Thomas Coburn

Mr. COBURN

Mr. COBURN. Madam President, I wish to also quote from what I think is a brilliant letter by a Dr. Robert Geist from St. Paul, MN, that was written as a letter to the editor in the Wall Street Journal today. The title of his letter to the editor is, ``The First Cost Controller Will Be Your Own Doctor.'' It is something I have been talking about since we started this. The last thing we want to do in health care in America is to make it where the doctor is not a 100-percent advocate for the patient's best interest. He quotes very directly the transfer. He said a previous article written: . . . doesn't emphasize a potential stealth cost-control aspect proposed in the bill. It will start pilot programs that would transfer the gatekeeper role to doctors at the bedside, a role currently held by ``payers'' (HMOs and government-agency insurers, including Medicare and Medicaid). The transfer will be via capitation fee payments, making clinics ``responsible'' for the cost of care of ``insured lives'' for one year. . . . The illusion of many pundits and policy makers is that mini provider gatekeepers can control costs after the very powerful payer gatekeepers-- That is, Medicare, Medicaid, and the large insurance companies-- have failed for decades. The problem for patients is the dilemma of all managed-care gatekeepers: cost, quality, access; pick any two. It is not pleasant to think that one's gatekeeper doctor will have to decide whether to order surgery for your painful [worn out] hip or only to increase the dose of-- Anti-inflammatories because they are worried about costs. That is the key point. We are going to now separate physicians in this country for doing what is best for the patient to meet the demands of the government.

Mr. COBURN. That is exactly why I am not a member of any HMOs.

Mr. COBURN. They will go to Thailand or India.

Mr. COBURN. Let me finish this for a minute, if I might. Here is the summarizing paragraph: The economic reality is that no rationing of care supply will ever control costs, when the problem is demand inflation driven by popular insurance tax subsidies too sacred to repeal. Consider that when federal fiscal ``necessity'' overwhelms empty slogans,-- Our empty slogans-- scores of new bureaucracies created in [this bill] would be able to implement Draconian rationing in collusion with subservient insurance and ``provider'' corporations. The high costs, as well as the rationing powers included in the more than 2,000 pages of the ObamaCare Senate legislation are very real. Which is the point I have been making all along. I am going to spend 30 minutes tomorrow talking about the rationing aspects of what we are about to do as we pass this bill.

Mr. COBURN. What we also know from the Congressional Budget Office is that between 9 and 10 million people who today have insurance through their employer will actually lose it. They are going to lose their insurance. That may be good or bad for them. But if you look at the incentives, the subsidy for people who do not get insurance through their employer, if you make $42,000 a year, today with your health insurance through your employer you get a benefit of about $5,749 from the tax system. But under this bill, you will be eligible for $12,500 worth of subsidy. What do you think an employer is going to do? They are going to look at their employees and they are going to say: I have to pay this penalty if I don't offer this, but it is a significantly smaller amount than what I am paying today. Therefore, I am going to make a decision to no longer offer health insurance, give my employees a small raise because the government is going to come in with $12,500 worth of subsidies to put them in a ``private'' plan inside the parameters of what is in the exchange. How many people do you think it is going to shift? What we are going to get is adverse selection. So the individual-- let's say I am working and I am making $42,000 a year and my employer decides to do that and let's say I am 35 years old and I know available to me is $12,500. Even though my earnings may go up, I am still 2\1/2\ times better off. I also know I will have to pay $3,000 or $4,000 of my own money to get that benefit. I will not cover myself because I know I can cover my little incidentals. If I get sick, they have to cover me in the exchange. So we are going to see adverse selection in the insurance market, people who are between 40 and 64 who are sick are going to pay far more for their health insurance and people who are sick who are younger than 40 are going to pay far more for their health insurance and everybody who is healthy under 40 is going to say: This is an economic bonanza for me. I am not going to buy insurance.

Mr. COBURN

Mr. COBURN. Regular order.

Mr. COBURN. Would the Senator yield for a question?

Mr. COBURN. Mr. President, I thank the Chair, and I look forward to hearing the remarks in the cloakroom of the chairman of the Finance Committee.

Mr. COBURN. Mr. President, if, in fact, we got rid of 50 percent of the fraud in Medicare and Medicaid, we would generate $600 billion every 10 years, more than offsetting the cuts that have been outlined in this bill.

Mr. COBURN. I want to raise an issue. It was raised in the Finance Committee markup; it was raised in the health care markup. I have behind me the Medicare cuts, and I understand they have been slightly reduced in home health--in the rebuild--but we are going to cut Medicare. We are not going to cut it significantly in the fraud--$2 billion. That is where the real waste is. The Senator from Rhode Island came down here and said we are trying to scare people, but when we offered the opportunity for the chairman of the committee to prohibit rationing of health care in this country, both the chairman and the Senator from Rhode Island voted against it. It was simple, straightforward, saying no matter what we do in health care, we are not going to do what other countries have done, and that is ration health care. Straight up-and-down votes--party-line votes-- against it. In fact, we are going to ration health care. That is what this bill does. The way we are going to control cost is through the mechanisms outlined in this bill that are going to allow government bureaucrats to decide what you can get treated for, when you can get treated for it, and where you can get treated for it. The rebuttal to that is: In Medicare, it is already illegal for them to ration care, so we don't need a prohibition. The fact is Medicare is rationing right now. They are rationing virtual colonoscopies, they are rationing bone densitometry, they are rationing Epogen, they are rationing Neupogen-- two key drugs to maintain survival during the treatment of chemotherapy. They are practicing medicine. So when given the opportunity to vote and put an absolute prohibition on the rationing of health care, what did the chairman of the Finance Committee do? He voted against that. Because what he recognizes is the ultimate plan. And the answer to Senator Burr's question is: This will collapse. It is not going to be sustainable. The Medicare cuts won't be made by us. We will put it off on a commission and say: Oh, we had to do it, and the result of that will be rationing. The other result will be what the Senator from Vermont actually wants, which is a single-payer, government-run system. That is why he is intellectually honest. He brought it to the floor and said this is how I think we ought to solve health care. We ought to have the government run it, and we ought to have the government make the decisions. He was honest about it. That is where this bill is going. So if you are a Medicare patient, you should be concerned. If you are a Medicare Advantage patient, you should be concerned. I have had criticism leveled at me because I do what the chairman of the Finance Committee suggests--I make competitive bidding for Medicare Advantage. But there is a big difference. Mine has no cuts in benefits. They cut benefits 50 percent, in terms of the Medicare Advantage differential. There are three things you can do to fix health care in this country: You can incentivize prevention and the treatment of chronic disease based on outcome; you can create transparency so that purchasers in the market can actually make a judgment about value and quality; and you can assist those who are on the lower rungs of the economic ladder to get the same kind of care we get. Those are the three things you can do. I readily admit we don't have a great competitive model in the insurance industry. I want to change that. We had Senator Wyden come to the floor and say that he loves the free enterprise spirit, yet we want to put an artificial fix in terms of the insurance company, in terms of what you have to have for a return. What if an insurance company came up with 20 percent greater efficiency in terms of outcomes and benefits? They still have to spend that money? In the name of the free enterprise system we are going to kill free enterprise? As a practicing physician, I bristle at the way I run into insurance companies. There is no question about it. We need to fix that. The point Senator Burr was making is this says it is this way or the highway, when the option we offered--the Patients' Choice Act--cuts taxes, doesn't raise taxes; expands exactly to the level or beyond of this bill and it does at in a faster rate. It extends the life of Medicare. It gives Medicaid patients the same kind of care we get. But it was defeated in committee on a party-line vote. It was filed as an amendment here but not accepted. We had 10 amendments voted on from our side on 2,400 pages of legislation--10 amendments. So it is not about being bipartisan, it is about you have to take this or leave it. What the American people ought to pray for is that somebody can't make the vote tonight. That is what they should be praying for, so that we can actually get the middle--not me, not mine. I understand I am way over here. But we ought to get the middle of America and the middle of the Senate a bill that can run through this country and actually do what we say we all want to do. There is a large difference of opinion, and it is not rhetoric that is unfounded, as Senator Burr outlined, and as Dr. Barrasso outlined with an estimate by NFIB of 1.6 million jobs lost. That may be old data, because who knows what the data is now. We haven't had a chance to look at it, because 30 hours after the bill is introduced for cloture and the cloture motion is filed, we are going to vote on it. I am not sure this is a great way to run the country. What is in the bill? There are zero guarantees that taxpayers won't finance abortion. There are zero prohibitions on the rationing of health care--zero. There is not one shred of evidence that we are not going to ultimately ration health care under this bill. We are. And the only reason you would vote against a rationing amendment is because you intend to see rationing carried out. There are zero Senators required to enroll in either Medicaid or a government-run option, either through OPM or Medicaid. There are now 10 new taxes created. There are 71 new government programs created. There are 1,697 times that the Secretary of HHS is going to write the regulations, and based on CRS calculations there are between 15,000 and 20,000 new Federal employees who are going to be required to carry out this legislation. There are 3,607 times, before we got the Reid amendment, that the legislation says the word ``shall.'' ``Shall'' is a very important word because the word ``shall'' takes away your options. There is no option when the word ``shall'' is used. The word ``shall'' also says whoever is directing the ``shall'' obviously has more wisdom, more knowledge, more experience than the person the ``shall'' is applied to. What we have said is, in all our wisdom, in all our many years of practicing medicine and being involved in the care of patients, that 3,607 times we are going to tell the American people what to do. One of the big ``shall also's'' that I do not think will ever hold scrutiny before the Supreme Court is, you shall buy an insurance policy. That doesn't fit anywhere in the Constitution that I read. If you do the legal research on it, as my staff lawyers from the Judiciary Committee have done, it is highly unlikely that will ever hold up. So the whole premise of a large portion of the taxes collected in this bill will be out the window. It also will totally change, through adverse selection, all of the insurance premiums in this country because, if you do not have an individual mandate making people buy insurance, the costs relative to the illness and the age, even though we have compressed the ratios, will rise exorbitantly. There are still going to be 24 million people left without health insurance in this country. There is a $10 billion cost just for the IRS implementation of this bill. There is at least $25 billion in mandates placed on the States, unfunded mandates. Actually it is much higher now. There is $28 billion-plus in new taxes on employers. There is $100 billion, by conservative estimates, in fraud and Medicare and Medicaid a year, and this bill goes after $2 billion over 10 years. So we are going to go after $2 billion out of $1 trillion--not $200 billion, not $20 billion--we are going after $2 billion. There is $118 billion in cuts to Medicare Advantage but only for those people who do not live in the State of Florida and a couple of other places. If you happen to live in Oklahoma, citizens under the Medicare Advantage are going to lose. This is now over $500 billion in new taxes on Americans. There is a quarter of a trillion dollars not in this in expense that everybody knows is an expense. We are going to restore the SGR. We are going to fix that. And that quarter of a trillion dollars is based on no increase in physicians over the next 10 years. How many in this body think we are not going to increase the pay of physicians in Medicare under the next 10 years? The assumptions in the CBO report that accompanied the Reid amendment, if you read what they said, they said it is highly unlikely. So that is a quarter of a trillion dollars even though it was not in their numbers. It also said if, in fact, the cuts came through, which they thought highly unlikely that they would, and if they didn't, then the fiscal numbers associated with the bill are out the window. The final number everybody ought to be paying attention to is $12.1 trillion; $12.1 trillion is what our kids owe outside of owing ourselves--$1.1 trillion. That is going to double in the next 10 years. Anybody with a lick of common sense who looked at the numbers on this bill would say: Washington, your accounting programs aren't any different from Enron. The same fate of those who created the Enron scam ought to apply to the Congress of the United States. The very fact we are not considering an SGR fix is evidence of that. At least you have to add a quarter of a trillion dollars every 10 years to this bill just to keep doctors even. And don't forget the fact that 34 million new Americans over the next 10 years are going to enter Medicare--are going to enter Medicare. What are the alternatives? I will not offer other amendments and make the chairman object to them because I know his answer. He calls it a stunt. It is not a stunt when you do not have vigorous amendments offered on the Senate floor. It is not a stunt. The stunt is not allowing amendments to be offered. To allow only 10 of our amendments to be offered on this bill is beneath the dignity of the Senate--on the biggest bill in the last 100 years in this Congress, the only bill in the last 100 years that is going to affect every American in a personal way but also in a fiscal way, a financial way. There was an amendment to be offered, a conscience protection for physicians. We didn't get a vote on it. Should we force physicians in this country to perform abortions or should we have a vote on whether, if they have a conscience protection, they ought to be exempted from that? Should that not be a part of health care reform? We are not going to get a vote on that. How about an amendment to reduce the waste, fraud, and abuse in Medicare and Medicaid Programs and protecting Medicare benefits? And increasing the fraud and waste from $2 billion to $100 billion over the next 10 years, that is just 10 percent of what is there. We are not going to get a vote on that. It is not going to be available. The American people are not going to get to hear the debate on that. They are not going to make up their mind. Why? You don't want them to hear the debate on it. If you truly wanted to have a debate on fraud we would have a debate on fraud, and we would have an amendment saying put your stamp down, or are you for the people who are defrauding? Or are you for the status quo? We are for the status quo. We are for the well- connected. The amendment on rationing that I talked about--or an amendment to limit the bureaucratic increase associated with this bill, which is an amendment I offered, we are not going to get a debate on that. That is a very straightforward amendment. It just says we are not going to increase the number of bureaucrats to implement this bill. We are going to drive efficiency in HHS; that is where this is going to. We are going to say: You can't get a net increase in bureaucrats so get more efficient. Since we are running $1.4 trillion or $1.5 trillion deficits, that is something that everybody else in the country would be doing, but we are not going to do that. We are not going to allow an opportunity for a vote or debate on that. We are not going to have that opportunity. I have heard the majority mention several times that we didn't have anything to offer. We offered the Patients' Choice Act. CBO said it cut long-term costs on Medicaid, that it saved money on Medicare. They said it saved $1 trillion over the first 10 years for the State and the estimates. Because we couldn't get the commitment that was made to us by the chairman of the HELP Committee that he would score the bill, the bill didn't ever get scored by CBO--but an outside score says it saves at least $70 billion the first 10 years and far in excess of that afterwards. It covers more people than this bill, saves personal choice, doesn't put somebody between you and your doctor. I heard the Senator from Rhode Island say we were lying about that happening. It is happening today, both from insurance companies and Medicare and Medicaid. So if we really wanted to reform health care we would be attacking that. Instead, we are going to make it worse. Let me tell you how we are going to make it worse. We are going to use cost comparative effectiveness, which is exactly what the U.S. Task Force on Prevention Services did. They used cost comparative effectiveness, and when they looked at breast cancer, they said it is not cost effective to screen women before the age of 50. You know what. They are right. It is not cost effective. But it certainly is clinically effective, especially if your wife is the one who is 40 and has breast cancer and it was found by a mammogram. You see, judgment goes out the window. What do we do? We reversed that finding, one of the first things we did as we started the debate. Are we going to do that every time the U.S. Preventive Services Task Force issues a ruling that is cost effective but not clinically effective? Are we going to do that every time the cost comparative effectiveness panel says: You will do this, and the American people say: That isn't right, the American Cancer Society says: That isn't right. Every time we get one of those rulings will we have to pass a piece of legislation to change it? The purpose of the three panels is well intended. The Medicare Payment Advisory Commission is well intended. Help us cut costs. But the only way you go for cost is through prevention and management of chronic disease. You are not going to cut costs any other way because 75 percent of everything we spend is on five chronic diseases. So unless you attack the real problem, the real disease, with our health care system, you are not going to solve it. The lack of art in medicine will become readily apparent in 2015, 2016, and 2017. We will see bureaucratic decisions in between a patient and their provider. That is not a scare tactic. That is absolute fact. We have it now with Medicare. It is there. If I have a woman who is 55 years of age today and I order bone density testing on her and find she has severe osteoporosis, I put her on medicine but am forbidden by Medicare to do the followup exam that is clinically necessary to see if the medicine is working, and not only that, under Medicare rules, she can't even use her own money to buy that test. So 2 years later, we do the test, and we haven't corrected her disease. Now we change medicines to try to find out, but we can't find out again. So she ultimately falls and breaks her hip. There is a 20-percent mortality rate from falling and breaking one's hip. But those are the rules we are operating under now, right now, that you want to expand. Government isn't ever compassionate. It is never compassionate. People are compassionate. Thought has to be in the middle of the practice of medicine, not distant thought, near thought. The very fact that an insurance company tells the doctors what they can and cannot do is no worse than what we are getting ready to do with the rest of government-run health care. We didn't fix that problem. We didn't address that problem with this. We didn't guarantee that you could walk with your feet. We said: Here is how much money you can earn, but we didn't address that. I will give two examples. Two people I have taken care of for over 15 years, both had no clinical indications that they had anything wrong. I contacted the insurance company. I thought they needed an MRI of the brain. Both of them were denied. I got friends who are radiologists to do their MRI. They both had brain tumors. One is still alive. What we are setting up isn't any different than what you have a complaint and gripe about now with the insurance industry. You didn't fix that in this bill. There is no health care reform in this bill. There is health coverage expansion, but there is no reform. One of those people is still alive, but had we followed either Medicare guidelines, cost comparative effectiveness panel guidelines, which would have forbidden doing an MRI, that one person out of the two would be dead today. So as we sit here and look at our health care system, my biggest worry is, I will be in Medicare. I will get rationed. I know that. The way we are going about it, that is what is going to happen. We are going to ration care. We will not vote to not ration it. You know it is going to be rationed or you would have voted for the amendment in committee that provided a prohibition. But my real concern is not my generation. My real concern is those who will follow us with $12.1 trillion worth of debt and the fact that every one of those is 25 years of age and younger today. Twenty years from now, they will be responsible for $1 million of both debt and unfunded liabilities for which we will have to collect, on average, $70,000 a year just to pay the interest on what we are sending them. Before they pay the rest of their income taxes, before they pay payroll taxes, before they pay unemployment taxes, before they send their kids to school, before they buy health insurance, before they buy a home, before they buy transportation, the real worry that should be in front of this country, which is the No. 1 issue on the public's mind, is: How do we get out of this financial mess? That is the No. 1 issue on people's minds. It is not health care. I have no hopes of convincing my colleagues that through 25 years of practicing medicine, dealing with Medicare, dealing with Medicaid, that that is of any value to you. Because we are hell-bent on passing a health care bill and dealing to make sure we can and creating inequities throughout this country and dividing our country. We heard the Senator from Rhode Island characterize us as liars, birthers, supporters of the Aryan nation. That is what I heard. I sat and listened to it. I think he doth protest too much, for he knows that is not true. There is nobody on our side of the aisle who cares any less than anybody on the other side of the aisle about fixing health care. The rub is, you believe the government is the most powerful thing and the best way to do it. We don't agree with that. We actually believe in the American people. We actually believe in the entrepreneurial spirit of the average American making good decisions for themselves every day, doing things we never do, which is prioritizing where their money is going to go and how they are going to spend it and working like heck to advance the cause of their own family, their own freedom, and their own liberty. You don't believe that because, if you did, you would never put this kind of bill on the floor. This bill limits liberty. This bill says you shall. Think of the first big step in this bill. In the United States, you no longer have the ability to not buy health insurance. If you have $\1/2\ million in the bank and you want to put that at risk and say: I don't want to, you either have to pay a fine, a tax, or you have to buy health insurance. So where is the liberty and where is the commerce clause in that and where does that tie in with individual liberty and individual responsibility? We say: If you don't want to be responsible, then we will make you responsible. We don't say: You have to suffer the consequences of your lack of responsibility. What built this country was people figuring out if you don't act responsibly, it is going to cost you. We are going to put a block on that and say: You don't have to act responsibly. You don't have to act in your own best economic interest. Don't worry. We will take care of it. Jefferson warned of that. One of the Founders of this country warned us against doing the very thing we are doing today. If you read the Federalist Papers, you will see what Madison wrote about the welfare clause and the commerce clause. He said, whenever the Senate starts to think about claiming it means something different than it does, here is what we want you to know. It doesn't. It is very limited in scope. I said yesterday in a press conference that this country is at the point of a crisis of confidence such as we have not seen in hundreds of years. It is true. Whether you are a very liberal individual or a very conservative individual, you don't have any confidence in us. The reason you don't is because we don't act in the country's best interest. We act in our political best interest. Republicans are equally guilty. We look at partisan issues rather than principled issues. What we miss in all that is the best right thing for the country. We are missing it with this bill. We are missing the best right thing for the country.

Mr. COBURN. I am happy to yield.

Mr. COBURN. And the outcomes are poor.

Mr. COBURN. The Senator raises a good question. How long have we known and how long has Medicare been in trouble that we haven't fixed it? We will not fix it. We will do exactly what the Senator says, what we always do, what we have done since I have been in this body. We put the credit card into the machine and say: Transfer this to your grandkids. We take no pain ourselves. What is lacking in our country today is moral character to lead on the basis of sacrifice. It should start with us as Senators in this body. Mr. President, I understand our time has expired.

Mr. COBURN. If we are going to tax tanning salons, why don't we tax anybody who goes to the beach? Because true sunlight is much worse for your skin than a tanning salon. So if the intention was to prevent disease, why wouldn't we tax it where most of the disease occurs? Or how about kids' sports in the summer. Let's tax kids' baseball. Or swimming. Let's tax all the swimming pools because we have exposure to UV light. This shows the precariousness and the silliness of a large portion of this, and I yield back.

Mr. COBURN

Mr. COBURN. The Senator has asked a lot of questions. There is an organization that is based out in Oklahoma. It is called Safeway. Safeway has 200,000 employees. They have had a zero percent increase in their health care costs in the last 5 years, doing the things that we talk about in the Patients' Choice Act: using market forces, getting patient participation. What have they found out? Their workers are healthier. Their absenteeism rate has gone down. They have lost cumulatively thousands and thousands of pounds. Their work product is better and their company is healthier because they are not spending more. What has happened to their wages? Their wages are going up. One of the statistics most people do not understand is that for every 3.5 percent rise in health care costs, you lose 2.5 percent in real wages. In other words, if health care costs would stay flat, you would get a 2.5-percent increase. If they go up 3.5 percent, you are going to lose that 2.5 percent. If they go up 7 percent, you are going to lose 5 percent. So controlling the costs, when we have a third of it wasted anyway, should be our goal, and that is not where we are headed. So the disappointment is not that we do not need to fix health care. We do. The disappointment is that--which I think I have outlined here today--the government is highly inefficient at everything it does, and effective only on a limited basis on the things we do fund, and then we are going to move another 20 percent of health care under the control of an organization that has proven itself ineffective at what it does. That is insanity. The direction of the bill is one that treats the symptoms so we will feel better for a while, but we still die. If we practiced medicine that way, we would be run out of town on a rail. You do not treat symptoms. Symptoms cover up worsening disease. You treat the real disease, and the real disease is lack of transparency, lack of accountability, lack of reform, lack of tort reform, and lack of a competitive nature, both in the health insurance industry as well as in providers like myself. Make me compete based on quality and price, and make sure my patients can see it, so that a consumer can make a real choice. If we were to do that--which this bill does none of that--if we were to do that, American consumers could get a much better deal. I thank the Senator.

Mr. COBURN. Would the Senator yield for a moment?

Mr. COBURN. You are not fixing the disease.

Mr. COBURN. There is one area I needed to cover that I didn't, and I will do so rather quickly. Since 1977, this country has said we are not going to take Federal taxpayer dollars to pay for abortions. That is a divisive issue. The only way we change that issue is to change people's hearts in this country. So we are going to have to all agree to disagree on abortion in this country, and it is about a 50-50 split. What is about a 70-30 split is that the vast majority of Americans don't think their tax dollars, whether they are pro-choice or not, should be used to pay for somebody else's abortion. What we saw come through the Senate this morning is something that every significant pro-life group in this country, including the Catholic Bishops, including Right to Life, including this doctor who has delivered thousands of babies and understands the issues of life, is going to abhor. What we have done is ultimately eliminate the Hyde amendment, and come next September 30, throughout the Federal Government as well as in this bill, the Federal Government is now going to allow taxpayer dollars to be used to pay for abortion. Congressman Stupak, who is a friend of mine, who made sure the House did not allow that to happen, has recently been quoted today saying this is absolutely unacceptable, and it should be. We should not be using Federal funds for that procedure to end the life of an unborn human being. With that, I yield the floor and yield back my time.

Mr. COBURN. It is $2.73 trillion.

Mr. COBURN. I think it gets paid for by rationing health care to Americans. That is how I think it gets paid for. You have three different programs within this bill, three different panels that are going to mandate what I as a physician can do with my patients. Once it gets applied, there is not going to be an exception to it. For 80 percent of Americans that is going to be fine. The real key is to ratchet it down by rationing care. What do we know? We know $1 out of every $3 that is spent on health care today does not help anybody. Do we fix that in this bill? No. We know that $1 out of every $3 does not prevent anybody from getting sick and does not treat anybody's illness. Did we fix that in this bill? No. We did not do anything about it. I will tell the Senator from South Dakota, the tenent of medicine is you do not treat symptoms. You find the disease and you treat the disease. The bill we have before us is a bill that treats the symptoms. It does not attack the disease. Because that $600 billion a year, at a minimum, that does not help anybody get well and does not prevent them from getting sick--if we just took half of it, we could cover everybody who is not covered in this country today. We could cover everybody and not spend a penny more on health care. But we have not attacked the disease. We are treating symptoms. We are not working to solve the real problems underlying health care. The problem in America for health care is access to services. The access limitation is because of cost. If you cut costs 15 percent tomorrow, you would increase the same number of people who are increased in the bill in terms of availability. If you had real transparency in the insurance industry, where people could see and actually compete and buy all across this country what they wanted, and we hammered the insurance industry in terms of transparency of outcomes--the same for doctors--you would cut the cost even further. In other words, you put the patient in charge. We have a government-in- charge bill that we are going to be voting on instead of the patients. So we are treating symptoms. We are not treating the disease. We are treating those who are screaming the loudest, but we are not fixing the problem. We are just making the problem worse and bigger.

Mr. COBURN. Will rise to 21 percent.

Mr. COBURN. Mr. President, I am going to spend a few minutes talking this afternoon. I apologize in advance because the staff is going to stay here, but this is an issue so big, this country has never faced it before. So the inconvenience for us to be here in the Senate Chamber is going to be very well worth it to the American people. We just heard the assistant majority leader and the Senator from Michigan explain how great what is getting ready to happen is, and I want to tell you, there is a different perspective coming from a country doctor from Oklahoma who has practiced under Medicare and Medicaid for a number of years. What we heard was, and it is important to the American people listening to this--I am going to go through what the Federal Government has been doing for the last 3 or 4 years, if you want to stay tuned for a civics lesson about the tremendous amount of incompetency and waste in this Federal Government. We just heard the assistant majority leader talking about amendments. What he did not tell the American people is that the majority required unanimous consent for us to get an amendment and they limited us to 10 amendments over the last 2 weeks. They strung it out so we could not get our amendments up. The other point I wish to make is that we now have a new amendment-- the one offered by the majority leader--to this bill, which we have no opportunity to amend. It is one-sixth of the bill, but there is no opportunity to amend it. So now we have a $2.5 trillion bill that has had 10 substantive amendments offered to it. The American people should not trust that process. We heard the Senator from Michigan just say it saves lives. I want to tell you, as a practicing physician, this bill is not going to save lives. It is going to cost lives because we are going to allow the Federal Government to determine what treatment you can get, when you can get that treatment, and who is going to give it to you. That is the ultimate result of this bill. Over the next few days, we will be explaining and showing why that is the case. The Washington-speak of ``it saves Medicare,'' a program that is bankrupt now, that has an infinite $85 trillion unfunded liability--we are going to cut $1 trillion out of it over the next full first 10 years of this program. And the American people are supposed to expect this is going to save Medicare? It is not going to come anywhere close. And save money? The assistant majority leader quoted the CBO. Let me read to you what he did not quote: It is unlikely that key cost containment provisions that are in this bill will remain intact. That is what CBO said today. You did not hear that statement from the assistant majority leader. Here is the other thing: It reduces payments to physicians by 21 percent starting in 2011. Do you really think we are going to reduce payments to physicians 21 percent in Medicare in 2011? One of the first bills we will see on this floor come January will be $250 billion that will be stolen from our kids to adjust the sustainable growth rate formula for Medicare. It will not be paid for, and that is one of the reasons this thing looks for--that is why the CB0 said: Wait a minute, before you claim this thing is so good, recognize that you are not accounting for $250 billion you are going to call an emergency and not pay for it. Here is the third thing he did not mention: An unaccountable, unelected board of bureaucrats must make arbitrary budget cuts to ensure the cost containments in this bill. We are saying we are going to have cost containment, but we are going to pin that on three different programs, boards, and panels in this bill that are not going to cause you to save lives. It certainly might save us money, but it certainly is not going to increase the quality of care and it certainly is not going to save Medicare. Here is the other thing he did not mention: CBO cannot predict that the quality of care will not decline. That is what they are saying. It is unclear whether such a reduction in growth rate can be achieved and, if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care. That is from the CBO. Here is the other thing the assistant majority leader did not mention: The long-term budgetary impact could be quite different if key provisions of the legislation were ultimately changed or not fully implemented. The U.S. Preventive Services Task Force recommended a change in breast cancer screening. They did it based on cost. We reversed it. I will bet a dollar against a nickel that the next three or four they recommend, we will not do, either, which are counted on in CBO's score for us to do. So the numbers on this do not make any sense. CBO says this will reduce the deficit, but people who understand the CBO from the inside out admit even their best estimates are professional guesses with lots of uncertainty. I ask unanimous consent to have printed in the Record the comments of Donald Marron, Alice Rivlin, and Phil Ellis.

Mr. COBURN. If, in fact, amendments were available, could amendments be filed to this bill and made pending? I will restate my inquiry to the Chair. Is it, in fact, a fact that because of the filling of the tree by the majority leader, the opportunity to amend the bill before us will be limited?

Mr. COBURN. Mr. President, the other statement the assistant majority leader made was that no bill was offered that they would not allow to be scored. There are four comprehensive bills out there that they have not allowed to be scored. Tomorrow afternoon, on this same floor, Richard Burr and I will go through the Patients' Choice Act which saves billions, saves the States trillions, covers exactly the same number of people or more, gives everybody freedom of choice and gets the government out of health care, requires competition, requires coverage of preexisting illness, accomplishes everything we say we want to accomplish in this bill. So now we are getting ready to turn over $2.5 trillion more of health care to the Federal Government. What kind of job have we done? Let's look at it for a second. Here is what we have done this year: 43 cents out of every dollar we spent in the Federal Government we borrowed against our children. It is going to be 45 cents next year. As we spend our taxpayers' money--and, oh, by the way, I recall that the Senator from Michigan stated that we are going to improve people's lives. We are going to improve everybody's lives except the generation that follows us and their children. We are going to damage their lives. So 43 cents of every dollar that the Federal Government spends, we are borrowing. How have we been doing? The claim is Medicare isn't broke. Anybody with a high school accounting class knows it is broke. The reason we know it is broke--and it is not only broke fiscally, it is broke in terms of methodology--is because it is a Ponzi scheme. We have robbed the money. We have promised benefits for years and never raised the taxes to pay for them. We now manage 60 percent of the health care in the country. Medicare is broke, the State Medicaid Programs are broke, the census is broke. We heard this week that Fannie and Freddie aren't going to require just $400 billion--that is a government-run mortgage insurance company that the Congress created--it is going to require $800 billion, almost $1 trillion to get us out of that. Social Security, we know, is going to be broke. It is fiscally unsustainable. The U.S. Post Office business model is broke; cash for clunkers; the highway trust fund is broke. We can't even get the $8 billion we need to continue to run it. We have done a great job managing that. Now we are going to put another 20 percent of health care in this country under the auspices of the very people who run the broke programs that have created $1.4 trillion worth of deficits. What is the meaning of that? How does it affect you? Well, right now, every child, every person, every grandparent in this country owes directly $39,000 in Federal debt, and that doesn't count everything they owe. That just counts what is external debt. That doesn't count internal debt, which is another $39,000. What do we know with regard to Madelyn here? She says: I an already $38,375 in debt--and, by the way, that was in October; it is over $39,000 now--and I only own a dollhouse. What we know is, this Federal Government spent $33,880 per household this last fiscal year, the highest total in history. The Federal Government collected $18,000 in taxes, and the remaining $15,000 we borrowed, mostly from the Chinese. Over 40 percent of everything we are doing, we can't fund. The inefficiencies of the programs we have created--but with no oversight and we won't manage--we continue to allow to fail. It is good for us to learn from our Founders. I will quote Thomas Jefferson: My reading of history convinces me that most bad government results from too much government. Creating $2.5 trillion in new health care programs and damaging the health care programs we have today isn't going to save lives, it isn't going to improve health care, and it certainly isn't going to save money. Nobody can name one thing the Federal Government does that saves money. Nobody can--that saves money. So I thought I would spend this afternoon kind of going through the last 4 years of oversight so people could actually get an opportunity to see some of the examples. It is interesting that in the last 12 days of Christmas, here is what the Congress will have done: On Sunday, December 13, we spent $445 billion on an omnibus package; on Saturday, December 19, we spent $626 billion on fiscal 2010 DOD, plus billions in pork; and on December 24, we are going to create a health care program that is going to consume $2.5 trillion over a 10-year period--or truly $250 billion per year-- and run it through the government. So in the 12 days of Christmas, the Senate is on pace to spend $1.942 trillion--in the 12 days leading up to Christmas. We are on pace to spend $6.7 billion an hour in the 12 days before Christmas. Then, before you know it, we will have to raise the debt limit by $190 billion. Then we are going to have to come back and raise the debt limit another $1.8 trillion because, statutorily, we can't borrow money we don't have, and we will not make the hard choices to cut wasteful spending. So what we are going to do is we are going to borrow it against our children's future. I have never voted for a debt increase. I have no intention of ever voting for one in the future. I have every intention to try to stop any debt increase we might vote on because the only thing that will cause us to make the hard priority choices in this country is not having the ability to borrow money from our children and our grandchildren. If you go to the Web sites of Members--and you can go to coburn.senate.gov--or any other Member site--and look at oversight reports--I thought I would go through a few of them so the American people can see where the waste is in the Federal Government. I am going to spend the time to talk about it because it is ludicrous what we have done and what we continue to do. Here is the Justice Department. We put out a report this last year showing $10 billion worth of waste a year in the Justice Department. That is $100 billion every 10 years. Here is a synopsis. Here is the report we put out. Nobody in Congress read it, other than my staff and a few other Members who are concerned about our spending: There were $500 million in grants allowed to recipients who were not legally capable of receiving them; $1.6 billion in unspent, unobligated funds. They are the only Federal agency that has unobligated funds that is allowed to keep them, and we have no management over it. We have this debate on earmarks--that we ought to be directing--but we will not do anything about allowing the Department of Justice to save the money at the end of the year that they don't spend and then spend it any way they want. We will not even do an oversight hearing on it. Here is $312 million on conferences for the Department of Justice-- $312 million for conferences. In 2007 alone, they lost 125,476 hours to employees who were supposed to be there that didn't check out, weren't on paid leave, weren't on sick leave, weren't taking unpaid time off, we paid them, and they didn't show up for work. Here is $529.7 million, 1,500 special projects that were earmarked from DOJ funding. What is an earmark? An earmark is something that benefits somebody politically and benefits somebody parochially and 98 percent of them are never competitively bid. What they are is they are the corruption of this Congress. Yet here we see $529.7 million worth of earmarks through the Justice Department. I will not go into the details, but if you want to go to our Web site, you can see this report and you can see how $10 billion of your money was wasted in the Justice Department. How about the Centers for Disease Control and Prevention? A 115-page report detailing the waste and mismanagement at the CDC and wasting billions of dollars in taxpayer money. We have offered amendments to clean up this stuff. They never pass because Members of Congress don't want to make the hard choices. They do not want to offend anybody. They had $45 million in conferences just last year, $1.7 million for a Hollywood liaison program, where we pay tax dollars to tell Hollywood studios how to get it right in terms of how they portray things. That is a wonderful use of our tax dollars, when we are borrowing $1.4 trillion a year. Again, a 115-page report outlining instance after instance of waste that the Congress will not do anything about with regard to the CDC. Here is a special little one that the American people, I know, will love. We are spending hundreds of millions of dollars a year putting sand back on beaches that nature says shouldn't be there. So the people who live in States on beaches share the tax dollars of people who don't rather than pay for it themselves because most of these are earmarked. The lobbying method of choice to get a beach replenished is to get an earmark. So hundreds of millions of dollars every year go out of here to put sand back that we put back 2 years ago, but because of the natural occurrence, it normally washes away. That is not a Federal responsibility. We are confused about our responsibility. But we are so enamored of the power to look good at home, we send taxpayer money home that is not a priority so we can get reelected. Here is a report on highway transportation waste: $78 billion has been obligated over the last 5 years for purposes other than the construction and maintenance of highways and bridges. Let me say that, again: Over the last 5 years, $78 billion from the Transportation Department has been spent on things other than highways and bridges and transportation, and we wonder why the highway trust fund is belly up and broke. This is all detailed. You can go to our Web site and find all the details of the stupid stuff, the low-priority stuff, the things that don't matter in the context of the problems we have and the situation we find ourselves in today of borrowing this kind of money against our children's future. Then we had a nice little Christmas gift last year--``The Worst Waste of 2008.'' We will be coming up with ``The Worst Waste of 2009.'' There was $2.4 million for a 3D space theater in Indiana--an earmark--so people in Colorado, i would remind the President pro tempore, got to pay for that. I know that has to be a priority. At a time when our country is struggling with 10 percent unemployment and a $1.4 trillion deficit, we are doing that kind of stuff. How about $2.8 million for a visitor center for a hatchery in Missouri? They have the hatchery, but we spent $2.8 million to create a visitor center in the worst economic times we have ever seen. How about $100,000 for studying Chinese video game habits? That has to be a priority for our country. We have to know what the habits are of the Chinese population in terms of playing video games. A $298,000 earmark to develop a potato for high-end restaurants or $82 million in SBA loans to liquor stores. That is wonderfully good for our society. Here is $13 million for an art museum in Iraq--not for us, for them. We are going to spend $13 million for that. Then we spent $784,000 for training classes for casino workers in Kansas. That is a high-quality project. You know, if you have casinos in Kansas maybe you ought to train your own workers rather than take the money from Colorado and Oklahoma to do that. If you would like to see that, this is a wonderful little--it has Santa Claus on the front, cheery--fits with our time. Then we put out two stimulus reports. We have a burr under the saddle for some people but, you know, dad-gummit, if we are going to spend $787 billion, and the inspector general says of that $787 billion at least $50 billion is going to get wasted--let me say that again: at least $50 billion is going to get wasted; that is the expectation from Washington--then we ought to be talking about where it is getting wasted and who is benefiting from it. The fact is that the vast majority of the funds that have gone out from the stimulus project so far have not been competitively bid, so the well-connected--those people who give campaign contributions--are the ones who are getting the contracts. Those who are most connected with people who are appropriators get the contracts. They do not have to competitively bid it, it is a gift. The first stimulus report outlined $5.5 billion. Remember, we have only sent $200 billion out the door on the stimulus, and we have already listed $12 billion in two stimulus reports of pure waste or at least nonpriority items. How about guard rails for a road over a nonexistent lake in my home State, $1 million? So we have one boondoggle in our State where the Corp of Engineers builds a lake where no water ever comes--never has come and never will come--and then we are going to spend $1 million on the road rather than close the road around a nonexistent lake--but that is the kind of priority we have? We are going to spend $10 million to renovate a train station that has not been used in 30 years and call this a priority rather than fix bridges that are crumbling in this country. Or how about the town of Union, NY, given a grant to spend money it did not request for a homeless problem it does not have, according to local officials? Or give a Nevada nonprofit a contract to do weatherization after it had been previously fired by the government for not doing good quality work? But we give the same money back to the same people? I wonder if there was any political connection. That is the first stimulus report. In the second one we sent out $350 million to get a broadband map that we could have bought for $35 million, but we spend 10 times what it was worth to get that done. How are we doing? Do you think we are doing a good job? Do you think we have our eye on the ball? Do we have a priority? Are we spending the American people's money wisely? No, because the Senate refuses to do significant oversight on spending. There is a reason for it because, when you oversight it, you expose the connectedness of the well-connected to Congress. So we do not want to do that. Then we talk about the census. The census is going to cost at least double what it did 10 years ago. Where do we find ourselves? We find ourselves with a government we cannot afford and there is not any other way you can describe that. If we were borrowing $1.4 trillion last year, and we are going to borrow $1.5 trillion this year, and the Senate has refused every attempt through the amendment process to cut spending in any area, every attempt--they may pass it when we have the bill, but when it comes out of conference it is always gone. So they want to look good, and then they can deny they knew it was taken out when they vote for the conference report. So not once in the last 5 years have we passed an amendment that has stuck, that reduced the spending in this country on waste and junk, like I just outlined. On January 1, 2009, the national debt was $10.6 trillion. It now stands at $12.1 trillion. That is not President Obama's fault. Do not confuse this with a partisan attack. My attack is on the Senate and on the Congress and the irresponsible behavior of Members of Congress who say they want to do one thing and then in the dark do something totally different. Our debt is rising $4.2 billion a day. In January 2009 the unemployment rate was 7.6 percent. Today it is 10 percent. That is not President Obama's fault either. That is our fault. It is the fault of the Members of Congress because in fact we created Fannie Mae and Freddie Mac. We allowed it, we failed to do the oversight. When we had an opportunity to fix it we got it struck down because of the well- connectedness of the financially influential people associated with that program. What it means is that we lost 12,210 jobs every day since January 1, and we saw an uptick in that this last week. That debt, as I show in the picture of Madelyn, is $39,000 per citizen. But it is important to think long term, which is my own criticism of my colleagues in the Senate. We think about the next election. We don't think long term. We think: How does this look for the next election? What the next election is going to show us is that we are going to be $14 trillion in debt; that every young person who is 25 years of age or younger in this country, they and their children when they are 45--that is 20 years from now--will each be responsible for debt and unfunded liabilities of $1,119,000. Let me say that again. Twenty years from now everybody in this country who is 45 years of age or younger will be responsible for $1,119,000 worth of debt and unfunded liabilities. Those are unfunded liabilities they will get no benefit from. Those are for the people who came before them. So they will be paying about $70,000 per year per individual just to fund the interest on the debt obligation that we are creating for them because we refuse to eliminate the silliness. We refuse to make priorities. We refuse to make the tough choices that may make somebody uncomfortable with us because we are thinking about the next election rather than the next generation. While individuals, families all across this country are worried about having a job next year, Congress is busy trying to keep their jobs by passing out earmarks; by trying not to offend the well-connected and well-heeled in this Nation. We have talked a lot about earmarks in the last year. Earmarks went down 6 percent this year in total number. They went down to 12,099 earmarks. Divide that by 100 Senators and see what you get. But the cost of them went up. In the last 11 months, Congress has passed trillions of dollars in new spending on everything from a multibillion-dollar lands omnibus package stuffed with 100 parochial bills benefiting only a few and endangering the property rights of Americans across the country, to a stimulus bill meant to generate economic growth and create jobs, the vast majority of which hired more government workers and transfer statements to States rather than created true economic activity. We bailed out the auto industry, we loaned hundreds of billions of dollars to private companies, we passed another omnibus spending bill just this past weekend with a price tag of $500 billion, including $3.7 billion in additional earmarks. Now we hear we are doing another stimulus, another jobs package. Where are we going to get the money? Where does the House say we are going to get the money? We are going to take the money from TARP that had not been borrowed yet, so we are going to borrow the money for another stimulus package against our children and grandchildren. The Congressional Budget Office had this to say about our fiscal situation, and we have had the Congressional Budget Office quoted: Over the long term, beyond the 10-year baseline projection, the budget remains on an unsustainable path. Unless changes are made to current policies, the nation will face a growing demand for budgetary resources caused by rising health care costs-- Not lowering health care costs, contrary to what we have heard in this body-- rising health care costs and the aging of the population. Continued large deficits and the resulting increases in Federal debt over time would reduce long-term economic growth by lowering the national saving and investment rates. Unless revenues were increased correspondingly-- And remember what we are talking about: significant, steep, severe tax increases on the American public-- annual deficits would climb and the Federal debt would grow, significantly posing a threat to the economy. Alternatively, if taxes were raised to finance the rise in spending, tax rates would have to reach levels never seen in the United States-- Never. We have had it up as high as 90 percent, I remind my colleagues-- some combination of significant changes in benefit programs, rationing, and other spending and tax policies will be necessary in order to attain long-term fiscal balance. We actually find our deficit situation endangering our national security now because so much of the value of the dollar is now dependent upon what China does because we have not been good stewards of the American people's money. If we want to reduce government spending, Congress has to start somewhere, even if it is just eliminating waste. I am going to go through $350 billion worth of waste that occurs every year in the Federal Government--$350 billion. I will not go through every bit of it to allow the clerk and the Presiding Officer and the staff to go home, but I am going to go through enough of it so people get a flavor of where the waste is. The cover of Newsweek's December 7 issue entitled: ``Steep Debt, Slow Growth, and High Spending Kill Empires--And America Could Be Next'' warns that our current fiscal situation is putting our country at risk and calling into question our position of power in the global economy. This is how an empire declines. It begins with a debt explosion. It ends with inexorable reduction in the Army, Navy and Air Force. . . . What did we just pass? A 4-percent increase for the military and an average 11 percent increase for every other branch of the Federal Government. We are already starting to see it. We actually increased our own budgets 6 percent, but what did we do to our military? What they are predicting in Newsweek we are already doing. We are destroying the ability to defend ourselves because, financially, we are not secure because we do not have the courage to make the hard choices in Washington. Government has grown to such an enormous size it is almost impossible to fully grasp just how huge the Federal operation has become. The 2008-2009 U.S. Government Manual now is nearly 700 pages long and provides details on 15 executive branch agencies and nearly 60 independent establishments and government corporations--60. We have 60 government corporations. The Government Accountability Office found that 13 different Federal agencies spent nearly $3 billion from 2004 to 2007 to fund 207 Federal Government programs to encourage students to enter the fields of math and science. Let me read that again: Thirteen different Federal agencies spent nearly $3 billion . . . to fund 207 Federal programs to encourage students to enter the fields of math and science. Why wouldn't we just have one? Why do we have 207 programs run from 13 different agencies to encourage people to go into math and science? That is the idiocy of what we are doing. Another example, the GAO report said with $30 billion, the Federal Government ``funds more than 44 job training programs, administered by 9 different Federal training agencies across the Federal bureaucracy.''--$30 billion, 44 programs by 9 different agencies. The right hand doesn't have any idea what the left hand is doing. Why not one agency? Why not all job training programs in one agency? We do not have the courage to change that? How about Federal domestic assistance? Fourteen departments within the Federal Government, forty-nine Federal agencies operating exchanges for study-abroad programs. Let me say that again. We have 14 different departments within the Federal Government, and 49 independent agencies operating study-abroad programs. Why not one? And why not ask the question, Is that a role for the Federal Government rather than the State government? Yet despite the decades of government spending hundreds of billions of dollars on programs that address every possible issue from homelessness to job training to obesity to education and everything in between, all these problems are actually worse--they still exist and they continue to worsen. This calls into question if mortgaging our children's future and endangering the country to spend money we simply do not have on programs that are working is truly an effective way to address the changes we face as a Nation. We have to address these issues. The reason I am spending time on our fiscal nature is because the thing that got us in trouble in health care, the thing that causes our problem in health care is the lack of any Federal restraint. Now we are going to move one-sixth of our economy under the purview of the Federal Government. Let me outline quickly $387.7 billion worth of waste that could be cut from the Federal Government: The general government in total, $150 billion; Department of Agriculture, $9 billion; Department of Commerce, $5.9 billion; Department of Defense, $36.6 billion; Department of Education, we could cut $6 billion, nobody would ever notice the difference; Department of Energy, $2.2 billion; Department of Health and Human Services, we could cut $1.8 billion and nobody would ever notice the difference. Medicare, by all sorts of studies now, we know that at least there is $100 billion worth of fraud in Medicare. We know that. The bill we are so proud of that our colleagues are going to pass without significant amendments on our part goes after $2 billion of that over 10 years. So they are going to go after two- tenths of 1 percent of the fraud and say they have done something rather than go after the fraud. Medicaid, we could cut $48 billion from it in waste, duplication, and fraud; Indian Health Service, the inefficiency in the AIDS program; Department of Homeland Security, $1.5 billion; Department of Housing and Urban Development, $4.8 billion; Department of the Interior, $2 billion; the Corps of Engineers, $1 billion; Department of Justice, at a minimum $1.6 billion. We have this report that outlines $10 billion of waste. They have $1.6 billion left over at the end of almost every year. They are the only agency that gets to keep their unexpended balances. We have no control over how they spend it. We haven't changed that. We have offered amendments to change it. They have been rejected. We have offered amendments to have that money come back to the Treasury. They have been rejected. Department of Labor, $12.4 billion worth of waste; Department of State, $2.5 billion; Department of Transportation, $4.3 billion; Department of Veterans Affairs, $1.3 billion. That comes to $387.7 billion a year which tomorrow would markedly improve the value of the dollar and could markedly change the long-term curve that we are going to have. Here is what it is. People need to pay attention to this. Every year we don't get rid of the $387.7 billion and continue to waste it speeds this curve up. Because this chart, which shows where we are now, shows the debt held by the public as a percent of GDP versus where it is going. So if you have a child today who is 1 or 2 years old or you are like Madelyn, the little girl who is 3, where is she going to be in 40 years? Forty years from now puts her at 2050. That means 300 percent of her GDP will be held by the public. What happens when we do that? No growth. Look at the lost decade of Japan. What is the implication for that? The implication is opportunity gets stolen. It is paramount that we change how we operate in the Senate and we start thinking long term. It is not a partisan issue. What it is is a careerism issue and a parochialism issue. If we care about what our oath is to this little book, the oath that every one of us took to uphold and defend the Constitution, and if we care about what the future holds, we should be worried about this. Because quite frankly, right here the interest on the debt will become $1 trillion a year, and that is irreversible. That will happen. By 2020, the interest on the U.S. debt will be at least $1 trillion a year. That is 10 years from now. We are going to be borrowing money and adding to the debt to pay the interest on the debt. That is called bankruptcy. That is why the Chinese are so worried about what we are doing and the fact that we are not effectively managing our government. At the end of World War II, with all the debt we had, we were only at 109 percent of our GDP; in 2080, if we don't change what we are doing, 600 percent of our GDP. Translate that into what that means for somebody's individual life. That means my grandchildren and their children will never be able to buy a home. They will never own a home. They won't send their kids to college to advance their education. They may not even be able to buy transportation for themselves. The reason it is important is because it is counter to the heritage we have. We are the first generation in this country, in its whole history, to leave the next generation worse off. Nobody seems to be worried about it. Nobody is willing to sacrifice their position in Washington to make the hard choices to fix what is wrong with the country. That doesn't mean I don't want to fix health care. I do. I have seen the experience, in 25 years of practicing medicine, of what government-run health care does to health care. And with all these other systems that are broke and all these different agencies that are broke and all this duplication and we won't fix it, what makes you think we will fix it this time? There is a rumble in America. I said that on the floor the first time 4\1/2\ years ago. It is growing. It is getting big. For the first time in America, independents poll higher than either Democrats or Republicans. There is a reason for it. They can't stand us. We refuse to make the hard choices they send us here to make. Consequently, they are discouraged. There is a crisis of confidence in America about a government that is supposed to be serving them instead of them serving the government. As this rumble builds, we should make no mistake about what the long- term consequences are, as many of us won't be here because Americans have had enough. If the average American knew what was in this book, the things we have allowed to happen and continue to allow to happen, they should fire every one of us today. There should be a recall election for every one of us. Because no matter where you are on the political spectrum, none of us has done enough to fix what is wrong. None of us has lessened the risk that will happen to our children. None of us has changed the curve of government dominance over liberty. Until we start doing that, that rumble is going to grow. The only way that rumble calms down is when we start taking the oath to the Constitution and recognizing the enumerated powers and having respect for the tenth amendment that says specifically, everything that is not specifically mentioned in here as a role for the Federal Government is explicitly reserved to people and their States. All you have to do is look at the health care bill that is going to pass Christmas Eve. We are taking a valuable freedom away in that bill. We are taking away a right. We are going to say if you are an American citizen, you have to buy something. That is a big leap on the commerce clause that we have never had before. It is going to get challenged constitutionally. There is no question. But we are stealing liberty with that one little section called an individual mandate; you have to buy something in this country. What should be our goal in the sunset years of our lives, after serving in this body, is that we should have preserved or increased freedom for people, not lessened it. Whether it is under Republican domination or Democratic domination, liberty has shrunk. As the government grows, liberty declines. Another one of Thomas Jefferson's sayings: Compelling a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical. That last word is an important word in America. They see tyranny. You are going to tell me I have to buy a health insurance policy. What if I have $250,000 in the bank and I don't want to buy a health insurance policy; you are going to tell me I have to buy it? I have to buy it? That is tyranny. There is no freedom in that. There is no freedom to make an economic choice. There is no freedom to be responsible and accountable. We have said the government will know best. I will put some information on my Web site so that the Federal Government doesn't have to spend money. If we quit publishing this every day--it is available on line--we could save $6.5 million a year. Nobody reads them. Everybody looks at them on the computer. We could save $6.5 million a year if we quit doing this. But we won't quit doing it. It is $6.5 million peed down the drain every year for something that goes and gets recycled. But we won't do it. We won't do it. Those are the little examples. If you take 100 $6.5 million programs, you get $650 million worth of savings. There is thousands of $6.5 million programs we could all get together and eliminate. But we don't do it. I will make this available on my Web site. I had my staff use data from the Office of Personnel Management, the Office of Management and Budget, take data from those two areas compiled by the Congressional Research Service. Here is what I came up with in terms of Federal employees. It is pretty revealing. We now have in the Postal Service 762,000 employees; in the Department of Defense, civilians, 677,000 employees; in all the rest of the remainder of the Federal agencies we have 1.247 million employees. The direct compensation, the direct pay cost per person in the Postal Service is $55,614 a year. The Department of Defense civilian is $70,201. The remainder of the Federal agencies is $81,271. That is the direct pay. The benefits, however, at the Postal Service are $24,743 a year. Department of Defense civilian, not our soldiers, not our military, is $18,796 a year. And the remaining of the Federal agencies is $31,754 a year. So the total per capita compensation for active Federal employees right now is $113,000 a year--2\1/2\ times what it is in the private sector across this country. So the next time somebody comes to me and says: We need to increase the wages of Federal employees, I am going to lay down and stop it until we create the opportunity our children deserve to have that was given to us. We have wonderful Federal employees, but that is part of the things on which we have to start making a decision. We cannot continue to increase, increase, increase when we are borrowing all the money that we use to increase. With that, I yield to the Senator from South Dakota.

Mr. COBURN. Thank you. I do not object.