[Congressional Record Volume 150, Number 134 (Friday, November 19, 2004)]
[House]
[Pages H10059-H10064]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICAL MALPRACTICE INSURANCE REFORM
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 7, 2003, the gentleman from Georgia (Mr. Gingrey) is recognized
for 60 minutes as the designee of the majority leader.
Mr. GINGREY. Mr. Speaker, we just finished our elections, and we hear
a lot of browbeating and weeping and gnashing of teeth from the other
side of the aisle concerning what went wrong. Goodness gracious, what
in the world went wrong? We thought we ran a good campaign. We were
ready to elect a President, we were ready to take over the House, we
were ready to get the majority in the House and the Senate, and none of
those things happened.
Of course the pundits are on television every day, 24 hours a day it
seems, talking about exactly what went wrong. And there is a lot of
talk, of course, about the issue of moral values, traditional family
values, and Christianity. I am sure that that had something to do with
it. But I will stand here today, Mr. Speaker, and say to my colleagues
that I ran a race in which I won with 57.4 percent against an opponent
on the other side of the aisle who I think was a very strong Christian
man, a good man, and one who had great values. But he was running on a
party platform that did not embrace those traditional values that mean
so much to I think middle America and those of us where I come from in
Georgia.
But I think it goes beyond that. I think it goes far beyond that. And
I would suggest to my friends on the other side of the aisle, as they
try to play Monday morning quarterback and figure out what went wrong,
to think about issues like medical liability reform and the fact that
the Nation, 75 percent or more, the American people in every poll that
has ever been done, are very much in favor of medical liability reform.
And yet an issue like that, which really should not be a partisan
issue, because there is absolutely no reason why access to health care
and fixing a broken system should come down along party lines,
certainly did become partisan. It did in this body, and it did in the
other body.
In March of 2003, the HEALTH Act was passed in this House Chamber, as
my colleagues know, and there were Members of the Democratic minority
who voted for the bill, but only a few, only a handful, and practically
none in the other body. So today, as we stand here going into the 109th
Congress and President Bush's second term, we once again have a chance,
an even better chance, I think, to get medical liability reform passed
because we have increased our margins in the other body.
So there are a lot of reasons you can look back and try to figure out
why you lost, but that is one, I think, that my Democrat colleagues
need to take a close look at. When this issue comes before us in the
109th, if you want to do something positive, if you want to respond to
the will of the American people, this is certainly a great first step.
I would encourage my friends on the other side of the aisle and my
fellow Republicans in the House and the Members in the other body that
it is time. The American people want this. They need it.
Access to health care is hugely important. We are seeing more and
more physicians, and I will get to some specific numbers a little later
regarding doctors in high-risk specialties, like neurosurgery,
emergency room physicians, and OB-GYN, which is my specialty. I think
all my colleagues know that in my prior life I practiced medicine for
almost 30 years, and as a pro-life OB-GYN physician, delivering those
5,200 babies. Many of my colleagues in that specialty are dropping
[[Page H10060]]
out at the very peak of their practice productivity, in their late 40s,
early 50s. They are literally trading their stethoscopes for a fishing
rod or a set of golf clubs. They do not want to do that, but they have
been forced to.
I have a number of posters here, Mr. Speaker, that I want my
colleagues to pay attention to, which really give testimonials to the
statistics. Maybe my colleagues know some of these individuals, or
individuals just like them, or families who have suffered because, when
they went to the emergency room, there was no emergency-room physician
to take care of their injured child or their loved one who had had a
stroke and needed immediate care from a neurosurgeon.
Just look at some of these posters. This is talking about women's
health care in particular. Women's Health in Jeopardy: A pregnant Texas
woman was forced to drive 80 miles to a San Antonio hospital because
her family doctor in her rural hometown had stopped delivering babies
because of malpractice insurance concern. This was in the Fort Worth
Star Telegram January of 2003.
Nationwide, doctors are leaving and patients are suffering. Look at
these people. Look at these physicians. I do not know if my colleagues
can see some of these posters, but they are not saying ``Vote for
George W. Bush, or Reelect Bush, or Vote For Kerry and Edwards, or I am
a Democrat, I am a Republican.'' They are saying ``tort reform now.''
Insurance rates are driving doctors out of business. What good is
insurance, health insurance, if you cannot find a doctor to provide the
care, and on and on and on? Look at some of these headlines, Mr.
Speaker: ``Doctors Protesting Skyrocketing Malpractice Premiums.''
Springfield State Journal Register, February 2003. ``Malpractice
Insurance Prices Send Physicians to the Streets.'' USA Today, February
2003. ``Caps on Noneconomic Damages Most Common Solution Considered by
States in Crisis.''
There are twelve States in crisis, and 30 more near crisis. If my
colleagues do a little quick math, that is 42 out of 50 that are either
in crisis or near crisis today. USA article, February 2003. ``Medical
Malpractice Premiums Jump 50 Percent, Average Cost Tops $1.4 Million
Per Hospital.'' PR news wire, January of 2003.
It is not just the physicians; it is the hospitals that are suffering
as well, many of whom are self-insured up to probably $10 million, $15
million, or $20 million; and it is literally driving the small rural
hospitals out of business. And in so many instances, the hospitals and
the school system might be the only two employers in a whole county, or
the two major employers in a whole county. When you shut them down, you
are talking about job loss.
So this is really an economic issue. It is a health issue, no
question about that. Lack of access to health care is a real tragedy
and a real crisis, but we have heard for the last 2 years, as we led up
to this Presidential election year, the other side of the aisle talking
about President Bush being the only President since Harry S Truman who
actually lost jobs on his 4-year watch. Three million of those happened
to occur after the dot-com bubble burst and the recession that started
during the Clinton administration. The rest of it occurred shortly
after 9/11, which cost the economy of this country almost $3 trillion.
The other side kind of changed their tactic, Mr. Speaker, as we began
to grow jobs as those tax cuts for all Americans with their special
emphasis on small businessmen and -women began to put people back to
work. All of a sudden, when we gained 1.7, 1.9 million jobs back, then
they had to change their tactics at the last minute.
But make no mistake about it, this medical malpractice crisis and
lack of access to care, and the fact that physicians are shutting their
offices, it is a job issue as well because it is not simply one
physician but in many cases it is 15 to 25 people who are actually
employed in that office and all of them are without a job. Talk about
outsourcing of jobs.
We could have done a lot to prevent that right here in our own
country with some meaningful leveling of the playing field with fair
and balanced tort reform in regard to medical liability.
Continuing with some of the posters, these are real-life situations
that I want to bring to the attention of my colleagues.
{time} 2015
Michelle, a breast surgeon, serving more than 5,000 patients a year,
experienced a 760 percent increase in malpractice insurance over an 8-
year period of time. That is an average 76 percent increase per year.
This was a testimonial on 60 Minutes in March, 2003.
Doctors in rural Mississippi can expect to pay over $70,000 in
malpractice premiums. Their average salary in rural Mississippi,
certainly not an affluent State, about $72,000 a year. They are
literally almost as much, not more, but almost as much in malpractice
premiums as they are making in income and probably working 70 hours a
week.
Lehigh Valley, Pennsylvania, lost one-third of its neurosurgeons due
to unrelenting problems with medical malpractice insurance. That is in
Lehigh Valley, Pennsylvania.
Listen to some of these numbers. Talk about bullet points. This
really cuts right to the chase. Let me give my colleagues a few numbers
to ponder.
America's medical liability crisis, we all pay for a broken system.
The number 19, as I said at the outset of the hour, the number of
States in a full-blown medical liability crisis in which the cost of
frivolous lawsuit settlements and jury awards cost physicians' medical
liability premiums to skyrocket. As a result, patients lose access to
care when physicians are forced to give up parts of their practice,
such as delivering babies or performing high-risk surgery.
Mr. Speaker, 72 percent of Americans favor a law that guarantees full
payment of lost wages and medical expenses but limits noneconomic
damages. That is the point that my colleagues on the other side of the
aisle seem to miss. We spend all this money on polling. We poll and run
TV ads, and then we send out mailers depending on what the public
perception is of an issue. And 72 percent, talk about a plurality, a
supermajority of Americans understood this issue, and clearly today
understand that we are a country in crisis in regard to our health care
delivery system. They want change, they want fairness, and yet my
colleagues who have a lot of heartburn over this recent election are
still trying to figure out what went wrong. Certainly they were wrong
on that issue.
The figure of $70 billion to $126 billion a year, the cost of
defensive medicine which could be significantly reduced by medical
liability reforms. Now we just passed yesterday an increase in the debt
ceiling of $800 billion. There was a lot of rhetoric from the other
side and a lot of complaining about the runaway deficits and the
growing, burgeoning debt.
With medical liability reform, it is estimated that we would save the
government close to $40 billion a year. Keep in mind that the Federal
Government really pays about two-thirds of all of the health care in
this country with four programs: Medicare, Medicaid, Tricare for our
military personnel and their dependents, and our VA health care system.
If we put all of those programs together, we are talking about two-
thirds of the health care costs in this country the Federal Government
pays. If we had some meaningful tort reform and doctors did not have to
do all this defensive medicine and add all of these additional tests
which we know and the hospitals know are totally unnecessary in many
instances, but doctors are just trying to protect themselves from a
lawsuit, if we could get all of that out of the system and go back to
just practicing common-sense medicine, this is the amount of savings we
would incur. Then we would not have to increase that debt limit.
I am very pleased tonight, Mr. Speaker, to be joined by one of my
colleagues on my side of the aisle and a fellow physician, not only a
fellow physician but also a fellow OB/GYN physician. He has not
practiced quite as long as I have nor delivered quite as many babies as
I have, but he is one fine doctor and a fine Congressman.
Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess).
Mr. BURGESS. Mr. Speaker, I thank the gentleman from Georgia (Dr.
Phil Gingrey) or Dr. Phil, as we say here in Congress. I need to point
out that I am
[[Page H10061]]
just a simple country doctor, and while the gentleman from Georgia will
spend a lot of money on polling, my operation in Texas is far too small
for that. But I do talk to a lot of my constituents, and the doctor is
right that this is an issue understood by average, everyday Americans.
They understand it very well. They understand it is limiting their
access to medical care, and they want this situation fixed.
The Subcommittee on Health Policy met this summer and had a hearing
on medical liability reform. We wanted to bring the spotlight to what
are some of the successes we can point to in this country in this
arena, not just simply rehash and recover old territory but what are
some of the solutions. We were fortunate to be joined by a doctor from
California who was actually practicing medicine in California 1975 when
the California Medical Injury Compensation Reform Act of 1975 was
passed.
Of course, he talked about the night-and-day difference that it made
in his State as far as being able to practice medicine with the
noneconomic damages capped at $250,000 and how that held down premiums
and allowed doctors to continue in practice and not leave the State
because they were in a crisis in 1975.
Let us remember the governor who signed this bill into law from the
California legislature was none other than Jerry Brown, not known for
his conservative thoughts or principles. It was truly landmark
legislation when it was passed in California now some 28 or 29 years
ago.
In Texas, we passed legislation this past legislative session that
also limited noneconomic damages, put a cap on noneconomic damages. It
was a little bit different. We might say it was a 21st century
variation of capping noneconomic damages. There is a cap of $250,000
for the physician's component, a cap of $250,000 for the hospital
component, and another $250,000 if a nursing home is involved. But
altogether, the noneconomic damages in a case would be capped at
$750,000. This has had an enormously positive impact on the State of
Texas as far as liability reform is concerned.
Consider this: When I was practicing medicine in the late 1990s,
there were 17 insurers who would write a liability policy for doctors
in the State of Texas. As the medical liability crisis mounted in my
State, the number of insurers dropped out and left the State to the
point that, by 2002, there were two remaining insurers writing medical
policies in Texas.
What did this mean for the average medical practitioner and their
patients? When I was campaigning in 2002, when I would do speaking
events, I remember a young woman came up to me. She was probably in her
early 40s. She said, ``I am a radiologist who studied at State schools
and I did my residency at a State-supported institution. My insurance
carrier left the State 3 months ago, and now I cannot buy liability
coverage at any price, and I cannot afford to jeopardize my future, my
husband's future, and my children's future by continuing to practice
medicine without a liability policy, so I am a stay-at-home mom.''
That is an admirable thing for someone to do, but the State of Texas
had made a significant investment in her college and medical education.
In addition, she did her residency at a publicly funded hospital.
Again, a good investment made in this bright individual to practice her
craft of radiology, a lot of investment was made by the State of Texas,
by the people of Texas, in her medical career, and she was unable to
practice her profession because of the unavailability of liability
insurance at any cost, let alone liability insurance that might have
been quite costly.
One of the people we heard from at that hearing was Texas Insurance
Commissioner Jose Montemayor. This hearing was in June. Commissioner
Montemayor talked about some of the improvements that had come to Texas
as a result of this law that was passed by the Texas State legislature.
We had gone down to two liability insurers. We were now up to 13. Of
those that had come back into the State in 8 months time, they had done
so without an increase in their rates, contrasting with the neighboring
States of Oklahoma and Louisiana where those insurers were able to show
and justify an increased rate of 50 percent in Oklahoma and 80 percent
in Louisiana. So this is a big difference this law has made in Texas.
In addition, Cristus, a Catholic not-for-profit health care system in
south Texas that self-insures, has been able to, by June of this year,
6 months into this fiscal year, had posted a $20 million savings in
their insurance premiums that they were then able to directly invest in
hiring nurses, direct patient care, and capital improvements in their
hospitals there.
So this is a tremendous gift or tremendous savings for the people in
the State of Texas, and one of the things that we were able to showcase
in that hearing is one of the proven successes in the country for
medical liability reform.
We also heard from an individual, and I apologize. I am blocking on
his name. He was the administrator of the hospital in Uniontown,
Pennsylvania, and there the story has not been as benevolent.
Pennsylvania has not managed to pass medical liability reform in their
last legislature. Because of the peculiarities of their State system,
they will have to pass that legislation two times in the form of a
constitutional amendment. So 2007 or 2008 is the soonest time they can
expect any type of relief from their medical liability crisis.
The administrator at Uniontown Hospital told us he is down to one
ear, nose and throat doctor who is now responsible for about 140,000
patients in that area. I did some quick math, that is about 300,000
ears for one doctor. That is a lot of work for one ENT doctor, and they
cannot bring in another doctor to help him because of the cost of their
liability insurance.
About a year and a half ago, we were at a field hearing up at ANWR,
and we came back home through Nome, Alaska. When a group of congressmen
come through Nome, Alaska, it is a big deal, and a lot of people turn
out for that. They heard that one of the congressional representatives
was a physician representative, and the entire medical staff of their
hospital came out to lunch with us.
Over lunch, they asked questions. What it was like to serve? And one
said we hope Congress gets that medical liability law passed because we
cannot afford an anesthesiologist for our hospital here in Nome.
I asked what kind of medicine he practiced. He said I am an OB/GYN,
just like you.
Mr. Speaker, what a deal. Practicing OB/GYN in your hospital without
an anesthesiologist in Nome, forget pain relief during childbirth. We
are talking what do you do if you have to do a c-section. He said,
well, we get that patient on an air ambulance as soon as possible and
get her to Anchorage for her c-section. Well, Anchorage is an hour and
a half a way, and I am given to understand there is poor weather
sometimes in Nome, Alaska.
I cannot understand how we feel that we are furthering the cause of
patient safety by allowing this system to continue.
People do ask me back in Texas, they say, we have done a good job
here in Texas. Why are you worried about medical liability insurance
anymore? It is not an issue for us here in Texas. But as Dr. Gingrey
has pointed out so clearly, it costs our country billions of dollars
every year.
{time} 2030
In the Medicare system alone, the cost of defensive medicine from a
1996 Stanford University study was estimated to be between 30 and $50
billion a year in the cost of defensive medicine. Do the math on that.
What is the average of 30 to $50 billion? It is $40 billion a year. Dr.
Gingrey is quite right. We were criticized last night about increasing
the debt limit. We were criticized a year ago for passing a Medicare
bill that costs $40 billion a year for prescription drug coverage. We
basically would save that amount of money if we would only pass
meaningful medical liability reform. That is why it is a national
issue, because we are all paying for that. Every taxpayer in the
country is paying that freight for this medical liability system. $230
billion a year in direct costs for medical liability and about 20
percent of that actually goes to injured patients.
Do not tell me that by capping noneconomic damages that we are
keeping money out of the hands of patients.
[[Page H10062]]
The system is keeping money out of the hands of patients today under
the present system and the only parties that are enriched by today's
system are the trial lawyers.
With that, I see my time is about up. I appreciate so much the doctor
organizing this Special Order this evening. It is of critical
importance that we get this done. We did not manage to do it this year.
There has been a little bit of a change across the Capitol rotunda, and
I am very optimistic that as we start into the 109th Congress, this
will continue to be an issue of pressing concern for it, and we will
get this job done for the American people.
Mr. GINGREY. I thank my colleague from Texas for joining us this
evening for this discussion, and I appreciate his very accurate
remarks. I know one thing he was talking about, physician access and
which specialties doctors choose today based on this liability crisis.
I want my colleagues to listen very carefully to this number: 48
percent, the proportion of American medical students in their third or
fourth year of medical school who indicated that the liability crisis
was a factor in their choice of specialty, threatening patients' future
access to critical services. I am sure that Dr. Burgess would agree
with me that when we were in medical school a few years ago, OB-GYN was
one of the most popular specialties. It was the one that everybody
wanted to go in. It was the compassionate, the feel-good specialty,
delivering babies, being with a family, at what usually is the happiest
day, the happiest moment of their lives, the birth of a child.
Yet today because of this crisis, as he well knows, we are having
fewer and fewer, not only fewer and fewer of our best and brightest
students from college wanting to get into medical school and go into
the practice of medicine in any specialty but particularly OB-GYN and
general surgery and neurosurgery and some of these higher risk
specialties.
Mr. BURGESS. If the gentleman will yield, about a year ago I was
having a discussion with a woman who was in charge of the residency
program at a northeast hospital. I trained at Parkland Hospital,
arguably the best residency program in the country, but this one in the
northeast has a good reputation as well, and she said that they were at
the point now where they were taking people into their OB-GYN residency
program that 5 years ago they would not even have asked in for an
interview, such has been the dropoff in the quality and caliber of, as
you put it, the best and the brightest not going into the specialty.
These are children's doctors. These are the doctors that are going to
be there for the next generation of Americans. Again, I fail to see how
allowing this system to continue is furthering the cause of patient
safety or excellent patient care.
Mr. GINGREY. The gentleman is absolutely right. I am pleased to have
another physician Member with us tonight in my colleague from Florida,
Dr. David Weldon. Dr. Weldon is an internal medicine specialist. I
think I am recalling correctly that he is about to begin his sixth term
in this august body and has certainly been a great mentor to both Dr.
Burgess and myself as we came in 2 years ago as freshmen and really
needed to get up to speed on the Medicare law and all the nuances of
that. It is certainly a distinct honor and a pleasure to have Dr.
Weldon join us this evening.
Mr. WELDON of Florida. I thank Dr. Gingrey for his kind words. I must
confess that he did not need a lot of mentoring. All his years in the
State senate prepared him quite well for the busy work that we are
about here. I just want to amplify a little bit on what our good
friend, Dr. Burgess, the gentleman from Texas, was talking about,
specifically the high cost of defensive medicine. As you mentioned, I
was a full-time practicing internal medicine doctor. Actually, I still
see patients about once a month in the veterans clinic on a voluntary
basis in my district.
As an internist, internal medicine specialist, I did a lot of
diagnostic tests. A lot of people come in the office saying I hurt
here, I hurt there, I can't breathe when I walk. You do a physical
examination, and you typically send people off for studies and tests. I
regularly on a daily basis practiced defensive medicine. I would do my
history and physical, and I would come to a conclusion as to what I
thought that patient most likely had and then there was always that
little voice in the back of my mind, what if you are wrong? What if you
miss something? What if you get sued? What will happen to you if you
get sued? Will it hurt your practice? Will you lose patients? Will you
lose your house? These are the kinds of things that go through your
mind.
What you do is you order extra tests. We had a special name for doing
that. But I was one doctor in one town, and there are hundreds of
thousands of doctors every day in America spending hundreds and
thousands of dollars each. I was so glad Dr. Burgess mentioned that
study out of Stanford University. That was the first study that
conclusively showed that defensive medicine was real and it was very,
very costly and that was that famous, a famous study now, that came out
of Stanford University. They looked at expenses before medical
malpractice and after medical malpractice for just two diagnostic
codes, two different conditions, and showed a significant reduction in
Medicare charges, and what is most important in this, no increase in
what we call morbidity and mortality. In other words, the patients did
fine, but the charges went down. They said at the end of that article,
this is the first really good scientific study that shows that
defensive medicine is real.
And how much does it cost? Ladies and gentlemen, we are struggling in
this body to figure out how are we going to keep Social Security
solvent in the future and how are we going to keep Medicare solvent in
the years ahead.
Actually, Social Security gets talked about much more in the press,
but the real problem is Medicare. Social Security will be solvent for a
long time to come. Medicare could start going broke before the end of
this decade. The crisis in Medicare is much more serious. What did that
study show? It showed that defensive medicine costs us tens of
billions, maybe as much as $50 billion, $75 billion a year just in the
Medicare plan.
How much money could we save over the next 5, 10 years if we on a
national level can institute some kind of caps on all of this medical
malpractice? Let me just say as well, the problem that we have in the
State of Florida is very severe. I know there are many other States
that are very severely affected, but I just want to share some
statistics here. In 1975, in the State of Florida, there were 380
lawsuits for medical negligence allegations. Those 380 lawsuits
resulted in $10.8 million of settlements. It cost $1.5 million for the
insurers to defend. In the year 2000, the next year that we have good
statistics on this, it went up to 880 lawsuits resulting in awards
totaling $219 million.
So we have a serious problem. This is not just a Florida problem.
This is not just a Georgia problem. It is not just a Texas problem.
This is a national problem. This body, the Congress of the United
States, we are the fiduciaries of the Medicare plan, and we can save
the Medicare plan by putting some reasonable caps on medical
malpractice settlements. Every year that I have been here, and I have
been here 10 years, going into my sixth term, we have passed some form
of medical malpractice reform. Typically, we have passed this $250,000
cap on what we call pain and suffering claims, or noneconomic damages.
The important thing there is that if people cannot work, they can be
compensated for that. If they have medical bills, they can be
compensated for that. And if they have pain and suffering, they can get
$250,000. But gone are the days of these multimillion-dollar
settlements for pain and suffering. And why do we have to do that?
Because we all pay for it.
I just want to share one other thing that is critically important.
Most of the job creation in my congressional district over the last 10
years has been in the small business sector. When I meet small business
men and women in my congressional district and I ask them, what are the
problems that you are struggling with now, what can I help you with,
invariably the first words that come out of their mouths is the high
cost of health insurance for their employees and that many of them
cannot afford to insure their employees anymore.
What can we do to help them? Actually, one of the best things we can
do is
[[Page H10063]]
pass medical malpractice reform. I spoke earlier, Dr. Burgess spoke
earlier, Dr. Gingrey spoke earlier about the high cost of defensive
medicine. That drives up health insurance premiums. If you are a small
business and you employ 10 people and it is costing you $600 a month
per employee to insure all those employees, you can lower that premium
if we can get reasonable and sensible caps on medical malpractice.
What is going to happen there? It is going to make those businesses
more competitive. It is going to make those businesses better able to
hire more people. The other thing is there are a lot of small
businesses that just have decided they cannot afford health insurance
anymore. These are the people that I am most worried about, the working
uninsured. These are people who end up using our emergency rooms for
their health care services. How can we get some of these uninsured
people insured? One of the things we can do is pass medical malpractice
reform.
This is not just a doctor issue. As a matter of fact, the doctors
complain about it all the time, but they just pass the costs on to
their patients. This is really a competitiveness issue for our Nation.
This is about how do we deal with the uninsured. This is about how do
we keep Medicare solvent. And it is a national crisis. I want to thank
Dr. Gingrey for taking the lead on this issue. It is a critically
important issue. If we can finally get something done in the next
Congress, it will be good for the uninsured, it will be good for
America, it will be good for OB-GYNs, one of the most aggressively
assaulted specialties in the Nation, constantly being sued, many OB-
GYNs getting out of the business of delivering babies.
In many regions in the country, communities, they do not even have a
doctor that delivers babies. They have to get in ambulances and drive
or fly in helicopters to a town where there is a doctor who is willing
to deliver babies. That is a sad state of affairs. It has been
precipitated by the failure of the other body to really take this issue
up and deal with it. We have passed it every year that I have been
here. We need to do something about it in the 109th Congress. I thank
the gentleman so much for his leadership on this. I really appreciate
it.
Mr. GINGREY. I thank the gentleman from Florida so much. We
appreciate him being with us tonight and sharing those thoughts. It is
so important that he pointed out to our colleagues that this really is
not just about doctors and their practice, Dr. Weldon's practice, Dr.
Burgess, Dr. Gingrey, or an individual like this Dr. Leon Smith, Jr.
I happen to know Dr. Leon Smith, Jr. He practices medicine in Athens,
Georgia. I went to medical school with him. I knew him very well. Both
he and his brother are OB-GYN physicians. His group, I think six or
eight of them, recently stopped practicing, had to stop obstetrics and
curtail their practice drastically because of this crisis. Dr. Smith
was actually interviewed on ``60 Minutes'' on March 9, 2003. Here is
what Leon said, Dr. Leon Smith, Jr.:
``We're giving up something I have always wanted to do because of the
malpractice crisis after insurance premiums broke a million dollars.''
This is real life. This really puts a face on this problem. But as
Dr. Weldon points out so vividly, it is a jobs issue because it is not
just Dr. Smith and colleagues like him that have to give up their
practices. It is the fact that small business men and women over the
last 5, 6, 8 years are seeing double-digit increases in the amount that
they have to pay for health insurance to provide to their employees.
And they cannot do it. It is becoming the highest cost of them doing
business. And a lot of small businesses fail. This is one of the main
reasons that they fail.
And so we are not just talking about doctors not being available to
help patients. We are also talking about small businesses closing and
people being out of work. I think it is so important that we keep that
in mind as we try to address this crisis and try to do it in a
bipartisan fashion.
{time} 2045
Mr. Speaker, I want to show this last poster before I go on with some
additional remarks, but this is pretty telling and the title of this
poster is ``Show Me the Money.'' ``Show Me the Money.'' And I have
heard, I am not sure who it was, maybe some wise, erudite talk show
host recently say, If you want to know what the problem is, just follow
the dollar. Follow the dollar.
I can remember during the Medicare Modernization, Improvement, and
Prescription Drug Act debate that we had on the floor of this House
last year, this Medicare modernization, which we had not done in 38
years, and this prescription drug benefit, which seniors have been
begging for, pleading for, been promised by previous Presidents and
previous Congresses and nobody ever delivered, we finally delivered on
that promise.
And the criticism we received from the other side of the aisle was
well, it was just a giveaway from the pharmaceutical industry. That is
all it is. All these Republicans getting all this money from the big
drug companies. And in fact, it was said, Mr. Speaker, by so many of my
colleagues on the other side of the aisle that the pharmaceutical
industry wrote the bill. I guess they think the doctors and hospitals
wrote the original Medicare bill that was passed in 1965, but I do not
think the doctors and the hospitals have done too well, but it has been
a boon to seniors. Medicare has worked well. It is going to work even
better. But while they were criticizing us purportedly for accepting
money from pharmaceutical industry lobbyists, look at what is happening
on this ``Show Me the Money'' poster.
Why do Democrats put trial lawyers before patients? That is my
question. That is the question I want my colleagues to answer for me.
Seventy-four percent of the campaign contributions made by lawyers and
law firms during the 2002 election cycle went to Democrats. I am not
sure what the number is in 2004, but I imagine it is probably a little
higher than that with a couple of lawyers on the Democratic ticket, one
a trial lawyer who made his living suing doctors like me and my
colleagues. Seventy-four percent of the campaign contributions made by
lawyers and law firms during the 2002 election cycle went to Democrats.
Over $87 million to Democratic candidates during that cycle. Seventy-
four percent came to over $87 million. In fact, the average
contribution to a House Democrat totaled $57,281.
I like to think that we cannot be influenced by money, and I think
that that statement is, in fact, true. I think most of my colleagues on
the both sides of the aisle would agree with that. Men and women of
honor and integrity. But these figures certainly have to be
frightening, and maybe it is some of the explanation why, which has no
reason to be partisan. A high-risk mom who desperately needs
obstetrical care, she is not worrying about whether that white coat has
an R or a D on its shoulders. She is looking for an M.D., of course,
and this should not be a partisan issue. We need to get beyond that. It
is too important. It is hugely important. Just as Medicare
modernization, Social Security, these other issues, education, none of
that should be partisan. So I hope that as we go forward in the 109th
that we will all join together and finally get this job done.
I was giving some numbers a little bit earlier, and I would like to
give a few more. The number 29. Mr. Speaker, 29 is the number of years
that California's comprehensive medical liability reforms have
protected the State of California and their patients, physicians, and
taxpayers. 1975 was when MICRA, Medical Injury Reform Compensation Act,
was passed; 1975, 29 years ago. Since then premiums in the United
States, the rest of the 49 States, have grown by 750 percent. In
California premiums have increased only 245 percent. Another very
telling statistic.
Listen to this one. And I want my colleagues to listen carefully to
this: $778,334, that is the amount a patient would receive for a $1
million jury award, an injured patient, a patient that deserves
compensation, and we all are aware of that in many instances, $778,334,
the amount a patient would receive for $1 million jury award by
reforming the current contingency fee system. Now without any reform, a
trial lawyer typically takes $400,000 or more of that settlement. That
is not right. Mr. Speaker, that is not right.
The people who are injured, the mom, the dad, the parent, the child,
in cases
[[Page H10064]]
that are not frivolous, somebody has practiced below the standard of
care. Maybe it is one of my physician colleagues. Maybe it is a
hospital. Maybe something happened in the emergency room. That patient
has been injured and suffered and has significant economic losses, and
they deserve fair and just compensation. But they are not getting it
because of this contingency fee system which causes a lottery mentality
among a lot of trial attorneys. Not all of them. Certainly not all of
them. Most, in fact, I think are men and women of high integrity and
provide a good service to their clients as they practice this
subspecialty of personal injury.
3.9 million, and let me repeat that, Mr. Speaker, 3.9 million, the
increase in the number of Americans with health insurance if Congress
were to pass commonsense reform. Almost 4 million more people would be
able to afford health insurance. We have been talking about that issue
ever since I have been here in this Congress about the 40 million or so
mostly working Americans who cannot afford to have health insurance.
Either they cannot pay their part of the premium or their employer
cannot provide it for them. It is estimated with meaningful leveling of
the playing field, not taking away anybody's rights, that an additional
4 million people would be covered by health insurance.
I could go on and on with these numbers and statistics, but let me
just talk a little bit in some of the time that we have remaining. Mr.
Speaker, there are a number of provisions in the bill that we passed,
the Health Act in 2003. That bill primarily puts a cap on noneconomic,
so-called pain and suffering. But what it does not do is it absolutely
does not limit recovery for injuries, economic losses; and in many
cases those awards are in the several millions of dollars. But there is
no way that one can put any estimate on pain and suffering or
noneconomic losses. And that is the hallmark really of MICRA, the law
that was passed in California, and it is a model that we know works.
And as I said before, if this bill is passed, and I feel that we will
pass it in the 109th Congress, any injured patient would be well
compensated for the economic losses and any medical care that is needed
as they go forward in the rest of their lives.
Another provision in this bill is something that is called joint and
several liability. I want my colleagues to understand this concept:
joint and several liability. That is what exists today. That means that
if 10 doctors are named in a lawsuit, it does not matter who is the
major culprit or the one who practiced the least close to the standard
of care. One of those physicians who had very little to do with the
case could end up paying the whole judgment or the whole settlement
just simply because they have the deepest pockets. In this law that we
passed, the Health Act of 2003, it would be proportioned depending upon
their degree of responsibility, as well it should be.
Another provision is called collateral source disclosure. Collateral
source disclosure simply means that a jury needs to know if an injured
patient has health insurance, has disability income, because their
injury has been eligible and is now receiving Social Security
Disability benefits and by virtue of that is now eligible for Medicare.
Under current law in most States, the jury is not permitted to know
that as they calculate what a just and fair settlement or award should
be. And, Mr. Speaker, that is what I would call double-dipping, and
that is wrong.
Another provision of course in the bill that I talked about a little
earlier was contingency lawyer fees, and I think they ought to get paid
and they will get paid and they will do very well. I do not believe
there is a shortage of attorneys in the State of California. I do not
see any of them coming to Georgia, thank goodness. I think they are
doing well out on the west coast and will continue to do well. But if
we are going to have a shortage, I think most of the Members of this
body, my colleagues, would agree it is probably a lot better to have a
shortage of lawyers than a shortage of doctors because we need access
to health care. And that is what this is all about, that and job
creation and to take some relief off the men and women who are trying
desperately to provide health care to their employees.
Mr. Speaker, it has been an honor, really, and a pleasure to come
here tonight and talk about something that is very near and dear to me
as a physician Member of this body. And in closing, my plea to my
colleagues on the other side of the aisle and my fellow Republicans and
those Members of the other body is to think about that statistic that I
gave them a little bit earlier. Seventy-five percent of the American
people want this, and they are not going to wait any longer. And if
they do not get it, they are going to hold them responsible in 2006
just as they obviously did in 2004.
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