Small Business Lending Fund Act Of 2010

Floor Speech

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A SECOND OPINION

Mr. BARRASSO. Mr. President, I come to the Senate floor again today as someone who has practiced medicine in Casper, WY, taking care of families there since 1983. I come also as the medical director of the Wyoming Health Fair and someone who has brought low-cost blood screening to people, looking for ways to help with early detection of medical problems, whether it is high blood pressure or diabetes or cancer because so often early detection means early treatment and, as a result, longer survivability and better care.

So I come to the floor of the Senate today with a doctor's second opinion about the health care law that was signed by the President a little over 100 days ago. The goal, of course, of health care reform was to lower the cost of care, to increase the quality of care, and to increase the access to care around the country. Since this bill was signed into law, we have heard week after week of new unintended consequences. We hear the personal stories of people whose lives have been affected because of the law, whose lives have been impacted by the unintended consequences of the law.

During the entire debate, I was concerned if the legislation passed and became law that it would be bad for patients relying on our health care system, bad for providers--the nurses and the doctors in this country who take care of patients--and bad for payers because I believed the law would drive up the cost of care, making insurance more expensive, and also have an impact on the taxes people would pay. So I have come each week, as I do today, with this doctor's second opinion of things that have happened during the past week; new things that we have learned about the health care law and what is happening with trying to provide health care to so many Americans but also people worldwide.

As part of the discussion of this health care law, there was a discussion about the Canadian health care system and the British health care system. We now have in charge of Medicare and Medicaid in this country someone who has said he is in love with the National Health Service, which is the British health care system. So, Mr. President, I come to the Senate floor today having come across an article in a British paper--the Sunday Telegraph--about their National Health System--a system who some in this country have held up as a model. It is a system I look to as one that results in people having care delayed and care denied.

When I look at the survivability of patients after, say, cancer in the United States, we know patients with cancer survive longer in the United States than in Britain or in Canada, and not because our doctors are better but just because people receive more timely care.

Mr. President, I am going to quote from this article, but I ask unanimous consent to have printed in the Record the entire article.

The ACTING PRESIDENT pro tempore. Without objection, it is so ordered.

(See exhibit 1.)

Mr. BARRASSO. Mr. President, this article, as I said, is from the Sunday Telegraph, and the headline is ``Axe falls on NHS services.'' This is dated July 24, and it talks about some of the most common operations performed in England, including hip replacements and cataract surgery. I am an orthopedic surgeon, so I have done many hip operations, but this is what the article says:

Many of the most common operations--hip replacements and cataract surgery--will be rationed as part of attempts to save billions of pounds, despite government promises that front-line services would be protected. Patients' groups have described the measures as ``astonishingly brutal.'' An investigation by The Sunday Telegraph has uncovered widespread cuts planned across the National Health Service, many of which have already been agreed by senior health service officials. They include: Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery, and orthodontic procedures. Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, ..... the closure of nursing homes for the elderly ..... a reduction in acute hospital beds, including those for the mentally ill.

The article goes on:

Thousands of job losses at NHS hospitals, including 500 staff to go at a trust where cancer patients recently suffered delays in diagnosis and treatment because of staff shortages.

They are cutting 500 more staff positions there. The article continues:

The Sunday Telegraph found the details of hundreds of cuts buried in obscure appendices to lengthy policy and strategy documents published by the trusts. In most cases, local communities appear to be unaware of the plans.

When we read on in this article, it is very disturbing. If I were living in Britain, I would be very disturbed. As someone living in the United States, with a new person now in charge of Medicare and Medicaid who has said he loves what is happening in the British health care system, I have great concerns.

The article also says:

As well as sending more patients home to die, the paper said the savings would be made by admitting fewer terminally ill cancer patients to hospital because they were struggling to cope with symptoms such as pain. Instead, more patients would be given advice on ``self management'' of their condition.

In other words, essentially telling them to go it alone. These are very disturbing words and a very disturbing situation now occurring in Britain.

Next, there is an article that appeared in Tuesday's New York Times--yesterday's New York Times--entitled ``Settling Down to a New Job, but Hampered by Old Words.'' This is an article about the new Director of Medicare and Medicaid. This article by Robert Pear talks about the fact that the new administrator has never had a confirmation hearing, never had a confirmation hearing and never had to respond to the American people through Congress to the questions that the American people have about the person who is newly in charge of Medicare or Medicaid, especially when we see the hundreds and hundreds and hundreds of billions of dollars spent every year by Medicare and Medicaid.

The article says he never had a confirmation hearing and has not responded publicly to critics. It goes on to say:

The White House has declined to make him available for an interview.

Amazingly, the budget--we hear so much about the Pentagon and the military budget--but, amazingly, the budget of Medicare and Medicaid is larger than the budget for the Pentagon. Here we have someone newly appointed, in a recess appointment, someone in charge of Medicare and Medicaid at a time when this Congress, through its action and the laws signed by the President, cuts $500 billion from our seniors on Medicare and does it without having someone come and explain to Congress how he plans to keep the quality of care up or try to keep the quality of care up at a time with such cuts--not to save Medicare but to start a whole new government program.

Dr. Berwick, it goes on to say, ``has received an honorary knighthood from Queen Elizabeth II in 2005,'' because of his love of the British health care system. In fact, they quote him here in this article saying, ``I am romantic about the National Health Service.'' He says, ``I love it.''

The other thing so interesting, at this time in the history of the United States, is we now have someone in charge of Medicare and Medicaid who says that ``any health care funding plan that is just, equitable, civilized and humane must--'' and he repeats the word ``must''--``must redistribute wealth from the richer among us to the poorer. .....''

It is no surprise that this week in a report out Monday, 58 percent of Americans, in a Rasmussen poll, favor repeal of the health care law. Fifty-eight percent of Americans favor repeal of a law that was forced down their throats, with people around the country saying no, don't do this to us, we do not want to go in that direction. But this Congress, this body, felt it knew more than the American people.

I talked a little bit about the British health care system. People also look to
Canada where, as the President said to us when we had our roundtable discussion in January, the summit at the White House, he said: Everybody in Canada gets coverage.

There is a big difference between coverage and care. It is interesting where things are turning in Canada. It is in Regina, which is the birthplace of Canada's socialized health care system. That is where, in 1962, the bill was passed and the law was signed for a government-run health care system. Now the health care plan there is contracting out CT scans to the private sector. They are contemplating private reforms because the government system is failing.

Some people say: But in Canada everybody has a doctor. According to the Canadian Medical Association, this report shows 4 million to 5 million people still do not have a family physician.

By the government's own standards in Canada--and that is a government and those are standards where they are used to waiting in line, where they expect long delays--even according to their own standards they are saying the Canadians are now waiting too long for care. This is even after massive increases in spending.

They go on to talk about how much better the care is in the United States, in terms of surviving cancer, surviving heart attacks, surviving transplants--because in America there is greater access to preventive screening tests and higher treatment rates for chronic illnesses. So Canada is rethinking their system. Britain has announced they are rethinking their system under the new Prime Minister there, and the new government. They are cutting significantly more.

That brings us back to Dr. Berwick, who said ``the decision is not whether or not we will ration care, the decision is whether we will ration with our eyes open.''

It is no surprise that many people across this country view this nominee the same way that a former nominee who received a recess appointment was viewed. I will quote at the time Senator Obama when he was talking about a recess appointment made by then President Bush. He talked about the appointee, saying, ``He's damaged goods. He'll have less credibility.''

That gets back to the New York Times headline, ``Settling Down to a New Job But Hampered By Old Words.''

Does the public deserve a hearing for this Medicare appointee? Does the public deserve a hearing? Do they have a right to hear what this man has to say? According to the Washington Post, in a headline of their July 23 editorial, ``The public deserves a hearing for a Medicare appointee.''

This goes on and says, in explaining his move to sidestep the Senate:

President Obama said in explaining his move to sidestep the Senate and use a recess appointment to install Donald Berwick to run Medicare and Medicaid--they had some reasons.

But they go on to say:

Mr. Obama's hurry would have been more understandable had he not waited for more than a year to select an administrator. .....

Now the President has resubmitted Dr. Berwick's nomination, as is the general practice here, and those Members of this body and specifically those on the Senate Finance Committee, want and have made a reasonable request for a confirmation hearing. Still, none has been planned.

It is interesting because the American people still want to know more about this nominee, what his beliefs are, and what we have to go by are the quotes. I have gone through a number of them now.

The question comes also to what questions does Dr. Berwick not want to answer. When one looks into the past, you say: He is a doctor, he is going to be involved with health care, he is going to likely have to live under the system with Medicare and Medicaid. I am sure he is not going to establish something that is going to impact his health personally. But that gets back to the source, where Dr. Berwick has come from. It turns out Dr. Berwick does not need to worry about those things. He does not have to deal with the anxieties the rest of America deals with, created by limited access to care and the extent of coverage. I am reading now from an article from Washington, from the Examiner:

As it turns out, Berwick himself does not have to deal with the anxieties created by limited access to care and the extent of coverage.

It goes on to talk about a ``special benefit conferred on him by the board of directors of the Institute for Health Care Improvement,'' where he came from, ``a nonprofit health care charitable organization that he created and which he served as chief executive officer.''

He and his wife will have health coverage ``from retirement until death.'' He has now retired to come work for the government, to be the head of Medicare and Medicaid. According to page 17 of his employment contract, under postretirement health benefits, ``health care coverage from retirement until death.''

How many others can look for that sort of benefit who are working for nonprofit charitable organizations? Maybe he does not want to answer those questions. The Senate has a right and the American people have a right to ask the questions.

I also found it interesting that for somebody at a nonprofit charitable organization, that that benefit of health care from retirement until death went along with the salary he earned. His compensation in 2008--$2.3 million, in a nonprofit charitable organization. I think it is reasonable for people to want to ask the questions, where does the $12 million in contributions come from? Where are the grants? How did it come in? What impact are those people going to have and try to have on you as you work on rules and regulations in Medicare and Medicaid? Those are reasonable questions that the American people would want to have answered, yet we do not have the answers.

As a doctor, I go home every week, visit the people in Wyoming, and visit with doctors and nurses and patients. One of the things that strikes me is the last report--they talk about side effects. ``Obamacare,'' it says, ``Could Punish Docs for Better Quality Care.''

That is what I hear about the most at home from doctors who are taking care of their patients, saying: I do a good job, I do everything I can. Yet the rules and regulations are going to punish me for doing what I know is right for my patients.

Part of that is rules and regulations that are coming out of Medicare and Medicaid and the Secretary of Health and Human Services who is developing these with financial incentives dealing with patient outcomes. One of the things they want to do is punish people, punish physicians and hospitals by penalizing them if a patient returns to the hospital after they have been discharged within a certain number of days.

One of the finest hospitals in this country is the Cleveland Clinic, specifically relating to heart conditions. People from around the world--kings, sultans, queens--come to the Cleveland Clinic. Some fly in in their private jets. Why? Because of the quality of care at the Cleveland Clinic--very understandable.

It is interesting, when the Cleveland Clinic took a look at their numbers, seeing how they are likely to do under the scenario that the Secretary of Health and Human Services says is the way to improve care in this country, the clinic found--it has to do with people with heart failure, people who are being readmitted to the hospital, patients with heart failure. It is considered to be a sign of poor quality care when a heart patient must be readmitted for further treatment.

What the clinic did is they studied their readmission rates and they found that their readmission rate, in a 30-day period, was actually much higher than the national average. So they must not be a very good hospital, according to the Secretary of Health and Human Services, because that is how they are being judged.

But when you look at the Cleveland Clinic in terms of how the patients do, how many live for much longer, what we find out is that the survivability of the patients at the Cleveland Clinic is also much longer. More people survive. The results are better. So if you are a patient with heart failure, you want to go to the Cleveland Clinic. If, on the other hand, you are somebody who works at Health and Human Services and are just keeping the records, they are going to say: You don't want to go there because some people come back into the hospital.

Once again, we have a situation where government is saying one thing
and people--doctors, nurses, patients, families--know that the government is wrong and we should trust the doctors to make the right decision.

That is why I return to the floor today to say it is time to repeal and to replace this health care law. We need a patient-centered health care bill. We need to replace anything that is either insurance company centered or government centered, and be patient centered. We can do that by allowing patients to buy insurance across State lines, to give people who buy their own health insurance the same tax breaks that the big companies get; by providing individual incentives for people who stay healthy, take preventive measures, lose weight, get their diabetes under control, get their blood pressure down, quit smoking--provide those incentives because that will lower the cost of care.

We need to deal with lawsuit abuse and the expenses of unnecessary tests provided by doctors practicing defensive medicine. We also need to allow small businesses to join together to buy health insurance much more effectively.

Those are the things that will work to get down the cost of care, increase the quality and increase the access. That is why today I offer my second opinion: It is time to repeal and replace this health care law.

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