Thomas Coburn

Mr. COBURN

Mr. COBURN. Madam President, will the Senator yield for a question?

Mr. COBURN. Does the Senator recall the vote in the HELP Committee when this bill was offered--this bill that allows you to keep whatever you have, if you like it; this bill that gives no tax increases on American families; this bill with no increase in taxes on American business; this bill that lowers everybody's health insurance premium; this bill that covers preexisting conditions, period; this bill that protects seniors' high quality of care and keeps their choices; this bill that increases personal control over health care; this bill that does not do a Medicaid expansion but, instead, puts Medicaid patients into real insurance so they can have the same choice as every other American; this bill that protects physician-patient relationships; and this bill that empowers patients, families, physicians, and providers, but does not empower the government--what was the vote, does the Senator recall?

Mr. COBURN. It puts the consumer--i.e, the patient--in charge of their health care rather than the government in charge of their health care.

Mr. COBURN. Mr. President, I thank you. I appreciate it. I sat here and listened to my colleagues to hear their input. I find it extremely peculiar that the only industry for which you would limit their taxes is one that has not struck a deal with the committee. The only one. Pharmacists are going to spend $70 million advertising for this bill. The other industries are putting up additional moneys to advertise for this bill. The only industry that we are going to restrict is the industry that is in opposition to what we are doing. It is interesting. Senator Cornyn made the point with me a moment ago that we are going to take $450 billion, and we are going to give it to the very industry you are talking about. We are going to take $463 billion from Medicare and give it to the same industry you are now criticizing. Senator Baucus said--and let me quote--he said: As we tried to work this, it was ``rough justice'' to put this agreement together. This is democracy. It was done behind closed doors. That is not democracy. It was done behind closed doors. The Senator from Arkansas asked why we have not brought forward something. The Senator from Massachusetts asked. The first bill introduced was the Patients' Choice Act. I commend to my colleagues a white paper by Thomson Reuters, a very well respected firm, talking about the $600 to $850 billion worth of waste in the health care system today, entitled ``Where Can $700 Billion in Waste Be Cut Annually From the U.S. Healthcare System.'' The reason we are concerned about $465 billion coming out of Medicare, to be paid to the very insurance companies you are going after right now, is because we are not going where the real waste is. The promise of the President was to cut the cost of health care. Right here is where it is. This bill does not touch it. There is $175 billion a year in fraud in the health insurance industry. You all go after $2 billion of it--$2 billion. There is $175 billion a year in fraud. What is in it? Nothing. We are going to manage to pay a private industry, but only the private industry that will not play along behind the closed door, rough justice of democracy in this country. When Senator Corker asked the chairman of the Finance Committee, Why are you taking the money from Medicare and using it somewhere else, rather than extending the life of Medicare, he did not answer the question. The fact is, there is a $44 trillion--according to the latest calculation, if you go to the Medicare trustees: $44 trillion--counting what has been borrowed--unfunded liability over the next 75 years for Medicare. We are going to take $\1/2\ trillion out of that program that we all know is going wrong. And I do not doubt the motives of anybody here. I just think we are misdirected. And we are going to take that and spend it on another program. That is where people ought to be concerned. It is interesting--I will submit another document for the Record. This is a report from the Congressional Research Service, released December 1, 2009, at my request. I ask unanimous consent that document be printed in the Record.

Mr. COBURN. Here is what it says. I asked them what percentage of health care today is run through the government. You might be interested to know it is 60 percent. As the Finance chairman responded on why we were fixing it, we are going to create 70 new government programs in this bill--70 new government programs in this bill--and we are fixing the government programs we have now. And we wonder why health care costs are out of control? They are out of control because the government is running 60 percent of it now, and there is no competition for that 60 percent. Nobody is going to defend outlandish salaries, but it is interesting, we are not going after the outlandish salaries of the companies that are going to spend $80 million to support this bill, the pharmaceutical companies. We are not going to go after the salaries of the people who run the hospitals who, on average, make more than $1 million a year. We are not going to do any of those. Only the ones who say: Wait a minute. Maybe this is not such a good deal. Mr. President, I commend to my colleagues a document entitled ``Impact Of The Patient Protection And Affordable Care Act On Costs In The Individual And Small-Employer Health Insurance Markets'' from Oliver Wyman and Associates, because what you claim you want to do is going to create 11 million young people who are not going to have insurance, and for those who remain, their insurance is going to cost twice as much.

Mr. COBURN. Supposedly.

Mr. COBURN. Mr. President, I thank the chairman for allowing me to respond.

Mr. COBURN. I don't think there is any question that is going to happen. Actually, it is even going to be worse than that because we have shrunk the differential for young people. If you are a young person, listen to me. The cost of your insurance is going to double under this bill. If you are a young couple or a young individual--and I am talking 40 and under, 24 to 40--your insurance is going to double under this bill. What you are going to do, you are going to do this: You are going to say, I am going to pay the tax rather than coverage for insurance because it is financially much more important for me to do that. And what we know is that between 6 million and 11 million young people are going to cancel their insurance under this bill, according to a report put out by--and I will reference it here--Oliver Wyman and Associates.

Mr. COBURN. If I might, I ask unanimous consent to have printed in the Record the consolidated audited financial statements of AARP. They are the fifth largest insurance sales company in America.

Mr. COBURN. And it doesn't reform. I have wondered that.

Mr. COBURN. Well, I wouldn't go quite that far. There is no question that some people who have no coverage today will get Medicaid. But compared to the Patients' Choice Act, they could get a private insurance policy instead of Medicaid. They would get access to all of the physicians, not just 60 percent of them.

Mr. COBURN. Well, we have protected some through earmarks in this bill--certain States; we have protected some. In some States, if you have Medicare Advantage, you are protected. In other States, if you don't happen to be on that side of the aisle, or you don't need help in your reelection, you don't get that.

Mr. COBURN. I yield the floor, and I suggest the absence of a quorum.

Mr. COBURN. If they could afford it--and that is where a large number of Medicare Advantage people will be hurt; most of those people cannot afford to buy a supplemental policy. The fifth largest seller of insurance policies in the country happens to be AARP.

Mr. COBURN. For AARP.

Mr. COBURN. We are fairly cynical, and we don't mean to be. We need to wrap up, if we can. There are two ways of fixing health care in this country. One is, we have the government running it--I make this point. Everybody agrees that in 2017 or 2019, Medicare will go belly up. Medicaid is already belly up. They are all in trouble. They are running deficits. The Census is broke. Social Security is going to be broke. The U.S. Post Office is absolutely broke. Cash for clunkers was broke before we started. The highway trust fund is $18 billion in the red. And we are going to put another 16 percent of health care--76 percent instead of 60--in the hands of the government. Or we can utilize what we know works, which if you incentivize the management of chronic disease and incentivize prevention, incentivize transparency, and you create a way for people to have access, the Patients' Choice Act will insure 94 percent of Americans with a real insurance policy, not Medicaid or Indian health care. By the way, Native Americans, listen up. Under our bill, if you are due health care, you get a card and you can go anywhere you want and it will be paid for. We need to do that for veterans, too. The point is there is a choice. We can run a large government option or we can run a small government with 50 States, incentivizing them to do the right and best thing for their citizens, where we will actually lower costs, increase access, and have better care, and we won't destroy the best health care system in the world. I challenge my colleagues to come down here to the floor and debate me on that, because I guarantee you that in their families I can find somebody who was saved because they lived in this country and, had they not, they would not be alive. It is the best health care system in the world. Why should we destroy that as we try to fix what is wrong in health care in America today?

Mr. COBURN. Let me interrupt my colleague. Here is what the constellations show. Walk with me slowly. If you are 25 years of age or younger today in America--and we go out 20 years--that will be 45 and younger--that is 103 million Americans who will be in that group. Here is what they are each going to owe based on the unfunded liabilities of Medicare, Medicaid, and Social Security: 103 million Americans, 45 years and younger, will each owe $1.119 million. That is what they will be responsible for. They will have to pay the average interest on that, which will be about 6 percent. Before they ever pay the first bit of income taxes, they will have to cover that interest; otherwise, that will grow. How does that fit a young family 20 years from now? We are talking about tax rates that allow no increased standard of living. As a matter of fact, they are rates that decrease the standard of living by 35 percent. That is the heritage we are creating and what we are going to expand with this health care bill the majority leader has brought to the floor. We are going to steal the future and the opportunity for those 25 years and younger today, because we cannot live and make the hard choices that are necessary, and we think the answer to every problem is more government, rather than more personal responsibility, competition, transparency in a market, and incentivizing people to do the right thing, rather than punishing them when they do the wrong thing.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that Josh Trent of my staff be granted the privilege of the floor for the duration of the debate on H.R. 3590.

Mr. COBURN

Mr. COBURN. I have a question. Does 60 Plus sell supplemental insurance policies to seniors?

Mr. COBURN. But AARP does. I wonder why people want seniors off Medicare Advantage.

Mr. COBURN. I thank the Chair. We are in trouble in Medicare in this Nation. Everybody knows it. We have made promises. The unfunded liability on Medicare is $79 trillion. For us to take $\1/2\ trillion, no matter what the Enron accounting says afterward, the fact is we are going to reduce that; we are going to make that worse. We may not make it worse next year or the year after, but we are going to make it worse. It is going to be worse for seniors, but it is also, as the Senator from Tennessee said, going to be extremely worse for the seniors' kids and grandkids. Not only have we done that, we have raised the taxes in Medicare on a certain group of people and we are going to take that money and not put it in Medicare; we are going to take that money, a Medicare tax, and create a new entitlement. So the Senator from Florida is absolutely right. If you vote against the McCain motion you are saying you want to cut $\1/2\ trillion out of Medicare and that it will have no effect whatsoever on the care. I remind the Senator from Florida, there are 1 million people on Medicare Advantage in the State of Florida, 1 million people who are going to lose benefits under this bill. One million people in the State of Florida will lose benefits under this bill.

Mr. COBURN. I think that is entirely possible. I don't know that to be factual as of yet. What I do know is we are going to have 44 million baby boomers in the next 12 years jump into Medicare and we are cutting Medicare. We are going to have 44 million baby boomers jump into Medicare. I am one of them. We are going to cut the amount of available funds from Medicare under this bill.

Mr. COBURN. My one criticism of my colleagues in writing this bill is I think there is money we can save in Medicare. It is called waste, fraud, and abuse. A Harvard professor who studies this says there is at least $125 billion a year in fraud. We have had several studies that say it is anywhere from $100 billion to $175 billion a year. There is nothing in this bill to eliminate fraud. What we are doing is we are taking care from seniors instead of taking the money from the fraudulent actors in the health care system.

Mr. COBURN. There is no question, to answer my colleague from Idaho, that if it doesn't eliminate the ability, it will deny by delaying the ability. Care delayed is care denied. All you have to do is read all of the tragedies that have gone on in this country for people who have delayed care which has resulted in large complications for that individual.

Mr. COBURN. Madam President, it is interesting, as a practicing physician who has actually cared for women and nobody so far who has been in on this debate has ever done. I congratulate the Senator from Maryland for her care about prevention because we all know that is key. The mischaracterization we heard about this bill is astounding. The reason we got in trouble with the Preventive Task Force is because it did something that was inappropriate and did not have the appropriate professional groups on its task force when it made its recommendation on breast cancer screening. The Murkowski amendment says we will rely on the professional societies to make the determinations of what must be available. We have heard the Senator from Iowa say health insurance will decide that. That is absolutely untrue. Health insurance will not decide it. The professional societies will decide what will be covered, and the insurance companies must cover it under the Murkowski amendment. The second point is there will not be any objective criteria. The objective criteria doctors practice under today are the guidelines of their professional societies. Here is the difference between the Murkowski amendment and the Mikulski amendment: The Senator from Maryland relies on the government to make the decision on what will be covered. She refers to the Health Resources and Services Administration. She refers to the Health Resources and Services Administration which has no guidelines whatsoever on women's health care right now, other than prenatal care and childcare. That is the only thing they have. For whom does HRSA work? HRSA works for the Secretary of Health and Human Services. So the contrast between these two amendments could not be any more clear in terms of do we want to solve the problems we just experienced on mammogram recommendations? We can let the government decide, which got us into this trouble, and they will set the practice guidelines and recommendations for screening or you can let the American College of Obstetricians and Gynecologists or the American College of Surgeons or the American College of Oncologists set and use their guidelines. The choice is simple: The government can decide what care you get or the people who do the care, the professionals who know what is needed, who write the peer-reviewed articles, who study the literature and make the recommendations for their guidelines. Every month I get from the American College of Obstetricians and Gynecologists their new guidelines. I try to follow them at every instance. The fact is, the Mikulski amendment says government will decide. That is what it says. The government will decide through HRSA. The Murkowski amendment says it is the best practices known by the physicians who are out there practicing. What is the difference? How does it apply to you as a woman? It applies to you as a woman because the people who know best get to make the recommendations rather than a government bureaucracy. That is the difference. If you will recall, under the stimulus bill we passed, we have a cost comparative effectiveness panel, which will surely be in the mix associated with the recommendations. If you look at what the task force on preventive recommendations said from a cost standpoint, they were absolutely right. From a patient standpoint, they were absolutely wrong. The real debate on this bill--the Mikulski amendment is the start of the real debate--is do we have the government decide based on cost or do we have the professional caregivers who know the field decide based on what is best for that patient. That is the difference. What the Senator from Alaska does, which is necessary, is she says we will rely on the American College of Obstetrics and Gynecology. We will rely on the American College of Surgeons. We will rely on the American College of Oncologists to determine what should be the screening recommendations for patients. For, you see, what happens with the Mikulski amendment is the government stands between you and your doctor. That is what is coming. That is what will be there. There is no choice under the Murkowski amendment for an insurance company to have the option either to cover or not to cover. They must. It says ``shall'' do that. So the mischaracterizations on what the Murkowski amendment actually says and does are unfortunate.