John Barrasso

Mr. BARRASSO

Mr. BARRASSO. I will, Mr. President.

Mr. BARRASSO. Mr. President, I come to the floor also to talk about Medicare and what I see to be significant cuts in the Medicare Program. I practiced medicine in Wyoming for 25 years, taking care of families from across the State and many of these wonderful folks who are on Medicare. They depend on Medicare for their health care. They depend on Medicare. Patients depend on it, the hospitals depend upon it, the physicians, the nursing homes, the home health care agencies--all of them depend on Medicare for their health care. I listened to my close friends from across the aisle come to the floor as well, and they seem to be trying to convince the American public that the 2,074-page bill which weighs over 20 pounds actually does not cut Medicare. I heard the chairman of the Finance Committee talk about it on the floor; I have heard it from the majority leader. The health care reform plan we are looking at on this floor cuts $464 billion from Medicare, and I have a list of all the Medicare cuts in this bill, page after page, column after column. When you add them all up, it cuts $135 billion from our hospitals--from our hospitals--that are providing the care. We have heard about some of the cost shifting from the Senator from Rhode Island. Cost shifting occurs. Medicare is one of the biggest deadbeats when it comes to paying for hospital services, and it is why hospitals end up shifting more costs to people who have health insurance, and why, for those people, their premiums will go up if this bill becomes law. So $135 billion cut from hospitals. The bill cuts $120 billion from a program called Medicare Advantage. There are 11 million Americans in this country who are on Medicare Advantage. They know who they are. They know it is a program that has worked well for them. People ask me what the difference is. Why would somebody want to be on a program called Medicare Advantage? Well, there is an advantage to those seniors who depend upon Medicare for their health care if they are on Medicare Advantage. The No. 1 advantage is, it actually helps coordinate care. We know one of the best ways to help people keep down the cost of their medical care is to find problems early and to get early treatment. So find the problem and treat it before it gets too bad. Well, Medicare Advantage does both preventive care as well as coordinated care. One of the big problems with Medicare is, it will pay a lot for doing something to someone, but it will not pay much for helping someone stay healthy. But now all of a sudden we are going to cut $120 billion from Medicare Advantage, which actually works on prevention and on coordinated care. Then there is $42 billion from home health care agencies that will be cut. Those are the folks who come into someone's home and help them stay out of the hospital. The advantage of home health care is to allow people to get care at home and not need to be in the hospital, but suddenly we are looking at $42 billion in cuts on Medicare for home health care agencies. Then let's take a look at nursing homes: $15 billion in cuts for nursing homes--those facilities taking care of people on Medicare-- which, to me, means they are actually cutting it from the people who depend on Medicare for their nursing home needs. As an orthopedic surgeon, I have taken care of many people, such as a grandmother who breaks her hip. She doesn't need to go into a nursing home permanently, but what she needs to do is to go there for a short period of time for rehabilitation, where she can get better and get stronger. She is not ready to go home, and she does not need to stay in a hospital, but she needs to be in a nursing home for a period of time to get rehabilitated and then to get ready to go home and go back to an independent life. There is a gap in time, and nursing homes help with that. They are wonderful as a way to give somebody an opportunity to gain their strength. In our country, such as it is now, so many grandparents are living in communities where, perhaps, their children or grandchildren are no longer living or they can't go and live with a son or daughter, but they need additional help and so they go to a nursing home. So for that patient who has broken a hip--the type of patient I have taken care of in the hospital--this bill is going to end up cutting from the hospital $135 billion from Medicare for that patient. It will end up cutting nursing homes by $15 billion, for patients who rely on nursing homes as they recover from their hip surgery. Then once they get home and get ready for an independent life, a lot of times they can benefit from home health care--someone coming into the home and checking on them, giving them medications, making sure they are doing all right, checking their wound, and a number of different things--this bill will cut $42 billion from home health care agencies; again, cutting the services to people who depend upon those services for their health care needs. Then there is an $8 billion cut from hospice providers, people who take care of our patients--my patients--in the final stages of their life. At a time in their life when their body may be riddled with cancer or they just need a place to go and be treated with respect and to be cared for, we are cutting $8 billion in this bill from the hospice providers--people who are there and helping people in the final stages of their life. When I look at this, I say: How in the world can my colleagues on the other side say they are not cutting Medicare for our seniors? I read through the bill and there is $135 billion from hospitals, $120 billion from Medicare Advantage, $40 billion from home health care agencies, almost $15 billion from nursing homes, and $8 billion from hospice providers, for a total of $464 billion for this country's seniors. I don't think we should pass this bill. Of course, there is another $500 billion in taxes. It is a huge and hugely expensive bill. To me, this is absolutely nothing but robbing our folks who are on Medicare to start a whole new government program. I am worried seniors all around the country are going to have less access to doctors, especially in rural and in frontier States, such as Wyoming. I am concerned they are going to see community hospitals and home health care agencies and nursing homes--skilled nursing facilities--struggling to keep their doors open. It is time for this Congress, for this Senate to listen to America's seniors. Let's listen to the administration's own chief actuary. Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services, said if these Medicare cuts take effect, then many providers ``could find it difficult to remain profitable and might end their participation in the program.'' They may say: I don't want anything else to do with Medicare. I am closing my doors to Medicare patients. We cannot have that in this country, but I believe that is what this bill does. Even the nonpartisan Congressional Budget Office said these Medicare cuts could ``reduce access to care or diminish the quality of care.'' Is that what this Senate wants, to reduce access to care or diminish the quality of care? How many experts does it take to convince the majority party that cutting Medicare to pay for a brandnew government program is irresponsible? We all agree Medicare is going broke. The trust fund will run out of money in the year 2017. It has more than $37 trillion in unfunded liabilities. The Presiding Officer knows that in his State, as well as in mine, Medicare's physician payment formula, which calls for doctors to face a more than 40-percent cut over the next 10 years, is a system that is broken. The Reid bill does nothing to fix this problem. Instead, it takes $\1/2\ trillion from Medicare to create a brandnew entitlement program. It punishes a group of people in order to benefit another. To me, that is not reform. It will only make the system worse. That is why I support the motion we will be voting on today, the McCain motion. It says we are not going to finance a new government program on the backs of our Medicare patients, on the people who depend upon Medicare for their health care. It instructs the Finance Committee to write a bill that doesn't cut hospitals, that doesn't cut home health care, that doesn't cut Medicare Advantage, and that doesn't cut hospice for our seniors who depend upon those services. A vote for the McCain motion gives us a chance to get this right. I do want health care reform. I just don't want this bill. This is the wrong prescription for our country. I don't believe we have to take the money out of Medicare and then spend it on a brandnew entitlement program. I go home to Wyoming every weekend--and I know other Members go home and listen to their constituents--and what I hear from the people in Wyoming is: Don't cut my Medicare. Don't raise my taxes. Don't make things worse for me in this economy. I certainly can't afford it. The people of Wyoming want practical, commonsense health care reform; reform that drives down the cost of medical care, improves access to providers and creates more choices. It is clear this bill has a very different plan in mind. It is not too late to work together for meaningful reform. We do not have to dismantle the current health care system and build it up in the image of big government and then try to say this is reform. The American people are telling us what kind of changes they want, and that is why I will be voting for the McCain motion. I yield the floor.

Mr. BARRASSO. Mr. President, my wife Bobbi was diagnosed with breast cancer by a screening mammogram in her forties. It is that screening mammogram that has saved her life. By the time of the mammogram, the tumor had spread and she has had two operations and two full bouts of chemotherapy. I do not want a government bureaucrat making a decision for the women of America if they should be allowed to have screening mammograms. It saves lives--1 in 1900, for women in their 40s. The Reid bill empowers bureaucrats to decide what preventive benefits will be allowed for American women. The amendment from the Senator from Maryland does the same--bureaucrats, not the physicians who are doing the treating. That is why I support the amendment of the Senator from Alaska, because that amendment says the Federal Government cannot use recommendations of the U.S. Preventive Services Task Force, recommendations from bureaucrats, to deny care to anyone including seniors on Medicare--anyone in America. That is how this decision should be made, not by government bureaucrats. I yield the floor.

Mr. BARRASSO. The current system is broken, Mr. President. The reimbursement system focuses more on doing things than on helping patients stay healthy and get better. Medicare has done a terrible job of that over the years, in terms of giving incentives for people or even for paying for preventive services. They have not done that over the years. This is an illustration of how the system is broken. It is now December--the end of the year--and it is the busiest time of year for me as a physician in Wyoming because people have met their deductibles--those who have insurance have met their deductibles for the year--and they come into the office and say: Is it now time for my operation? I have to get it done before the 1st of the year because my deductible has been used up, and I want to have my operation so I am not going to have to pay for it. In this country, we have the incentives all wrong in terms of health care. We do need health care reform.

Mr. BARRASSO

Mr. BARRASSO. The reasons for that are they are not doing early enough screening, and even once they are able to find the cancer in Great Britain, how long do they have to wait in line until they actually receive the surgery? The delay of care is the denial of care, and that is what is going to happen under this bill. I see my colleague from Idaho standing as well because he is familiar with this situation. But I look at this and see the numbers. They said: Well, we don't want to cover this service because it would only save 1 life out of 1,900 women in their forties. Well, in my case, that 1 life out of 1,900 was my wife Bobbi. I know the Senator from Idaho wants to get involved in this discussion. Senator Risch.

Mr. BARRASSO. Twenty-five years taking care of families and the people of Wyoming. I have taken care of people on Medicaid and Medicare. We heard from Senator Burr about North Carolina and Medicaid as well as Medicare and I have concerns about both. I take care of all patients, regardless of their ability to pay. So what we know right now is that the Mayo Clinic--and the Mayo Clinic in Rochester, MN, has been held up in the Senate by our colleagues. It has been held up by the President of the United States as the model for what we should try to get to do in America for health care. The Mayo Clinic has now told Medicare and Medicaid patients they are not welcome. It has put out the sign: No vacancies for you. It is astonishing. It is hard to believe the Mayo Clinic would say: No thank you, we don't want you, but they have done that.

Mr. BARRASSO. As the senior Senator from Tennessee said, it is like having a bus ticket when no bus is coming. Others commented in the paper that it is like putting more people into a sinking ship. Why would the renowned Mayo Clinic not want to see these patients? They are sending out letters saying if you are from these surrounding States--Wyoming and others in the Midwest and the Rocky Mountain West send many patients there--you cannot do it. The Mayo Clinic is able to provide the kind of care they do because they take very few Medicaid patients, they take very few Medicare patients, and they take people who have insurance. That is why we know premiums go up when more people are on Medicaid. There are actually two hospitals in Rochester, MN-- Mayo Clinic, where 5 percent of their patients are on Medicaid. At the neighbor hospital in the same community, it is 29 percent of their patients. The hospitals in Tennessee cannot take everybody out of town. We have to take care of those people. When reimbursement is so low by the Federal Government, which is the biggest deadbeat payer in the world when it comes to health care--the deadbeat Federal Government pays so little, the Mayo Clinic wants nothing to do with them. That is why they came out against these proposals. Harvard Medical School gave these proposals a failing grade and said people who support these are collectively in denial, because they know we are looking at a health care bill that will raise the cost of care, to be paid for by raising taxes and cutting Medicare for seniors. Our seniors on Medicare cannot even get into the Mayo Clinic. It is fascinating. Mayo set up a branch in Arizona. They say they will no longer accept Medicare for patients seeking primary care at its facility in Arizona: We don't want them. No vacancies for you. If you want to come in, you have to pay additional fees--a $250 annual fee plus anywhere from $174 to $400 a visit if you are on Medicare.

Mr. BARRASSO. It will absolutely prevent new Medicare and Medicaid patients from getting in. The Medicare cuts will prevent doctors from taking new patients and may cause them to drop others. The concerns are so large, and the concerns aren't just for the doctors. I am concerned for the people in Wyoming, who depend upon Medicare for health care. I know the Senator is concerned for them in Tennessee. How will they get the care they need? More people are coming of Medicare age every day. This big bill, this monstrosity, will cut close to $500 billion from people who depend on Medicare for their care. The American people-- those watching--need this care. But this takes it away to start a whole new government program. It is not fixing the program that is going broke already. So the hard reality is--and I think the spokesperson for the Mayo Clinic said it well. She said that ``it simply is the reality of the health care business and how we are going to be able to continue our mission when these payments are so far below what it costs to provide the care.'' You are not even talking about staying open, keeping the doors open, breaking even. The reimbursements are so far below what it even costs the Mayo Clinic--the model being held up by Senators on the other side of the aisle--so far below what it costs them to provide care. So as we look at this and say how can we take care of and help the people of America get health care, quality care, what we need to do is be aimed at driving down the cost of care. This means an increase of the cost of care and premiums. They are going to do it by raising taxes, and everybody will be affected. The Senator from North Carolina, a State with an incredible background in technology and advances in medical devices--anything that taxes them will be passed on to everybody, regardless of income level. Every patient in America will suffer. The Mayo Clinic--the world-renowned Mayo Clinic, where anybody in America would like to go for their care--I heard the Senator from Tennessee say, in addition to what the Senator from North Carolina said, that people in his State want to have the same level of care you would have. We would all want that. The Mayo Clinic says if you are on Medicare or Medicaid, like many of the other States, don't come here, because we cannot afford to have you, because Washington--the biggest deadbeat payer of all time--isn't paying enough to keep our doors open.

Mr. BARRASSO. Mr. President, I would say to my colleague and friend from Arizona, this type of legislation would have cost my wife her life. She is a breast cancer survivor, diagnosed by a routine screening mammogram. She was in her forties when that mammogram was performed. She went through the testing and had the operation. In that age, in her forties, she already had the breast cancer spread from her breast to one of the lymph nodes. It was a screening mammogram that saved her life. She has had three operations, two bouts of chemotherapy. As a result, she is a survivor--6 years later. But this piece of legislation says: No, no, do not worry about it. There is not going to be any denial of care. There is not going to be anything like that. But if you turn to page 1,150, it talks specifically about this preventative task force, specifically saying when they make their recommendations there is going to be money that taxpayers are going to pay to tell people what those recommendations are. Then, if you go to page 1,190, it says that if it is not approved, they will deny payment for that service--deny payment. It does not say they might.

Mr. BARRASSO. Some people might.

Mr. BARRASSO

Mr. BARRASSO. Mr. President, there are a lot of flaws in these bills because what Senator Enzi and I both hear when we go to townhall meetings--but also I had a telephone townhall meeting the other day-- is: Don't cut my Medicare. Yet when we take a look at the details of these bills, it is going to cut $500 billion--$500 billion--from our seniors who depend on Medicare for their health care. They also say: Don't raise my taxes. But taxes are going to go up across the board. Every family is going to notice an increase in their costs, whether through taxes, premiums, an increase in the cost of their lives in terms of how it is going to impact the care they are going to receive. They say: Don't make my family pay more for health care. But across the board, people look at this and say they are going to end up having to pay more. When Senator Reid brought this bill out, he said: Of all the bills I have seen, it is the best. To me, it is the best of the worst bills I could ever see. It raises taxes. It is not just me speaking. If you read what the people who had a chance to read the bill say--the Associated Press, the Washington Post, the New York Times, others throughout the country, our e-mails from home--there are higher payroll taxes, companies would pay a fee, rely primarily on new taxes, new fees, and then cuts in Medicare. It is beyond me that this Senate--that this Senate, the Senate of the United States--is ready to tell the seniors of this country they are going to cut $500 billion from the care these seniors get from Medicare. That is a growing number of people. Year after year, more people are on Medicare but yet the cuts are going to be there. The gimmicks, the budget gimmicks are astonishing. The advertised pricetag is an astonishingly large number, over $800 billion. To get down to that astonishingly high number, they have used quite a few gimmicks. You get taxes, you get Medicare cuts, and then you get the gimmicks. I visited with Senator Gregg from the Budget Committee earlier today. He is going to be on the floor to discuss the gimmicks. One of the things they have done is basically hidden the true cost of the bill. The true cost of the bill is going to be close to $2.5 trillion over a 10-year span. They have done it by putting in a whole new program called the Community Living Assistant Services and Support Act. It is a new Federal long-term care program. What happens in these long-term care programs? They take in the money early on and then they do not spend it until many years later. But in the way they count money around here--they do kind of a 10-year score, they call it. For the first 10 years they are going to be taking in all of this money, and then when it is time to pay the money out, that money is not going to be there anymore because they will have spent it on the increased cost of medical care because these bills do nothing to get the cost of care down. Kent Conrad, Democratic Senator from North Dakota, do you know what he called this part of the bill, the Democratic bill on which we are going to be asked to vote? He called it a Ponzi scheme of the first order. He said it is the kind of thing that Bernie Madoff would be proud of. That is a Democrat talking about what is in this bill. What has the Washington Post said? ``It's a gimmick. These are not savings that can honestly be counted on the balance sheet of reform.'' Do we need reform? Yes. Do we need health care reform? Do we need to change the system? Absolutely. But this is not the way to go. Senator Enzi is here. He has done a remarkable job as a member of both the Finance Committee and the HELP committee, and he has been part of the markups for both of the bills. He has focused relentlessly on trying to get the costs down so the premiums for the American people will not go up, and he has offered amendment after amendment, and they have been rejected time and time again. Then Senator Reid gets these two bills--one from the HELP committee, one from the Finance Committee--tries to stitch them together behind closed doors, and there is an amendment that Senator Enzi had put into the bill, one of the bills--it was voted on and approved--and then it magically disappeared without the knowledge of any members of the committee. It was something intended to help the American people, but that got taken out and thrown away in the dead of night. I don't know if Senator Enzi would like to comment on that, but this is a Senator who was working to improve the lives and health and pocketbooks of the American people, and his great idea is thrown away.

Mr. BARRASSO. It is the wrong prescription for America. I am going to continue to speak on the floor about the things that I think are problems with this bill. I think it is the wrong approach. I think it costs way too much. I think it raises taxes on all Americans. It cuts Medicare. What we have heard now, and what we know for sure, is it is going to raise premiums for people who have insurance, who like the insurance they have, who want to keep the insurance they have; and their costs are going to continue to go up if this becomes law, at a rate faster than, as we saw from the graph, if nothing was passed at all.

Mr. BARRASSO. Mr. President, if you do a poll of doctors, with the question: Have you ever ordered a test that was not going to help that person get better, that patient get better, but you were doing it because you did not want to miss something for fear of a malpractice suit, every hand will go up of every physician. The Massachusetts Medical Society did a poll and 87 percent of doctors said that. Massachusetts has their new health care plan. As an aside, the dean of the Harvard Medical School had an editorial in one of the major national publications this week, and he gave this whole thing--he said: I give this whole thing a failing grade. He said people who support this--the legislation that is being proposed--are engaged in collective denial. We need to do some things that will help with cost, with access, with quality. All this bill is going to do is drive up the cost, with no improvement at all in quality. So there are step-by-step things we can do: letting people buy insurance across State lines, getting the same tax breaks as others. The Senator talked about helping people stay healthy--exercising, getting down the cost of their care by getting their cholesterol down. But also you have to deal with lawsuit abuse. It is out there. You could do a thing as easy as loser pays. Obviously, there are great objections to trying to do that. There are people who would oppose that all the way. But it would help eliminate--eliminate--a lot of the unnecessary tests and certainly a lot of the costs of the system. Because two-thirds of the cost of that whole liability system goes to the system, it does not even go to the injured person. If somebody is injured, you want to take care of them. But this does not do it at all. One of the things the Senator from South Dakota mentioned, fairly quickly in passing, was age band ratings, which flies in the face of the things we have been talking about: individual responsibility, opportunities for people to stay healthy. The big problem is that we know 50 percent of all the money we spend on health care on this country is on 5 percent of the people--the people who eat too much, exercise too little, and smoke. But yet under this government-forced insurance, where people are going to be forced to buy insurance--and if young people do not buy it, they are going to be listed as either tax cheats or criminals because they are going to get fined or they are going to get taxed an amount for not buying the insurance--they are going to have to buy insurance. As the Senator from South Dakota talked about a 3-to-1 ratio--and the Senator from Maine mentioned the same thing--what that means is for the youngest, healthiest person buying insurance--that kid out of college who is staying healthy or might be working construction, who is in good shape, going to the gym--what they are doing on a 3-to-1 ratio is that person has to pay a lot of insurance compared to the person who does eat too much, exercises too little, and smokes. The ratio of their insurance premiums--this person can pay no less than one-third of what this person pays, when you might have 100 young people where their total health care bills for a year would be equal to that one person who exercises too little, eats too much, and smokes. So these young people are going to end up paying the cost. And it is their premiums--and I think we heard that from the Senator from South Dakota--their premiums are going to go up--did I hear 69 percent?

Mr. BARRASSO. Those costs will have to go up. Premiums will go up for all people who have insurance, private insurance. The Senator from Nevada is correct. Some people think the number is 15 million more who will go onto the Medicaid rolls because there is a difference between the Senate bill and the House bill as to how many more folks they move onto the Medicaid rolls. But either way, we are talking tens and tens of billions of dollars that will come out of the taxpayers' pockets around the States. But that is still for a government-run program that doesn't reimburse, doesn't pay the hospitals, doesn't pay the doctors even what the cost of delivering the care is. Across the board, hospitals will tell you they cannot keep their doors open if everyone is paid at Medicaid or Medicare rates. The only way they can pay the nurses, keep the lights on, take the food in the trays around to the patients, do all the things a hospital has to do, or keep a doctor's office open, the only way they can do it is because they charge more to people who have private insurance than they get paid for people on Medicare or Medicaid. And Medicaid is worse than Medicare in terms of the payment. So it is this cost shifting that occurs. Who pays that? The people who have regular insurance. It is the hard-working men and women of America through their jobs who pay for that. We just heard from the Senator from Maine. Anytime we try to help that individual--I see the Senator from South Dakota is in the Chamber as well, and he may want to jump in as well because South Dakota is a State like mine where we have lots of small businesses that are going to be hit specifically hard as they try to continue to provide insurance. This does not even allow small businesses to group together to get better deals. The Senator from Nevada talked about buying insurance across State lines to help people get the costs down. This bill prevents that. It also prevents small business groups from getting together, which would be a great help. I know the Senator from South Dakota is interested in getting into the discussion. I invite him to discuss this very aspect and the impact of all these increasing premiums on the folks in his State.

Mr. BARRASSO. It is millions and millions of people, with the cost to the States. You say we will take it out of here. You won't see it in this bill because they are going to make the States pay over $20 billion in money because it is a matching program, so they get it off the Washington books. But it is still the taxpayers and the States, and we all come from States. That is going to drive up the cost for individuals as well as increase taxes around the country.

Mr. BARRASSO. Plus, when you read this bill, one of their so-called solutions is they will put more people on the Medicaid rolls.

Mr. BARRASSO. Mr. President, I find it fascinating, listening to the comments from the Senator from Maine. Maine and Wyoming are similar in a number of ways. One is that the engine that drives our economy is small businesses. What we heard is that this bill right here, this large bill which is the bill the Senate is considering right now, over 2,000 pages--underneath it is the bill that passed the House--I hear these are actually going to penalize the small businesses of Maine and the small businesses of Wyoming when those businesses try to hire another employee. We are looking at 10.2 percent unemployment right now. People in our States are well aware of those numbers. I don't know if that number is being neglected by others, but for small businesses trying to hire people, this health care bill makes it much tougher. It will certainly make it tougher for them to provide insurance, and it will make it tougher for those small businesses to give raises to people. It is, indeed, unfortunate that we are here in the Senate Chamber looking at a bill that is going to raise premiums for the American people who have insurance and who like the insurance they have. Their big concern isn't cost. We are looking at a bill that is going to cut Medicare for seniors who depend on Medicare, and the numbers are huge, almost $500 billion. And we are looking at a bill that is going to raise taxes on the American people. I heard the Senator from Maine, and she can jump in and correct me if I am wrong. What I heard her say is that it is not just a tax on the rich; it is a tax on people all across the board because the taxes are going to be passed on. I see the Senator nodding her head in the affirmative. When taxes are raised on medical devices or on medication, on one thing after another after another, those are costs that will get passed on to all the consumers of health care. Right before this party took the floor, we had the senior Senator from Minnesota talking about the Mayo Clinic and the wonderful care that is given there. It is wonderful care. But the Mayo Clinic has also said they don't want any part of this bill, nothing to do with it, to the point that they have sent doctors in my home State and States surrounding the Mayo Clinic who refer patients--and I practiced medicine in Wyoming for 25 years, have taken care of families there as a physician, and we sent patients to the Mayo Clinic--they just said: Stop sending patients on Medicare or Medicaid. We want nothing to do with it because the government is the biggest deadbeat payer. The Mayo Clinic said: Every time we get one of those patients, we have to charge the people who pay their own way, the people who have insurance. We have to charge them more. We don't want to take any more patients on Medicare and Medicaid. Hospitals and the communities in Maine, South Dakota, and Nevada, hospitals in those States have to take all those patients. So what happens to people who pay their own way because they buy insurance themselves or they get it through work is the hospitals have to charge them more to make up for the biggest deadbeat payer of all time--the Federal Government. I see the Senator from Nevada rising to his feet. I imagine the exact same thing is happening to hospitals in Nevada. Premiums are going up on the 85 percent of the people who have insurance they like. Yet we in the Senate tomorrow night are going to vote on a bill which, to me, the people of America don't like. Do you know who doesn't like it the most? Seniors. They are concerned. They know Medicare is going broke. And by the year 2017, there will be $500 billion of cuts in Medicare. Yet the money that is being cut from Medicare isn't being used to save Medicare; it is to start a whole new program that will cause Americans who have insurance to pay more. It will cause people who don't have any insurance to make it harder to get or if they go to an emergency room and have to pay a bill, that bill will be higher, all because of what I believe is an irresponsible piece of legislation that is going to be a huge weight on the American economy at a time when we have 10.2 percent unemployment. I see the Senator from Nevada. He has a similar copy of the bills next to him. He may want to chime in on what he sees in his home State and what he is hearing from people who live in Nevada, from small businesses as well as hospitals and providers.

Mr. BARRASSO. Mr. President, there are improvements that need to be done to the system. There are simple things we can do to keep down the cost of care, such as allowing people to buy insurance across State lines as well as giving individuals the same tax breaks big companies get, ending lawsuit abuse and dealing with what is needed to be done in terms of incentives to help people stay healthy so they have opportunities to save money themselves, and allowing small businesses to join together. The bill we are looking at here is going to raise premiums for people who already have insurance. It is going to raise taxes on all Americans. It is going to cut Medicare--cut Medicare--for our seniors who depend upon Medicare for their health care needs. And while they are doing it, they are going to fund a whole new program rather than save Medicare--a system we know is going to go bankrupt. Thank you, Mr. President. I yield the floor and note the absence of a quorum.

Mr. BARRASSO. The Senator from North Carolina, who has been a champion of early detection, early treatment, and prevention of disease, did see a preview of rationing this past week when this Preventive Services Task Force made a decision and recommendation about breast cancer. The Senator talked about our seniors. I worry about rationing of care, delaying care, denying care. They said for women under 50 they should not have mammograms anymore. They should not do a breast self- exam. They said for women over 75, they should not have a mammogram anymore. I will tell you that my wife is a breast cancer survivor, and she was diagnosed by a mammogram under the age of 50. And they cannot say that mammograms are not helpful. What they are saying is that the number of mammograms done per life saved is not cost effective. I know both of the Senators who are on the floor, from New Hampshire as well as from North Carolina, have talked about early detection, early treatment, not using cost as the issue on comparative effectiveness research. We say let's use some clinical judgment. Let's see what we can learn. But, no, because for women under 50, they have to do 1,900 mammograms to save a life. For women over 50, it drops down to 1,300 mammograms to save a life. So that is what they are putting the cost of a life at: a 600-mammogram difference. But for my wife--who is alive today, after three operations, and two full bouts of chemotherapy, and is now 6 years cancer free--having that mammogram under the age of 50 meant the difference between life and death. That is what this bill has to do with. It is the difference between life and death for people. If you get into rationing care, delayed care--that is why people come to the United States for their care. It is the best care in the world. That is why Canadians and Europeans come here, because they have to wait too long. That is why our techniques and our treatments and our survival for cancer is so much better in the United States than these other countries. Because the Senator from North Carolina knows it is that early treatment that makes a big difference.

Mr. BARRASSO. I have 24 years practicing orthopedic surgery, taking care of the families of Wyoming.

Mr. BARRASSO. The people who have private insurance end up paying more for their insurance premiums to help make up the difference because the government has across the board been the greatest deadbeat payer. Washington is a deadbeat when it comes to paying for health care costs, both for Medicare as well as Medicaid across the board. That has been the long tradition of Washington and health care. The other people who are penalized under this situation are people who have no health insurance, because they are being charged at a higher rate. The person who works hard and says, I will kind of self-insure in case something happens, I get sick and I have to pay the full bill, they pay the full bill to cover themselves as well as more to help for the underpayment done by Washington. That is how, when you have more and more people on the Medicaid rolls, more and more people forced onto that through Washington's wisdom, it is going to be harder on people who have insurance through their jobs. Insurance premiums, for people who have insurance and like their insurance, those rates are going to go up. It is going to make it harder for American families and for small businesses that want to hire someone, because the rates of insurance will go higher. It will make it harder for small businesses to provide health insurance for their workers, and those who continue to provide health insurance will not be able to give raises because the costs are going to go up. This whole approach to health care reform was supposed to be designed to help keep the cost of care down. That is what the President and the Senate promised all through the year. But it does not. It drives prices up. When I hear my colleague from New Hampshire talk about all of the gimmicks being used in an effort to claim this is a good bill, I refer to this morning's column ``Health Bill Hoax.'' Only Bernie Madoff could believe the Senate's health care bill will expand coverage to 31 million while cutting the deficit by $127 billion over 10 years. It would be the first profitable entitlement. Kind of like when the President of the Senate, at an AARP townhall meeting this year, said: We have to spend money to keep from going bankrupt. On its face, we know how absolutely ridiculous that sounds. You can't do that. This is an incredible expense: taxes galore, all over the place. The word ``tax'' is used in the Senate bill 183 times; ``taxable,'' 164 times; ``taxes,'' 17 times; ``fee,'' 152 times; ``penalty,'' 115 times. For people who believe this will keep down the cost of care, it will not. As my colleague from Wyoming said earlier, I advise Members to take a look at an editorial by the dean of Harvard Medical School, living in a State where they have the Massachusetts health care plan, which is government-forced insurance, government-mandated care, government-run care. According to the dean of Harvard Medical School in an editorial this week, the health debate deserves a failing grade. The plan is wrong and those who support it are living in collective denial. This is what is wrong with this. This will markedly accelerate national health care spending rather than restrain it. It will do nothing or little to improve the quality of care. That is what we started with at the beginning--to improve quality, improve access, and lessen the cost. What we have is a bill which, if passed into law and signed by the President, will decrease quality, increase cost, and lessen the access of Americans to health care providers. I appreciate my colleague's comments. The numbers are so high. These are staggering figures. How do you communicate to the folks back home how astonishingly large these numbers are? Because people say: We do want you to fix things, but don't cut Medicare, don't raise our taxes. Drive down the cost of medical care. Improve access to providers. Create more choices. As I look at this, to me this is going to mean higher health insurance costs, higher taxes, Medicare cuts and then, unfortunately, more government control over health care decisions.

Mr. BARRASSO. The answer is no. Doctors' offices cannot stay open at the rate that Medicaid reimburses, and no hospital in the country can stay open if they are getting paid across the board at Medicaid rates. You have to have other people who are paying more to make up for the underpayment by the government on Medicaid.

Mr. BARRASSO. Mr. President, that is exactly what is going to happen. No. 1, we will get this huge push of an unfunded government mandate onto the States, a mandate that both Republican and Democratic Governors have called the mother of unfunded mandates, and they are across the board opposed. This is the way that Washington, with its wisdom, will say: We keep the price down, but what we will do is make the American people pay for it in a roundabout way. The more people you have on Medicaid, the program to aid the poor--and we have seen this in Massachusetts with their health care plan; there are not enough doctors to take care of everyone so the system is swamped, which is why it is taking now up to 9 weeks to get an appointment to see a doctor in Massachusetts, but also about 40 percent of doctors do not see Medicaid patients because the reimbursement rate is so low. What you said, 60 percent of the cost, that is exactly right. It doesn't cover the cost of seeing the patient. We are talking about hiring a nurse, turning the lights on, paying the rent on the office, doing all of those things, the medical charts, the liability insurance, the whole list of the costs of having an office opened. You cannot keep the office open if all of your patients are Medicaid patients. As a result, physicians--and I saw every Medicaid patient who wanted to see me. My partners and I have the same program where anyone can call and get an appointment, regardless of the ability to pay. But we know 40 percent of the doctors don't see patients on Medicaid.

Mr. BARRASSO

Mr. BARRASSO. Mr. President, continuing along this line--because both of us have practiced medicine--I took care of families in Wyoming as an orthopedic surgeon for the last 25 years; Dr. Coburn in Oklahoma for longer than that. We know there are things that need to be corrected. There are improvements that need to be made. We need to fix what is wrong with the system, and that is what I hear every weekend when I go home. It is what I have talked about in the surgeons' lounge in the hospital. That is what I have talked about in the office with my patients. So we need to fix what is wrong with the health care system. But whatever we do, we have to make sure we do not make matters worse. So I say to my friend from Oklahoma, absolutely, my concerns are that this absolutely is going to make matters worse. It is going to increase premiums for families who have insurance. It is going to take almost $500 billion away from our seniors who depend upon Medicare for their health care. It is going to raise taxes on everyone in America--not just on people above a certain income level, on everyone. They all are going to be impacted when you look at all the taxes that are going to be thrown on this. It is going to be passed along. People in America understand that. People know exactly what is happening here. That is why when I had a telephone townhall meeting earlier this week and asked: ``Is this the right way or the wrong way? Do you think you are going to pay more?'' Everybody thinks they are going to pay more. When asked: Do you think your system is going to get better or worse? They think it is going to get worse. Americans do not want to pay more and get less. That is not the value we as Americans want. It is not what we expect. People say: Don't cut my Medicare. Especially, if you are going to try to do anything with Medicare, do it to save Medicare, which is already going to go broke in the year 2017. Don't do it to start some whole new, big government program. They say: Don't raise my taxes. People want to know what is going to happen to them, what is going to happen to their family. What happens if they get sick? Well, they look at this and they say: We want practical, commonsense health solutions, not higher insurance premiums, not higher taxes, not Medicare cuts, not more government control over health care decisions. We want to have lower costs, improved access to providers, more choices. That is the whole crux of why we are doing health care reform, at least that is what I was told 9 or 10 months ago. When they said: We need health care reform. I said: Yes, we do. I served 5 years in the Wyoming State Senate. We did major pieces of legislation, always in a bipartisan manner, as the senior Senator from Maine has said. Now we are trying to find a way where somebody is trying to get just the minimum number of votes to pass this--not because they want to say, let's see what we have that will work for people. As doctors, we try to find solutions that work for people. We do not say: What is the very minimum we can do? That is what we are seeing here. We are saying: What can we do to get it right? What this bill is saying is: What can we do to get 60 votes, the minimum we can do to get this, to drag it over the next step along the line--not to solve the health care issue that faces our country. We know we need to deal with access to care, quality of care, and the cost of care. As my colleague from Oklahoma said earlier, it is the cost of care that needs the attention right now. Eighty-five percent of people like the care they have but they do not like the cost of that care. So what can we do to help get that cost down? Everything I read and everything I know and everything I study and everything I believe from my years of practicing medicine and taking care of patients tells me this is going to drive the cost up for everyone in the country. And that is not just me. The dean of Harvard Medical School said it just the other day. He gave the whole thing a failing grade. He said those ``people who favor the legislation are engaged in collective denial.'' And he went on to say that when you talk about the problems of cost and access and quality--with the cost, he said, this ``will markedly accelerate national health-care spending rather than restrain it'' and will ``do little or nothing to improve quality.'' Well, if you are going to spend much more money, you ought to get increased quality. But the problem is not that we are not spending enough money. We are spending enough money in the system. Half of all the money we spend in this country for health care goes for just 5 percent of the people--people who eat too much, exercise too little, and smoke. But there is nothing in this bill anywhere that gives an incentive to those individuals, to that one person to say: Hey, look, we want you to quit smoking. We want to help you lose weight. We want to help you get your cholesterol under control, through exercise get your diabetes under control, get your blood sugar down. There is nothing that gives an incentive to any one individual. Now, there is a lot of money in here for roadways and streetlights and jungle gyms to encourage community health. But that does not work. What works better is an individual incentive to some person to say you are going to save this much money, get this much money, if you take responsibility for your own health. A lot of people try to do that on their own. But those are the 95 percent, not the 5 percent who are costing this country 50 percent of its health care dollars. But I will ask my colleague from Oklahoma, do you see anything in here that focuses on that individual patient, a patient-centered approach, as opposed to a government-centered approach or an insurance company-centered approach? I see nothing here that is really focused on the individual patient, giving them incentives, giving them opportunities, giving that individual, American citizen more control, more freedom of choice, to help stay healthy and keep down the cost of their care.

Mr. BARRASSO

Mr. BARRASSO. Mr. President, I rise today to express our Nation's deepest thanks and gratitude to a special young man and his family. I was saddened to receive word that on November 16, 2009, SSG Ryan Zorn of Wright, WY, was killed in the line of duty while serving our country in support of Operation Iraqi Freedom. Staff Sergeant Zorn died near the town of Talifar in northwestern Iraq from injuries sustained when his armored vehicle overturned. Staff Sergeant Zorn was assigned to the 1st Battalion, 34th Armor Regiment, 1st Brigade, 1st Infantry Division, out of Fort Riley, KS. Staff Sergeant Zorn grew up in Upton, WY, and joined the Army following his graduation from Upton High School. He loved his country, and loved serving his country. His mother JoAnn says this is what he lived for. He was on his third tour of duty in Iraq. His family and his faith were very important to him. Friends and neighbors remember him as always open and friendly, with a broad smile and a wonderful sense of humor. He was dependable and generous, always willing to help others without hesitation. It is because of Ryan Zorn that we are allowed to go about our daily lives as free people. America's men and women who answer the call to service and willingly bear the burdens of defending our Nation deserve the deepest respect and gratitude of all Americans. They put their very lives on the line every day, and because of them and their families, our Nation remains free and strong in the face of danger. Jesus says in the Book of John that, ``Greater love has no man than this, that he lay his life down for his friend.'' SSG Ryan Zorn gave his life, that last full measure of devotion, for you, me, and every single American. He gave his life serving and defending his country and its people, and we honor him for this selfless sacrifice. Staff Sergeant Zorn is survived by his mother JoAnn, his father Myron, and his brother Todd. He is also survived by his brothers and sisters in arms of the U.S. Army. We say goodbye to a son, a brother, a friend, and an American soldier. The United States of America pays its deepest respect to SSG Ryan L. Zorn for his courage, his love of country and his sacrifice, so that we may remain free. He was a hero in life and he remains a hero in death. All of Wyoming, and indeed the entire Nation, is proud of him. May God bless him and his family and welcome him with open arms.