't have it both ways. Nobody wants it both ways. The fact is, I saw this on the Internet this week. I thought it was appropriate for where we are. Here is a youngster walking on a street. She says:

I'm already $38,375 in debt and I only own a doll house.

Everybody agrees we have a too costly health care system. Everybody agrees we need to fix that. What we don't agree on is how to fix it. We have heard 2 hours of what is wrong with the private insurance industry that has not been allowed to be competitive, has not been forced to be competitive. And yet the answer to that question is that we want the government involved. The Senator from Pennsylvania talked about all the government programs. Sixty-one percent of all health care today comes through the government. Every government program is over budget, associated with fraud, and ineffective in its implementation on a cost basis. That doesn't mean we want to get rid of them. It means we want to make them better. The real problem with having the government do more is, right now 43 cents out of every dollar we are spending we are borrowing. We create a government plan. We put $60 billion into it, and we can create competition. But we don't have competition now. Everybody agrees with that. Nobody denies that we don't have good competition. But we don't have good competition because we have failed to act.

The Senator from Ohio showed a chart of CEOs' pay. If they were having to compete, that pay wouldn't be there, especially not at that level. I don't disagree with that. But the way to control that is real competition. Forty-three cents of every dollar we spend this year we will borrow. And it will be worse next year. It will be 45, 46 cents next year of what we spend we will borrow.

This picture doesn't talk about what she owes. This is just what the debt is now, just the $11.8 trillion. What she owes is another $400,000, because we are paying out of Medicare what we have never created the tax base to fund. So in fact what we are doing is, we are going to charge this little girl for our Medicare. The impact of that is when she was born she owed $400,000. By the time she is 20, she will owe $800,000. What will happen to her?

There is no question we have positive benefits with Medicare. There is no question we are taking care of people who can't take care of themselves through Medicaid. There is a question of how effective we are doing with Native American tribes in terms of that. We are seeing improvements in veterans health care.

We have all these different programs that are run through the government. So when you only have 39 percent of the health care in the country to put into the market, it is going to be very difficult to lower costs.

What is the problem with health care in America today? The problem is cost. It is too expensive. It is about 40 percent more expensive here than anywhere else in the world. Why is that? Well, there are a lot of reasons for it. But the first reason is, we will not allow real markets to develop in the health insurance industry. We have stopped it. And now we come and say: We are unhappy with it, so we want to create a government plan--a government plan that will compete.

I do not have any problem if you create a government plan if you fund it and make it competitive. But that is not what we are going to do. Because what we are going to do with a government plan is we are going to turn it into another Medicare. It will supply people health care. It will lower their costs. But we are going to transfer the cost to this little girl. It is just $440 billion spent on Medicare this year, of which $80 billion of it was fraud.

So the problem is, which solution do you think works better? Do you think we have the history that says government-run health care is efficient and effective and, therefore, we ought to do more of it or should we say: We know what works in the rest of the industries and markets in this country. Maybe we ought to allow markets to truly compete--which nobody wants to do--to force the insurance industry into a competitive structure where you can actually see what you are getting and you can see what you are paying.

The other problem about this little number is, not only does she have $38,000 in debt right now, and another $800,000 when she gets ready to buy her insurance, we are going to tell her what she is going to buy. We are going to take the freedom away from her to decide what is best for her and her family. Then we are going to yoke her with a whole bunch more taxes.

There is no disagreement in this body that we need to make changes in health care; and the assumption that anybody would say that is absolutely erroneous and fictitious. We recognize that. The question is, which way do you fix health care? Do you fix it with a government that is bankrupt already, that has stolen the future from the next two generations, and add more on to them or do we get common sense back in and say: Well, first of all, we can eliminate 8 percent of the cost if we have good tort reform in this country because 8 percent of the cost of health care is defensive medicine.

I read a study this week. It is interesting--and I have some passion about this because I have been on the end of those lawsuits--I would note that the vast majority of those who have been discussing health care for the last 2 years are lawyers. They are not doctors. They never laid their hands on a patient. They never stayed up 20 hours in a row to take care of somebody who needed them. They have all the answers, but they have never been in health care.

Here are what the numbers are on malpractice lawsuits in the United States: Eighty percent of all the cases that are filed are thrown out of court. Of the remaining 20 percent, 89 percent are thrown out of court. So 3 percent of the cases are legitimate in this country. What do you think that is costing us? And we ignore it? We are not even going to talk about the fact that we have an extortioned service going on in health care that does not cost the lawyers a thing? It costs everybody else in this country billions of dollars a year because we are doing tests that nobody needs, except the doctors to defend themselves. And that is $200 billion a year out of $2.4 trillion. That is what the number is.

So when less than 3 percent of the people--and I am all for compensating people who are truly injured. I have no problems with that. As a physician practicing over 25 years, there is no question I have made mistakes. There is no question. There are no doctors who are perfect, and, consequently, sometimes people are injured because of doctors' mistakes. Most of the time they are not. And it is not about not compensating the injured. It is about changing the mindset in this country that you can extort people into settling when you have no real claim, and that is what is going on with 85 to 90 percent of the cases.

So the answer for health care is: controlling costs. So how do we best do that? It is interesting, we have had the accusation that there are no other plans out there. My colleague from North Carolina and I introduced the first plan in Congress for health care.

What does it do versus what the Baucus bill or the public option bill will do, according to CBO? We cover 94 percent of Americans--identical to what the Baucus bill does. So 94 percent of all Americans will get covered under our bill. We save the Federal Government $70 billion in the first 10 years, close to $1 trillion in the second 10 years.

What does the Baucus bill do? It saves $88 billion, and nobody knows what it is going to save after that. But it costs the States billions. Our bill saves the States, in the first 10 years, $960 billion. We cover more people, with no increase in the cost to the Federal Government, versus a marked increase in the cost to the States by the Baucus bill, or by the public option plan.

It eliminates preexisting condition. We all agree we need to do that. Nobody is fighting that. The question is, how do you do it? Do you do it in a competitive model that costs insurance companies pain if they are not covering the people properly? And if, in fact, there is an incentive to cover preexisting conditions, then you have an incentive for the insurance companies to invest in the management of chronic care rather than ignore covering somebody.

I do not deny there is cherry-picking going on right now, but it is only because we allow it. We do not have to allow it. But the answer does not have to automatically be another long-term, bankrupt plan run by the government. Nobody can deny the $95 trillion, 100-year unfunded liability for Medicare. That is GAO, that is CBO, and that is the Medicare trustees. You cannot deny that.

So we have a program that seniors are fairly happy with, except the Baucus plan is going to cut a half a trillion dollars out of it. But we cannot pay for it. So we are not doing anything to drive that cost down, to drive in efficiency. What we are going to do is create more government, to have another plan that is going to get in the same shape as Medicare.

We all want the same thing. We want to get everybody covered in this country. We want the cost of health care to be affordable. And we do not want to bankrupt our children. We have already bankrupted them. So the danger of having a government-centered, government-centric, government-run, government-devised, government-managed health care program--just by history, look at what we have done.

Medicaid costs tons more than it was ever supposed to cost. SCHIP costs tons more than it was ever supposed to cost. Medicare costs tons more than it was ever supposed to cost. Indian health care--it does not cost more because we just let them suffer. We do not put the money into it. VA costs tons more than it was ever supposed to cost. TRICARE costs more than it was ever supposed to cost. They are all government programs. They are all way over budget.

So the question the American people ought to ask is: If we all want to get everybody covered, and we all want to drive down costs, does the government have a track record that says it has done that? No. As a matter of fact, it has done the opposite of that.

So it is not a matter of whether you trust in government. We have 61 percent of health care running through government. And as a physician who has practiced for over 25 years, I will tell you, it is my opinion the reason costs are out of control is not because of the insurance industry--and I am not a defender of them; as a matter of fact, I hate them about as bad as I hate anybody telling me what I am going to do to my patient--the problem is, we have directives coming from the government that have disrupted the market in health care and created this tremendous differential.

The other difference that we have in the Patients' Choice Act is that we do not put another burden on the States, which all these bills do. The States are swimming in debt. They are struggling to stay ahead, and we are transferring billions, almost--we are transferring trillions of dollars of expense to the State. We are making it nice for four States. We have picked four States and we have said: You don't have any cost the first 5 years. We just, out of the hat--because they are having a little worse economic time than others, we have said: You don't have it. But for the rest of the States, it is the mother of all mandates, and they will never be able to afford it.

There is also another little sneaky provision in the bills--both in the HELP bill, the House bill, and the Baucus bill--which is, we know we are not going to cut doctors' fees 21 percent. The Presiding Officer would agree to that, the Senator from Colorado knows we are not going to do that. But we are not going to recognize it. We are not going to recognize that cost. So we are playing games with the American people. We are saying: Here is what it costs, when we know it is going to cost a lot more than that because we know we are not about to do that. But we do not have the courage to admit that. We do not have the courage to ask for an honest score.

The other difference is, we empower patients and States, not bureaucrats. We preserve the right, the inherent individual liberty right, of an individual to decide what is best for them rather than having the government decide what is best for them. In our bill, 9 out of 10 Americans get a tax cut.

So let me draw the parallel again. We do not have a government-run program. We save the Federal Government money. We save the States $1 trillion. We get more people covered than any other plan that is out there. Nine out of 10 Americans get a tax cut. We eliminate preexisting illness. And we bend the cost curve down considerably.

And, oh, by the way, we do not destroy innovation in health care, which is 75 percent of the innovation in the world, which will go away if any of these other plans are instituted--the incentive to put capital at risk to create opportunity for medical innovation.

There is a lot I could say, but I think what I would like to do is yield to my colleague from North Carolina in terms of someone who has been with me, who knows health care, who has been from the start working with us to try to put forward a plan that says we can accomplish this same thing and save tons of money.

Mr. President, I yield to my colleague from North Carolina.


Mr. COBURN. I thank the Senator. I am sitting here thinking, if I was sitting at home tonight listening to this, how do I hear the story that I heard for 2 hours on having a government-run plan and how bad the insurance industry is? As a physician, I don't like them a whole lot, I can tell you that. I don't like some of their tactics. I certainly don't like the way they cancel insurance policies on people. There is a lot about them I don't like. But I don't want to eliminate them. What I want to do is create a real market where they have to be savvy and compete and they have to be efficient and they have to help us help one another get well.

We are going to hear a lot over the next month on health care. We are going to hear all these claims, much like we did from Congressman Grayson, who made an outlandish claim that my side of the aisle wants people to die. That is what was said in the House of Representatives. What I want is people to live. I want this little girl in the picture to live too.

Do we have an unsolvable problem? No. Do we have ways of making health care costs much less in this country? Yes. Do we have ways of ensuring increased innovation and advanced disease prevention in this country? Yes. Do we have ways to protect this little girl in the photo? Yes. But the debate is over how we do that. One side says we do it by making the government a whole lot bigger--$1 trillion bigger, $3 trillion bigger over the next 20 years. That is one side of the debate.

Our side of the debate says this is inefficient health care. We want to cover everybody. We never want anybody to go bankrupt or to be denied care. We think you can do that without growing the government by 25 percent. We think there are other ways to do it. We are honestly worried about our track record in Washington when we have a $1.4 trillion deficit this year and a Medicare Program that is absolutely bankrupt--it will run out of money in less than 7 years from now, totally out of money--and we are going to be borrowing it all then. Is there another way to do it? So either we make a large jump in the size of the Federal Government and add to the $838,000 that this little girl is going to have, or maybe we can work together and say the insurance companies are bad, but can we keep something like that and make them efficient? Can we allow people to buy across State lines? Can we give people opportunities to buy what they want to buy rather than being limited? Do we trust people to make good enough decisions for themselves?

The Baucus plan doesn't do that. It says we have three or four plans from which you get to choose, but we are going to tell you what you have to buy. And, by the way, you have to buy insurance in this country. Think about that.

I carry with me a copy of the the U.S. Constitution all the time. Every bill out there has said you don't have liberty because the Federal Government is going to tell you where you have to spend your money. You have to buy an insurance policy. So if you make a quarter million dollars a year, it doesn't matter if you want to fund that self-insurance, it doesn't count. You still have to do that. If you don't, you are liable to a tax. If you don't pay the tax, a $25,000 fine. If you don't pay the fine, you are in jail for a year.

How do we get off telling people that and taking away that liberty, that freedom that is supposed to be guaranteed under the Constitution? The answer is, well, it is better for everybody because if we don't have everybody covered, then it is going to cost more because that is the big government answer to it. Maybe it will cost more if we force and drive competition, if we create transparent markets, where you know what something costs before you get it in health care. In fact, there is a real connection with the purchase of health care and the payment because everywhere we have tried that, it is working to control health care costs. But we refuse to do it.

Frankly, the reason our idea is rejected, which is changing the Tax Code to treat everybody the same under the Tax Code, is because the labor unions don't want that to happen. That is exactly why. Everybody knows that is the problem. Everybody in the country knows that is the problem, but we don't have the political courage to face up to how to fix the problem.

As soon as you make everybody the same under the Tax Code, you empower 35 million Americans who don't have insurance today to get it. You save the States $1 trillion over the next 10 years, and you give 95 percent of Americans a tax cut, and guys like me will pay a little bit more for my health insurance and income tax. But we will not do that because the powers that deliver politicians to Washington are more powerful than the principles and the character to follow the pursuit of the Constitution.

This little girl in the picture, and everybody like her in this country, is at risk today. We are going to have this great big debate and say how bad the insurance companies are and how bad the government programs are. But the fact is, we don't have a bipartisan bill. Our ideas were thrown out, 13-10, at both the Finance Committee and the HELP Committee--13-10, 13-10, 13-10--because the idea is they didn't want a compromise bill. They didn't want to solve the problems. They wanted their way or the highway.

So, consequently, we are going to get a bill. I have no doubt. But my little Lucy right here and her football--she is going to lose her football. She is not going to have any little Lucys because she is not going to be able to afford them. She is going to be paying off her $800,000 worth of government obligations starting at age 20, and she will never climb out of the pit.

So when America thinks about health care, there are a lot of ways to solve it. One is to trust what makes America great--granted, with some changes--or the other is to trust the government to create more government programs.

I will just add this one point. Do you realize that in the bill that passed the HELP Committee there are 88 brandnew government programs--88; 219 times we have held the Secretary of HHS to write in-depth regulations. Now, 88 programs interfering in health care are going to be problem enough. But 219 new sets of regulations--oh, by the way, we created the comparative effectiveness committee with the stimulus bill, and we are going to have 26 people tell every doctor in the country how they are going to practice medicine, what is right and what is not right. And, by the way, in all the committees a prohibition on rationing was voted down.

What are we to think? We are going to create a large government program and grow the government by $1 trillion over the next 10 years, $2 billion-plus, maybe $3 trillion in the next 10 years, and we are going to have Washington tell people how the physicians and caregivers will treat, what they will use to treat, and all the time little Lucy will not matter if she gets sick. We will have already made her sick because we have stolen her future, her absolute future.

It is a cute picture, but it sends a devastating message to us as leaders in this country. How dare we do that. I wanted to bring out my other charts tonight, but I didn't want to bore everybody. The fact is, the appropriations bills that were passed--if we keep doing what we are doing--America, hear this--we are going to double the size of the Federal Government in 3 1/2 years.

We passed the Agriculture bill today, which is 22 percent bigger, and it was 15 percent last year, and that doesn't count any of the supplemental and the stimulus money. It doesn't take long, if you are growing something at 22 percent, for it to double.

My gray hair comes from the fact that I think we are missing a great opportunity to work together. I think we can solve the health care problem. I think we can do it without enlarging the Federal Government. Especially when we pay 40 percent more than anybody in the world, there ought to be savings that we can get to make health care cost less and to cover everybody else. I know we have seen the studies that show that.

So why isn't it going to happen? Why isn't there going to be a bipartisan bill? It is all political. It is not about the people in this country, it is about the political power structure in this country.

Problems can be solved, common sense applied to limited government and restoring freedom to individuals.

There are going to be so many lawsuits in this country, most of them legitimate, over the health care bill. You will not be able to uphold a challenge to the Constitution of forcing me to pay, take my money that I earn privately and spend it on what you say I have to spend it on. It is one of the greatest denials of liberty I ever heard of, and it is going to get challenged. It is going to go through the courts fast, and I suspect the courts are going to uphold the citizens of this country rather than the power center.

I yield the floor or I yield back to my colleague from North Carolina.


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