[Congressional Record Volume 153, Number 129 (Tuesday, September 4, 2007)]
[House]
[Pages H10061-H10065]
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 gentleman from Texas (Mr. Burgess) is recognized 
for half the time before midnight, which is approximately 50 minutes.
  Mr. BURGESS. Mr. Speaker, I wanted to come to the floor of the House 
this evening and do as I do many times late in the day after the 
official business of Congress has concluded and talk a little bit about 
health care.
  Health care is going to be one of the things that we hear about a lot 
over the next 14 to 16 months before the next Presidential election. 
There are a lot of areas that I could discuss, but I want to 
concentrate on two areas. Those are the physician workforce itself, who 
is actually going to provide the care. And we are coming up on the 4 
year anniversary of a law that was passed back in my home State of 
Texas that dealt with significant medical liability reform, and I would 
like to spend a few minutes talking about that also this evening.
  We have to, as a Nation, look at the effects that some of the 
policies that we have generated here in Congress, quite honestly some 
of the policies that we have had that have been prevalent in our 
Medicaid and Medicare system that have resulted in physicians not 
continuing their practices, or, I am afraid to say, in some instances 
young people even deciding that the practice of medicine may not be for 
them.
  Now, right before we left on break, we had an opportunity to 
reauthorize the Children's Health Insurance Program. It was a program 
that is now going on 10 years since its inception, passed by a 
Republican Congress, signed into law by a Democratic President, so 
truly a bipartisan effort 10 years ago. It is going to expire at the 
end of this month.
  Mr. Speaker, every one of us who stood in this Chamber and raised 
their right hand and swore an oath on January 3 that we were going to 
do the country's business this year, every one of us knew that the 
Children's Health Insurance Program expired at the end of the fiscal 
year, which is less than 30 days away.
  Still, we waited until the absolute last minute before we broke on 
our August recess. A bill came to the House floor after some fairly 
contentious committee proceedings. Regular order in the committees was 
not adhered to. We didn't go through a subcommittee process. We got a 
big bill dumped on us right before we had a full committee hearing, and 
as a consequence, there was no time to evaluate that in my Energy and 
Commerce Committee. It was brought to the House floor and it passed 
largely on partisan lines. It is strikingly different than the bill 
passed in the Senate, and the President had already indicated that he 
would not sign but veto the bill passed in the Senate. And I have to 
believe that the bill that was passed at the last minute, in the waning 
moments before the August recess by the House of Representatives, I 
have to believe that the President feels the same way about that bill 
as well.
  It is significant, of course, because there are a lot of people who 
depend on the State Children's Health Insurance Program.
  Mr. Speaker, I don't think I can name one person in this body on 
either side of the aisle who wouldn't be for a reauthorization of this 
program if we could simply sit down and do it in a reasonable fashion. 
Unfortunately,

[[Page H10062]]

that was not available to us. So now, we will go through and watch the 
drama of naming conferees and having conference committee hearings and 
we will have a bill that will come to us which may or may not be 
acceptable. I have to believe at the end of the day it is going to be 
very, very difficult for us to pass a conference report that the 
President can sign before the 30th of September.
  There was a lot of good stuff in the bill. There were a lot of good 
things in the bill that should have been tackled as separate entities, 
not rolled into this one big amalgam that was spread out before us 
right before the end of the session.
  One of the things that was addressed in the bill that I was grateful 
for was an attempt to deal with one of the things that has been a very 
contentious issue the entire 5 years I have been in this Congress, and 
that is the issue on physician payments. But as a consequence of how 
the bill has been handled and how the bill was brought to the floor of 
the House and how the bill was pushed through the committee process, 
again it is unlikely that the reasonable things that were in the bill 
will ever see the light of day and those things will still be requiring 
our attention before we get to the end of this year.
  Mr. Speaker, one day right before Chairman Alan Greenspan concluded 
his tenure as chairman of the Federal Reserve, he came and talked to a 
group of us here on Capitol Hill, and the question came up: Mr. 
Chairman, what do you see about the problems ahead for the Medicare 
program?
  Chairman Greenspan thought about it and he said: I think when the 
time comes, you will make the necessary hard choices that are required 
to keep the Medicare program solvent. He then went on to say what 
concerns me more is will there be anyone there to deliver the services 
when you actually require them.
  Those have been words that have stuck with me since the time Chairman 
Greenspan came and talked to us early that morning. He has since been 
back and talked to a different group, and I asked him if he feels the 
same way today, and the answer was not only yes, but yes and more so.
  Back in my home State of Texas in March, the lead article in a 
magazine that is published by the Texas Medical Association called 
Texas Medicine was an issue about running out of doctors and how 
medical schools were having to work extra hard to develop new doctors, 
and since this was a Texas-based article, to keep those doctors 
practicing in Texas.
  There is a series of three bills that I have recently introduced this 
year to try to deal with the oncoming physician manpower shortage as I 
see it. Now, the first of these bills would be to deal with graduate 
medical education and some enhancements to graduate medical education.
  This would help younger doctors with the creation of new residency 
programs. A strange thing about doctors is, and one of the things that 
was stressed in this article in Texas Medicine, we have a lot of 
inertia. A doctor is very likely to go into practice within a 50- or 
100-mile radius of where that doctor does their residency. They don't 
show a lot of originality of thought when it goes into establishing 
that private practice. They tend to stay where they were in training.
  There are a lot of reasons for that: Comfort and knowledge of the 
other practitioners in the medical community, knowing those pathways 
for referral, perhaps even already having established some pathways for 
referral sources while in the residency program. For whatever reason, 
doctors tend to practice very close to where they trained in residency.
  But a lot of smaller and medium-sized communities with hospitals that 
have a patient load that would sustain a residency program, in fact, 
don't have a residency program. The barrier to entry for a hospital 
like that to set up a residency program is quite expensive, and so the 
barrier to entry is significant. And as a consequence, those residency 
programs are just not done. They are not established.
  The bill I proposed is designed to get more training programs into 
areas where medical service is less than optimal, perhaps rural or 
inner city areas, to get young doctors training in locations where they 
are actually needed.

                              {time}  2230

  Now, the Graduate Medical Education Enhancement Act, as introduced, 
would develop a program that would permit hospitals that do not 
traditionally operate a residency program, it would allow them the 
opportunity to start a residency training program to begin building 
that physician workforce of the future.
  Now, on average, it costs about $100,000 a year to train a resident, 
and that cost for a smaller rural hospital can, in fact, be 
prohibitive. Because of the cost consideration, the bill would create a 
loan fund available to hospitals to create residency training programs, 
again where none has operated in the past. The program, of course, 
would require full accreditation and be generally focused in rural 
suburban, inner urban areas, areas where, again, the need is greatest.
  Now, a diverse group of professional organizations, including the 
American College of Emergency Physicians and the American Osteopathic 
Association, have been very supportive of this legislation, and I think 
realistically this is something that this Congress could take up and 
could agree upon in a bipartisan fashion, and in fact, we likely could 
do that before the end of the year if we were to set our minds to it.
  But locating young doctors where they're needed is part of solving an 
impending physician shortage that realistically could encompass the 
entire health care system in the country.
  Another aspect that needs to considered is actually training the 
doctors for those high-need specialties. Now, a second bill introduced, 
H.R. 2384 for those of you who are keeping score at home, the High Need 
Physician Specialty Act of 2007, establishes a mix of scholarships, 
loan repayment funds and tax incentives to entice more students to 
medical school and to create incentives for students and newly minted 
doctors. This program will establish a repayment program for students 
who agree to go into high-need specialties, again family practice, 
internal medicine, emergency medicine, general surgery, OB/GYN, and 
practice in a medically underserved area. It will be a 5-year 
authorization at $5 million per year.
  This bill would provide additional educational scholarships in 
exchange for a commitment, and that commitment is to serve in a public 
or private, nonprofit health facility determined to have a critical 
shortage of primary care physicians.
  Other prominent groups such as the American Association of Retired 
Persons and the American College of Physicians support this high-need 
physician specialty legislation, and Mr. Speaker, I would just 
parenthetically point out, we did earlier this year a similar bill to 
offset some of the costs of educating young lawyers. And perhaps we 
should devote some similar attention to young physicians as well.
  But you know, Mr. Speaker, in addressing the physician workforce 
crisis, in a little bit we're going to focus on some liability concerns 
in reforming the liability system. I've already talked about placement 
of doctors in locations in greatest need and the financial concerns of 
encouraging doctors to remain in high-need specialties.
  But the other thing we've really got to focus on is perhaps the 
largest group of doctors, and I know for a fact it's the largest and 
still growing group of patients, that group that's encompassed by the 
so-called baby boom generation and their effect on the entire Medicare 
program.
  We've all heard it before. The baby boomers are going to grow older 
and retire, and the demand for services are going to go through the 
roof, and if the physician workforce trends continue as they are today, 
that is, a downward trajectory, we may not be talking about just simply 
funding a Medicare program. We may be wondering where all the doctors 
are who are supposed to be taking care of those seniors.
  Again, I allude back to the comments of Chairman Greenspan, and I 
think those comments echo very strongly today. But year over year, one 
of the reasons for this happening is year over year there's a reduction 
in reimbursement payments from the Center for Medicare and Medicaid 
Services to doctors, to physicians for services that they provide to 
Medicare patients.

[[Page H10063]]

  Now, Mr. Speaker, this is not a question of doctors just wanting to 
make more money. It's about stabilized repayment for services that have 
already been rendered, and it isn't affecting just doctors. This 
problem affects patients and becomes a real crisis of access.
  Now, Mr. Speaker, not a week goes by that I don't get a letter or a 
fax from some doctor back in Texas who said, you know what, I have just 
had enough, and I am going to retire early or I'm no longer going to 
see Medicare patients in my practice or I'm going to restrict those 
procedures that I offer to Medicare patients.
  Mr. Speaker, I know this is happening because I saw it in the 
hospital where I practiced in my own hospital environment before I left 
the practice of medicine to come to Congress back in 2003, but I 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 to change doctors? Mr. Speaker, 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.
  Medicare payments to physicians are modified annually under something 
called the sustainable growth rate formula. You probably hear it 
referred to in the Capitol as the SGR formula. There are flaws in this 
formula. There's flaws in the process, and the SGR-mandated physician 
fee cuts in recent years have only been averted at the last minute by 
fixes that Congress does legislatively, usually at the eleventh hour 
right before we wrap things up at the end of the year.
  If no long-term congressional action plan is implemented, the SGR, 
the sustainable growth rate, formula will continue year over year to 
mandate fee cuts. Mr. Speaker, let me also point out that these last 
minute fixes, Mr. Speaker, they're not free. They add to the cost of 
ultimately repealing the SGR.
  One of the things we hear over and over again, it just costs too 
much, we can't repeal the SGR. But every year that we delay fixing the 
SGR, we add billions and billions of dollars to the total cost of 
ultimately repealing this sustainable growth rate formula, the formula 
under which no physician can continue to practice and see Medicare 
patients.
  Mr. Speaker, unlike hospital reimbursement rates, which closely 
follow what's called the Medicare economic index, that's basically a 
consumer price index or cost of living adjustment, however you want to 
look at it, it's called the Medicare economic index which measures the 
cost of providing care. What is the cost of input for taking care of a 
patient in either a hospital or medical practice setting? But physician 
reimbursements don't track the Medicare economic index.
  In fact, Medicare payments to physicians at present only cover about 
65 percent of the actual cost of providing services. Mr. Speaker, can 
you imagine anyone in business or any industry and ask them to continue 
in business if they receive only 65 percent of what it costs them to 
deliver whatever good or service it is that they're providing? There's 
a recipe for financial disaster if you're in that sort of business. If 
you're losing 35 cents out of every dollar that is spent on health 
care, guess what; you don't make it up in volume.

  Well, currently, the sustainable growth rate formula links physician 
payment updates to the gross domestic product, and Mr. Speaker, for the 
life of me I don't understand that. There is no relationship to the 
gross domestic product to the cost of providing care to America's most 
vulnerable patients, most complicated patients, our senior citizens.
  But we hear it over and over again. Simply repeal of the sustainable 
growth rate formula is cost prohibitive, but you know, maybe if we do 
it over time, maybe if we don't try to do it all at once right here and 
now, maybe there is a way forward in this.
  Last year, I introduced a bill, H.R. 5866, which sought to repeal the 
SGR straight up, just get rid of it, and the cost for that was scored 
by the Congressional Budget Office as being $218 billion. Reality is 
today, because of the cost of doing nothing, that repeal would likely 
cost in the neighborhood of $265- to $275 billion over that 10-year 
budget window, that elusive 10-year window that we're always talking 
about.
  Mr. Speaker, paying physicians fairly will extend the career of many 
doctors who are now in practice, who otherwise some mornings may wake 
up and just opt-out of the Medicare program and may seek early 
retirement. They may run for Congress or they may restrict those 
procedures that they offer to their Medicare patients. You know, I 
talked about ensuring an adequate physician workforce. If we were to 
fix this problem with the sustainable growth rate formula, if we were 
to evolve to a Medicare economic index way of paying for those costs of 
actually delivering the care, maybe then older Americans could have the 
insurance that they will have the access to the coverage that they 
want, they need and that they expect.
  Mr. Speaker, we hear a lot in this body about things like pay for 
performance. Well, Mr. Speaker, I would just ask the question, how does 
driving out perhaps some of the most capable doctors, doctors who are 
mature in their practice, who have developed practice patterns that are 
economical, they've developed efficiencies in their practice, that they 
are the doctors who are the most proficient in the operating room, the 
ones that will come to a diagnostic conclusion quickest, if we drive 
all of those doctors out of practice, how much are we going to have to 
pay for performance in that scenario?
  Mr. Speaker, in a bill that I introduced, H.R. 2585, the physician 
payment stabilization bill, the sustainable growth rate formula would 
be repealed in 2 years' time, in 2010. That's 2 years from now, and by 
some other budgetary techniques, resetting the baseline in the SGR 
formula, provide physicians the protections that they would need for 
2008 and 2009 so they would not see reductions in reimbursements over 
those years and would then provide them the sustained protection of the 
Medicare economic index in 2010 and beyond.
  Now, recently, again the Congressional Budget Office estimated that 
the practical effect of my payment bill would bring a 1.5 percent 
update in 2008 and a 1 percent update in 2009 and then a complete 
elimination of the sustainable growth rate formula in 2010. The CBO 
also calculates an additional savings of $40 billion off of the total 
price tag of the SGR elimination.
  Additionally, Mr. Speaker, we always hear how things like improving 
health information technology and, indeed, reporting and incorporating 
some performance measures will lower the cost of care. Included in this 
bill would be two voluntary programs which would augment physicians' 
payments 3 percent for a physician or group who instituted some changes 
in their information technology and a 3 percent update for physicians 
that would participate in a voluntary reporting process, for those 
individuals who want to further offset the damaging effects of what the 
last 10 years of cuts in the sustainable growth rate formula have 
brought to their practices.
  But Mr. Speaker, the concept here is very simple. It's so simple that 
sometimes we forget what the concept is. The concept is stop the cuts 
and repeal the SGR formula. It's the only logical, economically viable 
solution, and Mr. Speaker, it is the only solution that has in its 
focus the long-term problem.
  Again, a lot of people say why not just bite the bullet and go with 
the full repeal of the SGR and get it out of the way. I tried that last 
year. I really found no enthusiasm for it, either in this body or any 
of the professional organizations that are out there that ostensibly 
would be there to help push a concept like this.
  And Mr. Speaker, again, on paper it costs a tremendous amount of 
money to do that, and we're required here in Congress to live under the 
rule of the Congressional Budget Office to find out how much things 
cost: If we're going to be spending the taxpayers' money, how much are 
we going to spend, over what time will we spend it.
  Because of the constraints of the Congressional Budget Office, we're 
not allowed to do what's called dynamic scoring. We can't look ahead 
and say, you know, I think if we do things this way, we're actually 
going to save some money. You can't do that under the current 
Congressional Budget Office constraints, and maybe that's okay, but it 
certainly puts some limits on some of the things that you're able to 
do.

[[Page H10064]]

  Mr. Speaker, case in point is the trustee's report from Medicare that 
came out earlier this summer, and the bad news is that Medicare is 
still going broke. But the good news is that Medicare is going to go 
broke a year later than what they told us, 2019 instead of 2018.
  The reason for that, Mr. Speaker, is because 600,000 hospital beds in 
2005 were not filled in the Medicare program. Those were beds that were 
expected to be filled, but in fact, those patients weren't admitted to 
the hospital. Because why? Doctors are doing things better. Doctors are 
doing more procedures and offering more in their offices, in their 
ambulatory surgery centers. Because of the way that the Medicare 
payment works in Part a, Part B, Part C and Part D, money that we save 
for Part A, because we spent more in Part B, never gets credited to 
Part B.

                              {time}  2245

  That's why we have such a difficulty in offsetting these costs. This 
bill that I have introduced would actually take those savings, 
sequester them, aggregate them, protect them, and 2 years later, cost 
savings from part A would, in fact, be applied to part B to bring down 
the cost of repealing the sustainable growth rate formula.
  One of the main thrusts of the bill is to require the Centers for 
Medicare & Medicaid Services to look at the top 10 things that cost the 
most amount of money each year, to require the CMS to adopt reporting 
measures relating to these top 10 conditions. These things have already 
been developed. This is not reinventing the wheel.
  The American Medical Association and several medical consortia have 
already developed reporting measures on the 10 conditions that drive 
medical costs so high.
  We all remember the famous bank robber Willie Sutton. When they asked 
him why does he rob the bank, he replied because that's where the money 
is. Let's go where the money is. Let's go with these top 10 things 
where the greatest amount of money is spent because that's where the 
greatest amount of savings can occur.
  If we can deliver care in a more timely fashion, if we can improve 
outcomes, we are actually going to spend less. If we spend less, let's 
give credit where credit is due. That's not by building up the trust 
fund in part A; that's by buying down the SGR formula in part B and 
ultimately repealing it once and for all.
  The same considerations may apply to the Medicaid program as well, so 
it will be a very useful exercise to go through and identify those top 
10 conditions, and where the savings can be the most easily gathered. 
Not only will it have an effect on Medicare, but I suspect Medicaid as 
well.
  I think we ought to report back to the doctors to how they are doing, 
confidentially, of course, and individually. We don't tell everyone 
about every doctor, but let the doctor know how he is doing compared to 
his peers, how he or she is doing as far as their Medicare 
expenditures.
  You know what? Since we will have the data there, and it's already 
collected, I think we should share data with the patient as well. How 
much did your care cost the government last year? Try to encourage 
patients to do those things to participate in their own care and see if 
they will not participate in bringing the cost of that care down.
  Now, why do I spend so much time talking about this? Because it's a 
very important concept. Now, in the SCHIP bill, as was passed by the 
House, there was a modest physician fix for 2008 and 2009. It was less 
than the CBO scores, the physician fix for my bill, but the reality is, 
that the SCHIP bill, the physician fix contained within the SCHIP bill 
did not have as an end point the repeal of the SGR.
  I reiterate, if you don't repeal the SGR, you only make the problem 
worse than in the out years. By 2010, what happens under the SCHIP 
bill? All those cuts come back, 10 percent, 13 percent reductions in 
payments to physicians that year alone, and it continues year over year 
for the remainder of that budgetary cycle.
  In fact, the scenario, as it was described to me, is modest update in 
2008 and 2009, you fall off a cliff in 2010, and you are frozen in 
2013. It doesn't sound like an attractive proposition to me.
  There is a way forward in this that makes sense. I encourage Members 
of Congress to look at 2585. It is a reasonable alternative to what was 
proposed in the SCHIP legislation. The reality is, as we all know, the 
SCHIP legislation is going to change radically before it ever sees the 
light of day. It's unclear and uncertain at this time whether a 
physician fix will, in fact, survive in that bill.
  Whatever minutes I have left, I want to talk for just a little bit 
about medical liability reform, because I think this is an issue that 
this House still needs to address. My home State of Texas, now going on 
4 years ago, September 12 of 2003, passed a major piece of legislation 
that was modeled after a bill passed in the State of California back in 
1975.
  I hate to admit that California was ahead of the curve on this, but 
the Medical Injury Compensation Reform Act of 1975 passed in the State 
of California, which capped noneconomic damages, had a very, very 
significant effect on what, at the time, was an out-of-control 
liability climate in that State.
  The State of Texas adopted a similar program in 2003, modeled after 
the Medical Injury Compensation Reform Act of 1975 in California. The 
Texas bill actually puts a $250,000 cap on noneconomic damages as they 
pertain to the physician, a $250,000 cap on noneconomic damages as it 
applied to the hospital, and a second $250,000 cap on noneconomic 
damages if there is a second hospital or nursing home involved, for an 
aggregate cap of $750,000 for noneconomic damages. Actual medical 
injuries are paid at the actual rate, but noneconomic damages are 
capped at $750,000 under the Texas law.
  This was a major, major change for Texas when this happened back in 
September of 2003. We had been undergoing many years of 20 to 30 
percent increases in premiums for physicians' practices in Texas. In 
the late 1990s, we had 17 medical liability insurers in the State of 
Texas. In 2002, we were down to two medical liability insurers in the 
State of Texas. The rest had fled because the litigation climate was so 
unfavorable in my home State of Texas. You don't get very much 
competition. You don't get your very best competitive rates when you 
have only got two companies continuing to write business in your home 
State.
  In 2003, we did pass the medical liability reform based off the 
California law, and a legitimate question to ask is how has Texas done 
since then? Remember I said we dropped from 17 insurers down to two, 
because the medical liability crisis rose very quickly. Within 2 years' 
time, we were back up to 14 or 15.
  I don't know the total number today, but I believe it is either in 
the high 20s or perhaps even as high as 30 carriers in the State, a 
significant change from the environment from just 4 years ago. Most 
importantly, the carriers that have come back to the State have 
returned to the State of Texas without an increase in their premium.
  In 2006, only 3 years after its passage, the Medical Protective 
Insurance Company had a 10 percent rate cut, which was its fourth 
reduction since April of 2005. Texas Medical Liability Trust, my last 
insurer of record, declared an aggregate of 22 percent cuts. Advocate 
MD, another company, filed a 19 percent rate decrease, and Doctors 
Company announced a 13 percent rate cut. Real numbers, real numbers 
that affect real people and affect real access for patients in a State 
that realistically was in peril in 2002, a significant reversal. More 
options mean better prices and a more secure setting for medical 
professionals to remain in practice.
  One of the unintended beneficiaries of this act was the effect on 
small community not-for-profit hospitals, the type of hospital who 
would have been self-insured for medical liability.
  They have been able to take money out of their escrow accounts and 
put it back to work in those hospitals to capitalize improvements, pay 
for nurse's salaries, just the kinds of things you would want your 
small, medium-sized not-for-profit community-based hospital to be 
doing, not holding money in escrow against the inevitable liability 
suit that might occur.

  I took the language of the Texas plan, worked it so it fit with our 
constructs here in the House of Representatives. I took that language 
to the

[[Page H10065]]

ranking member of the Budget Committee before we did our budget vote 
earlier this year.
  Representative Ryan, Ranking Member Ryan on the Budget Committee had 
that proposal scored by the Congressional Budget Office. The Texas 
plan, as applied to the House of Representatives, to the entire 50 
States, would yield $3.8 billion in savings over 5 years' time; not a 
mammoth amount of money, but when you are talking about a $2.999 
trillion budget savings of any size, moneys that we will leave on the 
table in this budgetary cycle that could have gone into some other 
spending priority, I've got to ask you, I've got to tell you, I just 
frankly do not understand why we would not look more seriously about 
taking up that type of plan.
  Now, on the fourth anniversary of the passage of the Texas plan, I do 
intend to introduce this legislation. I think it is commonsense 
legislation that would bring significant relief to our doctors in 
practice and be a significant source of monetary savings for this 
House.
  If Texas is doing such a good job as a State, why do I even care 
about it? Why do I even bring up that maybe we ought to look for a 
national solution?
  Well, consider this. A 1996 study done at Stanford University 
revealed that in the Medicare system alone, that's a system that we pay 
for, that we have to come up with the money for every year, in the 
Medicare system alone, the cost of defensive medicine was approximately 
$28 to $30 billion a year.
  That was 10 years ago. I suspect that number is higher today. That's 
why we can scarcely afford to continue on the trajectory that we are on 
with medical liability in this body and in this country. Again, I 
frankly do not understand why we will not embrace and capture those 
savings that are sitting out there within easy reach.
  I began this hour talking about the physician workforce, and let me 
conclude this part of the liability discussion by coming back to the 
issue of the physician workforce.
  No other issue in the practice of medicine, and I speak to you for 
someone who had a medical license and who still has a medical license, 
but it was an active practice for over 25 years before coming to 
Congress. No other issue grates on the sensibilities of a doctor in 
practice as a constant concern about a medical liability suit. We go 
into practice to do good work. We go into practice to do good things.
  If a mistake is made or if an outcome is bad, it doesn't always mean 
that the next step has to be a trip to the lawyer's office and going 
through one of these egregious, emotionally trying lawsuits. That's one 
of the things that keeps young people away from the practice of 
medicine. They look at it and they think, well, it will cost me an 
awful lot to get that education. You know what, those courses are real 
hard, and by the time I get there, I will have to pay an enormous 
amount of money for my liability policy, and I don't even want to think 
about what it would be like if I actually got sued.
  Young people getting out of college, are they considering medical 
school under those conditions? Unfortunately, a lot aren't.
  We are keeping some of our best and brightest young people out of the 
health care profession because of the burden that we put upon them, the 
burden economically that we put upon them to get that education, just 
the burden that the education itself entails. It can't lighten that 
burden. It takes a lot of effort to study medicine. It takes more 
effort, I would suspect, here in the early 21st century than it did 
late in the 20th century when I was in my medical school classes.
  But we have to consider the emotional price that we are asking young 
people to pay if they are go into the practice of medicine. It is 
within our grasp to reform this system. It is within our best interest 
as a country to reform this system, and financially, it makes 
tremendous sense to reform this system.
  So I ask other Members of Congress to join me when I introduce this 
legislation later this month. This, again, is a commonsense, practical 
approach, proven in the laboratory of the States, my home State of 
Texas, to be a proven and effective method of reducing the cost of 
medical liability.
  You have been very indulgent this evening.

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