[Congressional Record Volume 153, Number 89 (Tuesday, June 5, 2007)]
[House]
[Pages H6001-H6002]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the Chair recognizes the gentleman from Texas (Mr. 
Burgess) for 11 minutes?
  Mr. BURGESS. Mr. Speaker, I come to the floor tonight for what time 
is left to us to talk a little bit about health care. I do try to do 
that every week because this is such an important issue that faces our 
country, and over the next 18 to 24 months we are going to see perhaps 
some significant changes proposed and some, in fact, enacted in the 
Nation's health care system.
  Mr. Speaker, I wanted to draw your attention, today there was an 
excellent piece written in today's Wall Street Journal. This piece was 
on the editorial page, it was written by Dr. Robert A. Swerlick. It is 
entitled, ``Our Soviet Health System.''
  Mr. Speaker, Dr. Swerlick does such a good job of encapsulating a lot 
of the issues that I have been talking about here over the past several 
weeks and I just wanted to share a couple of quotes with you from his 
article as we get started. He is talking about the imbalance between 
supply and demand. He became aware of it when he found no trouble 
finding a veterinarian for his pet, but found difficulty finding a 
pediatric endocrinologist for a diabetic child. And the reason for the 
imbalance, Mr. Speaker, according to Dr. Swerlick, is because of some 
of the distortions of the marketplace and the inaccurate signals 
delivered to the marketplace because of our manipulation of those 
signals and of those market forces with the pricing structure we have 
in our Medicare system.
  I am quoting from the article from today, and it says, ``The roots of 
the problem lie in the use of the administrative pricing structures in 
medicine. The way prices are set in health care already distorts the 
appropriate allocation of efforts and resources in health care. 
Unfortunately, many of the suggested reforms of our health care system, 
including the various plans for universal care or universal insurance 
or a single payer's system that various policy makers espouse, rest on 
the same unsound foundations and will produce more of the same.'' Going 
on and continuing to quote, ``The essential problem is this; the 
pricing of medical care in this country is either directly or 
indirectly dictated by Medicare. And Medicare uses an administrative 
formula which calculates appropriate prices based upon imperfect 
estimates and fudge factors rather than independently calculate prices, 
private insurers'', and Mr. Speaker, this is key, and many House 
Members don't realize this, let me slow down and say this again. 
``Rather than independently calculate prices, private insurers in this 
country almost universally use Medicare prices as a framework to 
negotiate payments, generally setting payments for services as a 
percentage of the Medicare fee structure.''
  Then further on into the article, again quoting, ``Unlike prices set 
on the market, errors in this system are not self-correcting.'' That 
is, we make a mistake in our policy meetings, in our committee 
hearings, we make a mistake in setting the actual value to a medical 
service, and that mistake never gets corrected by market forces. It is 
insulated, it is anesthetized from market forces, and the consequence 
is it gets worse over time. And then we compound the error when we try 
to fix things at the committee level or at the level of the Federal 
agency.
  One last thing that I would like to point out that the article does 
state so succinctly. Markets may not get all the prices exactly correct 
all of the time, but they are capable of self-correction, a capacity 
that has yet to be demonstrated by administrative pricing.
  Again, a very worthwhile article. And I commend it, Mr. Speaker, to 
you. And perhaps some of our colleagues will also be interested in that 
article as well because I think it very succinctly sums up a lot of the 
things that I have been pointing out over the past several weeks here.
  Mr. Speaker, in the few remaining minutes that I have left, I wanted 
to talk just a little bit about the physician workforce of the future, 
because that is something we have to focus on as we have this health 
care debate. A lot of times I worry we are getting the cart before the 
horse. Here is a cover of the Texas Medical Association's professional 
magazine back in my home State of Texas. Texas Medicine last March 
devoted a lot of the issue to the concept of running out of doctors. As 
a consequence, I am introducing three physician workforce bills 
tomorrow that will deal with the person perhaps thinking about a career 
in medicine, the young physician just starting out in either medical 
school or residency, and then finally, a third bill to deal with the 
iniquities in the Medicare pricing system that I just referenced in the 
article of today's Wall Street Journal.
  The physician workforce crisis has to be approached on several 
fronts. The issue of medical liability is one that we need to take on, 
and we need to be quite serious about that. But when we look at perhaps 
the largest group of doctors that we may not have in the very near 
future because of the things we are doing in our Medicare pricing 
schedule, these are the areas where we really need to concentrate. Baby 
boomers are going to retire, they are going to get older. Demand for 
services are going to go nowhere but up. If the physician workforce 
continues its downward trend, as it is doing year over year, we may not 
be talking any longer about funding a Medicare program, we may be 
talking about why there is no one there to take care of seniors.
  Year after year reduction in reimbursement plans from the Center of 
Medicaid and Medicare Services to physicians for services they provide 
for

[[Page H6002]]

their Medicare patients. This is wrong. It is not a question of doctors 
wanting to make more money, it's about a stabilized repayment for 
services already rendered. And it isn't affecting just doctors, it is 
affecting patients every day. It becomes a real crisis of access. Not a 
week goes by that I don't get a letter or a fax from some physician who 
says, you know what? I've just had enough and I am going to retire 
early, or I am no longer going to see Medicare patients in my practice, 
or I am going to restrict the procedures that I offer to Medicare 
patients. Unfortunately, I know this is happening because I saw it in 
the hospital environment before I left practice to come to Congress a 
few years ago. And I hear it in virtually every town hall that I do 
back in my district. Congressman, how come on Medicare, you turn 65 and 
you've got to change doctors? The answer is because their doctor found 
it no longer economically viable to continue to see Medicare patients 
because they weren't able to cover the cost of delivering the care, 
they weren't able to cover the cost of providing the care.
  Medicare payments to physicians are modified annually using a formula 
called the Sustainable Growth Rate. I won't bare you with the 
intricacies of that formula tonight, I may do that at some other time. 
But because of flaws in the process, physicians get a mandated fee cut 
every year, year over year for several years to come. If no long-term 
congressional action is implemented, the SGR will continue to mandate 
fee cuts. Unlike hospital reimbursement rates, unlike reimbursement 
rates to HMOs or drug companies, those closely follow the cost of 
living index, but the physician's formula does not. In fact, Medicare 
payments to physicians cover only about 65 percent of the actual cost 
of providing the services. Can you imagine, Mr. Speaker, any industry 
or company that would continue in business if they received only 65 
percent of what it cost to cover the care? Currently, the SGR links 
physician payment updates to the gross domestic product, which has no 
bearing in reality as to what it costs to deliver those services.
  The problem is repeal of the SGR is very costly. The Congressional 
Budget Office currently scores that at about $280 billion. There are 
ways to approach this. There are short term and long-term ways. And we 
need to have the political courage, we need to have the political will 
to do the things necessary to ensure that we do repeal the SGR and the 
formula and pay doctors on a more rational Medicare economic index such 
as hospitals are paid that recognizes the increase and cost of 
delivering care. All of this information is technicomplex and it is 
even boring to listen to, but it is an incredibly important story for 
our country. It is a story of how the most advanced, most innovative 
and most appreciated health care system in the world needs a little 
help.
  The end of this story should read ``happily ever after,'' but I am 
not sure we can reach that conclusion given where we are today. The 
last chapter should read ``a privatized industry leads to a healthy 
ending.''
  As I stated in the beginning, before I began this talk, we are in a 
debate that will forever change our health care system. We must 
understand what is working in our system and what is not. We cannot 
delay making changes and bringing health care into the 21st century. 
The only way that we can have this to work is to allow the private 
sector to lay the foundation for improvements. The pillars of this 
health care system we have must be rooted in the bedrock of a thriving 
public sector and not the shaky ground of a public system that has 
proven costly and inefficient in other countries and in fact in our own 
back yard. Again, I reference the article from today where the errors 
are self-perpetuating in the system and market forces are never allowed 
to correct those errors.
  We must devote our work in Congress to building a stronger private 
sector in health care. History has proven this to be the tried and true 
method. We can bring down the number of insured, we can increase 
patient access, and we can stabilize the physician workforce, modernize 
our technology, and bring transparency to the system. All of these 
things are within our grasp if we have the foresight, the 
determination, the courage and the political will to get things done.
  Thank you, Mr. Speaker, for your indulgence. The day is concluded, 
and I will yield back the balance of my time.

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