[Congressional Record Volume 156, Number 33 (Tuesday, March 9, 2010)]
[Senate]
[Pages S1274-S1276]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. BARRASSO. Mr. President, I just heard the Republican leader talk 
about the issue of health care in America and the goal which we heard 
so much about of getting the cost of care under control.
  I have practiced medicine for 25 years in Casper, WY. I was in 
Wyoming yesterday visiting with physicians, visiting with nurses, 
visiting with those who are patients, as well as those who are 
providers, and talking with them about what is happening in this 
country and in this body with the discussion about health care in 
America and the legislation. No matter whom I talk with in Wyoming, 
when they look at this massive, 2,000-page bill and they think about it 
and then they ask questions about it, they say: How in the world is 
this actually going to get the cost of care down? How is this going to 
help them save money? Because as they read it and as they look at the 
rules and the regulations and the new mandates for more bureaucracies--
they say it is going to be more government employees at a time when 
there is 10 percent unemployment in the country--they say: It is going 
to likely cause my own cost of health care to go up, my own insurance 
coverage to go up. They have great concerns that the quality of their 
own care will go down--go down. Americans, and certainly the people in 
Wyoming, are very worried that if this bill becomes law, the cost of 
their care is going to go up and the quality and availability of their 
care is going to go down. That is not what they want.
  The President was speaking in Philadelphia yesterday. The front page 
of one of the papers this morning says: ``[The President] Turns Up the 
Volume in Bid for His Health Measure.'' And he said, as a challenge to 
Democrats, ``If not us, who?''
  Mr. President, it should be all of us. This should not be something 
that is being rammed through the House and the Senate and force-fed to 
the American people at a time when 75 percent of them want nothing to 
do with this bill. Three out of four Americans say: Stop, we don't want 
this, because they are worried about the cost of their own care and the 
availability and the quality of the care they are receiving.
  So when the President gives his speeches, as he did yesterday, I 
would say: Involve all of us. Involve all of us in the discussion, 
which is what we should have been doing for over a year.
  I look at what he said in his speech, and he talked about an 
insurance broker who apparently told some others there was so little 
competition--this is the President now talking, saying there is so 
little competition in insurance, that allows people to drive up the 
cost. The solution to that is the Republican solution that says: 
Increase the competition, increase the competition. That is what we 
need. Patients, people, citizens of this country want to be able to 
shop around, buy insurance across State lines, look for what is best 
for them and best for their families. If we did that, if we did that 
today, there would be 12 million more Americans with insurance by 
merely being allowed to have more competition, to be able to shop 
across State lines and to look around for something that is best for 
them and for their families--not the limited choices they may have in 
the State in which they happen to live.
  So I look at this from the standpoint of practicing medicine for 25 
years, visiting with patients, visiting with providers, talking with 
nurses, talking with doctors, saying there are things we can do to get 
down the cost of care. Unfortunately, they are not included in this 
2,000-page bill that is now sitting over in the House, with all of 
these different approaches to force this through in a way that 
undermines what the American people want, what the American people are 
asking for--the opinions of the American people--by a group of people 
in this body who say: We know better than the American people.
  This body does not know better than the American people. The House 
does not know better than the American people. It is time to listen to 
the American people, which is why I go home every weekend to visit with 
those folks in my State, in my home State of Wyoming, to visit with 
them about their needs, their concerns. And they have great concerns 
about this bill.
  It is not just people in my home communities. Warren Buffett, the 
great investor, says Washington should scrap this health care bill and 
start over. He said they should focus, as our Republican leader said a 
few minutes ago, on the costs. He said we should say we are going to 
focus on the costs and not dream up 2,000 pages of other things. Warren 
Buffett says get rid of the nonsense, and this bill is loaded with 
nonsense. This bill is loaded with nonsense--nonsense that is going to 
drive up the cost of care and decrease the quality of care in this 
country.
  So we have now been going through this for a year. The President is 
out trying to make an appeal to the Nation to say: Yes, buy this 
package I am trying to sell. The American people are too smart for 
that. They realize this package cuts $500 billion from Medicare 
patients who depend on Medicare for their health care--$500 billion in 
Medicare cuts. Part of it is to hospitals and part of it is to a 
program called Medicare Advantage. There are 10 million Americans on 
Medicare Advantage. The reason they signed up for this, they choose 
this, is because there is an advantage for them as seniors to 
participate in this program because this is a program that actually 
works with preventive care, with coordinating care, things that regular 
Medicare does not do. They are going to cut over $100 billion from our 
nursing homes and money from home health, which is a lifeline for 
people at home. They are going to cut money from hospice for people in 
their final days of life. That is part of this big bill the President 
is supporting and that he is asking the House to vote for. It is a bill 
that raises taxes by another $500 billion. It is a bill the House is 
going to be asked to pass that includes every one of the sweetheart 
deals because their first act in the House is going to have to be to 
pass the bill the Senate passed on Christmas Eve and that includes all 
the sweetheart deals, whether it is to Nebraska or Louisiana or 
Florida. Thirteen different Senators had sweetheart deals put into that 
bill the Democrats are going to be asked to vote for because the 
Republicans see through this whole thing.

  So the opposition to this is bipartisan. It is bipartisan opposition. 
Those who support it is one party only.
  We are looking now at a mandate where every American is going to be 
forced--forced--to buy a product, to buy insurance--forced under this--
or they will either have to pay special taxes, have their wages 
garnished or pay a fine or a penalty under this plan

[[Page S1275]]

that the American people, three out of four, have absolutely rejected.
  I see my colleague from Arizona has taken to the floor, and I would 
ask him if he is hearing similar things when he goes home to Arizona to 
visit with the people and what concerns he is hearing because there are 
certainly many seniors in the fine State of Arizona.
  Mr. KYL. Mr. President, I appreciate my colleague asking. There are 
330,000 seniors in the State of Arizona who rely on Medicare Advantage. 
It is exactly as Dr. Barrasso said: Medicare Advantage is a program 
that helps people with preventive care, with coordinated care, and with 
some of the things that aren't available under regular care, including 
vision care, audio care, and the like. These benefits would be 
drastically cut under the proposal in this legislation, so they are 
naturally very much opposed to it. I think Arizona represents the 
second largest State in terms of the number of seniors participating in 
Medicare Advantage.
  The other part of this that concerns them is the fact that if it is 
such a good idea to eliminate this program--or to drastically curtail 
it, to be perfectly accurate--then why is it that in one State the 
Senator was able to get his senior citizens who have Medicare Advantage 
programs exempted from the bill? If it is such a wonderful idea, why 
shouldn't it apply to everybody? But the seniors in Florida would be 
grandfathered in their Medicare Advantage plans because, of course, 
they don't like these cuts any more than seniors in Arizona or Wyoming 
or any other State.
  So this brings up the question: How can these provisions that are 
objected to by the American people be fixed in the process that has now 
been settled upon, this so-called reconciliation process?
  If I could address that for a moment. The author of this so-called 
reconciliation process is our esteemed colleague, the senior Senator 
from West Virginia, Robert Byrd. Here is what he had to say about using 
the process he created, this reconciliation process, for the purposes 
of consideration of health care legislation. I quote him from the 
Washington Post, March 22, 2009:

       I am certain that putting health care reform and climate 
     change legislation on a freight train through Congress is an 
     outrage that must be resisted.
       Using the reconciliation process to enact major legislation 
     prevents an open debate about the critical issues in full 
     view of the public. Health reform and climate change are 
     issues that in one way or another touch every American 
     family. The resolution carries serious economic and emotional 
     consequences.
       The misuse of the arcane process of reconciliation--a 
     process intended for deficit reduction--to enact substantive 
     policy changes is an undemocratic disservice to our people 
     and to the Senate's institutional role.

  That is what Senator Byrd had to say. Yet that is the process that 
has been selected by the Democratic leaders to force this legislation 
through the Congress.
  The final point I wish to make with respect to this is I think, to 
some extent, it may be a cruel hoax on some of our Democratic 
colleagues in the House of Representatives who are counting on the 
Senate to back up the reconciliation bill that might be passed in the 
House of Representatives. What they are assuming is, when they attempt 
to fix the Senate bill they don't like very much by amending it through 
this reconciliation process and then sending that bill over to the 
Senate, the Senate is simply going to pass the bill. Voila: The bad 
Senate bill has been fixed, the President can sign the reconciliation 
bill, and we will now have national health care reform.
  Well, not so fast. As a matter of fact, the author of this 
reconciliation process also created what is known around here as the 
Byrd rule, which means that if you go outside the narrow lanes of the 
reconciliation process and try to include things in the bill that don't 
belong in the reconciliation process, then it is, of course, subject to 
a point of order, as it should be, and it would take 60 Senators to 
override that point of order.
  Well, there are a lot of things that are going to be attempted to be 
fixed in the reconciliation bill that are subject to a point of order--
the Byrd rule. Those points of order will be upheld because I am going 
to predict to my colleagues that 41 Republican Senators are not going 
to allow that misuse of the reconciliation process--going outside what 
is clearly a reconciliation process--which means the bill that is 
passed in the House of Representatives, if it is, would not be passed 
by the Senate. Key provisions of it would have been stricken on points 
of order. Then, our friends in the House of Representatives would be 
faced with the prospect that they had already passed this bad Senate 
bill they don't like very much--and that I don't like very much--but 
the President can sign that into law. Yet the process by which they 
would attempt to fix it has failed because of the points of order that 
can be raised and that will be raised and that will be sustained, as 
should be the case, under the application of the so-called Byrd rule.
  So when my colleague from Wyoming talks about his constituents in 
Wyoming objecting not only to the substance of the bill but also the 
process by which it has been handled, I can answer the question: Yes, I 
met with a whole group of people from different States this weekend--
from Pennsylvania, California, New Jersey, New York--I visited with 
folks from literally all over the country, and they had the same 
objections, both as to the substance of the legislation, but they were 
also very curious about this reconciliation process because they had 
heard it could be used to ram the bill through by a process that it was 
never intended for, and they wanted to talk about that. When we 
explained the fact that the legislation adopted by the House--if it 
is--would not necessarily be adopted in the Senate but would be subject 
to these points of order--and, by the way, amendments, an unlimited 
number of amendments--then at least they understood why House Democrats 
who will insist on amending the Senate bill should not rely on the 
Senate to do their bidding. That isn't going to happen.
  Let me say one other thing before I turn it back over to my colleague 
from Wyoming. It has been such a learning experience for us and an 
inspiration to have a couple real physicians in the Senate. Our only 
two physicians here are Dr. Barrasso, an orthopedic surgeon from 
Wyoming, and Dr. Tom Coburn, a physician from the State of Oklahoma, to 
talk about the real world of treating patients and how there are ways 
that care can be given in a less expensive way but retaining both the 
essential quality of care and that intangible but incredibly 
important--almost sacred--relationship between the doctor and the 
patient.
  I see Dr. Coburn has joined us on the floor. It is key for the rest 
of us to understand how this process works when physicians sit down 
with patients and determine the best course of action to preventive 
care, that can both be the least expensive and yet still deliver the 
quality care that their patients deserve.
  I think we ought to pay more attention to the advice they have 
provided to us, and I commend both Senator Barrasso as well as Dr. 
Coburn for the advice they have given to us, and I hope we will 
continue to listen to that advice as this debate unfolds.
  Mr. BARRASSO. Mr. President, I would say to my colleague from 
Arizona--and there is actually a Mayo Clinic in Arizona, as there is in 
Florida and as there is in Rochester, MN, which is the home of the Mayo 
Clinic--one would think, since the President early on talked so much 
about the Mayo Clinic being a model for health care in the country, the 
Mayo Clinic might agree with what the President had to say. But if you 
go to the Mayo Clinic's blogs, they say:

       The proposed legislation misses the opportunity--

  We have an opportunity now--

     to help create high-quality, more affordable health care for 
     patients. In fact, it will do the opposite.

  So here you are. The proposed legislation misses the opportunity to 
help create higher quality, more affordable health care for patients. 
In fact, it will do the opposite.
  Mr. KYL. If my colleague would yield for a quick comment on that 
point.
  Mr. BARRASSO. Absolutely.
  Mr. KYL. The Mayo Clinic in Arizona, unfortunately, has had to 
announce that in several of its key facilities there, it will no longer 
accept new Medicare patients. Why is that so? Because the government 
program of Medicare, which our seniors rely on, is getting to the point 
where it does not

[[Page S1276]]

pay physicians what they require just to stay in business, just to have 
their office practice continue.
  The Medicaid Program, which is the other government program, is 
already so low in its reimbursements to physicians that--the numbers 
differ, but 50 to 60 percent of physicians are no longer taking 
Medicaid patients. As a result, these government programs end up 
getting very close to rationing care because there aren't enough 
physicians and facilities to take care of the people who are enrolled 
in the programs. Imposing yet another entitlement for even more people 
to have this care with fees regulated by the Federal Government and 
reimbursements at levels too low for physicians to take advantage of 
will simply continue to drive physicians away from the treatment of the 
patients they have treated over the years and want to continue to 
treat.

  It would be our hope we could bring the incentive for physicians to 
continue to treat these patients, rather than the disincentives the 
Mayo Clinic is pointing to in backing out of the treatment of folks in 
Arizona.
  Mr. COBURN. Mr. President, if the Senator will yield, one of the 
important points he made a moment ago is a doctor sitting down and 
listening to their patient. Mayo has it right. If you are not going to 
pay us enough to sit down, we refuse to practice medicine the way 
Medicare is directing us to practice: Listen a little bit and then 
cover it with tests.
  The reason costs are out of control is because Medicare wouldn't pay 
for a physician to sit down and truly listen and come to a centered 
point on what the patient's problem is and the way to get around it. 
Consequently, what we have seen in the Medicare Program is doctors have 
to see so many patients that they don't get to listen to them and they 
consequently cover that lack of listening by ordering more tests.
  What do we know about tests? We know we order $\1/4\ trillion worth 
of tests every year that aren't needed. There are two reasons we are 
ordering them. No. 1, the reimbursement to sit down to listen to the 
patient is so low the doctors can't afford to take the time to cover 
the test; and No. 2 is the threat of tort litigation. So now we are 
ordering tests not for patients, but we are ordering them for doctors. 
If we want to change health care, we have to drive costs down. I am 
proud Mayo recognizes we are not going to sacrifice our quality, so, 
therefore, we are saying: No, we are not going to take any more 
Medicare patients because we can't do it in a way that lends a quality 
outcome at an appropriate cost.
  Mr. KYL. Mr. President, I remember sitting back in the cloakroom and 
listening to Dr. Coburn when he was talking about how he treats 
patients who come into his office. A child, he said, comes in who has 
had a fall on the playground and the parents, understandably, are very 
concerned. Dr. Coburn said to me: If I just sit down and talk to that 
young man, that child, talk to his parents for a while, I can usually 
figure out what kind of treatment is going to be necessary without 
necessarily ordering a bunch of tests. But under the medical 
malpractice situation we have to work under today, I am almost required 
to order those tests or, if something should go wrong, be accused of 
malpractice. I wonder if my colleague could relay that story.
  Mr. COBURN. Every summer, we have thousands of kids hit the ER, 
whether they ran into a pole or they had a baseball bing them in the 
head. The standard of care now is to put that child through a CT scan. 
These are children the vast majority of whom have no neurologic signs 
whatsoever. But now we are not only spending that $1,200 per child, we 
are exposing those children to radiation they don't need.
  So there are two untoward events for what has happened as we see the 
hijacking of medicine by the trial bar. No. 1 is we spend a whole lot 
more money unnecessarily, but No. 2 is we are actually now starting to 
hurt people by exposing them to radiation they don't need.
  That is another cost. We know we can bring down costs if we change 
the tort system in this country to one that is sensible and reasonable 
and still allows, when doctors make mistakes, for them to be 
compensated for their economic damages and the harm that was caused to 
them. No one is saying we should eliminate that. What we are saying is, 
it should be appropriate and in a venue that represents the real risks 
without disturbing the practice of medicine because we cannot afford 
it, and the children who are getting these tests, their bodies cannot 
afford it. It is just common sense that we would go that way.
  I wonder if the Senator will yield for a moment before we lose our 
time that I might discuss the amendment I am going to have up in a 
moment.
  Mr. KYL. Mr. President, might I just inquire how much time remains on 
the Republican side?
  The ACTING PRESIDENT pro tempore. There is 3 minutes 15 seconds 
remaining.
  Mr. COBURN. Mr. President, I ask unanimous consent to take that time, 
if I may.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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