[Congressional Record Volume 155, Number 158 (Wednesday, October 28, 2009)]
[Senate]
[Pages S10805-S10807]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. COBURN. Mr. President, I listened the last few weeks on the 
Senate floor to many of my colleagues on both sides of the aisle. I 
happen to be one of two physicians in the Senate. I still practice. I 
saw 11 patients Monday morning in an office in Muskogee, OK. I saw some 
sick kids, saw some women, some senior citizens, saw people having 
difficulties with pregnancies. I was kind of struck, as I watched and 
listened, to where we are in the country today.
  We have a lot of problems in front of us, including the financial 
problems, our unemployment problems, the fact that we need to get our 
economy up and going. But I saw something my staff sent me that 
explained and gave a great big, huge answer to me. It became crystal 
clear. It was a guy holding a poster. I have added a few things to his 
poster, but in essence here is what it said.
  On the top line it said: ``Medicare is broke.'' That is true. We all 
know that. It runs a negative cash balance, total negative cash balance 
starting in 2017, probably 2014. So 5 years from now, the vast majority 
of the funds from Medicare are not going to come from Medicare taxes. 
They are going to come from the citizens of this country through their 
regular taxes or we are going to borrow it from our kids.
  The States are broke because they have Medicaid, and they are all 
struggling mightily right now, so Medicaid is broke.
  What else is broke? The Post Office is broke. We know that. We just 
gave them $2 billion to get them out of their cash flow, but they are 
going to run about an $8 billion, $10 billion deficit next year.
  The census is broke. We know that. It is going to cost 2\1/2\ times 
what it

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cost the last time, and we are not even sure we are going to get an 
accurate census.
  The highway trust fund is broke. We are getting ready to have a bill 
on the Senate floor in the very next few days or weeks that will extend 
the life of the highway trust fund. It is going to take $248 billion 
from our grandkids with a wink and a nod and say it is not broke. It is 
not any different from what we were trying to do on the Medicare doctor 
fix, on the reimbursement fix. So the highway trust fund is broke.
  Fannie Mae is broke. Freddie Mac is broke. Medicare is broke. 
Medicaid is broke. The country is broke.
  Here in the midst of all of this, we are getting ready to add a $1 
trillion program run by the very same individuals who have Medicare 
broken, Medicaid broken, highway trust fund broken, Post Office broken, 
census broken, Fannie Mae broken, Freddie Mac broken, and we are 
supposed to trust us to design a system to fix the problem.
  There is no question there are some problems in health care. The 
biggest problem is that it costs too much. I see that every day when I 
practice medicine. I have seen it for 25 years. It is exacerbated now.
  Most people won't agree with my assessment, but one of the reasons 
the costs are so high isn't just technology--and certainly it isn't the 
insurance industry--it is the demands we place on the system through 
Medicare and Medicaid. I get to experience that every day--the added 
costs that go into the health care system because I have to do 
something the way Medicare wants me to do it, not the way I would do it 
normally. I have to cross the T's and dot the I's for Medicare.
  It is ironic that right now, as we are sitting here, there is a 
hearing going on on strategies to address Medicare fraud. We have a 
bill that is getting ready to come to the floor that doesn't have any 
of that in it. Why didn't we have that hearing 6 months ago when we 
asked for it? Or a year ago when we asked for it? Two years ago, we did 
have one in my subcommittee, where we found out that HHS doesn't even 
know how much Medicaid fraud there is, and they underestimate their 
Medicare fraud by 50 percent, according to GAO. We are almost at 20 
percent fraud. And now we are having a hearing, after a bill is 
written, to find out new strategies for it.
  Why? It is because there is no defense that we could ever muster or 
maintain against the accusation that we have allowed a system to have 
this kind of fraud in it. Yet we are supposed to turn around and ask 
the American people to trust us to fix what is wrong in health care. 
There are significant things wrong in Medicare. It costs way too much. 
It doesn't have to cost way too much. But we have put that into the 
system.
  Let me, for a minute, defend American medicine. If you are sick 
anywhere in the world, the best place to get sick is in this country. 
We have a 30- to 50-percent higher cancer cure rate than anybody in the 
world. If you have an acute coronary syndrome, heart attack, or stroke, 
we have the best hope for the best outcome and the best survivability 
for you. If, in fact, you have an orthopedic problem, whether it is a 
fractured hip or leg, or you need a new joint, this is the best place 
in the world to get the best care with the least complications, with 
the best outcome of anyplace in the world.
  There have been a lot of people critical of the bad parts in health 
care, and they should be. But what we are about to do is to damage the 
very best health care in the world to fix what is wrong with that 
system. So rather than to preserve what is good, we are going to take 
over--we are already at 61-percent government-run health care; 61 
percent of all health care is run by the government today. Add it up--
whether it be military health care, Indian health care, VA health care, 
Medicaid, Medicare, SCHIP, or the Federal employees health care, FEHBP. 
Sixty-one percent of health care is run through the government today. 
You may say, how in the world can we have the cost go out of line? It 
is because we have health care bills that will not address the real 
costs.
  Instead of having a monstrous bill that costs $1 trillion--actually 
far more than that, about $2.8 trillion the full first 10 years it is 
in effect. Rather than doing that, we ought to fix the easy things 
first, such as the fraud in Medicare. It is not hard to fix. We pay and 
chase. We have known that for years. We tried to do something about it, 
but we cannot do anything about it. We assume that when you bill 
Medicare, you bill them right and we pay you. If you don't do it right, 
we try to figure out, rather than having active live intervention to 
determine that you did a certified procedure or used a certified 
product. So we could save, in health care, $60 to $70 billion a year 
just in government programs if we fix the fraud.
  We can save another $100 billion a year if, in fact, we incentivize 
or change the tort system in this country, because what we know is that 
80 percent of all lawsuits are frauds in health care. They all get 
dropped. They never get paid attention to. But they get filed, hoping 
to extort money out of our insurance companies that cover doctors. Of 
the remaining 20 percent, 89.9 percent of those are found in favor of 
the providers. So what that says is less than 3 percent of all the 
suits that are filed are legitimate, and those poor people who win the 
3 percent--60 percent of the money doesn't go to them; it goes to the 
system.
  What else could we do? We can change the Tax Code so that if you are 
an individual, you get the same tax benefit that corporations do when 
they buy their employees health insurance. No, we won't do that. We 
have not done that in this bill. So if, in fact, you are well-to-do or 
you have the benefit of employer-paid health care, you get $2,700 worth 
of health benefit a year; but if you are a single man or woman trying 
to raise a child, and are self-employed, you get $100 worth of tax 
benefit. So we totally side with those who are well-to-do, in terms of 
the tax benefits in this country, rather than help the people out there 
trying to buy individual health insurance.
  We can create a transparent market. We can mandate tomorrow that for 
all insurance sold you have to put out the quality, your payment terms, 
and you have to put out the prices you will pay, and the same with 
every provider in health care, so that you can know what you are going 
to get, what it will cost, and the likelihood of the outcome 
beforehand.
  Finally, we could encourage the sale of insurance products across 
State lines to force competition into the insurance market. There is no 
question they need competition. They have it inside, but it is mandated 
down to the State level. So the only way you will ever create real 
competition and force competition in health care is to make them all 
compete against each other, which will give you the ability to buy what 
you want for your family, what you think you need, and get the care you 
want, at a price you can afford. We are not going to do that with this 
plan or any of the plans that have been offered. We are going to see 
the cost of insurance go up, not down.
  Finally, we could have group health associations, where businesses 
can come together across State lines and join an association and have 
buying power in the insurance industry. That has been blocked in this 
body for 4 years.
  So we can do four or five things, and none of those would cost any 
money. None of that would require us to steal money from Medicare 
Advantage and Medicare to create a new program, rather than to fund the 
sustainable portion of Medicare. So as we look at health care--and 
there is no question we have problems, and I want to see them fixed--it 
is important to put it into perspective. We have failed at everything 
we have done, in terms of being effective stewards, when it comes to 
health care programs through the Federal Government. They are neither 
efficient nor highly effective. We are getting ready to ask the 
American people to trust us with another couple trillion dollars over 
the next 10 years to create a new system, demonstrating the fact that 
we don't know how to run and won't be responsible for the systems we 
have. We are going to create a new system, and the idea is to just 
trust us. Our actions which have demonstrated a lack of financial 
stewardship of the health care programs today ought to give us all 
great caution that somehow the Federal Government knows what it is 
doing when it comes to health care. The proof is that we absolutely 
have no idea what we are

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doing. That is why there is an $85 trillion unfunded liability on 
Medicare. That is why there are over $100 trillion in unfunded 
liabilities when it comes to Medicare, Social Security, Medicaid, and 
SCHIP that we will never be able to take care of, which we will shove 
over onto our kids and grandkids. But trust us, we can get it right 
this time.
  We can create 88 new programs--that is what is in this--new 
bureaucracies, new government programs, with 150,000 new employees. And 
if you think that 150,000 employees won't stand between you and your 
provider, you have another thought coming. They are going to write 
rules and regulations that will cripple the ability for you to make 
decisions about your health care in your family. It is going to slow 
your access to health care and raise your cost of health care.
  There are ways to get out of this. There are ways to lower the costs. 
There are ways to not grow the government and make more health care 
available to hundreds of thousands and millions of American citizens. 
The first health care bill introduced was the Patients Choice Act, 
filed in this Congress by myself and Richard Burr. It saves money 
rather than costing money. It saves $70 billion in the first 10 years. 
It saves the States $1 trillion in the first 10 years. It is the 
opposite of what we have coming. It is a patient-centered plan rather 
than a government-centered plan. It puts patients in charge rather than 
government bureaucrats and Senators. The last thing I want to happen to 
my patients and me--I am 61 years old, and it will not be long before I 
am eligible for Medicare--is somebody in Washington making a decision 
about what my family and I can get. And whether I can afford it is up 
to me. But what I can get, and where I can get it, ought to be totally 
and 100 percent left in my hands as an individual who is free in this 
country.

  I have one final point. In this bill is a mandate that you have to 
buy insurance. You have to buy insurance. If you own your own home, you 
don't have to buy homeowners insurance. If you don't want to have 
general liability on your property, you don't have to do it. If you 
choose not to drive a car, you don't have to buy auto insurance. By the 
way, 25 percent of the people who own a car don't buy it or they buy it 
and they cancel it. We know that. That was the latest statistic. So we 
are going to tell everybody in America that you no longer have the 
freedom to make a choice, that if you have the assets and you choose 
not to buy health insurance, you are going to get a fine--a 
misdemeanor--from the Federal Government. We are going to take away 
your freedom to make a decision you think is in your best interest.
  I note that I have a limited amount of time. With that, I call on the 
American public to pay very close attention not to what we say and are 
going to do in the next few weeks in Washington but look at what we 
have done in the past. I don't think you can trust us with health care 
the way we are going. We have not demonstrated we can do that. The 
person to trust on health care is you. We can fix what is wrong without 
bringing another 20 percent of health care into the Federal Government 
and shackling our children forever.
  I yield the floor.

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