[Congressional Record Volume 151, Number 37 (Tuesday, April 5, 2005)]
[House]
[Pages H1757-H1763]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2005, the gentleman from Pennsylvania (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY. Tonight Republican Members of Congress will be talking 
about Medicare. Now, as we are getting into this, what I want to make 
sure that we first look at here is that many talk about is the Federal 
Government

[[Page H1758]]

doing much with regard to health care? And Medicare, Medicaid, veterans 
benefits, and other programs that the Federal Government pays for 
consume a massive amount of the Federal budget. And I wanted to point 
out, just to begin with, if we can look at this, that about 45 percent 
of all mandatory spending, all mandatory spending we spend, is on 
health care, and about 15 percent of all discretionary spending is 
spent on health care.
  If we look at mandatory spending here in health care, we see that the 
section here which is Medicare is $297 billion, or about 24 percent 
overall; Social Security disability is in this category here, too, 
about 6 percent; State Children's Health Insurance Programs, about $5 
billion or 4 percent; and Medicaid is $176 billion, or about 14 percent 
of overall mandatory spending.
  So we see that for those seniors and disabled who receive the 
benefits of Medicare is a large part of the Federal budget and one that 
has a history of providing good benefits for our seniors; benefits we 
are proud of, benefits we are pleased to continue to offer them.
  But tonight we are going to talk about a number of things happening 
in Medicare. Some of these will be issues that are staying with 
Medicare; some will be some positive changes, areas that are growing; 
some of the new parts that have to do with prescription drug benefits; 
some some actions on waste, fraud, and abuse; some on new programs that 
deal with prevention and new physicals for Medicare; and many, many 
other parts of this we will be talking about tonight.
  The overall purpose here is that as we look at the amount of money we 
spend and the services that we provide, it is Congress' responsibility 
to be constantly reviewing this and saying can we do it better to 
provide quality health care that is accessible for our seniors in 
America? And those who are not seniors yet recognize that about 2.9 
percent of wages, half from you and half from your employer, goes to 
fund Medicare. Thus, every taxpayer is concerned with how this money is 
spent and what quality is associated with it.
  Now, being the first speaker tonight, I want to talk a little bit 
about one area that I am introducing a bill on to improve Medicare, 
although it provides a lot of services in many areas of health care. 
One of those that I believe we need to see some changes in is in mental 
health coverage.
  As a practicing psychologist myself for many years, I recognize that 
when you integrate the care of mental illness in with other aspects of 
medical care, it actually is something that reduces the cost of health 
care and improves health overall.
  Let me describe to you now what Medicare does in all this. Currently 
Medicare beneficiaries pay about a 20 percent copayment for all 
outpatient health services except for mental health providers, where 
they have to pay a higher copayment of 50 percent.
  According to the National Institutes of Mental Health, nearly 2 
million Americans over the age of 65 suffer from depression. The 1999 
Surgeon General's Report on Mental Illness found that 20 percent of 
Americans 55 and older experience mental disorders that are not 
considered a normal part of aging, such as anxiety, alcoholism, and 
various other disorders. As many as one in two residents of nursing 
facilities are at risk for depression.
  A June 2002 MED-PAC report, that is the Medicare Payment Advisory 
Committee that recommends changes to Congress, stated that ``Medicare 
beneficiaries are apparently having difficulty in obtaining needed 
mental health services. Despite the availability of proven treatments, 
one recent analysis found that of those beneficiaries over 65 with need 
of treatment, 63 percent did not receive it.'' And it goes on to say, 
``Beneficiaries face a 50 percent coinsurance for most outpatient 
mental health services compared with 20 percent for most other 
outpatient services. Equalizing cost-sharing for outpatient mental 
health and other outpatient care would reduce the financial barrier to 
mental health care and provide parity to beneficiaries with mental 
disorders and those with other illnesses with a small increase in 
Medicare spending. This change would also simplify Medicare's cost-
sharing structure.''
  Now, here I am talking about the cost of Medicare and talking about 
something here which on the surface would appear that we are proposing 
more spending. And oftentimes when proposals come before Congress, they 
are scored in terms of what the increased spending would be, but not 
necessarily scored or reviewed in terms of what the savings would come 
from this.
  Let me describe what happens when you have untreated mental illness. 
Patients suffering from untreated depression, for example, use health 
care services more often; pay one and a half to two times more for 
health care costs that they accrue. They also tend to have increased 
lengths of hospital stays. Untreated depressed parents tend to have 
decreased adherence to life-style changes needed for health 
improvement. Depression also complicates the treatment of those with 
heart disease. And those with increased psychological stress or 
depression have increased platelet reactivity to thrombosis or blood 
clotting, which can complicate heart disease.
  Now, as a result of this, I have introduced the Medicare Mental 
Health Copayment Equity Act to reduce the copayment for mental health 
services to seniors on Medicare to match the standard 20 percent rate. 
With such a high amount of seniors afflicted with mental illness, that 
discriminatory Medicare copayment rate must end.
  When we look at ways such as integrating the care for our seniors 
with something that afflicts so many, such as mental illness and 
depression, by using such innovative approaches, we can actually save 
cost and provide better care for our seniors in America.
  Now, in addition to some of these things we can look at improving, 
and we will be talking more about them tonight, a number of aspects, it 
is important to also recognize that Congress is also being a watchdog 
of some problem areas for Medicare. What happens sometimes is people 
see this as a system that they can abuse. Whether it is providers or 
patients or others, they see this as a way they can get health care 
that perhaps is not needed, or we have a mechanism that sometimes, 
quite frankly, just pays too much.
  To talk about this issue tonight, I will call upon my colleague, the 
gentlewoman from Florida (Ms. Ginny Brown-Waite), and she will be 
discussing waste, fraud, and abuse in Medicare, and I yield to her now.
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I thank my colleague 
from Pennsylvania.
  You know, for most seniors Medicare is their only form of health 
care. Congress must make absolutely certain that not one penny of it is 
wasted and not one penny is given to those who only want to defraud the 
system. When Members of Congress voted for the Medicare Prescription 
Drug Improvement and Modernization Act last year, we voted in favor of 
important measures to combat waste, fraud, and abuse.
  Under the MMA, which I know that the gentleman from Pennsylvania 
supported, the HHS Secretary was directed to conduct a demonstration of 
recovery audit contractors in at least two States for 3 years to 
identify under- or overpayments. This demonstration project allows HHS 
to identify more efficient ways of working with States on Medicare 
waste.
  The MMA also opened the durable medical equipment industry to 
competitive bidding. And why did we do that? To ensure that Medicare, 
that our taxpayers, get the best prices on equipment that patients use. 
Additionally, the MMA ended overreimbursements for prescriptions and 
administering costs by replacing the average wholesale price system 
with a more accurate and verifiable average sales price system.
  More importantly, for those of us who worked in favor of the Medicare 
Modernization Act, we voted in favor of making health care fraud a 
crime, a serious crime. We voted in favor of punishing those who 
defraud this precious program. Instead of just slapping them on the 
wrist, there will be serious penalties. These criminals are defrauding 
our most vulnerable and our elderly seniors, and they should be very 
strictly punished.
  These measures were very important steps, but more are still needed. 
The most conservative estimates suggest that waste, fraud, and abuse in 
the Medicare system is somewhere around $33 billion a year. That is 
billion with

[[Page H1759]]

a ``B.'' Scam artists, however, are using innovative and cunning ways 
to con Medicare every year. Many use computers to scour the Internet to 
find holes in Medicare and Medicaid payout systems.
  The scam artists register also as providers and then file a slew of 
claims through the payment system to determine which claims would be 
automatically approved by Medicare and Medicaid computers. Once these 
claims are determined, the cons just sit back and they wait for the 
payments.
  Others set up fake medical storefronts. In one case, actually in my 
home State of Florida, a ``provider office'' was found to be nothing 
more than a couple of post office boxes, cell phone, and a beeper. The 
owner vanished when he caught on that Medicare officials were onto him, 
but not before he collected $2.1 million in payments. They are still 
looking for him.
  Today the Heritage Foundation released their study about waste in 
various Federal agencies, and guess what? They pointed to the Centers 
for Medicare and Medicaid, CMS, because of their paying excessive 
prices for medical supplies and care. They pointed out that in so many 
instances they paid thousands, not just hundreds of times but thousands 
of a percent, more than what the VA pays for the very, very same 
service.
  And my colleagues, I am sure, saw this in today's Congress Daily. 
There is a story in here about how the new chairman of the House 
Committee on Appropriations is settling in, and that the staff director 
of that committee is mandating that they go after agencies. And he 
said, ``The first rule is: There aren't any good government programs 
anyplace. They are chock-full of fraud, waste and abuse; frittering 
away millions in appropriated funds. Believe it, focus on it, find it 
and report on it.'' Obviously, Congress is getting very serious about 
waste, fraud and abuse in our system, and every Member of this body, I 
am sure, are very, very grateful for it.
  Protecting Medicare against predators should be a bipartisan issue. 
The last time I checked, there were no Rs or Ds in the word 
``solution.'' Guaranteeing the solvency of Medicare has to be a 
priority of Congress, and we have to begin by ensuring that every penny 
going to Medicare is being spent on legitimate Medicare benefits. If 
both sides of the aisle do not work together to protect Medicare, the 
legacy of this program diminishes with every penny that is lost.
  I look forward to working with the gentleman from Pennsylvania (Mr. 
Murphy) and the other Members of Congress who are serious about making 
sure that the Medicare system is a sound system and one that provides 
necessary health care for our most vulnerable, our seniors.

                              {time}  2030

  Mr. MURPHY. Mr. Speaker, I thank the gentlewoman from Florida (Ms. 
Ginny Brown-Waite), and could the gentlewoman repeat how much waste, 
fraud and abuse is estimated? I believe it is over $20 billion a year.
  Ms. GINNY BROWN-WAITE of Florida. I do not want to misquote. It is 
$33 billion. The most conservative estimates suggest that waste, fraud 
and abuse in Medicare is somewhere around $33 billion per year.
  Mr. MURPHY. Mr. Speaker, what we have to make sure is understanding 
in a budget that is approaching $300 billion for Medicare overall, and 
when people are concerned is it providing enough coverage, the issues 
that the gentlewoman from Florida (Ms. Ginny Brown-Waite) brought forth 
is an area where every senior and their family member can help deal 
with the spiraling cost of health care.
  I have a chart here, and notice how health care costs are spiraling 
up. Notice the growth in terms of Federal outlays and how much it has 
climbed over the years. It is quite dramatic. The area of waste, fraud 
and abuse has grown with it. I would like to advise that one of the 
messages that we as Members of Congress need to get out to constituents 
is understand how we can help our constituents find and report waste, 
fraud and abuse.
  Sometimes Medicare fraud is purposely billing for services never 
provided, billing Medicare and another insurer for services someone 
never received, for equipment because you received equipment different 
from what you are billed for, and using another person's Medicare card 
to get medical care, supplies or equipment, and billing Medicare for 
home medical equipment after it has been returned.
  I have heard of constituents who have reported these kinds of things, 
and it is important that we do this as a mechanism to save government 
money, save taxpayer money, and make sure that money goes towards care. 
People also need to be suspicious. Anytime a provider tells you a test 
is free, they only need your Medicare number for their records, and the 
provider may state that the cost to the person with Medicare is free, 
be wary if tests are being provided and the patient is told they are 
free, make sure you understand why they are being done and what they 
are. Or if the provider says Medicare wants you to have the item or 
service, Medicare does not recommend services, it is up to the 
physician and health care provider to recommend services. Or if someone 
says I know how to get Medicare to pay for it, again, the questions 
family members and Medicare recipients should be asking is I want to 
know what I really need, and do not be afraid to get other opinions.
  Sometimes people say the more tests you have, the cheaper they are; 
or the equipment or service is free, it will not cost you anything. But 
be aware, and Members need to educate their constituents that anytime 
someone is offering that, this is taxpayer money being spent on 
services that may or may not be needed. And it is important that we 
encourage Americans to review that and determine if it is medically 
necessary.
  There are ways that you can prevent Medicare abuse, and there are 
ways you can report this: by contacting the inspector general of 
Medicare, by looking at the Medicare Web sites to report specific 
information. It is a way that every American citizen can be a watchdog 
and can lead to cost savings for Medicare and make sure that care goes 
to patients.
  I would like to turn toward the gentleman from Georgia (Mr. Price), 
an orthopedic surgeon, a good friend to the health care caucus and one 
who has been very diligent in dealing with health care costs. He will 
be addressing patient choice and satisfaction with the Medicare 
program.
  Mr. Speaker, I yield to the gentleman from Georgia (Mr. Price).
  Mr. PRICE of Georgia. Mr. Speaker, I appreciate the opportunity to be 
here and talk to an issue near and dear to our hearts. As we talk about 
the challenges that we have with Medicare, as with many programs, what 
we are attempting to do is to lay out the issue before us and to make 
certain that we retain those aspects of the program which are so very 
important and provide for greater health, higher quality health for our 
seniors, and that we do so in a way that listens to principles. I am 
fond of going back and talking about principles because I think unless 
you understand what principles you want to institute, you can get off 
the mark.
  The principles that I like to talk about when I am speaking about 
Medicare is that we have the highest quality of care that is available, 
that the cost for that care be absolutely reasonable, that people are 
not being gouged and you do not have the problems with the waste, fraud 
and abuse that has been talked about.
  And finally, what is incredibly important for Medicare, patient 
choice. That is patients get to choose who is taking care of them and 
where they are being treated. Let me just chat a little bit about some 
of the challenges that we have before us and why we are in the kind of 
situation we are in.
  This chart may look familiar because it is a chart that we have used 
to demonstrate some of the challenges that our Nation has as it relates 
to other systems, the Social Security, for example. But the demographic 
changes that are occurring in our society right now, the aging of our 
population, that really is the main reason that we have got these 
challenges within the Medicare system.
  As Members see here, today's workers are providing the moneys for the 
Medicare system, those individuals who are the recipients. So you need 
a lot of workers to provide the resources with which to care for our 
seniors. In 1950, there were 16 workers for every

[[Page H1760]]

retiree or every senior. This year, there are 3.3 workers for every 
senior retiree. In a few number of years, there will be two workers for 
every retiree.
  What that means for Medicare is we have an aging population and fewer 
resources with which to support that population's health care. I think 
it is important to appreciate that principle. Remember that principle 
of highest quality, reasonable cost, and choice for patient, and the 
demographics of our society, the aging of our population, is driving 
some of the decisions that we make that may violate some of those 
principles.
  What is going on with the cost of health care? The gentleman from 
Pennsylvania (Mr. Murphy) had a poster up before that talked about and 
showed the increasing line of money being spent for health care. That 
will continue of necessity because of the aging of the population.
  One of the problems that we have with Medicare, though, is it is an 
inflexible system. A number of years ago, we, the Congress, instituted 
a program called ARBORS, Resource-Based, Relative-Value System, which 
means we as a Nation will decide how much money we are going to spend 
on health care for seniors; and regardless of the amount of money that 
is needed or regardless of the amount of care that is going to be 
provided, we are not going to violate that. We are going to have a pool 
of money and pay for the care needed out of that pool. If there is a 
lot more care that needs to be provided, we have challenges in our 
system. Remember, we wanted highest quality care, reasonable cost, and 
choice for patients.
  What we have now is a system that oftentimes is being held together 
just by the altruism of the individuals involved in providing that 
care, the doctors and hospitals at home, those individuals who are 
being asked to do more with less, and oftentimes are being asked to do 
a whole lot more with a whole lot less.
  The system we have worked well when there were a lot of workers. 
However, now when we have fewer workers in this pay-as-you-go system, 
it becomes more difficult to hold that system together. It is an 
inflexible system. It is not able to juggle or change with the changes 
in our society. I want to use as an example of that the debate that has 
been going on over the last couple of years about a prescription drug 
plan or a prescription drug benefit in Medicare.
  When Medicare was instituted in the mid-1960s, medications, drugs and 
pharmaceuticals, were not necessarily that extremely important for the 
care of disease because there were not a whole lot of variants in the 
type of medications that we had. Oftentimes the treatment for a disease 
or an illness was in the hospital, which is why Medicare built up as a 
system that provided primarily for hospital insurance, for hospital 
care, and provided coverage for the physician as well; but did not have 
a drug component to it, did not have a prescription drug benefit within 
the system.
  Over a relatively short period of time after the mid-1960s, the 
explosion in our technology and in our ability to have medications that 
truly affected the outcome of illness and provided a higher quality of 
care, and remember one of our principles is that high quality of care, 
medications just flourished. But the Medicare system stayed absolutely 
the same. Through the 1980s and 1990s as so many medications were 
discovered and have been utilized to save people's lives, Medicare was 
stuck in the mud not providing any prescription drug coverage.
  So the President to his great credit put this issue on the table, and 
in 2003 a Medicare prescription drug plan was introduced. That is 
important because we have moved now to a health care system that relies 
a whole lot more on medications than it did in the past.
  My purpose in bringing that issue up is that it took us 40 years to 
get to a point where we had a system that provided for prescription 
drug coverage. That is a program, a Medicare program, that I believe is 
inflexible and does not have the kind of capability to change with the 
needs of patients. One of our principles is patient choice. Patients 
ought to be able to choose who is taking care of them, where they are 
being cared for, and what kind of care they are receiving. That brings 
me to the final point I would like to make.
  I think as we move through this discussion, it is imperative that we 
make certain that the highest quality of care that is being delivered 
at reasonable cost, those principles, also have the principle of 
patient choice. When I was a practicing physician, I knew that the 
important things that patients would talk to me about, if they did not 
tell me what their wishes and desires were, I could not respond 
adequately to the kinds of needs that they had. That is patient choice. 
In an inflexible system, in a Medicare system that is inflexible, it is 
not possible for patients to be able to exercise their choice.
  I believe as we go through this discussion and make certain that we 
retain a Medicare system that will provide the highest quality of care 
at the most reasonable cost available, but with patient choice, patient 
choice is what is so incredibly important, as we allow and provide for 
patients to be able to have the access to the care that they so need.
  Some improvements have been discussed. The gentleman from 
Pennsylvania (Mr. Murphy) has talked about a proposal that I think has 
great merit. I just hope as we go through this discussion that we do 
not end up in the political name-calling and demagoguery that has been 
so wont to happen in other issues that we have talked about here. I 
think if we just stick to the principles of highest quality of care at 
a reasonable cost and make certain that one of those principles has to 
be that patients have choice, choice about who is taking care of them, 
where they are being cared for and the kind of treatment that they are 
receiving, that we will end up with a program that will be flexible and 
that will be much more responsive to patients' needs, which in the end 
is what it is all about.
  Mr. Speaker, I thank the gentleman from Pennsylvania (Mr. Murphy) for 
the opportunity to participate in this incredibly important and vital 
issue that means so much to so many Americans.
  Mr. MURPHY. Mr. Speaker, I thank the gentleman from Georgia (Mr. 
Price) for his important information about other areas of care. As we 
continue on this evening, I want to turn to one of our colleagues, the 
gentleman from Louisiana (Mr. Jindal), who is an expert on Medicare. He 
wants to talk about the need to address premium cost and 
recommendations of the National Bipartisan Commission on the Future of 
Medicare.
  Mr. JINDAL. Mr. Speaker, we come together in this body to talk about 
a very important topic, our Nation's Medicare program. Medicare has 
served our country's seniors well. However, this is a program that is 
in serious need of strengthening and improvement.
  I was privileged to serve as the executive director of the National 
Bipartisan Commission on the Future of Medicare. We spent an entire 
year looking at the Nation's Medicare program, and we heard from dozens 
of witnesses. We had countless hearings. I can summarize the challenges 
facing the program in three ways.
  First, we have a Medicare program by any measure that is facing a 
huge financial challenge, a program that is going to go bankrupt, quite 
frankly, unless we do something differently.

                              {time}  2045

  We can measure that as a share of the GDP, we can look at the ratio 
of workers to retirees, we can look at that as a share of payroll 
taxes, or we can look at the life of the trust funds. Quite simply, we 
have got a Medicare program today that goes from about four workers per 
retiree, it is going to eventually be at about two workers per retiree, 
a trust fund that will not last even long enough for the baby boomers 
to not only finish retiring, but to finish utilizing their health care 
services.
  So the first challenge facing the Medicare program is increasingly we 
have got a program that is facing solvency challenges. Secondly, we 
have got a program that, as it is defined today, does not truly cover 
adequately the health care needs of our Nation's seniors, our parents, 
our grandparents. We have got a program that covers about half the 
health care costs of our parents and grandparents. We have got a 
program that until next year does

[[Page H1761]]

not really even begin to cover prescription drugs, does not provide an 
adequate long-term care benefit; a program that charges over a $800 
deductible every episode, every time our parents go to the hospital; a 
program that until recently did not cover many preventive care benefits 
and still lags behind the private sector in terms of what is considered 
first-class medical care; a program that has no real meaningful 
catastrophic stop loss coverage; in other words, a program that looks 
largely like the 1960s insurance product it was modeled after. In the 
private insurance world, we no longer get our physician insurance 
separate from our hospital coverage. Yet that is exactly what Medicare 
continues to do today.
  So the second challenge facing our program is that it is a program 
that does not adequately cover the health care needs, does not 
adequately provide a modern benefits package for our Nation's seniors. 
We can see that by the fact that 89 percent of our Nation's seniors 
have something other than just plain Medicare fee-for-service alone. 
Eighty-nine percent have either some kind of wraparound coverage, 
supplemental coverage, Medicaid, private HMO coverage, have something 
in addition to just plain old vanilla Medicare fee-for-service 
coverage.
  The third challenge facing our program is it is a program that has 
not been run all that efficiently. You can look at that by comparing 
Medicare's growth rates to the private insurance world, to the other 
Federal programs that we run, by looking at the billions of dollars, 
not millions but billions of dollars, we waste every year.
  We all have our favorite stories. I know my colleagues have heard 
from their constituents, and we have heard, about the equipment that 
Medicare will rent but not purchase even when it would be more cost-
effective to buy it. We have heard about the times that Medicare would 
pay for a patient to go to a physician's office to receive an 
injectable medication, but would not pay for that same patient to 
receive those drugs orally. We have heard about Medicare not paying for 
preventive care, not paying for more cost-effective outpatient-based 
care. Year after year Congress tries to put a Band-Aid and tries to 
improve the program and tries to catch up with the latest medical 
technology, but inevitably we are always a little bit behind what 
people are getting below the age of 65.
  So we have got three challenges being faced by our Medicare program: 
First, a program that, by any account, faces severe financial 
challenges; secondly, a program that does not adequately cover the 
benefits that our seniors deserve and need; and then finally, third, a 
program that is not all that efficient compared to other programs.
  The good news in all of this is that Medicare has done a remarkably 
good job taking care of our parents and grandparents. We do not need to 
throw the Medicare program out. Rather, we need to improve it, 
strengthen it, and get it ready for this next century, get it ready for 
the baby boomers that are beginning to enter this program.
  How do we do that? I would like my colleagues to remember just two 
numbers that came up during the Commission's deliberations and just two 
numbers that stand out to me in all the hours of testimony that I 
listened to. The first number is this: The CEO of the Mayo Clinic 
testified to our Commission. He said, We count 130,000 pages of rules 
and regulations. There has been some dispute. Everybody agrees there 
are tens of thousands of pages of rules and regulations. It does not 
really matter if you believe it is 130,000, or whether you believe it 
is 
20-, 30-, 40,000. The bottom line is this: Tens of thousands of pages 
of rules and regulations telling the Mayo Clinic, telling physicians, 
telling hospitals how they must provide care.
  I do not know about you, but to me this debate really comes down to 
who do we want in control of our health care. I would much rather my 
physician, my health care provider, working with me to make those 
decisions. No matter how well-intentioned, I do not want a bureaucrat 
making my health care decisions for me.
  The American Hospital Association talks about the fact they have 
documented nurses in many hospital settings spend an hour filling out 
paperwork for every hour they provide care. At the same time, we have a 
shortage in this country of about 100,000 nursing vacancies, 100,000 
vacancies we cannot fill today, and that number is only going to 
increase, and we are drowning our health care professionals in 
paperwork.
  The second number I ask this body to remember is that we heard from 
an economist testifying to our Commission basically in the Medicare 
program that we are trying to set 10,000 prices across 3,000 counties. 
We call them parishes in my home State of Louisiana. But the bottom 
line is this: 10,000 prices in 3,000 counties. We do not buy anything 
else in the Federal Government that way. It makes no sense that that is 
how we buy medical services. The problem is sometimes we will be too 
high, and sometimes we will be too low. We heard so many stories about 
how this distorts the quality of medical care that our parents receive. 
This distorts their access to services.
  We have all heard the complaints from physicians about the inequities 
of the sustainable growth rate reductions they are going to face. We 
heard about physicians leaving the Medicare practice. We have heard the 
stories of patients, we heard it in the Medicare Commission, about 
patients going to the hospital. We had a patient that told us a doctor 
wanted to perform a procedure on him. He was in the emergency room 
thinking he was about to die of a heart attack. Once the physician 
found out he was in Medicare, the physician said, I don't need to do 
that service anymore. It turns out Medicare would not pay for that 
procedure. Not only that, Medicare would not let him pay for that 
procedure or his private insurance pay for that procedure. I think most 
of us, if we were in the emergency room, would not want a bureaucrat to 
make that decision. We would want our physician to make that decision.
  That really is the question facing us when it comes to the future of 
Medicare: Who do we want making our health care decisions? Do we want 
our physicians working with us, or do we want bureaucrats? It is as 
simple as that.
  The Federal Government runs a different health care program. We run a 
health care program that has over 300 plans competing to provide 
coverage. We run a health care program that has had lower inflation 
rates; a health care program with incredible approval ratings, over 85, 
90 percent approval ratings; a health care plan that does provide 
adequate prescription drugs, is not going insolvent. It is a very 
simple plan. Members of Congress are allowed to participate. Federal 
employees, the very employees that design and operate Medicare, are 
allowed to participate. The simple concept behind the Federal 
employees' plan is this: We give people choice. The Federal Government 
pays the majority of the premiums. If somebody wants to buy a little 
more expensive plan, they pay a little bit more. If they want to buy a 
more efficient plan, their premiums go down.
  We tried this in Medicare some years ago, except Congress said 
private plans were not allowed to reduce their cost below the 
government plan. That makes no sense. If a private plan is more cost-
effective, of course they should be allowed to lower their prices. Why 
in the world would we not want our parents and our grandparents to be 
able to lower their premiums? Fortunately we fixed that, but we have 
got a lot more fixing to do.
  I was pleased today to learn from CMS, I know many of us were, that 
our seniors, over 90 percent of Medicare beneficiaries next year may 
have more choices of how they get their health care, may actually have 
a choice of how they get their health care plans. For those that want 
to stay in Medicare, they can continue to do that. Nothing has changed. 
But the good news is more and more of our parents and grandparents are 
getting more choices.
  I know my time is running out, and we are limited in our time 
tonight, but I think if we remember one thing about the Medicare 
debate, it is simply this: We must give our parents, we must give our 
grandparents more choices.
  We had a bipartisan Medicare Commission that was chaired by the 
gentleman from California (Mr. Thomas) of this body, cochaired by 
former Senator Breaux of my home State of Louisiana. We came up with 
good bipartisan findings contained in the cochairman's report. The 
bottom line is this:

[[Page H1762]]

If you remember nothing else but all the numbers and all the facts and 
all the details, Medicare has done a good job. To make sure it 
continues to do a good job for our parents and grandparents, let us not 
be scared of giving them the kind of choices they had before they 
became the age of 65. If we do that simple thing, not only will it be 
good for them, it will help us balance our budget, and it will slow 
down that growth by getting rid of some of those inefficiencies.
  Mr. MURPHY. I thank the gentleman from Louisiana not only for the 
depth of his knowledge in Medicare, but his service before to our 
country. Certainly if we are able to implement some of the changes he 
has spoken about so eloquently tonight in changing not only the waste, 
fraud and abuse, but making Medicare work more effectively, we can make 
it last longer.
  The points made here about when we think about Social Security 
hitting its financial demise sometime around 2042, when they talk about 
Medicare, if we do not make some changes to improve the system, again 
that is what we are talking about, improving the system, it may face 
its own demise in 2024, some 20 years ahead of Social Security, not 
because the difference in more people retiring at faster rates and less 
money going in, but because of the waste, fraud and abuse that is in 
the system and because of inefficiencies.
  It is so important that we work together in a bipartisan way to 
improve the efficiency of Social Security so that money goes to care 
for our seniors in ways that we need to make sure they get that care.
  I would like to turn to another one of my colleagues for the wrap-up 
in our session tonight, and that is the gentleman from Georgia (Mr. 
Gingrey), who is no stranger to speaking on health care issues. He and 
I chair this conference team on dealing with health care issues. He is 
as dedicated as they come to working on this.
  Mr. GINGREY. I thank the gentleman from Pennsylvania, my cochair on 
this team, for yielding.
  Once again we are bringing to our colleagues, Mr. Speaker, the issue 
of health care. This is something that we have committed to do, those 
of us who are in the health care field and interested, as our previous 
speaker, the gentleman from Louisiana (Mr. Jindal), who worked in the 
administration prior to being elected to Congress from the great State 
of Louisiana and specifically worked within the Medicare system.
  There are a lot of people, Mr. Speaker, on our side of the aisle who 
understand the issue of health care. It is disturbing to me as a 
physician/Member when I hear the other side in the Social Security 
debate, as we hear some of these Special Orders in the evening from the 
other side criticizing the President, criticizing the Republican 
leadership, the Republican majority for wanting to make some meaningful 
changes to a 70-year-old system that needs to be brought into the 21st 
century. Of course, I am talking about Social Security.

  But we are hearing from the other side, and I hear this in my 
district. A lot of times it seems like they encourage people to come to 
these listening sessions or town hall meetings and say, why are you 
Republicans so concerned about Social Security when you are not doing 
anything about Medicare? What they fail to tell these good folks in our 
districts, usually seniors, that in December of 2003, we historically 
passed the Medicare Modernization and, yes, Prescription Drug Act, Part 
D of Medicare, and really made some significant, meaningful changes to 
this program. Admittedly, Medicare, and Medicaid as well, are very 
expensive programs, and as our seniors are living longer and, of 
course, putting more of a strain on the Social Security system, the 
same thing is happening in Medicare. But to suggest that we in the 
majority or this President has ignored meaningful changes, 
modernization indeed, in just this past December of 2003, trying to 
address that problem, and for us to say that we have done nothing, and 
to try to divert our attention away now from trying to do the same 
thing to bring Social Security into the 21st century, I think, is a 
paper tiger on their side of the aisle.
  What we have done, and I thank my colleague from Pennsylvania for 
putting this special hour together tonight, besides the prescription 
drug part, which is significant, and I will not spend my time talking 
about that, but I want to talk a little bit about the modernization 
part of Medicare in that historic 2003 bill.
  Medicare was a little later coming to us than Social Security. Social 
Security came along in 1935, 1936, and it was not until 1965 that the 
Medicare bill as part of Social Security was offered to our seniors. It 
has been a great program, but at its outset it was all about episodic 
care. Part A was hospital treatment, nursing home, a little bit of home 
health care; and Part B, of course, the optional part, the premium-
based part of Medicare, was for the provider services, the physician or 
outpatient hospital procedures, durable medical equipment, certain 
drugs, as the gentleman from Louisiana pointed out earlier, but only 
those that are administered by an injection, not something that you 
could get by a prescription.
  The original Medicare, and as the argument against it, again, from 
the other side of the aisle back a year and a half ago, was they are 
about to take away Medicare as you know it. Well, thank God if we did 
that. Thank God, and thank the Republican majority, because now instead 
of treating people when they have a heart attack, when they fall over 
at home in the shower having had a stroke because their high blood 
pressure was never treated, never even recognized until it is too late, 
and then you get into the really, really expensive part of health care, 
that long-term hospital stay, that ambulance trip to the emergency 
room, that nursing home stay until you have exhausted all of your 
benefits, and all of a sudden you end up destitute and covered by 
Medicaid, no senior wants to be in that situation.
  But what we did in the modernization part, most of the attention, 
yes, was the prescription drug benefit, the optional Part D benefit 
that was finally delivered by this President, finally fulfilled, a 
promise that had been made and broken really by so many previous 
Congresses and administrations.

                              {time}  2100

  But the modernization part, if my colleague will further yield, Mr. 
Speaker, I wanted to talk about that because we never got the 
opportunity to just go to the doctor and have a physical exam. As I 
said, it was always if one has got chest pain, if they got a nose 
bleed, if they have a stroke, then they get covered under Medicare.
  But with the modernization program that we passed in December of 
2003, when a person turns 65 and first becomes eligible for Medicare, 
now Medicare will pay for a complete, a complete head-to-toe thorough 
physical examination by a primary health care provider, a family 
practitioner or a general internist; and these are the diagnosticians. 
A lot of times people will refer to those specialists as 
diagnosticians; and, indeed, they are. They are the real medical 
sleuths that can detect disease before the patient has any idea that 
something is going amiss in their body. I am talking about a slight 
elevation of blood sugar or a slight elevation of blood pressure or 
maybe a person is getting a little short of breath and that internist 
or primary care doctor knows that they need some specific tests to rule 
out things like coronary artery disease or to institute some 
prescription medication.
  Those physical examinations in the past were not covered under 
Medicare. It seems ridiculous, but back when we started the system, 
nobody really thought that that was that important, just as they did 
not think that prescription medication was so important. But we know 
now today that if we can detect these diseases as they are starting 
before the patient has had a significant complication, to treat it, to 
treat it, as we say, medically with, yes, prescription drugs, that now 
these seniors can finally afford, and those that are at or near the 
Federal poverty level, they can literally get prescription medications 
to treat one of these diseases at its inception by paying $1 or $3 or 
maybe at the maximum a $5 co-pay for a prescription that may have cost 
hundreds of dollars if they did not have this benefit.
  So I am very pleased to be here tonight as part of this hour, this 
Special Order, with my colleagues, many of

[[Page H1763]]

them health care providers, to remind our colleagues on both sides of 
the aisle what we have already done in regard to trying to fix the 
Medicare program and in the process, of course, to provide much greater 
care, a better standard of care, 21st-century medicine, to our seniors 
who deserve that and have been waiting really so long for it.
  They get that entry-level physical examination so that some of these 
catastrophic things do not happen to them, and if they choose in 
January of 2006 to have signed up for the optional part D, as 96 
percent have signed up for the optional part B, the doctor part, then I 
think we are going to see some cost-shifting in this program.
  Yes, it is an expensive program. And certainly the prescription drug 
part is going to be a big expensive number. I do not know exactly what 
it is, but what I do know is that the number crunchers, whether it is 
within the Centers for Medicare & Medicaid Services or whether it is 
the Congressional Budget Office or the Office of Management and Budget 
from the administration that have given us a number, and we heard $400 
billion over 10 years and then we heard $520 billion over 10 years, and 
now we are hearing 750 or 950. I do not know.
  But I do know this, that no credit is given for the possibility, the 
distinct possibility, that because of the prescription drug benefit, 
because of the initial complete physical when a senior turns 65, 
because of the multiple screening tests that are now paid for under 
Medicare on an annual or every-2-year basis, and I am talking about 
cholesterol screening, I am talking about pap smears for women to 
detect early cervical cancer or ovarian cancer, I am talking about 
colon cancer screening, Flexible Sigmoid tests or colonoscopies, I am 
talking about osteoporosis screening, doing all of these things, 
bringing Medicare into the 21st century is going to prevent some of 
these catastrophic, very expensive things from occurring.
  So while we are spending a little bit more money on that and maybe a 
lot more money finally offering a prescription drug part, we are going 
to save money on hospitalizations. We are going to save money on fewer 
days in a nursing home. We are going to prevent people from ending up 
with a stroke, and, yes, indeed, maybe being in a vegetative state for 
15 or 20 years, and we just talked about that last week in the Congress 
and know how expensive that kind of care is.
  So really what we have done, and I am going to close with this, Mr. 
Speaker, and yield back to the gentleman from Pennsylvania (Mr. 
Murphy), but what we have done in modernizing Medicare and not ignoring 
it, as the other side would suggest, is we have done the right thing, 
we have done the compassionate thing for our seniors, and we have done 
the cost-effective thing.
  And I thank the gentleman from Pennsylvania (Mr. Murphy) for yielding 
to me tonight during this hour and for our continuing to do these 
health care initiatives on a regular basis.
  Mr. MURPHY. Mr. Speaker, reclaiming my time, I thank the good doctor 
from Georgia for his comments, as well as the gentleman from Georgia 
(Mr. Price), the gentlewoman from Florida (Ms. Ginny Brown-Waite), and 
the gentleman from Louisiana (Mr. Jindal) for their comments tonight.
  And noting that what we have discussed tonight as we recognize that 
Medicare is a program that albeit is expensive in terms of what it 
costs the Federal Government and taxpayers to pay for it, we believe it 
is worthwhile to protect and ensure the health and health care of our 
elderly; but we also have to note here, as even the best of programs 
can use better care, in this case the best of care, what we want to 
make sure that Members do on both sides of the aisle is work towards 
eliminating waste, fraud and abuse, updating the Medicare program to 
make sure it is providing that high-quality care, recognizing that 
there have been changes in how health care is provided since the 1960s 
when this program began, and we need to make those things work better.
  We need to apply some of the changes that were recommended by the 
Commission on the Future of Medicare. We need to make sure that care is 
integrated together with examples of what I presented before, with such 
things as mental health care integrated with other aspects of care; 
making sure that we improve the system so that we have electronic 
prescribing that we would reduce the many medical errors that occur, 
reduce the about 16 million errors that occur on prescriptions every 
year that are written in part because we still use an old system of 
paper and pencil where someone may misspell a word or not be able to 
review it correctly or a physician cannot possibly know all the 
medications the patient is on, all of those things to be corrected with 
the major moves that were in the Medicare bill that we voted on a 
couple of years ago, but will begin to take effect in January of next 
year.
  These are positive changes that I believe will help reduce the 
thousands of deaths, the millions of errors that occur with 
prescription drugs, and work for the betterment of health care in 
America to save lives, to save money, and to improve that.

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