Richard Burr

Mr. BURR

Mr. BURR. Mr. President, I call up amendment No. 3390.

Mr. BURR

Mr. BURR. May I ask a question of my colleague? Listening to this list of products that have been denied people in Great Britain, and certainly this is true in some other countries, makes me look at the Medicare population in this country with the realization that the way Medicare was constructed, a senior can't pay out of pocket because no provider can receive a payment from a senior. If for some reason this bill were passed and you took part of the arsenal of drugs away from seniors or procedures away from seniors, how can a senior get a benefit if no provider can receive an out-of-pocket payment from a senior?

Mr. BURR. Madam President, will my colleague yield for a question?

Mr. BURR. If, in fact, the Congress did reverse the decision of an advisory board, what does that do to the budget deficit? And what does it do to the claims that this current bill being considered is paid for?

Mr. BURR. So if the authors of this bill never intended to make cuts, then it blows the budget neutrality that is portrayed in this bill. But if they use all the mechanisms that are in place to make sure reimbursements are cut or the scope of coverage is affected by a decision to limit one's care, then we could see prevention cut, wellness programs cut, or even the preventive diagnosis such as for breast cancer limited to a much smaller group.

Mr. BURR

Mr. BURR. If I can comment to my good friend, who started on a quest with me several years ago to try to put together a health care reform bill, I might say it was the first one introduced in the Congress in May of this year on comprehensive health care reform--not that it is better than anybody else's, but I can honestly say today it was true reform. I think that is what Dr. Coburn is trying to say. In this bill, it lacks reform. What do I mean by that? Their reform is to set up an advisory panel that if we exceed the costs we have designated for health care, they are going to cut the scope of coverage or the reimbursement. So either the array of coverage for a senior or for an American is ``skinnied down'' or we cut the reimbursement to the doctor or the hospital, and they call that reform. What Dr. Coburn and I found out, as many other Members have, is if you look at the successful companies across this country that have held down their health care costs through doing real reform--paying for prevention and wellness in work, changing the lifestyles of the employees--we saw companies that, for 4 years, had a 45-percent increase in their health care. Where is any of that in this bill? Out of 2,700-plus pages, there is no attempt to do that. There is no attempt to try to affect the lifestyles through supporting chronic disease management, prevention, and wellness, but we set up a lot of independent advisory boards. As a matter of fact, they were so scared that in the managers' amendment, it is no longer called the Medicare independent advisory board. It is called the independent advisory board. So the word ``Medicare'' was dropped, not to signify that they are going to cut Medicare, but that is exactly what CBO and CMS have said. These will kick in. The question is, Are they sustainable or will Congress legislatively override their authority to cut the spending?

Mr. BURR. Madam President, I think many Members have to ask: Why are we here? We are here because at 1 a.m. this morning, there was a cloture vote on the consideration of the Reid managers' amendment. I think it is important that we discuss what that means. It means there are going to be no more amendments, no opportunity for any Senator from any State to propose a change to the bill. At some point, we will have an up-or-down vote on exactly what Senator Reid has presented to us. But here is what we do know. We are going to steal $466 billion from Medicare. We are going to take that $466 billion away from hospitals, from hospice, from nursing homes, from home care, and, yes, a popular target up here--the insurance product many Americans have chosen, 20 percent of the seniors, Medicare Advantage. We are going to eliminate that option. So this is one case where if you like your health care, you are going to lose it. The bill that we are considering and that will be voted on later this week raises $519 billion in new taxes and fees--$519 billion in new taxes. I might add for my colleagues, we are taxing tanning salons at 10 percent. What in the hell does that have to do with health care? Well, the reason it is in there is because we dropped taxing Botox. Hollywood saw this was not advantageous to have Botox taxed, so when they dropped that, they had to find something else: poor tanning salons, small businesses in every community across this country. We are going to actually tax the majority of Americans the President said he would never tax: those under $200,000, the ones who can't afford to go to the beach every weekend; the ones who don't have a beach house. They are going to pay a 10-percent tax when they go to get a little bit of a tan. Well, when they do that, how far off are we from fining parents because we don't put a high enough SPF on our children, or are we going to start charging when we go to the beach because we get exposure to the Sun? That is what happens when the government becomes a more dominant role in health care. I might add: No doctor fix, something many of us have highlighted. In the bill, there was a 1-year fix. Doctors are going to be faced with a 21-percent cut in their reimbursements after this next 2 months. There was a 1-year fix to it. It didn't do away with the problem. It didn't fix the whole problem. But now there is no 1-year fix. We have said in 60 days doctors will be on their own. Yes, there were some special deals--the cornhusker kickback, the windfall for Nebraska. I have to admit that I was proud of my colleague, Senator Johanns, who came to the floor and said: Let me assure you, the people in Nebraska have never asked for something different than everybody else. They are willing to pay their share of the way there. They haven't asked for it to be free for them and cost everybody else. Yes, it will cost my constituents in North Carolina, and it will cost the constituents in Nevada--well, it won't in Nevada. I think maybe there is even a deal that affects them to some degree. Is it fair? No, it is not fair. The fact that it wasn't fair was called: ``That is compromise.'' That is not compromise. We are here under an obligation to make this fair to all of the American people. But in this case, it is not. Yes, there are 31 million Americans who are going to have health insurance, 15 million of whom are delegated into Medicaid, the most dysfunctional delivery system that exists in the American health care system. Yes, there is, for many States, an unfunded mandate to those States because after 5 years, for most States, except for those who got these special deals, the States are going to be responsible for some portion, an average of 10 percent of the cost of Medicaid. Let me tell you what my Governor, Governor Bev Perdue of North Carolina, said earlier: The absolute dealbreaker for me as governor is a Federal plan that shifts costs to the States. Well, we are shifting costs to the States, and she is nowhere to be found now. But the people in North Carolina, the taxpayers of North Carolina are going to continue to be charged for this expansion of Medicaid when that is the most inefficient place for us to have put these 15 million Americans who were promised health care. While we do all this, according to the Chief Actuary of the Centers for Medicare and Medicaid Services, CMS, 20 percent of our hospitals and nursing homes are going to go bankrupt. They are going to go out of business because as the Chief Actuary said: They would be unprofitable within the next 10 years as a result of these cuts. Hospitals, nursing homes, at a time that our senior population is getting ready to explode as the baby boomers hit it, we are cutting $466 billion from Medicare, and we are starving the infrastructure of hospitals and nursing homes and hospice and home care. What is going to happen to the providers? The Chief Actuary, again, said if we pass this plan, the result is providers will be unwilling to see Medicare and Medicaid patients. Today, 40 percent of providers don't see Medicaid patients. Does that mean it is going to be 50 percent or 60 percent or 70 percent? We are ballooning a system that today is having a hard time finding providers. To most of us that doesn't make sense, but that is what the Senate is going to do. I might also add that the attempt was to expand coverage; and, yes, sure, in numbers, we are expanding coverage. But, if passed, the Congressional Budget Office says 8 million to 9 million individuals who currently have employer-based health care will lose that health care. Eight million to nine million who currently have their health care will lose their health care with the passage of this bill. The net-net is not real pretty, and when you look at the $2.3 trillion that health care costs, you have to ask yourself, where is the beef? Where is the value in this? As hospitals close, as nursing homes close, as providers don't see Medicare and Medicaid, ask yourself, have we really done something good? Chances are, you will find out if we do nothing, if we do nothing, we will actually save money in the health care system. The last fact: The Chief Actuary of Medicare said: If you pass this bill, the cost of health care will be $\1/4\ trillion more than if we did nothing. The President talked about bending the cost curve down. We are bending that cost curve up in this bill. We are bankrupting hospitals and nursing homes. We are chasing providers from seeing Medicare and Medicaid patients. There are not too many things we can point to that are great about this bill. That is every reason we should start over. I know my colleagues are here to join in and to offer some perspectives, and I would ask them to chime in.

Mr. BURR. I thank our colleague from South Carolina. I know we are about to run out of time, but I wanted to go back to the Chief Actuary at Medicare because I think the way they analyzed the bill is absolutely essential for the American people to understand what is in it. The Chief Actuary, the President's Actuary, said: The Reid bill funds $930 billion in new spending by relying on Medicare payment cuts which are unlikely to be sustainable on a permanent basis. It gets to what Dr. Coburn said. By design, maybe this could work, but there is not a will because there is not reform. We have spent a lot of money, and at the end of the day, it looks as if the only thing we have done is tried to address waste, fraud, and abuse. For $2.3 trillion, it seems as if you could bring more bacon to the table. It seems as if there would be a little more meat. It seems as if there would be some substance there we could look at and say: Look at the improvements our health care system makes. I know Dr. Coburn has said many times: If we do this wrong, what we do is we chase innovation out of this country, out of our system, the breakthroughs that go from maintenance to cure, the research on a bench that finds us new ways to address diabetes where amputation and blindness are not in somebody's future. If we go backward, if we chase that innovation out, we lock ourselves into not only the most costly health care but health care that achieves the least amount of quality for future generations.

Mr. BURR. Madam President, I am going to be joined by a number of my colleagues, so I ask unanimous consent that we be able to have a colloquy during the remainder of our time.

Mr. BURR. I thank the good doctor, and I thank the Presiding Officer, and I yield the floor.

Mr. BURR

Mr. BURR. I appreciate that, Mr. President. We have gone through this, and we are refused the ability to offer amendments. We are refused the opportunity to sit in the back room where the legislation was constructed. It is shared with us when they are ready. But they use everybody's money. Tell me how it is fair to the American people. When Nebraska gets a sweetheart deal under Medicaid, and Massachusetts and Vermont, in the managers' amendment, when Nebraska is told: We are going to expand Medicaid and we are going to hold you harmless in perpetuity, you will not have to pay, tell me how that is fair to the taxpayers of Virginia, tell me how it is fair to the taxpayers of Ohio, tell me how it is fair to the taxpayers of North Carolina that they are going to pay for what Nebraskans should be obligated to pay. I believe, knowing Nebraska, that the people of Nebraska would want to pay their fair share. But, no, to buy a vote, they have been given a deal. This bill is still $2.5 trillion. It still steals $464 billion from Medicare. It still puts a tremendous unfunded mandate on every State in this country with the exception of the State of Nebraska. There are a number of States that have a grace period for some period of time, whatever it took to get their comfort level of their vote, but for every other State, at some point they are going to be obligated to pick up that difference. We cover 3l million Americans who were not covered--that is a wonderful thing--and 15 million of them are dumped into Medicaid, the worst health care delivery system that exists in this country, a health care system that only has the opportunity today to see 60 percent of the available doctors because the other 40 percent will not see them. Oh, by the way, what did the Chief Actuary of the Centers for Medicare and Medicaid Services say? The Reid bill is especially likely to result in providers being unwilling-- Unwilling-- to treat Medicare and Medicaid patients, meaning that a significant portion of the increased demand for Medicaid services would be difficult to meet. The Chief Actuary went on to say: The CMS actuary noted that the Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. I just heard the Senator from Rhode Island basically come out and say that was a fabricated thing on the part of somebody on this side of the aisle. I am quoting the Chief Actuary, the President's chief health care budgetary person. The Actuary said it ``could jeopardize Medicare beneficiaries' access to care.'' He goes on to say that he finds that roughly 20 percent of all Part A providers--hospitals, nursing homes, et cetera--would become unprofitable within the next 10 years as a result of these cuts. Hospitals will close, nursing homes will close. This isn't fabrication. This is the Chief Actuary of the Centers for Medicare & Medicaid Services, who is part of this administration. The CMS's Actuary found that further reductions in Medicare growth, through the actions of the independent Medicare advisory board--this is the advisory board that is being set up to make determinations about coverage in the future--which advocates have pointed to as a central linchpin to reducing health care spending, may be difficult to achieve in practice. In other words, we are making claims that aren't right, it is the authors of the bill who are making claims that are not accurate, according to the Chief Actuary. I yield to the minority leader.

Mr. BURR. The Senator makes a great point, and I am sure we have loaded the chairman of the Finance Committee with additional good ideas he can go back and think on. I am sure before it is over, we will fine parents who don't put suntan lotion on their children--especially if it doesn't meet high enough SPF to block everything the Sun might produce. This is out of control. This is not the way to write a bill that affects one-sixth of the U.S. economy. I mean it is bad enough it is done behind closed doors, in a back room, with only a few people there, but when the No. 2 Democrat can walk on the floor and say: I haven't seen it, either--well, if the No. 2 Democrat hasn't seen it, how many people were there? How many people had input into this? Was it just Leader Reid and Senator Nelson? Was it the Presiding Officer from Minnesota? Nobody knows. Nobody knows. The truth is, and what we do know is that the American people don't like the process, and more importantly the American people don't like the bill. The chairman of the Finance Committee and others have said: But once it is out there and they get a taste of this, they are going to like it then. Well, let me remind my colleagues: It is too late. The Chief Actuary already told us: Hospitals are going to close, nursing homes are going to close, doctors are going to quit practicing medicine. They will quit seeing Medicare and Medicaid beneficiaries. How do you repair that after you have done the damage? Are we willing to risk that for the future of this country and generations yet to come? Boy, we have a few hours--8 or 10 hours--before we vote. I hope people get some sense. I hope they pull back from this. Let's leave for Christmas. Let's think about this. Let's go home and talk to people. Let's listen to people in this country. If we do, we might come back, get a new piece of paper, take some of the things in this bill and take some of the things we have talked about on this side of the aisle, take some of the things the American people have talked about, and find a way for 100 percent of the doctors, nurses, and hospitals to survive; find a way for 100 percent of the American people to have coverage, and not the 31 million covered in this bill, leaving 24 million outside the scope of coverage. You see, when we set out we had three objectives: One was to cover all the American people. We flunked. Another was to invest in prevention, wellness, and chronic disease management. The doctor and I both say we haven't come anywhere close to doing that. The third and most important was to make sure it is fiscally sustainable. CBO, CMS, wherever you want to go, the only way this is fiscally sustainable is if the independent Medicare advisory board continues to cut reimbursements, the scope of coverage, to meet how much we are willing to spend on health care to say it is affordable. I don't believe that is reform. I believe that is legislation that picks winners and losers, and that is not the role of the Senate of the United States. I yield to the good doctor.

Mr. BURR. I do, Mr. President.

Mr. BURR. Regular order, Mr. President.

Mr. BURR. Mr. President, I look around this Chamber, and I see the busts of many Vice Presidents who have served as the leaders of this Chamber. It makes me wonder what would they think of the process in which we are currently engaged, individuals who, in a time of history of our country, took so seriously what went on in this Chamber and the effects it had on the American people. I look at the process we are going through right now and see the way we have trivialized this process--votes in the middle of the night. Twenty-four hours ago, there was not a managers' amendment. There was not a score. Then yesterday morning we got a managers' amendment, 380- some pages, and we got a score. Today we get a notice from the Congressional Budget Office saying that in their score, they made a $\1/2\ trillion error, a $500 billion, $\1/2\ trillion error in the projection they sent to Congress. In 24 hours, $\1/2\ trillion. Why doesn't this seem to bother those who are the authors of the bill? It is because it is not their money. It is the American people's money. That is the only way you could rationalize how you could be in Washington talking about spending $2.5 trillion at best to stop waste, fraud, and abuse, because, let's face it, Republicans and Democrats agree: There is no health care reform in here. There is a coverage expansion, but there is no health care reform. Democrats have walked to the floor and said that we lie. I am not lying. Show me the health care reform. Show me where you have drastically changed, transformed health care. If you transform health care, then you wouldn't have to steal $464 billion from Medicare.

Mr. BURR. The minority leader makes a great point. If we waited another day to vote, we might save another $\1/2\ trillion. That is probably in the best interest of the American taxpayer. I will wrap up, Mr. President, because I know Dr. Coburn wants to speak. Let me say this. I said earlier this still steals $464 billion from Medicare. It also still raises taxes and fees to the tune of $519 billion. Many of those taxes and fees, by the way, are going to impact people well below the $200,000 threshold the President promised he would never touch. We have just learned in the managers' amendment that we have dropped the doctor fix. They should be comforted in knowing that they have a 2- month extension, but the 1-year extension was dropped in the managers' amendment. Dropped. Why? Because they had to pay for what they were doling out to get extra votes. I ask unanimous consent at this time, Mr. President, to set aside the pending amendment, and I wish to call up amendment 3134, which is a 3- year doctor fix of the SGR and ask for its immediate consideration.

Mr. BURR. I yield to the Senator from Oklahoma.

Mr. BURR. Well, Mr. President, my hope is no other Member from the other side will come to the floor and say that Republicans haven't come up with substantive amendments to this bill. Dr. Coburn and I participated in 56\1/2\ hours in the HELP Committee. We offered numerous amendments. Some technical amendments were accepted. The amendments that meant anything were rejected along party lines. We have filed a comprehensive health care reform bill--the first one introduced in Congress--in May of this year, I believe. Still, Members from the other side come to the floor and say Republicans haven't offered anything. We were the first. They may not have liked it, but we were the first. You know what, it doesn't cost this much and it doesn't raise taxes. I think Dr. Coburn will later talk about that bill a little. I was glad to see that politics comes from all sides. In the managers' amendment we dropped the tax on botox. Hollywood spoke out about this tax on one of their health care tools. And what did we replace it with? We have now put a 10-percent tax on tanning salons. How in the hell does that affect health care? Explain that to me. Are we going to tax everything in this country? I can make a tremendous case that the 10-percent tanning salon tax gets exactly the person that the President said he wasn't going to affect, people who make under $200,000--or are we income testing the tanning tax, too?

Mr. BURR

Mr. BURR. Mr. President, as my colleague finished, he made the statement, ``when the other side comes to the table.'' Let me just say at the beginning, we have been asking to be invited to the table since the beginning of this debate. Unfortunately, we don't know where the table is. We have never been invited, and we hope before this is over we will have an opportunity to provide input into a health care bill that affects 300 million Americans. But on this rare session, as I have heard it described, of a Sunday session of the Senate where I know the Presiding Officer of the Senate has sat in the chair for quite a while now, I am reminded of one of our colleagues, the Senator from Oklahoma, the doctor, Tom Coburn, whose mother passed away on Sunday. Sometime this weekend there is a service. I know my colleagues join me in saying to Tom that our hearts and our prayers go out to him and to his family. My mother died in between the time I was elected to the Senate but before I was actually sworn in. She was able to see me win, but she didn't live to see me sworn in to the Senate. I know how traumatic the loss of a parent can be. I remember, in my case, how quickly you focus on the fact that mothers have an incredible gift given to them by God--the gift of birthing children, of replenishing the next generation. I remember my focus shifted from the loss of my mother to the responsibility of my children. I think as parents we had undervalued that. That was a shock to me to make me wake up and say: I have a responsibility now to make sure that I nurture, to make sure that I raise, to make sure that I educate. It fell on my wife's and my shoulders because that is the next generation of business. That is and will be the next generation of leaders locally, at the State level, and at the national level. Parents are invaluable but so are the kids they produce and the opportunity from there on generationally to experience what is great about this country, and that is unlimited opportunity. My responsibility is not just to nurture and to raise two sons, in my case, or in Tom's case great daughters, and one is a tremendous opera singer--probably one of the most sought after in the world--but it is also to make sure we protect the opportunities we were given, to make sure that what people have fought for in wars before are recognized to preserve the opportunity of success. I feel as though, in our position today, that is part of our responsibility. We are here to preserve the opportunity for generations--for pages, for children, for our own kids. So it does hurt on a rare Sunday session to have come in during one of the most difficult economic crisis periods in our country's history and watch without much thought as the Senate passed a spending bill that had a 12-percent increase from last year, something no family can do right now, something that no individual can do. We will borrow 43 cents of every dollar that we just spent in that bill. There is no family in the world who can go into a bank today and say: I would like to borrow 43 cents on every dollar. I would like to go out and buy this big-screen TV. I don't need it, but I want it. There are some things in this bill we need. But there is a lot in this bill we just want--over 5,000 earmarks. Members of Congress actually, at a time that we should be prioritizing our spending in this country, not only did we raise it 12 percent over last year, but we had the audacity to stick 5,244 earmarks in this bill because we can do that, because somebody asked us. The truth is, families cannot, communities cannot, most States cannot. They have laws against it. They have to balance their budgets. Families have to balance their budgets or they file for bankruptcy. Communities have to balance their budgets and try to meet the core responsibilities of providing services to their communities. There is a choice when they do it: Do we overtax a community through property taxes or do we prioritize on what we spend our money? We never prioritize in this institution anymore. We believe we can spend as much as we possibly want to, and that is evidenced by 5,244 earmarks. The fact is, we just spent $3.9 billion that was not even in the bill originally when the appropriators received their caps. I am sure the community needed their park, and I am sure that the community needed the study or the service that each one of those 5,244 earmarks represent. But let me ask this: If they need it that badly, couldn't they fund it themselves? Let me say it again. If they need it that badly, couldn't they fund it themselves? Why were earmarks created? It is a way to get somebody else to pay for something you want, not necessarily what you need. Let me say to you, Mr. President, and my colleagues, to everybody listening: We are broke. We borrow 43 cents of every dollar we spend in the Federal Government right now. The 10-year projection says we are going to increase the debt in the next 10 years more than we did under the previous 43 Presidents. What else do we need to hear to stop spending? It just continues to roll on and on. You know what. We are going to get another opportunity next week to spend money we don't have. We are going to get an opportunity to raise the debt ceiling, something that for the 15 years I have been here was a big debate: How much do we need? When do we do it? It was a tool that we used to force us to prioritize. We are going to stick a $1.8 trillion debt ceiling increase into a Defense appropriations bill so that everybody feels guilty about voting against it if they do--and I will, for the first time, because I believe it is wrong. I believe it is wrong, and it should not be done. Let me just say this: Sometimes you have to say no. As my children grew up, the toughest thing was to look at those kids and say no. I want this. What do you want for Christmas? I want this. No. When I started work, I was always told in sales: The toughest thing you are ever going to have to do is say no. I will buy it from you, but I will only pay this much. No. We are at that point where the American people have said prioritize. We have to look at communities, we have to look at States, and we have to have guts enough to say no. Wealth is not created by government. Wealth is not created by States. But government steals wealth when the opportunity is available. Communities will grow, and they will be healthy, and States will grow and they will be healthy but only through local success. It does not come through handouts from the Federal Government. All that does is give us a false sense of security and a false sense of a bank account. In the midst of all this, as we passed this huge spending bill, a 12- percent increase, we are debating health care. We are debating a $2.5 trillion health care bill that steals $464 billion from Medicare. I talked about the transition I went through from the loss of a parent to the focus of children, and now all of a sudden I am back to stealing from my parents. As an institution, we are getting ready to steal $464 billion from Medicare, and people up here don't seem worried about it. My dad and possibly your dad and your mother have been paying into it their entire lives and were promised it would always be there. I am going to tell you a little secret today: Medicare is underfunded by $34 trillion. That is trillion, with a ``t.'' You know the most popular bumper sticker around today is: Don't tell Congress what comes after a trillion. So Medicare is underfunded by $34 trillion. That is not a guess by an actuary, that is a real number. The Medicare board says it is insolvent in 2017--8 years from now. What are we doing? We are stealing $464 billion out of it. I have heard people come to the floor and say they will never miss it. It would not affect a benefit. It would not affect a service. It would not affect a facility, a hospital. Now, all of a sudden over this weekend, we have been presented with news stories that suggest--because nobody has seen a bill, including many Democrats--there may be a deal that expands Medicare to include the 55-to-64-year-old age group-- potentially, 20-plus million people. I have heard other people say it is only going to be 2 million or so. I guess it will be crafted in a way that it will leave some out and put some in. I am not sure how you do that. I thought the purpose of the Federal Government was to be fair and equitable to all. But maybe this will be crafted in a way that we let 2 million 55-to-64-year-olds in and we leave the other 18 million- plus out. Anyway, my good friend from Rhode Island talked about the CMS Actuary and what he had to say. I wasn't prepared to come today and read every editorial out of the Wall Street Journal, but had I done so, I think they would have rebutted most of what my colleague said. But let me just read a couple quotes from the Actuary--the same one Senator Whitehouse talked about. This report says: The Reid bill is especially likely to result in providers being unwilling to treat Medicare and Medicaid patients. `` . . . unwilling to treat Medicare and Medicaid patients.'' In other words, not stealing the $464 billion--well, yes, stealing the $464 billion is going to generate less interest by providers to see patients. There is only 60 percent of the doctors today seeing Medicaid patients. There is about 74 percent seeing Medicare patients. So if you like your health insurance, you can keep your doctor, you can keep your plan. Well, that is out the window basically, based upon what the CMS Actuary said. The Actuary noted: The Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. Keep in mind, this is the President's person. Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. He also found that roughly 20 percent of all Part A providers, which are hospitals and nursing homes--two things additionally that we specifically cut, hospitals and nursing homes--would become unprofitable within the next 10 years as a result of these cuts. Well, my take as a businessman, not a lawyer, is that when an entity is unprofitable, they go out of business. When there is not enough revenue to meet your expenses, you close your door. So in essence, what the CMS Actuary noted in this was that hospitals and nursing homes would shut their doors. They would close. That is why Senator Conrad and others and me, who represent rural parts of the country, have tried to say to my colleagues: Pass that bill, and you eliminate rural hospitals. You eliminate the ability to provide preventative care in rural America. When a woman in rural America gets pregnant, there will not be prenatal care there. She will have to drive 60 miles to get the prenatal care she needs, and she will never do that. But she will drive 60 miles to deliver that baby who will end up in the NIC unit, probably for weeks, because she didn't have the proper prenatal care. We will spend hundreds of thousands of dollars to treat that baby when we could have kept that local facility open to provide the level of preventative care she needed. But, no, in this it says 20 percent--20 percent--of our country's hospitals and nursing homes will close if we pass the Reid bill. The Actuary also found that further reductions in Medicare growth rates through the actions of the Independent Medicare Advisory Board-- now, this is important, because this is what they always point to, that the Medicare Advisory Board is going to do this. The Independent Medicare Advisory Board, which advocates have pointed to as an essential linchpin in reducing health care spending--may be difficult to achieve, in practice. In laymen's terms: They ain't gonna do it. So the independent Medicare advisory board, the CMS Actuary says it is not going to happen. Gees, how can we take the same Actuary's report and get such a different view of what the results of this bill are between me and the last speaker? The Actuary says: The Reid bill would cut payments to Medicare Advantage plans by approximately $110 billion over 10 years, resulting in less generous benefit packages and decreasing enrollment in Medicare Advantage plans by 33 percent. Like your insurance? You get to keep it. No. Like your doctor? You get to keep him. No. Like your hospital? You get to keep it. Not if it closes. Like your nursing home? You get to keep it. No. The Actuary says 20 percent of them are going to go out of business. They would not be in business. As a matter of fact, the Reid bill funds $903 billion in new Federal spending by relying on Medicare cuts. As a result, the actuary says: Providers could find it difficult to remain profitable, and absent legislative intervention might end their participation in the Medicare program, possibly jeopardizing access to care for beneficiaries. Well, now we have eliminated the hospital, we have eliminated the nursing home, we have eliminated Medicare Advantage, and now the Actuary says the doctors, because of what we are doing, may opt out of the system. The majority whip came to the floor earlier, and he said the Republicans will not offer a plan. For the record, and for the 100th time, Tom Coburn and I introduced comprehensive health care legislation in May. We were the first Members of Congress, House or Senate, to introduce comprehensive health care legislation. I am not sure how many times I can come to the floor and say that. Tom and I have come down and spoken hour after hour and given descriptions of what our plan does. We don't expect it to be adopted. It has some good things in it. We would love to have some input into whatever the legislation is going to do. But make no mistake about it, just because you stick your head in a hole and do not see anything else out there doesn't mean it is not there. To come to the floor and claim that no Republicans have offered a legislative remedy to health care is to stick your head in a hole and say: I am not going to look; therefore, nothing exists. I know I am coming to the end, and I see the ranking member of the Finance Committee wants to speak.

Mr. BURR. Mr. President, I ask unanimous consent to speak for 20 minutes.

Mr. BURR. My good friend from Rhode Island said--I wrote it-- ``Actuaries can't cost it out.'' He said before he left the floor: ``Actuaries can't cost it out.'' Well, he may or may not be right. I can tell you this: The American people can cost it out, and the American people have said no--no to passage of this Reid health care bill. We should listen to the American people. I yield the floor.

Mr. BURR

Mr. BURR. Madam President, I rise to reiterate exactly what my colleague just said, that transparency with the American people on the cost of this plan is absolutely essential. If you are going to tax the American people, tell them what you are going to tax. If you are going to cut their benefits, tell them what you are going to cut. Do not use smoke and mirrors to create a panacea for the people down the road to find out they have been sold a pig in a poke. I want to talk about not what has been introduced but what has been reported in the press as to where we may go on this bill. As many know, the bill that is under consideration that is supposed to reform health care is a bill that was crafted in a back office in the Capitol where very few people participated, and those who did participate were only Democrats. It was not until it was rolled out on the Senate floor that many of us had an opportunity to read the 2,074 pages. If the American people are like I am, we are still working our way through section by section trying to figure out exactly what it says and, more importantly, exactly what it means and, even more important than that, how does it affect me? How does it affect my family? You see, health care is a very personal issue for everybody in this country. It is important that we display the honesty they expect from us. If, in fact, we are going to reform health care, then let's reform it. If we are going to do what we have done over the past several weeks, which is have a debate about coverage expansion, then let's be honest with the American people. Who is going to pay for it? We know how CBO looked at the bill and how it was designed by the majority leader. They are going to steal $464 billion from Medicare. That is a fact. Nobody disagrees with that. Madam President, $464 billion would be stolen from Medicare which the Medicare trustees say will be insolvent in 2017, a mere 8 years from now. I am not sure that is fiscal responsibility, but it is in the bill. In the last 24 hours, the press reports the majority leader has sent a new proposal to CBO, the Congressional Budget Office, because he is seeking to find out what that new proposal will cost. If the reports are correct, he has decided to drop the public option and to craft a new coverage plan for some segment of the American people. Again, by news accounts only, that would be an expansion of coverage for individuals in this country 55 to 64. I do not know whether that is the entirety of the group. That is 24 million to 30 million people. The likelihood is if it were opened to any segment, it would be like a magnet to those who probably had some type of health condition because if you do not have a health condition, the likelihood is, in the open marketplace through your employer, if you are employed, you can find a reasonably priced plan. Automatically, the way we have designed it is we are going to attract the sickest of that population. In the process of doing that, we have to pause for a moment and realize that we have over 40 million seniors and disabled already in Medicare. It is a system that does not reimburse for 100 percent of the services provided. In other words, for Medicare, we reimburse a doctor and a hospital less than it costs them to deliver the service. Nationally, we have accepted that because in that system, when a senior goes in under Medicare and gets a service, what is not reimbursed is then shifted over to the private sector side. It is shifted over to people who pay out of pocket. It is shifted over to people who have private insurance. Doctors and hospitals have been successful at managing their payer mix. A lot of doctors have X amount of Medicare, X amount of Medicaid, and X amount of private pay. When they put them all together, they find a way to stay in business. I think it is safe to say if you change the doctors' payer mix or you change the hospitals' payer mix, you could take a provider and move them from slightly profitable, enabling them to practice, over to losing money based upon how the payer mix reimburses them. My point is, as you take people out of private pay, which is coverage by their employer under a health care plan, payment out of pocket or purchase of health insurance, where that health insurance pays at 100- plus percent of the cost of a service provided, we are basically putting 24 million possibly new additional covered lives into Medicare under Medicare reimbursements. Through that, we automatically change the payer mix of every potential provider in America. We put in jeopardy the doctor. We put in jeopardy the hospital. We put in jeopardy anybody who provides a service under Medicare. What is the doctor going to do? The doctor can look at it and say: I can absorb the reduction and the change in the payer mix or the doctor may look at it and say: I cannot add any more Medicare beneficiaries. I am sorry, I saw you before when you were on private insurance, but I cannot continue to see you because now I do not get reimbursed sufficiently. So you are going to have to find another doctor. Now we have gotten into the core pledges of the President where he said: If you like your plan, you get to keep it; if you like your doctor, you can continue with him. We are putting a burden on the doctor or the hospital to make a determination as to how they monitor and control their payer mix by one simple change: by increasing the opportunity for people to participate in a program that up to this time has been sacred and, I might also add, is a program that every participant has paid in their lifetime to be enrolled in. Medicare is a trust fund. I think we forgot that, when we arbitrarily said we can take $464 billion and steal it out of Medicare and use it to fund this new entitlement. This is not our money to steal. This is the beneficiaries' money that they have paid taxes on their entire life to fund their Medicare benefits. I am not sure why we believe we have the right to go in and move that money from one account to another, where, in essence, we are moving it from one account and using it for somebody totally different. It is unfair to those who planned a lifetime for this. Let me go back to the payer mix. As you increase the rolls of Medicare beneficiaries, you affect the viability of every outlet of medical services--hospitals, doctors, this could also affect pharmacists. It is important that we realize we have already increased in this bill the number of individuals who will be covered under Medicaid. The majority leader's original bill mandates that every State will now raise their limit on Medicaid participation from 100 percent of poverty to 133 percent of poverty. Medicaid reimburses at about 72 cents of every dollar of service provided. When you do that, you have now enrolled between 11 million and 15 million new covered lives under Medicaid. So every provider in the system is already looking at what has been proposed--until the press accounts of the last 24 hours--and said: I am going to have 11 million to 15 million more people. I am being reimbursed 72 cents of every dollar provided. It is hard to stay in business when it costs you a dollar to deliver a service and you get 72 cents back as payment. They are already trying to figure out how they are going to adjust their payer mix to meet the demands when all of a sudden we come out with a new proposal that the press accounts say we could enroll 24 million people in, that further contributes to cost shift. Let me say to my colleagues, I was in full agreement with the President when he came out and said: Here are our goals. We have to reform health care. We have to focus on making sure every American has access and affordable options to health care. We have to make sure it is fiscally sustainable. Why, in the 21st century, would we design a health care system that we could not be certain was financially sound for generations to come? The truth is, by every account, in a real 10-year period, 10 years of taxes and 10 years of benefits going out, this bill before the revision yesterday is a $2.5 trillion bill. It will contribute to the debt. It will borrow money that our children will be obligated to pay interest on and pay back. This just compounds the problem, a breakthrough. This is not about policy; this is about in a back room in Washington in the U.S. Capitol, where the majority leader was trying to get to 60 votes. It is real simple. Listen to the American people and we would start over and we would start over with the principles of the President: Make sure what you do reforms health care, attracts 100 percent of the American people because of access and affordability, and it is fiscally sustainable for generations to come. The truth is, we have been on the Senate floor for 2 weeks. We have debated a bill that does coverage expansion. I admit openly, it covers 3l million more Americans. But it misses the mark of doing any health care reform because, you see, the bill, before the press accounts of the last 24 hours, assured every American that if they had private insurance or they paid out of pocket, their health care costs were going up. There is no way they could not. Now what we have done is we have shifted and said we are going to increase the amount of the cost shift. Let me explain for just a minute what a cost shift is. Cost shift is when somebody goes in and is provided a medical service, and if they do not pay for that service or they do not pay the entire cost of that service, what is left over is shifted somewhere in the system. Well, somewhere in the system is the next person who walks in with insurance or who pays out of pocket. Because of the blend they have to meet, they pick up the difference. Why has health care had such a phenomenal increase in cost? It is because as we increased the rolls of Medicaid, as we had more seniors go into Medicare, we had more costs that were shifted. Up to this point, the President, the Congress, and others were only focused on the uninsured and the underinsured. Well, they are a contributor to the cost shift, there is no question. But let me suggest to you that if we provide insurance--and we should provide access and affordability for every American. By putting people into Medicaid, all you are doing is exacerbating the cost shift. If, in fact, you create a health care system that has an incentive for an individual not to purchase their own health care because it is cheaper to pay the fine, all you are doing is exacerbating the problem of cost shift. Health care reform is about changing the health system so that cost shift is eliminated. Quite frankly, it starts with making sure we pay 100 percent of what the cost of the services are. But we are not having that debate. This debate on the Senate floor right now, 2 weeks before Christmas, is about coverage expansion. It is not about health care reform. If it were about health care reform, we would be talking about how we create an incentive for private companies to create products that allow an individual to construct their health insurance so that it matches their age, their income, and their health condition. That is not what we are doing. We are sitting in Washington, creating a one-size-fits-all program and saying: You know what, if this doesn't fit, well, we are going to create a government option for you, and we will subsidize you and put you in the government option. Where is that fair to the American taxpayer? That is why Senator Crapo's motion is so important. Refer it back to committee. Start over. We have our priorities wrong as it relates to our ability to dip into the American people's pockets and use their money to fund something that is not going to benefit them one bit. This would be a different debate if we could look at the people who are not covered and say: We have fiscally maximized our ability to provide you health care but not necessarily abused the American people's pockets to do it. America is the most compassionate country in the world. But when we debate things such as this, we are also the most foolish country in the world because it is irresponsible on our part to abuse the power of this government to spend money like this without the benefits that we set out to achieve. So it is my hope that as we go through the weekend, we will have an opportunity to see what the new proposal is that is laid down on the table. Again, I have to go by what I read, and that is not always accurate in this town. The CBO has stated that a similar proposal, which was a proposal for a buy-in at the age of 62, would result in an adverse selection in the Medicare Program and would drive up premiums. Let me quote CBO because I don't want it just to be me. This is what the CBO said: A potential problem with this option is that the amount of adverse selection that the program experienced could be greater than anticipated, which would put upward pressure on premiums. CBO is the entity that is evaluating the cost of the current proposal, which nobody knows what is in it. But this was a proposal that was sent to them some time ago that had the buy-in starting at 62, not 55, and their assessment of it, with a buy-in of 62, is that the adverse selection--meaning more sick people were going to migrate to this new option--would cause upward pressure on Medicare premiums and upward pressure on premiums across the board. So it is my hope that we will have an opportunity very soon to know what is in the proposal and to be able to debate the facts versus just trying to educate ourselves based on the leaks from the media. But there is one thing for certain: The American people have voiced their position on health care reform. They do not see it as reform. They do not see it as positively affecting themselves. They see it as too expensive, they see it as a breach of trust on a plan that seniors have become 100 percent reliant on because they paid into it. This path has a lot of problems. It is not just the new proposals, it is the proposal that has been on the table for some time. It is my hope that we will continue this debate as long as it takes to make sure that at the end of the day we do what is right for the American people and not necessarily what is expeditious for Members who would like to be home for the holidays. I thank the Chair, and I yield the floor.

Mr. BURR

Mr. BURR. That association supposedly looking out over the seniors in this country.

Mr. BURR. Madam President, this is self-explanatory, I think. Today we are borrowing 43 cents out of every dollar we spend; 43 cents of every dollar we spend in the Federal Government we are borrowing from somebody. You know, we talk about these unbelievable numbers in Washington--billions and trillions. The most popular bumper sticker out there is this: Don't tell Congress what comes after a trillion. Personally, I don't want to know, because I know if we get there, we are at the point of no return. Senator Coburn and I are close to the same age. We have kids just getting started raising families. We know what they are going to be faced with to raise their families, to make sure their children and grandchildren get educations, to make sure they go to college and have that opportunity, and make sure they have an opportunity after that for a place to work and an income. Do you know what is going to be the thing that dictates most of what they are faced with? It is right there on that chart. For every penny we borrow, it means we have an obligation to pay interest on that penny. Today interest is practically zero. We provide, as a Federal Government, money to banks they can lend out, and we charge them practically zero. That will not last forever. At some point, interest rates will go up. Depending upon how much money we have borrowed, that will dictate how much we are obligated to pay in interest.

Mr. BURR. The Senator is absolutely correct. What we can only hope to pass on to the next generation is an opportunity equal to what we have had. To strap them with this debt, to continue to go down this road and pile on the obligations, we will limit the next generation's opportunity. As you choke that opportunity for them, you will choke the fabric of this country in a way that the problems we are faced with today are minor in comparison to what they will deal with in the future. As we sit here and debate the pluses and minuses of this health care legislation, I remind my colleagues, when you talk about $2.5 trillion--and you probably never will save that money out of Medicare; you probably never will cut that doctors' reimbursement quite as much as in there--every time you don't do that, we are borrowing 43 cents of every dollar we spend. That is the obligation our children will inherit from us. I am not willing to do that anymore. I want to make sure we are focused on the opportunity that is there for them. We can only do that if we do it in a responsible way, do the right thing as it relates to health care here.