[Congressional Record Volume 153, Number 67 (Wednesday, April 25, 2007)]
[House]
[Pages H4168-H4173]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE FUTURE OF MEDICINE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 18, 2007, the gentleman from Texas (Mr. Burgess) is recognized
for 50 minutes as the designee of the minority leader.
Mr. BURGESS. Madam Speaker, I come to the House tonight to talk about
something that isn't number one or number two or perhaps even number
three on the list of things that people are concerned about, it is
number four, it is health care, health care in our country that is
provided by the private sector, that is provided by the public or the
government sector. It is a debate that we will be hearing a lot more
about as we get deeper into a year that's going to be consumed by
presidential politics.
Right now in our country we have an amalgam, if you will, of health
care, part paid by the government, part paid by the private sector. I
am oversimplifying for the purposes of debate, but the public or
government sector, in pure dollar amounts, accounts for about 50
percent of the health care expenditures in this country. The private is
sector insures about 160 million Americans, and that is roughly 50
percent of the lives covered by private insurance in this country. And
we will have the debate, as the presidential
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year unfolds, more government, more private sector. But tonight, what I
really want to do is focus on the physician workforce, the physician
workforce that we have now and the physician workforce that we might
expect to have in the future.
Alan Greenspan, about a year and a half ago, right as his last days
at the Fed were winding down came and talked to a group of us one
morning, and inevitably the question came up about Medicare. In fact,
we saw the trustee's report yesterday; everyone is concerned about the
funding for Medicare, the future obligation that is there in Medicare.
And Mr. Greenspan was pretty circumspect, he said, ``At some point I
expect the Congress to deal with the problem of funding.'' And then he
went on to say, ``What concerns me more is will there be anyone there
to provide the services when you want them?'' That really struck a cord
with me. And in fact last month, the month of March, back in my home
State of Texas my Texas Medical Association puts out a periodical every
month called ``Texas Medicine,'' and the cover story was in fact
dedicated just to that concept, ``Running Out of Doctors.'' And the
thrust of the article is how do we keep the medical students that we
graduate from Texas schools, how do we keep them practicing in Texas,
particularly in the high-need areas in Texas? And concentrating on the
physician workforce is what I want to do during this discussion, in the
time that I have available for the discussion this evening.
My perspective, of course, 30 years ago I graduated from medical
school in Houston, Texas, so I do have the perspective of looking back
over the last 30 years. But I also want us to look over the horizon to
the next 30 years. What about the young man or woman who is graduating
from medical school this year, what kind of world do they want to find
themselves practicing in? What type of practice environment do they
want to see that we have laid out for them 30 years from now? It is
going to be important that we take the correct steps today in order to
provide the correct practice environment 30 years from now.
Since we're talking about the physician workforce, the part that the
government pays for is paramount, that is critical. And really the
thing that I want to focus on of that government sector is the pricing
and the payment schedule in the Medicare program itself.
{time} 2315
Medicare, a good program, just celebrated its 41st or 42nd birthday.
We had the second anniversary of the prescription drug benefit part D,
which in my first year here we passed in 2003 and was added on in the
year 2006.
Medicare is an integrated program. Part A is the hospital, part B is
the doctor's care, part C is the Medicare, what is now called the
Medicare Advantage Plans or the HMOs, and part D is the prescription
drugs. But while it is an integrated program, the funding for Medicare
actually exists in funding silos.
If we look at the comparative payment updates from the year 2002 to
projected 2007, you see that there is something wrong with this
picture. And what is wrong with the picture is that physician
reimbursement in part B is significantly lagging behind the payment
updates for the Medicare Advantage Plan's hospitals and nursing homes
are shown on this graph. And there is a reason for that. It is really
not a very difficult reason: Medicare Advantage Plan's hospitals and
nursing homes receive every year essentially a cost-of-living update.
It is a market-basket update that they receive based on the cost of
inputs from the previous year. CMS has actuaries that go back and
figure this out: What did it cost the hospitals to provide the care
that they delivered to our seniors?
Part B is calculated differently. Part B is what is described as a
volumetric formula. It weights volume and intensity. But basically you
have a fixed amount of money, a finite pie, that if more and more
people are submitting claims, the slices get progressively smaller. And
in 2002, you can see there was a big drop. The reason 2003, 2004, 2005
are not a downward projection is because in fact at the last minute,
Congress swept in and said we are going to do something to prevent this
from happening. And, in fact, doctors got a modest update in 2003,
2004, 2005. 2006 doesn't really show up because that was a zero percent
update.
Now, Madam Speaker, I have not been in Washington all that long, but
I have learned some of the parlance and the lexicon that we use here.
And in any other Federal program or any other federally funded program,
if you are held to a level funding or a zero percent update for that
year, anyone else would regard that as a cut. But we told the doctors
that was great, you are going to get a zero update for that year and
you will be happy for it.
Projected for 2007, if we don't do something, is going to be a
substantial decrease. Once again, we may very well ride in at the last
minute and do something to blunt the effect of that; but year in and
year out, this problem continues; and the real insidious part of this
is the dollars to fix the problem get higher and higher every year.
Last year I introduced a bill to just simply do away with the SGR and
replace the SGR with a market-basket update. It is called the Medicare
Economic Index. And it is not my idea; a group called MedPac, a
Medicare Payment Advisory Commission, worked this out in actuarial
fashion some years ago. And the Medicare Economic Index would in fact
provide a 2 to 2\1/2\ percent update for most years based on the cost
of input for the physicians providing the services to the patient.
The cost last year scored by the Congressional Budget Office of
replacing the SGR formula with the Medicare Economic Index was $218
billion. Clearly, that is a lot of money, and it disrupts any budget
that either party might put up there. So, as a consequence, I didn't
get a lot of activity on that bill last year. It is still important to
do. And every year that we delay doing something, and even those years
that we come in and it looks like we fixed it a little bit, we actually
just compound the problem and make it worse in subsequent years.
So in just very general terms for this evening's talk, we have got a
lot of people who are going to be joining the Medicare generation. As
the baby boomers age and retire, the demand for services is going to go
nowhere but up. And if the physician workforce trends continue as they
are today, we may be not talking about funding a Medicare program, we
may be talking about there is no one there to take care of the seniors.
In my home State of Texas, the number of physicians between 1995 and
2005 increased by 46 percent or nearly 5,000. Okay, that is good, it
went up. However, the State is still below the national average, the
national average being 230 physicians per 100,000 population. In Texas
the ratio, even with the increase, is 186 to 100,000 residents.
The American Academy of Family Physicians predicts serious shortages
of primary care doctors in five States, including Texas, and says that
all States will have some level of family physician shortage by the
year 2020. The Council on Graduate Medical Education, a congressionally
authorized entity, estimates that after 2010, growth in the physician
workforce will slow substantially; and after 2015, the rate of
population growth will exceed the rate of growth for the number of
doctors. In other words, we won't be keeping up anymore. At the same
time, the demand is only going to increase year over year, resulting in
critical shortages, particularly in primary care, but the reality is
all specialties may well be affected.
So my thesis, my proposition, is that Congress needs to approach this
sort of as a three-pronged attack or a three-pronged solution to
mitigate this shortage for the future, to improve payments to current
doctors, keep them in practice longer, improve Federal assistance to
medical students, encourage students to go into high-need specialties,
and increase the number of residency training programs, particularly in
rural and suburban areas, and keep the physician pipeline open.
To do that, I am going to be next week introducing three bills to
deal with those three areas. The first, to insure the physician
workforce, really deals with the Medicare funding and the SGR. You talk
to doctors my age, those who graduated from medical schools 30 years
ago, and their concerns are really consistent. They are concerned about
the liability environment, which is not part of tonight's
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discussion but one that we certainly need to have and I hope we do have
in this Congress this year. Their concern is the year-over-year
reduction in payment that the Center for Medicare and Medicaid Services
comes up with for physician reimbursement. And it is not just a
question of doctors wanting to make more money; it turns to be a real
patient access problem, because there is not a week that goes by that I
don't get a letter or fax from someone who says, you know what, I have
just had enough and I am going to retire early, I am no longer going to
see Medicare patients in my practice, or I am going to restrict the
procedures that I offer Medicare patients.
Unfortunately, I know that is happening because I saw it in the
hospital environment before I left the practice of medicine to come to
Congress. But I also hear it in virtually every town hall that I do
back in my district. Someone will raise their hand and say, How come on
Medicare, you turn 65 and you have got to change doctors? And the
answer is, because their doctor found it no longer economically viable
to continue to see Medicare patients because they weren't able to pay
the cost of delivering the care, let alone making any money on top of
it. They weren't able to cover the cost of providing the care.
So in the bill to address that, the bill that I introduced last year,
again, just simply repealed the SGR outright. The difficulty that I had
with that was, again, just the cost was too high. But if we do that
over time, perhaps we can bring that cost down to a level where it is
manageable.
Getting the payment policy right in Medicare is going to be the first
order of business for preserving the physician workforce. Paying
physicians fairly will extend the careers of many physicians who are
now in practice who would otherwise opt out of the Medicare program,
seek early retirement, or restrict those procedures that they offer to
their Medicare patients.
It also has the effect of insuring an adequate network of doctors
available to older Americans as this country makes the transition to
the physician workforce of the future.
In the bill, the SGR formula, this volume-based formula would be
repealed in 2010, 2 years from now, but also provide incentive payments
based on quality reporting and technology improvements to protect the
practicing physician against that 5 percent cut that is likely to
happen in 2008 and 2009. That would be voluntary. No one would be
required to participate in the quality program or the technology
improvement, but it would be available to those doctors or practices
who wanted to offset the proposed cuts that will occur in physician
reimbursement in the 2 years until the formal repeal of the SGR
happens.
Now, why do it that way? Why not just bite the bullet and let's go
ahead and get the SGR out of the way and get it repealed? Remember, it
costs a tremendous amount of money to do that. Another problem that we
have in Congress is we are required to submit all legislation to the
Congressional Budget Office to find out how much it costs. If we are
going to be spending the taxpayers' money, how much are we going to
spend? Over what time will we spend it?
So that is not unreasonable, but because of the constraints of the
Congressional Budget Office, we are not allowed to do dynamic scoring.
We all knew, for example, when we began the prescription drug benefit 2
years ago, that if you deliver medications in a timely fashion, the
timely treatment of disease, you are going to get better patient
outcomes. And, in fact, that is what the trustee's report for Medicare
that was released yesterday, although it still shows that we have got a
big problem in paying for Medicare, the actual outlays for Medicare
were down. And the reason they were down, I suspect, is a compendium of
things; but part of it is treating disease in a timely fashion, not
always catching it at the end stage but treating it at the beginning,
you are going to end up with more functional individuals, to be sure,
so they are going to continue to be productive in society. But the
overall cost of Medicare is going to go down.
Unfortunately, we can't do that look-ahead with the Congressional
Budget Office and say, you know, I think if we do this, we are going to
save some money. So give me credit for that against that SGR score that
you always rate my bill with. They won't and they can't do that.
So by postponing the repeal of the SGR by 2 years' time, taking the
savings that occurs during that time and applying it to the SGR
formula, actually may give us a number that is doable as far as
releasing the SGR and replacing it with the Medicare Economic Index.
One of the main thrusts of this bill is to require the Center for
Medicare and Medicare Services to look at their top 10 conditions that
drive the highest percentage of payments in Medicare part B, and
require CMS to adopt reporting measures relating to these conditions
that have already been developed. It is not reinventing the wheel. The
AMA Physician Consortium has already developed those reporting measures
that drive that spending so high.
You know, the old famous bank robber Willie Sutton when he was asked
why do you rob the bank, he said that is because that is where the
money is. Let's go to those top 10 things where the greatest amount of
money is spent, because that is where the greatest amount of savings
can occur. If we can deliver care in a more timely fashion and if we
can improve outcomes, we are actually going to spend less. And by
focusing on those top 10 programs, at least initially, that will be the
greatest return on investment for CMS and ultimately will be the
greatest return on investment for retiring the SGR.
The same considerations may apply to the Medicaid program as well, so
it will be a very useful exercise to go through that and identify those
top 10 conditions. And where cost savings may be most easily gathered,
not only will it have an improving effect on Medicare, but I suspect on
Medicaid as well. We are going to establish quality measures focusing
on these core conditions, and that is where the add-on payment for
those 2 years, that is where half of it will come from. A 2\1/2\
percent update for those physicians who do voluntarily report quality
measures on those top 10 conditions, that is where the protection from
the continuation of the SGR for 2 years, that is where that protection
will derive from.
We are going to report back to doctors on what their volume and
intensity is. This information will not be made generally public, but
it will be made available to the individual physician so they can see
how they are doing, how they are doing relative to other doctors in
their practice, other doctors in their community, other doctors around
the country.
But the important point here is these are voluntary measures that
will protect the physicians from the cuts that are inevitably going to
occur as a result of the SGR program until the SGR can actually be
repealed.
{time} 2330
But, physicians can opt to take advantage of the bonuses, and it is
going to return some value back to their businesses and return value to
the taxpayer. Again, there may be an unintended benefit for the
parallel Federal program to cover poor Americans under the Medicaid
program if some of these programs deliver the benefit back that it is
anticipated that they will.
The quality measures are going to be built around these high-cost
conditions, and strive to improve the quality of care not only for
those conditions and patients, but to drive down the cost of delivering
Medicare.
There is also going to be a provision in the bill to help physicians'
offices to bring their information technology, their infrastructure,
hardware and software, bring it up to a standard where it will begin to
derive benefit to not only the patient and the practice but to the
Medicare system in general.
The percentage add-on payment is proposed to be 2\1/2\ percent, so
those two bonus payments in aggregate would be 5 percent. And again,
that is designed to be a protection against what are the anticipated
reductions in payments that would occur in 2008 and 2009.
The provision will also create a safe harbor that will allow clinics,
physicians' offices, and hospitals to share health information
technology platforms, and the standards will be established and
available to physicians' practices so they will understand how they
need to comply with this. The
[[Page H4171]]
standards must be established no later than January 1, 2008.
Madam Speaker, I wasn't always a big proponent of things like
electronic records. I wasn't sure if it would deliver the payoff that
people said it would. But here is a picture of the medical records
department in Charity Hospital in New Orleans. This picture was made in
January 2006, about 4 or 5 months after Hurricane Katrina and the
downtown flooding that occurred. It is the medical records room. These
records are ruined. You can see, this is not smoke or soot damage, this
is black mold that is growing on the records. You look there and it
almost goes on to infinity, tens of thousands, hundred of thousands of
records that were active, ongoing charts of people's medical conditions
absolutely now unavailable. No one is going to get into that medical
records department and risk inhaling the spores from the mold that is
covering those charts.
This is the kind of problem that you can get into with a paper
medical record. Of course the youngsters of today, the college students
of today, the young physicians of today, they understand this very
well. They are all connected and wired in. They would no more imagine
turning in or doing a paper for one of their classes where they just
had a single copy, a single paper copy, the old adage ``the dog ate my
homework,'' most students will have a paper on a disk, on a flash drive
and readily accessible and retrievable in many forms. We should do no
less with our medical records.
But it costs money to do this. It is going to require a push for the
private sector. I prefer to think as a bonus payment as being an
inducement, an enticement for physician's offices to participate in
this type of program. But it is also just good medicine. It is good
patient care.
We all heard about the troubles at Walter Reed Hospital a few months
ago. I went out to Walter Reed probably the week after the story broke
in the Washington Post and talked to this young man who took me around
Building 18. Yes, there was some concern. It was a crummy building. But
his biggest concern was spending hours and hours with his medical
record, his service record, going through the various parts of that and
highlighting things. He had a yellow marker, a highlighter,
highlighting parts of his medical record because this is how he was
going to establish the benefits that he was going to receive in the VA
system for his disability.
He said I can spend 20 man-hours putting this medical record together
and it ends up on someone's desk and it doesn't get picked up, and then
no one can find it and I have to start all over again. That was his
main message to me that day.
Now the VA system has been indeed very forward-thinking in its
embrace of electronic medical records and its investment in information
technology. The problem is the medical records from the Department of
Defense and the Department of Veterans Affairs do not possess the
interoperability necessary to make this type of activity unnecessary.
So clearly delivering value to the patient, particularly a patient in
that situation, is of paramount importance. And it is my contention
that if we do make the bonus payment generally available to physicians,
this will be something that they will embrace. There is a learning
curve, to be sure. It is going to slow people down a little bit
initially. But ultimately, the rapidity of the system will be
impressive. And even in a smaller physician's office the ability, just
think, never having to wait while they find your medical record because
somebody didn't put it back in the right place. I know it happened in
my medical practice, and I suspect it happens in offices across the
country on a regular basis. If nothing else, you will save that time
and embarrassment of not being able to locate a patient's record.
One of the problems last year when we dealt with trying to provide
the health information technology bill that we passed here in the House
and were never able to come to agreement with the Senate, part of the
difficulty was being able to have the hospital and the clinic and the
physician, there may need to be some relaxation in what are called the
star clause to allow safe harbors so that these conditions can be met.
But the reality is that once people become used to this technology
will embrace it. The other unintended consequence, the other unintended
benefit of this is the rapidity with which the system can learn. When I
say the system, the entire health care system because wouldn't it be
nice to know which treatments deliver on the promise of getting people
better faster at a lower cost. Wouldn't it be great to have that
information and know what treatments were effective and what treatments
were only marginal? That information can be literally at a physician's
fingertips with the right type of computer architecture and technology
environment. I believe the time has come that we do need to embrace
that.
So the bill will include a Federal incentive to implement health
information technology along with provisions providing safe harbors for
the sharing of software, technical assistance and hardware, as well as
the creation of consortiums.
Now, it is not just about physicians my age, because we have got to
also concentrate on helping the younger doctors with residency
programs. The funny thing about doctors is we to have a lot of inertia.
A lot of us tend to practice very close to where we did our training.
So the idea to get more training programs in areas that are
underserved, rural areas, inner city areas, to get more training areas
where the doctors themselves are actually needed.
So the second bill or the second prong of this three-pronged approach
would be to develop a program that would permit hospitals that do not
traditionally operate a residency training program, allow them the
opportunity to start a residency training program to build the
physician workforce of the future.
This bill would create a loan fund available to hospitals to create
residency training programs where none has operated in the past. The
programs would require full accreditation and generally be focused in
rural, suburban, inner urban or frontier community hospitals.
On average, it costs $100,000 a year to train a resident and that
cost for a smaller hospital can be prohibitive. The other issue is in
1997 the Congress passed what was called the balanced budget amendment
and within that there is a residency cap that also limits resources to
nontraditional residency hospitals such as smaller community hospitals.
For the purposes of this bill, the loan amount to any institution would
not exceed $1 million, and the loan itself would constitute start-up
funding for a new residency program. And the start-up money is
essential. Since Medicare graduate medical education funding can be
obtained only once a residency program is firmly established, the cost
to start a training program for a smaller, more rural or suburban
hospital can be cost prohibitive because these hospitals operate on
much narrower margins.
The overall bill would authorize a total of $25 million to be
available over 10 years. The fund, of course, would be replenished
because these are constructed as loans and the Health Resources Service
Administration may make the loans available to new loan applicants or
extend loans to increase the number of residency slots available at
existing programs or a loan to continue newly established residency
programs to hospitals that have been approved.
To be eligible, a hospital must demonstrate that they currently do
not operate a residency training program, have not operated a residency
training program in the past, and that they have secured preliminary
accreditation by the American Council on Graduate Medical Education.
Additionally, the petitioning hospital must commit to operating an
allopathic or osteopathic residency program in one of five medical
specialties, or a combination of these specialties: Family medicine,
internal medicine, emergency medicine, obstetrics and gynecology, or
general surgery. Again, the hospital may request up to $1 million to
assist in the establishment of this new residency program. Funding
could be used to offset the cost of the residents' salaries and
benefits, faculty salaries and other costs directly attributable to the
residency program.
The bill would require the Health Resources Services Administration
to
[[Page H4172]]
study the efficacy of this program in increasing the number of
residents in family medicine, internal medicine, and primary care, and
whether the program led to an increase in the number of available
practitioners in these specialty areas, particularly in underserved
areas. The loans would be made available beginning January 1, 2008, and
the program would be sunsetted in 10 years time, January 1, 2018,
unless Congress elected to reauthorize the program.
The third prong of the physician workforce for the future would be
ensuring the availability for adequate future physicians, and provide
medical students with assistance and incentives to practice in shortage
specialties and shortage areas.
The third bill would establish a mix of scholarships, loan repayment
funds, and tax incentives to entice more students to medical school and
create incentives for those students and newly minted doctors to become
primary care, family physicians, general surgeons, OB/GYNs and practice
in shortage areas such as rural or frontier areas.
This bill would provide additional educational scholarships in
exchange for a commitment to serve in a public or private nonprofit
health facility determined to have a critical shortage of primary care
physicians.
{time} 2345
Such scholarships will be treated as equivalent to those made under
the National Health Service Corps Scholarship Program and penalties
apply for those that take advantage of the scholarships but do not go
into one of those practice areas.
This will be a 5-year authorization, authorizing these loans and
grants to be $5 million a year. The scholarship amounts will not exceed
$30,000 per year. The scholarship amounts may be adjusted based on
financial need, geographic difference and educational costs.
Again, this is going to be administered through the Department of
Health and Human Services, specifically through the Health Resources
Service Administration.
This program will have an established repayment program for students
who agree to go into family practice, internal medicine, emergency
medicine, general surgery, or OB/GYN, and practice in underserved
areas. Again, HRSA will administer and promulgate the requirements.
Recipients must practice in the prescribed specialty and prescribed
area, which is designated as an underserved area, and the practices may
include solo or group practices, clinics, public or private nonprofit
hospitals. Again, a 5-year authorization at $5 million per year.
This will establish the Primary Care Physician Retention and Medical
Home Enhancement grants to help ensure that primary care physicians
continue to provide coordinated medical care to patients in underserved
areas or high-risk populations. Now, I know we can all think of areas
like that in our home districts and home States.
Also, in an area such as the gulf coast area where so many physicians
left after the devastating twin hurricanes of Katrina and Rita a year
and a half ago, it has been very hard on doctors in those areas. Many
doctors have left. It is going to be difficult to attract doctors back
to that area, and this will be yet one more tool, one more way, to get
doctors to consider practicing in an area where the need is great.
This encourages States to establish Physician Workforce Commissions,
especially in rural areas and in certain practice specialties such as
family medicine, again basically primary care, by exempting from income
tax any amount paid by the Physician Workforce Commission in the form
of salary to a physician who has signed a contract with the political
subdivision to practice in that area for any amount of time, no fewer
than 4 years.
Every year there would be a report back to Congress about the
effectiveness of this program, that is, once again, are we spending our
dollars wisely, are we getting what we thought we would get when we
initiated that program.
So, Madam Speaker, those are three bills that, again, I will be
introducing during the week next week after we get back. I think these,
while they may not be the answer to all the problems, certainly focus
on where the problem areas exist, that is, physicians who are my age,
50 years plus or minus a little bit, who are in the Medicare program
but looking to drop out or opt out because they can no longer continue
their practices because we in Congress are cutting reimbursements to
the point where we are no longer paying our fair share. We are no
longer paying the freight on taking care of Medicare patients, but in
addition to that, looking over the horizon to the future, being sure
that we have the physician workforce of the future, to provide care for
the baby boomers who are getting older, but just being able to provide
that care in general.
In fact, we are not even talking about just the Medicare population
here. We are talking about doctors who are going to work in primary
care in a medically underserved area in a specialty which is in short
supply in that area. That dual approach of increasing the number of
residency slots, again, doctors tend to go into practice and stay in
practice where they trained, and the other, a loan forgiveness program
and a tax incentive program to young physicians getting out of school,
may have several hundred thousand dollars in debt from their
undergraduate and then their medical school training, this is a way for
them to begin their careers without having that incredible debt load to
carry with them, a loan forgiveness, a tax incentive program, provided
they are willing to give back some time in a medically underserved area
in a specialty that is in high medical need.
I believe that by taking these three steps, Madam Speaker, we really
will go a long way towards alleviating the physician shortage. There is
no question that we are going to need to devote a lot more time and
energy to how we approach the problem dealing with health care in this
country and dealing with the uninsured. I expect to have many more
hours on subsequent evenings in the coming weeks to talk about just
this problem and just what are some of the approaches that may be
taken.
We had a fairly long hearing in committee this morning, in my
committee, the Health Subcommittee of Energy and Commerce, hearing from
a variety of people about how to provide additional care for the
uninsured. Again, it is going to be a lively debate, what happens in
the private sector or do we just simply give it over to a government
program, perhaps bring the age for eligibility for Medicare down lower
and lower, expanding the SCHIP program higher and higher, and then the
two programs will meet in the middle and provide coverage for everyone
in the country. I do not think that is necessarily a good way to go.
I think there are some reasons that the private practice of medicine
does bring value to the entire American medical system. There is no
question we have no shortage of critics in this country and around the
world about the system of health care in this country, but my opinion,
it is the American system that stands at the forefront of innovation in
new technology, precisely the types of system-wide changes that are
going to be necessary to efficiently and effectively provide care for
Americans in the future.
There was an article in the New York Times published October 5, 2006,
by Tyler Cowan. He writes, ``When it comes to medical innovation, the
United States is the world leader. In the past 10 years, for instance,
12 Nobel prizes in medicine have gone to American-born scientists
working in the United States, three have gone to foreign-born
scientists working in the United States, and just seven have gone to
researchers outside of the country.''
But he does go on to point out that five of the six most important
medical innovations of the past 25 years have been developed within and
because of the American system.
The fact is the United States is not Europe. American patients are
accustomed to wide choices when it comes to hospitals, physicians, and
pharmaceuticals. Because our experience is unique in this country,
because Americans indeed are exceptional and we are different from the
types of programs that are in other countries, this difference should
be acknowledged and embraced, whether we are talking
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about public or private health insurance programs.
Madam Speaker, it has been a long day and we have gone fairly late
into the evening. I appreciate the time.
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