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Medicare

Floor Speech

By: John Barrasso

Date: Nov. 19, 2008

Location: Washington, DC

Issues: Drugs

MEDICARE -- (Senate - November 19, 2008)

Mr. BARRASSO. Mr. President, today I come to the floor to tell the Nation a story, and it is the story of a Wyoming doctor, a doctor by the name of Randy Johnston. He is an ophthalmologist who practices in Cheyenne, WY. He is very qualified. He is very capable. He is also a good friend.

The reason I come to tell you this story is because, like many doctors across the country, Randy takes care of people on Medicare, and occasionally in his practice as an ophthalmologist he gives shots to people on Medicare. As a matter of fact, there is a picture of Dr. Johnston on the front page of the American Medical News. This is an article dated November 10, written by Jane Cys, and it shows Dr. Johnston in his office in Cheyenne getting ready to give a shot.

Well, in the past, Randy would buy the drugs that his practice uses and then bill the patients for the treatment. The drugs that Randy uses are typically injected, but under this Part B Medicare drug program some are infused through a patient intravenously right into the vein.

Two years ago, Randy enrolled in a new program created by the 2003 Medicare Modernization Act. This Medicare Part B program was called the Competitive Acquisition Program--CAP is the phrase they use. It was designed to give doctors a choice in the way they administer the drugs.

Under the program, the doctor would first see the patient, then order the medicine from a Government vendor, then get the medicine, and then give the injection.

Well, the way it worked is, Medicare would then pay the vendor for the drugs. Medicare also would bill the patient if there was a copay or a premium the patient owed. Randy was only responsible to bill Medicare for the actual treatment of the patient, not for the medicines.

Congress and the Centers for Medicare and Medicaid Services hailed this new program as a way to alleviate administrative burdens and reduce Medicare costs--a good idea. Doctors could now spend more of their time with their patients rather than serving as drug purchasers and bill collectors.

Randy signed up for the program early, and the program that was passed as part of the 2003 bill finally got started in 2006. Randy thought it made good sense for him, good sense for his patients. Some of his Medicare patients could not afford to pay for their office-administered drugs, and Randy saw great potential in this new program. He could transfer the Medicare billing part of it to someone equipped to handle the administrative redtape, and this freedom would leave him more time to focus on practicing medicine.

The program has now been in place for 3 years. What are the results? Well, only 4,200 doctors signed up for the program. You may ask, why is that? Dr. Johnston can tell you, and this article in the American Medical News explains it very well. Administrative hassles, burdensome drug transportation and storage rules, and vendor delivery problems--and that is just to name a few.

For example, the Government rules require doctors to give patients the drugs only in the facility where the vendor delivered the medicine--no exceptions, none. This requirement prevented doctors from moving drugs between their main office and a part-time satellite office they may have in another community.

Washington bureaucrats simply do not understand what a burden this policy can be in rural and frontier communities. Seniors living in rural States such as Wyoming often have to travel great distances--hundreds of miles--to see a specialist like Dr. Randy Johnston. This program, with good intentions, clearly was not designed to meet the unique needs facing rural patients and health care providers who work tirelessly to serve their patients.

Dr. Johnston was also required to order the drugs for a specific individual patient by name. He was not allowed to restock a general office supply to use on multiple patients.

I understand the Government is trying to prevent drug stockpiling. But this rigid program requirement does not give doctors the flexibility they need to practice medicine. This is especially true in emergency situations.

So who is liable when a patient comes to the doctor's office needing immediate treatment but the doctor cannot help because he has to call the Government to send the medicine in the first place, even if he has a supply on hand for another patient? The program's current design has turned out to be a bureaucratic nightmare.

After only 3 months in the program, Randy Johnston wrote Medicare a letter begging--I say begging--to be let out of the program. Why? Well, it was not just the excessive paperwork and the excessive phone calls to get the medication; Randy saw how absolutely wasteful this Government program had become.

When Dr. Johnston purchased Medicaid vials himself from a local pharmacy, the local pharmacy would divide it into multiple doses that could be used for different patients. Using the new Medicare program, Dr. Johnston had to order an entire vial for each patient, use the one dose the patient needed, and then throw the rest away.

Why would Medicare force seniors and taxpayers to foot the bill for an entire vial of medication containing 400 doses when the patient only needed 1 dose? At a time when Americans are facing such painful financial times, this wasteful Government spending is appalling. We are talking about lifesaving medicine, expensive medicine. I do not know anyone who buys a loaf of bread, takes out one piece and eats it, and throws away the rest of the loaf. This makes no sense to anyone.

It is well past the time that Washington bureaucrats start treating taxpayer dollars like the money in their own personal checkbooks. When emergencies, illnesses, or major household repairs occur in our families, we find a way to pay the bill. We look at our budgets, we tighten our belts, and we find alternative places to save. We eliminate luxury items. We stop wasteful spending.

Dr. Johnston was absolutely right to try to get out of this absolutely wrong, wasteful program. Washington bureaucrats who have never been on the front lines treating Medicare patients developed this program. They do not understand the practical applications. So I was not surprised when Medicare announced in September of this year they were putting the entire program on hold starting in January 2009. Washington bureaucrats claim they are considering alternative ways--alternative ways--to improve the program because they want it to succeed.

The new administration has a tremendous opportunity to learn from Randy Johnston and from the 4,200 other participating doctors. Rather than hamstring providers, perhaps Washington should start to focus its efforts on eliminating waste, eliminating fraud, and eliminating abuse in the Medicare system.

This year alone, we have seen one news report after another uncovering Medicare wasting money. These news reports sound the alarm to every hard-working taxpayer in the sound of my voice and all hard-working taxpayers across America.

Who is holding these bureaucrats accountable? Just this week, the Department of Health and Human Services issued the Agency Financial Report. This document shows that in fiscal year 2008, these Government check writers made $10.4 billion--$10.4 billion--in improper Medicare fee-for-service payments. We can do better. We can do much better than this.

Wasteful spending strips Medicare of the vital resources that are needed to care for our elderly, to care for our frail, to care for the vulnerable. The new administration has a real opportunity to show leadership. Working together, we can fix this flawed policy. Medicare patients, doctors who take care of Medicare patients, and the American taxpayers deserve nothing less.

Mr. President, I yield the floor and suggest the absence of a quorum.

The PRESIDING OFFICER. The clerk will call the roll of the Senate.

The assistant legislative clerk proceeded to call the roll.

Mr. BARRASSO. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

The PRESIDING OFFICER. Without objection, it is so ordered.

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Medicare

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X_FRAME_OPTIONS	`'DENY'`
YEAR_MONTH_FORMAT	`'F Y'`

Signal	Receivers
class_prepared
connection_created	register_type_handlers
got_request_exception
m2m_changed
post_delete
post_init	ImageField.update_dimension_fields, ImageField.update_dimension_fields, ImageField.update_dimension_fields
post_migrate	create_permissions, create_contenttypes, create_default_site
post_save	create_user_profile, TagField._save
pre_delete	clear_site_cache
pre_init
pre_migrate	inject_rename_contenttypes_operations
pre_save	clear_site_cache, set_zip4_userprofile
request_finished	close_old_connections, close_caches, reset_urlconf
request_started	reset_queries, close_old_connections
setting_changed	reset_cache, clear_cache_handlers, update_installed_apps, update_connections_time_zone, clear_routers_cache, reset_template_engines, clear_serializers_cache, language_changed, localize_settings_changed, file_storage_changed, complex_setting_changed, root_urlconf_changed, static_storage_changed, static_finders_changed, auth_password_validators_changed, user_model_swapped, update_toolbar_config, reset_hashers, reload_api_settings, reload_api_settings, uninstall_if_needed, clear_caches, FileSystemStorage._clear_cached_properties, FileSystemStorage._clear_cached_properties, FileSystemStorage._clear_cached_properties, FileSystemStorage._clear_cached_properties, StaticFilesStorage._clear_cached_properties

Path	Location
.DS_Store	/var/www/justfacts/assets/.DS_Store
.well-known/apple-developer-merchantid-domain-association	/var/www/justfacts/assets/.well-known/apple-developer-merchantid-domain-association
pdfs/Mobile_Messaging_Terms_and_conditions.pdf	/var/www/justfacts/assets/pdfs/Mobile_Messaging_Terms_and_conditions.pdf
pdfs/CNIP-signed-bylaws-2023.pdf	/var/www/justfacts/assets/pdfs/CNIP-signed-bylaws-2023.pdf
pdfs/PolicyforFundraisingandGiftAcceptance_1.3_Edition.pdf	/var/www/justfacts/assets/pdfs/PolicyforFundraisingandGiftAcceptance_1.3_Edition.pdf
pdfs/CNIP2018.pdf	/var/www/justfacts/assets/pdfs/CNIP2018.pdf
pdfs/CNIP2019.pdf	/var/www/justfacts/assets/pdfs/CNIP2019.pdf
pdfs/2021/162017-Vote Smart-Brochure-Proof.pdf	/var/www/justfacts/assets/pdfs/2021/162017-Vote Smart-Brochure-Proof.pdf
pdfs/2021/990-2021.pdf	/var/www/justfacts/assets/pdfs/2021/990-2021.pdf
pdfs/2020/CNIP2020.pdf	/var/www/justfacts/assets/pdfs/2020/CNIP2020.pdf
pdfs/2020/Vote-Smart-FY21-Audit-Report-Final-Signed.pdf	/var/www/justfacts/assets/pdfs/2020/Vote-Smart-FY21-Audit-Report-Final-Signed.pdf
pdfs/2020/VoteSmartbrochure.pdf	/var/www/justfacts/assets/pdfs/2020/VoteSmartbrochure.pdf
pdfs/forcandidates/2023_states/2023_New_Jersey_State_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/2023_states/2023_New_Jersey_State_PCT.pdf
pdfs/forcandidates/2023_states/2023_Mississippi_State_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/2023_states/2023_Mississippi_State_PCT.pdf
pdfs/forcandidates/2023_states/2023_Virginia_State_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/2023_states/2023_Virginia_State_PCT.pdf
pdfs/forcandidates/2023_states/2023_Kentucky_State_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/2023_states/2023_Kentucky_State_PCT.pdf
pdfs/forcandidates/2023_states/2023_Louisiana_State_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/2023_states/2023_Louisiana_State_PCT.pdf
pdfs/forcandidates/states/2022_MS_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MS_PCT.pdf
pdfs/forcandidates/states/2022_IN_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_IN_PCT.pdf
pdfs/forcandidates/states/2022_AL_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_AL_PCT.pdf
pdfs/forcandidates/states/2022_WY_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_WY_PCT.pdf
pdfs/forcandidates/states/2022_NY_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_NY_PCT.pdf
pdfs/forcandidates/states/2022_NJ_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_NJ_PCT.pdf
pdfs/forcandidates/states/2022_SC_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_SC_PCT.pdf
pdfs/forcandidates/states/2022_MA_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MA_PCT.pdf
pdfs/forcandidates/states/2022_NM_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_NM_PCT.pdf
pdfs/forcandidates/states/2022_NB_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_NB_PCT.pdf
pdfs/forcandidates/states/2022_MD_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MD_PCT.pdf
pdfs/forcandidates/states/2022_MO_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MO_PCT.pdf
pdfs/forcandidates/states/2022_MINN_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MINN_PCT.pdf
pdfs/forcandidates/states/2022_AZ_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_AZ_PCT.pdf
pdfs/forcandidates/states/2022_PA_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_PA_PCT.pdf
pdfs/forcandidates/states/2022_OK_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_OK_PCT.pdf
pdfs/forcandidates/states/2022_OH_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_OH_PCT.pdf
pdfs/forcandidates/states/2022_NV_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_NV_PCT.pdf
pdfs/forcandidates/states/2022_WA_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_WA_PCT.pdf
pdfs/forcandidates/states/2022_FL_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_FL_PCT.pdf
pdfs/forcandidates/states/2022_MI_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_MI_PCT.pdf
pdfs/forcandidates/states/2022_CO_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_CO_PCT.pdf
pdfs/forcandidates/states/2022_OR_PCT.pdf	/var/www/justfacts/assets/pdfs/forcandidates/states/2022_OR_PCT.pdf

Path	Location
admin/img/icon-no.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-no.svg
admin/img/README.txt	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/README.txt
admin/img/icon-yes.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-yes.svg
admin/img/inline-delete.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/inline-delete.svg
admin/img/selector-icons.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/selector-icons.svg
admin/img/icon-calendar.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-calendar.svg
admin/img/search.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/search.svg
admin/img/LICENSE	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/LICENSE
admin/img/icon-unknown.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-unknown.svg
admin/img/icon-viewlink.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-viewlink.svg
admin/img/icon-changelink.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-changelink.svg
admin/img/calendar-icons.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/calendar-icons.svg
admin/img/icon-alert.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-alert.svg
admin/img/icon-unknown-alt.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-unknown-alt.svg
admin/img/tooltag-add.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/tooltag-add.svg
admin/img/icon-addlink.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-addlink.svg
admin/img/sorting-icons.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/sorting-icons.svg
admin/img/icon-clock.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-clock.svg
admin/img/icon-deletelink.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/icon-deletelink.svg
admin/img/tooltag-arrowright.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/tooltag-arrowright.svg
admin/img/gis/move_vertex_off.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/gis/move_vertex_off.svg
admin/img/gis/move_vertex_on.svg	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/img/gis/move_vertex_on.svg
admin/fonts/README.txt	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/fonts/README.txt
admin/fonts/LICENSE.txt	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/fonts/LICENSE.txt
admin/fonts/Roboto-Regular-webfont.woff	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/fonts/Roboto-Regular-webfont.woff
admin/fonts/Roboto-Light-webfont.woff	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/fonts/Roboto-Light-webfont.woff
admin/fonts/Roboto-Bold-webfont.woff	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/fonts/Roboto-Bold-webfont.woff
admin/js/SelectFilter2.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/SelectFilter2.js
admin/js/nav_sidebar.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/nav_sidebar.js
admin/js/core.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/core.js
admin/js/popup_response.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/popup_response.js
admin/js/collapse.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/collapse.js
admin/js/autocomplete.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/autocomplete.js
admin/js/change_form.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/change_form.js
admin/js/jquery.init.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/jquery.init.js
admin/js/calendar.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/calendar.js
admin/js/urlify.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/urlify.js
admin/js/cancel.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/cancel.js
admin/js/prepopulate_init.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/prepopulate_init.js
admin/js/actions.js	/usr/local/lib/python3.12/dist-packages/django/contrib/admin/static/admin/js/actions.js