Claire McCaskill

I'm worried, like the rest of my colleagues--and there have been a number of questions on this already--about the Train and Equip mission.

At what point in time, General Austin, do you envision us admitting that... the job of finding willing fighters... are running for the exits?

If we did an indiscriminate carpet-bombing of a major area, and killed thousands of women and children, would you assume that would have some impact on their ability to recruit misguided barbarians?

For Medicare, if I am on Medicare, a utilization manager is going to make that decision.

I certainly want to thank Senator Collins for all of the years of work she has put into this issue, and I know her knowledge and perspective are going to be invaluable as we struggle with public policy in this complicated and difficult…

If there is no difference in the treatment and there is no difference in what happens, then why do we need time constraints at all?

Thank you very much. We appreciate all of you.

I am happy to continue the great bipartisan tradition of this Committee and I am pleased that we are holding this hearing on such an important issue.

I think we should be informing beneficiaries of their status so that they do not get this unexpected bill later.

Explain that. That was not clear to me.

I will begin with questions and then ask the other Senators to make their questions.

I think if we went to no contingency and just a flat fee, you take away the incentive for them to ferret out people who are abusing the system.

I think, going forward, that these ACOs are really our best hope to handling our generation and the costs that will be associated with our generation as we all move into the Medicare system.

As Senator McCaskill said, it can be thousands of dollars because there is no limit on that 20 percent in observation.

We need to understand what is causing it and we need to make sure that it makes sense, most importantly, for the patients.

I am concerned that it could lead some patients to not get the care that they need or not get the diagnosis that they need because they are worried about the financial implications.

I think a right to know is pretty important. I mean, it is their money, right?

Yes. You guys really need to get after this in the next contract.

I mean, do we have to wait for the next RAC contract to be finalized before we would implement those suggestions?

Thank you, Senator Collins, for giving me the opportunity to remember how it was in the good old days.

I cannot find that well-defined set of clinically appropriate circumstances.

I have to go to the emergency room for something. Who makes the decision whether or not my status is observation or whether I am admitted?

The patient should certainly know their status and know it as early as possible.

Should we not, like, make this a little simpler?

I think it would be.