Senate Proceeding on Oct 21st, 2009 :: 3:53:55 to 4:06:45
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3:53:44 to 3:54:04( Edit History Discussion )

Chuck Grassley: sustainable growth rate. generally around here we refer to that as t s.g.r. it's the formula f reimbursement of doctors under medicare. it w designed in the first instance to control physician spending and to determine annual physician payment updates by means of a targeted growth rate

3:53:55 to 4:06:45( Edit History Discussion )
Speech By: Chuck Grassley

3:54:05 to 3:54:27( Edit History Discussion )

Chuck Grassley: system. but the s.g.r. is not the only problem with the medicare physician payment system. everyone who knows any about physician payments and medicare knows that this s.g.r. formula is not working. it's a fee-for-service system

3:54:28 to 3:54:49( Edit History Discussion )

Chuck Grassley: that rewards quality or this means that medicare simply pays more and more as more and more procedures and tests and services are provided to patients. providers that offer higher

3:54:50 to 3:55:12( Edit History Discussion )

Chuck Grassley: quality care at a lower cost get paid less. somehow it's a backwards a perverse system. and it's one of the driving force behind rising over utilization of health care, particularly in some parts of the united states.

3:55:13 to 3:55:36( Edit History Discussion )

Chuck Grassley: in addition, the sustainable growth rate formula itself is the s.g.r. is designed determine annual physician payment updates by comparing actual expenditures to expenditure targets. the purpose of the g.s.r. was to

3:55:37 to 3:55:57( Edit History Discussion )

Chuck Grassley: put a break on runaway medicare spending. the s.g.r. was intended to reduce physician payment when spending exceeded growth targets. in recent years medicare physician spending has

3:55:58 to 3:56:18( Edit History Discussion )

Chuck Grassley: those that has physician payments being cut. as the magnitude of these payment cuts has increased over time, congress has stepped in to avert these scheduled cuts in

3:56:19 to 3:56:40( Edit History Discussion )

Chuck Grassley: reimbursement to doctors. now in a round about way the s.g.r. has been serving its purpose. numerous improvements in medicare payment in other areas have been implemented over the years to offset or to pay for the various so-called doc fixes

3:56:41 to 3:57:02( Edit History Discussion )

Chuck Grassley: that we've had to do and generally do them on an annual basis. presently they were done on an 18-month basis expiring december 31st of this year. we should, in fact, be reforming physician payments. that's why i supported the s.g.r. amendments offered by my

3:57:03 to 3:57:24( Edit History Discussion )

Chuck Grassley: colleague, the senator from texas, during the senate finance committee markup that concluded just eight days ago. those amendments would have provided a physician update for the next two years. and if we

3:57:25 to 3:57:47( Edit History Discussion )

Chuck Grassley: the debate on the flawed stabenow bill, i'll have an alternative to offer good friend, the chairman of the senate budget conrad. a conrad-grassley amendment would be a bipartisan approach to this. realigning incentives in medicare program and paying for quality rather than quantity of

3:57:48 to 3:58:10( Edit History Discussion )

Chuck Grassley: services is, of course, an essential part of physician payment reform. but as fundamentally flawed as the physi s. fundamentally flawed.

3:58:11 to 3:58:32( Edit History Discussion )

Chuck Grassley: s. 1776 would add -- can you believe this -- add a quarter of a trillion dollar cost to national debt. a quarter of a trillion dollars, obviousl but worse yet it does not fix the problems tt we have

3:58:33 to 3:58:53( Edit History Discussion )

Chuck Grassley: the physician payment system. it just simply gives a permanent freeze to the american association of neurological surgeons and the congress of neurological surgeons oppose the stabenow bill for precisely that reason. and i applaud them for having

3:58:54 to 3:59:14( Edit History Discussion )

Chuck Grassley: the courage to say so. my majority leader, claims that this bill has nothing to do with health reform. well, i think it has everything to do with health reform. he say to this bill is just correcting,

3:59:15 to 3:59:35( Edit History Discussion )

Chuck Grassley: in his words, discrepency." merely, in his words, "a budgetary problem." a problem that needs to be fixed. but i don't believe anybody is going to not even "the washington post". so i would have here a recent

3:59:36 to 3:59:58( Edit History Discussion )

Chuck Grassley: editorial. they said -- quote -- "$247 billion is one whopper of a discrepency." and to fix a budget payment discrepency. it is being offered as one

3:59:59 to 4:00:19( Edit History Discussion )

Chuck Grassley: whopper of a backroom deal to enlist the support of the american medical association for a massive health reform bill that's being written behind closed doors. nobody is being fooled. what is really going on in this

4:00:20 to 4:00:41( Edit History Discussion )

Chuck Grassley: body, the in the world, the united states senate. when president obama spoke to the joint session of congress last night -- or last month it was. it was the week after back from our made a commitment to not

4:00:42 to 4:01:02( Edit History Discussion )

Chuck Grassley: dime to the deficit, now or in the future. and those are his words, not mine. but article or editorial notes, s.

4:01:03 to 4:01:23( Edit History Discussion )

Chuck Grassley: 1776 would add dimes to the deficit. let me put that another way. 2.47 trillion dimes to the deficit. so we go to chart two now.

4:01:24 to 4:01:44( Edit History Discussion )

Chuck Grassley: that woulde 2,470,000,000,000 dimes. rotunda. and it would fill the capitol rotunda 23 times, not just so now we have chart three. i wholeheartedly agree with the

4:01:45 to 4:02:05( Edit History Discussion )

Chuck Grassley: editorial's the "post" editorial said, and i'm quoting -- "a president who says that he is serious about dealing with the dire fiscal picture cannot credibly begin by charging this one to the national credit card." highlighted out of that same

4:02:06 to 4:02:30( Edit History Discussion )

Chuck Grassley: editorial. the office of management and budget and the treasury department just announced that the fiscal year 2009 deficit hit a record according to the government accountability office, public debt is projected by the year 2019 to surpass the record that

4:02:31 to 4:02:51( Edit History Discussion )

Chuck Grassley: was set in 1946, one year after the end of world war ii, and that debt was attributable to the war which was the war to save the world democracy's -- for democracies because of the dictatorial governments of

4:02:52 to 4:03:14( Edit History Discussion )

Chuck Grassley: and japan, as you recall from history. there is no doubt that fixing the flawed physician payment system is something that must be addressed, but the -- but the problem, this problem with the phicians' payments is one of the biggest problems in he

4:03:15 to 4:03:36( Edit History Discussion )

Chuck Grassley: care that needs fixing. but at a time when the budget deficit has reached an all-time high of $1.4 trillion, ts situation demands fiscal discipline. as "the washington post" correctly has pointed out, s. 1776 is indeed a test of the

4:03:37 to 4:03:57( Edit History Discussion )

Chuck Grassley: president's pledge to pay for health care reform. repealing the s.g.r. without a offsets, as 1776 would do, is a flagrant attempt to try and hide the true cost of comprehensive

4:03:58 to 4:04:18( Edit History Discussion )

Chuck Grassley: health care reform. and let me suggest to the american people that that bill comprehensive alth care reform, at least the one that came out of the senate finance committee, is that thick at 1,502 pages that we all are committed to reading before it

4:04:19 to 4:04:44( Edit History Discussion )

Chuck Grassley: goes to the floor. that bill, of course, won't go to the floor because now it's being emerged in secrecy with the senate health committee bill, and so it may come out this thick. who knows? and we're talking about a great deal of costs connected with that and the s.g.r. fix being

4:04:45 to 4:05:07( Edit History Discussion )

Chuck Grassley: connected with tha as well. now, we have in the senate finance committee bill that was reported out, significant payment system reform. that bill takes savings of almost half a trillion dollars to fund a new entitlement program outside of medicare. the priority for medicare savings should be fixing

4:05:08 to 4:05:28( Edit History Discussion )

Chuck Grassley: medicare probls, and the physician payment issue and the s.g.r. is the biggest payment system problem in medicare today. it should get fixed in health care reform with those medicare savings. so, mr. president, i must

4:05:29 to 4:05:51( Edit History Discussion )

Chuck Grassley: therefore object not to fixing the s.g.r. and improving the system for physicians' payments, which clearly must be done, but to this very it's only a permanent payment freeze. it doesn't fix the problem.

4:05:52 to 4:06:13( Edit History Discussion )

Chuck Grassley: it is not paid for. it should be a part of health care reform. it adds a quarter of dollars to the it is one whopper of discrepancy. it is not credible. so i urge my colleagues to oppose cloture on this train

4:06:14 to 4:06:34( Edit History Discussion )

Chuck Grassley: wreck of a bill. i yield the floor, and since i don't see any of my colleagues waiting to speak, i will suggest the the presiding officer: the clerk will call the roll.