Foreign Intelligence Surveillance Amendments Act of 2008--Continued
Floor Speech
FOREIGN INTELLIGENCE SURVEILLANCE AMENDMENTS ACT OF 2008--Continued -- (Senate - July 08, 2008)
BREAK IN TRANSCRIPT
Mr. CORNYN. Mr. President, Medicare provides important health care benefits for our Nation's seniors. Since 1965, the Federal Government has promised that those over the age of 65 years, or those afflicted with certain disabilities, will have access to health care. Unfortunately, Congress has had a checkered history of keeping that promise.
The vote we had 2 weeks ago, to which the distinguished Senator from Michigan just alluded, and one we will apparently have tomorrow afternoon, should be an embarrassment to Congress but not for the reasons that she and others have suggested. We should be looking to solve the looming problems with Medicare permanently, not just with temporary patches or fixes. We need a permanent solution. We should keep our promise to seniors that they can rely on Medicare and provide fair compensation for the physicians to make sure our seniors will actually have access to that coverage.
I have repeatedly heard from seniors in Texas who depend on Medicare that they find it hard to even find a physician who will accept below-market Medicare reimbursement rates. Even if we pass an 18-month extension now, I am not optimistic Congress will seriously consider permanent reform before the next round of scheduled cuts. And I shudder to think whether we can prevent the 20-percent cut that will occur 18 months from now.
This, of course, should not be about partisan politics, which it has become, because this is about people's lives. The Medicare Program, simply put, is in a nosedive headed for bankruptcy. As this chart demonstrates, without a long-term solution, the future is bleak indeed for Medicare providers.
This chart depicts how the practice costs of physicians continue to go up year after year. Yet because of a law Congress passed in 1997, Medicare reimbursement rates continue to be projecting downward. You can see the gap here. No wonder many physicians are no longer able to accept Medicare patients.
In Texas recently, a survey of physicians indicated that only 58.1 percent of physicians currently accept new Medicare patients because reimbursement rates are so low that they are below market and physicians cannot afford to accept those patients and those low Medicare reimbursement rates.
Congress needs to step up with a permanent solution, not the kind of shameful temporary patches and fixes that require physicians and other health care providers to come hat in hand to Congress every 6 months or 12 months or 18 months and that leave Medicare beneficiaries in doubt--our seniors--about whether, in fact, Congress will do its duty.
No one gets to conduct their business this way, other than the Congress. If you were in the private sector, a small or large business, you would be out of business or behind bars if you tried to operate your business the same way Congress has dealt with Medicare reimbursement rates.
The Medicare trustees expect future costs to increase at a faster pace than both workers' earnings and the economy overall. As a matter of fact, the Medicare Hospital Insurance Fund will be exhausted by 2019, and Part B premiums will have to increase rapidly to match expected expenditure growth. The Medicare trustees have warned Congress more than once to act, cautioning that the sooner the solutions are enacted, the more flexible and gradual they can be.
Mr. President, Medicare is a ticking time bomb. Today, Congress should be all about debating and preserving Medicare. Instead, we have been presented a bill that turns a blind eye to this smoldering powder keg of long-term Medicare problems and the terribly flawed physician payment system. Rather than real reform, the majority party--the Democratically controlled Senate--has presented us with a bill that prolongs damaging and rigid price controls, sets up increased premiums and increased taxes, abandons some private sector options, and keeps Medicare on the path toward more health care rationing.
Why would anyone be proud of this? The distinguished Senator from Michigan was saying that all they needed is one more vote to pass this partisan bill. Why would anyone be proud of this temporary fix, these price controls, along with submarket reimbursement rates, so that while we make the promise of Medicare coverage, the actuality of access is diminishing with each day?
This partisan bill bypassed not only the minority in the Senate, it bypassed the Senate Finance Committee as well. Now we are told by the majority leader that he will refuse the opportunity to offer any amendments when the bill comes to the floor. The Democratic-controlled majority has not held one hearing or introduced one piece of legislation in the last 6 months that begins to address the long-term problems.
Mr. President, I intend to offer a bill that will begin the process of reform and permanently eliminate the periodic cuts that are almost never allowed to go into effect. I think seniors and physicians and the American people deserve explanations and answers, and ultimately solutions, rather than more posturing and just kicking the can down the road.
It is worth taking a few minutes to recall how we got here in the first place.
In 1997, Congress was struggling with rising costs under Medicare and passed the Balanced Budget Act, which established something called the sustainable growth rate, or a formula which was intended to serve as a restraint on Medicare spending. Thus, the Federal Government instituted arbitrary price controls in an effort to reduce Medicare spending. What was the result? Well, the SGR--the sustainable growth rate--formula and arbitrary price controls have reduced access to quality care for beneficiaries.
While the first 2 years after implementation the SGR resulted in positive updates for physician payments, decreases in payments have been required every year since 2002. But what has been the experience of Congress? This chart indicates that except for the first year, in 2002, Congress has acted to reverse the cuts that have come with a temporary patch, and temporary fix after temporary fix. In fact, I think one could be forgiven for wondering whether Congress ever intended these cuts to take effect in the first place.
Thank goodness we haven't because continuing to cut into the muscle and
then into the bone of the Medicare system means that the promise of Medicare coverage is a hollow one indeed for patients, for seniors, who are increasingly having a very difficult time finding physicians who can accept Medicare rates because they are so low.
As you can see from this chart, not only has Congress, except for 2002, not allowed these cuts to go into effect based on temporary patches, it has actually provided a very modest update in most years, except for 2007, when it just got back to zero. But the fact is, Congress never really intended or was never prepared to allow these cuts to go into effect. Most of the time, if you look for how Congress has attempted to ``pay for'' or find revenue to offset this reversal of these cuts, all it amounts to is budgetary gimmicks and games.
As the American Medical Association has noted, ``every temporary intervention has increased the cost of a permanent solution.'' Thus, seniors and physicians find themselves coming back to Congress every 6 months or every 18 months hat in hand seeking to prevent these cuts with the kind of histrionics that we see on the Senate floor today and that we saw by the majority leader just 2 weeks ago after the failed cloture vote--not a serious discussion of public policy but, rather, a political action designed to gain partisan advantage.
At this point, to repeal the SGR formula created by Congress will cost an estimated $250 billion or more. That is a big number, and a major reason Congress has been unable to pass, or more likely unwilling to even debate, a long-term solution. While many of my colleagues have spoken at great length about their grandiose plans to reform the entirety of America's health care system, they seem to whistle past the Medicare graveyard.
We can and we must do better. What good is Medicare if there is no access to coverage? Even with reversing the Draconian cuts in reimbursement, as I said, many doctors refuse to even see patients with Medicare because the payments are so low. Yet Congress is seen patting itself on the back saying: Didn't we do a good job? Only to have more and more seniors unable to find doctors willing to accept Medicare payments.
Physician reimbursement cuts have been looming over the heads of seniors and physicians for years. Yet Congress repeatedly puts off until tomorrow what desperately needs to be done today.
What does the bill before use to pay for reversing these cuts for 18 months? Well, it undermines the one private sector alternative to traditional Medicare--Medicare Advantage--currently subscribed to by about 450,000 Texas seniors, leading to less choices, fewer services, and, yes, more government control.
We have a choice. Do we pass the hot potato once again, praying that we are not the ones who get burned, or do we stand up, do the responsible thing, and actually take decisive action by reforming the broken SGR formula for Medicare reimbursement?
While some in Congress seem determined to have the Government control all health care decisions, competition in the private sector holds real promise for the future of health care, and we do not have to look very far to find the proof. All we have to do is look at Medicare Part D, the prescription drug program that we passed a few short years ago.
The Congressional Budget Office recently released a report showing how effective Part D has been in lowering drug prices for seniors. This year, Part D expenses will be almost half that of the original projections 2 years ago. Competition by private companies that provide benefits for seniors under Medicare Part D has actually created about $40 billion in savings this year. What's more, Part D will be returning roughly $4 billion this year in unused funds due to cheaper than expected drug purchases.
Still, with the resounding success of Medicare Part D and the competition we should look to as a model, not one to be discarded or gutted or cannibalized in an effort to pay for this temporary patch, many of my colleagues want to give up on the private sector alternatives to traditional Medicare. Competition created by programs such as Medicare Advantage has the potential to save more money in the long run and to provide more choices and better quality services to Medicare beneficiaries.
I would be the first one to say that Medicare Advantage is far from perfect. As a matter of fact, I have heard from many of my constituent physicians who have complaints about the way Medicare Advantage is run. But it would be a terrible mistake to gut it. We ought to fix it, not gut it.
Rather than abandoning the principles of the benefits of competition in health care, we should work to make it better. With the results of Medicare Part D as an example, we should work to increase the role of nongovernment entities in lowering costs and increasing access and affordability of health care.
These are only a few of the reasons why, over 3 months ago, in anticipation of the looming physician payment cuts set for July 1, I introduced legislation that solves this problem permanently. This legislation I called Ensuring the Future Physician Workforce Act of 2008. It provides positive reimbursement updates for providers, it eliminates the ineffectual expenditure cap, and increases incentives for physician data reporting. At the same time, this bill facilitates adoption of health information technology by addressing costs and legislative barriers; it educates and empowers physicians and beneficiaries of Medicare spending and benefits usage, and studies ways to realign the way that Medicare pays for health care.
My bill does not mandate whether physician payments should be based on utilization, performance, care coordination or any other methodology, but it does start to lay down a new path toward reform, innovation, and restoration of the eroded physician-patient relationship. It does say the providers and beneficiaries should not be the ones to be punished by Congress's failure to act. We have to decide now.
Mr. President, I ask unanimous consent for 3 additional minutes to speak.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CORNYN. Mr. President, we have to decide now whether Medicare is worth protecting or whether political gamesmanship and partisan politics are going to take over. While it is costly to fix Medicare and the SGR, stalling will be far more expensive. So while some of my colleagues on the other side of the aisle may be content with another shortsighted, short-term fix, I suggest we debate and pass a bipartisan solution that will keep the promise of Medicare for seniors but also make sure there will be access to that coverage by providing fair compensation for physicians. Why should we, and why should they, settle for less?
I yield the remainder of my time.
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