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Public Statements

Protecting Access to Medicare Act of 2014

Floor Speech

Location: Washington, DC


I would like to spend some time talking about the bill that is on the floor.

I thank my colleagues from Oregon and Virginia. I have enjoyed working with them.

The bill we have on the floor is one of the reasons I am leaving Congress at the end of this year. This is why the American people are disgusted with us. We are going to put off until tomorrow what we should be doing today. We should be fixing this problem instead of delaying the problem. I concur a lot with what my colleague from Virginia said. But the fact is that there is no courage, there are no guts, and there are no intentioned actions to do what is the best thing in the long term for this country in this body anymore.

We have a bill that came to us--and I appreciate the fact that the chairman wants to try to fix it. But if they vote for this bill that is on the floor today, they are part of the problem. They are not part of the solution; they are part of the problem.

There are four budget points of order that lie against this bill. Why in the world would there be four points of order lying against this bill? We are only going to vote on one of them. It is because it is a sham. It is a lie. The pay-fors aren't true. They are nothing but gimmicks. It is corruptible. There is no integrity in what we are getting ready to vote on in terms of being truthful with the American public and in terms of being truthful with the people who are providing the care for Medicare patients.

I have a little bit of experience--25 years of practicing medicine. I can tell you what is wrong with the payment system. We have a payment system both from the insurance industry and from Medicare and Medicaid that says: See as many patients as you can if you want to pay your overhead because we are going to pay you based upon a code rather than how much time you spend with a patient.

The first thing a doctor is taught in medical school is sit down and listen to the patient. If we spend time with the patient, the patient will tell us what is wrong with them. We know that is true because we have two of the sets of data now--both on the concierge medicine that has come up in the past few years as well as what we have seen in one of the great HMOs on the west coast. They order 62 percent fewer tests when they are listening to the patient.

One of the biggest costs for Medicare, one of the biggest wastes for Medicare is tests. Why do doctors order tests? Because they didn't spend the time figuring out what is really wrong with the patient, so they order a bunch of tests to try to help them; whereas, if they had spent an additional 15 or 30 minutes with the patient, most of those tests--and most are not without risk--would never have been performed.

We have the Senate doing what we usually do: We are putting this off until tomorrow when we can actually fix the real problem now.

It comes to another principle of medicine. The principle of medicine is that we don't treat symptoms, we treat disease. When we treat the disease, the symptoms go away. If we just treat the symptoms, we will never find the disease. We will cover up the disease. That is exactly what we are doing.

The SGR was a great idea. It started in 1995 in the Ways and Means Committee in the House under former chairman Bill Archer. Had we followed it, we would have seen some significant reining in of the costs of care and Medicare. But what happened? We cut spending and we cut reimbursement rates one time. Instead of responding to the political clamor of the provider group, we fixed it--a short-term fix. We have been doing that ever since 1999, short-term fixes.

We are not fixing this problem today. What we are doing is taking a big old can and kicking it down the road. Worse than that, we are not even being truthful about what we are doing.

One of the little gimmicks is to shift $5 billion of sequester from 2025 to 2024 and say you saved money. But we all know this little red area on this side will go over to the other side and we will spend that money. Nobody believes it. It is kind of the wink and the nod to the American public: Oh, look at us.

There is no truth, there is no honesty about what we are doing. And that is only one. This is the other offset. The sequester was the one I just showed. Savings from future Medicare cuts: $2.3 billion. They will never occur. If you think they will occur, you obviously think--if they will occur, then we should have fixed the real problem, the real disease of Medicare today. But we didn't. So the actions will continue to be exactly the same. That $2.3 billion will never be materialized whatsoever. It is a falsehood--$4.4 billion to Medicaid. It will not ever come about. That is in the future, but we will take the money now to pay for it.

In this bill of approximately $20 billion, half of the savings we say are there aren't there. Every Member of this body knows that. So when they vote for this fix today and vote against the budget point of order, what they are saying is: I am dishonest, I am playing the game, and I will not stand up for truth so the American people actually know what we are doing. I do not believe in transparency. I do not believe that we ought to have to live within our means, that we ought to make hard choices, just as every American family out there does today.

Finally, some of this is very unfair to the very people who worked on this with the committees because they made some commitments for real cuts to them to get a long-term fix. Guess what. The real cuts--the portion that is actually paid for--pay for it for only 1 year. So not only are we dishonest with the American people, we are dishonest with the stakeholders who negotiated this for a 10-year elimination.

The budget points of order against this bill--just so we know what we are talking about, it violates pay-go. Plain and simple, it violates pay-go. This bill increases the on-budget deficit. I dare somebody to come down to the floor and tell me it does not. It does.

It violates the Ryan-Murray 2014 congressional Budget Act because it violates the top line. Nobody is going to come to the floor and say it doesn't. We won't hear one speaker come to the floor and say it doesn't violate that. It does. They know it does, but they won't speak the truth.

This bill also spends money in excess of the Finance Committee's allocation--another point of order against the Budget Act. Everybody knows that is true, but they won't come down and say it doesn't; they will just vote for it.

It also has language in it within the Budget Committee's jurisdiction that has not been reported or discharged. So we are totally ignoring the process the chairman of the Finance Committee would like to have so we can do the expedient political thing to take some pressure away, just as we did on the flood insurance bill. It got a little hot in the kitchen. Instead of actually cooking the omelet, we threw the eggs in the trash can and ran out of the room, and that is exactly what is going to happen in the Senate. We are again putting off the hard choices.

Let me tell you why this is important. The Senator from Virginia outlined this a little bit. When I came to the Senate, which was 9 years ago, the individual debt each one of us held on the national debt was under $32,000. Today it sits at 54,800-and-some-odd dollars. We can kind of get lost in that. What we have to think is this: Well, what is my family's obligation for what we haven't paid for in the Federal Government?

Let me tell you what it is. For every family in America, whose average income is $53,000 per year--the same as it was in 1988 in terms of real dollars; we have gone backward--your obligation is now $1.1 million per family.

And we are going to play this game again and we are going to add another $10 to $12 billion between now and April? We are going to say and claim it doesn't add anything, but we are going to add another $10 billion so we can get away from the heat, so we can get out of the kitchen, so we won't be responsible.

Which is more responsible--to tell the truth about where we really are or to actually profess an untruth to your constituents in this vote this evening? Because that is what it is. Mark my words: Every Senator who votes for this bill that came out of the House will be telling an untruth to the American people. They know it is not paid for. They know it violates all sorts of rules in the Senate. They even violated the House rules as they passed it--all to meet a deadline?

To give a little history, we have missed the deadline before on SGR fixes. Does it cause additional work for providers, doctors, hospitals, and doctors' offices? Yes. Does it provide additional work for CMS? Yes. Do we eventually catch up on it? Yes. So what is the hurry? Why not really treat the real disease? The real disease is that we have a payment system that is not good for patients and is not good for providers. We can't fix it over a weekend, but we can fix it. If we don't fix it, as the chairman would like to see a long-term fix--I don't necessarily agree with everything he wants to do, but I applaud his effort to get a long-term fix. If we don't fix it, we don't deserve to be in the Senate.

There will be no credibility left and there will be no legitimacy left if we pass this bill. It is all a pack of untruths--untruths to the stakeholders, untruths to the American public and, most importantly, untruths to the generation coming up that is going to pay the bill for our untruths.

This isn't an unfixable problem. It is a problem that hasn't gotten the attention and the time it needs, and it reflects poor leadership of the Congress and the committees. We knew this was coming up 1 year ago. The Senator from Oregon can totally be forgiven because he wasn't in charge of the Finance Committee until 1 month ago. But there is no denying the fact this problem was there.

Doing a patch--and even doing some of what Senator Wyden wants to do--won't fix the ultimate problem. Think about the interaction you have with your caregiver. The average time in a doctor's office when you go in, before you are interrupted by your physician, is now 6 seconds. You go in, sit down, and the doctor asks: Why are you here today? You start to say something, and the first thing you know, you get interrupted. Why? Because that physician knows he needs to get to the next patient to pay the bills because we are paying bills based on CPT cuts rather than paying the physician based on the amount of time they spend with the patient, including outcome measures.

We have a system that is designed to be defrauded and creates overutilization. We designed it. We can fix it. Voting for this bill doesn't fix anything except a little heat in the kitchen. When we come back the next time, the heat is going to be hotter, and hotter, and hotter. This bill is a cowardly response to the real problem that we have. It is time we quit being cowards.


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