I listened very intently to the first two speakers this morning, and as somebody who has now been a physician for almost 30 years, practiced full time for over 25 years, i heard the senator from Iowa in what his desire would be in the chart that he showed. he showed 100% screening occurring now in three areas. i want to tell you, that isn't true. we're not screening. we hope to screen and we hope to screen 100%, but the facts are on screening that was available is only used 5% by Medicare patients on the screening that was already available with no cost to medicare patients. so we have to distinguish between what we desire and what's actually going to happen. 

Let's just take the example of colon screening. I'm a colon cancer survivor. I was diagnosed through colonoscopy with colon cancer. But let's take that example and then let's take the example of the other aspect of the Affordable Care Act which is called the Independent Payment Advisory Board. Now, what's the purpose of the Independent Payment Advisory Board? It is to cut the costs of Medicare through decreasing of reimbursements, first for the first eight years physicians and outside providers, and then starting in 2019, hospitals. Well, what do you think is the first thing that's going to get cut? The first thing that is going to get cut is the reimbursement rate for a colonoscopy. So when the reimbursement rate for a colonoscopy goes bow the costs -- and it's very close right now, by the way. The cost to actually perform a colonoscopy versus what Medicare reimburses -- when that is cut, what do you think is going to happen on screening?

The goal of changing health care is an admirable goal. We know that one in three dollars doesn't help anybody get well and doesn't prevent them from getting sick today, but what the American people need to understand is what is coming about is a group of 15 unelected bureaucrats who cannot be challenged in court, who cannot be challenged on the floor of the Senate or House, mandating price reductions to control the cost of Medicare. What does that ultimately mean? They will do their job. We won't be able to do anything about it, but what it means is they will reimburse at levels less than is the cost to do services, and so consequently what will happen is the service won't be there. They also are going to do what is called comparative effectiveness research. We know about comparative effectiveness research.

If you're a practicing physician today you have to do continuing it's like they're reinventing something that already exists. The point is they're going to use that to deny or change payments for procedures that patients need. What's wrong with all this? What's wrong with all this is we are inserting a government board and government bureaucrat between the patient and the doctor. Think about that for a minute.

When I go to my doctor, I don't want him concentrating about anything except me. And if he's looking over his shoulder about whether or not he met the IPAB’s comparative effectiveness study on what he's doing for me when in fact the art of medicine as well as the science may say they're wrong, and he's going to do what the government says rather than what he thinks is best for me, what am I getting for that? I'll be on Medicare next year. Much to my regret, because my choices will now be limited in terms of who I can see.

The greatest threat to the quality of care -- it wasn't intended to be that way. It was intended to be helpful. I don't doubt the motives of anybody that set this board up. The greatest threat to the quality of care for seniors in this country is the Independent Payment Advisory Board and their non-caring position, because they're going to be looking at numbers and words, and they're never going to lay their hand on a patient. They're never going to impact a patient directly. They're never going to listen to a patient. But they're going to make the ultimate decisions based on what that patient's going to get.