[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
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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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