Thomas Coburn

Mr. COBURN

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

Mr. COBURN. Mr. President, I ask unanimous consent that the pending amendment be set aside and that amendment No. 581 be called up.

Mr. COBURN

Mr. COBURN. Will the Senator yield?

Mr. COBURN. I ask unanimous consent that the Senator from Nebraska be recognized next.

Mr. COBURN. Mr. President, I have been sitting here for about an hour. I have to think the American people are pretty sick of what they have been hearing. We heard the Senator from New York talk about how bad the Republicans were. We heard the Senator from Utah talk in Hobson fashion. It doesn't come anywhere close to solving the problem. I think we ought to have a discussion about how we got here. How do we find ourselves in the mess we are in? I think we can look at history. There was a great historian named Alexander Tytler. He looked at the ancient Greeks and looked at what happened to them as they fell. He said this about republics. He said: All republics fail. They fail as soon as the people figure out they can vote themselves money from the public treasury. There is no question we are in hard times. There is no question we need to do a stimulus package. There is no question the Federal Government has the power to make a big difference in a lot of people's lives who are hurting right now. I don't think it would be fair to say that there is anybody in this Chamber who doesn't want to try to accomplish that. The difference is, how do you do it? In doing so, what kind of problems do you create? The way we got here is abandoning this little booklet. If you read article I, section 8 of the Constitution and then read what the Founders had to say about article I, section 8, it is called the enumerated powers. They were very clear in the role of the Federal Government. We are in trouble today, this Nation is in trouble today-- not something we can't get out of, we can; not something that the American spirit won't overcome--because we let the politicians abandon the very clear rules and wisdom that was given to us by a unique, almost ordained group of individuals over 200 years ago who saw a vision and said: How do we keep this? When we abandon this book, as we have and as we did, and we get into trouble, it is important to recognize what we did wrong, if we are going to try to fix it. The other thing I am tired of hearing about--and I think the American people are too--this isn't a Bush, Clinton, or Obama thing. This is a Congress thing. No President can spend money without us allowing it to happen. I almost laughed when I heard the claims on the Senate floor from both sides about the trouble we are in and how we got there and deficits and the Senator from Vermont and his claim of a trillion dollars. I think the CBO cost on that was $60 billion on estate taxes. But the idea that we would put a blame on anybody other than ourselves, the truth of that is, go look at the votes on appropriations bills for the last 8 years. It is nearly 100 percent on one side and almost 95 percent on this side of people voting to spend money we didn't have for things we didn't need. It is important the American people, as they see us trying to work through a process, No. 1, reject any partisanship they will hear. When somebody starts being partisan, turn the TV off because what it means is, they don't have anything substantive to talk about if they are pointing their finger at somebody else. The second question we ought to ask is, is what we are doing going to fix the problem? Here is the problem. The problem goes back to this. We set up two agencies, Fannie Mae and Freddie Mac, to socialize the risk for homeownership, a total violation of what is in this book. It is a total violation. Then we said: Maybe we can help people a little more, so let's go to subprime mortgages and let's bonus the people who work at the GSEs, Fannie Mae and Freddie Mac. The more subprime mortgages they take, the more money they make. If I remember, one former leader of Fannie Mae made $140 million because we bought mortgages he knew people weren't going to be able to pay for, but the incentive was there, in a quasi government-owned agency, to do something that is outside of the enumerated powers of the Constitution. So as we abandon principles, the best way for us to solve the problems in front of us is to go back and look at the principles. The other concern is, do we have the potential to make things worse? Nobody has talked about that today. Does what we are doing have a potential downside? You can't talk to one economist who doesn't say yes. As a matter of fact, by CBO's own score, 10 years from now this will either have zero effect or anywhere from a minus 2 to a plus three-tenths effect on the economy. The reason for that is we are going to borrow so much money, as we do in this bill, we are going to crowd out private investment. The Government is going to have all the money, and people will not be able to borrow money to invest in new ideas which create opportunity, which create jobs, which create increased standards of living. So going back, how did we get here and what is the real problem for us to create a stimulus bill right now, before we have a way to solve the housing and mortgage crisis--because the bank problem wouldn't be there if the mortgage and housing crisis wasn't there, for us to fix those first before we do this and for us to have a plan to do that--as a physician, one of the things I notice is, if somebody comes into the emergency room with chest pain, it is one of three or four things. Either they have an esophageal spasm or their esophagus is irritated or they have terrible reflux where the fluid from the stomach acid is burning the esophagus or they are having angina, heart pain, due to lack of blood supply. If you treat the symptoms, you can make that angina go away, but they still have a vascular abnormality around the heart that could kill them. My worry with this bill is that we are treating symptoms. We are not treating the disease. We are arguing, partisan arguing: Was this a bipartisan bill, wasn't it a bipartisan bill; you did this over the last 8 years, you did this. We need the country thinking forward, not backward. The guide for that has to be the Constitution, which every Member of this body is sworn to uphold but violates daily. We are in this trouble because the Congress put us in this trouble. The blame lies solely here. Let me talk about the bill for a minute. This is the bill. I won't pick it up and wave it around for fear I would be called into account of using theatrics. But do the American people realize nobody who is going to vote on this bill has read it? There is $727 million worth of spending on every page of this bill. That is what it averages out. So not counting interest, we have a less than $800 billion bill that had 30 amendments in the Senate before it went to conference. We hear they are accepted. Some of them were accepted. We voted on one unanimously, and it got thrown out in conference, just a simple little thing like maybe we ought to make sure that contracting is competitively bid. Now the language reads we ought to try to do that, but we will not make sure that happens. I brought along with me, thanks to somebody down in the Senate gift shop, this little green item. It is called a thimble. In Oklahoma, we have a statement for that kind of thinking. It is called ``there is not any more commonsense than what can fit in a thimble.'' So when we take out something that is agreed to unanimously in the Senate to mandate competitive bidding so even if we are wasting money, we waste it efficiently, you have to wonder what is going on. Let me tell you what is going on. This is a massive bill. Supposedly, it doesn't have any earmarks, which is laughable, if you have been around here any period of time. The conference did clean it up so you can't truly find out where the earmarking is. You could find it out a little bit before it went to conference. Now you can't pinpoint it all. But we are going to move from earmarking to a concept called ``phone marking.'' It is a new concept. It is more powerful than earmarking. Phone marking is this: This bill gets signed, $500 billion of it is going to be disbursed through the agencies. Guess what is the first thing that is going to happen after President Obama signs this bill. Members of Congress and Senators are going to be on the phone saying: I want this money spent here and here and here, and if you don't, in your appropriations next year, you are going to suffer. That is exactly what will happen with the money in this bill. Everybody who works inside Washington knows exactly that will be what happens. We have heard talk about the earmarks. I won't try to repeat some of the things that are in this bill. But I will talk about one. We have a private company that was developed. It has spent several million dollars developing a railroad from California to Las Vegas. Do you know what this bill does? It wipes them out. They invested private capital to develop a railway. In excess of $10 million has already been invested in that, and with the wisp of one earmark, we are going to bankrupt people who invested their life savings to try to do something good because the Government is now going to do it through an earmark and going to try to accomplish something that has only been done in one country and not effectively. It costs $100 million a mile to build a maglev train, and we are not going to see any of that money spent for 4 or 5 years because the technology is not here. That aside, there also was an amendment that truly would have done something to fix the real problem: housing--the Isakson amendment, with a $15,000 tax credit, if you are buying a primary residence, whether it is a foreclosed home or a new one. It would have done something magnificent in terms of lessening the crisis in housing. What did we do? Out. It had an overwhelming vote in the Senate, but it is out. How do you explain that? What is going on here? What is going on here is the initiation of what Alexander Tytler talked about: the failure of a republic. And it is about short-term politically, expedient thinking to the benefit of politicians, instead of what is the best right thing we can do for our country. The very claim that Senator McCain did not offer a substantive bill that would have significantly increased the number of jobs created, at a significantly lower cost, as scored by CBO and as scored by outside economists, is a spurious claim. Another thing that got added into the bill is the most dangerous precedent for health care in this country we have ever seen. We are now, with this bill, embracing Great Britain's health care system. What we are saying is that we are going to allow the Government in the future to decide what care you will get. It is called comparative effectiveness, and it is going to be based on cost, not clinical outcomes. We are going to abandon the knowledge of physicians, the experience they have with their patients, the 8 to 12 years of additional training they have and the lives that have been dedicated to improving the health of their patients. We are going to abandon that to a bureaucracy where the Government says: We know best. We are going to do that because we cannot afford Medicare in the future, and we are going to say, just like England says, if you only get 1 more year of life, then the most we can spend on you is $49,000. If you are 75 years of age and you are a Medicare patient and you fall and break your hip, we are sorry, we are not going to do it because it is not cost-effective. The first leg of you losing a doctor-patient relationship and the freedom to have health care decisions made by you and your caregiver is buried within this bill and will kill health care in America as far as its quality. You will get access--you will get to wait just like Canada and England do--but you will kill the quality and will kill medical innovation in this country. This country leads the world. Mr. President, 7 out of every 10 major breakthroughs in medicine occur in this country. And the reason? It does not mean we have a good system now. It needs to be improved. Here is the theory as I have observed it in the 10 years I have been in Congress: Never do what is best when you can do what is safe. That is how it operates in Washington and throughout the Federal agencies. They are risk averse, just like the politicians are risk averse to challenging priorities in this bill, that we ought to have priorities to spend the money for what would get the most jobs, the most economic benefit. I had an amendment that was adopted. It had 73 or 74 votes. It got watered down and divided in conference because a lot of special interest groups said: Oh, no. You can't do that. So what did we do? They are not a priority as far as what we should be doing right now. As a matter of fact, 80 percent of--most of the groups that were complaining about it get their funds from private sources. The best way to get them funded back up is getting private sources moving again in terms of the economy. But what did we do? We chose the politically expedient path. Again, it was not often thought of--political expediency--by the people who created this country who risked their lives and their fortunes to make sure we have the freedom we have today. But yet we are abandoning that. It comes back to: What is our heritage as a nation? What is the heritage we as a nation have been brought forward with? I will tell you what I think it is. I think the heritage we have is that one generation was willing to make hard choices and hard sacrifices so the generation that followed would have greater opportunity--greater opportunity--a higher standard of living, more freedom, more liberty. What have we done? We are going in reverse. What we have been doing for the last 10 to 15 years in this country, what we have been saying is we will take it now. Kids, you lump it. As an example of that, if you look at 2008, the Federal Government spent $25,000 per household of your money. A good portion of it--a third of it--was borrowed. But we spent $25,000 as a Federal government per household. With this bill, we are going to spend $38,000 per family--just with this one bill. And we are hurrying it up. We have to get it done right now because there are CODELs, trips, and junkets waiting for Members to go on, including the Speaker of the House. So we have a bill that nobody has read, that has some real questions about whether it is going to be stimulative, that has taken out good financial controls such as competitive bidding, taken out listing priorities, and we are going to vote on it tonight, with nobody ever having read it. That is about as bad as the partisan bickering we have heard. Does it serve us well to hurry and do something when we do not know what we are doing? Now, there are some staff members who know some of what is in here. But there is not one person who knows the full extent. Mark my words, within a month, we will be back in here passing a bill to do all the corrections to this bill that we do not have right and correct at this time. That is how sloppy we do our work. So it is not only sloppy in terms of our effort, it is sloppy in terms of our theory. I would also add we are going to move from $2,000 per family in interest costs to $4,817 per family this next year. Now, in my State, the average family income is below what the Federal Government is going to spend with this bill. In my State, average family income is under $36,000. Yet we are going to spend $38,000 this next year per family in this country, and we are going to justify we had to do it to get us out of trouble. And we are going to do it because we did not fix the real problem, we are treating the symptoms. We are all going to feel good, and we are all going to take the invite of the Senator from New York to come on over and join us. The fact is, my oath as a Senator should disallow me from ever voting for this bill. Anybody who votes for this bill will be violating their oath to this Constitution. America demands something be done. They are right. We need to do something. Should we do it sloppily? Should we do it without focus? Should we do it without temperance? And should we do it in a timely manner to make sure we are not treating the symptoms as reflux or esophageal spasm, but we actually go in and take the clot or the plaque out of the artery that surrounds the heart? Isn't that what we should be doing? Shouldn't we be fixing the real problem? While we are at it, we ought to be fixing us because we are the cocommitters of the real problem. Shouldn't we all be thinking long- term rather than short-term political benefit? Shouldn't we be realizing what is expected of us? I would hope Americans tonight, if they have children, will go and look into the eyes of their children. There is something you see in children in this country that is very different than when you look in the eyes of some starving African child or some Third World country child. What you see, when you look into those beautiful brown, blue, green or hazel eyes, is hope. I think about my four grandkids and the one who is on the way. When I look in their eyes, I see hope. Then contrast that with the pictures you have seen of the despair and look of no hope of the kids around the world who have not had the opportunity of this country. What we are doing is we are stealing some of that hope tonight from our children. If you do not have a young child but you have one who has grown up, think back to that picture you have on the wall and look into those eyes and say: Do you want to steal that hope? Because that is what we are doing. We are limiting their liberty economically. We are limiting their freedom to be the best and brightest and have the greatest potential that any society has ever offered their youngest citizens. That is what we are doing with this bill. I will close with this and reserve the remainder of my time. There was a President we had who made a statement that was fairly popular, but it has great application right now. He said: Freedom is a precious thing. It is a precious thing. It is never guaranteed. It is not ours by inheritance. It has to be fought for and maintained and won by every generation. As we embrace this bill, we are selling out the heritage of our country. We are denying the hope and joy in those young eyes and we are limiting the freedom our children will enjoy. We can do better. We must do better for this country. Our country needs statesmen who will sacrifice themselves for the best interests of the country rather than the best interests of their party or the best interests of their political career. Freedom is precious. We are going to take a bit of it away tonight. It is going to go away, and you will see a little decrease in the glimmer of those children as they contemplate and we contemplate their future. Mr. President, I reserve the remainder of my time.

Mr. COBURN. I will be happy to yield myself the time. The Senator paints with an awfully broad brush. I have been in this Senate for 4 years. He knows very well that I voted against most appropriations bills. I talked about the debt in almost every speech I have given. So I hope we would talk about individuals rather than a group because it is not necessarily representative of all on my side.

Mr. COBURN

Mr. COBURN. That is one of the problems with this bill. Let's talk about the big problem. As a practicing physician, I know what physicians are taught. First, do no harm. Second, listen to your patient, and they will tell you what is wrong with them. Third, if it has already been done, don't do it again. That is what they are taught. With that comes years of experience, clinical judgment, and in-depth knowledge about people and their disease. In this bill is a statement that says: We are going to develop, through a large slush fund at Health and Human Services, a model called comparative effectiveness. There is nothing wrong with comparing effective outcomes. There is nothing wrong with trying to use clinical data to move us in a better direction. But that is not what this is about. This is comparative effectiveness to control cost. I warn the American people tonight, if this bill goes through, we are well on the way to absolute government control of the patient-doctor relationship, because we are going to assume that there is no way that a doctor can make a better decision than a computer. I will give two examples that happened in the last 5 years in my practice, two people who came in who had no clinical signs, had no indications other than my knowing them for years and developing a suspicion that something was wrong. They didn't come with a complaint. Their complaint was something else. I ordered MRIs on both patients. They were both denied by their insurance company. I arranged for both of them to get MRIs. Both had deadly brain tumors. They never would have fit in the comparative effectiveness or the cost control mechanism that we are setting up with this so we can control Medicare costs. This is the first step for the government to start rationing the very care it says it wants to give to the American people.

Mr. COBURN. I ask unanimous consent for 1 additional minute.

Mr. COBURN. The American people better pay very close attention to this bill. If you are on Medicare today or if you are 55 years of age, you better be plenty afraid of the language in this bill, because it is setting up the basis with which the Government will decide what kind of care you get. We are going to use a chart. If you don't fit in the chart, you are out of luck. You are going to lose the ability for clinical skills to make a difference in your life. Talk to the people of Great Britain where cancer cure rates are lower than ours because they don't have access to treatments Americans have today. I yield the floor.

Mr. COBURN. Mr. President, I wanted to spend a few minutes this evening talking about what we think, what we think--I am going to emphasize that--because nobody has seen the bill that I understand we are supposed to vote on tomorrow morning, that spends almost $700 plus billion. We have not seen the bill. We have not seen the report language. And I can assure you that this Senator is not about to vote on this bill until he has read the bill and we will do due diligence to do that, if we ever get a copy of the bill. But I wanted to talk about a couple of things that are important that we think are in the bill, and it has to do with health care. I have a little bit of experience in that. I have practiced medicine now for 28, 29 years. I find parts of this bill that I know when it is explained to the American public, they will agree with me, it is ludicrous. Let me tell you the first part of the bill. There is $20 billion in this bill to pay hospitals and doctors to buy health IT. Now, at the beginning you would say, well, what is wrong with that? We want electronic medical records. We want to see the benefits that come from the economy of scale, the increased productivity that comes from IT to help us in health care. Where this bill does not understand what is happening out there is doctors will buy health IT, and hospitals will improve--they all have health IT right now, by the way--will improve their health IT once there is a program out there that is interoperable with the rest of the program. The reason doctors are not buying programs for electronic medical records has nothing to do with a lack of money, it is this very simple reason: They know if they buy it now they get to buy it again, because none of the computers in health IT talk to each other. They will not talk. The way to make them talk is called an interoperable standard. And a good example for you to compare, think about where we had ATMs. How did we make an ATM, where you can go anywhere in the country if you have a credit card that allows you to get cash and go into any ATM in this country and get cash. How did we do that? How did ATMs come about? They came about because the private sector, the banking industry, created an interoperable standard first. Because they had the interoperability standard, where every bank could make sure that they could talk to every other bank, they put in ATMs. All of a sudden, voila, anywhere in the world today, if you have money in the bank and you have an ATM card, you can get money out of the bank. They did not build the ATMs first, they did not have the Government buy the ATMs before they had the standard set. People say, well, we have taken care of that in this bill. We are going to have the Government decide what the interoperable standard is. Well, the Government has been working for 6 years to develop an interoperability standard. They are at least doing it through a private consortium now, and 80 percent of that standard has been accomplished. It will be completed in 2011. But it will not be completed the way this bill is written, because we are going to pull it all back from this public-private consortium and we are going to have some bureaucrats at HHS decide what the standard is going to be. There are a lot of problems with that. One is nobody at HHS knows that information. No. 2 is, everything that is out there in the market today is now put at risk, so you are going to absolutely stop private investment in this area that is so much needed. So what we are going to do is we are going to allow bureaucrats to decide what is it going to be. We are going to eliminate companies that have great ideas, because they are not going to be in the mix, and we are going to accept a standard that is not going to be the best standard. The way HHS has it set up now with a public-private consortium was a poor way to do it, but at least it has got it 80 percent of the way there. We are going to backtrack on it. Just so you know, we are so good at spending money. We have spent $780 million already of your money trying to get this, that we are going to now throw down the toilet so we can start over and have bureaucrats exactly decide what the standard is going to be. Well, I will predict to you, everything else we do in IT in the Federal Government, 50 percent of the money we waste. That is what our studies show. We waste $32 billion a year on IT programs that never work, out of a $64 billion budget for IT programs alone. So we are going to waste a ton of money. But that is not the important thing in this bill. We are going to give every doctor in the country, no matter how much money they make, if they do not have electronic medical records, we are going to give them $60,000 to buy an electronic medical record. Now, it would seem to me that with the incomes of the average physician being over $200,000, the last place we want to give $60,000 to buy a piece of software that is not going to work, that is going to have to be replaced anyway, is to those who are in the upper income in this country. But that is probably not as important as we are going to give for- profit hospitals and the profitable non-profit hospitals $11 million each to buy electronic medical record software that still will not talk to the doctors who bought it and we gave $60,000. The total cost of this, and what we are doing, is going to be in excess, by the time all of the problems are solved and all of the defects are figured out, and all of the wasted money, of $100 billion. This bill is going to waste $100 billion. Now, tell me for a minute why we would give some of the most profitable companies in the country, the for-profit hospitals and the not-for-profit hospitals who last year made in excess of $6 billion-- that is the not-for-profit hospitals made in excess of $6 billion besides doing the charity care that they did--why are we going to give them $11 million each to accomplish something that cannot be accomplished? I will tell you why we are going to do it. Because some Congressman or some Senator said the way you solve this problem is to throw money at it. They haven't thought it through. There has been no development on or recognition of what is needed, which is an interoperable standard. What should we have done? Seven years ago when we started down this process, there were three great programs out there: one at Mayo--I am talking big programs--one at Cleveland Clinic, and one at Kaiser Permanente. What should we have done? We should have bought all three of those, created the ability for those three programs to talk to each other and given it away. We would have spent about $20 or $30 million, maybe $100 million, maybe $200 million, but not $100 billion. So again, Washington has messed it up. The very thing we are hoping to fix we are going to ruin. As we do it, we are going to waste $100 billion, and $30 billion of that total is in this bill. The other interesting thing is none of this money starts rolling out until the middle of next year. I am told I have 1 minute remaining. I ask unanimous consent for 2 additional minutes.

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

Mr. COBURN

Mr. COBURN. Mr. President, I thank my friend from Nevada. I wish to spend just a few minutes. I am not going to talk for a long period of time, and I will yield back my time. I am extremely concerned with the nomination of Mr. Lynn. It has nothing to do with Mr. Lynn. Some can be critical of his time as Comptroller. Some can be critical of some of the lack of forthrightness in some of the answers about the accounting and controlling and auditing systems in the Pentagon, and I think that is rightly so. We had several hearings on IT improvements and waste in the contracting of IT through the Pentagon. We had several hearings in the last two Congresses about the waste in contracting. Mr. Lynn dealt with a large amount of that. Let that be as it may. The reason I stand to speak against his nomination is this is a nomination that is going to be the person who runs the day-to-day operation of the Pentagon. If you look at management experience, what there has been in running an organization that has 2.9 million employees--it is the largest component, even including mandatory programs, that we have. It also is the area where we have some of the greatest amount of waste. We had it during his tenure as Comptroller. We had it during the Bush administration years. Why would we put someone into that position who has not performed in a stellar fashion when given the authority to fix a lot of those problems before? Why would we put someone in charge who is going to be handicapped? There is no question, given the waiver he has received, he will be absolutely handicapped in all the contracting that goes before the Pentagon. Let me explain. His former company is one of the five largest defense contractors in the country. It is not just the areas he has lobbied in the past few years, such as the Aegis Ballistic Missile, the DDG-1000 destroyer, the Excalibur precision-guided munitions, the Joint Land Attack Cruise Missile Defense Netted Sensor System and the Multiple Kill Vehicle System, which comes to $41 billion, 10 percent of the Pentagon's budget, but every other contract that has Raytheon as a subcontractor from which he is going to have to recuse himself. What he is going to be limited to is personnel matters and accounting matters. He will not be able to make those decisions without first getting a waiver to make them and then, if you are granting a waiver to make the exception and make a decision, here is what is going to happen. Let me give the history of the tanker program in the United States. We, first, had a contract let to Boeing, which was complicated by some very bad acting on the part of Boeing and some Defense Department officials, and it got thrown out. We last had a contract for the tanker program that was awarded to EADS. There was a protest filed on it. It got thrown out. Everything he is not involved with, Raytheon can file a protest that they were excluded because the management chain was not the same. We have created the basis for a new protest on everything Raytheon will not win in the future. If Raytheon does win a contract, we have created a protest for everyone who wasn't Raytheon to protest because there is a conflict of interest. Ask yourself, in this dire economic time we are in, with the largest agency we have, why we would put somebody in that position who is going to be--for at least 1 year and probably for 2, if we wanted to ethically look at it--totally out of the realm of the most important, outside our military men and women, most important aspect of the Pentagon, which is purchasing, contracting defense weapons systems. We are setting a man in a position. It is no reflection on him. He is very knowledgeable. He has been a good public servant. We are putting him in a position to fail. We have guaranteed that contracting will not go smoothly at the Pentagon because we have created two new bases for protests over contracts. We can go through all the contracting, and it is going to be raised--and rightly so. There is going to be a legitimate protest on both sides of these issues that is going to delay the ability of the American people to contract for things we should be contracting for. More importantly, it is going to significantly raise the cost. The third point I would make is, because he is going to have to exclude himself from the vast majority of decisions in contracting and purchasing, the very position he is meant to fill, to run the day-to- day operations, means Secretary Gates is going to have to run the operations. If he has to run the operations himself, why does he need a Deputy Secretary of Defense? President Obama, I think rightly, has asked Secretary Gates to stay on. I think the continuity with that was great. I am sorry he didn't ask others to stay on until we got past this period of time. In spite of the good will of Mr. Lynn, a man of character, a man of integrity, we have set him up to fail. I have no doubt he is going to be placed in that position today when we vote. But we ought to think. The biggest problem we have with our body, in terms of what we do, is we do not think long run. We think short term. What we have done is totally handicapped him, but we are also going to handicap our military. This is not a time we should be doing that. We should be creating a streamlined procurement process that rebuilds the procurement offices, which need to be rebuilt--that has no question about the authority of the Deputy Secretary of Defense to make solid, fair, clear, and decisive actions and decisions. What we are going to do is ensure that does not happen. I thought it was interesting that Senator McCain's main point was he did not have the managerial experience to do this. Senator McCain is going to vote for him because he has such high regard for Secretary Gates. But think about that statement. He does not have the managerial experience to run a 2.9 million individual organization, and he is handicapped. We are going to handicap him so he meets the ethical outlines President Obama so rightly has put in place. I think it is a bad decision. I think it is a wrong decision. Once again, the consequences for that will be inefficiency, ineffectiveness, and a greater cost for this country. Anytime we have a greater cost on anything now, it goes directly to our kids and our grandkids. I hope my associates in the Senate will give a rethought to whether we ought to handicap this man this way. Surely somebody can fill the bill and let Mr. Lynn wait a year and then come in and do what he wants to do and what President Obama wants him to do. Again, we will make a serious mistake if we approve him, not only for us, not only for our kids but for him as he attempts to run the largest organization in the world.

Mr. COBURN

Mr. COBURN. Madam President, this economic stimulus bill contains $87.7 billion to bail out State Medicaid programs and more than $21 billion to have the Government control the adoption rate of health information technology (health IT) through Medicare and Medicaid. We are in the middle of an economic crisis today. Yet the health IT spending through Medicare and Medicaid will not start until 2011. Interestingly enough, the Congressional Budget Office, CBO, has stated it ``anticipates near-universal adoption of health IT over the next quarter century even without legislative action. As a result, the 0.3 percent reduction in health care costs estimated to result in the near term from enactment of this bill would diminish in later years, when the use of health IT will be more pervasive in any event.'' So this stimulus bill spends money more than 2 years after the economic crisis has started on an issue that the market would have addressed on its own. This is just one of the many examples that illustrate that the stimulus is, as recently noted by the Wall Street Journal's editorial page, ``90 percent social policy and 10 percent economic policy.'' I believe that this ``social policy'' will be counterproductive to the goals of universal adoption of health IT because it will mire the health care system in new bureaucratic red tape. Another example of the stimulus's social policies is its inclusion of $1.1 billion for research on medical treatment comparative effectiveness. This is to be used to ``accelerate the development and dissemination of research assessing the comparative clinical effectiveness of health care treatments and strategies, including through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions and (2) encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.'' Included in this $1.1 billion spending is a $400 million ``slush fund'' given to the Secretary of Health and Human Services, HHS, that could be construed to allow the Secretary to use however he or she wishes. Let me be clear, none of the comparative effectiveness research funding under the stimulus may be used for anything but research on comparative clinical effectiveness. While I recognize and appreciate that the comparative effectiveness provisions of this bill only permit comparative clinical effectiveness, I am concerned that this lays the groundwork for comparative cost effectiveness with bills that the Obama administration will push and Congress will consider in the future. Why else would they be pushing to spend $1.1 billion on comparative clinical effectiveness, if the intention was not to one day tie the answers from that research to cost and coverage decisions? To quote one of President Obama's top White House health advisers, Jeanne Lambrew, ``There is a bipartisan--I should be careful about the bipartisan, working the bipartisanship in the Senate. The House isn't quite as bipartisan as we would like but there has been support for investing about $1.1 billion in this economic recovery act for over two years for ARC and partly for NIH and partly for under agency activities to begin to try to say how do we get at the relative costs, excuse me, the relative effectiveness of the different services.'' That statement could be characterized as a Freudian slip. While Congress has limited comparative effectiveness research funding in the stimulus to clinical effectiveness questions, I am concerned that the sponsors of this bill and the Obama administration have plans to force on the American public coverage decisions based on comparative cost effectiveness. Make no mistake: I will vigorously fight those efforts in the future. In addition to the comparative clinical effectiveness research spending, the stimulus bill creates a structure similar to the Federal Health Board described in the book ``Critical'' by former Senator Tom Daschle. President Obama endorsed this book and has relied on Senator Daschle's advice in crafting his health care agenda. A new, bureaucratic Federal Coordinating Council for Comparative Clinical Effectiveness Research would be established under section 802 of the stimulus. The council will advise the President and Congress on No. 1. strategies with respect to the infrastructure needs of comparative clinical effectiveness research within the Federal Government; No. 2. appropriate organizational expenditures for comparative clinical effectiveness research by relevant Federal departments and agencies; and No. 3. opportunities to assure optimum coordination of comparative clinical effectiveness and related health services research conducted or supported by relevant Federal departments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources. The council would be composed of 15 members, all of whom are senior Federal officers or employees with responsibility for health-related programs. It concerns me that no attempt is made with this language to ensure council membership includes private, nongovernment experts. The American people know that medical experts at places like Harvard, Johns Hopkins, and Yale have more expertise on medical issues than bureaucrats at the Department of Health and Human Services. In the future, I will work to ensure that this council--and the American people--benefit from the expertise that resides in the minds of our country's premier medical experts. The council would report annually on Federal activities in this area and recommendations for further research. While I recognize and appreciate that the comparative clinical effectiveness research and the council in the stimulus do not go as far as the board outlined in Senator Daschle's book, I am gravely concerned that it is simply the precursor to a full-fledged Federal Health Board. In Senator Daschle's own words, a Federal Health Board may alter the traditional doctor- patient relationship by giving the Federal Health Board new powers to make coverage decisions about medical technologies, treatments, drugs, and procedures, ``Doctors and patients might resent any encroachment on their ability to choose certain treatments . . .'' The model proposed by Senator Daschle and endorsed by President Obama--and which I am concerned the stimulus lays the groundwork for-- would be disastrous for American patients. This exact model is a failed policy of the past in Great Britain's health care system. Great Britain's National Institute for Health and Clinical Excellent, NICE, evaluates new medical drugs and treatments for coverage decisions for all British citizens. An approach like NICE neglects the basic fact that medical decisions vary by individual patient and disease processes. Medicine is not simply a cold science; it is also an art that reflects each individual patient's condition. An approach like NICE will ultimately attach price tags to patients' lives and result in treatment rationing. To quote my friend Dr. Scott Gottlieb in a recent Wall Street Journal opinion editorial, ``[NICE] has concluded that $45,000 is the most worth paying for products that extend a person's life by one `quality-adjusted' year. (By their calculus, a year combating cancer is worth less than a year in perfect health.) . . . In Britain, there's vocal dissent against NICE constraints, especially among the cancer patients who are denied many effective new drugs that, for now, are widely prescribed in the U.S. The rich, of course, are able to opt out of the British controls. But the rest of the country has to appeal to politicians--rather than their doctors--to gain access to restricted medicines.'' Rather than top-down Government solutions that control costs by one- size-fits-all coverage mandates, I believe that a health care market that plays by fair rules is a far more powerful force to control costs and improve quality. The American people know it works because that competition and entrepreneurship has worked in every other American industry. I support creating a health care system where patients and doctors are able to make decisions based on individual patient conditions and needs. The American people know that bureaucrats and politicians cannot be trusted as the ultimate arbiters of medical decisions. I will vigorously oppose any efforts to take choice and individualized care away from patients and their doctors.

Mr. COBURN

Mr. COBURN. I ask unanimous consent to consume that 4\1/2\ minutes and an additional 1 minute, if the generous chairman will accept.

Mr. COBURN. Madam President, I hear the word ``legacy.'' The legacy that is going to be left from this bill is demonstrated to us by history. Here is what we did the last time we found ourselves in this shape. The Federal Government as a percentage of GDP went from 2\1/2\ percent to 20 percent in all the New Deal programs. There is a wonderful book, and people ought to read it. It is called ``The Forgotten Man,'' Roosevelt's ``Forgotten Man'' series. This is an analysis of what we did, how we did it, what worked, and what didn't. Quite frankly, what you can see from this chart is that Government never got small again. Never. And what is going to happen is, if you look outside of this chart to what we are doing now, you are going to see Government grow again. So the total State and Federal take from GDP will be above 38 percent from now on. Now, what does that mean to you? What is the legacy of that? The legacy of that is lost opportunity--not for us; we will be pushing up daisies. Our children and our grandchildren, though, will suffer from a massive decline in their standard of living. That is not to say we shouldn't do a stimulus bill. The stimulus bill we should do should be very targeted--this one is not--it should be timely--this one is not--and it should be temporary--this one absolutely is not because we are going to see this same thing happen. Even our own budget chairman, the honorable Senator from North Dakota, says, at a minimum, $124 billion a year increase in the baseline, additional spending that will never go away--never go away. So what does it mean when we say we have a legacy? Here is the legacy of this bill: The cost this year, not including interest, for every family in this country is going to be $11,000. That is what we are going to borrow against your future earnings. We will increase the baseline budget this year $350 billion. That is just this year. The increase in the annual deficit will be somewhere between $50 billion and $185 billion, before interest. And we are going to pay $438 billion in interest on this borrowed money over the next 10 years. Everybody knows that if you save before you spend, it costs you about half. But what we are doing is spending and costing the future of our children. What is the Congressional Budget Office's best guess? That we will create somewhere between 1.3 and 2.9 million new jobs. But also their best guess is that in about 10 years, this ``stimulus'' will have a negative effect on the economy. We are going to spend $15 billion to renovate offices for Federal employees. What percentage of this $800- plus billion bill will really stimulate? About 12 percent. The other thing that is wrong with the bill is that there are no brakes on it. What happens when we have two or three quarters of growth? Do you think this body will come back and take this money away? No. Politicians are averse to ever taking anything away because they care more about getting reelected than they care about what is in the long-term best interest of the country. So here we have a stimulus bill that will forever raise the baseline and the interference of Government. Now, what does this really mean if it goes to 35 percent? What it means is that you lose liberty. You lose freedom. If you think the Government is involved in the decisions you make now, just grow it another 10 percent total and see what happens. Your liberty and your freedom. It doesn't mean we shouldn't do a stimulus bill. We should. But we ought to do one that will really make a difference. The other moral hazard with this bill is that we didn't hear today what the plans are for the mortgage problems, the housing problems, or the bank problems. Now, the reason we didn't hear about that is because we have to get past this vote because when you get ready to swallow the near trillion dollars they are going to come and ask for on those two problems, this is going to seem small. But if you have to talk about both at the same time, $1.8 trillion, now we are at $25,000 per family. The fact is, what was done in this country from 1929 to 1938 didn't work. We are not even doing as good a job as they did in terms of directing the money. Yet, because of the basis of fear, we are going to pass a bill saying we have to do something. We do have to do something, but it doesn't have to be done today. It needs to be done in a very meticulous manner to make sure we get it right. There is a legacy with this bill. I will spend the last few minutes talking about the fact that there are no earmarks in this bill. That is an out and outright untruth. There are tons of earmarks in this bill, from electric golf carts, to power generations for specific lobbyists who spent well over $1 million getting it in there, to a new building for the State Department to train its security personnel. They spend $12 million a year now. They are going to spend $275 million now and still spend $12 million a year, but we get a building in West Virginia because the Senators from West Virginia want that building there. The competitiveness clause we put in, which the Senate voted unanimously on to put all contracts competitive, it will be blown out of the water, it will never come out of conference----

Mr. COBURN. Because we don't want to do what is best for the children of this country; we want to do what is best for the politicians. I yield the floor.

Mr. COBURN. Madam President, I rise to address my colleagues regarding the importance of improving access to health care in our rural communities. Rural America accounts for about 20 percent of the Nation's population, yet only 9 percent of the country's physicians. It should, therefore, come as no surprise that nearly 70 percent of the primary care health professional shortage areas are in rural communities. The disparity in access to quality health care has a substantial and tangible impact on the quality of care and the quality of life for rural Americans, who are typically older, poorer, and sicker than the population at large. That also has an impact on the economic vitality of those regions. I do not believe that the stimulus legislation is the right vehicle for the majority of the spending it contains. Of the spending it contains, I note that the bill spends a substantial amount of money for health care in rural communities. This spending is directed toward health care access points, health information technology, workforce training development, and broadband deployment. At this point, it is likely some version of this package will move forward. As Congress spends this money, I would encourage my colleagues to give appropriate focus to preventive care and approaches that integrate these various components of health care across an entire region. Improving health outcomes for a community requires going beyond building hospitals and clinics. A regional ``systems'' approach to improving health may provide effective opportunities to improve the health outcomes of individuals and communities in a cost-effective manner. Such an approach could integrate health coverage initiatives with prevention programs, primary care clinics, advanced specialty outpatient care programs, hospital-based care, and a regional health information network. I plan to work with my colleagues to shape policies this Congress that will improve health care across America, including rural communities. Individuals, communities, private foundations, and the Government must work together if we are to be successful.

Mr. COBURN. Madam President, how much time remains on this side?

Mr. COBURN

Mr. COBURN. Mr. President, I can't say I didn't expect that we would be where we are tonight. But this country needs to know the way this bill we have been talking about, and probably the bill we are going to see, is undoubtedly the largest generational theft bill in the history of mankind. When I say generational theft, I am not just talking about money. I am talking about opportunities and I am talking about futures. There is nobody on this side of the aisle who doesn't want to do something to fix our economy and stimulate our economy. What this bill does--and the families who are listening to this right now, you ought to think: If you are one of those who are unemployed right now and hurting, $12,000 is going to be added to your debt once you get a job again, for your family. If you are struggling out there, but you are holding on, we are going to steal $12,000 from you and your kids. Then those of us who might be doing well, we are going to take $12,000 from you, so maybe that is OK in a time such as this. But what is not OK is how this bill is going to spend that money. If you like how efficient the post office is that lost $3 billion this year, and if you like the way the Federal Government works, wait until this money starts going through the Federal Government. If we have $450 billion that is going to be in programs, 10 percent of it is going to get chewed up before it ever leaves Washington. Then, when it gets to your State to supposedly be a stimulus, another 10 percent of it is going to get chewed up. So we are going to lose $90 billion because we are going to decide to run it through the inefficient bureaucracies. I would ask: What does that stimulate? Federal workers are great, but they don't produce wealth, and the money ought to go into job-creating exercises that create wealth. What is going to happen to your family? The question will be, What is going to happen if we don't do anything? We are not proposing to do nothing. There could be a true bipartisan solution to this, but that hasn't been offered. We have seen slow walked all day the inability to get amendments. It is highly unlikely any other amendments will be offered. I want my colleagues to think how can we best stimulate this economy, and how can we do no harm as we do that? This bill--this generational theft bill--does tons of harm. Let me tell my colleagues the biggest harm it does. There is no guarantee this is going to work, especially when we haven't fixed the housing and mortgage system and we haven't fixed the liquidity issue. Here is the harm it does. Every State, save California and New York, will get more money out of this bill than their deficits are today--every State. We are going to transfer, by what we are doing here, a lack of fiscal responsibility to every State. We have had Governors calling up here from all across this country saying, You are going to send us a whole lot more money than we need. I have legislators who are trying to spend money. They are slow walking me now, so I can't run this State and keep it fiscally sound. That is coming from Democratic and Republican Governors alike. We are going to transfer the incompetence of the Federal Government in Congress to every State house in this country. Think about what we are doing with $12,000 per family. One final point I will make. Barack Obama is my close personal friend. One of the things he said is that we ought to get rid of the programs that don't work. We ought to put metrics on the programs so we can measure them, and then when we look at them we will know whether we are truly investing in an adequate way. We are blindly going to invest in things and there is not one iota in this bill or the House bill that eliminates any of the $300 billion that we know is being wasted right now and can be fully documented--not one attempt to do that. So if we cared about stimulating the economy and we cared about the future and we cared about those who are having a hard time today, why wouldn't we do the hard work to get rid of what doesn't work before we spend more money on things that don't work? I would end with this. We got in trouble and we are in this mess because we spent money that we didn't have on things we didn't need. And the answer for Congress is to do more of the same. When we do more of the same, what we do is we mortgage--the only thing we are doing on mortgages is we are mortgaging our children's and grandchildren's future. This body works on the power of 60, and it will happen, but the precarious nature we find ourselves in today, the responsibility of passing this bill when most of it is not going to make a big difference--not truly going to stimulate the economy--and claiming it is bipartisan when it is not, is going to leave a legacy that nobody who votes for this bill is going to embrace. With that, I yield the floor.

Mr. COBURN. I yield back our time.

Mr. COBURN

Mr. COBURN. Mr. President, this is a simple amendment that says we ought to have a priority of what we do. It is not about being against swimming pools, zoos, museums, or anything else. It is about saying to the American people we are going to prioritize the spending on this legislation. What this amendment does is prohibit money to go to low-priority, low-infrastructure things. We have 233,000 bridges in this country that are in trouble--233,000. Instead of spending money planting trees along a causeway, what we ought to be doing is fixing the bridge that is on that causeway. So this amendment is designed to prohibit money going into these areas so we will have money next year and the year after that, or maybe redirect money within the bill to actually do something we are going to have to spend money on anyhow, rather than do something that is optional and low priority.

Mr. COBURN. Mr. President, the question we need to ask ourselves is, What is the real problem we have in the economy? And what is the best way of fixing it? Not whether somebody looks good or looks bad. How do we do what is in the best long-term interest of the country? The problem with this bill, once you really see it--and even a $100 billion smaller bill--is, it does not address the real problem. We are going to be treating symptoms, and we are going to be highly inefficient as we do that. We say we want to have a stimulus bill. Yet what we are going to do is stimulate a baseline increase in the budget every year from now on of at least $124 billion, probably closer to $300 billion, because we have not done what we say we are doing with this bill. The other thing is, the fear that is driving this bill and what might happen if we do not hurry up and get a bill is probably the worst motivation we could have. The real fear we ought to have is, have we done it right and have we not created a situation in which generations that follow us, especially the next two, will say: What were they thinking? Why didn't they do it right? Why didn't they target the money truly to stimulus instead of creating this worst of all habits--which we are now going to ensure that the States pick up and learn from us. It is a virus. It is a virus we have that says: You do not have to worry about what it costs in the long run. You do not have to target it. You do not have to be efficient. You do not have to look at programs and make sure they are working. You do not have to have metrics. Now that the States are in trouble, we are going to absorb a portion of the problems the States have because they have not been fiscally prudent, and we are going to say: We are going to bail you out. Well, think about what that says to State legislators all across the country.

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

Mr. COBURN. Mr. President, I yield back.

Mr. COBURN. I yield back my time.