[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14310-14313]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. COBURN. I wish to take a few minutes this evening to kind of 
discuss with the American people what is going to happen on health 
care--what it looks like is going to happen.
  As a practicing physician, there are things I know that if we start 
from ground zero we would do in health care in this country. But as I 
was reading some articles, I pulled this quote. This is by Adrian 
Rogers, and it really belies what is happening right now with this idea 
of transferring the wealth. Here is what he said:

       You cannot legislate the poor into freedom by legislating 
     the wealthy out of freedom. What one person receives without 
     working for, another person must work for without receiving.
       The government cannot give to anybody anything that the 
     government does not take first from someone else. When half 
     of the people get the idea that they do not have to work 
     because the other half is going to take care of them, and 
     when the other half gets the idea that it does no good to 
     work because somebody else is going to get what they worked 
     for, that, my dear friend, is about the end of any Nation. 
     You cannot multiply wealth by dividing it.

  Those are pretty wise words.
  As I think about the trillions of dollars that have gone through 
Congress this year and the fact that our spending is totally out of 
control, with minimal effect other than things like the Senator from 
Georgia--had we actually spent the $35 billion on a tax credit to 
stimulate housing rather than spending about $100 billion on true, true 
stimulus activities and another $680-some billion on other items, and 
the fact that all of a sudden we are now talking about pay-go--that is 
about me paying and you going--and we have spent $800 billion in the 
last year and avoided pay-go 15 times in the Senate in the last year. 
Fifteen times we have said: Oh, time out, pay-go does not count. And we 
spent another $800 billion. What that means is we did not have the 
money, we borrowed it.
  So as we start into the health care debate, there are some things I 
believe are critically important that I think most Americans would 
agree with.
  The first is that individuals ought to be in charge of their health 
care. Nothing should stand between you as a patient and your physician. 
No bureaucrat, no government-run program should get in between that 
relationship.
  The second thing I know is you ought to be able to pick what you 
want, you ought to be able to afford what you want, and you ought to be 
able to do that at the time that is appropriate for your health care 
needs. That means you have to be in charge of your health care, you 
cannot have someone else. I am reminded of that fact because we have a 
Medicaid Program in which 40 percent of physicians in this country do 
not participate, and what we are

[[Page 14311]]

really saying to people on Medicare is: We will give you health care, 
but we will limit a large number of physicians and providers because we 
are not willing to pay what it actually costs to do that.
  The third thing is that we cannot assume, which we have, and I am 
worried we will, that people cannot manage their own health care, that 
they have to have Uncle Sam manage it for them. Nothing could be 
further from the truth.
  There are some key components. Health care is about people. It is not 
about an insurance company, it is not about your employer, and it is 
certainly not about the government. It is about you. And if it is about 
you, you ought to be in control of that--absolutely, without a fact be 
in control. You ought to have a caring professional who will be able to 
spend the time with you to truly teach you prevention, to truly work 
with you on wellness, to truly manage your chronic disease, and then we 
ought to recognize that those services ought to be paid for, not 
outlandish fees but appropriate payment.
  You recognize that in none of the government-run programs, which is 
now 60 percent of health care, do we truly pay for prevention. We will 
pay for it when you get sick. That is why we have ``sick care'' in 
America. We do not have health care, we have sick care. And we do not 
have real insurance. What we have is prepaid health expense, which 
about 20 percent, 25 percent of the money that went into that health 
insurance doesn't ever come back to help you get well or prevent you 
from getting sick.
  So we ought to be about the fact that we know there is something 
wrong with health care in America today. We all know that. We are 
dissatisfied, whether it is the bills you get after you get a test that 
you can't read or can't understand or you have to wait or have an 
approval to get something. Regardless of what your doctor thinks, you 
still may not be able to access that care. There is no question we need 
to fix health care, and I will be the first to admit we need to do 
that. But how we do it--how we do it is ultimately important, not just 
for the health care of Americans, but it will markedly impact our 
economy.
  The very idea that we have to have another $1.3 trillion to $2 
trillion to fix health care does not fit with any realistic set of 
facts anywhere else in the world. We spend twice as much per person in 
this country as anybody else in the world save Switzerland. We are not 
getting value for what we are buying.
  Now, why aren't we? One of the reasons we are not is because you are 
not in control of your health care. You do not get to see a transparent 
price or quality or availability for what you purchased because we have 
given over the payment for that to some other organization. So we are 
less inclined to be prudent purchasers because it is not coming out of 
our pocket, whether it is Medicaid or Medicare or a health insurance 
plan. We ought to be about fixing that. And our health care cannot be 
about bureaucrats in Washington. It is personal. It is also local.
  The trust in a patient-doctor relationship is enhanced by 
transparency of the cost and transparency of the quality. You ought to 
be able to go and buy a health care service and know what it is going 
to cost before you buy it, and you ought to know that you are likely to 
get great outcomes based on transparency of quality. That has to be 
there.
  The second thing that has to be there is you have to know we are 
going to spend the dollars in a way to prevent you from getting sick, 
not just take care of you once you get sick. Grandmom was right: An 
ounce of prevention is worth more than a pound of cure. Yet we do not 
incentivize that in any of the Federal Government programs we have 
today. And we do some--especially in the ERISA-based plans or the 
company-owned plans, they have learned this.
  A great plan that is out there that people are fortunate to have is 
Safeway. Safeway's health care costs have risen one-half of 1 percent 
in the last 4 years. The average of other plans of other employers has 
risen 42 percent. What is the difference? Why is it that Safeway, with 
200,000 employees, has been able to have only half a percent, plus they 
also have increased satisfaction with the health care they are getting? 
What is the difference? The difference is prevention and wellness and 
management of chronic disease.
  So anything we do that does not address prevention and incentivize 
it, wellness and incentivize it, and management of chronic disease and 
incentivize it will not make any fix we do here sustainable. We can 
cover everybody in the country. We can charge $1.2 trillion or $1.3 
trillion to our kids over the next 10 years and we can get everybody 
covered, but if we have not fixed the sustainability to where we do not 
have a 7.2-percent automatic inflation in health care every year, we 
will not have done anything. And it will not be long before we will not 
be able to afford it, and then we will take the people in the 
government-run option and we will put them into Medicare, and then we 
will do a price control.
  There is no question that we need to carefully address America's 
health care challenge. We need to find immediate measurable ways to 
make it more accessible and affordable without jeopardizing quality. We 
need to make sure we give individuals choice at every point in the 
health care continuum. And we need to make sure we allow personalized 
care. We are not a bunch of cattle lining up in the chute. Everybody is 
different. Everybody needs to be able to make their own decisions.
  On top of that, the No. 1 thing we have to do is protect the doctor-
patient relationship. Half of getting well is having confidence in the 
person who is treating you. When you do not get to choose that, as you 
do not in Medicaid and oftentimes in Medicare because we are limited to 
the doctors who are taking Medicare, you are limiting the outcome.
  If you cannot get treatment when you need it, there is a crisis. If 
you are denied the ability to choose the doctor or hospital that is 
best for you, that is a crisis for you. If you cannot afford the 
coverage you need for you and your family, then you have a crisis.
  We need to stop looking at it from a global perspective and restore 
the humanity to health care. We need to focus more on people and less 
on the system.
  I have a lot of ideas on health care. I, along with many others, have 
introduced the Patient's Choice Act, where we allow everybody to have 
insurance in this country. We equalize the tax treatment for everybody 
in this country.
  All the studies say that any plan Congress puts forward, our plan 
will do as well or better with some major differences. We do not raise 
the cost at all. It does not cost anything. As a matter of fact, it 
saves the States $1.3 trillion over the next 10 years just on Medicaid 
alone. And every Medicaid patient out there will have a private 
insurance program, and nobody will ever know if they got it through 
Medicaid or not. They will be truly accessing and having the care, and 
we will not raise taxes on anybody to do that--no one.
  The other thing we do is, if you like what you have today, you can 
keep it. You absolutely can keep it. If what you have is what you want, 
it gives you care when you want it, access to the doctors you want or 
to the hospital you want, and you can afford it, you are going to keep 
it. But if you would like something different, and not be locked in, 
not having to stay at a job because you are afraid you will not have 
insurance when you leave, you need to look at what we are talking 
about.
  There is no preexisting illness exclusion. There is no individual 
mandate, although there is an auto enrollment where you can opt out. If 
you do not want health insurance, you do not have to take it, but you 
do not get the tax credit that goes along with buying it.
  So, in fact, of the 46 million people who do not have access to care 
today through an insurance program, they will have it under this 
program, and they will have prevention, and they will have wellness, 
and they will have a medical home or an accountable care organization 
to manage their chronic

[[Page 14312]]

disease, help them manage it. And they will get to do that where they 
want to do it, not where some bureaucrat tells them they will do it or 
where some insurance company tells them where they will do it.
  We have a chance to hit a home run for the American people on health 
care--not just on their health care, but keeping us globally 
competitive, keeping jobs here at home instead of shipping them off 
where the labor costs and health care costs are less. We have a chance 
to hit two home runs. The question is, Will we do it?
  We have before us in the HELP Committee a draft of a bill that has 
three big blanks on it. We do not have any analysis by the CBO on what 
it is going to cost. We have no knowledge about what it costs, and we 
are going to be marking that up in a week. We are supposed to get 
health care done in 6 weeks in this country, which is 17 percent of our 
GDP, one-sixth of our economy, and we are going to do it without 
knowing what we are doing.
  The parameters under which this Senate is addressing health care are 
a prescription for disaster. What we should do is put out the bills, 
have a legitimate debate about what is a proper way to go, and let the 
American people hear the debate and see which way to go. I will tell 
you, if you allow the American people to decide: Here is a government-
controlled option or here is my option, with me choosing everything, me 
not depending on the government, me making the choices for my family--
when I want it, where I want it, and how I want it--individual freedom 
and liberty will win every time over a government-mandated program or 
a, quote, public government-run insurance company.
  The PRESIDING OFFICER. The Chair reminds the Senator that his time 
under morning business has expired.
  Mr. COBURN. Madam President, I ask for 10 additional minutes.
  The PRESIDING OFFICER. Is there objection?
  Mr. WHITEHOUSE. I do not object. It will be the last extension?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. I thank the Chair.
  One of the questions we ought to ask the American people is: Would 
you rather pay the costs you pay today for the quality of care you 
currently receive or would you rather get in line, pay less, not have 
the same quality, and not get to choose the health care you are going 
to get or your family is going to get--defer the decisionmaking about 
you and your family's health care to a government bureaucracy?
  All of us agree, Democrats and Republicans, we want to fix health 
care. All of us want prevention, wellness, management of chronic 
disease. All of us want as much freedom as we can give the American 
people. But the difference lies in how we do it and who pays the bill. 
That is why I started out with the article from Adrian Rogers. We are 
going to spend $2.4 trillion on health care this year, and we are going 
to get back $1.7 trillion worth of health care.
  We should not be spending a penny more. What we should be saying to 
the Senate is: Why aren't you fixing what is wrong with this terrible, 
broken system? And the answer is: We need more money. That is the 
government's answer every time. Every time: We need more money. We need 
a new program.
  We do not need a new program. What we need is to allow the individual 
entrepreneurship and ingenuity of the American people and give them the 
resources with which to buy their health care and make their personal 
choices, and what you will see is a dynamic that squeezes $500 billion 
to $700 billion out of the cost of health care in this country.
  There are a lot of components. Health care is a complex issue. 
Everybody who worked on it knows it. It is hard in a 20- or 30-minute 
talk on the floor to explain a bill fully. But if you had absolute 
access, and you could afford health care, and you got to make the 
choices, and it did not cost your kids any more in the future to pay 
for that by borrowing against their future, most Americans would say: I 
will buy something like that. That is a fix.
  And by the way, we are going to incentivize the $40 billion we spend 
every year supposedly on prevention to where it is actually making some 
difference on cost. We are going to quit paying for food that is 
terrible for you through the Food Stamp Program. We are going to fix 
the School Lunch Program so we do not feed you high carbohydrates and 
fat. And we are going to give you protein, fruits, and vegetables. We 
are going to do that which is necessary to put us on a glidepath to 
where we have real health care instead of sick care in this country. 
People will buy that.
  I cannot wait for the real debate to start on health care. When you 
hear the talk, and you read the articles that have been written--just 
for example, on comparative effectiveness, the director who is involved 
in that in England said it was the biggest mistake they ever made. It 
explains why people in England die earlier. It explains why they have a 
cancer cure rate about a third lower than ours. It explains why people 
cannot get care because they have a government option. They have a 
government option that eliminates the ability for true choice, true 
access, and true affordability.
  One of the things our bill will do is make sure, no matter how sick 
you are, you get an insurance policy. When it comes time for renewal, 
they cannot deny you. Our bill gives everybody insurance in this 
country and incentivizes you to the point where you will have extra 
money with which you pay for the additional costs associated with that 
care.
  Our plan does not mandate anything, except the base minimum plan is 
the base minimum plan the Members of Congress get. If you want to buy 
more than that, you can. But nobody is going to tell you what you have 
to buy. You buy what is right for you, what is right for your family.
  One of the costs of health care in this country--and it is about 8 or 
9 percent of the cost of health care--is doctors like me ordering tests 
you do not need because I fear a malpractice lawsuit. We incentivize 
the States to make changes--very simple changes--do not eliminate the 
right of any individual to go to court, but set up health courts or set 
up judge-doctor-lawyer panels or a combination thereof, and we give 
them extra money if, in fact, they will do that. It is an easy, cheap 
buy. Because if we reform the tort system State by State, we get back 
about a hundredfold for every dollar we put out that comes out of 
health care that will then go to prevention, wellness, and management 
of chronic disease.
  We have cost-shifting in this country. If you opt out and you go to 
an ER, your State can buy you a high-deductible policy, whereas you are 
still covered. You are not going to ever lose your home because you had 
an accident or you had a major health complication because you will be 
auto enrolled as soon as you hit the ER. So we eliminate about $200 
billion in cost-shifting.
  I have just outlined $500 billion that can go away under our bill out 
of $2.4 trillion--money that does not help anybody get well, money that 
does not prevent anybody from getting sick.
  I had an orthopedist in my office today and he had a patient who he 
thought had a torn anterior cruciate ligament. That is a ligament 
connecting the femur to the tibia. And she could not relax. He is a 
good orthopedist. By clinical exam, you can tell if somebody has torn 
an ACL, anterior cruciate ligament. So he said: Well, you can't relax. 
We'll do an MRI. So she comes back a week later and says: Doctor, I 
didn't do the MRI. I didn't want to pay for that. And she brought a 
glass of wine with her, a glass of chardonnay. She said: I think if I 
drink this, about 15 minutes after I drink this, I think I will be 
relaxed enough for you to do it. Well, sure enough, she did, and she 
relaxed. She had a torn ACL, and she never had to have an MRI. It just 
saved us about $1,800. It saved her and us $1,800. He could have given 
her xanax and done the same thing.
  But the point is, she made a logical decision not to spend $1,800 
because there was another way of doing it. Part of that was because she 
had a $5,000 deductible health care policy, so she

[[Page 14313]]

made a good economic choice. Multiply that 100,000 times in this 
country every month and see how much money we can take out of the 
health care system by people acting in their own best health interest 
and financial interest.
  We have a lot in front of us, and we have a lot that is riding on us. 
I hope we get to see the bills, which we have not seen yet, and what 
people want to do. The first bill out is: The government does 
everything; the government is in control. There is not one government 
program that either offers the services or is not bankrupt that we have 
on health care today. Medicare is bankrupt. Medicaid--we are bankrupt, 
so they are bankrupt. They have $80 billion worth of fraud in Medicare; 
$40 billion worth in Medicaid. The Indian Health Service is a sham, 
especially on the reservation, because we do not have the quality and 
we have not put the money there. Why shouldn't a Native American have 
an insurance policy to be able to buy health care wherever they want? 
Why shouldn't a veteran be able to get care wherever they want rather 
than have to travel 200 miles to a VA health care center? Why can't we 
keep the commitment that we would say: If we are going to offer you 
access, then we are going to offer you access to the best, the highest 
quality health care, with you making the decisions about your care, 
when you get that care, and who gives you that care.
  The patient has to come first. Senators' egos have to come second. 
And we have to fix this program in a way that not only solves the 
health care crisis but does not create another crisis for our children 
down the road.
  With that, I yield the floor.
  I thank my colleague from Rhode Island for his patience, and I wish 
him a good night.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The Senator from Rhode 
Island.
  Mr. WHITEHOUSE. Mr. President, it is always a pleasure to hear the 
Senator from Oklahoma discussing health care, which I know is very dear 
to him. So I did not feel my time was wasted listening to him speak on 
that subject, and I wish him a good evening as well.
  Mr. President, I ask unanimous consent, if I may, to speak in morning 
business, but to exceed the 10-minute rule.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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