Protecting Access to Medicare Act of 2014
Floor Speech
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Mr. President, first of all, I thank the chairman of the Finance Committee for his efforts in this endeavor. I am disappointed there was an unwillingness to at least have a vote on this important issue. I have been a very lucky individual. I have had the opportunity to have a career in business, and I have had a career as a Governor. In each of those cases, I had to learn business practices and accounting practices. Business accounting practices are different than government accounting practices. State accounting practices are somewhat different as well.
But I have to tell you, what takes the cake is what passes for rational accounting and scoring practices in the Federal Government and how we maintain these fictions about what are costs, what are expenses in a way where the vast majority of Americans do not have the slightest idea what we are talking about: SGR, OCO, terms we throw around in this body that have no relationship to the bottom line but prevent us from taking action to at least start the process of getting our balance sheet right, a balance sheet that right now is $17 trillion in debt, that goes up 4 billion a night.
The chairman of the Finance Committee outlined very well how this process came to be, the sustainable growth rate, where Congress 17 years ago said they saw at that point that the cost of Medicare would rise and the cost of our entitlement programs was rising. They put in place at that point what they thought was a rational solution to slowly slow the rate of growth.
The challenge was Congress immediately punted. As opposed to resolving it at that point, we have maintained this legal fiction and this accounting fiction that no one under any kind of traditional standards of accounting would accept, where we built in this cost increase, and then each year we come back and so-call patch it.
Each year we go through a fire drill where lobbyists across town harangue and harass Members of both parties on a universal basis and say: Oh, my gosh. We cannot allow this to happen. Hospitals and doctors who should be spending time providing health care or finding cheaper and better ways to deliver health care storm the halls of the Capitol to make sure we do not provide what would now be an unsustainable cut in their reimbursement rates.
But it appears to me we are now about to go, for the 17th time, one more year on a short-term patch and will one more time kick this can down the road. What we are avoiding, if we take this vote this afternoon and simply patch over an effort that was brought over from the House, an effort in the House that I would remind my colleagues never came to a rollcall vote, we will once again avoid the opportunity to start to, in effect, clear our balance sheet, to make the size of our debt and deficit--and for those of us who have been involved in this issue, to go ahead and get rid of some of the budgetary fakery that quite honestly makes so many of our other efforts that may be legitimate seem illegitimate because we cannot even clean up our books.
The chairman of the Finance Committee went through how this SGR was created in 1997 and how we have gone through annual patches. It is remarkable that the total cost of these patches actually exceeds--what we have already spent exceeds the cost of repeal. The repeal of SGR at this point is roughly $135 billion. Based upon previous budget estimates, this is the year to take this action.
What has been the challenge in the past, while there has been agreement--we heard from the Senator from Alabama, and others will come and bemoan the fact that SGR is a fakery, SGR is budget gimmickry. We have this action that is taken on every year, where doctors, hospitals, others storm the Congress and say please do not do this, and then at the eleventh hour we extend.
What has avoided opportunities in the past to get rid of this issue is that there has not been a solution, not been a bipartisan solution. But this year, due to the good work of the chairman, the ranking member of the Finance Committee and their equivalents in the House, there is agreement on what a replacement to the SGR would look like. We would move to a system that would actually fix the problem but also improve the quality of service covered under Medicare.
We would move to a payment system which would reward doctors for focusing on providing high-quality care. Doctors would actually be rewarded for talking to each other, to make sure tests and services are not unnecessarily duplicated. Doctors would be rewarded for ensuring patients have access to care when they need it, such as same-day appointments. Doctors would be rewarded for spending more time with patients and genuinely talking about the patient's priorities and concerns rather than running off to their next appointment.
These are all goals--regardless of what some of our colleagues may feel about the Affordable Care Act, these are all goals that almost all of us would agree would actually improve the quality of health care in America, and for Medicare start to help drive that cost curve back in the right direction.
If we would act on this bipartisan solution, we could make a real demonstration, even in an election year, that Congress is actually working together to solve the problem.
The chairman of the Finance Committee noted that in the 5 years I have had the honor of representing Virginia, there is no issue I have been more passionate about, involved with, than trying to find that common ground around our debt and deficit, sometimes to the chagrin of my own colleagues on this side of the aisle.
I believe getting our fiscal house in order is absolutely the top priority that this Congress and our Nation face. I believe failure to do that will squeeze out any investment in education, infrastructure, military, whatever our other priorities are. Part of that is getting our entitlement costs under control. But if we are going to get our entitlement costs under control, we have to eliminate the budget gimmicks and fakery that now are part of the process.
The primary one on the entitlement side is the SGR. We have a remarkable opportunity to get rid of this peace of budget fakery, to clear the books, to put in place a better system. I know there have been questions about the cost. I believe the chairman of the Finance Committee will soon put up a chart which will quote a periodical that does not often say good things about those of us on this side of the aisle; that is, the Wall Street Journal, which has called the SGR a "bookkeeping gimmick which merely hides Medicare's true cost by moving future spending off the balance sheet.''
Again, we have a chance to get rid of that today. What I think the chairman of Finance Committee has offered is we could actually get a two-for. We could get rid of repealing and replacing the SGR and at the same time eliminate another budget gimmickry tool, the OCO account.
I cannot understand why we would not take advantage of this opportunity to start down the path of cleaning up our balance sheet. At the end of the day, the actions we take today will not get rid of that $17 trillion in debt. It will not bring down our deficit in itself, but it will allow future actions to be dealing with an accounting system and a budget that is much truer to reality.
The chairman of the Finance Committee has called this the Medicare migraine. I think it is time for this Congress, this Senate, to actually take two aspirin, pass this replace and repeal, get rid of this migraine, and at the same time show the American people we can act in a bipartisan fashion, even in an election year.
The ACTING PRESIDENT pro tempore. The Senator from Oregon.
Mr. WYDEN. Mr. President, before he yields the floor, through the Chair, I would pose a question to the distinguished Senator from Virginia.
The Senator from Virginia has, as usual, gotten right to the heart of the long-term challenge with respect to entitlements. I have always tried to describe it as the challenge of protecting the Medicare guarantee because what seniors have is a guarantee. It is not something that is up for grabs. It is a guarantee. It is inviolate. Protecting their guarantee means that in the days ahead we are going to have to figure out new ways to hold down costs.
What I have heard the Senator from Virginia talk about very eloquently is one of the key ways to do that is what the Senator from Virginia and I have sought to do, which is to start having Medicare--start having Medicare pay for value rather than just staying with this volume-driven fee-for-service system, which largely rewards inefficiency. I think it is my sense that the Senator from Virginia believes it is very hard to start the kind of real entitlement reform we need, where we protect the Medicare guarantee and hold down costs, unless we make the kind of approach we are advocating in this repeal-and-replace strategy with SGR.
We better get to it, because until we have those changes, we cannot begin to get on with another area that the Senator from Virginia feels very strongly about; that is, chronic diseases--diabetes, cancer, heart disease, and stroke--which consume more than 80 percent of the Medicare budget. By my calculation we cannot get on that or any of the structural entitlement challenges until we do what the Senator from Virginia is talking about: Is that pretty much the way the Senator from Virginia sees it?
The ACTING PRESIDENT pro tempore. The Senator from Virginia.
Mr. WARNER. Mr. President, I would agree with the comments made by the chairman of the Finance Committee. In the repeal-and-replace proposal we have laid out ideas that again I think across the aisle there is going to be common agreement on. I know we have been joined by my good friend the Senator from Oklahoma. No one knows more about health care and has been a stronger voice on entitlement reform than the Senator from Oklahoma.
We have spent an awful lot of time wrestling with how we get to that common cause. These commonsense reforms that move us closer to quality rather than quantity are a first step.
Also, a first step is trying to relieve the annual or sometimes every-6-month fire drill we go through where health care providers across the country have to rush to Congress to try to get a patch in place, which at the end of the day we know we will put in place. The way we put the patch in place more often than not is simply passing more cost to the providers in an outyear. This is the kind of budget gimmickry that quite honestly we tried to address in our so-called Gang of 6 that would have had more constraints. We didn't get it done.
We have another opportunity today--not to solve the whole problem, but by getting rid of SGR, by getting rid of OCO, we are moving two of the accounting and gimmickry obstacles, which would help clear the decks toward the ultimate debate we are going to have about tax reform and about retirement reform. But the value is that by repealing the SGR, we would also put in place reforms that move us toward a better quality health care system for our seniors.
I know the consensus and conventional wisdom is that at moments such as these we will always punt. We will have a chance this afternoon to see whether we will punt one more time or whether we will actually--if it takes a few more days--wrestle this to the ground and come up with a common cause where we could repeal SGR, replace it with a better system, and perhaps at the end of the day get rid of not one but two gimmicks that have made our budgeting so much more difficult.
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