[Congressional Record Volume 152, Number 113 (Wednesday, September 13, 2006)]
[House]
[Pages H6526-H6532]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   THE ROAD TO AFFORDABLE HEALTH CARE

  The SPEAKER pro tempore (Mrs. Schmidt). 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 too would like to say it is a privilege 
to come to the floor of the House and be able to address the House on 
important matters of the day.
  In my first term in the House, the 108th Congress, and my background 
is actually as a physician, and when I came to Congress in 2003, one of 
the things that you do with a doctor when you put them in Congress is 
put them on the Transportation Committee. So I had a very good session 
of Congress on the Transportation Committee. I was fortunate enough 
after my reelection in 2004 to be placed on the Energy and Commerce 
Committee on the Subcommittee on Health. So having had experience in 
Congress on both roads and now health, what I thought I would talk 
about tonight is the road to affordable health care.
  Some of the things that I want to talk about tonight are the overall 
affordability of health care and where we are in this country and where 
we are going. I want to talk about the public versus the private 
systems in this country. We obviously need to talk about the uninsured 
and some of the programs to help with the uninsured, federally 
qualified health centers, association health plans and health savings 
accounts.

                              {time}  2300

  You almost can't talk about health care in this country without 
talking about liability reform, and, indeed, we do need to touch on 
that, and the sustainable growth rate, patient access for Medicare 
patients, how physicians are reimbursed under the Medicare system, an 
item that is becoming of critical importance if we want to keep some of 
our best doctors providing care for some of our most complex and 
challenging patients.
  Information technology has been one of the buzzwords up here ever 
since I started my time in Congress, and, indeed, we need to talk about 
that. Preparedness, whether it be from terrorism, whether it be from 
natural disaster, or whether it be from an outside source like the 
worldwide flu pandemic that hit this country in 1918, we need to be 
prepared for that should it happen.
  We need to talk a little bit about the number of State mandates that 
are on insurance policies that tend to drive the cost of health 
insurance up and thereby reduce the overall affordability of health 
care.
  There are some interesting things that are being done in some of the 
States as they approach some of the difficulties they had in providing 
health care to their citizens. I would like to particularly talk about 
Governor Mitt Romney's plan up in Massachusetts that provides for 
personal responsibility in health care.
  Finally, if there is time, we will talk a little bit about the 
reauthorization of trauma centers in this country. We will talk a 
little bit about transparency, raise transparency for price cost and 
quality in our health care system and maybe just a little bit about 
long-term care, because that is one of the drivers that is going to 
vastly increase the cost of Medicare and Medicaid as more and more baby 
boomers retire.
  Let me just remove this for a minute so it is not distracting to any 
other Member of the House who might happen to come by and look at it.
  We talk about the current problem facing us. We spend a fair amount 
of money in this country on health care. We have a gross domestic 
product of upwards of $11 trillion, and we spend about 16 percent of 
that on health care; $1.4 trillion is spent on health care in this 
country. In fact, Medicare and Medicaid alone in our HHS appropriations 
bill, which we have yet to pass, that bill will probably be upwards of 
$660 billion just for Medicare and Medicaid.
  Of course, we have the Indian health service, the veterans health 
service, Federal prisons also providing health care, so there is a 
significant chunk of this Nation's health care that is already borne by 
the Federal Government. The other approximately 50 percent is broken 
down to that care that

[[Page H6527]]

is just simply not compensated or not remunerated. You might call it 
charity care or just simply uncompensated care. Some of it is paid for 
out of pocket or self-pay, and certainly the lion's share is borne by 
the private insurance market in this country.
  Well, between the public and the private sectors, how is the best way 
to get more health care coverage into the hands of more people? Should 
we just simply expand the public sector to the point where it 
encompasses all or nearly all of the health care expenditures in this 
country, a so-called Canadian system? I don't think so. Even the 
Canadian Supreme Court in 2004 and 2005 said that they had a problem 
with access in their country, and, in fact, access to a waiting list 
did not equate to access to care.
  In the British national health service, some of the most expensive 
care in the world is in Great Britain. They have a two-tier system. 
They have their national health service, and then they have private 
care, and that private care in that country, the cost for that, has 
gone significantly up. The waiting time for someone who is over 80 
years of age, that becomes really problematic. You put someone over 80 
years of age on a waiting list for a procedure, a hip replacement, a 
heart bypass, and the likelihood of them being able to sustain 
themselves until they receive that service starts to go down. That's 
unfair as well.
  Well, what about the private sector? I believe that we have the best 
health care system in the world in this country, largely because of 
contributions of the private sector.
  We have more innovation in this country than almost anywhere else in 
the world. We have the ability to integrate new technologies rapidly 
into the treatment rooms, the operating rooms, into the health care 
system in general in this country.
  Finally, because we have such a significant component that is borne 
by the private sector, we have willing sellers and willing buyers. The 
waiting list is not as big an issue, if an issue at all, in most parts 
of this country.
  Some of the other things that we will talk about, as we talk about 
expanding the private sector, or at least maintaining the component of 
the private sector in this country, is the little bit of the history of 
what we called at one time ``medical savings accounts.'' We now refer 
to them as health savings accounts as they were expanded significantly 
under the Medicare Modernization Act of 2003.
  But the old medical savings accounts had a lot of restrictions on 
them. There weren't many companies who stepped up and provided that 
type of an insurance product, and, as a consequence, you never saw the 
savings with medical savings accounts that, really, should have been 
there.
  I will contrast that with health savings accounts now. You can go to 
your search engine, you can type in ``health savings account'' into 
Google, and you are offered a vast array of different companies and 
plans that sell, market on the Internet. With, in fact, the competitive 
power of the Internet, many of these plans, these high-deductible 
health savings account plans are priced well within reach, of, say, a 
young person just getting out of college.
  Contrast that with the mid-1990s when a young person getting out of 
college who didn't have an employer-based health insurance, who just 
wanted to go buy an individual policy, I know, because I had experience 
with that in my own family, you just almost could not buy an individual 
health insurance policy for a single individual in the marketplace. No 
one was interested in selling that to you at any price. But now you can 
go on the Internet, and you can find a lot of products that are 
available.
  The last time I looked, which, albeit it was a couple of months ago, 
but for a young person, 25 years, male, in the State of Texas, for a 
high-deductible plan, would range between $50 and $60. There were some 
that were even cheaper, but they were companies that I didn't recognize 
the name of, and I certainly wouldn't recommend that someone buy from 
someone they have never heard of before. But there were some reputable 
names, named insurance companies that had providers, provider lists 
that were more than adequate, that were for sale at a price that I 
would consider affordable for a young entrepreneur just perhaps 
starting their own business or leaving the protective fold of a group 
health plan from their employer.
  How we keep the private sector involved and keep health care 
affordable is truly one of the challenges that we in this Congress, not 
just Republicans and not just Democrats, but both sides of the aisle, 
need to take on and meet head on.
  Some of the downsides of going to a completel nationalized system is 
I am afraid we will lose a lot of the energy toward innovation. When 
you stop and think about it, we have had three Presidents in my 
lifetime who have espoused programs of a nationalized health insurance, 
President Truman, President Nixon and President Clinton most recently.

  Under Truman, if they had gotten their way and nationalized health 
care, what if, what if we had stifled innovation with that type of 
maneuver? The antibiotics that we used today would be penicillin and 
tetracycline, those that were most commonly in use in the late 1940s 
and early 1950s.
  Under the Nixon administration, what if they had gotten their way 
with the nationalized health insurance with, again, a chilling effect 
on innovation? We might be looking at treating psychiatric illness 
still with Thorazine rather than having the availability of the very 
potent antipsychotics and the selective serotonin reuptake inhibitors 
that we have now today. During the Clinton administration in the 1990s, 
there are just untold innovations that have happened.
  Even in the last 15 years, there are innovations in the treatment of 
arthritis, innovations in the treatment of osteoporosis. In fact, if 
innovation had been stifled in 1992, osteoporosis would be treated 
today with estrogen replacement and pain medicines, as opposed to 
having the newer phosphonates or medicines like Fosamax and Actonel and 
Boniva that are available to us today.
  When we look at the uninsured in this country, it is an election 
year, so we can certainly expect the number to go up. The most recent 
U.S. Census Bureau was 46 million people uninsured.
  Interestingly enough, between the years 2004 and 2005, there were 1 
million more people who had health insurance in 2005 than had it in 
2004, and I suspect the reason for that was because of the expansion of 
health savings accounts.
  But when someone is labeled uninsured, it means that for any portion 
of a year they lacked health insurance. It doesn't always mean, though, 
that they have no access to health care. Access to health care, I will 
tell you as someone who made a career of being a physician, access to 
health care is uniformly available. It may be expensive care, it may be 
care that is accessed far later in the course of the disease than 
anyone would recommend, but access to health care does not, or not 
having health insurance, does not equate to not having access to health 
care.
  In fact, this Congress in the 1980s mandated that anyone arriving in 
an emergency room would have access to health care, whether or not they 
had the ability to pay for it. In fact, as a physician, I was required 
to respond to that patient within 30 minutes or a reasonable timeframe 
or face some rather significant civil money penalties. So lack of 
insurance does not equate to lacking access to health care.
  We also have a system in this country, under the Federally qualified 
health center system, that provides health care and continuation of 
care in a medical home to between 15 and 17 million recipients. That is 
a significant number of people who lack health insurance but have 
access to a medical home and have access to care when they need it and, 
in fact, have continuity of care that in a lot of cases rivals that of 
any HMO out there.
  There are some things we could do, I think, to strengthen the ability 
of federally qualified health centers to provide care when it is 
needed. I represent an area of north Texas, Denton County, Tarrant 
County. Fort Worth is the largest city in my district.
  Last year when Hurricane Katrina hit the gulf coast, we had a number 
of persons who were displaced by Hurricane Katrina, who came to the 
Dallas-Fort Worth area, individuals who came needing medical services 
and not being able to wait the 6 to 8 years that is now

[[Page H6528]]

required to set up a federally qualified health center.
  Indeed, last year, the Deficit Reduction Act, I tried to introduce 
amendments that would streamline the process of setting up a federally 
qualified health care that would make more of those facilities 
available to more patients so that they could have more services 
available to them.
  Unfortunately, those amendments did not stand during the conference 
report. But there is still an opportunity to work on streamlining the 
startup procedures for federally qualified health centers. Indeed, in 
my district I am working on a couple of those even as we speak.
  Another issue is having affordable products for companies to sell. 
You got 46 million uninsured. Don't think that Aetna Life and Casualty 
wouldn't look at that as potential market share if we would provide 
them the tools that they need to have an affordable policy available to 
individuals.
  We will talk about this a little bit more in just a moment, but to 
give some relief for some of the mandates that are put on insurance 
companies, where they have to offer brow lifts and involved infertility 
treatments to every person who purchases their insurance when it may 
not be necessary, and, indeed, the cost of adding those benefits may be 
keeping insurance benefits from a greater segment of the population.
  On the concept of health savings accounts, we did expand them 
significantly during the Medicare Modernization Act. There, in fact, is 
legislation out there this year. Eric Cantor, from Virginia, and myself 
have introduced legislation to expand and make a little bit more 
flexible the health savings account.

                              {time}  2315

  One of the things, in the interest of full disclosure, some employers 
will provide employees an amount of money to have each year to perhaps 
pay incidentals or eyeglasses or maybe even help pay for a higher 
deductible that is selected to offset some of the cost of the insurance 
premiums, these so-called use-it-or-lose-it funds that a company might 
provide a patient every year. But when you get toward the end of the 
year, and gosh, nobody wants to lose that money, they want to get the 
use of that money, it may be as much as $1,800 or $2,000, so we 
actually incent people to go out and spend more money on health care 
that perhaps they might not even need.
  There was a big, full-page ad in the Dallas Morning News right before 
I left to come back up here about a doctor who provides refractive 
surgery, or LASIK, for someone's eyes, and if you have a use-it-or-
lose-it policy at your work, look into buying yourself LASIK for 
Christmas this year, because you will lose that money if you don't 
spend it. Again, a kind of the wrong incentive and the wrong message to 
send to employees that yes, you have to spend at least $2,000 on health 
care every year or you are going to be penalized.
  For people who are young and healthy who feel that they are 
bulletproof and they don't even need to buy insurance, making these HSA 
premiums payable with pre-tax dollars would be a powerful incentive to 
get these individuals to buy into the concept that they do need to 
insure themselves.
  For low-income individuals, people who don't make enough money to 
even cover the relatively low cost of a Health Savings Account 
insurance premium, provide them with a pre-fundable tax credit or a 
voucher, if you will, to be able to buy that insurance, or perhaps at 
least buy down the cost of the insurance premium for someone who is not 
unemployed but doesn't make enough money to pay for health insurance.
  What about someone who has got a chronic disease? A Health Savings 
Account may not be the best option for them. It might be, if we allowed 
employers to make a larger contribution, a larger or greater HSA 
contribution for someone with a chronic illness, say someone with 
diabetes, someone who is in remission from leukemia, a valuable 
employee that an employer wants to be able to keep on the payroll and 
keep on providing their insurance benefit and would welcome the 
opportunity to be able to buy one of these lower cost Health Savings 
Accounts and yet contribute a greater amount to that person's 
deductible.
  Allowing flexibility to coordinate Health Savings Accounts with 
existing health coverage, like a flexible spending account or a health 
reimbursement account, and allowing early retirees to use HSA savings 
to pay for insurance coverage premiums until they are of an age that 
they can be covered on Medicare.
  But probably the most powerful tool that we could employ is providing 
a pre-tax treatment of health care expenses incurred under HSA 
compatible plans. That has been something that has met with some 
resistance, but truly I think it is time to investigate that and take 
that up.
  Association Health Plans. You hear it talked about. I have heard it 
talked about every year since I have been in Congress. Over 60 percent 
of all uninsured workers are employed by small businesses with fewer 
than 100 employees. But what if we were to give small business, give 
those small employers the ability to pool together, and if they are of 
a similar business model, say they are chambers of commerce, or say 
they are realtors, or say they are physicians or dentists offices, if 
they could pool together to be able to get the purchasing power of a 
larger entity, then they would be able to command more control in the 
insurance market and command a more cost-effective premium.
  What if we allowed them to do this across State lines? That has been 
the difficulty in allowing, or for the Senate or the other body to 
allow the institution of Health Savings Accounts. They came very close 
this past year. I know they worked very hard on that over there.
  Association Health Plans may not immediately bring down the number of 
uninsured like expanding Health Savings Accounts will, but allowing 
Association Health Plans would provide some measure of stability and 
affordability in insurance premiums that would allow small businesses 
more certainty in that market and would keep them from leaving the 
health insurance market for their employees.
  Well, as promised, it is almost impossible to talk about the 
affordability of health care and not bring up the question of 
liability, medical liability reform. We have done that I don't know how 
many times on the House side.
  Some states, my home State of Texas, has made great strides in 
improving the liability picture back home in the State of Texas. But 
these State-by-State solutions are in constant jeopardy by special 
interests who will reappear every legislative session to try to undo, 
for example, the good that they did in my home State of Texas.
  When we passed H.R. 5, which was the Medical Liability Reform Act in 
this body in 2003, the Congressional Budget Office scored that as a 
savings of $15 billion over 5 years. I believe the amount really will 
turn out to be much greater than that because of the pernicious effect 
from a spending standpoint of defensive medicine. In fact, a study done 
out of Stanford, California, in 1996, in the Medicare population alone 
showed that the practice of defensive medicine cost about $30 billion a 
year in 1996 dollars to the Medicare system. So there would be a 
significant cost savings across the board in this country if we would 
be able to pass some type of meaningful liability reform. We are 
wasting money by not pushing for this on a national level.
  What happens if we don't change? Well, several years ago when I was 
on the transportation committee we had a field hearing up in ANWR. On 
the way back we stopped in Nome, Alaska, for lunch and kind of had a 
Chamber of Commerce type lunch there in Nome, Alaska
  Because it is unusual to have a congressional delegation come through 
Nome, Alaska, all of the people turned out for that, including all 19 
members of the medical staff of the hospital there at Nome. They spoke 
to me with great concern saying, I hope you will be able to get that 
medical liability bill passed, because we can't afford the insurance 
premiums for an anesthesiologist at our hospital.
  I said to the person sitting next to me, what kind of medicine do you 
practice, sir? He said I am an OB-GYN, just like you.

[[Page H6529]]

  How do you practice OB-GYN without an anesthesiologist in your 
hospital? Forget an epidermal for pain relief during labor. What do you 
do if the patient requires a C-section?
  He said, we get an airplane and take the patient to Anchorage.
  Anchorage is an hour-and-a-half away, and that is if the weather is 
good. Nome, Alaska, as I understand it, has episodes of bad weather 
where aircraft can't take off. I fail to see, Madam Speaker, how we are 
furthering the cause of medical safety, patient safety, by allowing 
this system to continue.
  In addition, the head of one of the residency programs in New York 
was speaking with me one night. I asked if the medical liability 
climate was affecting their ability to get OB-GYN residents into their 
program. It was related to me that evening that, well, Congressman, we 
are taking people into our program that we wouldn't have interviewed 5 
years ago.
  Wait a minute. These are our children's doctors they are educating 
today. How are we furthering the cause of patient safety, how are we 
enhancing patient safety by allowing that system to continue? The best 
and the brightest are not going to go into fields like OB-GYN or 
neurosurgery, so-called high-risk specialties that might expose them to 
a greater degree of liability peril.
  Well, in Texas, we did do what I consider a very good thing as far as 
medical liability was concerned, and we did pass a so-called cap in 
Texas, a cap on non-economic damages.
  It was a little different from the House-passed bill. The House-
passed bill was a $250,000 cap on non-economic damages. In Texas we 
passed a bill that would cap $250,000 of non-economic damages for the 
doctor, another $250,000 for the hospital, and another $250,000 for a 
second hospital or nursing home, if one was involved. This bill 
required the passage of a constitutional amendment in Texas in 2003, 
and it did indeed pass, and now Texas is well into its third year of 
this medical liability reform.
  What have been the results? Texas Medical Liability Trust, my old 
insurer of record when I left the practice of medicine in early 2003, 
the cost for premiums from Texas Medical Liability Trust, coupled with 
the rebates that had been given to doctors who were their customers 
over the last 3 years, have now totaled to over 20 percent. That is 
significant, because in the 2 years before I left the practice of 
medicine, my rates went up by 20 percent and 30 percent for those 2 
years before I left the active clinical practice of medicine. So it is 
a significant change that has happened in Texas.
  One of the major advantages has been what has happened with mid-
sized, not-for-profit hospitals who were self-insuring for medical 
liability before. Many of these smaller hospitals have found millions 
of dollars that are now returned to them in medical liability premiums 
that are available for capital expansion, to hire more nurses, the 
kinds of things you want your mid-size, not-for-profit community 
hospital to be able to do.
  We have some other options in our Committee on Energy and Commerce on 
our Health Subcommittee. We have talked about some of the other 
options. Arbitration, mediation, certainly if there could be an 
expansion of those to allow for an earlier settlement or even the 
concept of an early offer for someone who actually has been harmed.
  One of the really unspoken but one of the significant downsides of 
our medical liability system is it takes on the average of almost 8 
years for a patient who is truly harmed to receive any type of 
compensation. Then the amount of compensation they receive is 
strikingly reduced by legal fees and court costs and preparation costs 
and all of the things that go into that. So there is a very lengthy 
process that doesn't really help anyone as far as getting money to 
someone who is truly injured.
  The concept of an early offer or even arbitration or mediation, we 
will have to make some adjustments to what is referred to as the 
National Practitioner Data Bank, and hopefully my committee will be 
able to take that up in the near future.
  Let's shift gears for just a minute and talk a little bit about 
something that significantly affects patient access to physicians, and 
that is the proposed reductions in physician payment that are going to 
occur under the Medicare system, the so-called reductions because of 
the sustainable growth rate formula, something that I believe needs to 
be fixed and it needs to be fixed this year.
  Under the sustainable growth rate formula, physicians' compensation 
is basically set. It is an attempt to limit the amount of expenditures 
of medical care under the Medicare system by controlling volume and 
intensity of services.
  Other parts of medical care delivered under the Medicare system, the 
year-over-year rate is calculated based on the cost of input, a market 
basket type of update that is based on medical inflation. This rather 
graphically shows the results of the two different types of formulas.
  Compare the reimbursement for the Medicare Advantage Plans, compare 
the reimbursement rates for hospitals or nursing homes with the 
reimbursement rate of physicians. This blue line here represents the 
year 2002. That was the first year that a cut was allowed to proceed 
under the sustainable growth rate formula. It was about 4.4 percent, 
what is euphemistically referred to as a ``negative update.''
  The next 3 years, Congress came in at the last minute and said, we 
will give you a little bit of a bump up. As you can see, a little bit 
less than 2 percent for each of those years.
  Last year, we held the SGR rate at a zero percent update. It didn't 
go up or down. Almost anywhere else in Washington, if you hold spending 
level for a year, you are accused of having cut benefits. But that is 
what we did for our physicians last year. And really part of that story 
is we didn't do it by January 1, we had to come back after the first of 
the year to provide that zero percent update. In reality, January 1 
physicians got again a 4.4 percent negative update.

                              {time}  2330

  Yes, the administrator of the Center for Medicare and Medicaid 
Services did come in and say that as long as Congress does what it is 
supposed to do at the end of January, which we did, that CMS would come 
back and reimburse physicians for that amount of money to bring them up 
to that zero percent. Unfortunately, there are many private insurance 
companies out there that pay into Medicare; so doctors took a pay cut 
for other private insurance, which was never the intent of this 
Congress. It was never the intent of the administration of the Senate, 
but nevertheless, that is what we did.
  The purple line here represents the proposed 5.1 percent negative 
update that is to go into effect if we do not affirmatively do 
something before January 1, and that is why I say it is incumbent upon 
us to do something, in fact, this month before we wrap things up on the 
30th of September.
  I would just like to make a couple more points about this graph. 
Cutting Medicare rates hurts all physicians and patients. Private 
health plans and other government programs follow Medicare's 
reimbursement trends. They look at Medicare's reimbursement rates, and 
they structure their plans to pay physicians the same, regardless of 
how much it costs the physician to provide the care. TRICARE, for 
example, reimburses at a rate that is 85 percent of Medicare. Many of 
the private plans will reimburse at rates that vary between 85 percent 
and 120 percent of Medicare. But, again, it was never the intention of 
this Congress to provide a break for private insurance with the SGR 
formula.
  Setting up the silos for Medicare reimbursement is itself flawed. We 
have a silo for the Medicare Advantage programs, a funding silo for 
hospitals, for nursing homes, and physicians. With more procedures and 
more services being delivered outside of hospitals, the payments should 
be based on the highest quality and most cost-effective treatment 
setting. Elements of the sustainable growth rate formula originally 
were designed to control utilization by reducing physician fees. The 
primary drivers of utilization, however, are new, improved 
technologies, patients' increased awareness of treatment options, and 
the general shift from inpatient to outpatient care. Physicians control 
none of these factors.
  And there is even one more factor over which physicians have no 
control,

[[Page H6530]]

and those are the mandates that this Congress puts on Medicare for 
types of medical care that have to be included. The Welcome to Medicare 
Physical, I personally think that is a good idea. I think you are going 
to pick up problems where you can more timely diagnose and treat those 
problems. But it costs money and that money comes out of the 
physicians' position of the SGR formula.
  Again, in the Deficit Reduction Act, we passed a measure that would 
require every person on Medicare to have an EKG at age 65. That money 
comes from somewhere. It does not come out of the hospitals. It does 
not come out of the Medicare Advantage plans. It comes out of the 
physicians' part of the sustainable growth rate.
  We also decided that everyone should have a screening for an 
abdominal aortic aneurism. It may or may not be worthwhile, but that 
money is going to be taken out of the physicians' portion of the SGR 
formula. And, again, physicians have no control over that utilization.
  The legislation introduced right at the end of July, H.R. 5866, would 
put the focus to ensure that elderly patients have better access to the 
health care they need.
  Four goals of this legislation: ensure that physicians receive a full 
and fair payment for services rendered; create quality performance 
measures that keep consumers informed; improve the quality improvement 
organizations' overall accountability and flexibility; and, finally, 
find reasonable methods, reasonable offsets for paying for these 
benefits.
  For fixing the SGR, for title I of that bill, it ends the application 
of the sustainable growth rate formula January 1. So January 1, instead 
of a pay cut, SGR would go away. It substitutes for the sustainable 
growth rate formula a different formula. One that was derived by a 
group called MedPAC, the Medicare Payment Physicians Advisory 
Commission, called the Medicare economic index. And this shifts 
physician compensation so it will more closely mirror hospitals and 
Medicare Advantage plans. It bases updates and physicians' compensation 
on the market basket.
  What does it cost to deliver the care and how much did that cost 
increase over the past year based on medical inflation? That is the 
Medicare economic index. We will use the Medicare economic index minus 
1 percent, which will be an increase of about 2 percent for physicians 
for the year 2007. And it basically puts us back on a more market-
sensitive system. What is health care inflation? What is it costing the 
hospitals, the Medicare Advantage plans, and the doctors to deliver the 
care and compensate them accordingly? Under the quality measures, in 
conjunction with physician specialty organizations, it creates a 
voluntary system of evidenced-based quality measures. It gives doctors 
feedback on their performance. As a physician, you are always wondering 
how you are doing; how do you compare to your peers; how do patients 
rate you. This is information that we are always seeking. It also 
allows patients to be selective. If a doctor elects not to voluntarily 
report, that information could be available to patients when they make 
their selection as to what physician they see.
  There will be offsets in the bill. Currently, the offsets that are 
made are looking at the Medicare Stabilization Fund from the Medicare 
Modernization Act and eliminating the double payment for medical 
education costs in the Medicare Advantage plans.
  The important thing here is it keeps the power in the health care 
community. It does not devolve that power to the Federal Government. 
And it is just a start. It is a start on the path of developing a 
product that will ultimately be satisfactory to all of the 
stakeholders.
  A quote from the AMA news: ``We are encouraged by the introduction of 
this legislation that would replace the current flawed Medicare 
formula,'' from the AMA Chair, Dr. Cecil B. Wilson.
  One of the things that is talked about a lot here on the House floor, 
and, in fact, we passed H.R. 4157 in July, which is the Health 
Information Technology Promotion Act, there is no question that health 
information technology holds a great deal of promise for being able to 
streamline the delivery of medical care to provide a method of 
continuity of care if something happens. With electronic medical 
records, those are then available online. And if something happens to a 
patient's original medical record, all is not lost. You can go to a 
safe, secure, sequestered Web site in order to retrieve that patient's 
medical data.
  I will admit I came late to the table on health information 
technology and its promise to improve medical care in this country. My 
own attempts at electronic medical records, electronic prescribing 
seemed to increase the time involved with every patient interaction. 
And, of course, there is no additional compensation for that increased 
time with every patient interaction.
  But last January, my committee, the Oversight an Investigations 
Subcommittee of Energy and Commerce, went to New Orleans and had an 
opportunity to visit Charity Hospital. And there in the basement in 
Charity Hospital we were still walking through water that was still in 
some places ankle deep, looking in the medical records room there in 
the basement of Charity Hospital. Here were rows and rows and rows of 
medical records that were absolutely ruined when the basement flooded 
and the water came in and now had black mold growing up and down the 
sides to some places where you couldn't even read those bright pastel 
numbers that were on the sides of medical records.

  Clearly, Katrina showed us how vulnerable our medical data can be 
even in a venerable institution like Charity Hospital in New Orleans 
that you just assume is always going to be there and those records are 
always going to be there. Well, this time they weren't. And when some 
of those individuals came to Texas and came to north Texas, it made 
delivery of their medical care much more difficult.
  The bill that we passed does provide for updating some standards, 
reporting on the American health information community, with a 
strategic plan for coordinating the implementation of health 
information technology.
  Well, talking about Charity Hospital, talking about New Orleans, I 
mentioned that we were going to discuss preparedness. And we are just 
beyond the 1-year anniversary of Hurricane Katrina. We have to step 
back and ask what we have learned. While we watched that hurricane, my 
wife and I, coming up the Gulf of Mexico, it was almost like watching a 
train wreck in process. We were transfixed by the hourly reports of the 
progress of the hurricane. It looked like it was just going to hit the 
central city of New Orleans and just at the last minute took a little 
bit of a turn back to the east, and the central city of New Orleans was 
spared. And I think the headline in my paper was ``Bullet Dodged,'' or 
something to that effect. It was only later, not even that day but the 
next day, on Tuesday, when we realized how serious the situation had 
become because of the flooding caused by the breaches in the levees.
  Back in my district, my home district in north Texas, we watched, of 
course, as people were taken into the Astrodome and then, of course, as 
the waters rose. And people who had not left the city of New Orleans 
had to be evacuated. Many of them were evacuated to Dallas, Texas, to 
Fort Worth, Texas, where my district office is in southern Fort Worth. 
A gymnasium on the same campus where my district office is was 
converted to a shelter for individuals who had been displaced. We set 
up 250 pallets that night. We had chicken dinners that were donated by 
a restaurant, waiting for displaced persons from Katrina when they 
arrived. Some very tragic stories from some of the individuals who 
arrived there over the next couple of days.
  I got a call from my staff, and they asked me how soon can a woman 
who has had a C-section sleep on the floor? I said, why do you want to 
know this information? They said, well, we have three women here who 
just had C-sections, and we want to know if we can put them on pallets 
or if we have to find cots for them.
  I said, I will be right there.
  One of these individuals, her baby had been in intensive care. They 
were separated in the process of the evacuation. And it was only after 
several days with my staff spending every hour on the phone that we 
were finally able to reunite mother and baby. And just

[[Page H6531]]

this past week they had a 1-year anniversary there in Mississippi with 
mother and baby, celebrating the anniversary of not the child's birth, 
but the mother and baby getting back together after the hurricane was 
over.
  The Dallas County Medical Society, on a holiday weekend, Labor Day 
weekend, the blast fax went out to probably 800 members of the Dallas 
County Medical Society. A quarter of them showed up in the parking lot 
of Reunion Arena to help with the medical care for people who had been 
evacuated from the Louisiana Gulf Coast. What a tremendous story of all 
of the individuals getting off the buses that evening. They had a 
triage desk set up. If someone had been off their meds and simply 
needed meds, there was a mobile pharmacy set up where they could be 
administered those medications.
  And of all of the people who got off the buses that night, in the 
thousands, only about 200 required hospitalization as a result of 
having been in a shelter and off their medications for several days. 
The doctors that were there did a tremendous job of identifying who was 
sick and who was simply in need of a hot shower and a warm place to 
sleep and getting back on their medications.
  One of the other great stories was there was a lot of fear with this 
many people crowded into a shelter, would there be an outbreak of 
transmissible illnesses like gastrointestinal illnesses, infectious 
diarrhea? They had hand sanitizers. You could not walk 10 feet without 
someone putting a bottle of hand sanitizer in your hand. People used 
them repeatedly throughout the day and night, and as a consequence, 
only a very limited number of people actually had any type of 
gastrointestinal illness. They were quickly sequestered in another 
facility, and as a consequence, a public health crisis was averted.
  In follow-up, I have traveled to New Orleans twice in the past year, 
once in October at the request of one of the hospitals down there to 
try to get some help for their medical providers. And then in January, 
as I mentioned, our Oversight and Investigation Subcommittee went to 
New Orleans, and we had a hearing down there. It really was remarkable 
to see what the difference in preparedness between the Charity Hospital 
and the private hospitals, Tulane University Medical Center.
  HCA hadn't planned necessarily for a hurricane, but they had some 
disaster plans in place. They had been rehearsed. They had been 
practiced. And as a consequence, when we were there in January, they 
were about ready to open their emergency room again. Charity Hospital 
still appeared to be light years away from being able to reopen.

                              {time}  2345

  So some of the lessons that came out of that trip down there were 
when you have disaster plans, when you have preparedness plans, it is 
not good enough to just have them and have them on the shelf. And I 
heard this from nursing homes, and I heard this from hospitals that, 
unfortunately, there were places that had purchased disaster plans but 
no one had looked at them. You have got to take them off the shelf, you 
have got to break the seal, you have got to break the shrink wrap that 
surrounds them, and you have got to practice them.
  Our chairman of the House Government Reform Committee held a series 
of hearings on what happened in the aftermath of Hurricane Katrina. And 
for any House Member who hasn't read or at least looked at that 
publication that they put out as a result of those hearings, the title 
was ``Failure of Initiative.'' That is truly an outstanding work that 
Chairman Davis did, and I know every House Member got a copy of that 
and I would recommend that they look at that. Remember, this was a 
committee, a special select committee. It was bipartisan, though many 
people on the other side of the aisle chose not to participate. It 
wasn't an unelected, unaccountable commission like the 9/11 Commission. 
These were our House Members who were truly interested in what happened 
in the aftermath of Katrina and were very interested in getting it 
right.
  As you think about Hurricane Katrina, as you think about 9/11 and 
some of the disasters that have befallen not just this country but the 
world, with the tsunami right after Christmas in 2004, the fact of the 
matter is we just can't afford to fail next time, whether it is a 
hurricane, whether it is a terrorist, or whether in fact it is a 
problem with a worldwide pandemic.
  And I won't spend a lot of time on this, because I can talk about the 
avian flu for an hour in and of its own right, but just a couple of 
points. As of September 8, 2006, just last week, the World Health 
Organization had confirmed 244 human cases of avian flu with 143 
deaths.
  What is so remarkable about this illness is that it seems to be so 
lethal. That is an over-50 percent mortality rate for influenza. That 
is unbelievable to have that type of mortality rate.
  During the summer months on a trip over to Iraq and Afghanistan, I 
was actually able to stop in Geneva for a few hours and talk to some of 
the folks at the World Health Organization. At that time, when I was 
there, there were coordinating efforts between 192 different countries. 
Dr. Michael Ryan, who is the director of the Strategic Health 
Operations Center, provides strategic support and global coordination 
to the World Health Organization, the Center for Disease Control, and 
our own Health and Human Services Administration. Dr. Ryan, I should 
point out, is on loan to the World Health Organization from the Centers 
for Disease Control. And the idea is that we won't reinvent a global 
CDC over there, but we will take the expertise of the CDC, apply it to 
the World Health Organization, and allow them a greater reach as far as 
monitoring and notifying.
  The concept is to control the disease at its source, culling of 
infected avian populations, isolation of infected avian populations, or 
humans should they become infected, vaccination and antivirals for 
people who are exposed or infected. We need intelligence, we need 
verification, and we need assessment, and we need a response, all of 
which can act globally, because as this map shows, it is indeed a 
global issue.
  This shows eight areas where the avian flu has occurred and areas 
where human cases have occurred. If you notice the time line, the 
arrows are pointing from east to west. And with the migratory flyways, 
it is possible that in wild birds and wild water fowl, the carriage of 
this disease could occur from the eastern hemisphere to the western 
hemisphere perhaps as early as this fall or winter. To date, it has not 
been detected in the western hemisphere. To date, there has not been an 
easy or facile transmission from human-to-human. Human-to-human 
transmission only occurs with great difficulty. The virus hasn't 
undergone that mutation that would allow for facile transmission from 
human to human.
  But clearly, with a disease that is so widespread in the avian 
population and with a disease that has shown such a striking lethality 
rate, it is critical to keep the surveillance up and to make certain 
that other countries do what they are supposed to do in this regard. 
International transparency is absolutely key. A country keeping silent 
on a problem it is having with this illness is not only not acceptable, 
but it may be lethal to other areas in the world as well.
  It is already a pandemic in birds but not in humans. The best way to 
prevent a pandemic is to control it in animals before effective human-
to-human transmission occurs, meaning to minimize cross-species contact 
and make certain that in countries where avian populations are infected 
that there is the proper culling of avian populations, and that it is 
done safely without unduly exposing those people who are handling the 
infected birds.
  Protecting North and South America from this global health threat, 
all of the outbreaks have been contained so far. Indonesia was a point 
of particular concern a few months ago where many people appeared to be 
infected in a cluster, but it does appear that those were all a direct 
result of either living with infected birds or close human-to-human 
proximity that allowed for that human-to-human transmission.
  Clearly, we have got to prevent the spread to the United States and 
Central and South America. The disease at this point may know no 
boundaries because of its distribution in the avian population. And 
other countries, it is critical we have got to monitor the disease at 
the border.

[[Page H6532]]

  I did also take a trip just up the street to Bethesda, Maryland to 
meet with Dr. Anthony Fauci to talk with him about a vaccine 
development. There are some remarkable things that are going on as far 
as vaccine development.
  I guess one of the important aspects of bird flu is we are going to 
develop more capacity for delivering more vaccine for just the regular 
flu as a consequence for the preparedness that is happening with 
getting ready for the possibility of a worldwide pandemic.
  This may not be the one. Avian flu may sputter out and never be the 
pandemic that everyone fears. But the fact remains that almost for 
every century that anyone has kept track, about three pandemics per 
hundred years do occur. We did indeed have three during the last 
century, and even a relatively mild pandemic of the Hong Kong flu still 
claimed 50,000 lives in this country. So it is a matter of no small 
importance.
  Additionally, we have got to be certain that, just like the nursing 
home in Louisiana that left their disaster preparedness plan on the 
shelf with the shrink wrap still on it, we have got to be certain that 
we take those plans down and we talk to our local first responders, our 
local health departments. And I had such a roundtable just last week in 
my district, very well received by the folks at the health department, 
by the administrators in all three hospitals in one of my counties. I 
wish we had a little more participation of the medical staff, but we 
did have some and I did at least receive an invitation to talk at one 
of thei medical staff meetings.

  But the key for us here in Congress is when faced with whether it be 
the avian flu, terrorist attack, another hurricane, we have got to be 
honest. No spin, no sugar-coating, no BS. And, above all, we have to 
communicate with our constituents and with our first responders back at 
home.
  One other thing that I want to talk about as time runs short here is, 
and I mentioned this earlier, about a bill that is out there to reduce 
or restructure the number of mandates that are on health insurance. 
Again, Aetna Life and Casualty might look at 46 million uninsured 
individuals as potential market share if they only had a product that 
they could sell.
  Now, in our Committee on Energy and Commerce we had a debate on a 
bill that would reduce significantly the number of State mandates on 
insurance policies in the individual market. This wasn't even discussed 
in the group health insurance market, but just the individual market. 
It was a pretty contentious debate and there wasn't a lot of agreement 
across both sides of the aisle, and that is unfortunate, because when 
the American people watch what this body does, they are really not 
interested in the tennis match or volleyball match that goes on from 
one side or the other. They want results. They want more affordable 
health care, health insurance. They want Aetna Life and Casualty to be 
able to look at that 46 million uninsured as a potential market share.
  Well, what if we could get together across the aisle and discuss what 
is that basic package of benefits that we would like to see available 
in a health insurance policy, one that could be sold on the Internet 
from State to State. It seems like an almost impossible task, or at 
least it seemed almost impossible that night when we were debating this 
bill in the Energy and Commerce Committee. But the fact is we have 
already done that work. I say ``we.'' I wasn't here 30 or 40 years ago 
when the federally qualified health center statutes were first written. 
But in fact, in that statute in law is identified a basic package of 
benefits that has to be offered at every federally qualified health 
center.
  Well, we have already agreed then in principle what that basic 
package of information is. Now, the information may be 30 or 40 years 
old, but perhaps we could sit down and decide which of those things we 
could eliminate because they are no longer necessary, which of those 
things we would have to add because we have learned some stuff since 
then, and then go to our private insurers and say, here is a basic 
package of benefits that, if you will abide by these rules and make 
certain people know what they are buying, that there is full disclosure 
about what is covered and what is not covered in these insurance 
policies, that you can then market this to the uninsured. And then give 
individuals who are unemployed a voucher or a pre-fundable tax credit 
to purchase that insurance. Or give that family that is of a low-wage 
earner, give them some additional health, buy down that premium.
  These are the types of concepts that, really, the American people are 
anxious to see us work on, and I for one would really welcome the day 
that we could do that.
  Just one last brief thing about the Medicare part D, the Medicare 
prescription drug program that actually started the first of this year. 
At the end of the enrollment period, well over 38 million people had 
prescription drug coverage under Medicare. This was the population, the 
Medicare population that was the largest population that didn't have 
access to a prescription drug plan if their employer or retiree 
insurance did not offer it.
  This is a tremendous benefit. We will and do hear a lot of discussion 
about people who are caught in the so-called gap coverage. But 
remember, there are plans out there that if a person is willing to 
consider a generic compound, there are plenty of plans that cover in 
the gap; and in my home State of Texas, there was at least one 
insurance company that would cover both brand and generic in the gap.
  So I would encourage people who have looked at the difficulty they 
are having with the so-called donut hole, when they re-up on their 
insurance plan, their prescription drug plan in November in that open 
enrollment period, look at one of those plans that will provide for 
coverage in the gap.
  Madam Speaker, I yield back the balance of my time

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