All articles in House section

DOCTORS CAUCUS
(House of Representatives - February 14, 2013)

Text of this article available as:
        


[Pages H531-H537]
                              {time}  1540
                             DOCTORS CAUCUS

  The SPEAKER pro tempore (Mr. Massie). Under the Speaker's announced 
policy of January 3, 2013, the gentleman from Tennessee (Mr. Roe) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. ROE of Tennessee. Mr. Speaker, before starting this Special 
Order, I'd like to yield as much time as he may consume to my friend 
from Mississippi, Steven Palazzo.


                         Sequestration Effects

  Mr. PALAZZO. I want to thank the good doctor from Tennessee for 
yielding me some time.
  Mr. Speaker, in 2 weeks we face one of the most devastating cuts to 
our military that our country has ever seen, literally, a worst-case 
scenario for our men and women in uniform, all in just 2 weeks.
  For a year and a half, several of my colleagues and I have been 
discussing with anyone who will listen the devastating impact of these 
automatic budget cuts, but still we have stalled and delayed till we 
are where no one in their right mind would want to be.
  If these cuts are not stopped, not only will our military be hollowed 
out, but a number of other agencies will be severely impacted as well. 
Defense cuts are bad enough. Unfortunately, these cuts affect a lot 
more than just defense. These automatic cuts affect food inspections at 
the Department of Agriculture, FBI investigations, TSA screening at 
airports, and others. No agency is untouched.
  One example in Mississippi alone is it is anticipated that these 
automatic budget cuts could cost as many as 845 jobs in the education 
sector alone. These are the people we task with educating our future 
generations and ensuring our country's success.
  We're now hearing of furloughs across the government agencies. This 
would mean that families that are dependent on that paycheck to put 
food in their children's mouths and clothes on their backs will be 
forced to stay home as much as 1 day a week for up to 22 weeks.
  This means millions of dollars in lost pay for dedicated public 
servants because Congress and this President cannot get their act 
together and do what is right for our country.
  At this point, the House has passed two separate plans that were 
never even considered by the Senate. Ultimately, inaction by the 
President and Senate are allowing us to inch closer and closer to the 
disgusting reality of these cuts.
  Even more disappointing than the Senate and the President's inaction 
is the ridiculous position of many that seem completely content to 
throw their hands up and say that we have done all we can do.
  But I am perhaps the most disappointed in my colleagues that want 
these cuts to take place in the name of spending cuts only. What good 
are spending cuts when you can't defend the Nation you are trying to 
save and destroying our economy in the process?
  I am in favor of reducing our national debt and balancing our budget 
as much as anyone in this Congress, but I refuse to do it on the backs 
of our men and women in uniform and their families. I will not 
jeopardize their safety and security, yet some in this body want to do 
just that.
  It is foolish--no, naive--to believe that allowing $1 trillion in 
spending cuts to our national defense is responsible or sustainable. 
Many of my colleagues seem to have forgotten that these automatic cuts 
were intended to be the absolute worst thing we could do. It was 
designed to force bipartisan action on addressing our spending 
addiction in this Congress. It is the unintended consequences of an 
absolute failure by the supercommittee. So, instead of using a scalpel, 
we're using a meat-ax, and the impact of our failure to act will soon 
be all too apparent unless we avert this irresponsible action.
  Despite repeated requests for over a year for more details on what 
effects these details will have, only now, 2 weeks before they are 
scheduled to take place, have we received any information from this 
administration.
  The military services have let us know exactly what effect they think 
sequestration will have, and it is not a pretty sight. We are talking 
about one of the biggest drivers of small businesses, a major employer 
of our Nation's veterans, and a major economic driver in our economy. 
And some here are willing to see it slashed for no benefit whatsoever.
  But civilians are not the only issue here. We are downsizing our 
force to deal with the cuts already in place--$487 billion worth. We 
will have to cut further into our active duty if these cuts are not 
rolled back and replaced responsibly.
  In my district, over 10,000 people walk through the gates of Ingalls 
Shipbuilding in Mississippi every day. If just one ship contract is 
cancelled as a result of sequestration, we are talking about thousands 
of people being immediately unemployed and layoffs at small businesses 
in over 49 States. These are some of the most patriotic and hardest 
working people I have ever met in my life. They have dedicated their 
lives to building the greatest naval ships the world has ever seen.
  So this week, I spoke with our most senior military leaders, and they 
told us very directly, if you want our military to continue doing what 
it's doing today, then we can't give you another dollar.
  There are similar stories across the Nation at plants building the 
largest planes to the smallest component parts. These are the stories 
of real people who go to work every day to make America a better place. 
These skills are not easily relearned. Once they go away they are gone 
forever, and I will not stand by and allow inaction by my colleagues to 
kill American jobs.
  I ask my colleagues: Is this what you want? Do you honestly believe 
this is for the best?
  I beg anyone to explain to me how we're a better country if these 
cuts take place.
  Mr. Speaker, I implore our leaders, the Senate, and the President to 
act. The future safety and security of our Nation is at stake.

  Mr. ROE of Tennessee. I thank the gentleman.
  Mr. Speaker, we're going to take the next hour or so, the Doctors 
Caucus, Dr. Gingrey, myself, Dr. Harris, and we're going to speak about 
the Affordable Care Act, how we got where we are, the plan to save 
Medicare, and other health care issues.
  I came to this Congress after a 31-year medical practice in Johnson 
City, Tennessee, just a doctor out each day in east Tennessee taking 
care of patients; and I made a decision that I didn't like the 
direction that the country was headed in health care, and I wanted to 
run for Congress to be here for that reason.
  Well, it turned out that two Congresses ago we did have a debate on 
the health care issue. We have nine physicians in our health care 
caucus, and not one of us was consulted about that health care bill. 
Not one of us was brought in the loop and said, What do you think?
  Well, we had an extensive debate, I will admit, in the House. This 
bill was passed on a pure party-line vote in November of 2009; and on 
Christmas Eve, the Senate passed a bill that had not been vetted, had 
not been heard in the House, was not debated in the House, a completely 
different bill. But because of the rules in the Senate, it never got 
heard here and was not debated fully in the Senate.
  That bill was passed, it will soon be, 4 years ago--3 years ago, I 
mean. We thought that we'd have an opportunity after the Supreme Court 
looked at this--those challenges were brought to overturn this bill--
and we're going to spend the next hour explaining why we don't think it 
was the right prescription for the health care of the citizens of this 
country.
  I bring an extensive knowledge about a health care reform bill we did 
in our State of Tennessee. The biggest problem with the health care in 
this country is not the quality of care. Certainly, we can always do 
better, and physicians want to do better and have new techniques and 
new innovative medicines that we use. But the biggest problem with 
health care in America is the cost of that care. I got to see it every 
day in my practice, where going to the hospital could bankrupt families 
if they didn't have proper insurance, it was more expensive to come in, 
and so the number one driver was cost.

                              {time}  1550

  Number two, there's no question we had a group of people who worked

[[Page H532]]

every single day of their lives and could not afford health insurance. 
It was not affordable for them. I would see it in my community where 
you would have, let's say, a carpenter who would work and during the 
winter they didn't get to work too much. They would work and maybe make 
$20,000 or $25,000 a year. Their wife may work at a local diner, maybe, 
and make $20,000 or $25,000. Together, where we live, they could make 
$40,000 or $50,000, maybe, in combined income and they could live okay. 
But they could not afford a thousand dollars a month for health 
insurance coverage. It was just out of their reach. And thirdly, we had 
a liability crisis in this country.
  So what did the Affordable Care Act actually do? Well, it did 
increase access. But it increased access mainly, the best I can tell, 
through a massive expansion of a failed system called Medicaid. The 
Medicaid system right now in this country is broken and needs to be 
reformed. We did not reform it with this bill. So that's one thing it 
did.
  Two, it did not touch liability. And we can go into that a little bit 
later. But the liability crisis still exists. My State of Tennessee has 
done something, as has the States of Texas and California. Other States 
have been successful in liability reform. And that has helped. But the 
President was here Tuesday night. We were all sitting in this Chamber. 
And amazingly, in the seat right below you here on the dais, the 
President said with a straight face that his bill, his Affordable Care 
Act, so-called ObamaCare, had lowered costs. I was astonished by that 
because it clearly has not done that at all. And let me just go through 
a few things.
  I serve as the chairman of the Health, Employment, Labor and Pension 
Subcommittee in the Education and Workforce Committee. So if you have a 
private health insurance plan, that issue, that plan will come through 
my subcommittee. Let me just go over a couple of things that we found. 
We've had numerous hearings over the past 3 years about this. And this 
is recent data right here. President Obama's health care law will push 
about 7 million people out of their job-based insurance coverage, 
nearly twice the current estimate. That was just in the last week or 
two, that estimate, according to guess who? The Congressional Budget 
Office. Not Phil Roe and not some Congressman. But the CBO believes 
that. So twice what they thought it would do.
  Spending on health care is up. And we estimate it's as much as $4,500 
per family since this bill has come into play. That is not pushing the 
cost of health care down. So we see that. And one of the things that 
this bill did, I think which was good and bad, Mr. Speaker, is we 
allowed millions of young people under the age of 26 to be on their 
parents' health care plan. That sounded like a good idea. And if you 
have a mom and dad that paid for that, it probably is a good idea if 
they pay for. I know one of the great points of my life were when my 
three children got out on their own and paid their own health 
insurance. That was the biggest raise I probably ever got, them getting 
out of college and paying their own health insurance.
  But what happened was, the way the bill was written, actuaries can no 
longer charge the actual cost of that care. Let me give you an example. 
If a person my age is out buying an individual policy, it will cost 
about six times what a young person under 26 pays because actuarially 
I'm much more likely to need health insurance or need my health care 
plan. This bill only allows a 3-to-1. So that means a young person is 
going to pay two to three times, that person out there paying for that 
health insurance coverage, than they otherwise would have.
  I've had a good friend of mine who's in the health insurance market 
at home, and for all three of my children I bought them individual 
plans, and I specifically remember exactly how much I wrote the check 
for. He said, Dr. Roe, I was having these plans for about $100 a month, 
just a basic health care plan. Some less than that, depending on risk. 
Immediately after that bill passed, those rates tripled--they were $280 
a month. All of a sudden now, if you're an individual, that isn't 
affordable. Most people don't have an extra $200 or $300 right now in a 
tight economy to do that. So we've made it less affordable for a lot of 
young people. More accessible but less affordable.
  I'd like to introduce my colleague and cochair of the Doctors Caucus 
and fellow OB/GYN physician from Georgia, my good friend, Dr. Phil 
Gingrey.
  Mr. GINGREY of Georgia. I thank the gentleman from Tennessee for 
yielding to me. He has already alluded to some of the things that I am 
going to say in my remarks but the most important thing that he stated: 
On Tuesday night, President Obama stood here in this Chamber and he 
gave his State of the Union address and said:

       Patients enjoy stronger protections than ever before. 
     Already, the Affordable Care Act is helping to slow the 
     growth of health care costs.

  Well, President Obama obviously didn't get the memo. We must not have 
read the same CBO report, Mr. Speaker. ObamaCare is not slowing the 
growth of health care costs. ObamaCare is driving up the costs, 
jeopardizing insurance coverage, and placing excessive burdens on small 
businesses, limiting their potential for growth.
  In 2010, President Obama and the Democrats assured us that their 
health care law would lower costs, it would cover millions of uninsured 
Americans. Well, as Dr. Roe said, fast forward 3 years and we have seen 
nothing but broken promises and this enormous pricetag. Just last week, 
the CBO--the Congressional Budget Office--the unbiased scorekeeper that 
works for Congress, reported that under ObamaCare--PPACA, health care 
costs will increase and 7 million Americans will lose their coverage. 
These are the facts, despite any State of the Union rhetoric.
  Young Americans will also be severely impacted with an exorbitant 
rise in health insurance premiums due to a provision in ObamaCare. A 
lot of people are not aware of this, Mr. Speaker. This provision 
requires insurance companies to reduce their rates for seniors--a 
laudable goal. Premium costs for individuals under the age of 40, 
though, are going to significantly rise to even out that balance. By 
limiting these--we call them age ban discounts--that are called for in 
ObamaCare, a 3-to-1 ratio. So someone, let's say as an example, that is 
in their very early sixties and they're not eligible for Medicare at 
age 65, and they already possibly have multiple systems diseases, as we 
say in medical parlance, and are on many prescription drugs, expensive 
drugs--they're a much greater risk in regard to an insurance premium 
coverage of busting the ceiling on that every year. But under ObamaCare 
it says their premiums cannot be more than three times the premium of 
someone who is 28 years old, 10 feet tall, and bulletproof.

  As a result, these are some of the problems that that creates within 
these exchanges. It will absolutely discourage the younger people from 
buying insurance. They'll pay the fine. They will not pay those higher 
premiums so that they stay within that 3-to-1 ratio. It will likely 
force young healthy individuals out of the insurance market. That's 
some of those 7 million we're talking about that are going to lose 
their insurance because of this.
  Let me just give a real specific, and then I'll yield back to the 
gentleman so he can yield time to our other colleagues. For a 27-year-
old earning $33,500 a year, premiums are expected to jump from $2,400 a 
year to almost $3,200 a year. This is an outrageous increase in costs 
that young people can't afford. If they get a job in this current 
climate where we've had 7.6 percent or higher unemployment--the entire 
time that President Obama has been in office--they're not going to be 
able to afford these premiums. And they clearly are not going to pay 
for them. ObamaCare is negatively impacting the insurance market on two 
fronts: it forces rising premium costs on the young, and it increases 
the total uninsured population, as I stated earlier.
  So at this point I'll yield back to the gentleman from Tennessee and 
I hope to remain with my colleagues for the remainder of the hour as we 
continue this colloquy.
  Mr. ROE of Tennessee. I thank the gentleman.
  I'd now like to yield time to my good friend, Dr. Andy Harris from 
Maryland. Andy is an OB anesthesiologist. And I say this to my good 
friend: I

[[Page H533]]

spent a good bit of my adult life waiting for anesthesia to put my 
patients to sleep so I could operate. So I now yield to Dr. Harris.

                              {time}  1600

  Mr. HARRIS. I want to thank the gentleman from Tennessee and the 
gentleman from Georgia.
  Following up on what the gentleman from Georgia said, Mr. Speaker, 
the President stood there and told America that health care costs have 
gone down. Now, I don't know if the President has been in a pharmacy 
lately or been to the doctor or bought a health care insurance policy 
lately, but the fact of the matter is the price has gone up--in some 
cases, dramatically--and it's going to go up more, especially for the 
young, who actually are the highest percent of the uninsured of any age 
group.
  Look, it's just the facts. Folks, when they're 18, 19, 20, 25, they 
don't think anything is ever going to happen to them, so they don't buy 
a policy. And the policies now, I sat down with someone whose daughter 
was insured, and she had one of the HSA accounts, those health savings 
accounts, and $2,500 goes into the health savings account. The first 
$2,500 she would pay, and above that, the insurance would kick in. It 
was an affordable policy. It used to be less than $100 a month. Imagine 
that, $100 a month, guaranteeing that young person, God forbid they get 
into a bad accident, God forbid they develop a tumor at an early age, 
they have coverage for the really expensive things that you may need. 
That was affordable. I think most people would say $80 a month is 
affordable.
  That policy went up to $110, and this time the renewal was 22 percent 
more than that. And it's going to get worse because the President now, 
in the Affordable Care Act--ObamaCare, as he prefers it to be called--
actually reduces the amount that those health savings accounts can 
hold. It's now limited to $2,500. You can't get your premium lower by 
saying, Okay, I'll take a little more risk, increase my health savings 
account. So those costs are going to skyrocket. And when they 
skyrocket, the gentleman from Georgia is absolutely correct, a young 
person is going to say, I'll pay the penalty.
  So a young person who may have had insurance before because it was 
only $80 a month--and it protected us from having to pay for those 
medical costs, God forbid that young person had a catastrophic illness 
or injury. That person is going to make what looks like a logical 
choice now and say, You know what; I'll pay the penalty and drop my 
insurance. It's going to have exactly the opposite effect of what was 
intended, and predictably so, when you force those premiums up.
  Again, the President stood here and said that health care costs went 
down. I've got to tell you, I still have yet to run into someone at one 
of my town hall meetings that says, Good job, Andy; my health care 
costs or my insurance is going down. It's not, it's going up.
  Let me address, because the gentleman from Tennessee touched on it, 
one of the problems that the President didn't consider--tort reform. 
You have three physicians here, two of whom spent their professional 
lives in the labor and delivery suite delivering babies, practicing 
obstetrics. I practiced obstetric anesthesiology, do those epidurals, 
those spinals, relieve women of their pain in childbirth.
  Over my career, my generation--I finished my training in 1984, 28 
years ago. At that time, to show you what the effect of not having tort 
reform is, the cesarean section rate for American women having a baby 
was 15 to 17 percent. One in six to one in seven women would have to 
have a cesarean section. Now, 28 years has passed. I don't know if the 
Speaker is aware, but the cesarean section rate is now 33, 35 percent, 
in some hospitals 40, up to as high as 70 percent in some hospitals. 
That's in one generation.
  I will tell you, as a physician, not much has changed to patients in 
one generation. What has changed is that you don't find an obstetrician 
who's willing to take the risk of doing a delivery in a high-risk 
patient, a normal delivery, because of the medical malpractice 
exposure--not that they would commit it, but they would be charged with 
it, that a baby doesn't come out perfect, because that's the way the 
world is. Yet they would be charged, brought into a court of law, and 
lose millions of dollars in a settlement. So what do they do? They 
choose, when there is any question, to do a cesarean section, and who 
can blame them to do it.
  Mr. Speaker, those women who are watching, they know exactly what I'm 
talking about, because they know if it was their daughter or 
granddaughter or a friend of theirs, they all know someone who has had 
a cesarean section. If the women who are in the audience now think back 
to one generation ago, it was much more rare. So what's happened? We 
haven't had tort reform.
  But that's not all. By the way, the cost to the system is billions of 
dollars a year for those extra cesarean sections, billions of dollars 
direct cost to the health care system.
  If that was all, we'd say maybe we can tolerate that, a doubling of 
the rate of cesarean sections, but that's not all. When those women go 
to see their obstetrician now, one generation ago when I started, when 
I had my first child, my wife went to an obstetrician. It was a solo 
practice. And that obstetrician apologized to my wife and said, You 
know what, I'm sorry, but every other weekend someone may have to cover 
my practice, so I may not be able to guarantee you that I'm there with 
you at your delivery.
  Let's fast-forward one generation, 28 years. You can hardly find an 
obstetrician in solo practice anymore. They simply cannot afford the 
medical malpractice premium. They may never have been sued in their 
life, and they may have to pay over $100,000 a year just for the 
medical malpractice premium, never having been sued in their life. So 
what happens? They're all forced into large groups.
  Now, that same conversation, if my daughter now goes in to see an 
obstetrician, that conversation would run like, You know, ma'am, you're 
going to have to see everyone in the group during your pregnancy, and 
we have seven or eight people in the group. So every time you're going 
to have to see someone else so that everyone gets to see you because we 
don't know who's going to be there the day you deliver.
  Now, is that good care? Is that a good relationship that woman 
develops with her obstetrician when she doesn't even know who's going 
to be there to deliver her? In fact, she doesn't even know who might 
see her the next time she's in the office, one of the most important 
times in her life. We have completely changed the doctor-patient 
relationship because we don't have tort reform in this country.
  If it was just the rate of cesarean section doubling or just the fact 
that you have to see seven or eight people and you don't really know 
who's going to deliver you on a given day, we might accept that, but it 
goes beyond that, Mr. Speaker. Because what's happened now, a good, 
highly trained obstetrician stops delivering babies in their forties or 
fifties because they have developed their practice, they have seen 
those patients. They just take care of their gynecology problems and 
they spend the last 20 years in their career not delivering a baby. 
Having delivered them for 20 years, gaining all that experience, the 
most experienced obstetricians don't deliver our babies anymore. And 
why don't they? Because if they stop delivering babies and promise 
their insurance company they will not deliver a baby, all of a sudden 
that $100,000 premium becomes $20,000. If you were in your forties and 
fifties and could afford to do that in your practice, you might say, 
You know what; it makes sense for me to stop doing this.
  So when you add up all the things that have happened because the 
President, in his Affordable Care Act, refused to have real tort 
reform--and it's possible, because it happened in California. I mean, 
there are areas in the country that have it. But nationally, he refused 
to have it--and the gentleman from Georgia is very familiar with this 
because his bill deals with this. Because of that, we have a cesarean 
section rate that's twice as high as it ought to be, and some people 
will tell you it might be three or four times as high as it ought to 
be. We have women who never develop a close doctor-patient relationship 
with their obstetrician because you really can't. I mean, you're seeing 
a group of seven or eight purely because the malpractice premiums are 
now spread out. Frequently, somebody else even pays.

[[Page H534]]

They may be part of a hospital group, for instance.
  Finally, our most experienced physicians for women in a time--you 
know, you talk about taking care of children. You've got to start right 
at the beginning. You've got to have the most experienced person there. 
See, I've been at thousands of deliveries.

                              {time}  1610

  Ninety-nine percent of the time they go all right. But when they 
don't go all right, you want the most experienced person there. And, 
Mr. Speaker, our lack of tort reform means we no longer have it. We 
have entirely changed the way we deliver obstetric care. So if you even 
said, look, we're not even going to worry about costs, let's not talk 
about costs, let's talk about access to experienced, personalized care 
for our women having babies, it's virtually gone because the President 
and our counterparts across the Capitol in the Senate refuse to take up 
the issue of tort reform and restore some commonsense, good medical 
care to Americans.
  Obstetrics is an example. We could go into neurosurgery and many 
other examples, and I'll leave it with that. We have so many 
opportunities to reduce the costs and improve the quality and access to 
medical care, and it was lacking in the State of the Union Address.
  Mr. ROE of Tennessee. I thank the gentleman for his comments. I felt 
a little deja vu there, Dr. Harris, after walking out of the delivery 
room after about 5,000 deliveries for some of the very reasons that Dr. 
Harris brought up. I'd now like to yield to my friend from Georgia, Dr. 
Gingrey.
  Mr. GINGREY of Georgia. Mr. Speaker, the gentleman from Tennessee is 
generous with his time. I did want to follow on to what the gentleman 
doctor from Maryland is just talking about in regard to tort reform. 
Yes, he covered that very, very clearly and pretty completely.
  But there are other things in this law, the so-called Affordable Care 
Act--well, Patient Protection and Affordable Care Act. And, yes, I 
think President Obama proudly likes to have it called ObamaCare. Maybe 
he hopes that one day that will be his legacy. There are provisions 
that, particularly in these exchanges that are being set up in all 50 
States, the States that are doing it, the territories and the District 
of Columbia, that basically say what best practices are for the 
different physician specialties, including the specialty of obstetrics 
and gynecology which Dr. Roe and I practiced many years. But in these 
descriptions of what's the best practice for a general surgeon or an 
internist or a pediatrician, in some cases, they're not a carbon copy 
of what our specialty societies recommend. The American College of 
Obstetricians and Gynecologists, as an example, does a wonderful job of 
making sure that each one of their members gets a monthly bulletin and 
current updates on what the best practices are for our specialty. It's 
based on science by the best and brightest. And, yet, this law may ask 
us to do something that goes against that.

  I have introduced a bill, Mr. Speaker, to protect our physicians. If 
they are following the guidelines of their specialty, or, on the other 
hand, if they're following the guidelines of the government that some 
government bureaucrat says is the best standard of care, if they're 
doing that and they have a bad outcome, this provider shield would 
protect those physicians from liability. It's something that's 
desperately needed because of this law.
  There is another bill that I have introduced called the SCOPE Act. 
SCOPE is an acronym for the Safeguarding Care of Patients Everywhere. 
What would prevent the Secretary, Ms. Sebelius, or whomever, from 
saying what qualifies a physician to be on a provider group in one of 
these exchanges? Is it what she says or what their specialty society 
says?
  So, again, these are things that we're working on very hard to 
correct, I think, a very bad situation. We members of the Doctors 
Caucus, we on this side of the aisle will continue to fight for that. I 
thank the gentleman.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. Just to 
carry on with what Dr. Gingrey and Dr. Harris have brought up, let me 
share with you about affordability. When Dr. Harris was talking about 
young people, it's obvious that the President--I don't know who writes 
the check for health insurance in his home, but he hasn't looked at the 
check, whoever is writing it, if he hasn't figured out that costs have 
gone up.
  Dr. Harris, I may be a little more than a generation past where you 
are, but when I left, when I quit operating and doing obstetrics, I had 
an 8 percent primary c-section rate. You've seen that. And why did that 
happen? When I came back from the Army to Memphis, I trained at the 
University of Tennessee in Memphis. I had 2 years of training, and then 
I had to go in the military for 2 years and came back and finished my 
training. All the malpractice carriers left the State of Tennessee. In 
1975, they all left. So the doctors and the Tennessee Medical 
Association set up an organization called the State Volunteer Mutual 
Insurance Company. This insurance company was a mutual company, so 
money that we didn't pay in came back to us at the end of a year. It 
wasn't owned by some stock-traded company. Strictly, it was just to 
give us malpractice liability insurance coverage, which I've kept until 
this day.
  In the entire time that that company has been in existence, over half 
the malpractice premium dollars have not gone to injured people. 
They've gone to lawyers, both plaintiff and defense lawyers. What a 
terrible system that is; to try to compensate someone who has actually 
been injured, we have no way to do it. Less than 40 cents on the dollar 
that we paid in for 35 years has actually gone to people who have been 
hurt. That's a terrible system. We need a better system.
  As Dr. Harris pointed out, when I started my practice, my malpractice 
premiums were $3,000 a year. Five years ago, when I left, a young 
physician who replaced me was paying $7,400. And guess what? The 
patients didn't get better quality and better access. They just got 
higher costs. So that's why we need to address that issue. I think 
you're spot on, Dr. Harris. I yield to the gentleman from Maryland.
  Mr. HARRIS. I thank the gentleman from Tennessee for yielding. To 
follow up on his point, Mr. Speaker, I don't know if Americans realize, 
the gentleman is absolutely right. If you have a case litigated, a 
birth injury claim, and it goes to a jury and there's an award, let's 
say, of $6 million--not an unusual award--40 percent of that award, 
$2.4 million plus expenses, goes just to the attorney. Is that fair? 
You have an injured baby--and we're not going to decide what the injury 
is. But is it fair that when the court renders a decision that half the 
money doesn't go to take care of that baby? It doesn't seem fair.
  I want to briefly go back to some of the issues in the Affordable 
Care Act. One that really struck me is the medical device tax. Now, I 
know the President likes taxes. There are 21 in the Affordable Care 
Act. He stood up there 2 days ago and talked about taxes, increasing 
taxes as a solution to our problems. But let me tell you what the 
problem with that medical device tax is. And I'm going to hearken back 
to my experience, again, over 28 years. I remember training in the 
early eighties. Some of the people watching, Mr. Speaker, might know if 
they had a kidney stone 30 years ago and had to have an operation for 
that kidney stone just how serious that was. And I remember, I did 
anesthesia for many of them. There were big incisions on your back, on 
your side, a week in the hospital, and you could get infections from 
it. It was a terrible experience if you needed an operation to remove a 
kidney stone.
  So 2 years ago, I had the opportunity to work in one of the urology 
operating rooms. It was a kidney stone removal. And here I'm going, 
wow, I haven't seen one in a while, I'm going to give the anesthesia 
for it, I'm going to prepare for a big operation. The surgeon said, no, 
no, no, no. We're doing this with a laser. I said, a laser? That kidney 
stone is deep inside. It's inside your body. He said, no, you've got to 
see what we got.
  They brought a laser machine in, and I apologize I didn't bring a 
sample of these catheters. It's a catheter, a wire that's about a yard 
long, and it's fiber optic. Oh, my gosh, it's thinner than the lead in 
a pencil, and it's flexible. They thread this up--and I won't go

[[Page H535]]

through the exact anatomy--they thread it up to where that kidney stone 
is. They fire a laser through this, and they break the kidney stone up 
into tiny little pieces, or evaporate it, and it just comes out. 
There's no incision. These patients go home the same day.

                              {time}  1620

  Why? Because of medical innovation, because some company took a risk 
to develop that laser product. I tell you, it's not cheap. I'll also 
tell you it's a whole lot cheaper than several days in the hospital.
  The President stood there and said, We don't want to pay by the 
hospital day; we want to pay by the quality. Let me tell you something: 
if I have a kidney stone, my hand is going up for that newest method 
because it's the quality method. What does the Affordable Care Act do? 
It taxes it. If that person had the old operation, there's no taxes 
involved; but if they have that new device, there's a tax on it.
  I learned in the legislatures that there's a saying that if you want 
to discourage something, tax it. We have these arguments over tobacco. 
You want to discourage tobacco? Let's tax it. Most States have taxed 
it, the Federal Government taxed it, and sure enough we have less. I 
don't understand. Is that the same thinking we have about innovative 
medical devices? Are they all of the sudden not a good idea? That's 
exactly what this bill does, it taxes them.
  One of two things is going to happen: either that tax is going to be 
passed on--because that's what businesses do: when you tax businesses, 
they pass them on--or we won't innovate as much. That would be a 
disaster because the key to improving our health care quality, going 
into the future, especially with American ingenuity and innovation and 
expertise, is innovating. We're taxing innovation. It makes no sense, 
Mr. Speaker.
  I hope we move a bill through this Chamber to remove that taxation. 
It's a very bad idea for the quality of health care in the United 
States because some of these new products, whether it's for treating 
diabetes or whether it's for treating kidney stones, are amazing new 
technology.
  Mr. ROE of Tennessee. I think we all could stand here for hours 
talking about--I certainly could--the innovative new devices that I've 
used through laparoscopy that have helped patients shorten their length 
of stay, shorten their pain. I hope we don't go into the Middle Ages of 
health care in technology because we could spend literally hours 
talking about what we've seen. We're the place in the world that people 
come for this.
  Before I go back to costs, the estimates are that this device tax 
will cost 43,000 jobs. The fear is that we'll start producing these 
offshore and lose jobs in this country. That makes no sense whatsoever. 
Actually, it was Dr. Milton Friedman who said:

       If you want more of something, subsidize it; if you want 
     less, tax it.

  That's a fairly simple concept.
  Back to the initial problem we have in health care, which is cost. 
Let me just go over a couple of things, and not just behavioral things. 
In a recent Gallup survey, the top concern cited by small business 
owners was rising health care costs. Remember, the President stood 
right here--and I listened to the debate and so did Dr. Gingrey--for 
hours on end about how this was going to lower the average person's 
health care insurance premium by $2,500 a year. Remember that? You 
remember that, Dr. Gingrey. I heard it over and over right in this well 
and right at this dais. Guess what? Exactly the opposite happened, 
which is exactly what we predicted would happen. It did not bend the 
cost curve down, and it's making it less successful and affordable for 
people.
  Anyway, on with this Gallup survey. So three-fourths, 74 percent, of 
respondents reported that rising health care costs were hurting their 
businesses; and 61 percent of small business owners, who are not 
hiring, point to worries about potential costs of health care as a 
reason for why they're not hiring. That ought to be a clear signal to 
everyone here that we need to deal with costs.
  What I should have stated at the outset of this hour is what we do 
not need to do. Health care decisions should be made between 
physicians, the family, and that patient. That's who should be making 
them. It should not be insurance companies and certainly not some 
bureaucrat here in Washington or some policy wonk up here that thinks 
they know what's best, as Dr. Harris just pointed out what is best for 
that patient. He saw and he knows what's best because that's what he's 
done for the last 30 years.
  I think our cost issue is clearly what we're not dealing with with 
this care. Are there good things in this bill? Sure. There are things 
in here that I like in the Affordable Health Care Act, and we can talk 
about that.
  Dr. Gingrey, I would like to yield to you at this point.
  Mr. GINGREY of Georgia. Again, I thank the gentleman from Tennessee 
for yielding because I wanted to follow on in this line of discussion 
with regard to costs.
  The way doctors were paid by Medicare in 1965 was, to my 
understanding--I think I'm correct on this--just like private 
insurance: an 80/20 indemnity kind of coverage, and the cost was 
accelerating.

  Then in 1998, I believe, the Balanced Budget Act of 1997 put in this 
formula to control Medicare spending, particularly the spending that 
goes to the health care providers, which by the way is only about 12 
percent of total Medicare spending.
  In any regard, that seemed to be the greatest concern, controlling 
how much the doctors were getting paid. So they put in this formula 
that's called SGR, sustainable growth rate, based on some calculus. But 
it was flawed. It was flawed badly. And for the last, I would say, 10 
years, when you calculate that formula for the expenditures for doctor 
fees for the previous year, the formula would call for a cut of 1 
percent, 2 percent, 4 percent. Over those 10 years, it's up to 26.5 
percent. Well, thank goodness Congress, we Members of Congress on both 
sides of the aisle, have the ability to mitigate that; and we have done 
that because we know the formula is flawed and it needs to be repealed 
and replaced. Yet we have not been able to do that.
  I'll tell you this, though: in this House of Representatives, in this 
113th Congress, with Republican control under Speaker Boehner and 
Leader Cantor and committee chairmen like Fred Upton in Energy and 
Commerce and Dave Camp on Ways and Means, we are going to fix that 
flawed formula once and for all. We're not going to keep putting Band-
Aids on it, mitigating a little bit at a time, and kicking the can down 
the road. That is our pledge to the American people.
  I hope our colleagues in the other Chamber, controlled by the 
Democratic Party, will go along with us on this because what we realize 
is that all of the doctors in the House and in the Senate, they 
understand that if you enact those cuts that will come due again at the 
end of this year, almost a 30 percent cut in what you reimburse for 
Medicare providers, then there will be no doctors. People will have a 
Medicare card, but they will not be able to find a physician to take 
care of them.
  This ObamaCare bill did nothing except, in fact, enact a provision, 
which I know my colleague from Tennessee wants to talk about, that 
makes it worse, that doubles down on it. We need to repeal SGR and 
figure out a better way to reimburse, to pay physicians based on 
quality of care, rather than volume. I think that's a good idea. But 
there's a provision in ObamaCare that could trump all of that and make 
all of our efforts in that direction go for naught.
  So I want to end here so the gentleman from Tennessee can explain 
what I'm talking about because he has the repeal bill for that.
  Mr. ROE of Tennessee. I thank the gentleman.
  I do want to say to the American people that 47 million people, 
including Dr. Gingrey and I, are on Medicare.
  We made a solemn promise to our seniors in 1965. When that program 
came out, it was a $3 billion program. Why was it put in place? Because 
many people retired from their business at that point in time, they no 
longer worked, and they had no access to care. Again, lack of access to 
affordable health insurance.
  It was a $3 billion program. There was no Congressional Budget Office 
at that time, but the estimators here in Washington said we believe in 
25 years

[[Page H536]]

this will be a $12 billion program and maybe even balloon to $15 
billion. The actual number in 1990 was $110 billion. Today, in 2013, 
it's going to be over $550 billion.
  Now, we've made a solemn promise to people who paid premiums--2.9 
percent of their income, basically. The employer pays 1.45, and they 
pay 1.45. Of all the income you make, all of your paycheck goes to 
that.

                              {time}  1630

  One of the things that we've discovered and found out is that we pay 
in, as I have--as the average person does--about $117,000 or $118,000 
over a lifetime, a family does, but they get out over $300,000 in 
services. So we know we can't pay $100,000 in and get three times that 
much service out. What are the reasons? It's the same issue with Social 
Security. We have fewer and fewer people paying in and people living 
longer and longer and longer. By the way, each day in this country, 
over 10,000 baby boomers hit age 65. That's 3.5 million people a year 
who are getting to be about 65 years of age.
  You have to laugh at the lingo up here, when ``savings'' means that 
you take money out of something and when an ``investment'' means you 
spend it into something. So you have to learn the language up here to 
understand what people are talking about.
  About $700 billion was taken out of the Medicare program--savings--
and we've got 3.5 million more people being added every year. Well, you 
do the math. How they were going to control this cost was with a little 
plan called the Independent Payment Advisory Board. What that is is a 
board of 15 unelected bureaucrats who are appointed by the President 
and confirmed by the Senate. Here is a little tricky part of the 
legislation. The President is supposed to be appointing these people 
this year. If they are not appointed to that board, one person--one--
the Director of HHS, Kathleen Sebelius, has the power to enact all 
this. We have given that bureaucratic power to one person if those 
members and that board are not confirmed. Most people don't know that.
  I've heard all the pros about how wonderful this is. I go back to my 
scholarly journals, and I want to refer people to the New England 
Journal of Medicine. An attorney in the New England Journal of 
Medicine, Timothy Stoltzfus, wrote an article in June of 2011, not pro 
or con, but just about the Independent Payment Advisory Board.
  In addition, my friend Dr. Gingrey just said--and he is absolutely 
correct--that Congress changed this payment to doctors, the so-called 
SGR--the sustainable growth rate--so that patients would maintain their 
access to their doctors. We've had a retrospective look at the last 25 
years. Let's say we fix SGR, like we're talking about, so that patients 
maintain their access. In a retrospective look in his report, the CMS 
actuary questioned--this is not me saying this--whether this goal is 
achievable to maintain these cuts, noting that the IPAB-targeted growth 
rates would have been met in only 4 of the last 25 years and would have 
approximated the sustainable growth rate, meaning that a cut would 
happen. We have almost no power to change this.
  Now, here is what I found interesting. In the bill, it's absolutely 
correct that you can't ration care, that you can't do any of those 
things. That's maybe true, but if patients don't have access to their 
doctors, you, in effect, have rationed care. It's that simple.
  This is what Peter Orszag said, the former Office of Management and 
Budget Director here in the Obama White House:

       The IPAB is the single biggest yielding of power to an 
     independent entity since the creation of the Federal Reserve.

  That is an astonishing statement when you hear it. That's one of the 
reasons I'm so passionate about maintaining the decision-making power 
with patients and with their families and their doctors and not with 
some bureaucratic board up here and also, certainly, not with the 
insurance companies. I agree with that.
  Another comment that I've seen made:

       The Independent Payment Advisory Board puts important 
     health care payment and policy decisions in the hands of an 
     independent body that has far too little accountability.

  That's one of the things. You may like it or not, but we in Congress 
have been able to change these things, and it would require 60 votes in 
the Senate to do it. Quite frankly, with my good friends on the other 
side of the building here, you couldn't get 60 Senators hardly to agree 
whether the Sun came up in the east, so the benchmark is very, very 
high.
  Mr. Speaker, how much time do I have remaining?
  The SPEAKER pro tempore (Mr. Mullin). The gentleman has 8 minutes 
remaining.
  Mr. ROE of Tennessee. I want to finish by spending the last little 
bit of time on Medicare. It is such an important part of our health 
care system. I want to strengthen this program--and I certainly know 
the folks on my side of the aisle and, I think, on the other side of 
the aisle want to--for future generations. We've made a promise to our 
citizens in this country that when they are at retirement age they'll 
have at least an affordable health insurance product available to them.
  Let me tell you, the funny thing I found out about myself when I 
turned 65 was, the day before, I had a health insurance plan. It had a 
prescription drug benefit plan; it had a hospitalization part; it had a 
part that paid for my physician services. The day I turned 65, I got a 
part A, a part B, a part C, and a part D I could have. Well, nothing 
happened except I got 1 day older. Why, when a person turns 65, 
wouldn't you just have a health insurance plan that offered you those 
various options in your plan? You should be allowed to pick what's in 
your best interest and need.
  Remember, in the Affordable Care Act, the Federal Government now 
decides what's an essential benefits package. You don't make that 
decision with your family and your doctor. A Federal bureaucrat makes 
that decision--what you must buy, a good or a service that you must 
purchase.
  Some of the facts I've mentioned already about Medicare, and one of 
the things that we have to do, I think, in Medicare--and I know my 
colleagues will confirm this--is that, currently, one in 10 physicians 
is not accepting new Medicare patients. In some areas, it may be as 
many as three in 10 primary care or as many as half won't. We have a 
huge shortage of primary care physicians in this country. We know that 
the hospital insurance trust fund is insolvent. It may run out of money 
as soon as 2016.
  I yield to my colleague, Dr. Harris.
  Mr. HARRIS. I thank the gentleman from Tennessee for yielding.
  The gentleman is absolutely correct. We made a promise to our 
seniors. To the people who've worked all their lives, we made a promise 
that we're going to take care of you, but we have to be honest with how 
long we can do that. What are we going to do for my children? for 
people who are in their twenties or thirties? How are we going to 
preserve that system and preserve their ability to choose their 
physicians and allow their physicians to choose what's best for them? 
Because that's really what's critical, that we preserve that in the 
system.
  The gentleman is right. For the seniors who are watching this 
afternoon, they know that, in many parts of this country, if their 
primary care providers, their internists, their family doctors retire 
or move to other States, it's going to be hard to find someone, not 
because doctors don't want to take care of Medicare patients. We all 
do--we've taken care of thousands of them in our lives, in our 
professional careers--but the fact of the matter is that, every year, 
the government threatens to cut the reimbursement, the payment for 
services, by 25 percent, and it hasn't had an increase for inflation in 
10 years.
  This kind of uncertainty means that we may end up looking like the 
other program the Federal Government runs, Medicaid, where the 
statistics are dire and where fewer than one-half of specialists can 
afford to see a Medicaid patient because the government simply has 
decided we're just not going to pay. It's where fewer than half of the 
primary care providers don't see Medicaid patients because the 
government has said we just can't pay, and we're not going to. It's 
where hospitals now are wondering how they're going to staff and how 
they're going to keep up with the best medical equipment and the

[[Page H537]]

best medical delivery because they're afraid the government is not 
going to pay. Who can blame them? Every year, the government threatens 
to cut the pay to our seniors' doctors 25 percent, and, every year, the 
government threatens to cut the pay to our hospitals that are taking 
care of our seniors. Every year, this goes on. It has to stop.
  I hope the Speaker and the gentleman from Tennessee will agree that 
we have to address this seriously, honestly, with a view to two things: 
preserving the benefit for people who are in retirement and keeping the 
system going for every American. An American born today, February 14--a 
child born today--should have a system that he knows is going to be 
there, not bankrupt, but a system that's there when he reaches those 
golden years, and we can do it if we all work together.
  I was hoping I'd hear more from the President. I didn't. The 
President is still not willing to come and talk about preserving 
Medicare, because, Mr. Speaker, you know that the trustees have said it 
goes bankrupt in 10 years. The current system will not be there for 
everyone retiring. The 10,000 people retiring today, February 14, enter 
Medicare. That system will not be there in 10 years. It will be 
bankrupt. So the current system doesn't even protect our current 
seniors, much less a baby born today.

                              {time}  1640

  We have to deal with it. Mr. Speaker, I urge the President to step up 
to the plate, be serious. Our colleagues on the other side of the 
Capitol, step up to the plate. This program is too important to let go 
bankrupt within 10 years.
  Mr. ROE of Tennessee. I thank the gentleman. He is absolutely spot 
on. One of the reasons that he ran for Congress and I ran for Congress 
is to preserve this great program for our seniors out there, and I am 
absolutely committed to do it.
  Let me give a couple of facts before we end up. The actuary of the 
Medicare program--this is not me, this is the Medicare actuary--said 
that congressional action will be required to ensure that our seniors 
have continued access to care. In May 2012, he said it is reasonable to 
expect that Congress would find it necessary to legislatively override 
or otherwise modify the reductions in the future to ensure that 
Medicare beneficiaries continue to have access to Medicare services.
  This is not some right-wing Republican, this is the Medicare actuary, 
and we're not even talking about it. We have heard nothing from the 
President about how we preserve this great program other than we just 
keep doing what we're doing. That's not an honest, fair assessment of 
where we stand today. The sooner we deal with it, the more likely we 
are to come to a less painful solution to this.
  I do want to finish by saying that I appreciate the hour you've shown 
us, Mr. Speaker. We will continue this very, very important discussion 
on Medicare in the future, and I yield back the balance of my time.

                          ____________________




    

All articles in House section