Thomas Coburn

Mr. COBURN

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

Mr. COBURN. Mr. President, this amendment saves $6.5 billion over the next 10 years for what it does on fraudulent Medicaid prescriptions-- $6.5 billion--$650 million a year on fraudulent prescriptions. It also creates a prohibition so that erectile dysfunction drugs are not paid for by the American taxpayers to convicted rapists, those convicted of sexual assault, and pedophiles in this country. You can say a lot of things about a lot of amendments. This is not a game amendment; it actually saves money. All the States are struggling with Medicaid. This is a way to spread $650 million a year to the States. I reserve the remainder of my time.

Mr. COBURN. Yes, they will pay the fee. They will pay the tax and say it is easier. Consequently, the young people in our country, because we do not have a big enough payment under the ``individual mandate,'' are going to say it is smarter for me to save my money, pay the fine, and not get insurance because when I get sick, I can get it. You are going to get what is called adverse selection, which is even going to drive the rates up further. Anybody 40 or older, watch out, your health insurance rates are getting ready to bloom.

Mr. COBURN. What it is going to do is exacerbate the cost shifting going on with Medicare and Medicaid right now, which means insurance rates for everybody else in the country are going to go up.

Mr. COBURN. I thank the Senator from New Hampshire. As I contemplate what is happening at 62 years of age and looking back through my life, this is undoubtedly the greatest assault on liberty this country has ever had. It is not direct; it is indirect. But it is what the Senator from New Hampshire talked about: we are going to decide for you what you get. What the American people still don't understand is there are three areas in this bill that in the next 5 years will put the government in charge of everybody's health care--what you can have, what you can't have, and who can give it to you. That is what is coming. So if you are a caregiver or you are a patient, you might think long and hard about the three provisions in this bill that are going to do that: a Medicare advisory commission, the cost-effectiveness comparative effectiveness panel, and the U.S. preventative task force panel. All of those are going to carry the force of law, and it will not just apply to government-run plans. If you have private insurance with your employer today, you are going to be told what treatments you can have because some group of bureaucracies in Washington are going to decide that. That is what is in this bill. The Senator from New Hampshire mentioned several claims that have been made. I ask unanimous consent to temporarily set aside the pending motions and amendments so I may offer an amendment which is at the desk, No. 3556.

Mr. COBURN. And people who are not necessarily getting a subsidy.

Mr. COBURN. What happens to all this? What is the ultimate? The ultimate is failure of the insurance market.

Mr. COBURN. Mr. President, do I have time remaining?

Mr. COBURN. I think there are two reasons. One is because there is large support of those who wrote this legislation by those who benefit from suing doctors. That is pretty straightforward. And the doctor's only defense is to order tests which they need but which the patient doesn't necessarily need. The second is because they couldn't get--or wouldn't put it in the bill because they knew it would pass and the American people would agree with it. You know, it is beyond me. But let me go to the point of this current amendment. I have delivered somewhere over 4,000 babies, and 2,000 of those were Medicaid babies. Over half the babies I have delivered in my life I have cared for through Medicaid. The State of Oklahoma just cut, in February or March, Medicaid reimbursements 3 percent. They are going to cut it another 8 percent. Forty percent of the primary care doctors don't see Medicaid patients because the price that is paid for the coverage doesn't cover the cost, let alone any margin. It doesn't cover the cost of nurses, the rent, the malpractice, and everything else. The second point is, of the specialists who are available, 65 percent of the specialists in this country won't see Medicaid patients. So when I am taking care of Medicaid patients, I have trouble finding somebody better than me in a specialized area to care for my patients. What is the other thing we know about Medicaid? Even if you normalize for social factors, their outcomes are worse. The cost in terms of the number of procedures, the failure of therapeutics--all are worse. So why is this a good idea? It is not just a political stunt. If Members of Congress are enrolled in Medicaid, the first thing that is going to happen is Medicaid and reimbursements are going to go up so that the availability of the finest and the best and the brightest in this country is available to Members of Congress. So it is not just a stunt to say we put our membership in Medicaid; it is a very important ulterior motive to improve Medicaid. Think about it. If you are one of the 16 million people who are going to get health care under Medicaid, supposedly, in this bill--and I doubt that seriously, simply because we are going to see a marked decrease of 50 or 60 percent of doctors who won't see them--think about what is going to happen: You are not going to be able to find a doctor. You may have coverage, but you won't be able to get anybody to care for you. Is that coverage? Is that care? Is that prevention? Is that management of chronic disease? No. None of that will happen. So the whole idea of placing us in a leadership position into Medicaid is so that we will lead and fix it and make it what it should be. There is only one health care system worse in America than Medicaid, and that is the Indian Health Service. That is the only one that is worse. Everything else outside of those two programs is better. So why would we consign 16 million Americans to a health care program that is failing today? So the way to fix that is to put us into it. And I guarantee you, the self-interests of the Members of Congress will fix Medicaid and make it what it should be. With that, I yield back to the original author of the amendment.

Mr. COBURN. Reserving the right to object.

Mr. COBURN. We got this 1\1/2\ minutes ago to see the language. You have an amendment on the floor that actually accomplishes everything you want to do. Why are we doing this? Because you do not want to mess up a package that is clean. It has every application, the Burr amendment, to this. With that, and the fact that this is exactly the kind of shenanigans the American people do not want, I object.

Mr. COBURN. That is correct.

Mr. COBURN. That is the goal, so the government can control it all. I yield back.

Mr. COBURN. I thank the Senator for his question. If you look at Thomson Reuters and several others who have studied the health care field, the estimate for defensive medicine costs is $250 billion a year. It is not just that we order tests that protect us from frivolous lawsuits, but those tests have consequences. Some of those tests actually hurt patients or expose them to radiation or, in fact, limit our ability to do what is best for the patient because we are more interested in protecting ourselves.

Mr. COBURN

Mr. COBURN. Madam President, I rise to bring attention to the crucial role of health care professionals in providing quality health care across our Nation. Other than being a father, grandfather, and husband nothing has been more personally satisfying for me than meeting and caring for patients. As a practicing physician I have seen firsthand the importance of each and every health care practitioner--not just doctors and nurses--in meeting this country's diverse health care needs. I am thankful for the contribution that dedicated health professionals have made to not just my medical practice, but all of our communities. These professionals are found not only in hospitals and doctor's offices, but everywhere from local schools to athletic training clinics, long-term care facilities to rehabilitation centers, and providing loving care in hospices and private homes. There are more than 100 distinct allied health professions including respiratory therapists, music therapists, athletic trainers, clinical laboratory scientists, radiologic technologists, medical assistants and many others. They provide expert care in a number of therapeutic, diagnostic and preventive services in a multitude of settings. These professionals practice expertise in disease prevention and control, dietary and nutritional services, mental and physical health promotion, rehabilitation, and health systems management. Approximately 6 million individuals are currently serving in allied health professionals, representing about 60 percent of the healthcare workforce. According to the Bureau of Labor Statistics, 10 of the 20 fastest growing occupations for 2008--2018 are in the health professions. As Congress continues to engage in a national debate on health care, I have consistently been offering patient-centered solutions that would allow individuals to access care tailored to their individual needs. Consumer choice, not government coercion, has made goods and services that were once scarce affordable and accessible. For instance, in the past 18 months the number of unique iPhone applications available to consumers has gone from 500 to more than 140,000--with 3 billion applications downloaded. If patients were empowered to take control of their health care spending, it would enable health care professionals to more freely exercise their immense talents--no doubt putting Apple and the iPhone to shame. Regardless of the outcome of the health care debate, these health care professionals will continue to make a difference in their patients' lives. I want to personally thank, and express my support for, these vital health care professionals. Our system could not function without their tireless efforts. I urge my colleagues to join me in recognizing this important group of individuals.

Mr. COBURN

Mr. COBURN. Mr. President, I understand the Senator from Virginia is going to speak now, and I ask unanimous consent that when he finishes, I be given 45 minutes at the completion of his time.

Mr. COBURN

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

Mr. COBURN. Mr. President, I compliment my colleague from Virginia. I am a cosponsor of his amendment. I think it is a very noble attempt to try to put better hands on the stimulus. It is interesting to note that when we had the first hearing with the IG who is overseeing the stimulus, he said, regrettably, $50 billion would be wasted; that is, $50 billion out of $867 billion--actually, some $940 billion--was going to be wasted. We started with the assumption that about 6 or 7 percent of this money was going to be defrauded. I congratulate my colleague because some of the steps he is talking about in his amendment will actually lessen that, hopefully. I agree with him. It is exciting for me to see a bipartisan attempt to start bringing teeth into the laws we pass, not toward the American public but toward the agencies that administer the funds. I congratulate him. I think he has a good amendment. I think we will have a great vote on it.

Mr. COBURN

Mr. COBURN. Mr. President, I wish to spend time talking about the bill we are considering. Yesterday afternoon, I had the great fortune--my daughter was performing in Florida and was driving back to New York. I got to see my 7-month-old granddaughter. Anybody who is a grandparent knows what it is like to see your grandchildren. There is nothing wrong with it and everything right with it. You get a picture and see in your grandchildren aspects of your children. It draws back memories. But I was struck by that encounter with my daughter and granddaughter and, by the way, her dog. What are our hopes and dreams about? What are the hopes and dreams we have for our children and our grandchildren? Our hopes and dreams are that they will have great opportunity to flower and blossom in a way that they can take advantage of their God- given talents and their hard work and become a success in their life's endeavors. And then you contrast that with the heritage of our Nation-- a heritage which is about sacrifice--where one generation makes hard choices, makes difficult decisions, where they sacrifice their own benefits from their own endeavors to create opportunity so that the next generation of Americans can have that opportunity to fulfill and expand their heart's desires. We heard the Senator from Utah today talk about where the problems were with our Nation, and he talked about where all the gold was in terms of fixing what is wrong. I would have to say I disagree with him. When I look at the U.S. Constitution, and then I look at all the government programs the Federal Government has fostered, passed, and funds, I see a black-and-white slate. I see on the one hand the very limited intent of our Founders, which was spelled out very clearly in Article I, Section 8 of the enumerated powers--here are the powers you are to have. We are designing this to be a limited Federal Government and we are going to reserve everything else to the people and the States through the tenth amendment. Those words are actually in there. What is not spelled out for the U.S. Federal Government is explicitly reserved for the people and their States. So when we consider the mess we are in--the fact we had a $1.56 trillion deficit last year, that 43 cents of every dollar we spent we borrowed from our grandchildren, that this year it will be $1.8 trillion, that over the next 9 years we will spend $10 trillion we don't have--and I would put forward most of it on things we don't need--look at it in the light of what our constitutional charge is. I have made this statement from the floor several times. The oath we take--when I was sworn in, in January of 2005--is to uphold the Constitution. The Constitution is our guideline, our direction for what our responsibility is and what should be left to the States. So I agree with my colleague that unless we reform entitlements, we are going to have a difficult time solving our problems, but there is another answer. Actually, there are two other answers. One of the other answers is to go through with a fine-tooth comb and look at every Federal Government program and ask: Is it a legitimate responsibility of the Federal Government? And if it is, is it a program we need? You know, in 2 weeks time, my staff found 640 duplicative programs in the Federal Government, across all agencies, that all do the same thing--105 programs to encourage students to go into technology, math, engineering, and science. There are 105 different programs. So as we look at comparing what is our obligation and what is our charge under the Constitution with what is happening, all of a sudden a wide world opens up of monies we don't have to spend, that aren't absolutely necessary, that aren't absolutely a priority, that we shouldn't be spending money on in a time when we are borrowing and stealing the future of my little granddaughter Katie Rose, and everybody else's granddaughter. Why would we not demand that we do the hard work of going through what is truly our obligation and eliminating what is not, and eliminating the multitude of duplications that the Federal Government has? Why shouldn't we put ourselves to the same test every other family in America is put to. Once you have maxed out your credit card, once you have passed your limits, they do not continue to extend you money. Unfortunately, what they do is jack up your interest rate. Well, guess what is getting ready to happen to us. We do not have an unlimited credit card. What is going to happen to us over the next few years? We are seeing 30-year bond obligations today going for a higher percentage than what they have ever gone for in the last 4 or 5 years, and we are going to see that trend continue. Out of the $10 trillion we are going to spend--money we don't have--in the next 9 years, $5.6 trillion of that is to pay interest on the national debt. So we are going to find ourselves in the same predicament as that person who has maxed out their credit card who is now paying interest on the interest instead of paying off the debt. I said there were two ways of looking at this. The second is to go through the Federal Government and eliminate the waste, fraud, abuse, and duplication. One is to eliminate where we don't truly have a responsibility or authority for what we are doing under the Constitution, but the second is we have identified $350 billion a year of waste, fraud, and duplication in the Federal Government. We have done that over a period of hearings over the past 4 years. One amendment out of about 800 I have offered over the last 5 years has been accepted to eliminate something--just one. They have all otherwise been voted down. And they have been voted down because Members of this body refuse to make the hard choices about priorities, because they think we don't have to. Well, the gig is up. There is a real rumble among the American people. There is a rumble in America about holding us accountable for the future of this country, which means no longer ignoring the hard choices, no longer adding to the credit card. I say all that to talk about the bill that is before us. We have a bill before us that is called the tax extenders bill. But that is not what it is. It is the debt extender bill. Because this bill, in light of all the speeches we will hear in this body, and all of the excuses and all the press releases that are going to be released, is going to add $104 billion to our children's credit card. Yesterday this body voted to go forward with that. They voted to not make the hard choices, not offset the spending. If these are priority items that we should be doing in this bill, then why aren't we going after some of the waste, fraud, and abuse in the Federal Government and getting rid of it? There is $104 billion over the next 10 years, with this one bill alone, that we are going to add to the debt, and that comes down to $10.4 billion a year. We have $350 billion worth of waste. Yet we refuse to go into that $350 billion worth of waste, fraud, and duplication, and eliminate anything to pay for this. Instead, we are going to steal that opportunity, we are going to steal that future, we are going to put a blight on the blossom of opportunity for our children and grandchildren. I beg America to hold us accountable; to not accept business as usual anymore. When you get down to it and start talking about what this means--when you take the $104 billion and divide it by the 300 million people in this country and then multiply it by the average family size--what you get is $1,282 per family that this bill will add. So if in fact you go to sleep the day after tomorrow, when this bill has passed the Senate, when 60 Senators vote for it and we go on and do this--35 or 36 will vote against it, but 64 or 65 will vote for it--when you put your head on your pillow at night, you can thank them for jeopardizing the future of your children. And not because what they want to do in the bill is necessarily wrong, but because they lacked the courage to stand up and make the hard choices that are required in times of distress in our country. If you study our history, our greatest leaders exhibited courage in the face of adversity. They pulled us through by making hard choices, not running away from the hard choices. We had a lot of people who were critical of Senator Bunning because he raised the issue on a $12 billion jobs bill--that isn't going to do anything--and said we ought to pay for it. We voted him down. We said no. But you know what, as I read the American public, about 80 percent of them said we should have paid for it. We should have done that. And those people who were most critical of Senator Bunning on the floor are the people who have hardly ever voted against any spending bill in their entire career in the Senate. They honestly believe it is okay to mortgage the future of our children to benefit their own political careers. So what we have developing in the Senate isn't partisanship, it is policy differences that will make the difference for this country. And if the ne'er-do-wells of doing it the same old way win, our children won't have a future. What they will have is a debt burden they will never get out of. We hear speeches, as we did from the Senator from Utah, that tend to push us, and we think, well, we have to figure out how we can fix Medicare and Social Security. Well, how do we fix Medicare and Social Security? We have to delay retirement, lessen benefits, eliminate fraud in Medicare, and delay eligibility. Those are the only answers. Or we have to raise taxes. But how do you raise taxes on the American people when you know you are spending $350 billion a year that is wasted? How do you, in good conscience, even consider that? I am not against having a tax increase when and if we have done everything we can do to get this government efficient and eliminated what is not our role and gotten rid of the fraud, waste, and duplication. And most of America wouldn't be against that either. But right now they do not trust us. And for good reason they don't trust this body. Because we are not shooting straight with them. We are not telling them that we are going to add $1,282 to their kids' debt. When you take this number--this 347 figure, and you look at kids 25 years and younger, and you take that out 20 years, here is what you find: Not only are they going to be responsible for the debt we have today, but the $78 trillion worth of unfunded liabilities for Medicare, Medicaid, Social Security, and all the other trust funds, including Federal employees' retirement, which adds up to $1.3 million for every person in this country under 25, ask yourself: How in the world will they ever own a home or send their kids to college if in fact they are having to support $60,000 a year in interest on a debt they didn't create? The promise of America was freedom. Debt is a hard taskmaster. But it is doubly hard when it wasn't your debt but that of your parents and your grandparents, yet you are tasked with changing your lifestyle, your opportunities, your hope and vision for your children because this generation didn't have the courage to stand up and say: Enough is enough. When will it ever be enough--when we can't sell our bonds? When will it ever be okay to offend those who are on the dole and who don't deserve to be on the dole? When will it be okay to eliminate the waste in the Federal Government, if not at a time we are going to have a $1.8 trillion deficit; if not at a time when $50 billion is going to be defrauded out of the stimulus program? When will we ever do it? We have never been in the financial situation our country is in today--never before in our history. Our whole foreign policy is now being affected and impacted because of our debt. We have to keep an ear toward China as we conduct our foreign policy, in the fear that they may dump our bonds. Why would we put ourselves in that position when we do not have to? Because there is no spine in the Senate. There is no spine in the Congress. There is no spine to go out and say: Yes, I made the hard choices. You may not like it, but your children deserve that we make hard choices and difficult decisions. If I am not here, it is OK, I did the right thing. I secured our future. I will be able to sleep at night, knowing I was not a part of taking and stealing that blossom of potential from our children and grandchildren. I will finish by asking a question of the American people. Is it right that you have to make choices within a finite budget, yet your elected leadership in Washington does not? Is it fair for you to have to sacrifice to create a future for your children, when we are destroying that future in Washington? It is a time for Americans who have never been involved in the political arena, in our Nation, to get involved because the future of your children and your children's children depends on it. We have a very short window within which to recapture the economic renaissance in our country, and it is less than 4 years. If you look at what we are coming to in terms of debt-to-GDP ratio and in terms of the size of the government to the size of the GDP, we will be on an irreversible course that will eliminate American exceptionalism forever because the thing that made us free and kept us free was a fairly limited Federal Government. What we have in front of us is an attempt not to get it back down to a size that is manageable and within the intent of our Founders' vision and the American people's expectation; we have an intent to grow. The discretionary budget of the Federal Government, on the rate that has been passed by this body the last 2 years alone, not counting the stimulus, will cause the Federal Government to double in size in 5 years. We are 40 percent bigger than we were 2 years ago; actually, it is 38.6 percent bigger. We hear the average Federal employee now makes $72,000 and the average private employee now makes $40,000. We have added 170,000 new jobs in the government in the last 7 months, while we have lost three times that in the private sector. Things are out of whack. The only way they are going to change is if the American public demands it to be changed. I will go back. This is not a tax extenders bill. This is a debt extension bill. We are going to extend another $104 billion of debt across the threshold of opportunity for our children and grandchildren. I am not going to be a part of that. I am not going to be complicit in it. If that is not satisfactory to the people of Oklahoma, I am fine with that. I am ready to make the hard choices to make us a lean mean fighting machine again as an economy, a lean mean fighting machine as far as opportunity. The way to do that is to downsize the Federal Government, put it back within the role of its intended purposes, and return to the States both the money and the authority to handle what is rightfully theirs in the first place. The second thing that is important is to get rid of the $350 billion worth of waste, fraud, abuse, and duplication that occurs every year that we do nothing about. We do nothing about it. We send out press releases, but when it comes time to vote to make a hard choice, we do not do it. We refuse to do it. We refuse to offend those who are well connected and well heeled, while we send our country into the trash heap of history through financial collapse. My hope is, my colleagues will stand and say we are not going to pass this debt extender bill until you pay for it, until you make the hard choices about what is waste, what is duplication, what is fraud, and get rid of some of that to pay, if these are truly priority items. You see, if they are truly priority, if America truly needs them, then there has to be something that is a lower priority that we can take away. But we do not have that kind of thought in the Senate because we just keep putting the credit card into the machine. Thank you, China. It is not going to be too long before we are saying: May we please, China. May we please. May we. Watch what is happening to Greece. Look at the articles on Ireland today, the hard choices they had to make to get themselves out of trouble. But they are doing it. We are ignoring it in this body, and we are going to pass another $104 billion along to our children and grandchildren. I yield the floor and suggest the absence of a quorum.

Mr. COBURN

Mr. COBURN. Mr. President, we just voice voted an amendment that will not do anything. What this amendment says is, where we violate our own rules in terms of pay-go, we will actually publish both the number of times and the amount of dollars we do that. It is about transparency of the Senate, being honest with the American people. With great fanfare, the Senator from Montana came down and we put into law a pay-go law. Since that time, including this bill, we will have passed $120 billion of debt to our kids by saying we waive pay-go. That is OK. That is the right of the body to do that. But it is not OK not to let the American people know that and let them keep track of us. This amendment is very simple. Anytime we create a new program, anytime we pass and violate the pay-go rules by overriding the pay-go point of order, then we should list that with the American people so they can see what we are doing. It is quite simple, quite straightforward. It doesn't require any time. You will spend forever going to the Congressional Budget Office to find this. This makes it very simple, very straightforward. I reserve the remainder of my time.

Mr. COBURN. I ask for the yeas and nays.

Mr. COBURN

Mr. COBURN. Mr. President, I object on behalf of the managers who are not present at this time.

Mr. COBURN. Mr. President, we are going to have an amendment on the floor in just a moment that simply requires the Senate to post every time they create a new program and every time they spend money outside of pay-go so that we truly are transparent with the American people about what we are doing. With great fanfare, we passed pay-go. We made it a statute. The last three bills in a row, we have allocated up to $120 billion outside of pay-go. With all the claims, with all the fanfare, we said we are going to now start paying for everything we do, and the first three bills to come before the Senate, what do we do? We simply say: Rules off; doesn't count; we are going to spend our grandkids' money. For the life of me, I do not understand the controversy around this amendment. It is about us being transparent with the American people. No more games. No more saying we are doing one thing and doing another. All this amendment says is, when we violate our own rules and we spend money we do not have and we do not pay for programs by eliminating programs that are not effective, that are not a priority, that we are going to list it on our Web site. Nothing could be simpler. We have offered the Secretary of the Senate our staff to do that work. It takes about 5 minutes a day to post that information and probably 5 minutes every third or fourth day. We will happily pay for that or we will offer one of our staff to put that information on the computer. We are going to have a side-by-side amendment that does nothing. We understand that. That gives people a way to not vote for our amendment. If we want to solve the problems in America and we want to solve our financial problems, the first thing we have to do is have real information about what this body is doing. This amendment will do that. I yield back the remainder of our time.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent to take that time, if I may.

Mr. COBURN. Mr. President, if the Senator will yield, one of the important points he made a moment ago is a doctor sitting down and listening to their patient. Mayo has it right. If you are not going to pay us enough to sit down, we refuse to practice medicine the way Medicare is directing us to practice: Listen a little bit and then cover it with tests. The reason costs are out of control is because Medicare wouldn't pay for a physician to sit down and truly listen and come to a centered point on what the patient's problem is and the way to get around it. Consequently, what we have seen in the Medicare Program is doctors have to see so many patients that they don't get to listen to them and they consequently cover that lack of listening by ordering more tests. What do we know about tests? We know we order $\1/4\ trillion worth of tests every year that aren't needed. There are two reasons we are ordering them. No. 1, the reimbursement to sit down to listen to the patient is so low the doctors can't afford to take the time to cover the test; and No. 2 is the threat of tort litigation. So now we are ordering tests not for patients, but we are ordering them for doctors. If we want to change health care, we have to drive costs down. I am proud Mayo recognizes we are not going to sacrifice our quality, so, therefore, we are saying: No, we are not going to take any more Medicare patients because we can't do it in a way that lends a quality outcome at an appropriate cost.