[Congressional Record Volume 152, Number 28 (Tuesday, March 7, 2006)]
[House]
[Pages H606-H608]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  THE STATE OF HEALTH CARE: REPUBLICAN EFFORTS FOR HEALTH CARE REFORM

  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. Mr. Speaker, I will be joined in a little bit by my 
friend and my colleague, Dr. Phil Gingrey of Georgia, for this next 
hour. It is important that we lay out a large segment of what we 
believe is a critically important agenda to reform health care in 
America.
  We know that few things are more valuable to us than the health of 
our families. When the health of our families is threatened, we feel 
frightened, we feel vulnerable, and we desperately search for help. I 
think few would challenge that the United States provides, as 
available, the best health care in the world, dedicated and caring 
physicians and nurses and hospitals and professionals, and we have made 
huge technological advances in fighting disease and prolonging life. 
Our research and medical technology is second to none. It significantly 
advances every year.
  However, despite these many accomplishments, the American health care 
system is burdened by severe problems that lower quality and increase 
costs and too often make this system unaffordable and inaccessible for 
millions of Americans. Too many families, unfortunately, are only able 
to window-shop for health care coverage, and they feel as though they 
cannot go into the store.
  Tonight, those colleagues of ours on our side of the aisle, who are 
part of our health care team, will be talking about a number of 
important issues to advance this cause. Mr. Speaker, before I go into 
this, let me pause, if I may, for a moment, and say usually when I have 
been here for Special Orders to talk about issues, I traditionally was 
walking up to the Capitol to make a call to my mother to let her know. 
She then would get on the phones and call all her friends. My mother 
was a nurse, worked for many years at hospitals in Cleveland, as well 
as in industrial settings.
  I am sad to say that since I last spoke in the Chamber, my mother had 
died, but I am sure she is still doing her own method of notifying her 
friends, and meeting my father now to talk to him and to say, make sure 
you pay attention to this message.
  It is a message that I hope Americans will attend to as well. Because 
while there are those who talk about the costs of health care, what we 
are going to be talking about tonight is ways of changing health care 
and not simply shifting the burden of health care to one or the other.
  Let me talk about a few of the costs that we need to pay attention 
to. Health care costs are skyrocketing. In 2005, the Federal Government 
spent over 45 percent of mandatory spending on health care programs, 
including almost $300 billion for Medicare and $181 billion for 
Medicaid. Medicaid costs now consume about 70 percent of States' 
budgets, and it is rising more than the rate of inflation. This, nearly 
half a trillion dollars, does not even include the billions that we 
spend at the Federal level in discretionary health care spending for 
Department of Veterans Affairs, $31 billion; the National Institutes of 
Health, which has increased over 100 percent in the last 10 years under 
President Bush, to $28.5 billion; the Centers For Disease Control and 
Prevention, $8.2 billion; the Indian Health Services, $4 billion; Early 
Head Start, $6.8 billion; and the Women, Infants and Children program, 
$5.3 billion.

                              {time}  2015

  When we add to this also the costs paid for by employers and paid for 
by families across the Nation, the numbers are staggering.
  The Federal Government has made a number of attempts over the years 
to deal with some of these increased costs, such things as dealing with 
the budget, where we try and increase copayments on prescription drugs, 
or we deal with premium costs in private or federally or State-funded 
health care programs, which have all been geared towards trying to 
share the costs.
  This higher cost-sharing requirement, in many cases, is designed to 
not only reduce some of the overall costs to the Federal budget, but 
also to help encourage patients to change some behaviors, such as not 
going to expensive emergency room settings for common ailments, such as 
colds and flu and scrapes and bumps, but instead to see their doctor. 
These increased copays are usually enacted to change these behaviors, 
and yet we need to be doing other things in order to actually change 
some of the flaws in our health care system.
  But let us make a point of this: whenever Congress has enacted those 
important issues to try and change some behaviors and actually save 
money, unfortunately, the Congressional Budget Office, which is there 
to tell us how much we are spending and give us some accurate numbers, 
simply is unable to do this at all.
  The Congressional Budget Office can only talk about savings when more 
money comes out of pocket, but they cannot and are unable to talk about 
savings that come from trying to prevent the problems we are talking 
about tonight.
  Since the CBO does not provide what is called dynamic scoring, a 
potential cost savings, the Federal Government in essence ties its own 
hands so we can only focus on cost sharing and not directly change 
efficiency and reduce errors in health care. We do not deal with the 
biggest drivers of these costs. We did not have a way here to look at 
this.
  Let me give you an example. If we were to ask the Congressional 
Budget Office how much it costs to immunize children in America or to 
inoculate them with several important inoculations that they receive in 
their infancy and young childhood, the CBO could give us that number. 
But ask them what this saves, what this saves in reduced hospital 
visits and the other medical complications, and they simply are not 
able to tell you.
  Ask the Federal Government CBO what treatment programs for alcohol 
and drug abuse save, and they cannot tell you.
  Ask them what Early Head Start's medical programs save when we get 
children to the doctor early. They cannot tell you.
  Ask also what would happen if we made our medical records system more 
efficient and eliminated many of the costly errors in the system. They 
cannot tell you.
  The CBO can tell us that, in the Deficit Reduction Act passed by the 
House, that $150 million was placed in there, through efforts of my 
office and others, in order to help hospitals in high Medicaid areas 
use electronic medical records in order to reduce costs. But, 
unfortunately, the CBO cannot tell us what those costs are.
  I am going to be talking a little bit more about these costs, but 
first I would like to yield to the gentleman from Georgia, Dr. Phil 
Gingrey, to lay out some general outlines of some other things we are 
going to be talking about tonight. Dr. Gingrey, a friend and colleague, 
who we often are on the floor together talking on these health care 
aspects, will lay out in general some of the things we will be talking 
about.
  As I said, I opened up naming some of the huge cost increases in 
health care, but Dr. Gingrey will lay out the general plan of where we 
need to go to make some substantive reforms in the health care system 
so that we are no longer talking about cost shifting, but really 
talking about saving money, and, more importantly, saving lives.
  I yield to Dr. Gingrey.

[[Page H607]]

  Mr. GINGREY. Dr. Murphy, thank you so much and thank you for starting 
this Special Hour and allowing me to get over, as we have a great line-
up of members, I think five members, of the Republican Healthcare 
Public Affairs Team that we formed, with Dr. Murphy and I cochairing 
that subcommittee of the Republican Conference at the beginning of this 
109th Congress. We have been talking about a number of issues during 
the past year relating to health care, the Medicare Modernization Act, 
Prescription Drug part D, tort reform, which we passed in this House 
many times and are still laboring to finally get that into law.
  But this gives us, really, a great opportunity to follow on to what 
our President said in the 2006 State of the Union address in regard to 
health care. Now, he did not spend a lot of time on health care, but 
what he said in just a couple of pages was significantly an important 
part of his address to the Nation.
  This Presidency and this Republican majority are fully, fully 
committed to making sure that we bring health care into the 21st 
century and we continue to maintain the edge that we have in regard to 
health care. But we are not going to maintain that edge if we continue 
to use a 20th-century model. It is just like the radio and the 
television set and the computer. We have to do this. We absolutely have 
to do it.
  Dr. Murphy probably in his opening remarks talked a little bit about 
one of the issues that I want him to address in regard to electronic 
medical records, or health IT, if you will, information technology.
  I was recently in Antarctica, and I was able to take my American 
Express card, actually, no, one of my bank cards, and swipe it and get 
U.S. dollars to buy some souvenirs. But God help me if I had been hit 
in the head in Antarctica by a snowball and couldn't speak to the 
doctors, because they wouldn't know a thing about my health care 
record. I know that Dr. Murphy and others have taken a leadership role 
on this particular issue.
  So I want to just go ahead at this point and begin allowing my 
colleagues to talk about some of these issues that are so hugely 
important. Dr. Murphy has already made some remarks and will speak 
further about health IT. Dr. Murphy is on the Energy and Commerce 
Committee, where the Health Subcommittee does so much work on Medicaid 
and other issues, as I previously have co-chaired the Healthcare Pubic 
Affairs Team.
  Dr. Murphy, I would be happy to yield back to you, or we can go to 
the long-term care issue and come back, whatever you would prefer.
  Mr. MURPHY. I would like to talk a little bit, if I may, about some 
of these issues about errors in hospitals.
  I opened up by saying we clearly have the best health care available 
in America, but I would like the Speaker and others to imagine this: 
when you go into a hospital or doctor's office, generally you will see 
filing cabinets packed with paper records of a patient's care. Now, 
imagine also if the patient has seen multiple doctors, there are 
multiple files, and probably stacked somewhere on top of those filing 
cabinets are reports waiting to be filed, and chances are pretty good 
that the records between doctors offices are disconnected, that is, one 
doctor may not know what the other physicians or treatment specialists 
have seen. Perhaps the patient has not gone for the lab tests or 
consultations they have been asked to do. Perhaps they have, and those 
records have not been returned, x-rays have not come back over, 
whatever that is.

  But you have a situation of voluminous paper records, oftentimes 
scattered within a hospital in different departments or between 
different offices, and that results in the likelihood that important 
medical records could be lost or not retrieved at that moment when 
someone needs to be making decisions.
  Having worked in both neonatal intensive care units, pediatric units, 
and my own private practice as a psychologist, it was often critically 
important to be able to access records and review them quickly. But a 
simple statement one was looking for in a file that was multiple 
volumes and oftentimes multiple inches thick, it could take hours to 
retrieve critically important data.
  The risk of that is that some information may be missing. The risk is 
that important information may be missed. One study even found that one 
in seven medical records was missing vital information, and this could 
then lead to redundant tests or misdiagnoses, redundant treatments or 
inappropriate treatments.
  Health administration paperwork costs almost $300 billion annually, 
equal to about $1,000 per person in America, or actually 31 percent of 
all health care expenditures in the United States; and yet we have 
hospitals with 21st-century technology that can use a 64-cut CT scanner 
that can give us three dimensional films of patients' hearts, but we 
are still using an 18th-century paper system to keep track of these 
things.
  The RAND Corporation reported that these critical errors that come 
from redundant, unnecessary, and missed information adds $162 billion 
in health care costs per year, a huge avoidable expense. Part of our 
move as the Republican conference here is to make sure that we 
encourage and fund through incentives hospitals and doctors' offices to 
move towards health information technology.
  Medication errors alone cost Medicare about $29 billion in costs. 
Whenever we talk about cost savings in programs such as Medicare and 
Medicaid, it is not slashing care, it is improving care; it is not 
denying access to care, it is bringing access to care. And that is 
vitally important.
  Anyone who has ever had a prescription that could not be read or the 
pharmacist had to call back or the patient wasn't sure if it was 
duplicating another medication recognizes how these errors cost the 
system. The best, the best doctors and the best hospitals and the best 
specialists have their eyes blindfolded when it comes to trying to deal 
with these.
  In the Deficit Reduction Act, as I mentioned a few minutes ago, $150 
million was put in there for hospitals to use grants in high Medicaid 
populations, but throughout the Nation we see many health information 
technology companies emerging at hospitals and insurance companies 
investing billions of dollars, a critically important issue.
  So next time when one goes to the doctor's office and sees the papers 
gone, but to see, for example, in VA hospitals now the doctor putting 
records on a computer, calling up x-rays on a computer, looking at CT 
scans and MRIs, and, yes, even watching films of surgery on their 
computer screen, recognize that this is part of where we need to go 
with 21st-century medical technology.
  But also know this: the physician who did the test or radiologist who 
did the x-ray can immediately send it over secure and confidentially to 
one's physician, who can then review the record.
  In fact, I have been in physicians' offices, since, unfortunately, a 
few months ago I had an accident in Iraq and then had a CT scan in 
Baghdad and an MRI done in Germany, and found that what could happen 
here is the records could then be spent over on computer disk to 
physicians in Washington, D.C. and Bethesda who could then review those 
and easily consult, without having to call for new tests and repeat 
those. It wasn't just the wording that they had of what was taking 
place in the medical test. They could actually see it themselves.
  Repeat this story millions of times a day across America, and you can 
see why the RAND Corporation says we could have savings of $160 
billion; and in addition to that, when you look at the savings that 
comes from otherwise lost days in the workplace, another $150 billion 
in savings.
  Let me mention one other area that we can track with electronic 
medical records, and that is infection rates. A bill that I am working 
on to actually give incentives to hospitals and medical practices to 
reduce infections is critically important.
  Health care-acquired infections cost the United States about $50 
billion in annual medical costs. Now, these infections are such things 
as staphylococcus, methacycline-resistant staphylococcus aureous, 
urinary tract infections, pneumonia, et cetera, where what happens is 
through such low-tech issues as hand-washing or cleaning equipment, 
because we take these things for granted so much, they are not done. 
Sadly, this leads to somewhere up above 75,000, some estimates

[[Page H608]]

even as high as 90,000, deaths per year, so says the Center For Disease 
Control, and these, in many cases are preventible. Now, in some cases 
they are not, if someone comes in with an open wound or someone is 
taking immunosuppressant drugs.
  But what we need to do here is actually help patients get better 
care. We can save massive amounts if we use Medicare and Medicaid to 
provide incentives and pay for performance for hospitals that reduce 
these.
  But this is where, again, using electronic medical records helps, by 
having this information available that hospitals can review and pull up 
information and saying what is happening? Are we seeing trends within 
the hospital? Should we take action? Information that can come up as an 
immediate alert to the hospital medical staff, to medical directors and 
hospital personnel, hospital administrators, to say infections are now 
detected within the hospital, we need to take affirmative, aggressive, 
and thorough action to isolate and deal with this. That being the case, 
we can save tens of thousands of lives a year and tens of billions of 
dollars.
  Now, we point these out because it is so critically important. I hear 
time and time again people misleading the American public that somehow 
we are trying to cut Medicare and Medicaid. That is not true.

                              {time}  2030

  What we are trying to do is improve the system. And any American 
family knows that whether it is your car or your house, that when you 
deal with using inefficient and cheap ineffective ways, you can end up 
paying much more because the tools you use may break or the system you 
are trying to use to fix the problem may actually be ineffective, and 
it is going to cost you more in the long run.
  Doing poor health care, making wrong decisions in health care, is 
what is expensive. Making the right decisions in health care and making 
sure we have the highest quality is what lowers costs. And once and for 
all, we have to put these tools back into the hands of health care 
providers across the Nation, give them the information that is needed 
on every patient, every time, making sure those records are secure and 
so that physicians are competent and hospital personnel are competent.
  Dr. David Brailer, the President's appointee to take many of these 
actions in the area of health information technology, and Secretary 
Leavitt, the Secretary of Health and Human Services, are leading the 
charge in some of these advances along with us in Congress.
  This is something that we want the American people to know, Mr. 
Speaker; that in so doing, we will actually be saving tens of thousands 
of lives and tens of billions of dollars. These are efforts we will not 
yield on, because we recognize that the number of deaths that occur per 
year from us having our eyes blindfolded and our hands and not being 
able to do the best in health care is actually more that occur in a 
single year than died in all of the Vietnam War.
  We have the tools to do this, and we as a Republican Conference will 
continue to lead this Nation in moving forward to save lives and save 
money.
  With that, I yield back to the gentleman from Georgia, Dr. Gingrey, 
to control the balance of my time.

                          ____________________