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Public Statements

Tax Extenders Act Of 2009 - Continued

Floor Speech

Location: Washington, DC


Mr. COBURN. Madam President, I thank my colleague from Florida. I, along with Senator Barrasso, attended the summit with the President. If I recall his words, we were going to take 4 to 6 weeks to see if we couldn't work out some compromises to get a bill the American people would accept but we also would accept.

Today marks a week since we had that summit. We had an announcement yesterday that it is time to quit talking, it is time to quit negotiating, and they are going to ram a bill through.

I think there is a big contrast. I appreciate what my colleagues have said. The problem in health care in America is not quality, it is cost. Whatever we do is going to expand the amount of dollars we spend on health care if we add people to it. But if we attack the cost, what we can do is add more people with no increase in cost.

The thing that denies somebody access to health care is not not having an
insurance policy, it is having a cost of the system that is unaffordable, whether you have insurance or not.

Malcolm Sparrow from Harvard said he believes 20 percent of all the billings in Medicare are fraudulent. That is over $100 billion a year. That is $100 billion just in Medicare. We have good indications there is $15 billion in fraud in New York City alone in Medicaid, in one city. Why would we not go after the fraud, which is the second largest component of wasted dollars in health care? Some of it the President has accepted. But the No. 1 cost that does not benefit anybody in this country is defensive medicine, and defensive medicine costs up to $250 billion a year.

Let me tell my colleagues why it is so bad and it is terrible for us to ignore that issue. It is not just that we spend money doing tests on patients. When we do tests on patients, we put them at risk. Let me give an example.

If you go to any emergency room in this country this summer on a weekend, you will see a kid in there who has gotten hit with a baseball. What the standard is now because of the legal system in this country is that child is going to be exposed to radiation from a CT scan, not because they need it but because the ER doctor needs it.

The standard of care should be, if you have reliable adults around the child and the child has no neurologic damage and neurologic signs, watching to see, an expectation in case some signs show up and then you return. But the legal system in this country has entrapped us where we do hundreds of thousands of CT scans on children that none of them need because they get hit with a baseball. The ones who have true neurologic changes do need it. The vast majority do not. There are billions of dollars in one summertime event that gets chewed up that is not there to take care of somebody at a level which they can afford because we have added that on to the cost, not because a patient needs it, because the system demands it because doctors have to protect themselves against untoward extortion lawsuits. To ignore that as a part of this bill says you are not going to go where the money is to cut the costs.

I will summarize very shortly. It is said that Republicans do not have any plans. We have not said that, the President has. Then when he acknowledges a plan, he acknowledges only one that covers 3 million. We have a plan. I have a plan. Senator Burr has a plan. Senator Gregg has a plan. Senator DeMint has a plan. Senator Enzi has a plan. They all cover 20 million to 25 million more Americans. They do it by not raising taxes, not stealing money from Medicare, which has a $37 trillion unfunded liability over the near term. We do all that without increasing the cost. We get a true expansion of coverage without an increase in cost.

What we think would be the right thing to do is to center health care on patients, not the government. This plan has 898 new government programs. It has 1,695 times where the Secretary of HHS will write new regulations for health care. What do you think the consequence of complying with those regulations is going to be in terms of cost? We are adding more cost into the system that does not go to help anybody get well but become compliance costs.

We believe in patient centered, not government centered. We believe in expanding options available to patients--patients--not expanding government. We believe in increasing access, not increasing taxes on people. We believe in reducing costs, not quality.

The bill we are going to have before us, no matter what the shenanigans are to pass it, does not attack the underlying problem, and that is cost. Until we look at cost, we will never get out of the problems with Medicare, and we will never truly improve access for Americans.

I yield to my colleague.


Mr. BARRASSO. If I may, one of the phrases the Senator used about using reconciliation was ``hijacking,'' hijacking the system, hijacking the way this works. That specific word was used by then-Senator Barack Obama when he was a Senator and very much opposed to this approach.

One of the other things he has said, when we talk about the $500 billion being cut from our seniors on Medicare, he talks about a program called Medicare Advantage. That is only a part of the area that is involved. For people on Medicare Advantage--and there are about 10 million of them--they know they are on it, and they like the program. There are some advantages. One is it actually works to help coordinate care. It works with preventive care. Those are things that are very important. But there are also cuts in Medicare for nursing homes, for payments to doctors, for home health care, which is a lifeline for people, for hospice care, for care at the end of someone's life. That is all going to get cut under these $500 billion of Medicare cuts.

Mr. COBURN. Will the Senator yield?

Mr. BARRASSO. Absolutely.

Mr. COBURN. The one problem with the $500 billion worth of cuts, if you read what the CBO said about that, they said it is highly unlikely Congress will ever effectuate those cuts. If that is true, then that means there is $500 billion in costs that are not accounted for. So, one, either you are going to undermine the trust fund and actually lessen the available funds for seniors today or you are not, and you are using a ruse and saying we are going to charge this to our children and grandchildren.

Having been in this body for 5 years, this body will not make those cuts. It will not do it.

I want to make one other point. It is this: We recognize there are difficulties in health care. We recognize that the No. 1 difficulty that is keeping somebody from getting care is the cost of care. This bill does nothing for that. I would go back and worry that when the President said we will look at this for 4 to 6 weeks and now we are less than a week later and he is ramming this through, what is it the American people want us to do? Do they want us to create another entitlement system when every entitlement system we have today is bankrupt and in creating that steal from the bankrupt entitlement systems we have today or do they want a commonsense approach that will go after the cost, that will lessen the cost of care for everybody in America because we will never solve the problem with Medicare and its unfunded liabilities and address the costs.

I see the Senator from Arizona is here, and I am glad he has shown up.

Mr. McCAIN. Madam President, now that my two favorite doctors are on
the floor, I wish to refer them to and ask a question of both of them about a statement that the President just gave. He said:

I believe it's time to give the American people more control over their own health insurance. I don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone. I believe that doctors and nurses like the ones in this room should be free to decide what's best for their patients.

By the way, I hope from now on our doctors will wear white coats on the floor. It would be impressive to me. But that is neither here nor there.

Isn't it true that on page 982 there is created a new board of Federal bureaucrats--the Independent Payment Advisory Board, it is called--required to make binding recommendations to reduce the costs of the Medicare Program? How does that work if the President is saying give the American people more control and there is an independent payment advisory board that is making binding recommendations, I ask my two doctor friends.

Mr. COBURN. There are three very worrisome provisions in this bill. One is the Medicare Advisory Board that the Senator from Arizona just talked about that will decide what gets paid for and what does not, and Congress will either have to agree to it or agree to some other cuts.

The second is the Cost Comparative Effectiveness Panel which says: We do not care what is best for you, this is the cheapest; therefore, this is what you are going to get, which ignores the doctor-patient relationship in terms of what is best for you as an individual patient.

Finally, the Task Force on Preventive Services, which we saw during the debate in December, had recommended women under 50 not get mammograms because it was not ``cost-effective.'' When you look behind that data, it is 1 to 1,480 versus 1 to 1,460, versus 60 years and above, versus 40 to 50.

What happens is, you now have three government agencies that are going to step between the doctor and the patient when it comes to Medicare and Medicaid in this country, and actually it will fall over and they will mandate it on your own private coverage. That is very inconsistent in terms of saying you want doctors to be in control of health care but you have a bill that has three organizations in it that are designed to allow bureaucrats to make the decision on what your care is going to be.


Mr. COBURN. Mr. President, I am going to spend a few minutes talking about an amendment I have, No. 3358, which has already been pending, but I think, first, it is important for us to know that last year we borrowed $4 billion a day in this country. Mr. President, 43 cents out of every $1 the country spent at the Federal level was borrowed.

What does that mean? What that means is that over the next 10 years we are going to be paying $4.5 trillion in interest on the additional $9.8 trillion we are projected to spend that we do not have.

It was less than 3 weeks ago that this body passed a statute. Here is what the statute said: If you do not have the money to spend, then you have to cut something if you are going to spend new money.

As of last night, in the 3 weeks since we passed that bill, this body has said: That does not count. Time out. We are going to spend $120 billion over the next 10 years, but we are not going to pay for it.

That is why when that bill came through, to tell America we were going to finally get some fiscal discipline, we, as a minority, voted against it, because we knew it was not true.

As a matter of fact, one of our newer Members wanted to vote for it, as I had in the past when I first got here because I believed what it meant was real.

The fact is, the pay-go rules are a ruse. Pay-go means: American people, you pay, and we will go spend it. Even more than that: What you don't pay, we will go spend anyhow and we will charge it to your children and your grandchildren.

So this amendment I am proposing to be a part of this tax extenders plan would require three things. It would require the Secretary of the Senate to post on the Web site the following three things: the total amount of spending, both discretionary and mandatory, passed by the Senate that has not been paid for. We have this big hullabaloo saying we are going to pay for it and then as soon as the hard choices come of getting rid of something that is a lower priority, we will not do it; we just charge it on the credit card. So this amendment would require us to post on our Web site all the spending we are doing that wasn't paid for. In other words, we are not going to tell America one thing and do another without at least being transparent in knowing we are complicit in not following our own law we passed that said you have to do this.

The second thing it would require is the total amount of spending authorized in new legislation as scored by the CBO. Because what routinely happens here, and what I have been rejected on over the last 5 1/2 years, is that if you want to start a new program that is well intended to help people, one of the things we ought to do is get rid of the ones that aren't helping people, the ones that aren't efficient, the ones that are a lower priority. In other words, we ought to have to do what every American family has been doing for the last 2 or 3 years as we have gone through this economic constriction, which is make hard choices. They put priorities on things. The fact is, we are going to have $120 billion inside of 3 weeks that we refuse to prioritize. We are just going to spend another $120 billion.

Finally, the third component of what I am asking for in this amendment is for us to put on the Senate Web site any new government programs we create. What are the new programs we create? That is transparency.

So this amendment is not a gimmick. It is not to try to make people look bad; it is to try to make sure the American people know what we are doing and can see what we are doing. It is also to make sure the American people know when we say one thing and then do another. It is to make sure the American people can see that the Senate has passed $120 billion worth of unpaid-for programs that we, in fact, directly charged to the next two generations, after we have passed a pay-go rule saying we will never do this. It is about credibility. It is about character. It is about honor. It is about fessing up, if you don't have the courage to make hard choices.

So it is very simple. Some of my colleagues think it is a gimmick. I don't think it is a gimmick. It is about being transparent with the truth about our lack of courage to make hard choices.

Ultimately, what is going to happen is the world financial system is going to force us into making hard choices. We all know that is coming. We are going to have a $1.6 trillion deficit this year. Forty-five cents out of every dollar we spend we are going to borrow against our children. When does it stop? When do we start making the difficult choices we were sent to make?

So my hope is that my colleagues will support this amendment and we will, in fact, be honest and transparent with the American people about what we are doing and how we are doing it and how we don't even follow our own rules. There is a Senate rule on pay-go, a budget rule, but now there is a statute. What we have done is, we have conveniently voted in the Senate that we are not going to honor the statute, we are not going to make the hard choices, and we are going to go on and spend the future of the generations who follow.

With that, I yield the floor.


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