S10618 CONGRESSIONAL RECORD — SENATE November 19, 2008 

Street. It must be significant and substantial and it must be targeted at our 

most pressing needs. 

The plan before us does that. It will 

prime the pump of America’s job machine, by fast-tracking $13.5 billion of 

investment into our Nation’s infrastructure which forms the bedrock of 

our economy. It will help the States 

avoid the difficult decision to raise 

property taxes; you cannot do that 

now. But some of them may have no 

choice because they have budget shortfalls. But we can avoid that terrible 

choice by delivering $40 billion in 

emergency fiscal aid through the 

FMAP. 

The stimulus package before us will 

jump start renewable energy production by making major investments in 

the technologies that will not only 

help America become energy independent but will make us a global leader in the next generation of fuel-efficient vehicles. 

Importantly, this bill will also resuscitate small business lending. We all 

know small businesses are the engine 

of our economy. But small businesses 

have been overlooked in the financial 

rescue efforts to date. 

So working with my friend and colleague from Massachusetts, Senator 

KERRY, we have worked to include provisions in this stimulus package that 

will throw our small businesses a life 

vest to weather this storm so they can 

emerge from it as leaders in job creation. 

Small businesses generally rely heavily on loans from banks to build inventory, meet their payroll consistently, 

and fuel the growth of the business. 

These loans have all but dried up, 

threatening the survival of car dealerships, mom-and-pop pharmacies, restaurants and shops all across the Nation. 

The Federal Reserve recently reported that 75 percent of domestic 

banks said they had tightened their 

lending standards for small-business 

loans, 75 percent. At the same time, 70 

percent of the lenders told the Fed that 

they would charge more for those 

loans. According to the New York 

Times in an August opinion poll, twothirds of entrepreneurs told the National Small Businesses Association 

that their companies had been hurt by 

the credit crunch. 

Traditionally, Small Business Administration loans have filled this gap. 

But chronic underfunding of the SBA 

under the Bush administration and its 

outdated fee structure have greatly reduced lender participation and undermined the valuable function that SBA 

lending could play during this credit 

crisis. 

In October alone, the number of loans 

made under SBA’s largest loan program dropped over 50 percent compared 

to the same month last year. So the 

economy desperately needs this shot in 

the arm. 

And SBA’s loan program is cut in 

half. What foolishness. Why do we not 

change it? That is why Senator KERRY

and I fought to include in the economic 

stimulus package provisions that will 

modernize the SBA and jump start 

lending to small business. 

Our bill provides $615 million to support $22.5 billion in zero-fee loans to 

small businesses under the 7A and 504 

programs. Providing zero-fee loans will 

deliver needed relief to small business 

on Main Street during Wall Street’s financial crisis. 

The bill also provides $1 million to 

support $10 million in new microloans 

for small businesses and $4 million for 

critical technical assistance for these 

new ‘‘micro’’ borrowers. 

In sum, our Nation needs this stimulus package, not just for the small 

businesses or the large businesses 

across the Nation but for the American 

families who have faced devastating 

hits to their wealth and economic security. We need to build a platform from 

which we can emerge from this credit 

crisis as a global leader in energy and 

innovation and high-paying job creation. I strongly urge the passage of 

this proposal. 

I yield the floor and suggest the absence of a quorum. 

The PRESIDING OFFICER. The 

clerk will call the roll. 

The 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 (Mr. 

CARDIN). Without objection, it is so ordered. 

The Senator is recognized for 10 minutes. 

Mr. BARRASSO. Thank you very 

much, Mr. President. 

f 

MEDICARE 

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 officeadministered 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. 


rfrederick on PROD1PC67 with SENATE
November 19, 2008 CONGRESSIONAL RECORD — SENATE S10619 

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 hardworking 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-forservice 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. 

f 

RECESS 

The PRESIDING OFFICER. Under 

the previous order, the Senate stands 

in recess until the hour of 4 p.m. 

Thereupon, the Senate, at 2:28 p.m., 

recessed until 4 p.m. and reassembled 

when called to order by the Presiding 

Officer (Mrs. MCCASKILL). 

The PRESIDING OFFICER. The Senate will come to order. 

Mr. BARRASSO. Madam President, I 

suggest the absence of a quorum. 

The PRESIDING OFFICER. The 

clerk will call the roll. 

The assistant legislative clerk proceeded to call the roll. 

Mr. BYRD. Madam President, I ask 

unanimous consent that the order for 

the quorum call be rescinded. 

The PRESIDING OFFICER. Without 

objection, it is so ordered. 

The Senator from West Virginia is 

recognized. 

f 

ECONOMIC STIMULUS 

Mr. BYRD. Madam President, in September, the Senate considered a $56 billion economic recovery bill, authored 

by Senator REID and myself. While the 

bill received 52 votes, the minority succeeded in blocking its consideration. 

In the following 2 months, the economy has continued to deteriorate. On 

Monday, Senator REID and I renewed 

our effort to stimulate the economy 

and help the millions of Americans 

hurt by the recession by introducing a 

$100 billion economic recovery bill. 

In response to higher unemployment, 

rising food costs, higher energy costs, 

State budgets in crisis, and increased 

dependence on foreign oil, Presidentelect Obama has called for passage of a 

second stimulus bill. I spoke with the 

President-elect yesterday, and I committed myself to helping the President 

implement his agenda. 

Madam President, it is time to deliver to Main Street USA. S. 3689 is a 

$100.3 billion economic stimulus package that would create over 635,000 jobs. 

I will repeat that. S. 3689 is a $100.3 billion economic stimulus package that 

would create over 635,000 jobs. The unemployment rate now stands at 6.5 percent, the highest rate since March 1994. 

The unemployment rate is up by 1.7 

percentage points since October 2007. 

The U.S. economy has lost jobs every 

month this year—a total of 1.2 million 

jobs, with almost half of the job losses 

coming in the last 3 months alone. New 

unemployment claims filed exceeded 

500,000, the highest number since just 

after 9/11. 

In order to respond to these grim statistics—and they are grim—the stimulus package extends unemployment 

benefits by 7 weeks in all States, as 

well as another 13 weeks in high-unemployment States. Thirty-seven States 

are facing a shortfall of over $70 billion 

in their fiscal year 2009 budget, necessitating cutbacks in education, cutbacks 

in health care, and cutbacks in law enforcement. 

The stimulus package includes $37.8 

billion—that is $37.80 for every minute 

since Jesus Christ was born—to reduce 

the State’s share of Medicaid costs by 

increasing the Federal share—increasing, I say—the Federal share by 8 percent. 

The economic recovery package 

also—I emphasize the word ‘‘also’’—includes a temporary increase in food 

stamp benefits. These funds—hear me 

now—these funds will be spent quickly, 

and they will help to stimulate the 

economy. 

Over $37 billion is included for essential infrastructure and investment programs. Now hear me, listen closely. I 

measure each word. There are consequences for failing to invest in America. For 8 years—8 long years—we have 

failed to make adequate investments in 

highways, transit systems, housing, in 

clean and safe drinking water systems, 

and in energy independence. This bill 

funds such investments, as well as 

small business loans, assistance for 

rural communities, and disaster relief 

for farmers hurt by the hurricanes and 

the floods this summer. 

I understand, I am sorry to say, there 

is going to be an objection to debating 

this bill. This would be a mistake. I 

will say that again. I understand there 

will be an objection to debating this 

bill. This would be a mistake—a mistake. Why? Because it is time to act. 


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