[Congressional Record Volume 152, Number 47 (Wednesday, April 26, 2006)]
[House]
[Pages H1842-H1849]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
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HEALTH CARE AND WHERE WE ARE GOING
The SPEAKER pro tempore (Ms. Foxx). Under the Speaker's announced
policy of January 4, 2005, the gentleman from Texas (Mr. Burgess) is
recognized for 60 minutes.
Mr. BURGESS. Madam Speaker, I come to the floor tonight to talk about
health care, but I have to spend just a minute or two addressing some
of the things that we just heard in the previous hour.
There has been a lot of discussion about the Jobs and Growth Act that
was passed in 2003, in fact in May of 2003, a reinvestment of $80
billion back into the American economy, back into the productive sector
of the American economy. The American people rewarded the United States
Treasury with an increase in collections to the Treasury the next year
with $260 billion that were not anticipated. Investment in the
productive sector of the American economy works every time it is tried,
and I am grateful to be part of the Congress in 2003 that provided that
reinvestment opportunity for the American people.
There has been a lot of discussion this past couple of weeks about
gas prices. We passed an energy bill at the end of July last year. Part
of the deal on that energy bill was that there was going to be no
liability protection for a compound called MTBE, a federally mandated
oxygenate in gasoline that is sold in this country in order to comply
with clean air restrictions.
Without MTBE, we are left with only ethanol as the only oxygenate
available for the mixture of gasoline that is required to be sold in
States that have clean air issues. We removed the MTBE because it was
placed in legal peril.
We had an opportunity in October after the hurricanes hit, after we
knew there was going to be trouble, we had an opportunity to address
the oxygenate requirements in the blended fuels that are going to be
blended and sold for this summer's driving season, precisely the time
we are up against right now.
This House passed that bill which would have allowed for that
relaxation of oxygenation requirements. We passed it with no Democratic
votes. It was only Republican votes that passed the bill, and it has
never been taken up by the Senate. The consequences are quite
predictable.
Now, we were told during the hearings on the energy bill the prior
year by individuals from, and you talk about a special interest group,
that is the ethanol lobby; we were told that the ethanol manufacturers
in this country had unbelievable success and they were able to produce
ethanol that exceeded their wildest expectations. Well, they were wrong
and they have not been able to produce the quantity they said, and it
is time for this country to look at the tariff that we place on foreign
imported ethanol. If we are going to require foreign imported ethanol
to be part of our gasoline oxygenate system, we are going to have to
import ethanol at least temporarily until we can increase production in
this country.
[[Page H1843]]
But I did not come to the floor to talk about gas prices and ethanol,
although that is important. I came to the floor tonight to talk about
health care. I want to talk about where we are and where I see us
going. I would like to spend a considerable time on the affordability
of health care because I believe that is the central issue. Whether you
talk about a single payer, government-run system or a system that
embraces the private sector, affordability of health care is going to
be one of the main drivers that we need to keep in our uppermost
consideration.
We need to talk about the uninsured and federally qualified health
centers. We will have a bill in the next couple of weeks in the
committee that will authorize the federally qualified health center
statute. Those are an important aspect of our delivery of medical care
in the 21st century in this country.
We have to talk about liability reform. We have talked about it a lot
in the past 3 years. We have yet to produce a satisfactory result, and
it is going to continue to be a part of a major discussion on health
care until we get something done in that regard.
We have to talk about provider relief and paying our doctors and
health care providers what they rightfully earn, and not continue to
cut their reimbursement rates year after year in the Medicare system
and ask them to shoulder a greater and increasing burden of the health
care costs when, after all, we turn to them to take care of the
uninsured at no compensation and then we continually cut their Medicare
compensation. We are driving good doctors out of practice and that is
wrong. We need to address that.
There has been an explosive growth in information technology in
virtually every sector of the American economy. Health care is no
exception. We need to make certain that we have the right kind of
informational technology at the disposal of people who provide health
care.
Of course, you cannot look at the last year with the problem with the
large hurricanes, the problems that loom on the horizon as hurricane
season is upon us again, and the problems that loom on the horizon from
an infectious disease, the likes of which none of us have ever seen in
our lifetimes, the specter of the avian flu. We have to talk about
preparedness.
When ethicists talk about health care and health care in this
country, they always seem to talk about affordability, access and
quality. I remember an ethicist that spoke to one of our classes years
ago said affordability, access and quality; we have only learned how to
handle two of the three at any one time.
Since I do not want to pick the one that is going to be left out, let
me concentrate on affordability. We will leave quality and access
discussions to other days. And I might add that I trust the American
medical system to provide us with the quality that we have come to
expect.
We already have a system that is paid for by, to a large degree, by
governmental agencies and by the Federal Government with a GDP of $10
trillion to $11 trillion and $1.4 trillion spent on health care. In
fact, in the HHS appropriations bill that we passed last December, over
$600 billion was spent on Medicare and Medicaid alone. So clearly,
almost 50 cents of every health care dollar spent in this country
arises right here in the halls of the United States Congress. The
remainder, the other 50 percent, is largely carried by private
insurance, commercial insurance. There is also some amount of that is
carried by self-pay. Again, we cannot forget the charitable care that
is delivered by hospitals and doctors and nurses all over the country
every hour of every day of the year.
The problem that I see if we do not address affordability of health
care, the default position on the horizon is going to be a single
payer, government-run system. Would that necessarily be a bad thing, to
vastly expand the public expenditure on health care? I look to our
neighbors to the north that have an entirely government-run, single-
payer system, and I think it was just in late 2004 or perhaps 2005 that
the Canadian Supreme Court ruled that their system, with its long
waiting lines, was no longer adequate. In fact, I think the Canadian
Supreme Court, their statement was access to a waiting line is not the
same as access to care.
In that system there are the problems with long waits for so-called
elective surgeries. Now, an elective surgery may be something as
serious as replacement of a diseased hip or fixing a problem that
someone has with a ruptured disk in their back or neck. It may even
include coronary artery bypass grafting. It may include some things
that we may not think of as being entirely elective. I would submit
that health care in Toronto would significantly suffer if they did not
have the safety net of Henry Ford Hospital in Detroit, Michigan to take
care of some of their excess.
On the other hand, in the United States, if we had a single-payer
system with long lines for access to care, I do not think we could
count on a hospital on our southern border to bail us out in a similar
fashion.
So in short, I believe we need the private sector, and in fact I
believe we need to encourage and expand the private sector as far as
delivery of health care in this country. Congress can take action by
promoting policies that keep the private sector involved in the health
care marketplace. Indeed, we have done exactly some of those things in
the short 3 years that I have been here.
One of the most significant things I think that has happened in the
last 10 years, in 1996 with the passage of the Kennedy-Kassebaum Act,
and the allowance for the first time for what is called medical savings
account. These were those high-deductible insurance policies where you
could put money away towards that deductible into a medical IRA, if you
will; allow that money to grow tax free to be a medical nest egg for
someone who may need it in future years, or to pay that high deductible
out of the medical savings account.
Now, medical savings accounts had a lot of restrictions upon them.
But even at that, when they were first offered back in 1996 and 1997, I
very quickly went out and signed up myself for a medical savings
account. I made one available in my medical practice to anyone who
wanted it, because I saw this as the tool for the future. It put the
decision-making for health care decisions back in the hands of the
health care consumer. I thought that was such a powerful concept.
Even though at the time medical savings accounts were kind of an
untried and untested premise, I thought that concept of putting the
health care decision back into the hands of the health care consumer
was so important, I was willing to take a chance on that. Mind you,
1996 and 1997 and 1998 was a time we saw explosive growth of HMOs in
this country. And more and more medical care was being dictated by the
chief executive officers of HMOs or medical review boards in a HMO, and
I saw this as a wonderful chance to reclaim the health care decisions
for myself and my family. I gratefully took that option. I am glad I
did because that policy served me very well until I came to Congress.
Now, coming to Congress in 2003, medical savings accounts were not
available in the Federal Employees Health Benefit Plan. Again, medical
savings accounts had a number of restrictions on them and they were
capped. Only 750,000 could be offered across the country, and they were
not that heavily subscribed.
When we passed the Medicare Modernization Act in November of 2003, we
expanded medical savings accounts in a way that I frankly did not think
was possible. But kudos to the Ways and Means Committee and Chairman
Thomas; they got the job done and vastly expanded the access to health
savings accounts not just for recipients of Medicare, but for anyone
who wanted to participate in that kind of high-deductible policy, and
having a savings account that is dedicated entirely to their medical
expenses.
There are some other improvements that can be made, and indeed there
are several pieces of legislation out there currently to allow for a
hybridization, if you will, between flexible spending accounts, health
reimbursement accounts and health savings accounts. I think those are
important steps that yet need to be taken. But with the expansion of
health savings accounts in 2003, making them more generally available
to the population, we unleashed a very powerful tool for providing
insurance to more people in this country.
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Madam Speaker, in the year 1994, I had a family member who was no
longer able to get insurance off my employer-based insurance. I set out
to get an insurance policy for that family member and it was all but
impossible to do at any price. I was a practicing physician at the
time, willing to write a large check for that insurance coverage, but I
could not find anyone who would write a single policy for a young,
single, uninsured person.
Well, fast forward 10 years to 2004, the year after we passed the
health savings account legislation and the Medicare Modernization Act.
And that summer you could go on the Internet, you could go to your
favorite search engine and type in ``health savings account'' in the
window, click ``go,'' and it would immediately return all kinds of
options to that person for the potential purchase of a health care
policy. I do this periodically to see what is available in my State for
a 20- to 25-year-old single person for single coverage, and you can get
a very reasonable, I do not want to say an insurance company's name,
but a large insurance company that has a color as part of its first and
second name; you can get a reputable insurance company's policy for
around $50 a month. Again, a young person age 20 to 25, with a high
deductible.
But think of that, a young person getting out of college who wants
to, instead of going to work for a large corporation, wants to work for
themselves. They want to do an Internet start-up company or any type of
self-directed entrepreneurial-type activity. No longer do they have to
turn their back on that as a career option because insurance is not
available. They can purchase a policy on their own, a policy that is
reasonably priced. Yes, it has a high deductible; but they also have
the ability to put money away towards that deductible, do so tax free,
and the money grows tax deferred.
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And if it is used for a medical expense, it is not going to be taxed
under any circumstance. We have another tool at our disposal. And the
House has passed what are called association health plans. We have
passed this two times a year, every year that I have been in the House
of Representatives.
The Senate very recently passed an association health plan bill out
of their committee. And this, again, is a powerful tool that allows for
small businesses, small businesses of a similar business model, to band
together and accrue the purchasing powering of a large group. The
association health plan is envisioned to be sold across State lines
such that a group of realtors in Texas could band with a group of
realtors in Oklahoma and combine and pool their resources in order to
get a lower price on their insurance coverage. Again, a very powerful
tool, one we have passed in the House on several occasions. It did
finally pass out of the health committee over in the Senate side, and I
do look forward to them taking that issue up to the floor of the
Senate, passing that successfully, and let's get to conference and
let's get the differences worked out, because this is something we need
to provide to our small businesses, the engine that drives productivity
in this country. We need to put this tool in the hands of small
business in this country.
When you think of consumer-directed health care, like a health
savings account, there has to be some method that the consumer, that
the purchaser has of evaluating different hospitals, different doctors.
There has got be a measure of transparency brought into the overall
purchase of that insurance plan. Right now there is opacity in the
system, and I understand there is opacity in the system because opacity
has value. It is perhaps worthwhile for a health care facility, a
hospital, surgery center, doctor's office, to have a little bit of
opacity in their pricing structure so that it is a little bit hard to
figure out what something costs. But we need to move and make an honest
effort to provide the information that the health care consumer needs
to make a well-founded, consumer-oriented decision. After all, we are
asking for consumer-oriented health care. We can't very well deny the
consumer the opportunity to be able to evaluate two health plans side
by side, two hospitals side by side, two surgery centers or two
doctors' practices side by side. They need the ability to do that.
Finally, a concept that has been around as long as I have been here,
and, I suspect, longer, is the concept of tax credits for the uninsured
or the underinsured, a voucher system, perhaps, if you will, just
helping someone who didn't make enough money to be able to pay for
insurance, helping them pay for insurance with an EITC-type tax credit
that is prefundable, not refundable. That is at the beginning of the
tax year that money would be made available to that person.
Some of the proposals that are out there would fund $1,000 for an
individual, $3,000 for a family. A lot of people will say, well, you
can't buy much in the way on the health insurance market for $3,000 for
an individual. But if you go to the health savings accounts Web sites,
you certainly can find products that are available that would allow
someone to purchase insurance coverage, again, for well under $1,000
for an individual, perhaps for 6- or $700 a year, and to begin to put
money away towards that high deductible. And I think that is a
worthwhile product, a worthwhile activity.
And I do look forward at some point to this Congress or the next
Congress taking up the concept of tax credits for the uninsured because
I believe that will, over the long term, all three of those concepts
taken together, health savings accounts, association health plans and
tax credits for the uninsured. Mort Kondracke in an editorial in the
Roll Call Magazine really 2 years ago estimated that you could cut the
number of uninsured by perhaps 13 million by those three entities
alone. I actually think the number on his estimate on health savings
accounts is a little low, because we have seen, over the last 2 years,
an increasing number of people select that type of health insurance,
such that now there are over a million people enrolled in health
savings accounts. The vast majority of these are individuals over the
age of 40, and a great number of these are people who would not be
regarded as high-income. Probably 40 percent of people earn under
$50,000 a year. So it is not just for the healthy and the wealthy; it
is a program that does have high utility for Americans across the
spectrum of all age groups and all earning capabilities.
As far as the uninsured is concerned, the U.S. Census Bureau, and it
seems like this number is higher every week when I read it, right now
between 43- and 45 million people who are estimated to be uninsured.
Now, this number is a little bit tricky because it does include people
who are uninsured for any portion of the year. So someone who is
uninsured for part of the year, but has insurance for the balance of
the year is going to be counted uninsured for the entire calendar year.
Does it count people who are perhaps in this country without a valid
Social Security number, people who are in this country without the
benefit of a valid visa or immigration papers? And the fact is that it
does, and it is going to be difficult to provide coverage to someone
who breaks the law by entering this country illegally.
But that doesn't remove the fact that there are a lot of people in
this country who lack health insurance. One of the things that causes
it, of course, is the high cost of health insurance. And when I talk
about the affordability of health insurance, I acknowledge that for
every dollar that health insurance premiums go up, a certain number of
people are going to be excluded from the rolls of the insured. And we
have done things that cause the cost of insurance to inexorably go
higher and higher, and as we do that, we are going to drive more and
more people away from the ranks of the insured onto the rolls of the
uninsured.
Now, one of the things that is not often talked about in context with
uninsured individuals is the concept of federally qualified health
centers. Now, the President talked about federally qualified health
centers on at least the last two occasions when he delivered his State
of the Union Address, and I believe the last time he was here he said
he wanted to see a federally qualified health center in every poor
county in the United States.
I submit that is a worthy goal, and I would also submit there are
some counties such as in my district back home in Texas that you
wouldn't necessarily record as poor, but they have areas of
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poverty within them that are as large as counties, and indeed as large
as some States back East, and these populations would benefit from
access to a federally qualified health center.
Now, we are going to be taking up the bill that will reauthorize
federally qualified health centers within the next few weeks in the
Energy and Commerce Committee. I suspect it will come to the floor
perhaps the latter part of June during Health Care Week. This is a
worthy exercise and one that the committee needs to take up, and indeed
the whole House needs to take up. I hope there are some improvements
that we can make upon the system.
One of the things I learned last year with the large number of
evacuees that came to my district from Louisiana, to my district in Ft.
Worth, Texas, it takes a long time to set up a federally qualified
health center. And if you have a large number of displaced persons who,
by virtue of the fact that they are low-income, by virtue of the fact
that they had to leave their homes under the worst possible of
conditions, and it is taking some time to get them set up in a new
life, or perhaps they are just temporarily going to be displaced in my
district, it takes too long to set up that federally qualified health
center structure to be able to help individuals like this in the time
frame where they need the help. So some streamlining of the federally
qualified health center application process, I believe, would really go
a long way towards helping these individuals. Backstop it. Make certain
that within 2 years time all of the other regulations that surround
federally qualified health centers have to be complied with, but ease
up the rules just a little bit in an area that is desperately medically
underserved to allow the setup and startup of one of these centers in a
timely fashion.
We have to provide that degree of flexibility. Otherwise, we are only
driving up the cost of health care in the hospital emergency rooms in
the area, in the doctors' offices in the area, where they are going to
see more and more uninsured patients and deliver more and more
uncompensated care, which they, in turn, will have to pass that cost
off to other patients and other health care consumers.
But the beauty of a federally qualified health center is it allows a
patient to have a medical home even though the patient does not have
insurance, and that is the least expensive way of delivering health
care to that group of individuals. Again, it keeps them out of the
emergency room. It keeps them from accessing health care at the most
expensive entry point into the health care system. It allows them to
enter in at the level of the medical office or medical clinic, as
opposed to the emergency room. And they frequently see the same doctor
for visit after visit, so that a problem such as high blood pressure,
diabetes, congestive heart failure, chronic long-term problems again
are going to be better managed if you see the same provider time and
time and time and time again. That continuity of care really is worth
something in that environment.
Now, there are a number of federally qualified health centers in this
country. I don't know the precise number. I believe that the number of
people who are actually served by federally qualified health centers is
going to number in the 15 million range, so that 15 million individuals
who are maybe uninsured but have access to health care through a
federally qualified health centers, it may not be actually accurate or
fair to carry them on the ranks of the uninsured. And that is why I say
that number of 42 to 45 million that is always reported by the Census
Bureau may be overreported because it doesn't take into account the
millions of people that get their medical care through a federally
qualified health center, which is a very reasonable, cost-effective way
to get good medical care for someone who doesn't have access in some
other form.
We have State governments that have, over the years, required that a
lot of things be covered on insurance policy, the so-called mandates
that are added to insurance policies. And tonight, not really the
purpose to get into what mandates are good and what mandates are bad,
but recognize that adding enforced coverage to insurance policies does
increase the cost of insurance policies. And again, for every dollar
that we drive up the cost of an insurance policy, we are excluding
people from insurance.
If it were possible to come to some agreement on what mandates were
absolutely necessary, people just can't live without, and which are
more optional, and come to a conclusion about is it possible for us to
designate a type of insurance, what would be covered under that type of
insurance that could be sold from one State to the other, sold on the
Internet, get the benefit of that type of competition across the
country, if it were possible to come to that type of conclusion about
what we have to have, what we can't live without in an insurance
policy, and allow insurance companies to market lower-cost products to
people who fall into the ranks of the uninsured, I believe that our
American insurance companies would look at that 42 to 45 million
uninsured as a market opportunity and would want to market an insurance
policy to that segment of Americans if they only were allowed to do so.
The good news, Madam Speaker, is we have actually kind of already
come to that agreement. And I go back again to the federally qualified
health center template. We have already decided within the federally
qualified health center structure what procedures have to be offered,
what conditions have to be covered, what benefits have to be offered in
the federally qualified health center structure. And if we could take
that template as a starting point and come to agreement amongst
ourselves, Republican and Democrat alike, stop the tennis match of my
mandate is more important than your mandate; stop the arguing over this
process, and simply come to an agreement, here is an insurance policy
that is good enough to be sold to America's uninsured, it covers the
things that should be covered, it doesn't add a lot of additional
expense for things that might be considered as optional; and then allow
American insurance companies to compete to sell to that segment of the
market, I think we would find that that is a very powerful tool and one
that, quite honestly, we do need to explore. And we need to explore it
in this Congress. We don't need to wait. The guys an hour ago were
talking about how different things are going to be a year from now.
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Well, it does not need to wait for a year from now. This is work that
we can do today, this month, this year. And I submit that it is good
work and one that we must take up in this Congress.
Madam Speaker, when I was originally talking about this, the concept
of liability reform is one that we visited on the floor of this House
many, many times since I took office in the beginning of 2003, I
believed before and I still believe now that we do need a national
strategy for medical liability insurance reform.
And I am from Texas. Texas has done a great job with medical
liability reform. Texas has done a great job with putting a cap on
noneconomic damages and has, I think, built upon and strengthened some
of the earlier programs such as the California program of the Medical
Injury Compensation Reform Act of 1975. I think the Texas compromise of
2003 really built on that earlier experience and is a very valuable
program. In fact, it is delivering cost savings on liability insurance
for the doctors of Texas. One of the unintended consequences was that
it really brought the cost of liability down for self-insured, not-for-
profit hospitals. They have been able to make more investments in
capital and equipment and nursing personnel than they thought possible
because of the cost savings they have gotten off of the Texas medical
liability reform that was passed in 2003.
Now, in this House we passed H.R. 5, which was a major medical
liability reform bill, in 2003. And when we passed that bill, Madam
Speaker, the Congressional Budget Office scored that as a savings of
$15 billion over 5 years' time. Now, it is not just the lower cost of
liability insurance that they are talking about and doctors passing
that cost on to their patients. No. The real savings in that H.R. 5 was
because of the perceived reduction in what is called defensive
medicine: I do not think this person has this condition, but I need to
[[Page H1846]]
do this test in case I am wrong and this case comes into court and I
want to be certain that I have got this evidence to back up my
decision-making process.
A study done back in 1996 at Stanford University estimated that out
of the Medicare program alone, just the Medicare program, the cost of
defensive medicine in 1996, that was 10 years ago, the cost of
defensive medicine for Medicare in this country was nearly $30 billion
a year. I submit that that 10-year-old study, if it were done again
today, would find that dollar figure to be actually much higher. CBO
did not score it as high, but still acknowledged that there was
significant savings to the Federal budget every year if the Congress,
House and Senate, would pass meaningful, meaningful medical liability
reform.
The problems of the expense of defensive medicine and the high cost
of the medical liability system as it exists today means that we are
taking money out of the health care sector of our economy and pushing
it off to somewhere else. And that somewhere else is too often paying a
contingency fee for a trial lawyer. And as harsh as it is to say it, we
can no longer afford that kind of luxury. We can no longer afford to
divest that kind of money in order to continue the medical liability
system that we have in this country. We need a fairer medical justice
system than we possess today.
The bill that we passed, H.R. 5, back in 2003, again basically put a
cap on noneconomic damages. It capped noneconomic damages at $250,000.
I believe it was a good bill. I voted for it in 2003. I voted for it in
2004. I voted for it in 2005. In fact, I will vote for it again if we
bring it to the floor of the House again this summer. But when you look
at the Texas bill that was passed in 2003, it actually structured
itself a little bit differently. Yes, there is a $250,000 cap for
noneconomic damages, but that cap exists for the physician, for the
hospital, and for a second hospital or nursing home if one is involved.
So the total aggregate cap is $750,000. I would have been concerned
back in 2003 if someone had said this is the way we are going to go
about the cap, that that was too high, that that would not bring the
cost of medical liability insurance down, that that would not reduce
the cost of defensive medicine. But, in fact, the story in Texas is
that it has brought costs down.
I will give you an example. In 2002 when I was running for office the
first time, we went from 17 insurers in the State of Texas, medical
liability insurers, 17 of them in the State of Texas at the start of
the year, 2 in the State at the end of the year. And the problem was
the high cost of medical liability and the draining of those insurance
companies by lawsuits.
The effect of passing that bill in June of 2003 and then the
subsequent constitutional amendment that was required to allow that
bill to become law in September of 2003, by the middle of 2004, less
than a year later, we had gone from 2 medical liability insurers in the
State of Texas back up to 13 or 14, and they had come back into the
State without an increase in rates. That is pretty powerful, because if
you go from 17 insurance companies down to 2, you have not got much in
the way of competition. You pretty much have to take what they say as
the going rate. So getting those insurers back into the State of Texas
was critical as far as keeping doctors involved.
I remember an event that I went to during the fall of 2002 when I was
running for Congress, and a young woman who was a radiologist came up
to me and said, ``I really hope you get something done on medical
liability. I have lost my insurance, not because of a bad case but
simply my insurer left the State of Texas and now I cannot get
liability insurance, and as a consequence I am a stay-at-home mom now.
I am not practicing radiology.'' Because, obviously, she cannot without
the protection of a medical liability insurance policy. So the State of
Texas had paid for her medical education. The State of Texas had
subsidized her during her radiology residency down at the University of
Texas at San Antonio. And now just a few years later, she was out of
medicine altogether and raising her children. I am sure she was very
happy in that role, but at the same time, what a waste of that woman's
talents. What a waste of that woman's training that she would not be
able to practice radiology in Texas simply because her insurer left the
State and she could not get someone else to cover her. That is the kind
of very stark reality that we were up against in Texas in 2002. We were
one of the top crisis States as designated by the American Medical
Association of that year.
Fast forward to June of 2003, a major liability provision was passed.
Again, it capped the pain and suffering damages at $250,000 for the
doctor, $250,000 for the hospital, $250,000 for a second hospital or
nursing home if one was involved, and very quickly there was a
turnaround, the insurers coming back into the State, hospitals saving
money. Doctors from Texas Medical Liability Insurance Trust, my old
insurer of record, the savings now, the accumulative savings, from when
that bill was passed to the present day is in excess of 20 percent
savings on their medical liability policies. These are policies which,
by the way, were going up by 10 and 20 percent every year for the 2 or
3 years that preceded that event.
So I think the Texas plan is a good one, and I like to sing its
praises every time that I come to the floor of the House. I think any
medical liability reform that we pass in this House, we could do worse
than to base it off of the Texas plan and the Texas compromise, the so-
called trifurcated cap. I would like to see us champion that concept
over in the Senate and see if we could not get their attention with the
trifurcated cap and perhaps get a bill that we could get to conference
that way.
But one of the critical things about medical liability insurance
issues, people say, you are from Texas and if you have solved the
problem in Texas, why do you continue to worry yourself about it in the
House of Representatives? And I will tell you why. Because that bill is
under attack every legislative session in Texas. There are special
interests. And, yes, addressing the Democrats, there are special
interests that work on your side as well as our side. There are special
interest groups that want to roll back that legislation. But there are
other issues as well.
During my first term, my first year in Congress, we took a visit up
to the ANWR up in Alaska. And coming back from ANWR we came through
Nome, Alaska. Nome, Alaska is a pretty remote place out there. So you
can just imagine that when a big plane with a bunch of Congressmen
land, it is a big deal in Nome, Alaska. They wanted to have a chamber
of commerce-type lunch for us, which they did. And when they learned
that there was a Congressman who was also a doctor on the plane, all
the medical staff got real excited and all 19 doctors on the medical
staff of the Nome, Alaska hospital came out to that lunch that we had.
And one of the doctors who was there said, ``Boy, I sure hope you get
that medical liability law passed up in Congress, because we cannot
afford the medical liability policy for an anesthesiologist here at the
hospital; so we need your help and we need you to get that done so we
can afford to have an anesthesiologist.''
I said, ``Well, gosh, what kind of medicine do you practice, sir?''
He said, ``I am an OB-GYN, just like you.''
``An OBGYN. How in the world do you practice obstetrics and
gynecology? How do you deliver a baby without the availability of
anesthesia? Forget a labor epidural and pain relief during labor. What
do you do if you have to have do a C-section?''
And he said, ``Congressman we get that woman onto a plane and we get
her down to Anchorage as fast as we can.''
Anchorage, an hour and a half away from Nome, Alaska. And I am not
entirely sure about this, but I believe there is a significant amount
of bad weather in Nome, Alaska. I do not want to upset the people at
the chamber there, but I believe there is a significant amount of bad
weather in Nome, Alaska, particularly in the winter months. How do we
further the cause of patient safety by requiring that that doctor put
his patient on a plane and send her to Anchorage to get a C-section
done with the care of an anesthesiologist? That system makes no sense.
Another opportunity I had was to visit with someone who was in charge
of the residency program of a large New York hospital. I trained at
Parkland Hospital, but I was aware of their
[[Page H1847]]
training program, and certainly it is a good second to Parkland
Hospital in Dallas. But this individual was in charge of the residency
program. And I said, ``How has the liability issue affected your
ability to recruit medical students for your OB-GYN residency there in
New York?''
And she said, ``Well, it is a real problem, and currently we are
accepting students that 5 years ago we would not have interviewed.'' In
other words, they have lowered their standards in that OB-GYN
residency, because medical students coming out of medical school with
huge debt do not feel that they can take on the expense and the trauma
of a large liability policy when they start their practice; so they
just do not go into OB-GYN.
These are our children's doctors. These are our children's children's
doctors that we are talking about. How are we furthering the cause of
better medical care in this country when we are allowing that system to
continue? It truly is unconscionable, and it is time for this Congress
to correct that. Both the House and the Senate need to take action on
this. We do have a President who has pledged to sign this bill if we
will get it to his desk, and I believe that we must do that.
On the concept of physician payment, I will say that we spend a good
amount of time in this body discussing health information technology
and pay-for-performance scenerios. We talk about them frequently. But
we do not address a serious problem that has been plaguing America's
physicians for the past 10 years, and that is the issue of the
continuing erosion of physician payments under the Medicare system.
Currently, physicians are paid under what is called the sustainable
growth rate, or SGR, which provides for a payment cut of 4 percent for
every year, year over year, to a cumulative total of some 26 percent.
And that has a negative effect upon the number of doctors who continue
to provide services for Medicare patients.
Now, I have done a lot of town halls around in my district, and I
have heard a lot of discussion about prescription drugs. But I have
also had a lot of people come up to me at the end of a town hall and
say, ``How come I turned 65 and I have got to change doctors?'' The
reason they have to change doctors is that their physician has
evaluated the Medicare reimbursement schedule and has decided that it
is not in their best interest to continue to provide care for Medicare
patients because of this continued erosion of provider reimbursement
rates that goes on year over year. Doctors look at that and they think,
well, Congress is likely to reverse that at least temporarily this
year. But it is very difficult to plan. It is very difficult to hire.
It is very difficult to justify equipment purchases if you have got to
factor in a pay cut of 4 to 5 percent every year for the forseeable
future.
Now, we passed a bill called the Deficit Reduction Act right at the
end of the year, but it turned out we really did not pass it until
January. Within the Deficit Reduction Act was a provision to keep the
doctors from having that negative 4.4 percent update; in other words,
just hold payment rates at a level amount and not decrease it.
{time} 2330
The effect of not passing that bill in December and allowing January
1st to hit without addressing that problem meant that every physician
in the country who does Medicare got a letter from CMS, the Center for
Medicare and Medicaid Services, saying your rates just went down 4.4
percent, or our reimbursement to you just went down 4.4 percent. My fax
machine lit up, because it was over the holidays and doctors wanted to
get word to me, saying here is the letter I accept to my patients,
Congressman. I will no longer be able to provide your care after the
first of the year because Medicare has again cut my rates.
So doctors not just in my district, but across the State and some
even across the country, called me and notified me that they were going
to drop their coverage of Medicare patients.
The problem is that these are doctors who are in the peaks of their
career. These are doctors who have established practices, the doctors
who come to a diagnosis the quickest, the doctors who spend the least
amount of time in the operating room, the doctors who are at the
pinnacle of their medical expertise, and they are being driven out of
the system. The problem is if you drive out your first tier of
providers, it is only going to cost you more in the long run.
So when we talk about things like pay for performance, I cannot help
but think if we run off our top tier of providers, we are going to have
to pay a lot more to get less performance in the future, and it is
incumbent upon us to take up that legislation, to take up that concept
and pass legislation that will once and for all fix the problems with
the sustainable growth rate and not make our provider community face
that 4 to 5 percent pay cut every year, year over year.
A concept derived by the Medicare Payment Advisory Council, so-called
MEDPAC, was for consideration of what is called the Medicare economic
index, which calculates the true cost of providing Medicare health
services, and the reimbursements would be based upon a formula which
factored in the actual cost of delivering that care, a very powerful
concept and an idea whose time I believe is long since overdue.
Another issue that we spend a lot of time talking about here on the
House floor and over in committee is the concept of increasing health
care technology. This is appropriate for Congress to be considering
this. It is an appropriate expenditure. It is terribly difficult for
small doctors' offices with one, two, three and four providers in an
office, to justify the kind of expense that would be required to
purchase that off-the-shelf health care information technology.
A lot of times a hospital would be willing to partner and help offset
some of that, because the hospital benefits as well. Currently we have
laws such as stark laws and anti-kickback statutes that prevent that
from happening. We need to seriously look the a those pieces of
legislation. They may have been of some value back in the 1980s, but
they are not a great help in the 21st century. They are not really
protecting anyone from any malfeasance, and they are preventing getting
this technology into the hands of people who need it the most.
The other thing that we have to consider is we have to assure
physicians, providers, hospitals, that they are not going to run afoul
of some statute in the HIPAA legislation, the patient privacy
legislation. Finally we need to concentrate on some coding uniformity
so that people will have confidence in these systems and know that they
can use them and that they are not only helping their patients, they
are helping their practices, they are helping their bottom line, they
are helping their hospital. It could be a win-win situation all the way
around, but we are going to have to change some Federal regulations to
allow that to happen.
One of the things that I talked about when I originally started this
evening was that we needed to touch on preparedness. When you talk
about preparedness, looking back over the last year, the twin
hurricanes of Katrina and Rita that hit Louisiana, Mississippi and then
Texas and Louisiana later in the year, it is impossible to talk about
preparedness without thinking about some of the lessons that we
learned.
When the hurricane was out there churning in the Gulf, the first
hurricane, Hurricane Katrina, you just knew it was going to be bad
news. It was a hurricane unlike anything that any one of us had seen
before, and there is no way in this day and age that it could select a
location for landfall along the Gulf Coast where it was not going to
affect a significant number of people.
Well, we all know the story. It came ashore. It kind of took a little
turn before it came ashore. We thought New Orleans had dodged a bullet,
only to find out that it got hit with even a larger bullet than any of
us thought possible.
I was back in Fort Worth and Denton, Texas, during the August work
period, and it was at that time that almost 25,000 people that were
displaced from that storm came to North Texas seeking shelter, seeking
medical care. To say that we weren't expecting it would be an
understatement. But the people of North Texas opened their homes and
their hearts. Hospitals, hotels, church camps did yeoman's work taking
in people who were affected by the storm.
[[Page H1848]]
Where my district office is in Fort Worth, at the Tarrant County
Resource Center, they immediately made provisions to take in 80
individuals. We set up pallets and cots well into the night on
Wednesday night and started receiving our first evacuees on Thursday.
A small Baptist camp in Denton, Texas, Camp Copus, opened its gates
up and received some 130 people who had driven in buses all night, in
two buses all night, from the Superdome in Louisiana when they finally
got out of there.
Probably one of the most heartwarming stories in the North Texas area
was the way that the Dallas County Medical Society really rallied
around and got their members out to provide care for these individuals
as they got off the buses. There are about 3,600 members of the Dallas
County Medical Society. When they heard the buses were on the way up
from the Superdome, we were right on top of Labor Day weekend, so most
people were closing their offices early, making plans for a holiday
weekend.
The Dallas County Medical Society sent out a blast fax to all its
member physicians, and 800 doctors showed up to provide medical care,
triage care, urgent care to these people that got off the buses who had
been displaced from Hurricane Katrina; people who had chronic medical
conditions, who had been off their medications for 3 or 4 days, who
with their chronic medical condition were about to have an acute
decompensation of hypertension, diabetes, congestive heart failure.
So as these people came off the bus, as the evacuees, they were
interviewed. If they thought they were ill enough to have to go to the
hospital, they were taken to the hospital, to Parkland Hospital there
in Dallas. If they simply needed a shower and a meal and a refill on
their medications, that was provided for them.
Of the 17,000 people who got off the bus in those first hours that
evening, less than 500, I think the number is actually in the range of
about 300, were actually hospitalized at Parkland Hospital, a
phenomenally small number when you consider that these were people who
had been in the worst of conditions for the past 3 or 4 days, again
many of them ill with chronic medical conditions who had been off their
medications for several days. Very few required hospitalization because
the doctors of the Dallas County Medical Society were there to receive
them.
One the great stories of that evening was some of the pharmacies in
the area provided mobile communications and mobile computer hookups,
and if those patients had received their medicines at one of the chain
drugstores in Louisiana, in New Orleans, they were able to actually
replicate their medications, duplicate their records for the
medications, what they were taking and the dosage schedules, and make
sure the right medicines were gotten to the right individuals. A
phenomenal story that occurred there on Labor Day weekend.
Another story you will never read about in the newspapers but really
was one of the phenomenal good news stories, the way you can save a lot
of money with just a small investment, everyone was given a little tube
or little canister of hand sanitizer, and every few minutes you would
see people sanitize their hands with an anti-bacterial, anti-viral
preparation.
In these kinds of conditions, where you have got a lot of people who
have been wet from a storm and then housed in the Superdome and then
got wet again when the Superdome flooded, on a bus for hours, you can
just imagine the bacteria and viruses find that an environment they can
thrive upon.
Diseases like the Norwalk virus, where gastrointestinal illnesses,
epidemic diarrheas are very, very common in those types of conditions.
They had very, very few people who became ill. Those that did have
symptoms were identified early and sequestered off in another facility.
But, again, the hand sanitizing that was done by providing low cost
hand sanitizing solution to every person within the Reunion Arena
shelter there really kept down trouble and spared a lot of human
suffering, spared a lot of medical expense for having to treat people
then of the subsequent gastrointestinal illnesses, the nausea, the
vomiting, the diarrhea, the dehydration that could accompany that.
As a follow-up, I have been to the City of New Orleans twice since
Hurricane Katrina hit. The first time was in October. I was there as a
guest of one of the hospital administrators who wanted me to see, he
had come before our testimony to testify in Washington and he wanted me
to see firsthand myself the destruction that is there.
Even if October, two months after the date, it is unbelievable. There
is work to be done that realistically will carry on for years. It is a
phenomenal task that is ahead of the people of Louisiana, the people of
New Orleans, the people of Mississippi and the people of the United
States of America as we help that part of the world recover.
I do want to share one other good news story. We toured Charity
Hospital and saw the degree of devastation there, and there is a lot of
work to be done if Charity Hospital is ever going to recover. Across
the street at Tulane Hospital, which is a private hospital, they had
invested insurance money, they had invested new capital and were well
on their way to having the HCA hospital up and running. In fact, I
believe their emergency room was open in time for Mardi Gras. I am not
sure if the hospital has opened up any of its wards yet, but it looked
like they were well on their way to getting that done.
An entirely different story just across the street from Tulane. They
both had the same degree of flooding, they both had the evacuation on
the same day, late that week after the storm, but involvement of the
private sector really did make a positive difference in the recovery of
the Tulane Hospital.
It is my hope that Charity Hospital will be able to recover as well.
I hope the individuals there involved in the State Medical System can
work with Federal agencies and can work with the doctors and the very
capable administrators on the ground, but they have got a long way to
go to recover the Charity facility.
I guess one of the main things that was learned down there, one of
the main lessons learned, an off-the-shelf preparedness plan that is
purchased by a hospital or nursing home is not going to do a bit of
good if it is not taken off-the-shelf and put into action.
Unfortunately, that did happen in more than one occasion in that area
after the hurricane.
I do need to add that just because a hospital was private does not
necessarily mean that it fared better than a public hospital. There
were other private hospitals that still lag far behind the HCA facility
there at Tulane, and it is my hope that more of those will follow the
Tulane model and make that private investment, invest those insurance
dollars that they receive and bring their facilities up and on line
quickly.
We did have hearings. The other side complained this evening about
oversight. There were excellent oversight hearings by Tom Davis'
Special Select Katrina Committee. All Members received or should have
received their report. It is called Failure of Initiative. It is a very
large book, but it is not a hard read. In fact, it is a very
interesting read. For those Members who have received that and not read
it, I would urge you to do so.
There is an excellent part in there about medical preparedness, but
in fact it talks about preparedness all down the line, and it is a
valuable instruction for all of us, especially when we talk about the
specter of the avian flu which could be facing us here in this country
as early as late August or early September.
When you look at the spread of that illness in bird populations
across Southeast Asia and then the Middle East and then in Eastern
Europe and now in Europe, clearly there is a continued spread of that
disease. When it gets into the flyways of the migratory bird patterns,
gets up in the polar regions perhaps by this summer, then down through
the upper North American continent in Canada, arriving in the United
States, pick the month, but one could easily assume it would be early
or late fall of next year.
I must stress that this is still a disease in animals, a disease in
birds, but there is a lot about it that is not known. Felines in
Germany have contracted the disease. Whether that is because they have
come in contact with animal waste or whether they have eaten animals
that is diseased, no one
[[Page H1849]]
really knows. It does appear to be a different disease in felines than
you would expect the avian flu to be in humans if it were to mutate to
a human form.
We have a lot of work to do as far as bolstering our vaccine
manufacturing capability within our shores, within our borders. It
needs to happen in this country. We need some liability relief to allow
that to happen quickly, but we also need to protect and indemnify our
first responders.
Those 800 people that came to the Reunion Arena parking lot from the
Dallas County Medical Society for Katrina victims may have an entirely
different view on the situation if they are being called to come attend
a large number of casualties from a disease that might well be an
infectious disease that they could catch. They will need to have the
availability of anti-virals. We will need to have the availability of
vaccines. But if those vaccines are relatively new and untested, we
need to have the ability to indemnify those first responders or their
families if the first responders are harmed by the vaccines.
{time} 2345
The disease knows no boundaries. It does not respect any Governmental
jurisdiction. If it does arrive on the upper part of the North American
Continent it will spread through the lower parts to the United States.
Can anyone guess how quickly? Suffice it to say that the conditions
are a little bit different here than in Southeast Asia and the Middle
East. Containment policies that have been somewhat sporadic would
likely be much more effective over here on this continent.
But that is not to say that we could not face a very serious problem.
It would be economically disruptive if nothing else if large numbers of
the poultry population had to be taken off line. But a very serious
potential human tragedy if the virus changes in its ability to infect
not just bird populations but humans as well.
But in summary, Madam Speaker, we have got a lot of work ahead of us
as far as health care is concerned over the balance of this year. I
know that the leadership takes this responsibility very seriously.
Certainly I want to make certain that the leadership and indeed every
Member of Congress knows that those of us who have a background in
health care stand ready and willing to help in this regard.
The concept of affordability of health care is one that I just cannot
stress enough, because if we do not attend to the affordability of
health care we may end up with a default position that none of us
really cares for.
And with that, Madam Speaker, I yield back.
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