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Floor Statement: Medicare Reform

Medicare Reform - Thursday, June 12, 2008 View video | Can't view the video?

You don't have to be an expert in health care policy to know that our health care system is in need of reform. Today we spend $2 trillion on health care or almost $7,500 per person. In ten years, national health care spending is expected to reach $4.3 trillion -- that is, more than double -- or $13,000 per person, which would comprise almost 20% of our gross domestic product. Clearly this rate of growth is unsustainable. While we should be enacting legislation to address this health care crisis, Congress is once again bogged down in debate on how to prevent physician payment cuts from going into effect. Meanwhile, the Sustainable Growth Rate, the S.G.R., which is the formula for these Medicare payments to physicians, has only increased costs, decreased beneficiary access and quality of care, and discouraged future generations of physicians, especially in primary care. If Congress fails to act, Texas physicians will lose $860 million between July 2008 and December 2009. That's $860 million. Which is a cut of $18,000 per Texas physician. That figure balloons to $16.5 billion dollars by 2016 due to nearly a decade of scheduled cuts.

It's great that members of Congress and outside coalitions are presenting health care reform plans, but they're ignoring the fundamental pr problem. You can have a great plan, you can have great coverage, but none of that's any good unless you have access to that coverage. Physician reimbursement cuts have been looming over our head for years. In fact, since 1996 and the passage of the Balanced Budget Act. Yet Congress continually decides to put off for tomorrow what desperately needs to be done today. So every year Congress cuts segments of health care services either rightly or wrongly to prevent these cuts.

I firmly believe -- and I can tell you that physicians in my state firmly believe -- that short-term fixes are not the solution -- last one was a six-month fix which will expire shortly. I don't know anyone else in the private sector, whether they be a physician or a small business, can continually plan based on the vagaries of a six-month fix and without really knowing whether they'll simply be put out of business or what the Congress will come up with as a solution on a six-month basis. We need a longer-term solution, in other words. And we can't address greater health care costs until we fix the mess caused by the S.G.R. Or the Sustainable Growth Rate formula for Medicare reimbursements.

Over three months ago, in anticipation of the looming physician payment cut set for July 1, I introduced legislation that addressed the issue at hand permanently. Even the proposal we're going to vote at 3:00 is only good for 18 months and I think we need a permanent solution. My legislation is entitled, "Ensuring the Future Physician Work Force Act of 2008, (S.2729)" and it provides positive reimbursement updates for providers, it eliminates the ineffectual expenditure cap known as S.G.R., and it increases incentives for physician data reporting. At the same time, this bill facilitates the adoption of health information technology by addressing costs and legislative barriers, educates and empowers physicians and beneficiaries in relation to Medicare spending and benefits usage, and studies ways to realign the way Medicare pays for health care in this country.

My bill doesn't mandate whether physician payments should be based on utilization, performance, care, coordination, or any other particular methodology. My bill does start to lay down a new path toward reform, innovation and restoration of the eroded physician-patient relationship. It does say that providers and beneficiaries should not be the ones to be punished by Congress' inaction. Why Congress decided in 1996 to try to balance the budget on the backs of health care providers is beyond me, because beyond the challenges that that presents to the health care providers, it's diminished access to health care because more and more physicians refuse to take new Medicare patients because the reimbursement rates are simply so low. In Travis county, where Austin, Texas, is located, there was a story published in the "Austin American Statesman" recently that said that only 18% of physicians in Travis county are accepting new Medicare patients. And I would like to say that's an isolated incident, but it's not.

Mr. President, this is a huge issue and deserves serious and thoughtful deliberation. The last time the majority party held a hearing on physician payment reform was almost 16 months ago, almost exactly a year before I introduced "Ensuring the Future Physician Workforce Act of 2008." Yet there's been zero legislative activity, let alone introduction of language addressing this critical issue from a long-term perspective. Again, we've been stuck in the same, old rut of coming up with temporary fixes, including the six-month fix that will expire July the 1st. I'm disappointed that by Congress's inaction in this regard and I do believe that Congress needs to do more than just simply kick the can down the road for another few months and put off a solution that we really ought to be working toward on a bipartisan basis and embracing today.

Now, my colleagues on the other side of the aisle I think have missed a major opportunity to take positive steps forward. They present a bill unfortunately we're going to vote on at 3:00 that bypassed the committee, ignores the importance of bipartisan input and contributions and they are determined to have a vote on a bill that they know has no chance of becoming law. Because, as we all know around here, no bill has a chance of becoming law unless it is truly a bipartisan product. The rules and traditions of the Senate guarantee that, and that's one of the things that makes sure that when we vote on things, they have broad support, represent a consensus position and that they are, in the few of the vast majority of Senators, in the best interests of the American people. But when you try to force a bill that is strictly partisan, has very little bipartisan support, we know what will happen and that's what's going to happen this afternoon on this vote. They don't become law.

The American people were promised a different way of legislating by the majority when they took power, but we've seen, unfortunately, this sort of gamesmanship occur time and time again, and I heard Senator Schumer, the Senator from New York, the Chairman of the Democratic Senatorial Campaign Committee, rail against obstruction of their legislative agenda. But you know, it's almost a sure thing when all do you is take a partisan position on legislation and you refuse, as the Majority Leader has done, to allow an amendment process like he did last week on the Climate Tax Bill and you deny full and fair debate. It's virtually a guaranteed result -- a failure -- when you take sort of approach to legislation. And that's what's going to happen again this afternoon.

Now, because the Chairman of the Finance Committee has chosen to take a partisan approach on this legislation, we have come up with an alternative that offers solutions to physicians, seniors, and taxpayers. This alternative will provide doctors with a positive increase in their reimbursement rates, extend critical programs, and reform payments to Medicare advantage plans and also implement many other necessary changes to the Medicare program. This alternative legislation includes provisions for e-prescribing, closely mirroring legislation I co-sponsored earlier this year.

We really need to change our ways here in the United States Senate, and rather than just trying to check off a box saying, yeah, we threw up a partisan effort that we know is going to fail and now we can claim that we were the champions of reform while the ones who would not allow this partisan process to go forward are obstructing it. We need to get together and work in a bipartisan way to ensure Medicare beneficiaries not only have the coverage they need and deserve but also the access which is guaranteed by a fair rate of compensation for physicians.