Recognition Of The Minority Leader

Floor Speech

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Mr. COBURN. Mr. President, I thank you. I appreciate it. I sat here and listened to my colleagues to hear their input. I find it extremely peculiar that the only industry for which you would limit their taxes is one that has not struck a deal with the committee. The only one. Pharmacists are going to spend $70 million advertising for this bill. The other industries are putting up additional moneys to advertise for this bill. The only industry that we are going to restrict is the industry that is in opposition to what we are doing. It is interesting.

Senator Cornyn made the point with me a moment ago that we are going to take $450 billion, and we are going to give it to the very industry you are talking about. We are going to take $463 billion from Medicare and give it to the same industry you are now criticizing.

Senator Baucus said--and let me quote--he said: As we tried to work this, it was ``rough justice'' to put this agreement together. This is democracy.

It was done behind closed doors. That is not democracy. It was done behind closed doors. The Senator from Arkansas asked why we have not brought forward something. The Senator from Massachusetts asked. The first bill introduced was the Patients' Choice Act.

I commend to my colleagues a white paper by Thomson Reuters, a very well respected firm, talking about the $600 to $850 billion worth of waste in the health care system today, entitled ``Where Can $700 Billion in Waste Be Cut Annually From the U.S. Healthcare System.''

The reason we are concerned about $465 billion coming out of Medicare, to be paid to the very insurance companies you are going after right now, is because we are not going where the real waste is. The promise of the President was to cut the cost of health care. Right here is where it is. This bill does not touch it.

There is $175 billion a year in fraud in the health insurance industry. You all go after $2 billion of it--$2 billion. There is $175 billion a year in fraud. What is in it? Nothing. We are going to manage to pay a private industry, but only the private industry that will not play along behind the closed door, rough justice of democracy in this country.

When Senator Corker asked the chairman of the Finance Committee, Why are you taking the money from Medicare and using it somewhere else, rather than extending the life of Medicare, he did not answer the question. The fact is, there is a $44 trillion--according to the latest calculation, if you go to the Medicare trustees: $44 trillion--counting what has been borrowed--unfunded liability over the next 75 years for Medicare. We are going to take $ 1/2 trillion out of that program that we all know is going wrong. And I do not doubt the motives of anybody here. I just think we are misdirected. And we are going to take that and spend it on another program. That is where people ought to be concerned.

It is interesting--I will submit another document for the Record. This is a report from the Congressional Research Service, released December 1, 2009, at my request.

I ask unanimous consent that document be printed in the Record.

There being no objection, the material was ordered to be printed in the Record

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Mr. COBURN. Here is what it says. I asked them what percentage of health care today is run through the government. You might be interested to know it is 60 percent. As the Finance chairman responded on why we were fixing it, we are going to create 70 new government programs in this bill--70 new government programs in this bill--and we are fixing the government programs we have now. And we wonder why health care costs are out of control? They are out of control because the government is running 60 percent of it now, and there is no competition for that 60 percent.

Nobody is going to defend outlandish salaries, but it is interesting, we are not going after the outlandish salaries of the companies that are going to spend $80 million to support this bill, the pharmaceutical companies. We are not going to go after the salaries of the people who run the hospitals who, on average, make more than $1 million a year. We are not going to do any of those. Only the ones who say: Wait a minute. Maybe this is not such a good deal.

Mr. President, I commend to my colleagues a document entitled ``Impact Of The Patient Protection And Affordable Care Act On Costs In The Individual And Small-Employer Health Insurance Markets'' from Oliver Wyman and Associates, because what you claim you want to do is going to create 11 million young people who are not going to have insurance, and for those who remain, their insurance is going to cost twice as much.

The PRESIDING OFFICER. The Senator's time has expired.

Mr. COBURN. Mr. President, I thank the chairman for allowing me to respond.

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Mr. COBURN. Madam President, we have been discussing health care in Washington for the past 8 months rather vigorously. Four years ago I started working on a bill with my colleagues in the Senate and we introduced a bill 2 years ago and modified it this year. It was introduced before the House bill, it was introduced before the Senate bill. It was introduced before the bill we have on the floor at this time. It is called the Patients' Choice Act.

We have heard several times that the Republicans want to stop this. As a practicing physician, I fully recognize the need to significantly reform health care. There is no question. I recognize that. In that bill is a guaranteed issue--no preexisting conditions are allowed in exchanges under our bill. But I also recognize that as we fix health care, some of the things we cannot do are make our fiscal situation worse and also our inefficiencies worse.

Earlier today I referred to research put out and published in October of 2009, which is a white paper on the waste in our health care. This is Robert Kelly, vice president, Health Care Analytics, at Thomson Reuters, a highly esteemed, reputable firm which says that every year between $600 and $850 billion of money is wasted in health care. It is wasted. It doesn't help anybody get well and it doesn't prevent anybody from getting sick.

When you look at the breakdown of where that comes from, it is rather apparent that the largest component of it is unwarranted use. They break that down. What is that? That is me as a physician--I am a practicing physician, delivered thousands of babies, cared for thousands of grandmoms, granddads, kids, set bones, done operations--old-time, broad-based practice.

But what is this unwarranted use? Madam President, 40 percent of $700 billion is $280 billion a year. They are saying a total of $700 billion, times 10 years in my math, at least from Oklahoma, is $7 trillion.

We have not begun to touch in any of these other bills this unwarranted use, the fraud and abuse--19 percent--that comes to $175 billion a year in fraud. Most of it is not in the private sector, it is in Medicare and Medicaid. That is where most of the fraud is. We have not begun to touch that, we have not attacked it. There is a minimal $2 billion over 10 years of direct fraud elimination in the bill we have on the floor.

Administrative inefficiencies. That is the bureaucratic paperwork that both the hospitals and the doctors spend money on to make sure they maintain compliance with the regulation of medicine--17 percent. That 17 percent comes to somewhere between $100 billion and $150 billion a year that does not help one patient get well. It doesn't prevent one patient from getting sick.

In this unwarranted use happens to be the very thing that none of the bills attack, except our bill, which is the defensive medicine costs in this country. Why would it be important to fix that? Because it is close to $200 billion a year. That is $200 billion of tests that are ordered on patients, on procedures that are done on patients they do not need, because the doctors need to do it to prevent themselves being exposed to unnecessary litigation. That is $200 billion a year, that is $2 trillion over 10 years. Yet we do not address it, not one iota in the bill we have on the floor.

Avoidable care--those are complications. Those are things that we cause. Iatrogenic, they are induced complications. We are not going to be able to do much with that. We could fix this--lack of care coordination with accountable care organizations--by incentivizing outcomes, by grouping in payment for how we pay. But we have not done any of that.

So here is Thomson Reuters that is showing if we want to drive down costs in our health care system, what do we have to do? We have to attack where the waste is. There is nary a gnat's rear end of reduction in these things in the bill that is before us.

The other thing I referred to earlier today was a report by the Congressional Research Service, which was issued December 1, this year, last week. What did they say? The question that was asked of them: What percentage of health care is run or funded by the Federal Government today--or the governments today? The number came back--I have been quoting 61 percent on my back-of-the-envelope calculation. The number came back, as affirmed by Congressional Research Service, that 60 percent of all health care in America is funded through or by your tax dollars funding through a government organization.

The question has to be asked: How well are we doing? Could there be any coordination or connection to the fact that the government is now running 60 percent of the health care, and health care inflation is twice what all the rest of the inflation is? Could there be any connection between the inefficiencies that are in health care and the fact that we have bureaucracies that have themselves in between patients and their providers? I think the answer to that is an astounding yes.

I visited with a cardiovascular surgeon, because I have made this statement on the floor and people have disputed it.

Find me a doctor who has trained in the last 30 years in this country, who spent part of his training at a VA medical center, and ask him or her the following question: If you or your family were sick and you had the choice of where you trained at a VA hospital or any other hospital you trained, would you go to the VA hospital or would you go to one of the private hospitals where you trained? One hundred percent will say no.

Our VA system has markedly improved. I will readily admit, in certain areas, they are better than anybody else, especially prosthetics, especially post-traumatic stress disorder. They are better. But on the vast majority of the issues, they are not. They are run by the government. Look at the Indian Health Service. We have a profound legal treaty obligation to provide health care to Native Americans. Yet Indian health care is abysmal. That is a government-run program. Then look at Medicaid, which we are going to put millions of people in. What happens? In Medicaid, 40 percent of the doctors and 65 percent of the specialists will not see you. But we are going to say: We will give you coverage in a system where you have access to only 60 percent of the doctors. That is not choice. That is relegating you to a system that says you can't get care.

I have talked on this floor about pediatric subspecialties. Because of Medicaid, we have an absolute dearth of pediatric subspecialties because the payment mechanism is so low that nobody will spend the extra time in residency to become a pediatric subspecialist. Whether it is a cardiologist or gastroenterologist or pediatric neurologist, we can't find them. Nobody will go there. The rates for reimbursement are set so low. So physicians graduating from medical school make an economic decision based on the health and well-being of their family to not go into those areas because we have forced them.

What we know is, there are poorer health outcomes in Medicaid. That should not be surprising. Some of the best doctors are not available to Medicaid patients because we will not pay for their expertise. We also pay an extra $1,800 per family, everybody in this country who has insurance, because of the underpayment of Medicare and Medicaid. Finally, with the large tranche of people under this bill who are going into the Medicaid Program, we are going to break the States, if they are not broken already. We are going to cover it for 4 years. For certain States, we will do a whole lot better than that; Louisiana and a few others for which we have made special exceptions. But we are basically going to transfer a load of fiscal responsibility, call it equal, and put that load on the taxpayers of the individual States.

As we look at health care, one of the things I wished to do was to talk about the problems but also talk about the bill we have before us and make this point. Are we better off with the government running health care or are we better off changing the system in such a way so the patient is put first, the government is put last, and the doctor is a 100-percent advocate for their patient? Which would be the better way? Knowing that we have $7 to $800 billion a year wasted, why would we not design a system that goes after that waste and create the same opportunity for everybody?

When you look at the Patients' Choice Act, which my colleague, Senator Burr, will talk about in a minute, there are some important things. First, let me tell what the CBO says about it. The CBO says it will reduce future budget deficits, relative to protections under current law, by amounts that increase over time--the first 10 years, $70 billion. But what it will do for the States is $1 trillion in savings the first 10 years. It will lead to lower budget deficits. That is what the CBO said. It said it also would reduce spending on health care because it will be more efficient spending. Then, finally, the Federal contribution for Medicaid would grow at a lower rate, lower than health care inflation, which means it is going to save a ton of money for the States.

The bill we have before us creates 70 new government programs. It has 1,696 times that we will write bureaucratic rules and regulations that are going to cause the government to step between the patient and their caregiver. It is estimated, right now, to add somewhere around 20,000 new Federal employees--we are trying to get a handle on that--20,000 new Federal employees to tell you what you will and will not do in your health care. It is going to create at least $5 to $10 billion in new requirements for the Internal Revenue Service just to check on you. That is per year to check on you to make sure you are filling out the forms right. It will create a massive disruption in the insurance market.

Nobody who practices medicine today likes insurance companies. The very fact that we would have our colleagues claim we are defending the process is absurd. What we are defending is allowing the free market, with legitimate regulation, to allocate a scarce resource without putting the patient second. There is a big difference. I can tell you horror stories about insurance companies, but I can tell you worse stories about the Federal Government and the fact that it denies twice as many claims per 10,000 claims as all the other insurance companies.

So when we are talking about access to care, both of the bureaucracies are a nightmare. Yet this bill creates the mother of all bureaucracies, the mother of all new programs.

I will make one last point and yield the floor. We have been down here fixing things that are wrong. We fixed the Preventive Services Task Force. We said it doesn't apply to breast cancer screening. That is what we said. We voted for it. It doesn't apply. Are we going to pass that every time? We didn't get rid of it. We didn't get rid of the Medicare Advisory Commission. We didn't get rid of the Comparative Effectiveness Panel. Every time they make a bad decision, are we going to pass a law and say: You were wrong or are we going to trust the professionals, the professional societies that guide my practice of medicine today or are we going to have a bureaucrat and a bureaucratic system that says what you will get and what you won't? Under the bill we have, you are going to have that. We have taken the hot potato off the floor in terms of breast cancer, in terms of what they said. We said it doesn't apply. We passed something for women's health which I applaud. But what about men's health? What about children, what about prostate screening for men? What about colon screening for men? What about cardiovascular screening for men? We didn't do a thing. Why didn't we? Because we know a larger percentage of the emotional attraction has to do with those things associated with women. So we pounded our chests and passed the Mikulski amendment for preventative care for women, and we ignored the preventative requirements of everybody else. How does that fit with what we should be doing?

It doesn't connect. It is political. It makes good news. It satisfies vocal interest groups. But does it fix the long-term problem?

I yield to my fellow Senator from North Carolina.

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Mr. COBURN. Madam President, will the Senator yield for a question?

Mr. BURR. I am happy to yield.

Mr. COBURN. Does the Senator recall the vote in the HELP Committee when this bill was offered--this bill that allows you to keep whatever you have, if you like it; this bill that gives no tax increases on American families; this bill with no increase in taxes on American business; this bill that lowers everybody's health insurance premium; this bill that covers preexisting conditions, period; this bill that protects seniors' high quality of care and keeps their choices; this bill that increases personal control over health care; this bill that does not do a Medicaid expansion but, instead, puts Medicaid patients into real insurance so they can have the same choice as every other American; this bill that protects physician-patient relationships; and this bill that empowers patients, families, physicians, and providers, but does not empower the government--what was the vote, does the Senator recall?

Mr. BURR. All the Republicans voted for it and all the Democrats voted against it.

Mr. COBURN. Exactly right. The difference is, you can either trust people or you can put all your trust in a nanny state, and the nanny state is running 61 percent, 60 percent of our health care today.

I thank the Senator for answering my question.

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Mr. COBURN. Madam President, I want to go back over some of the things in the Patients' Choice Act because people ask me why they have not heard of it, and it is because the press does not want to cover a commonsense bill that does not spend money. The majority does not want to incorporate the ideas because it is not government-centered, it is patient-centered. We have a bill on the Senate floor that is totally government-centered.

But what does the Patients' Choice Act do? Senator Burr alluded to a lot of it. But I want to go into it in a little bit of depth.

What it does it is looks at the five preventable diseases in this country that consume 75 percent of our dollars, five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. They cause two-thirds of the deaths and consume 75 percent of our dollars. The Patients' Choice Act invests in preventing those diseases.

The second thing it does is it creates affordable and accessible health insurance options--not government-run, not government-mandated, but uses the experience of 50 States through exchanges and sets a floor. What is the floor? The floor is the same level of care Members of Congress can get. That is the floor. But you get to choose. Nobody says you have to have this.

Do you realize that 15 million Americans who are going to be forced into Medicaid in this bill will not have any choice? They will just say: You have Medicaid. And they will be denied 60 percent of the doctors in this country.

It eliminates preexisting conditions. It eliminates the ability of an insurance company to drop you if you are sick. You get offered health insurance regardless of your age or regardless of your health. Yet we are saving trillions, and they are spending trillions.

What is the difference? What is the disconnect? It gives you, as Senator Burr talked about, an auto enrollment mechanism. If you choose to be irresponsible, that is fine, but the rest of us should not have to pay for your irresponsibility. So if you do not sign up, you have an automatic enrollment with your tax credit that puts you in a very high deductible plan, so if you have a catastrophic illness, the rest of us do not have to pay for you.

It also allows States to join in pooling arrangements, or regional areas, where they increase their buying power through these exchanges.

Whatever you have today, if you like it, you really can keep it. That is not true in this bill that is coming across the Senate floor. There is an absolutely zero tax increase on American families, and it is not true in this bill on the floor. There is $500 billion worth of tax increases on either families or businesses.

It lowers the cost of health insurance premiums. This one on the floor says, at best, in the large group and medium group market, it is going to be about the same trajectory of twice the inflation rate. But if you are in the individual market, it is going to be 10 to 13 percent higher. Our bill lowers everybody's cost.

It protects the seniors' high-quality care and choices today. It doesn't pick winners and losers; it allows patients to pick what is best for them. It increases patients' own personal control over their health care, and it converts Medicaid to a system where no longer are patients in Medicaid discriminated against because what we do is we buy them an insurance system--allow them to buy insurance where nobody will ever know they are a Medicaid patient, so nobody will ever know to deny them, because the patient rate will be equivalent to anybody else in the insurance market. So we give them the same access.

We treat Medicaid as we treat Indian health care: Here is your health care, but it is not as good, so tough it. Here is your health care. We know the outcomes aren't as good. So what. Those aren't Tom Coburn's opinions. Those are published data where we know the outcome in Medicaid isn't as good as any of the other insurance programs or it is not as good as people who are in the cash market even though they pay more.

It protects patients and their caregivers' relationship. Finally, it empowers patients. It empowers mothers to make choices for their children; gives them a broad array of choices. It empowers, but it doesn't empower the Federal Government.

The Federal Government is failing in health care right now. It really isn't my ingenuity that came up with this chart, but since I am around my three daughters and a lot of younger people who work for me on my staff, this is a comparison of the Patients' Choice Act or the act we have here. It is like comparing old Ma Bell to an iPhone.

The Patients' Choice Act is the iPhone.

A little over a decade ago, iPhones or even cell phones in general--who would have thought they would be so widespread? Apple's iPhone was the fastest growing smartphone of 2008, and its 2008 sales were 2 1/2 times higher than 2007. Why the increase? Why did iPhone sales take off? What did they do? They are hugely popular because they are user friendly and they allow tons of options and you get a personalized iPhone experience that you control.

So what does an iPhone have to do with health care? Both sides of the political aisle rhetorically agree that American consumers prefer products that are personalized, that fit their needs, that are affordable, and that are portable. It sounds a lot like an iPhone. As a matter of fact, my colleagues across the aisle are now using the language ``choice and competition'' to try to sell this monstrosity on the American people, the most massive expansion of Federal Government control since Johnson's Great Society.

The problem is that the policies in this bill would discard the iPhone's individual choices and consumer control. But what it would embrace is Ma Bell, the old land line black phone with a rotary dial. That is what we are going to embrace with this bill. We are not going to embrace the iPhone; we are going to embrace being locked to your house with limited choices, limited capability to expand your choices, and limited freedom.

Mr. BURR. Would the Senator yield for a question?

Mr. COBURN. I am happy to.

Mr. BURR. My question is this: It sounds as though the Patients' Choice Act allows an individual to design the coverage to meet their age, their income, and their health condition.

Mr. COBURN. Absolutely right.

Mr. BURR. That is customizing your health care choice.

Mr. COBURN. It puts the consumer--i.e, the patient--in charge of their health care rather than the government in charge of their health care.

Mr. BURR. So one could then conclude that the current legislation we are debating in the Senate not only limits but it takes away choices that currently exist to seniors, to people who work, and to the younger generation.

Mr. COBURN. I don't think there is any question that is going to happen. Actually, it is even going to be worse than that because we have shrunk the differential for young people. If you are a young person, listen to me. The cost of your insurance is going to double under this bill. If you are a young couple or a young individual--and I am talking 40 and under, 24 to 40--your insurance is going to double under this bill. What you are going to do, you are going to do this: You are going to say, I am going to pay the tax rather than coverage for insurance because it is financially much more important for me to do that. And what we know is that between 6 million and 11 million young people are going to cancel their insurance under this bill, according to a report put out by--and I will reference it here--Oliver Wyman and Associates.

Mr. BURR. But typically children are a lot less expensive to insure because they are younger and they are healthier.

Mr. COBURN. What do you think is going to happen?

Mr. BURR. What happens?

Mr. COBURN. What is going to happen is the spread--the people who have insurance, if you are over 40, because these young people drop out, your premium is going to go up. So what is available today because of the mix of people who are in the broad group of pools who are insured--we are going to drop out young, healthy people, so that small younger group insurance is going to go up. But because there are going to be 6 million to 11 million fewer of them and the insurance company keeps them in the pot to lower the cost for the older ones, the 65 and above, their premiums are going to go up.

So we are going to have exactly the opposite effect because when you mandate coverage and you force people to buy it with a big government program, people are going to make an economic decision--and the first year of this is $250 is all you have to pay, and it goes up to $750--they are going to say: Why would I do that? I will buy the insurance when I get sick.

So what we are going to do is totally disrupt--and it may be planned to be that way so we can come back and say: Well, look at the private insurance industry. It is not working. The government needs to take it all over. I don't know that is the case, but the consequences of what this bill is going to do----

Mr. BURR. From the way the Senator has described it, the current bill that is being debated in the Senate really doesn't benefit anybody. Everybody loses.

Mr. COBURN. Oh, yes, it does. We will have at least 20,000 new Federal Government employees. It will benefit them. It will benefit the bureaucracies. It will give them power to control. It is not a soft control or a light control; it is a heavy control. We will mandate on States bankruptcy through Medicaid--mandate to the States--the mother of all mandates to the States. So it will benefit the Federal Government and the bureaucracy but will have minimal benefit for the patients in this country.

Mr. BURR. So at best, we can claim that the bill being debated in the Senate is a $2.5 trillion bill designed to try to stop waste, fraud, and abuse in the health care system.

Mr. COBURN. Supposedly.

Mr. BURR. Think about that. We are spending $2.5 trillion to try to get waste, fraud, and abuse out of just the government side of health care. Yet the bill itself is making the government a bigger factor in health care, which means the likelihood is, because of the design not changing, you have more waste, fraud, and abuse. So there is no real value to the $2.5 trillion, except to the government workers who are hired to either collect the fines and the new taxes or sit on the panels to determine who gets coverage and who doesn't.

Mr. COBURN. Well, I wouldn't go quite that far. There is no question that some people who have no coverage today will get Medicaid. But compared to the Patients' Choice Act, they could get a private insurance policy instead of Medicaid. They would get access to all of the physicians, not just 60 percent of them.

Mr. BURR. And save $2.5 trillion of the American people's money.

Mr. COBURN. And save $2.5 trillion and have the flexibility of choice based on what they need and what they perceive their children or family needs.

So they do increase coverage, but how do they do it? They put you into a substandard plan. They put you into a plan that doesn't give you the same access Members of Congress have. They put 15 million people into that, and they decrease the flexibility and choice for those people, 11 million people, in Medicare, because we know better.

Mr. BURR. My good friend probably remembers the day we marked this up in the Health, Education, Labor, and Pensions Committee. As a matter of fact, it wasn't a day, it was 3 1/2 weeks and 56 1/2 hours, if I remember exactly. One of the amendments they accepted was an amendment that is titled this: The 2220 rule. My good friend being a doctor would recognize this was a program the Federal Government had to allow medical students to delay the repayment of their student loans until they actually got their practice up and running. That was eliminated about 2 years ago. I am sure the good doctor remembers that was accepted under a UC in the committee. But if you read the 2,074 pages, it was noticeably absent in the 2220 rule. Yet, as you know, we have less than a million doctors in the United States of America trying to provide medical coverage to 300 million people and growing. And some suggest that if this bill passed, we would lose 25 percent of our doctors in the first year who decided: This is it. I am going to retire. I am out of here.

The 2220 provision is the only thing we had in our bill that actually created an incentive for more individuals to seek medicine as a career.

Mr. COBURN. Madam President, if I may inquire how much time we have remaining.

The PRESIDING OFFICER. Nine minutes.

Mr. COBURN. Thank you.

Again, going back to incentive, carrots versus sticks, how is it that we have a shortage of primary care physicians in the country? Why is that? We have put a lot of money into medical schools. The States have put a lot of money into medical schools. We have student loans for physicians who average about $170,000 in debt when they get out of there. How is it that people don't want to be a pediatrician and a general internist or a family practice doctor? Why is that?

Mr. BURR. Reimbursements.

Mr. COBURN. The reimbursements, where you can invest 1 additional year in residency and double the income you can make from being a physician.

How did the payment rates get where they are? Who set the payment rates? The Federal Government set the payment rates because 60 percent of the payments to private physicians come from Medicare, Medicaid, TRICARE.

Mr. BURR. Indian Health.

Mr. COBURN. Those are contracted. Those are even lower. So they set them. Private insurance sets all the rates based on what the government does. So the government has created a shortage of primary care which we are going to see just explode as we put other people--the CBO has rightly said, if you add lots of people, you will get some increased utilization, a significant amount. They are not there. They are not there.

So you take somebody in their late fifties, mid- to late fifties or early sixties, who planned on practicing 10 or 15 years, and all of a sudden you say--and we don't in this bill. We had the claim today that this extends the life of Medicare. Well, here is how it does that. It uses the Medicare Advisory Commission to force cuts in Medicare, not fraud necessarily, just cuts. It doesn't pay for the doctor fix, which is $250 billion, and then it cuts Medicare.

So the reason--and I don't have any problem extending the life of Medicare--I think so--but it ought to be all about fraud. It ought to be all about--the vast majority of fraud in health care today is through government programs, not the private sector. The fraud rate in the private sector is less than 1 percent. Here we have $150 billion. We could save $1 trillion over the next 10 years if we had an effective fraud program, which this bill minimally addresses, which our bill aggressively addresses--aggressively addresses. We even have undercover patients, undercover doctors where we create sting operations to put people in jail--not fine them, not ban them from Medicare; we put them in jail if you are stealing from the American people.

There is nothing anywhere close to that in this bill. So, in fact, we are aggressively going after the largest problem of the $800 billion that is wasted every year, which is fraud.

The second largest problem is we need to incentivize the States to fix the tort extortion that is going on in this country that causes people to have tests done on them, not necessarily without any consequence to their health, and money wasted on tests so the doctors can be in a better defensive position.

Mr. BURR. How could a group such as AARP, whose primary role, by design, is to represent our Nation's seniors, be in favor of a reform package that doesn't provide any additional benefits to our Nation's seniors?

Mr. COBURN. And it doesn't reform. I have wondered that.

Mr. BURR. As the Senator knows, we drastically cut Medicare Advantage, the only private sector option that a senior has for coverage. We basically eliminate that. That is 11 million seniors in this country.

Mr. COBURN. Well, we have protected some through earmarks in this bill--certain States; we have protected some. In some States, if you have Medicare Advantage, you are protected. In other States, if you don't happen to be on that side of the aisle, or you don't need help in your reelection, you don't get that.

Mr. BURR. If somebody didn't have Medicare Advantage as a choice, what insurance product would they have to go into the marketplace to buy?

Mr. COBURN. If they could afford it--and that is where a large number of Medicare Advantage people will be hurt; most of those people cannot afford to buy a supplemental policy. The fifth largest seller of insurance policies in the country happens to be AARP.

Mr. BURR. AARP, yes. So to eliminate Medicare Advantage is a tremendous financial windfall to AARP.

Mr. COBURN. For AARP.

Mr. BURR. That association supposedly looking out over the seniors in this country.

Mr. COBURN. We are fairly cynical, and we don't mean to be. We need to wrap up, if we can. There are two ways of fixing health care in this country. One is, we have the government running it--I make this point. Everybody agrees that in 2017 or 2019, Medicare will go belly up. Medicaid is already belly up. They are all in trouble. They are running deficits. The Census is broke. Social Security is going to be broke. The U.S. Post Office is absolutely broke. Cash for clunkers was broke before we started. The highway trust fund is $18 billion in the red. And we are going to put another 16 percent of health care--76 percent instead of 60--in the hands of the government. Or we can utilize what we know works, which if you incentivize the management of chronic disease and incentivize prevention, incentivize transparency, and you create a way for people to have access, the Patients' Choice Act will insure 94 percent of Americans with a real insurance policy, not Medicaid or Indian health care.

By the way, Native Americans, listen up. Under our bill, if you are due health care, you get a card and you can go anywhere you want and it will be paid for. We need to do that for veterans, too.

The point is there is a choice. We can run a large government option or we can run a small government with 50 States, incentivizing them to do the right and best thing for their citizens, where we will actually lower costs, increase access, and have better care, and we won't destroy the best health care system in the world.

I challenge my colleagues to come down here to the floor and debate me on that, because I guarantee you that in their families I can find somebody who was saved because they lived in this country and, had they not, they would not be alive. It is the best health care system in the world. Why should we destroy that as we try to fix what is wrong in health care in America today?

Mr. BURR. I ask my colleague to put that next chart up.

I ask unanimous consent for 5 additional minutes.

The PRESIDING OFFICER (Mrs. McCaskill). Without objection, it is so ordered.

Mr. BURR. Madam President, this is self-explanatory, I think. Today we are borrowing 43 cents out of every dollar we spend; 43 cents of every dollar we spend in the Federal Government we are borrowing from somebody. You know, we talk about these unbelievable numbers in Washington--billions and trillions. The most popular bumper sticker out there is this: Don't tell Congress what comes after a trillion. Personally, I don't want to know, because I know if we get there, we are at the point of no return. Senator Coburn and I are close to the same age. We have kids just getting started raising families. We know what they are going to be faced with to raise their families, to make sure their children and grandchildren get educations, to make sure they go to college and have that opportunity, and make sure they have an opportunity after that for a place to work and an income. Do you know what is going to be the thing that dictates most of what they are faced with? It is right there on that chart. For every penny we borrow, it means we have an obligation to pay interest on that penny. Today interest is practically zero. We provide, as a Federal Government, money to banks they can lend out, and we charge them practically zero. That will not last forever. At some point, interest rates will go up.

Depending upon how much money we have borrowed, that will dictate how much we are obligated to pay in interest.

Mr. COBURN. Let me interrupt my colleague. Here is what the constellations show. Walk with me slowly. If you are 25 years of age or younger today in America--and we go out 20 years--that will be 45 and younger--that is 103 million Americans who will be in that group. Here is what they are each going to owe based on the unfunded liabilities of Medicare, Medicaid, and Social Security: 103 million Americans, 45 years and younger, will each owe $1.119 million. That is what they will be responsible for. They will have to pay the average interest on that, which will be about 6 percent. Before they ever pay the first bit of income taxes, they will have to cover that interest; otherwise, that will grow.

How does that fit a young family 20 years from now? We are talking about tax rates that allow no increased standard of living. As a matter of fact, they are rates that decrease the standard of living by 35 percent. That is the heritage we are creating and what we are going to expand with this health care bill the majority leader has brought to the floor. We are going to steal the future and the opportunity for those 25 years and younger today, because we cannot live and make the hard choices that are necessary, and we think the answer to every problem is more government, rather than more personal responsibility, competition, transparency in a market, and incentivizing people to do the right thing, rather than punishing them when they do the wrong thing.

Mr. BURR. The Senator is absolutely correct. What we can only hope to pass on to the next generation is an opportunity equal to what we have had. To strap them with this debt, to continue to go down this road and pile on the obligations, we will limit the next generation's opportunity. As you choke that opportunity for them, you will choke the fabric of this country in a way that the problems we are faced with today are minor in comparison to what they will deal with in the future.

As we sit here and debate the pluses and minuses of this health care legislation, I remind my colleagues, when you talk about $2.5 trillion--and you probably never will save that money out of Medicare; you probably never will cut that doctors' reimbursement quite as much as in there--every time you don't do that, we are borrowing 43 cents of every dollar we spend. That is the obligation our children will inherit from us.

I am not willing to do that anymore. I want to make sure we are focused on the opportunity that is there for them. We can only do that if we do it in a responsible way, do the right thing as it relates to health care here.

Mr. COBURN. I yield the floor, and I suggest the absence of a quorum.

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