Thomas Coburn

Mr. COBURN

Mr. COBURN. Reserving the right to object----

Mr. COBURN. Senator Rubio has been waiting all day to offer a unanimous consent request on a bill he has. I ask unanimous consent that the 2 minutes that Senator Rubio would like to have be available between Senator Enzi and Senator Merkley.

Mr. COBURN

Mr. COBURN. Mr. President, reserving the right to object, would the Senator from Nevada, the majority leader, consider an amendment that would modify his request that would provide an offset for this bill?

Mr. COBURN. I object.

Mr. COBURN. Mr. President, I would note--everybody should know that the U.N. gets well over $7 billion of money every year from this Congress, the American people, with absolutely no accountability. There is no transparency on how it is spent. There is no accountability. They are not held accountable for how it is spent. The oversight that we have done over the past 6 or 7 years shows that the waste associated with the money that is sent to the U.N. is at least 30 percent--at least 30 percent when you do the actual oversight of it. So we can talk about specifics. We can take a small portion from everywhere. I do not care. Or I will offer another pay-for. But the fact is, we do not get any accountability of the money this country sends to the U.N. today. Go see if you can find it. You cannot. You will not be able to find it. I want to fund Israel. I want to supply them. I also want to make sure our children have a future. It is not hard to find $225 million out of $4 trillion. I yield the floor.

Mr. COBURN

Mr. COBURN. Mr. President, let me say, first of all, I voted for the bill when it left here with the hope that we could accomplish something. We did accomplish some things. But it came back with $12 billion unpaid for. Because of that, I raise a point of order against the emergency designation provision contained in section 8803(b) of the conference report for H.R. 3230, the Veterans' Access to Care Through Choice, Accountability and Transparency Act of 2014 pursuant to section 403(e)(1) of the fiscal year 2010 budget resolution, S. Con. Res. 13. I ask for the yeas and nays.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that the pending amendment be set aside and my amendment No. 3549 be called up.

Mr. COBURN. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. COBURN. Mr. President, we have before us a bill where unfortunately we do not believe in markets. We are told markets will not work, so we have a terrorism risk insurance bill. That means the Federal Government is going to be the insurer of last resort. There have been some improvements over what we have put forward in the past, and I agree with those improvements if in fact we have to do this. I am not convinced we have to do it, but we are going to do it, and I understand that. I think the work of the committee, of which I am a member, has been very good. But there is one real problem with this bill, and it is about smoke and mirrors, it is about not being honest with the American people. This bill was designed so it would have no score. It was not designed to do the best we can for America should we have a tragedy, and it was not designed to create the flexibility that would be necessary if we do have a tragedy. Let me outline this for you. The way this bill is set up is that we could have a significant tragedy, God forbid, in this country from a terrorist attack, and the bill will mandate spikes in casualty and property insurance far above what will need to happen because we passed the bill to pass a CBO score. So what could happen is we would have to collect billions of dollars over an 18-month period through premium increases on everybody in the country, not just where we had the problem--everybody in the country--because we have designed a bill that will in fact mandate that or at least could mandate that. I have been around this place for 10 years. I know exactly what is going to happen if that comes about through this TRIA bill. The first thing that will happen is the Senate and the House will pass an elimination of this requirement. So what will happen is the American taxpayer will get stuck with all this. They all know that. Everybody agrees they designed the bill to meet CBO. So what I put in was an amendment that would give flexibility to the Treasury so we do not, after one tragedy, create another tragedy with markedly elevated casualty and property rates. We still recoup the money, but we do it over a longer period of time, if it is necessary, and we give the Secretary of the Treasury the ability to do that. My friend from New York says there is a budget point of order that lies against it. It does according to CBO. I agree, it does. But the difference between this and most budget points of order is my amendment will not increase the deficit one penny--not one penny. I would also note that my colleague from New York has voted to override budget points of order every time they have been offered this year. So it is going to be curious to me to all of a sudden have a budget point of order raised by someone who has voted to override the budget point of order every time it has been offered in the Senate this session, and it goes to why we should not pass this bill without common sense in terms of how we collect the recoupment. I understand the constraints of CBO, but I also understand common sense. So we are going to play the game on the constraints, and we are ultimately going to pass on--rather than recoup--we are ultimately going to pass it on to the American taxpayer, which hollows out the whole purpose of the bill. So this has a billion-dollar score, on which we are going to have a point of order, which I am sure I will lose. But when you vote for this bill, know you are not voting for what the bill says it is going to do because it is going to do something completely different than what it says, if we were to have one of these catastrophies. The political pressure to not have these massive increases in property and casualty insurance--this place will fall, and so will the House, and we will change this, and we will have the score then. We will have the score then, and ultimately your children will pay for the cost of this terrorism risk insurance, not the people who are owning the property today, not the insurance company. We will just kick the can down the road, just as we have on everything else. It would seem to me that we would want to do something that works along the parameters of this bill, and we ought to build in flexibility to this bill so that--it may be 10 years that we get on one of these because the bill is divided up to meet the score so it does not score in any one period. So over an 18-month period we could have to recoup it all and people could not tolerate those kinds of rate increases in their businesses or their homes. They would not be able to tolerate it and we would change it. Just as I am asking for us to change it now and be honest with the American people, we are going to change it if that happens. We will change this, and we will delay the onset of the collection of this recoupment. Everybody knows that will happen. So why not be honest about it and put it in the bill now and waive the budget point of order because it does not change the deficit one penny. It changes when we collect it, but we still collect it against the risk of not collecting it at all. That is what I ask my colleagues. I do not expect to win the amendment, but it is another confirmation to the American people that we are not about truth, we are not about doing commonsense things; we are about playing games and we are about satisfying the demands of the industry over which this applies. Nobody knows what could happen in this country in terms of terrorism, but everybody knows I am right about this issue. All I am saying is: Fess up. Be honest, colleagues. Let's build the flexibility in this so we do not have to address it, and the Treasury Secretary, no matter whether it is a Democrat or Republican administration, can use common sense to guide about how fast this recoupment will come; otherwise, you have not done anything to improve this bill if, in fact, this is not accepted. I will be leaving here at the end of the year. Hopefully, we never see another terrorism event in this country. But if we do, it will be a sweet irony when you all say: Oops, time out. We are not going to do what we said we were going to do in that bill because the country cannot take it. What you will do is put one tragic event on top of another. You will not do that. So what will happen? You will change this bill. You will get that score. You will call it an emergency. You will do it anyway. All I am asking is, be honest about what is going to ultimately happen on this should we have an event and it fall within one of these close parameters, based on what we said in the bill, because we are running the bill according to what CBO says, not as to what common sense is. I look forward to having a vote on this amendment. I understand my likelihood of being successful. But I also understand the lack of honesty in dealing with the American people if we do not accept this amendment. I yield the floor. Terrorist Attacks

Mr. COBURN

Mr. COBURN. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. COBURN. Madam President, I want to spend a few minutes discussing the effect and the premise of the legislation on which we just decided not to move forward. I have spent 25 years of my life caring for women. There is not a complication of pregnancy I have not handled. I have seen every aspect of it. I have delivered babies the size of my little finger and watched them move their little arms, not yet far enough along to survive. I have cared for women in the midst of lost pregnancies and the tragedy and trauma and the heartbreak. I have cared for women who have had abortions and the complications that has completed and exacerbated in their own lives from psychological to real physical problems. I have actually performed abortions to save women's lives who had severe congenital heart defects and would have died had their pregnancy continued. But the premise under which this bill was brought forward is an absolute false premise. You see, I come from Oklahoma. David Green and his family come from Oklahoma. They are the owners of Hobby Lobby. They are one of the finest groups of people I have ever met in my life. They are responsible corporate citizens. But everything they have done in their life is guided by their faith and their ethics. Therefore, they are not open on Sunday because they feel their employees have a right to a restful weekend. They pay a very livable wage. They have always had health insurance. The Supreme Court decision was about religious freedom and whether I, as a private businessperson, am still entitled to that as I carry on commerce in this country. What has been described--maybe not specifically but negatively--is that Hobby Lobby and the Green family do not appreciate women or their contributions or their rights or their freedoms. Nothing could be further from the truth. They had a very personal objection to four abortifacients--not birth control pills--four medicines, devices that actually kill a living human being. See, what we do not think about very often--and I think about all the time--is that when an egg and a sperm unite, there is created something that has never been created before: a unique human being. The genetic material will be no different at conception than it is when you are 85 years old. It is unique. It has never before been here; it will never again be here. So based on these deeply held beliefs and ethics--and what I would say is morals--they chose to supply their entire employee network with 16 different methods of birth control. But the four that actually kill a baby that has been formed--they thought it was their religious right to be able to say they should not have to take money out of their pocket to pay for something that goes against their strongly held moral, ethical, and faith beliefs. So we have had a reaction. It is political in nature. It does not have much to do with the facts. It has a lot to do with darkness, of saying something is so that is not true, and saying it often enough so we can tell people that here are those terrible Republicans and they want to hurt women. I dedicated 25 years of my life to helping women in every type of tragedy, every type of disease, whether it is cancer or diabetes or hypertension or pregnancy or miscarriages or just the common cold. Before the Senate forced me to stop delivering babies, I was delivering babies that I delivered; in other words, it was the third generation. That is how crazy the Senate ethics rules are. So the very undercurrent of what we heard could not be further from the truth. What we heard--the implications were that the Green family is somehow this negative corporate monster who wants to take women's rights away--is absolutely untrue. The other falsehood we hear is that if you do not have health care, you do not have available birth control. We spend $400 million a year on title 19, most of which is in birth control pills that are given out to women who do not have access. It costs $7 a month to buy birth control pills, and most physicians, like myself, who had women who could not either access title 19 or who did not have $7 a month, gave the pills themselves out of their stocks, their samples. So there is a reality other than what has been painted in the Senate, and I could not sit by and let this hang out, this terrible untruth. I do not know of a family business, I do not know of a business in America that cares more about its employees than Hobby Lobby, and it is manifested through the employee loyalty and also the success of their brand because they really have a team. And you do not have a team if you do not feel as if you are being cared for--that you are not one of the group. There are a lot of problems in front of this country. But the one described in this last piece of legislation is not one of them. The Green family does not keep anybody from buying abortifacients if they want them. They are not all that expensive. The morning-after pill is over the counter. But to force a person of faith to pay for an action against what they believe is morally wrong. It is far away from the religious liberties our Constitution guarantees. I know we can get hyped up on emotion, but the emotion we ought to get hyped on is preserving the rights our Founders guaranteed when they started this country. They were based on the same set of beliefs the Green family inculcates into everything they do with Hobby Lobby. It is pretty ironic to me that we have become so post-modern, so smart, so ``for'' what the government can do and mandate that we are willing to destroy the very freedoms that created this country in the first place. This bill was a cynical attack on truth. I am glad it is not proceeding. It is time to quit wasting the Senate's time on political games and start addressing the very real problems this country has, such as the fact that Social Security disability will run out of money next month; the fact that one-third of those on disability who are not truly disabled are threatening the livelihood of those who truly are; the fact that Medicare, 17 years from now or 16 years from now, will be out of money; the fact that Social Security will be out of money in 18 years; the fact that we are having corporations leave this country in a mass flood because we have a Tax Code that is not competitive with the rest of the world; the fact that we are wasting $250 billion a year on duplicative programs that do not accomplish the goals which the Congress set out for them. Yet we have no leadership that says we are going to address the very real problems in front of the country. It is not a great record to be proud of. I yield the floor and I suggest the absence of a quorum.

Mr. COBURN

Mr. COBURN. Madam President, I thank my colleague from Wyoming for allowing me to jump in for about 5 minutes. This became an issue as we faced the greatest recession we have ever had and, at the same time, we had GAO looking at how we are spending our money. For just a little history so everybody will know, when GAO did their first report we had 47 separate job training programs run by nine different agencies, and that year they looked at we spent $18.5 billion. What we found is only two had metrics on them, and we weren't even paying attention to the metrics to use them. I applaud the work of the HELP Committee, Senator Enzi, Senator Isakson, Senator Alexander, Senator Murray, and Senator Harkin, for bringing the bill to the floor. It is an improvement over what we are doing, but I wish to offer a couple of points I think the American people ought to know. We are not going anywhere far enough, not anywhere close to where we need to go. The SKILLS Act coming out of the House markedly changed job training in this country. Now, this is a big modification to the SKILLS Act, but the SKILLS Act actually paid attention to the Government Accountability Office. What they did is consolidate a lot of programs and put real metrics and real competition into job training. There are two critical flaws in this bill that I think are a mistake--and I know this bill is going to pass, so it is moving the ball down the road. No. 1, there is no metric in the job training program to say: Did somebody get a job in the area that they were trained for? So it doesn't matter how many people we train. If there is no job and they got no job for what they trained, we have wasted the money. So that is not anywhere in the bill. The second thing is the vast majority of money in this country that is spent on job training is Job Corps. When we ask behind the scenes why we didn't have major reform to Job Corps, it is because of all of the parochial people they employ. In Oklahoma, it is over 1,000. Most of the Job Corps programs in Oklahoma are highly inefficient and failing to do what we want them to do, and they are not going to be held accountable with this bill. So these are two really disastrous things that, had they been added, would have made a real difference. And let me say why I can speak to that. When the GAO put out their report on all the job training programs, I had every one of my staffers in Oklahoma go to every job training, State and Federal, in Oklahoma. Let me tell you what we found. What we found was the Federal programs were totally failing. We were very good at employing people in job training programs with Federal money, but when we looked for the outcome of whether we gave somebody a skill that gave them an ability to have a life, we failed. Contrast that to Oklahoma's Career Tech system and their own State- funded training programs, where they were 90-percent effective in giving somebody a life skill. So I am disappointed that the SKILLS Act didn't come over here and get voted on because that was what was in the SKILLS Act and it is really accomplishing the goal. My colleagues have been great with me in working on this bill to try to attest to and to accommodate my desires to see some changes. But there are these two critical flaws, and it speaks to the lack of courage in our country today that because we have people employed in Job Corps programs, we are not going to really shake that system up and make it do what it needs to do. I will never forget. I had a town hall meeting in Guthrie, OK, the largest Job Corps training in Oklahoma, and I wrote a report that was highly critical of it. They all came here, and I faced them down and said: Do you really want Federal Government money spent on your salary that doesn't accomplish the goal of giving somebody a life skill? They couldn't answer yes. They had to answer, no, they really didn't want that. But that is what Job Corps still is in this bill, and that is by far the biggest job training program we have. So I applaud the changes that we have made, the movements that have gone forward. But when there is no metrics on whether the skill that was trained for got a job, we don't have any idea what we are going to be measuring after this bill goes through. No. 2, if we have not fundamentally gutted the present Job Corps system and changed it to where it is responsible to actually accomplish a goal and hold them accountable--like we need to be holding the VA accountable--if we don't do that, we haven't really fixed anything. This bill has no CBO score on it. It is at least $58 billion over the next 6 years--at least. And we are going to vote on a bill again that doesn't have a score. So the intentions of my colleagues are pure, but I think they are missing two critical provisions if they really want to fix job training. I thank them for their work. I appreciate their accommodation. I know this bill will pass and it is an improvement, but it is not going to fix the fundamental problems. I yield the floor.

Mr. COBURN

Mr. COBURN. I thank the chairman of the Veterans' Affairs Committee for working with Senator McCain to get a bill. I support Senator Sessions and the budget points of order on this bill. I take exception to some of the statements by my colleague from Vermont. As reported yesterday, if you look at the patient list for many of the primary care doctors in the VA, they are half of what the average practicing physician outside the VA is. When you drill down on those, many of them have patients that have been deceased for years. About 10 to 15 percent of their patient list has never been to the VA, or they came once from a different State or were transferred from somewhere else. What you actually see is the patient load in the private sector is about 2\1/2\ times what the patient load is in the VA. I have no doubt we need to increase the number of physicians in the VA, but we also need to increase markedly the amount of output that those physicians perform. The other thing that is important in this bill is the transparency-- which I don't believe has been mentioned--that will actually allow veterans to know the quality outcomes of where they are being treated and the credentials of those who are treating them. Those are important factors for care. Our veterans deserve the best care. I agree with the chairman of the Veterans' Affairs Committee that the vast majority of our VA employees are hard-working employees, but there are some who aren't. Our lack of oversight and the lack of management expertise at the VA has now exploded into issues that are going to continue to be exploded. We hear every day new whistleblowers coming forward on the problems in the VA. It is not only scheduling; it is a lack of truthfulness in a lot of other areas. It is a lot of inaccuracy in terms of outcome. I agree with the chairman. This is just the beginning. But if, in fact, somebody puts their life on the line for us, we certainly, at a minimum, ought to make sure that we don't just have words that say we are going to give you the health care if you are an injured returning war veteran, but that we actually give that care, and that it meets the standard of care we want for anybody in our family. This is just the start. The other thing that I would say, in agreement with Senator Sessions, there are ways to pay for this bill. On the clinics, we drill down on one clinic--and I am going to go spend just a minute talking about it. It is a clinic that will triple in size, but with an average expected increase in veteran population of 5 percent and visits of less than 7 percent over the next 20 years. So it is going to go from 50,000 to 190,000 square feet. We are going to spend $188 million for that facility and pay $40 a square foot per year for it on a rate of increase of 4 percent in part of the lease. We can rent the same space in Tulsa at $15 a foot and spend less money than we pay for the engineering cost for this to have a clinic just as good or better. So the planning and the management of the VA on these clinics is suspect, and I plan on drilling down on every one of those before this bill comes to conference and give our conferees the information based on that. Because we are going to spend emergency money, as the chairman would like to do on this, we ought to make sure there isn't a penny that is wasted. So we can do it. We can do it better, we can do it for less money, and we can do it in the confines of what we are actually going to see. The final thing is I would say again to my colleague from Vermont, I appreciate his willingness to compromise on the issues. His heart is dedicated to veterans, and I understand that. Our philosophies are different on how we get there, but his commitment is nonetheless real and felt, and I thank him. I yield the floor.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. COBURN

Mr. COBURN. Mr. President, I wanted to spend a moment or two talking about the Water Resources Reform and Development Act conference report, and I want to say to my colleagues, both in this Chamber and in the House, some improvement in the WRRDA reauthorization has happened, but it is not nearly enough. From 1986 to 2010, the average new authorizations were over $3 billion a year, and the average amount of money was $1.8 billion a year. So we have been going backwards all that time. In this report, they did deauthorize less than 10 percent of the $80 billion in backlogged projects. Their attempt to take some of the political nature out of it is a good attempt, but it is not nearly complete and will be gamed, just as we have seen in the past. What really hasn't happened in the WRRDA bill, and partly because they do not have the authority to do it, is to change the Corps of Engineers. There has never been a project the Corps of Engineers doesn't want to build, and there has never been a study they do not want to do, because what that means is their budget continues and their jobs continue. So we do not have that distinct independent voice we can rely upon because bureaucratic malaise and self-interest trumps it every time. There is another critical problem with this report. The inland waterways trust fund is out of money. We steal it every year. Like Social Security, the money has been stolen and spent. Yet they change the requirement for inland waterway repairs. It used to be if it was under $8 million, we would pay for it out of the general fund--not the trust fund--but now they have moved that to $20 million. In essence, what that says is we are going to do things that are the responsibility of the trust fund but we are going to charge the American taxpayer rather than the users of the inland waterway to do these repairs. We have a lot of those in need of repair on the McClellan-Kerr waterway in Oklahoma. So there is a little sleight of hand, another smoke and mirrors set from the Congress of the United States to the American people about not being truthful about what they are doing. We need a priority of projects. We need discipline within the Corps of Engineers. There is none. There is no discipline. It is turf protection and bureaucratic excess continued as normal. What we should have done is to deauthorize about $40 billion worth of the projects that are presently in line and really put a priority on what is most important for the Nation, not what is most important for a certain Congressman or a certain Senator to look good at home. Unfortunately, we didn't have the courage to do that. We didn't have the strength of character to do that. We wouldn't stand and defend that. So what we did is make minimal progress--and there is some progress; I will admit it--but it is certainly not enough to get my vote. When we fix symptoms of disease rather than fixing the real disease, all we do is delay the onset of the cure, and that is exactly what we have done with the water resources conference report. Mr. President, I yield the floor, and I suggest the absence of a quorum.

Mr. COBURN

Mr. COBURN. Mr. President, per the Senate rules I have submitted a letter outlining my reasons for objecting to this, besides it not being paid for, and I object.

Mr. COBURN. I object.

Mr. COBURN. Mr. President, we went through this 10 days ago, and I gave a very long and detailed explanation of my objections to this bill. I won't belabor that again. But again, we are at the process where we owe $17 trillion, and we are spending money that we don't have in areas that are far lower in priority than this issue. I have no objection, and I think, in terms of bulletproof vests, this is actually a great way to protect those who protect us. But again, as I stated the last time we had this discussion, under the enumerated powers this is the responsibility of the States and local communities. On that basis I object.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that the following letter be printed in the Record.

Mr. COBURN

Mr. COBURN. Mr. President, reserving the right to object.

Mr. COBURN. Thank you. The most senior Member of our body understands the differences he and I have on a lot of issues. Most of what he said is true in his statement about the sacrifices and the effectiveness. Where we have a difference of agreement and a difference of understanding is in the enumerated powers of the Constitution of the United States. The fact is that every individual in this country today owes $50,000 just on the debt, and every family is responsible for $1,100,000 in unfunded liabilities that your children and you will ultimately pay for. This is not about vests. This is about continuing to do the same thing that got our country in trouble. This is a $120 million authorization with no offset, no cutting of spending anywhere else. If it is a priority, we ought to cut spending somewhere else. But, more importantly, the Constitution lists the enumerated powers, and there is no role for the Federal Government in terms of funding local police departments. It would be nice to do if we were in surplus. We could ignore the enumerated powers. But we are not in surplus. We are borrowing tons of money every year. We are going to borrow $580 billion this year--$580 billion against the future. And the small thing--this is small. It is only $120 million. I do not object to our police officers having vests. I want them all to have vests. I want all the women to have vests. But it is not a role for the Federal Government. It is a role for my hometown police department in Muskogee, OK. The taxpayers there should protect our police officers. Our Founders were very clear, and the reason this country is in trouble is we continue to practice outside the parameters of a limited government and take away the responsibility and obligations of State and local communities. On that basis, I raise an objection and do not agree.

Mr. COBURN. Will the Senator yield for a moment, just for a question? Is the Senator aware that I never voted for any of the money for that spending? (Ms. HEITKAMP assumed the Chair.)

Mr. COBURN

Mr. COBURN. I would like to spend some time talking about the bill that is on the floor. I thank my colleagues from Oregon and Virginia. I have enjoyed working with them. The bill we have on the floor is one of the reasons I am leaving Congress at the end of this year. This is why the American people are disgusted with us. We are going to put off until tomorrow what we should be doing today. We should be fixing this problem instead of delaying the problem. I concur a lot with what my colleague from Virginia said. But the fact is that there is no courage, there are no guts, and there are no intentioned actions to do what is the best thing in the long term for this country in this body anymore. We have a bill that came to us--and I appreciate the fact that the chairman wants to try to fix it. But if they vote for this bill that is on the floor today, they are part of the problem. They are not part of the solution; they are part of the problem. There are four budget points of order that lie against this bill. Why in the world would there be four points of order lying against this bill? We are only going to vote on one of them. It is because it is a sham. It is a lie. The pay-fors aren't true. They are nothing but gimmicks. It is corruptible. There is no integrity in what we are getting ready to vote on in terms of being truthful with the American public and in terms of being truthful with the people who are providing the care for Medicare patients. I have a little bit of experience--25 years of practicing medicine. I can tell you what is wrong with the payment system. We have a payment system both from the insurance industry and from Medicare and Medicaid that says: See as many patients as you can if you want to pay your overhead because we are going to pay you based upon a code rather than how much time you spend with a patient. The first thing a doctor is taught in medical school is sit down and listen to the patient. If we spend time with the patient, the patient will tell us what is wrong with them. We know that is true because we have two of the sets of data now--both on the concierge medicine that has come up in the past few years as well as what we have seen in one of the great HMOs on the west coast. They order 62 percent fewer tests when they are listening to the patient. One of the biggest costs for Medicare, one of the biggest wastes for Medicare is tests. Why do doctors order tests? Because they didn't spend the time figuring out what is really wrong with the patient, so they order a bunch of tests to try to help them; whereas, if they had spent an additional 15 or 30 minutes with the patient, most of those tests--and most are not without risk--would never have been performed. We have the Senate doing what we usually do: We are putting this off until tomorrow when we can actually fix the real problem now. It comes to another principle of medicine. The principle of medicine is that we don't treat symptoms, we treat disease. When we treat the disease, the symptoms go away. If we just treat the symptoms, we will never find the disease. We will cover up the disease. That is exactly what we are doing. The SGR was a great idea. It started in 1995 in the Ways and Means Committee in the House under former chairman Bill Archer. Had we followed it, we would have seen some significant reining in of the costs of care and Medicare. But what happened? We cut spending and we cut reimbursement rates one time. Instead of responding to the political clamor of the provider group, we fixed it--a short-term fix. We have been doing that ever since 1999, short-term fixes. We are not fixing this problem today. What we are doing is taking a big old can and kicking it down the road. Worse than that, we are not even being truthful about what we are doing. One of the little gimmicks is to shift $5 billion of sequester from 2025 to 2024 and say you saved money. But we all know this little red area on this side will go over to the other side and we will spend that money. Nobody believes it. It is kind of the wink and the nod to the American public: Oh, look at us. There is no truth, there is no honesty about what we are doing. And that is only one. This is the other offset. The sequester was the one I just showed. Savings from future Medicare cuts: $2.3 billion. They will never occur. If you think they will occur, you obviously think--if they will occur, then we should have fixed the real problem, the real disease of Medicare today. But we didn't. So the actions will continue to be exactly the same. That $2.3 billion will never be materialized whatsoever. It is a falsehood--$4.4 billion to Medicaid. It will not ever come about. That is in the future, but we will take the money now to pay for it. In this bill of approximately $20 billion, half of the savings we say are there aren't there. Every Member of this body knows that. So when they vote for this fix today and vote against the budget point of order, what they are saying is: I am dishonest, I am playing the game, and I will not stand up for truth so the American people actually know what we are doing. I do not believe in transparency. I do not believe that we ought to have to live within our means, that we ought to make hard choices, just as every American family out there does today. Finally, some of this is very unfair to the very people who worked on this with the committees because they made some commitments for real cuts to them to get a long-term fix. Guess what. The real cuts--the portion that is actually paid for--pay for it for only 1 year. So not only are we dishonest with the American people, we are dishonest with the stakeholders who negotiated this for a 10-year elimination. The budget points of order against this bill--just so we know what we are talking about, it violates pay-go. Plain and simple, it violates pay-go. This bill increases the on-budget deficit. I dare somebody to come down to the floor and tell me it does not. It does. It violates the Ryan-Murray 2014 congressional Budget Act because it violates the top line. Nobody is going to come to the floor and say it doesn't. We won't hear one speaker come to the floor and say it doesn't violate that. It does. They know it does, but they won't speak the truth. This bill also spends money in excess of the Finance Committee's allocation--another point of order against the Budget Act. Everybody knows that is true, but they won't come down and say it doesn't; they will just vote for it. It also has language in it within the Budget Committee's jurisdiction that has not been reported or discharged. So we are totally ignoring the process the chairman of the Finance Committee would like to have so we can do the expedient political thing to take some pressure away, just as we did on the flood insurance bill. It got a little hot in the kitchen. Instead of actually cooking the omelet, we threw the eggs in the trash can and ran out of the room, and that is exactly what is going to happen in the Senate. We are again putting off the hard choices. Let me tell you why this is important. The Senator from Virginia outlined this a little bit. When I came to the Senate, which was 9 years ago, the individual debt each one of us held on the national debt was under $32,000. Today it sits at 54,800-and-some-odd dollars. We can kind of get lost in that. What we have to think is this: Well, what is my family's obligation for what we haven't paid for in the Federal Government? Let me tell you what it is. For every family in America, whose average income is $53,000 per year--the same as it was in 1988 in terms of real dollars; we have gone backward--your obligation is now $1.1 million per family. And we are going to play this game again and we are going to add another $10 to $12 billion between now and April? We are going to say and claim it doesn't add anything, but we are going to add another $10 billion so we can get away from the heat, so we can get out of the kitchen, so we won't be responsible. Which is more responsible--to tell the truth about where we really are or to actually profess an untruth to your constituents in this vote this evening? Because that is what it is. Mark my words: Every Senator who votes for this bill that came out of the House will be telling an untruth to the American people. They know it is not paid for. They know it violates all sorts of rules in the Senate. They even violated the House rules as they passed it--all to meet a deadline? To give a little history, we have missed the deadline before on SGR fixes. Does it cause additional work for providers, doctors, hospitals, and doctors' offices? Yes. Does it provide additional work for CMS? Yes. Do we eventually catch up on it? Yes. So what is the hurry? Why not really treat the real disease? The real disease is that we have a payment system that is not good for patients and is not good for providers. We can't fix it over a weekend, but we can fix it. If we don't fix it, as the chairman would like to see a long-term fix--I don't necessarily agree with everything he wants to do, but I applaud his effort to get a long-term fix. If we don't fix it, we don't deserve to be in the Senate. There will be no credibility left and there will be no legitimacy left if we pass this bill. It is all a pack of untruths--untruths to the stakeholders, untruths to the American public and, most importantly, untruths to the generation coming up that is going to pay the bill for our untruths. This isn't an unfixable problem. It is a problem that hasn't gotten the attention and the time it needs, and it reflects poor leadership of the Congress and the committees. We knew this was coming up 1 year ago. The Senator from Oregon can totally be forgiven because he wasn't in charge of the Finance Committee until 1 month ago. But there is no denying the fact this problem was there. Doing a patch--and even doing some of what Senator Wyden wants to do--won't fix the ultimate problem. Think about the interaction you have with your caregiver. The average time in a doctor's office when you go in, before you are interrupted by your physician, is now 6 seconds. You go in, sit down, and the doctor asks: Why are you here today? You start to say something, and the first thing you know, you get interrupted. Why? Because that physician knows he needs to get to the next patient to pay the bills because we are paying bills based on CPT cuts rather than paying the physician based on the amount of time they spend with the patient, including outcome measures. We have a system that is designed to be defrauded and creates overutilization. We designed it. We can fix it. Voting for this bill doesn't fix anything except a little heat in the kitchen. When we come back the next time, the heat is going to be hotter, and hotter, and hotter. This bill is a cowardly response to the real problem that we have. It is time we quit being cowards. I yield the floor.

Mr. COBURN. I thank the chairman.

Mr. COBURN

Mr. COBURN. I thank Senator Blunt. I did not get to hear all of Senator Inhofe's comments, but as an Oklahoman I think we couldn't have a finer company or a finer corporate citizen than the Green family, in terms of their chains of stores around the country and what they have done. The reason they are successful is because they actually care, nurture, and support every one of their employees. They work on principles that they truly believe in, and it has really been the key to their success. They are never open on the sabbath. They believe in paying somebody a livable wage. They are big in the community. As a matter of fact, they are one of the largest contributors to organizations that are funded in the charitable realm. They go down deep to actually help people. They come with pure motives. The Senator from Missouri mentioned what Thomas Jefferson said in 1809: No provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of civil authority. I want you to listen to that for a minute. Jefferson, one of the authors of the rules of the Senate, one of the key Framers of the very Constitution that we live under, recognized that it is most important to protect this conscience of the Green family to do what they think, according to their faith, is the right thing to do. My colleague referenced the Religious Freedom Restoration Act. Why was that necessary? Because we saw civil government starting to impede into an arena that Thomas Jefferson warned about. That is why it was passed, that is why it was signed, and that is why it is the law of the land. This is going to be a seminal case, and it has nothing to do with birth control. Hobby Lobby pays for birth control. It always has and always will. It has to do with can we allow the civil government to impede to such a level, as my colleague from Missouri said, that the government can now tell you what your values are, what you have to think, and how you have to act, on the basis of what the government says your values are. As an obstetrician who has delivered more than 4,000 children, as somebody who has cared for every complication of pregnancy, as somebody who believes in the value of newly created human life, all the Greens are saying is: We really shouldn't have to pay our money to abort a baby when we find it unconscionable to take innocent human life. It doesn't mean that people that work for them cannot get an abortion. It just says they don't want to violate their own conscience by supplying it. The other issue that ought to be evident to everybody is that plan B is over the counter. It is not even part of your health care. You can go buy it. As a matter of fact, there is not even an age limit on it now. A 12-year-old can go buy it over the counter. So it is not about limiting abortion; it is about the conscience of a very successful company. The reason they are successful is they follow the teachings of their faith. Now we have government in a position where they are going to tell them what their faith is. Let me reiterate what Jefferson said: No provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of civil authority. These are deeply felt and held beliefs based on their faith. The other side of this is we see their deeply held beliefs and how they have rescued universities, how they have come to the aid of food pantries, how they have actually been active in the community. Everywhere they are involved they are out following the same deeply held beliefs of helping the poor and indigent, giving people an opportunity through a college education that they never would have had, giving people a day of rest. Their stores are not open late. Their employees get to go home. They could sell more products if they were open later. They could sell more product if they were open on Sunday. They choose not to because they think the principles under which they operate their business based on their faith have created an environment which allows everybody who works for them to succeed. If you go through their businesses, if you go through their warehouses, and if you go to their stores, what you see is a smile on almost everybody's face. Why? Because people enjoy working there, because they are treated as human beings. They are lifted up. They are given opportunity. They are given the very things that we all want for our neighbors and for ourselves. My hope is that the Constitution will be looked at as the Supreme Court considers this case and that the Religious Freedom Restoration Act will be looked at as the Supreme Court considers this case. The Affordable Care Act is not affordable; it is unaffordable. For Americans it has a $2 trillion cost over the next 10 years. It is a disaster in terms of how it has been implemented. It is going to be a disaster in terms of quality care and delayed care because of the increased deductibles that almost everybody is facing. We shouldn't let it be a disaster in terms of destroying businesses. We ought to embrace this family and their business for what they have done. They have taken advantage of the American enterprise system in a way that has built tremendous success, that has benefited not just the Green family but hundreds of thousands of people through their generosity, and their capability to empower people to get ahead. I am glad to see my colleague, and I yield the floor.