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Tax Extenders Act Of 2009 - Continued

Floor Speech

Location: Washington, DC


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. McCAIN. Madam President, I ask Dr. Barrasso, if these provisions were operative at this time, how would that have affected his practice?

Mr. BARRASSO. Well, it would have affected me in several ways. It would have affected my life in that my wife Bobbi is a breast cancer survivor. She had a screening mammogram when she was in her forties--something this Task Force on Preventive Services says was unnecessary. If it hadn't been for that screening mammogram, her cancer would not have been detected. And by having the screening mammogram, which the American Cancer Society and others recommend for women in this country, and following the guidelines of the cancer society as opposed to this new government-mandated guideline, her cancer was detected. She has had three operations, several bouts of chemotherapy, and is alive today, a breast cancer survivor, 6 years later, because she did what scientists and what those who know what is best for patients recommended as opposed to what a government panel might have recommended trying to focus on their cost-effectiveness.

Mr. McCAIN. So a patient comes to you with a certain orthopedic requirement that requires a certain level of treatment, and what does that do to you as a physician, as well as the patient?

Mr. BARRASSO. It puts the government between you and your patient, which is what you never want to have happen. As Dr. Coburn said, that is the wrong approach. It is not the way medicine has ever been practiced in America. It is not the way patients want it; it is not the way doctors want it. We don't want bureaucrats, whether government or insurance company bureaucrats, between doctors and patients.

As we saw at the health care summit on Thursday of last week, the President kept talking about covering people, health coverage, but he wants to put 15 million more people on Medicaid--a program where half the doctors don't see them because the government pays so little; a program where the Mayo Clinic, which the President has held up as a model for health care in America, says: We can't continue to see Medicaid patients from a number of States because we lose too much money. And now they have said the same with regard to Medicare. So when they are talking about $500 billion of cuts to Medicare, the Mayo Clinic, on January 1, said they can't handle additional Medicare patients because last year they lost, they said, $800 million by taking care of Medicare patients because the government pays so little.

Mr. McCAIN. On the issue of coming between the doctor and the patient, this legislation, the 2,733 pages, has 159 new boards, bureaucracies, and programs created--159.

When the President says you will be able to choose your health care, how in the world does that in any way comport with the fact that it requires every American to buy health insurance whether they want to or not, which, to me, raises a fundamental question, a constitutional question. Where in the Constitution does it say that we require every American to have a health insurance policy?

Finally, I would say there were a lot of impressive statements made during the Blair House meeting. I thought, frankly, Dr. Barrasso gave one of the most impressive ones I have heard. The perspective from practicing physicians is something that has all too often been absent from this debate.

I know my colleague paid attention when Congressman Paul Ryan gave his statement as far as the budgetary implications and the costs to Americans. It has been reprinted in the Wall Street Journal this morning. In 5 or 6 minutes, I think he encapsulated what this legislation does in laying out, in his view, a true 10-year cost of $2.3 trillion. He points out the gimmickry, and one of them, of course--the elephant in the room--is that you have 10 years of tax increases for $ 1/2 trillion and 10 years of cuts and $ 1/2 trillion to pay for 6 years of spending. Now, where in the world would you have a program that you pay for 10 years in taxes and cuts in benefits and have 6 years of benefits? So the true cost, the true cost over 10 years without the budget gimmickry is $2.3 trillion, and things such as $72 billion in claims and money from the CLASS Act--the list goes on and on.

So what I would ask Dr. Barrasso--we all trust the Congressional Budget Office. There is no doubt we all trust these people and their estimates, but their estimates are only as good as the proposals that are given to them. And I might add--again, I would request Dr. Barrasso's comments on this--that the President's proposal that was online was really an 11-page statement, and the Congressional Budget Office said they could not give a cost estimate because they didn't have sufficient information. So it is very clear, when you delay revenues until the year 2016, that obviously has budgetary impacts.

Finally, I would ask Dr. Barrasso to talk about this so-called doc fix which has been counted in the budget as reducing cost, and everybody knows we are not going to cut physician payments for treatment of Medicare patients. I think that would be an important one for Dr. Barrasso to discuss because I think it really encapsulates the kind of budget gimmickry that has gone on in the formation of this legislation.

Mr. BARRASSO. Madam President, I ask unanimous consent to continue for an additional 5 minutes.

The ACTING PRESIDENT pro tempore. Without objection, it is so ordered.

Mr. BARRASSO. Madam President, if I could, several things. There is a wonderful Paul Ryan op-ed in today's Wall Street Journal, and I would recommend it to anyone to look at that because he specifically points out that the President's own chief Medicare actuary says the Senate and House bills are bending the cost curve up, making the costs go up, which is what you hear if you go to a town meeting in Arizona or in Wyoming. When you ask people: If this bill passes, will the cost of your own care go up, the hands go up. When you say: Well, how about the quality; will the quality of your care go down? Again, the hands go up. So that is a continual concern of people all across America, which is why three-quarters of Americans have told CNN it is time to either just completely stop or stop and start over and only one-quarter of Americans support this proposal, because they realize this is going to do that.

The Senator from Arizona mentioned, and it was interesting, the 11 pages from the President. The gimmicks are still there. They may have taken out one of the gimmicks, but the spending gimmicks are there, plus the Louisiana purchase, the special carve-out for 800,000 people in Florida who are on Medicare Advantage. They are protected, but there are another 10 million Americans who will lose their Medicare Advantage.

Then the question came up of what we refer to as the ``doc fix.'' The way the numbers are moved around----

Mr. McCAIN. For the benefit of our colleagues, could the Senator explain exactly what the doc fix means and how we got to it?

Mr. BARRASSO. Right now--and we just passed a 1-month extension the other night--Medicare is supposed to cut the fees for all doctors across the country by 21 percent. Seniors know Medicare underpays right now. As one of my colleagues in the State senate in Wyoming used to say, government is the biggest deadbeat payer because they do not even pay enough to cover the cost of the care that is delivered in our hospitals. With ambulances, they do not cover enough to pay for the gas to fill up the ambulances to go the long distances we have in Arizona or in Wyoming.

But right now, to deal with some promises that were made years ago, the fees for physicians should be cut 21 percent, according to Medicare. A number of years ago, they were supposed to cut it by 1 or 2 percent, and they said: Well, we will not cut it, but next year we will cut it by 4 percent and then next year 8 percent and then 10 percent. Well, now they have continued to kick the can down the road enough so that this year they are supposed to cut the fees for physicians by 21 percent.

Mr. McCAIN. Which could not happen.

Mr. BARRASSO. It could not. According to the President's budget numbers and the way this bill is written and the financial gimmickry, they want to cut physician fees for Medicare by 21 percent and keep them frozen for the next 10 years. So it is cut and freeze for 10 years, and they use that as one of the additional financial gimmicks.

Well, if you do that to the doctors in the country, who are already reluctant to see Medicare patients because the payment is so low--the Mayo Clinic said they are not going to see new Medicare patients because the reimbursement at today's rates is so low--if you drop them 21 percent additionally at a time when the Congressional Budget Office says one-fifth of the hospitals and one-fifth of the doctors' offices in this country will be unable to continue to be solvent 10 years from now if this bill goes into place--we know without a question that we cannot allow that to happen. Congress knows that, the doctors know that, the American people know it. Everybody knows it except, apparently, the people writing the health care bill, who say: Oh, this is actually going to save money in the long run. When people look at this in an honest way, they know this is going to drive up the cost of care and make the quality of care for our American citizens go down.

Mr. McCAIN. Madam President, I ask unanimous consent to have printed in the Record the Wall Street Journal piece authored by Congressman Paul Ryan.

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


Mr. McCAIN. Finally, Madam President, I find it incredibly cynical to tell the American people that the cost of this reform is going to be I believe $371 billion less than we all know it actually will be.

I ask Senator Barrasso, if those cuts were ever enacted, what is the prospect of any of the overwhelming majority of doctors just saying: I am not going to treat Medicare patients.

Mr. BARRASSO. We are going to see that. We will see that across the board. I was at our hospital in Wyoming on Monday talking to physicians who take care of everyone, and they have great concerns because they say at that rate they can't afford to keep the doors open, if the Medicare cuts go through, the cuts the President says will have to go through if, in fact, he wants to hold up the numbers he continues to talk about.

Mr. McCAIN. Well, I hope we will continue to be on the floor. Again, we need to talk about what the President said during his campaign about many things but including what I saw this morning on FOX News where he said you shouldn't govern with 50-plus-1 votes, that he was in opposition to that. I am sorry he does not remain in opposition to that.

I thank Dr. Barrasso and the Chair, and I yield the floor.


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