[Congressional Record Volume 153, Number 53 (Tuesday, March 27, 2007)]
[Senate]
[Pages S3822-S3827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. COBURN. Mr. President, I understand that I am to be able to speak 
as in morning business for up to 1 hour.
  The ACTING PRESIDENT pro tempore. We are in morning business, and the 
Senator is recognized for up to 1 hour.
  Mr. COBURN. I thank the Chair.
  Mr. President, if you go out in our country and you ask, besides the 
war, what is on people's minds, the No. 1 topic you will hear about is 
health care. And what are the questions that you hear? Why can't I 
choose my own doctor? Why can't I pick my own health insurance plan? 
Why do my premiums increase every year but my benefits don't increase? 
Why do I have trouble understanding which benefits my health plan 
offers? Why does my employer get a tax break from my health care but I 
don't? Who can make the best health care decisions for my family, us in 
Washington, the insurance bureaucrats, other people, my employer, or 
how about me? How about me getting to make a decision about my health 
care?
  There is no question America's health care is broken. It is not that 
we are getting bad care, it is that we pay a tremendous amount for what 
we get in our care. The estimates are anywhere from $1 out of every $3 
to $1 out of every $4 we spend on health care doesn't go to help 
anybody get well in this country and doesn't go to help anybody prevent 
having an illness. That is $2.2 trillion, and it will be over $2.3 
trillion this year.
  When you see what happens--and these are not my numbers, by the way; 
these are Price Waterhouse numbers, a breakdown on health care 
dollars--what you see are some pretty interesting statistics. You see 
that when we go to spend $1 on health care, 35 percent of it goes to 
hospitals, 21 percent of it goes to doctors, 15 percent goes to 
prescription drugs, and 5 percent goes to equipment.
  All the rest of that, the medical liability insurance--nobody 
realizes that is 10 percent. Ten cents out of every dollar we spend 
goes to medical liability. We are insuring against a problem in health 
care--10 percent. It costs us 6 percent to process the claims. One-half 
of all the claims filed against all the insurance companies in this 
country are denied because the people haven't met their deductible, and 
yet we keep sending the claims, keep spending the money.
  One out of every three people who works in a hospital, one out of 
every three people who works in a doctor's office doesn't do anything 
to help anybody get well. Why is that?
  It is because of the system we have set up. If you add this 10 
percent for liability insurance, 6 percent for processing, 5 percent 
for marketing, 23 percent for the insurance industry profit--and I 
doubt seriously it is that low--what you come up with is 24 percent, as 
a minimum, that doesn't have anything to do with helping anybody get 
well.
  Now, why is that? Why is it we have this system? It is because we 
have somebody besides the patient choosing what they will get in terms 
of health care. In Medicaid, it is your State. Oftentimes in Medicaid 
it is your State paying a very low rate, so now you get to choose from 
those who will accept the lowest rates. In Medicare, they tell you 
exactly what the price is. We spend all our time around here trying to 
change Medicare, because when we push on the balloon one way, something 
else pops out.
  So whether it is the Deficit Reduction Act or some of the other 
things we have had, what we find is we cannot control this tiger 
because we have a bureaucratic maze that nobody understands. When we 
try to use price controls, when we try to limit expenditures, we end up 
losing control.
  So what happens? Who makes your health care decisions? Either CMS, 
the Center for Medicare Services, in conjunction with your State, 
either for Medicare or Medicaid, your employer, or an insurance 
company.

[[Page S3823]]

  Whatever happened to you making decisions about your health care, 
about which doctor, about which insurance policy, about which hospital 
you want to go to? And why is it that if you happen to be Medicaid, you 
get to choose less than somebody who doesn't happen to be Medicaid? Why 
is it we are treating in an unequal fashion those who are the poorest 
among us?
  Why shouldn't we have the right to pick what insurance benefits are 
best for us? Why shouldn't we have the right to choose who is going to 
be our caregiver, whether it is a doctor, a nurse practitioner, a 
physician's assistant, a chiropractor, or an optometrist? Why shouldn't 
we get to choose that, rather than an insurance company or an employer 
deciding who we can or cannot see?
  They also decide the price we are going to pay because we are trying 
to control all these costs. They are also going to decide which 
hospital we go to. But how is it that we have a system now where 
everybody except the patient gets to decide what happens to them in 
terms of their health care?

  We can't afford the health care system we have today. For one thing, 
16 percent of our GDP, the highest of any country in the world by 50 
percent, is spent on health care. Although we have good health care, we 
don't have better health care than those countries that are spending 
less. We are spending 16.2 percent, or $2.3 trillion, per year on 
health care, so we should be 50 percent better off. We should have a 
50-percent better life expectancy, 50 percent less heart disease, and 
50 percent less cancer. Of the money we spend on health care, fully 
three-quarters of that is spent on five diseases.
  Think about that: 75 cents out of every dollar that actually gets 
into health care, which is only 60 to 70 percent of the money we 
actually pay into health care, 75 cents of that goes for either heart 
disease, stroke, chronic obstructive pulmonary disease, diabetes, or 
cancer. Five diseases, most of which are readily preventable--not 
partially preventable but readily preventable--through increased 
prevention activities.
  This Government this year will spend $20 billion on prevention in 12 
different agencies, through 27 different programs, none of which are 
coordinated to try to maximize the education of the American people to 
what they need to know about their health care so they can make 
decisions on prevention. Consequently, we are very ineffective with 
prevention.
  If you look down the road at what is coming in terms of Medicare and 
Medicaid, what you see is an unfunded liability of over $60 trillion--
$60 trillion--we are adding. This isn't about health care now. That $60 
trillion that is getting ready to hit our kids and grandkids in terms 
of Medicaid and Medicare that we have promised for the future, that we 
have no way to pay for now, one of the great ways of lessening that 
number is to change what we do on prevention. Prevention is the key.
  Grandma was right: An ounce of prevention is worth a pound of cure. 
As a matter of fact, it is said in 2070 $1 out of every $2 that 
Medicare spends, at our current rates, will be spent on diabetes--$1 of 
$2. So when you look at this Medicare number, with the vast majority of 
the baby boomers who are going to retire and then their generation is 
going to retire, $1 of every $2 that will be spent by Medicare will be 
spent on one disease only, which means we only have $1 to spend on all 
the rest of health care for seniors, plus any attempts at prevention 
and at early diagnosis or new and modern treatments. We can't continue 
without a coherent plan on health care.
  The other problem that is facing us as a nation is right now we can't 
compete globally in many areas because of health care costs. When you 
compare GM and Toyota, there is a four times greater differential for 
what goes into a car made in this country by one of the Big Three 
versus what goes into a car made outside of this country by their 
competitors. So there is no way that we can, in fact, be competitive 
globally until we handle health care. There is no way we can handle 
Medicare and Medicaid until we change the health care system.
  Myself and Richard Burr and several other Members of the Senate will 
be introducing a bill tomorrow that addresses every problem our health 
care system faces today, whether it is tort liability, and making sure 
people get awarded what they need when a mistake is made during the 
practice of medicine, or whether it is immunizations. The fact is, we 
have very few States where we have achieved 90-percent immunization.
  We are going to address every problem we face, the liability that 
comes at us in the future through Medicaid and Medicare, the problems 
we face on liability, the problems on access, the inequality that 
somebody, because they happen to work at a very low-paying job, gets 
stamped with something on their forehead that says, you are of less 
value than somebody who happens to work someplace that has great 
insurance and a higher paying job.
  Our bill changes all of that, and instead of going to the Department 
of Motor Vehicles to wait in line, we are talking about a health care 
system where you, the consumer, are No. 1. The government isn't No. 1, 
the doctor isn't No. 1, the hospital isn't No. 1, the drug company 
isn't No. 1, but you, the patient, become No. 1. You get to choose what 
insurance you want, you get to choose what kind of insurance you want, 
and you get to choose how much you will pay for it. We create a new 
insurance market where everybody gets to play by an even set of rules.
  How do we do that? We do that by giving everybody the same advantage 
in this country when it comes to health care, and that is a refundable 
tax credit, $2,000 for every individual, or $5,000 for every family. 
What that means is, if you are earning about $120,000 a year or less in 
this country, you will gain in terms of your taxes off of this bill. If 
you are making $120,000 or less, what is going to happen is you are 
going to have the option of staying with your employer, if you like 
what they have, and that tax credit will be available to your employer. 
But if you decide you want something different, maybe it offers 
something you don't get covered today or doesn't cover a whole lot of 
things you think you need, you can take that tax credit and buy that 
insurance and save the difference in the money for your future health 
care. The Universal Health Care Choice and Access Act provides $2,000 
for every one of the 45 million uninsured tomorrow, every one of them 
as an individual.
  Now, what does that buy? People say: That won't buy much. Well, if 
you go to Kentucky and you happen to be 35 years of age, you can buy a 
$2,000 yearly deductible policy for $897 and have $1,300 or $1,100 left 
over between that and the deductible. If you try to buy that same 
policy in the Chair's State, it is almost $6,000 for that identical 
policy. Why? Because government has decided in New Jersey differently 
than what government has decided in Kentucky. Therefore, the cost of 
getting this minimal coverage, because of the mandates put on by 
government--not what a patient wants but by what government says 
patients should have--makes that unavailable in New Jersey.
  How do we fix that? We allow people to buy insurance anywhere they 
want, just like they buy their auto insurance today; like they buy 
their homeowner's insurance. They can buy it from any company anywhere 
in America, as long as they have a registration with a State. We create 
a primary and a secondary location for that. So if you want to buy 
something that has a better price, that fits your needs, you have the 
capability to do that and put the difference into a health savings 
account, where you can use it for future health care needs, that you 
can use to apply to any deductible, or if you get enough money in it, 
you can bring it down to where, if you want to, you can have a zero 
deductible--if you want--but most people will not want to do that. We 
allow you to select a health plan that truly meets your family's needs, 
not what some Government bureaucrat says or some Senator says you must 
have. It is what you want. We allow individuals to choose what they 
want in terms of their health care.

  What will that do in terms of the market? That is going to create 
innovation in the health care market all across this country. It is 
going to cause competition like crazy for the dollars. Once we truly 
have competition, which is something we do not have in health care 
today, which we tremendously need, then we are going to see a big 
change.

[[Page S3824]]

  The other thing this does is it gives access for affordable health 
care for a ton of people who do not have it today. They get to choose 
their health care provider. The patient gets to choose who takes care 
of them. Not the Government, not their employer, not the Senate, not 
their State insurance commissioner, but they are going to get to choose 
who is going to take care of them. It is the right to choose who is 
going to care for you.
  How do we do that for the States? We do not mandate anything for 
anyone. We do not say anybody has to do anything. But we create a lot 
of incentives. We tell the States that, if you want to, you can take 
your Medicaid funds and your disproportionate share funds and anybody 
who is Medicaid eligible, under the 133 percent of poverty level, you 
can take their $2,000, plus the Medicaid money, plus the DSH money, and 
you can help them buy an insurance policy in your State. If you want to 
stay with Medicaid, you can stay with Medicaid. There is no mandate 
from the Federal Government other than to get people into coverage.
  You ask any government tomorrow if they would take $2,000 per 
eligible person in their Medicaid program, would they take a deal with 
them having the freedom to design what is best for their State? Every 
Governor will tell you yes. Every Governor will tell you yes. Why? 
Because now we are given the resources there to allow a Medicaid 
patient to be just like everybody else--a Senator, their mayor or 
somebody who works at the best factory in town. They have an option to 
not be discriminated against because they show a Medicaid card. Now 
they have an insurance card. People ask: What about the people who do 
not want to have insurance? We allow the States the opportunity to have 
a default mechanism. If the State of Tennessee--I see the Senator from 
Tennessee here. If the State of Tennessee wants to decide we will 
option, if we have people in our State who are going to be so 
irresponsible that they will not even buy themselves coverage and they 
have an opportunity to take tax money to do that, then we are going to 
create a default mechanism whereby the State of Tennessee--if you are a 
25-year-old motorcycle rider and you don't want to buy insurance, they 
can take your tax credit and buy a high-deductible policy for you so 
when you go to the ER, all the rest of us don't have to pay all your 
costs. What is happening in our health care system is we keep 
transferring the costs so we have a rationale for jumping up the price 
because they are doing something for somebody else at a low price.
  What the real facts are--and we never hear it--the real facts are, 
when you look at the hospitals out there, all--the vast majority of 
them--and this is a very key, important point--the vast majority are 
nonprofit entities. That means they pay no income taxes, they pay no 
payroll taxes. On order, the vast majority, and on average, offer 10 
percent of their total billed care as indigent care.
  But that is not a real number. The reason it is not a real number is 
because they bill the highest prices they have for that indigent care. 
If you look at the cost of that care, it would be far below that. I 
know in the State of Oklahoma, the hospitals there last year billed 
over $5 billion in revenue, made over $5 billion in profit, and out of 
that they billed another $400-some-odd million in care that was 
uncollectible to people who did not have insurance or couldn't pay. 
That was not really their cost. That was their billed price.
  Remember, we give this nonprofit status to all these entities, this 
$500 million worth of profit in Oklahoma, for example, and they pay no 
taxes on that. They pay no real estate taxes. In essence, they offer 
about $100 million worth of charitable care.
  What this bill does is it takes away all the cost shifting.
  What are the other things we do? We incentivize high-risk pools. What 
about the person who gets a chronic illness and they say all of a 
sudden their insurance company drops them. We have incentivized so the 
insurance company is not going to do that. In every State we give a 
bonus if they set up a high-risk pool and then the high-risk pool is 
funded out of everybody who is insured in that State. So if you have an 
insurer insuring someone with complications from diabetes and they say 
we will drop this person because it is too costly, they go to the high-
risk pool. Guess what. That insurance company is going to pay for them 
anyway. There is no benefit for them to drop them. There is all the 
benefit then for that insurance company to get busy and involved in 
managing the chronic disease, where we know we can eliminate 
complications, we can improve the quality of life, and we can also 
increase life expectancy by managing the chronic disease.
  Here is what we do for Medicaid patients. They get a $2,000 check 
from the Federal Government plus from their State. They can go into 
whatever plan they want. If their State says we want to stay with 
Medicaid and take that in enhanced Medicaid, the State gets to do that. 
There is not a mandate in anything. What it says is: If you think a 
State Medicaid Program is better for your State, without choice, then 
you can do it. But all the rest of the States are going to say I think 
I would rather have our Medicaid patients have a true insurance, a real 
card where they have the same access, the same equality of access as 
anybody else.
  All of a sudden you have everybody in the marketplace compete. They 
can stay in a State-run system. They get to save what they don't spend 
on their health care for future health care needs.
  One of our problems is savings in this country. It is important. How 
do we fix our health care system? We know that, if we look at the 
liability costs that showed 10 percent of the health insurance dollar 
going for liability insurance, that is an underestimate. The American 
Hospital Association found, recently reestablished by another 
organization, I can't remember who, that repeated the study--what we 
know is each year, today, besides that 10 percent, providers order 
another 8 percent of the cost of health care for tests that patients do 
not need.
  Why do they do that? They do that because they perceive they need to 
have everything on the books to defend themselves that they can have, 
so they fire a shotgun at it. We will get this test, this test, this 
test--knowing they don't need it but they operate under the ``what if'' 
scenario, this adversary system that we have.
  Finally, we address liability. We give another percentage bonus to 
the States that will set up what is called a ``health court'' system. 
It is a real simple system. If you have a complaint against a provider, 
a hospital or a doctor, you can go to the health court. You don't have 
to go to the health court. But you can go to the health court and you 
can be seen in front of three lawyers, three doctors, and a judge who 
have their own expert witnesses. This judge is schooled in medical 
malpractice. They can make a decision for you right then.
  If you accept the decision, then you give up your right to go to 
court. If you don't accept the decision, you can't ever come back to 
that court on that particular issue, but everything you do in court is 
admissible. We do not take away anybody's right to go to court. But 
what we do accomplish is making sure people get made whole quicker and 
cheaper--40 percent now doesn't go to the trial lawyer for you to get 
made whole.
  There is no question we make mistakes in medicine every year. But why 
should we drag it out for 3 to 5 years, No. 1. Why should we pay 40 
percent of whatever the ultimate award is to somebody who helped us 
accomplish that, where we can set up a system that will arbitrate that 
in front of a nonbiased group of peers, lawyers and doctors who say: 
Here is the right thing, here is the medical case, the legal case, 
let's make a decision and send it on.
  What it does is it saves tons of money directly, but what will it do? 
As soon as you create confidence on the part of providers that they do 
not have to order this other 8 percent of tests, you are going to see 
that dropping about half. So we can gain 4 percent in this cost of 
health care by setting up health courts, by changing the dynamic under 
which we make sure people are made whole when something happens to them 
in the medical malpractice area.
  Not every State has to do this. But if your State decides to do this, 
you get a 1-percent bonus on your Medicaid money--out of a large pool.

[[Page S3825]]

  We have lots of ways in which we do not say we want the States to do 
this and now we are going to tell you how to do it. We are saying here 
are some ways we think you can also do it. Go figure out the best way 
for you, and by the way, if you do some of the things that we think 
will save some money, here is some extra money for you.
  Ultimately, if we do not fix health care--everybody in this Chamber 
knows we are going to go the way of Western Europe and that is the 
following: We are going to decide that we are going to have a single-
payer system run by the Government. As P.J. O'Rourke says: ``If you 
think medicine is expensive now, wait until it is free.''
  We are going to control costs. We are going to do it the same way we 
are trying to control costs with CMS. What happens? What happens is we 
are going to start rationing care.
  Let's take some real statistics. In England, diagnosis? Cancer. In 
England, if you get a diagnosis of cancer right now, the average 
starting time for your chemotherapy is 10 months after your diagnosis. 
Anybody here who wants that kind of medicine will vote against this 
bill. That is exactly what we get. We get rationing. What it means is 
people with great potential will not get the treatment in time to 
capture that great potential. What it means is great suffering. What it 
means is loss of innovation. What it means is a lack of available, fair 
access. It is everything in England in their health care system takes 
away all freedom.
  It is also interesting to know this past year in Canada there was a 
lawsuit filed, which was won. What this individual said is the Canadian 
law says I can't go to anybody except a Canadian doctor who is owned 
and run by the Government. They challenged that. The Canadian supreme 
court ruled on the side of the patient: You ought to have the right and 
freedom to go wherever you want, to whomever you want if you are 
willing to pay the bill.
  Paying the bill is the insurance part of this. If you want to be able 
to have that access, then you are going to want to be able to buy a 
policy that allows you to have it. If you don't want that access, you 
can buy a policy that says here is a straight HMO, here are the only 
four doctors you can go to, and here is the hospital you are going to 
get to go to.
  We are talking about freedom in health care. How do we get to the 
bottom line, away from 16 percent of our GDP, down to 10 percent of our 
GDP? More importantly, how do we create a system that gives us better 
quality, at lower cost, with better value. That is what we are talking 
about.
  I yield to the Senator from North Carolina.
  Mr. BURR. Mr. President, I commend my colleague from Oklahoma, a dear 
friend and somebody who has been passionate about health care for 
years. He and I came to Washington together in 1995. We served on the 
Energy and Commerce Committee, and we recognized then that changes 
needed to be made. Every year we have seen the same response in 
Washington. We have seen the end of a calendar year come, the need to 
find savings in health care. Administrations, Republican and 
Democratic, turn to Medicare and Medicaid and say we are going to 
extract $60 billion, $70 billion out of savings in these health care 
systems. We have laughed as they called it ``waste, fraud, and abuse'' 
because there is waste, fraud and abuse in it. We just didn't get any 
money out of it because we have been reluctant to fix the health care 
system in this country.
  What are we doing? What is this plan? This plan is universal health 
care. Let me say it again. This plan is universal health care. This is 
providing affordable, accessible health care, provided by the private 
sector, for every American in this country.
  This is change in the design of health care that has been 
historically, up to this point, employer negotiated, the majority 
employer paid for, and an employee has very little input into the 
makeup of the policies that cover them.
  It doesn't reflect their age, it doesn't reflect their health 
conditions, it does not reflect their income.
  What we are talking about is shifting it away from employers over 
time. We are talking about creating real incentives for individuals. We 
are talking about making sure 47 million uninsured Americans today and 
tomorrow have tax credits that can be used for real insurance coverage. 
What does that provide for them? For the first time, it creates a 
relationship between a patient and a health care professional.
  We have talked in this institution, we have talked in this town, and 
we have talked in this country about the need to project wellness and 
prevention in health care. Well, this does it. This, for once, 
accomplishes that because we as individuals can negotiate our plans, 
not through the group plan but as 250 million-plus Americans. We can 
negotiate what makes sense for us from the standpoint of the scope of 
coverage that reflects what we are willing to pay as it relates to 
premium--and, by the way, provides States the capability to do the same 
thing with their Medicaid beneficiaries, their Medicaid patients, if, 
in fact, they want to begin to change the way their care is delivered, 
by creating the same relationship between a health care professional 
and them, because they now have the same insurance we do.
  Medicaid beneficiaries have this big ``M'' on their foreheads. They 
do not want to be on Medicaid, but they are there because it is the 
last resort. What we want to do is integrate them into what all of the 
rest of us have; that is, individual insurance.
  Dr. Coburn hit on a real key; that is, an attempt to bring everyone's 
health care costs down. It is not to pick out a group and to say, We 
are going to reduce yours, and pick out a group over here and say, We 
are going to reduce yours. This is an attempt--it is the first real 
attempt--to bring every-body's health care costs down.
  What we learned when we created Part D Medicare, the drug benefit for 
35 million-plus seniors in this country, was that when we created real 
competition between insurers and we brought transparency to price, two 
very real things happened: In the first year, premiums dropped 28 
percent over what we had projected, and drug pricing dropped 33 
percent.
  We have a model we have already tried that seniors across this 
country say: Do not mess with this plan. That, in fact, exemplifies 
what we are trying to do. We are trying to create real competition 
between insurance for our insurance business; we are not letting one 
employer negotiate the plan and then dump it on the employees. But the 
question is, Can we have the same results as Part D by seeing the cost 
of health care reduced for all Americans? Well, you start that process 
when you eliminate cost-shifting. You accelerate that process when you 
inject what this bill does; that is, transparency in the price of 
health care that is delivered to you.
  Imagine the day that you can go online and you can actually see what 
your doctor's visit is going to cost, what the lab workup is going to 
cost, what a visit to the emergency room at your local hospital is 
going to cost. In markets in North Carolina today, some choose not to 
go to the hospital for the nonemergency care, even though that may be 
their primary provider; they choose to go to the community health 
center because the community health center actually delivers the same 
if not a better level of care. But one thing is for certain: They know 
exactly what it is going to cost them. And these are individuals who 
are insured.
  For the first time, all Americans have an opportunity at prevention 
and wellness. What does that mean? It means we can make decisions about 
our health care that have an impact on the cost of our health care to 
us and consequently have a ripple effect across the marketplace, that 
as more and more Americans make healthy decisions, the cost of health 
care overall comes down.
  It means we have freed up those valuable health care dollars to make 
sure they are there for the individuals who are going to be susceptible 
to disease--chronic or terminal illness.
  It means the relationship we have now established between patient and 
health care professionals means we have recognized we can accumulate 
the data we need so that Medicare reimbursements are no longer a shot 
in the dark where we pull a number down that may not be reflective of 
the cost of delivering the service, may not be reflective of the value 
of the service.

[[Page S3826]]

The reality is that when we create that relationship, we are able to 
accomplish the accumulation of data that tells us what things really 
should cost.
  In health care, those healthy decisions allow individuals to make 
decisions about disease management. The most costly part of the U.S. 
health care system is the chronic diseases that exist and our inability 
to manage those diseases. The most expensive is diabetes.
  Today, we have electronic capabilities for diabetics and for coronary 
heart patients where, at different periods during the day, their vital 
signs can be transmitted over a telephone line to their doctor. The 
doctor can instantly know whether, if it is a diabetic, they are 
managing their insulin. If it is a coronary heart patient, they can 
determine whether the fluid buildup means they need to adjust their 
medication. What does that give us the ability to do? It means we can 
take a patient who up to that point got too much fluid on the heart, 
made an emergency room visit, and in all likelihood was admitted for 3 
days as they get the medicine back in balance. Now, a doctor, 24 hours 
a day, as these reports come in, can change their diuretic, can work 
with a diabetic on checking their blood sugar and what their insulin 
intake is, can detect whether they took the right medication. We can 
extrapolate that across every disease because technology now lets us do 
it in a real way. If we are not able to do this, then we are not able 
to recognize the value of new technology.

  So much technology today that would benefit us in the Medicare 
marketplace is not reimbursable by Medicare. It is a decision they make 
because it is not tested in the marketplace; therefore, it has no value 
because they do not know how to reimburse for it. Well, the reality is, 
when you have a health care system that responds to the benefits to 
individuals, all of a sudden you have the market that creates a value 
for the technologies and for the innovations.
  So I am delighted to be here. There is so much to this bill. This 
bill is the most comprehensive transformation of the health care system 
in my lifetime.
  One might say it is difficult to do so big a bite at one time. I made 
that mistake. The reality is that when you look at the timeline we are 
up against every year we do not adopt this type of transformation of 
our health care system, more Americans become uninsured, more 
individuals with preexisting conditions no longer can afford health 
care, and the cost of everybody's health care in America goes up 
because we have not eliminated cost-shifting.
  With disease management we could do today if, in fact, people had 
incentives in their system to take the time to monitor their health, to 
take their medication, to counsel with health care professionals about 
changes they could make, the more money we can save not only for each 
one of us but for the total system.
  I am convinced that if you could only pick one thing out of this plan 
that you highlighted for the American people, it would be this: For the 
first time, we are presenting a very real way to insure 47 million 
Americans, the people who are most at risk in this country. If all of 
us were the beneficiaries in some way of reduced prices, more access, 
the ability to have transparency in pricing, the accumulation of data, 
electronic medical records that enable us to find savings, if that is 
the byproduct of us finding a way to use savings in the system to 
insure 47 million Americans, I believe that is the right thing to do.
  The President came out in the State of the Union and he presented a 
very similar plan. Our plan expands on what the President said. Our 
plan goes to the heart of the health care system and says: If we are 
going to change it, then we have to go through total transformation. 
This is that total transformation that at the end of the day empowers 
every individual in this country to have custom health care coverage 
for themselves, for everyone in their family, for their health 
conditions, for their income and, more importantly, for their security.
  So I commend the Senator for his work. I now look forward to working 
with him as we go through what I think will be a very intellectual 
debate about the future of health care in this country. As some look at 
Europe and look at other countries and say, Maybe we ought to do that 
in the future, I believe if we adopt this method we are going to have 
every country in the world looking at this model and saying, How do we 
do this? How fast can we do that?
  Mr. COBURN. People may be saying: Well, how do you know this will 
work? There is a great little company named MedEncentive. They have 
been running pilot programs all across the country. Let me explain what 
they do. They get doctors to agree to follow a certain set of protocols 
called best practices, and they sign up communities, municipalities, 
and their employees, and then they do a couple of things. They take 
them under coverage, and they reward the employee--i.e, the patient--if 
they will use those doctors.
  What is unique about this system? One is, after the patient has 
finished their office visit with the doctor, they have a patient-doctor 
interactive form they fill out that says: The doctor wants me to take 
this medicine. I understand this. Here is the reason he wants me to 
take this. So they have to fill out the form to say they really 
understood.
  The other thing is, on the professional side, the practitioner side, 
they agree to follow the best-practice model in how they treat these 
patients. That was actually developed by Vanderbilt, where they 
followed a best-practice guideline which helps them decide what to 
order, what not to order, what to do, what not to do in terms of what 
is best for that patient. They can get off if they choose to, if they 
think in their medical judgment that they need to.
  What has been the result? The three published results that I know of, 
in all three communities, in the first year of operating this where 
there was this competitive model, best-practice quality outline, 
patient followup, because the insurance company is involved in making 
sure the patient does that--what happened to their health care costs? 
One down 18 percent, one declined 22 percent, and one declined 12 
percent. Now, that is just in three. Each one of them had 300 or 400 
patients and took all comers, chronic disease or not.
  How did their costs go down? The costs went down for a lot of 
reasons. One is they were practicing not defensive medicine, they were 
practicing real medicine. They were not throwing tests at a patient 
because they were worried but because they had the background of the 
excellence of Vanderbilt University as a practice guideline at their 
defense.
  So what we know is that in the various test models where true 
marketing, true competition, true transparency as far as price, true 
concern for the patients' well-being, not just at the office visit but 
thereafter, wellness and prevention were modified, what happens is 
costs go down.
  That is just in three cities in Oklahoma. It has been done all across 
this country. But what we do know is that if we attack it in a 
nonbureaucratic way, but we allow competitive forces--which would you 
rather have, an insurance company that is invested to try to make your 
health better or one that just wants to make a dollar on you and turn 
on you?
  So going back, let me just kind of summarize. The system we have 
today limits our ability to do what we as Americans do well; that is, 
discern value for what we have purchased--discern whether we get value 
for it, discern how to do it, and we discern that on an individual 
basis.
  Our health care is not designed on an individual basis. In many 
places, we get one-size-fits-all; what the Government says you will 
have or what the State says you must have, you must buy this. I believe 
a lot of our problems have come because we have tried to micromanage it 
from Washington and from the statehouse. What we are talking about is 
giving freedom of choice, not just to patients and providers but to 
insurance industries.
  Imagine the tremendous possibilities that will come into a market 
that says: This is a new day. I get to market all sorts of different 
things that might match up with different people. All of a sudden, now 
I will have to compete not only with people in my State but all across 
the country for the best plan that gives me the best value that meets 
my needs. Why would we not want that? We have that in every other

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thing. Why would we not want to capture the best aspect of the American 
consumer, which is discernment?
  Not long ago I was sitting with some friends and put forth the fact 
that I believe Americans are smart enough to know what they want in 
health care. The idea got pooh-poohed. I thought, how insulting. We can 
figure out what computer to buy and how much memory we want and how big 
a hard drive we want and whether we want a photo section on it or a 
print lab. We can figure out all of those things--as a matter of fact, 
our 10-year-old kids can figure that out--but we can't figure out how 
to buy health care. We are going to say to the American people: You are 
not sophisticated enough, you are not smart enough to know what is good 
for you or to know what you need. So, therefore, the Government is 
going to tell you what you need. That is what we have today, whether it 
is the Government or your employer or somewhere else.
  This bill changes all that. This is a bill that will create 
transparency so you as a consumer can know what something is going to 
cost. It is going to create a situation where you can perceive whether 
you have value. It is going to create an incentive to save for health 
care for the future and an incentive for wellness, not just by what the 
insurance company will come to sell you but by the $20 billion that we 
are now spending, of which less than $2 or $3 billion makes any 
difference at all in somebody's health care. We are going to focus that 
on true prevention. We are going to direct that the HHS relook at every 
one of these programs and develop a model to where we educate the 
American people about the risk.
  Let me give a personal story. I am a colon cancer survivor. What we 
do know is with good prevention and good screening, one out of every 
two people who are going to get colon cancer we can keep from getting 
it. Why wouldn't we do that? Why wouldn't we prevent half the colon 
cancer in this country? We don't have a good reason. One of the reasons 
is because we have an ineffective prevention program.
  I am a small government person; I admit that. But there is a 
legitimate role for the Federal Government when it comes to teaching 
America about our health needs, prevention, and wellness. We have 
plenty of money to do it if we take the same money we have now and 
redirect it in a way that educates the American people. Innovation 
works. We know that. Competition works.
  Take, for example, a year ago a 46-inch plasma TV cost $11,526. Today 
you can buy the same thing for $2,300. Next year you will be able to 
buy it for $1,400. The next year you will be able to buy it for $700. 
Why? Competition. Competition breeds quality and value, only if you 
have a market under which you can operate. We don't have that today in 
health care. Innovation also works in health care.
  Look at Lasik. Here is a procedure that is not paid for by the 
Government. It is not paid for by any of the insurance industry. But if 
you are nearsighted and you want to be able to look far away, you can 
get that done. When it first started, it was $4,000 an eye. Now there 
are places you can get it done--the same piece of equipment, the same 
computer--for $500 an eye. Why won't that work? It will work in health 
care. It will work. Innovation will come as a result of that.
  What happens when we innovate. What we get is better quality at a 
lower price and better value. I am hopeful that as the American people 
look at this, they will be reminded of a couple things. This is 
universal coverage. Everybody in America gets treated the same by the 
Federal Government when it comes to health care. Everybody in America 
is on equal footing as far as the Income Tax Code is concerned when you 
go to buy your health care. No longer do we advantage the very rich 
with $2,700 a year in tax benefit and the very poor with $100. We 
totally neutralize that and say: Everybody ought to be treated the same 
under the Tax Code for health care. It is universal coverage.
  No. 2, it takes away discrimination. Because you are poor, because 
you don't have the ability to have a job that has insurance coverage 
today, and if, in fact, you are at 133 percent of poverty, why should 
you be discriminated against because you are on the Medicaid Program? 
This is no offense to any practicing professional out there because 
there are great professionals who are taking care of Medicaid patients. 
But if you look at the marketeering, the ones with the best doctors, as 
a rule, because Medicaid pays so low, do they have time to take care of 
Medicaid patients? No. What happens is, somehow they don't have time. 
So what we have done is discriminated down with Medicaid patients.
  Why shouldn't a Medicaid patient get the best doctor every time, just 
like a Senator? Why shouldn't they have access to capability? Why 
should they be discriminated against by having a Medicaid stamp on 
their forehead? We are talking about universal access, equality of 
care, and personal freedom and choice. You get to decide what is best 
for you and your health care and your family.
  By the way, when you get this money and you haven't spent it all, you 
get to save it for next year and the year after and the year after. You 
can buy what is best for you with that money.
  This money also goes to retirees. If you retire at 60 and are not 
eligible for Medicare, you still get your tax credit. We don't 
discriminate against anybody. Everybody gets the tax credit.
  The final thing I would say, it doesn't cost the American taxpayer 
one additional dollar in income tax. There will be no increased cost 
with this plan. Actually, we have tried to make it revenue neutral. My 
worry is that it will save us money. We have tried to make it where it 
does not. We have tried to make it the most generous thing we can to 
get the most coverage for everybody out there. Again, prevention first, 
free choice, freedom, and liberty. You get to decide who cares for you, 
what insurance, what hospital, and every American gets that. It is the 
Government not telling you what you must do but saying here is what you 
can do if you want.
  I yield to the Senator from North Carolina if he has any additional 
comments.
  Mr. BURR. I would only use that time to thank the Senator from 
Oklahoma. This is a crucial debate that this country needs to have, 
this institution needs to have. More importantly, we are at a point 
where we have to stop talking about what we are going to do and 
actually start doing something. The Senator from Oklahoma has stated it 
very well. What we can do is bring a higher level of care to all 
Americans--not just some Americans, to all Americans. Through that 
effort, all Americans receive a financial benefit. Our system prospers 
because we are able to take care of more, and we are able to provide an 
unlimited opportunity in the future because we unleash innovation and 
technology in health care.
  I have wondered what it would be like if we had innovation at the 
same level in health care as, say, in cell phones; that we would have a 
new platform every 6 years, and that platform would provide an array of 
opportunities to us that we are not forced to take, but they are 
available to us if, in fact, we want them. Health care has been starved 
of innovation, in large measure because it treats every American 
differently. This is the first real opportunity for universal coverage, 
universal access, where every American has an opportunity at the best 
coverage available.
  I thank the Senator from Oklahoma.
  Mr. COBURN. I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. BROWN). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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