[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 25327-25329]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      MEDICARE PHYSICIAN PAYMENTS

  Mr. McCONNELL. Mr. President, I am going to take a moment of my 
leader time. Americans are increasingly alarmed by the expansion of our 
national debt and this spending binge we are putting on the national 
credit card. They are asking us to do what they have been doing. They 
want us to take out our scissors and cut the credit card. They want us 
to live within our means so their children and their grandchildren do 
not wake up in the morning to find the American dream buried under an 
avalanche of debt.
  Our fiscal situation has simply spiraled out of control. Yet the 
proponents of this measure want to put another quarter of a trillion 
dollars on the Federal credit card. Republicans offered a series of 
fiscally responsible ways to prevent pay cuts to our physicians. That 
was not agreed to.
  Let me remind everybody, we are in very dangerous territory. I am 
going to vote against this deficit-expanding bill because enough is 
enough. I hope, on a bipartisan basis, we will send a message to the 
American people that we do not intend to charge from $\1/4\ trillion to 
$300 billion on the nation's credit card by approving this measure.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. REID. Mr. President, we have been aware of the fact that because 
of activities and actions of the Republican-dominated Washington for a 
number of years, that the doctors who take Medicare patients have been 
hammered so hard that not all doctors take Medicare patients.
  We want senior citizens, Medicare recipients, to be able to go a 
doctor. We do not want all of those folks going to Medicare Advantage. 
We want Medicare to survive as a program.
  Because people who ran this town for a number of years did not like 
Social Security, tried to privatize that, did everything they could to 
minimize and denigrate Medicare, we are now at a point where we have, 
in the bill that has been reported out of the Finance Committee, a 1-
year fix for the senior citizens, so that physicians will not be 
dropping Medicare patients. Then all of the physicians should know that 
we march to this position we are in now.
  We were told by the American Medical Association and others that we 
would get help from the Republicans to take care of senior citizens so 
that they would have doctors to take care of them. It is very 
interesting. One of the sponsors of this legislation, one of the 
Republican leaders, is not supporting the legislation. How do you like 
that? This is another effort of Republicans to slow down, divert, and 
stop what we are trying to do with health care and based on everything 
else.
  I just finished a meeting over here with my chairmen. We lamented the 
fact of how things have changed in this town, how in this new 
administration we have had to file cloture on a significant number of 
occasions to get people who have jobs in this administration approved 
in the Senate. During the Bush first year, during this same period of 
time, not a single nomination he requested had to be clotured; that is, 
to end a filibuster. We have numerous people to get approved.
  We have essential legislation, such as legislation that deals with 
giving people who are out of work unemployment benefits. It is not a 
gift. They pay into that fund or they thought it wasn't a gift.
  I want everyone to know we are going to take care of Medicare. If the 
Republicans in the Senate don't want to do it the way we have done it 
in the past by doing the doctors fix, then when we finish the health 
care legislation, we will come back and take care of a multiple-year 
fix for the doctors and senior citizens.
  I want everyone within the sound of my voice to understand that 
Washington is being driven by a small number of people on this side of 
the aisle who are preventing us from doing things that help the 
American people. We are not trying to run over people with the 60 votes 
we have. We want to work with people. We want to get along. I think it 
is really too bad that suddenly they have got religion. They never 
worried in the past about all the tax cuts being paid for. They never 
worried about drug manufacturers getting all the free stuff they got. 
They never worried about any of this. They now are suddenly being very 
frugal when they find it is a way they can slow down what we do here.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.

[[Page 25328]]


  Ms. STABENOW. Mr. President, if I might just add to what our 
distinguished leader has said and thank him for bringing this vote to 
us. This is about strengthening and protecting Medicare.
  The distinguished Republican leader is right: Enough is enough--
enough of running physicians up to the brink every year, not knowing 
what is going to happen; enough for seniors not knowing whether they 
will be able to continue to see their doctors. Seven different times we 
have brought them up to the brink and then not made the cut and have 
many times not paid for it. This legislation will wipe the slate clean 
and will for the first time bring honest budgeting to Medicare.
  Mr. LEAHY. Mr. President, I am proud to be a cosponsor of the bill we 
are considering today, the Medicare Physician Fairness Act, introduced 
by Senator Stabenow. This bill would permanently end the scheduled 
reductions in Medicare and TRICARE payments that physicians face each 
year. This legislation is long overdue and an important step in making 
sure doctors will continue to serve Medicare patients and veterans in 
the years to come.
  This year marks the 8th year in a row that Congress will be forced to 
prevent scheduled physician payment cuts under the Medicare Program. 
The scheduled cuts are based on a flawed formula, which cuts physician 
payments in the future if physician spending exceeds a target based on 
the growth of the economy. Because the scheduled cuts are cumulative, 
next year we could expect to see a 21-percent reduction in physician 
payments and a cumulative 40-percent cut scheduled by 2016. It is no 
wonder Congress has consistently acted to prevent these cuts and 
experts have called for a repeal of this broken formula.
  Without passing this bill and permanently ending the schedule of 
physician payment cuts, doctors will continue to struggle to budget for 
the future without knowing with absolute certainty that Congress will 
act to prevent payment reductions. The uncertainty in payment rates has 
already resulted in many physicians declining to accept Medicare making 
it hard for beneficiaries to find a doctor. In rural States like 
Vermont, finding a doctor is challenging enough without looming payment 
cuts affecting doctors every year. In addition to seniors, the more 
than 12,000 Vermont veterans and military personnel who participate in 
TRICARE will continue to feel their benefits are at risk so long as 
this flawed formula threatens payment reductions to their doctors.
  Some have argued that we cannot afford to make such an expensive fix 
to our health care system. I disagree. The President already assumed 
Congress will fix the payment cuts over the next 10 years in his budget 
proposal. We all know that without a permanent fix Congress will 
continue to act to prevent these debilitating cuts in payment rates to 
doctors. The administration's budget gives a realistic estimate of 
projected Medicare spending. Passing a permanent fix will allow us to 
have accurate estimates of Medicare spending, a first step toward truly 
reforming the physician payment system to one that is based on quality 
and performance and not on arbitrary formulas.
  This legislation is an important step toward making changes in the 
Medicare and TRICARE physician payment structure that will help our 
entire health care system. I regret that some misplaced partisan point-
scoring threatens to prevent us from considering a bill we should have 
passed long ago. I hope we can proceed to this bill and pass it swiftly 
so we can begin our work toward improving our overall health care 
system.
  Mr. BAUCUS. Mr. President, an old Chinese proverb says:
  ``If you do not pay the doctor who cured you, beware of falling ill 
again.''
  We are here today because we need to fix the way that we pay the 
doctors who cure us.
  The way that we pay for health care today contributes to spiraling 
health care costs. It contributes to quality-of-care that is not as 
good as it should be.
  Today's payment system rewards providers for the quantity, not the 
quality, of the services that they provide.
  Commonsense health reform must restructure the way that we pay for 
health care.
  Because of its size and purchasing power, Medicare can lead the way. 
But payment reforms won't be effective unless they're built upon a 
solid payment foundation.
  Unfortunately, the current Medicare payment system for doctors is 
fundamentally flawed. It does not provide stability and predictability 
for our doctors. It is not a solid foundation for the future.
  That is so, because in 1997, Congress created the Medicare physician 
payment system that we have today. Congress created a thing called 
``the sustainable growth rate,'' or ``SGR.'' It was meant to control 
what Medicare spends on doctors.
  But the SGR is not working. It never really has.
  Had Congress not intervened, the SGR would have produced steep cuts 
in physician payments every year since 2002. And if Congress does not 
intervene now, the SGR will continue to produce steep cuts for the 
foreseeable future.
  Without action, next year, physician payments will be reduced by 21 
percent. And the cuts will continue for the foreseeable future. The 
total cut over the next decade will approach 40 percent.
  Every year since 2003, Congress has intervened. Congress regularly 
acts to avert these cuts. And given the magnitude of the impending 
reductions, Congress will continue to intervene. The stakes are just 
too high.
  Allowing these draconian cuts to go into effect would jeopardize 
access to doctors for 40 million seniors--including 160,000 Montanans--
who rely on Medicare for their health coverage. That is why AARP 
unequivocally supports the repeal of the flawed SGR formula.
  But the damage would not end there. Because TRICARE--the health care 
system for active military personnel--bases its reimbursements on 
Medicare rules, 9 million members of the armed services and their 
families could also be left without physician care.
  The SGR must be repealed.
  But don't just take my word for it. The Medicare Payment Advisory 
Commission--or MedPAC--reported to Congress in 2007 that the SGR should 
be replaced with a more stable, predictable system. MedPAC recommended 
a system that rewards doctors based on the quality and efficiency of 
the care that they deliver.
  The Medicare Physician Fairness Act is the first step toward a 21st 
century physician payment system in Medicare.
  The Medicare Physician Fairness Act repeals the flawed SGR formula 
that has done nothing to promote more appropriate, evidence-based 
physician care.
  Repealing SGR will lay a solid foundation. And on that foundation, we 
can build delivery system reforms that fundamentally restructure the 
Medicare payment system. We can change it from one that focuses on the 
volume of services delivered to one that rewards doctors for the value 
of care that they deliver to patients.
  The bill that the Finance Committee reported last week includes these 
reforms. Our bill includes better feedback reports to doctors, so that 
they know how their utilization trends compare to those of their peers. 
Our bill includes incentives for physicians to work together with other 
health care providers in accountable care organizations that will share 
in savings they achieve for Medicare. And ultimately, our bill includes 
a payment system that rewards every doctor based on the relative 
quality and costs of care they provide to their patients.
  But first, we need to repeal the SGR, so that we can enact these 
meaningful reforms.
  Now, any honest discussion about repealing the current SGR system 
must also address the elephant in the room: the CBO budget baseline. 
The law requires CBO's budget baseline to assume that Congress will not 
suspend the SGR.
  The reality of the situation, however, is at odds with the CBO 
baseline. Future congressional action on the SGR

[[Page 25329]]

is certain. Seven consecutive cuts have, for good reason, been averted.
  Rather than continuing to enact short-term fixes that produce steeper 
cuts in the future, the Medicare Physician Fairness Act adopts the 
Obama administration's more realistic budget baseline. It does not 
increase spending over recent trends or future action. It preserves 
spending at current levels.
  Adjusting the SGR baseline without an offset is not something I 
endorse without hesitation. I believe in fiscal responsibility. And I 
am proud that the Finance Committee health reform legislation will 
reduce the budget deficit in the first 10 years and dramatically bend 
the cost curve in the long run.
  But by overturning each of the last seven SGR cuts, Congress has made 
clear that the current baseline is broken. And temporary band-aids have 
only increased the size of future cuts and the cost of future 
interventions.
  Eliminating the SGR now will avert devastating payment cuts. And 
eliminating the SGR now will create a more honest picture of our future 
budgetary commitments.
  And so, let us avoid merely putting another band-aid on the broken 
physician payment system. Let us truly reform the way that we pay the 
doctors who cure us. And let us enact the Medicare Physician Fairness 
Act.
  Mr. FEINGOLD. Mr. President, our Nation faces great challenges that 
require collective persistence and collective sacrifice to overcome. 
Two of these challenges that I hear the most about from my constituents 
are the need to reduce the national debt and enact health care reform. 
Their concerns come from a basic sense of responsibility and decency--
and are true to Wisconsin's progressive tradition. They believe, as I 
believe, that the government should be required to balance their budget 
just as Wisconsinites balance their checkbook. They believe, as I 
believe, that every American--regardless of wealth, race, gender, or 
age--deserves good, affordable health care. These basic principles of 
fiscal and social responsibility have guided me throughout my 17 years 
in the Senate. And it is these principles that lead me to conclude that 
I cannot support S. 1776, the Medicare Physician Fairness Act, because 
it will substantially add to our national deficit.
  I believe that the Medicare sustainable growth rate is a broken 
policy and must be fixed. I also believe that requiring Congress to pay 
for enacting new policies is critical to our long-term financial 
stability and strength as a nation. Waiving paygo requirements for this 
legislation simply puts a different name on the same $247 billion 
problem. It passes the buck, and that is not good enough for me.
  Just this week, I introduced the Control Spending Now Act. This bill 
consists of dozens of different initiatives that would collectively 
reduce the deficit by over $\1/2\ trillion over 10 years. Redirecting 
just a portion of the savings in my legislation would more than pay for 
the Medicare Physician Fairness Act. We do not have a lack of funding 
options; we have a lack of political will to make those tough 
decisions. And lack of political will is not a good reason to add to 
the national deficit.
  For years, I have called for significant reform of the Medicare 
sustainable growth rate formula. I have heard from countless Wisconsin 
physicians about how damaging these potential cuts are to their ability 
to provide health care. And I am seriously concerned that without a 
comprehensive change, Medicare beneficiaries' access to the health care 
they need will be limited. The Medicare SGR formula is a real and 
growing problem that deserves thoughtful and fiscally responsible 
reform.
  Mr. BYRD. Mr. President, while it is important that health 
professionals in my State of West Virginia receive the compensation 
they deserve, I will, however, vote against this measure. We are on the 
eve of one of the most historic debates surrounding health care since 
the inception of Medicare in 1965. To follow the many weeks of 
laborious debate and amendments in the Finance and Health, Education, 
Labor, and Pensions Committees, with this legislation is unwise. It 
sends the wrong signal. The health committees have not reviewed it. It 
addresses only a single problem, to the benefit of one group of health 
care providers, completely outside the context of broader reform. I 
believe piecemeal action on health care reform could be its undoing.
  In the coming weeks, I look forward to voting on the motion to 
proceed to a comprehensive health care reform bill. Reforming our 
health care system for the betterment of all of our citizens is 
necessary and vitally important. But we need to make certain there is a 
national consensus behind any health care bill. In order to pass a 
meaningful measure that will provide essential health care coverage for 
those in dire need, the Senate must be entirely forthright in both 
debate and intention. Mr. President, $247 billion is not an 
insignificant amount of money, and the Senate should be up front about 
the true costs of health care reform.
  Mr. DORGAN. Mr. President, my vote against cloture on the motion to 
proceed to legislation that would cancel the scheduled physician 
payment cuts in the Medicare Program should not be read as opposition 
to the idea of canceling those cuts.
  I support canceling the payment cuts for physicians. However, I think 
that action should be paid for. As it stands, that legislation would 
have increased the Federal deficit by $245 billion over 10 years. I 
cannot support that.
  Congress has acted to prevent scheduled cuts for 6 of the last 7 
years, creating a very large debt burden that becomes harder and harder 
to eliminate each time a temporary fix is enacted.
  Each year physicians face uncertainty as a result of not knowing 
whether or not their reimbursement will be cut. I support developing a 
new model that provides stability in Medicare payments.
  I am working with my colleagues to find ways to address the Medicare 
physician payment formula, and pay for the cost of doing so.

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