[Congressional Record Volume 155, Number 154 (Thursday, October 22, 2009)]
[Senate]
[Pages S10659-S10660]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    MEDICARE PHYSICIAN FAIRNESS ACT

  Ms. MIKULSKI. Mr. President, I am here today to speak on legislation 
on which we had a cloture vote last night, the Medicare Physician 
Fairness Act.
  I am here to express my disappointment and frustration that we did 
not vote through a parliamentary procedure so we could debate the issue 
of what is facing physicians who provide treatment to Medicare 
patients.
  Under the current situation, American doctors will face a 21.5-
percent payment reduction in what they get from Medicare when they 
treat Medicare patients. I think this is outrageous. Right now, we have 
people who took TARP money and they are acting like twerps.
  What they did is take the money. They don't lend the money, but they 
sure give themselves money with lavish compensation and bonuses. At the 
same time, every single day, 24/7, there are doctors on the front line 
saving lives, improving lives, and having people count on them. I am 
very sorry they chose over a budget debate to vote to take it out on 
doctors. We have to treat our doctors fairly for what they do and the 
sacrifices they make to do the job they do.
  This is a 21.5-percent payment reduction. Imagine that. Imagine if we 
had to take a 21-percent pay cut. Do you think we would have not voted 
for cloture? I don't think so. We are forcing doctors to maybe close 
their doors to seniors, denying people access to the doctors they need 
and the doctors they should have. We cannot let this happen.
  Every day, we ask the doctors treating our Medicare population to be 
unstinting in what they do. Then, when it turns around, the government 
is stingy. I think that is a double standard. We ask the people who 
provide the hands-on services to be unstinting. Yet when it comes to 
paying them for what they do, we are pretty stingy. This is 
unacceptable.
  As I said, we ask so much of our doctors. They need to be skilled, 
smart, empathetic, and they need to be available 24/7. We ask them to 
have the scientific understanding of a Nobel Prize winner and the 
patience and compassion of Mother Teresa. Our doctors assume tremendous 
responsibility for life, the risk and accountability for making the 
right diagnosis, the right treatment, which is tailored for each unique 
patient. They follow us all the way through when something happens to 
us or comes up in our lives.
  Our doctors look out for the aging population in our country. When 
people get older, they have multiple problems, and sometimes the very 
treatments contradict each other, requiring tremendous scientific skill 
and collaboration. When they treat older people, they need to take time 
to tell their story, their narrative. They don't go in just with a list 
of complaints.

  I have heard my Medicare constituents say time and time again: I 
don't know what I would do without my doctor. Our doctors are always 
there for us, but are we there for them? Look at what they face.
  First of all, in many instances, they are the first responders. They 
are there dealing with disease, trauma, and even death. For all the 
work they do while they are trying to work with patients, they have to 
face a health care bureaucracy--public and private. What is the one 
thing the public and the private programs have in common? They have a 
bureaucracy.
  Doctors tell me when they came into medicine, it was to make a 
difference in patients' lives. But what do they run into? Hassle 
factors, complicated administrative forms, preapprovals, and skimpy and 
spartan reimbursements, whether it is from private insurance or 
Medicare.
  In this country, we need to start focusing on value care, not volume 
care. Patients are grateful to their doctors, but Medicare 
reimbursement is important. All this work and this training is not 
rewarded for what doctors have to do. They have to work with a whole 
team of nurses, social workers, pharmacists, and integrative health 
professionals. One of the things we should do is make sure they are 
paid fairly. For health professionals--that entire team I talked 
about--their career is their calling.
  Mr. President, I am going to share a personal anecdote on why I feel 
so strongly about this--not only because I chair the Subcommittee on 
Aging, and not only because I have tried to be a champion for the older 
population throughout my public career. In July, I took a fall coming 
out of church after Mass. I broke my ankle in three places on that 
Sunday afternoon. I was in absolute shock. As I tried to figure out 
what I would do, some of the people from church came to my rescue, and 
I was able to contact my primary care doctor. I had an ambulance there 
pretty quickly and was taken to a downtown urban hospital--Mercy 
Hospital. It truly, in every way, exemplifies the quality of mercy that 
comes like a gentle drop.
  On my way there, and what happened to me as I went into the ER--that 
emergency room was like what we see on TV, only this was no miniseries; 
this was real life. The doctors at the hospital talked to me, and I 
spent time working with them as they treated me, got me through what I 
needed to do. I was met by the ER doctor. I had x-rays; there was a 
radiologist there. There was my primary care doctor on the phone. There 
was a gifted and talented orthopedic surgeon, who left his family at a 
cookout because the call of duty came, and he raced to be there. Was it 
for Senator Barb? No. The people in the ER were doing the same thing 
for everybody.
  As I waited a few days for the swelling to go down, I had surgery 
which involved the anesthesiologist. I could go on and on.
  When I look at all of the doctors who cared for me that day and in 
subsequent weeks--the ER doctor, the radiologist, the anesthesiologist, 
the orthopedic surgeon, my primary care doctor, and the cardiologist--
they were wonderful people at my side. They were people who graduated 
from college, who then had gone to medical school, at considerable 
stress and cost. They had gone through sophisticated residency 
programs, and some even fellowships. They also participate in ongoing 
continuing medical education requirements. But they do it not because 
it is required but because they want to be tops in their field.
  For all of that work and the responsibility they assume, we have to 
be able to reimburse them. Mr. President, I have seen the health care 
system from the wheelchair up. I have seen people who provide the 
health care, and I have been in rooms getting physical therapy with 
others who also need care. One of the things they are absolutely clear

[[Page S10660]]

about is we need to look out for the people who take care of us as they 
look out for us.
  Today I am asking that we recognize the doctors for all that we ask 
of them--the knowledge they need, the risk they undertake, the high 
cost of their education, spending 12 years in training, being on call 
24/7, often being rushed from their families when they want to spend 
time with them. I ask that we recognize those doctors by compensating 
them justly and fairly and not treating them like a commodity. We also 
need to do that for the nurses, social workers, physical and 
occupational therapists, integrative health people, and many others.
  If we don't pass this Medicare Physician Fairness Act, we have real 
problems. Failing to pass this bill is not an option. I think we need 
to do the right thing by the doctors, and I think we need to do the 
right thing by the people who need the doctors.
  Let's do the right thing and pass the Medicare Physician Fairness 
Act.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. ALEXANDER. Mr. President, is now the time to begin the Republican 
part of morning business?
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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