[Congressional Record Volume 153, Number 194 (Tuesday, December 18, 2007)]
[House]
[Pages H16826-H16830]
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 60 minutes.
Mr. BURGESS. We probably won't take the entire 60 minutes because it
has been a long week and it's been a long year, but I did want to come
to the floor of the House this evening and talk a little bit about
health care and talk a little bit about some of the things that are
going on in Medicare, some of the things that are going on in Medicare
as it affects our Nation's physicians workforce, and what, perhaps, I
see over the horizon for the next six to 12 months. It's going to be
kind of an interesting year. It's an election year in this country, and
that means we never want for drama during that time.
This is, of course, the special time of year at the end of the year
where we all pause and kind of give a little thanks for living in the
greatest country on the face of the Earth, the greatest country the
world has ever known. We're blessed with many, many benefits from
living in this country. Sometimes we take many of those for granted.
Our health care is one of those benefits that I think we do take for
granted, we overlook too often.
It is appropriate to perhaps have a little checkup on that little
tiny segment of the health care market that is controlled by the
Federal Government. Of course, I'm being factitious because the Federal
Government has under its direct control and grasp probably close to 50
cents out of every health care dollar that is spent in this country.
That is, 50 cents out of every health care dollar that is spent in this
country originates right here on the floor of the House of
Representatives when you configure or figure the expenditures on
Medicare, Medicaid, the VA system, the Indian Health Service, the
Federal prison system, the federally qualified health centers around
the country, 50 cents out of every dollar starts here on the floor of
the House.
But Medicare does have some operational problems with its physician
workforce, it has some distributional problems. There are some areas
that need attention in our Medicare system. And the problem, Mr.
Speaker, is not just money. We've heard a lot of folks talking on my
side, folks talking on the other side about the issue of money, but the
issue is not just about money, although the money is extremely
important. It's not just about money. It is the policies that we create
here on the floor of this House and the rules that are written in the
Federal agencies under our direction. It's the policies created in this
House that actually lead to most of the direct problems in that part of
health care that is paid for under the reach and grasp of the Federal
Government.
Now, Medicare was created a little over 40 years ago, the mid-1960s.
And it was created to make a connection between patients and their
physicians, patients and their hospitals and places where they needed
to go for care, care that was becoming very expensive, and for some of
our seniors was care that perhaps would be out of their reach.
{time} 2215
Now, Mr. Speaker, believe it or not, I was not in practice at the
time Medicare was instituted. My dad was. And I remember very clearly
when Medicare was started in this country and some of the concerns
revolving around that. I don't think anyone would have really thought
that we would have just done an appropriations bill where here some 43
years later after the enactment of Medicare, I don't know what the
total line expenditure for Medicare was, but it is topping $300 billion
for a year in Medicare. You add the expenses of Medicaid to that, and
the two together with what is spent at the Federal level and what is
spent at the State level when you involve Medicaid and we are well over
$6 billion a year for what we pay for that. So, again, it is really not
so much a question of money. It is a question of policy.
But the lifeline that was created between seniors and their doctors,
seniors and their hospitals, that lifeline that has been depended upon
by really two generations of Americans now, almost two generations of
Americans, that lifeline is frayed. Almost every day there is a little
nick, a little cut. It is death by a thousand scalpels, if you will,
since we are talking about health care. And it is that constant
nicking, it is that constant pressure on that lifeline that is causing
the lifeline to fray for many individuals.
Now, Mr. Speaker, I have said on the floor of this House before and
it bears repeating tonight, Alan Greenspan, the former Chairman of the
Federal Reserve Board, when he left his office as chairman just a
little less than 2 years ago through one of his sort of exit speeches
when he came through to talk to various groups, one of the things when
he came to talk to a group of us one morning back in January of 2005, I
think it was, and talked about the, well, he was asked about the cost
of Medicare, how in the world is Congress ever going to keep up with
the ever increasing cost of Medicare; how is Congress going to deal
with what is basically an unfunded obligation going into the future.
And the Chairman thought about it for a moment, and as always he is
very careful about what he says. He said, I think when the time comes
Congress will find the courage to do what is necessary to keep the
Medicare system up and running. He said, what concerns me more is will
there be anyone there to deliver the services when you require them?
Because, Mr. Speaker, January 1 of 2008 will be the year the first
baby boomers reach the magic age of 62. They begin entering their
retirement period, their retirement time; and as a consequence, we are
going to see a lot of pressure put, not just on the Medicare system but
on the Social Security system, on our system of long-term care, which
is basically the Medicaid system under the current construction.
So there is going to be a lot of pressure put on those Federal
programs as more and more people of my generation reach retirement age
and again to seek and ask for and collect those benefits that they
believe that they have been paying into over time.
But what happens if the supply-demand equation in regards to
America's physician workforce, and nurses too for that matter, but what
if the law of supply and demand has been drastically skewed so that
there is not the supply, we are not keeping up with the supply of
doctors and health professionals who are going to be required to take
care of those patients as they enter their retirement years?
At the risk of getting too technical, let me just share a few facts.
Mr. Speaker, I am sensitive to the fact that I must only address the
Chair and not address people who are here on the House floor with us,
Members who might be watching from their offices. I know I am not
supposed to direct my comments to people who might be watching on C-
SPAN so I will confine my remarks solely to the Chair and, Mr. Speaker,
this is a poster that I have used in the past, and many people have
seen this poster used on the floor of this House. This is a cover from
the periodical put out by the Texas Medical Association. Every year
they come out with a publication called Texas Medicine. And this is
from March of this past year, March of 2007. And the title article was,
``Running Out of Doctors.'' It is a concern, certainly a concern of my
professional organization, the Texas Medical Association back in Texas.
And it is a concern, I think, or
[[Page H16827]]
should be a concern for many of us here in this Congress.
Again, it was a concern of Mr. Greenspan's 2 years ago when he came
and talked to a group of us. And, in fact, Mr. Speaker, I asked Mr.
Greenspan again when he came back to visit with us just a few months
ago, I said, I often quote that statement that you made to me about is
there going to be anyone there to take care of the patients in the
future, and do you still feel that way, Mr. Chairman? And he said, Not
only do I still feel that way, I feel stronger about it today than I
did a few years ago. So this is a very relevant point and something
that certainly we need to keep in mind.
Now, one of the things that is still up to be done, one of the things
that is still on our to-do list here on the House side before we do
finally draw this year to a merciful close is we do have to address,
basically, what Medicare pays doctors. For whatever reason, we have to
deal with that every year, and we don't always do a good job. Certainly
when my side was in charge, we didn't always do a good job, and this
year I think that performance is being repeated, and perhaps it is even
a little bit worse this year.
The fact of the matter is that if Congress doesn't do something
before December 31 of every year, there is a scheduled series of
payment reductions that physicians will experience as a consequence of
the formula under which they are paid under Medicare. It is not a
problem that is unique to this Congress. It has been going on for
years. It has been going on through several administrations. It is a
problem brought to us by a formula called the sustainable growth rate
formula which is how physicians are paid under Medicare.
Now, it is different for hospitals, it is different for HMOs, it is
different for drug companies. Those expenditures are subject to
essentially a cost-of-living adjustment every year. So every year there
is perhaps a little bit of an uptick in what the hospitals receive,
kind of a what is called a market basket update where the cost of
inputs, the cost of delivering the care is figured into what Medicare
reimburses a hospital.
So part A of Medicare, which is the hospital payment, funded out of
payroll deductions, part A of Medicare, the hospitals do receive a
little bit, it is not terribly generous, but they do receive a little
bit of an uptick every year. For part C of Medicare, which is the
Medicare HMOs, they are perhaps even a little more generous than the
hospitals. They get a little positive update so they can continue to
meet the obligations that they have in taking care of our Medicare
patients. We are asking the HMOs to provide that care. We are asking
the hospitals; in fact, we are asking the doctors. Congress asks them
to provide the care so hospitals, HMOs and now drug companies receive a
little bit of an additional payment every year under the current
formula structure.
But for whatever reasons, physicians have been calculated
differently. And the physician rate of compensation for Medicare
patients is based upon something that has a little bit to do with the
gross domestic product and the idea that we are only going to be able
to control the expenditure on volume and intensity of Medicare services
if we really ratchet down what we pay doctors year over year. But the
negative consequences of that are significant, and the price that
doctors pay if we do not do our work by December 31, and it looks now
like we will sort of, and we will get to that in a minute, it looks
like we will do that work and accomplish that task before December 31;
but if we don't do that, then this year the Center for Medicaid and
Medicare Services came out with a report November 1 saying doctors
would receive payment reductions of a little bit over 10 percent, I
think it was 10.1 or 10.3 percent, for 2008 compared to what they
received in 2007. Well, stop and think about that for a minute, Mr.
Speaker. These are small businesses. The physician practices that most
of us were familiar with back in our communities, I was a physician in
my previous life. I am very familiar with this concept. We are small
businesses. And year over year, it is not costing us less to keep the
lights on in that office. It is not costing us less to hire our
employees to be able to provide the services that you want us to
provide. It is not costing us less for liability insurance year over
year.
Yet Congress in its infinite wisdom says that we should be able to
make do with a little bit less in compensation for the Medicare patient
year over year. This year that payment reduction was 10.1 percent.
Now, you might say, well, a physician's practice isn't just Medicare
patients. There is commercial insurance. There is self-pay. Why are we
so concerned about the Medicare aspect? What percentage of a
physician's practice will be taken up by Medicare patients? And the
answer is, it varies and it depends on different places in the country
and what the patient mix is in various places in the country. Arguably,
it might be higher in a State like Florida than it would be in a State
like Wyoming.
But nevertheless, the other effect of these Medicare compensation,
Medicare reimbursement reductions that happen and are scheduled to
happen every year for the next 15 or 20 years, the other effect is that
every commercial insurance company in this country, almost, not all of
them but almost, pegs their rates, pegs what they compensate, the level
of what they compensate doctors to the Medicare formula. So they pay a
formula such as 110 percent of Medicare usual and customary. Some will
pay less than Medicare. But most pay a little bit more, not a generous
amount more, but a little bit more than Medicare.
But if Medicare cuts its rates by 10.1 percent, then guess what? The
commercial insurance company will be only too happy to reduce their
compensation rates by 10.1 percent. And I don't think it was ever the
intent of Congress to legislate an improved business plan for America's
insurance companies. They are perfectly capable of doing that on their
own. They are perfectly capable of going into the physician community
and negotiating a lower rate if they need to do that if that is what
needs to happen so they can continue to provide the care for the
patients, continue to provide the coverage for the patients.
They are perfectly capable of going to the physician community and
saying this is what we need to do with the new rate structure; but they
kind of get a little gift every Christmas from the United States
Congress that says, well, we are going to reduce our Medicare rates if
we don't do our work. And guess what? All of you patients who are
covered under private insurance, your doctors are going to get paid a
little less even though they are going to do exactly the same work on
January 3 or 4 that they did on December 27 or 28.
Again, Mr. Speaker, I know I need to confine my remarks to the Chair,
and I will keep my remarks confined to the Chair. But it does happen
that sometimes people actually do watch C-SPAN this late at night and
they do see these discussions, and I have gotten some feedback, Mr.
Speaker, when I have put up this poster before. I actually have three
posters that delineate the actual payment formula for physicians under
the Medicare system. I have only brought one tonight in the interest of
time.
And I bring this not to elicit sympathy but I just want people to be
understanding and cognizant of just how complicated, how complicated
this process is under the actual gyrations that we go through to come
up with these physician formulas.
Now, this is actually the first part of what really should be three
slides, but I did promise some people that I wouldn't bring all three
slides tonight. But the payment for physicians is figured by taking the
relative value unit for work, geographical factor, a relative value
unit or the cost of inputs, the practice costs which is the subscript P
C in the middle parenthesis there, again, the geographic factor that is
figured in, and then the relative value unit for liability insurance,
and again a geographical factor figured in. Then the whole thing is
multiplied by a conversion factor down here, there is a misprint, that
should be C F, which is ``conversion factor,'' and the calculation of
the conversion factor is every bit as complicated as this first part of
the formula
Again, I don't want to lose people with this discussion, but I want
you to understand how difficult this is conceptually. As a consequence,
Members of Congress on both sides of the aisle,
[[Page H16828]]
when you sit down and say, I want to talk to you about how we
compensate physicians under the Medicare system, literally their eyes
glaze over and roll back in their head because this is simply too hard
for many people to think about.
Again I have spared, Mr. Speaker, the House from looking at the other
two slides which also are filled with various parts of the formula.
And too, let me, Mr. Speaker, this will give you some idea of how
long I have been doing this particular talk, because actually this
slide was current this time last year when I was doing this very same
discussion. And I need to update, because now we have completed fiscal
year 2007, so no longer will 2007 have an asterisk beside it. We
actually have the actual figures for that, and the figures for 2008
need to be added on.
{time} 2230
This illustrates the problem we have. Now, last year right before the
end of Congress, we hadn't quite figured out what we were going to do,
so it was projected that doctors would have a little over a 4\1/2\
percent payment cut. It turns out that that didn't happen. We actually
at the last minute came in and held doctors at what we euphemistically
call a zero percent update.
Well, I am here to tell you that anywhere else in Washington, if you
come in saying we are going to hold you at level funding, they will
say, Wait a minute, the cost of inflation, the cost of doing business
has gone up so much, that is actually a cut. Well, that is exactly
right, and doctors did receive essentially a cut, but we called it a
zero percent update, and we did not score it as a cut, but they were
scheduled to get a 4\1/2\ percent payment reduction.
This year, if we don't take up the legislation that the Senate just
zipped through at the last minute here at the end of the day on
Tuesday, if we don't take that up and pass that before we leave town to
have Christmas with our families, this negative projection will
actually be twice as far, down past the end of the page, because that
is a 10.1 percent reduction that doctors are facing this next year.
What happens, Mr. Speaker, is every year that we come in at the last
minute with that fix, that money that we come in at the last minute to
provide our physicians, guess what? It gets added on to the end of that
very complicated formula that I just showed you. So every year that we
don't fix the fundamental problem, which is to repeal the sustainable
growth rate formula, every year we don't do that, we make the problem
harder to solve next year, and at some point we will simply reach the
point where it is too hard to solve, it's too expensive to solve, and
people will either restructure the formula because it just collapses of
its own weight, or just say we are not going to even try to solve it
any longer because it is just too hard. It's an odd concept because
it's money that has already been spent.
Going back to 2002, when there was a 4.4 percent negative update, and
I was in practice then, and that did happen, but the moneys that were
paid in the Medicare system in 2002 have already been paid, they have
already been spent. So when they say it costs more to repeal the
sustainable growth rate formula every year, it's because we are
actually going to have to account for that money on our books, but the
money has already been spent.
There's not any magic here. We have paid the money to the physicians
for that given year. We just haven't quite accounted for it on our
books, and that is why there is that additive factor that goes on year
after year that kind of makes it impossible to ever dig out of this
hole. We certainly won't be able to if we don't ever start, and that is
the direction I have tried to take in the last Congress and tried again
in this Congress. I wasn't really successful in getting a lot of people
to understand the significance of this.
The reality is that as we continue, continue to cut at the
compensation rate for physicians in the Medicare program, what happens
is more and more physicians say, You know what? I just can't do it
anymore. I can't keep the lights on. I can't pay the help. I can't buy
my liability insurance and continue to see Medicare patients. And worse
than that, there's the pernicious effect of, come on, we are right on
top of the end of the year here and we are asking doctors around the
country to kind of trust us on this; we are going to fix it.
How do you plan in your business for expansion? How do you plan to
take out loans, take capital risks? How do you plan when year over year
over year in the Medicare system you have cuts stretching out ahead,
and, oh, by the way, commercial insurance is going to follow suit if
Congress keeps those cuts intact and keeps them in place, because we
don't really have a free market for health care in this country. We
have Federal price controls, and it's essentially cloaked in the
Medicare program, but, nevertheless, the end result is Federal price
controls on medical reimbursement rates for procedures all over the
country.
Now, one of the things that really disturbs me about this is it
really also is a pernicious effect, a chilling effect on young people
who might be thinking about a career in health care. I remember as a
young man in high school and college thinking about what a great thing
it would be to be a physician, to be worthy to serve the suffering, to
serve my fellow man. Yeah, I expected to make some money doing it, but
that wasn't the primary reason for going into the field.
But, at the same time, I didn't face the kinds of student loans that
the young individual today will face at the end of their 4 years of
getting their BA degree, let alone the loans going through medical
school, and then they have got to really defer earnings the years that
they are in residency. Yes, they are paid something during residency,
but nowhere near enough to pay the freight on those lines they have
through undergraduate school and through medical school. Basically, we
are talking about a person who may spend between 10 and 18 years after
high school getting through all of their education and their training.
Well, you think about that. Someone is graduating from high school
and 15 years later some of his classmates have already built and sold a
business and they are sort of semiretired. You give up. You postpone
those active earning years by a decade, a decade and a half, and that
is just one of the things that you expect when you take on a career in
medicine.
Well, young people are looking at that and saying, You know what?
That postponement of my active earning years, and the Federal
Government being so injudicious with what it is doing in the Medicare
system, and that affecting other areas in the commercial aspect of
medicine, maybe that is just something that I shouldn't do. Maybe I
will do something else with my life, because that is a little iffy, and
I don't really know if I will be able to afford the liability insurance
to go into practice.
So we have got to do something to help young people understand that
we value, we value their service in becoming a physician or becoming a
nurse, that this is something that we in Congress encourage them to do
and want them to do. But right now I have got to tell you they look at
it and say, I don't know if that is for me.
One of the other things, and this has come up just in the last two
weeks here in Congress, is we kind of worked with this concept of what
are we going to do to make things right for the doctors before we get
to the end of the year. Along comes this bill to require physicians to
begin e-prescribing. Well, that is a good concept. Certainly, no one
wants to argue with the theory. But it reminds me of an old professor I
had in undergraduate school. When he was asked a question too tough for
him to answer, he would look you back in the eye and say, Do you want
the theory or the application?
This is one of those instances where the theory is pretty good but
the application, at least as has been discussed in the last two weeks,
the technical term for it would be it stinks, Mr. Speaker, because we
want physicians, we want them to come into the 21st century, we want
them to use electronic medical records and things like e-prescribing.
Any one of us can cite chapter and verse all of the good things that
will come from e-prescribing; yet the number one group that we have got
to get to buy into this concept, well, we don't treat them very well
when we come at them with legislation, as the legislation that was
brought out a couple of
[[Page H16829]]
weeks ago over on the Senate side, but it's also been talked about over
here on the House side, the so-called carrot-and-stick approach. We'll
give you a little something nice now if you do it and, by golly, we are
going to make you pay in a couple of years. The carrot-and-stick
concept in this case really is more like, I don't know what vegetable I
would associate with it, probably something more along the lines of
spinach, or if we're talking about the first President Bush, perhaps
broccoli. But the other end, the stick, is extremely onerous for
physicians who are in practice.
Let me just give you the very quick version of what this legislation,
as provided to us, would entail. For doctors who participate in the
Medicare system, we are so anxious for them to prescribe in the e-
prescribing regimen, we are going to generously provide them an
additional 1 percent, a 1 percent upgrade on what we provide in
Medicare compensation.
Well, Mr. Speaker, I don't remember exactly what I received for a
moderately complex patient return visit. I am going to wage it was not
as much as $50. But let's stipulate, because the math is easy, let's
stipulate that that is a $50 reimbursement rate from the Medicare
system. And a good physician who is practicing careful medicine and
doing all the right things they are supposed to do as far as history
taking, good careful physical exam, patient education after coming to a
diagnosis and a treatment plan, you can probably see that patient in 15
minutes. So four an hour are what we are talking about, and we are
talking about a physician generating, not making, but generating $200
in income for that hour they spend in their office seeing those four
moderately complex return visit Medicare patients for which the Federal
Government pays them the generous sum of $50.
Now, if we add a 1 percent update to that, let's see, each patient,
that is about 50 cents. So for that hour's work we are going to add $2
to the compensation for that physician.
E-prescribing takes a little time. It takes some investment. It takes
some time to learn. It is not something you can just pick up. It is
quicker to scribble down a handwritten note. Now, no one may be able to
read it, but nevertheless you have performed that record-keeping
requirement, and it is much quicker to scribble down that handwritten
note in the treatment plan and write out a prescription and rip it off
and hand it to the patient.
The reality is e-prescribing takes some time. It adds time to that
patient encounter. It is time that realistically someone should
compensate that provider for providing. That would be a fair
assessment.
Now, what do we do if, after three or four years' time, the doctors
just haven't cottoned to this idea that we are going to pay them an
extra 50 cents per patient on average to do this work for us? Well,
then we come in with the stick phenomenon, and that will be a 10
percent reduction on that patient's services. So here we have gone from
a $2 increase for those four patients for that hour's work, or, perhaps
if the doctor hasn't done it, then that will be a $20 fine for those
patients for that hour's work.
Once again, our physician community is going to look at that and say,
No, thank you. I don't think I will participate in that. You can keep
your Medicare patients and you can keep your e-prescribing and I will
go off and do something else, and the patient is the one that suffers.
But it is a good concept. It is a good concept, and it is worthy of
Congress spending the time, and it is worthy of Congress providing the
proper compensation for physicians who are willing to invest in this
technology.
Right now, the bill as rolled out would provide $2,000 to buy the
equipment. It probably costs $25,000 in reality. Even if you gave it to
a physician's practice free, there is still going to be ongoing costs
of the maintenance of the software, the ongoing costs of educating the
physicians in that particular practice, and it takes longer to fill out
that electronic medical record and to fill out that form for e-
prescribing than what the doctors historically are used to in an old
paper system. But we have decided that is not a value and we are not
going to pay for that.
Now, some people think that this is such a good idea because they
are, in fact, going to make a significant amount of money. Certainly
the people that sell the software are likely to make a significant
amount of money. Certainly the pharmacy benefit managers, the big
pharmaceutical mail-order houses, they are likely to reap some benefits
from this.
But for whatever reason, all of this good stuff that is going to come
from e-prescribing, no one is really thinking that it is worthwhile to
share that with the physician. But the physician is the one we want to
buy into this new system. And it is a new system. It is a new way of
learning and it is a new way doing things.
Now, indeed, if nothing happens, younger physicians, as they go
through their training, they will be exposed more and more to
electronic prescribing and electronic medical records. There will come
a time in probably the not-too-distant future where this evolution will
just take place on its own. But the bill that was rolled out a couple
of weeks ago was an effort to make it happen a little faster, to get
some of those good benefits from e-prescribing, and they are
significant, to get some of those good benefits out there and
established early.
Again, it is going to make a significant amount of money for some
people who will be involved in this. But again, for whatever reason,
the Federal Government does not see value in allowing the practitioner,
the physician, to participate in that distribution of all of that value
that we are going to derive from this system.
Now, I don't mean to give the impression that I don't believe in e-
prescribing and electronic medical records. Let me just go with one
last poster, Mr. Speaker, and then we will wrap this up for tonight.
I haven't always been a big believer in electronic medical records.
Again, I have tried a couple of different systems in my time in private
practice and I didn't find them all that intuitive or user friendly,
but this is the day I became a believer in electronic medical records.
This is the basement of Charity Hospital in New Orleans. Charity
Hospital, one of the venerable teaching institutions in this country.
Many of the professors I had at Parkland Hospital in the 1970s actually
did their training in this very building at Charity Hospital.
Charity Hospital in 2005, August of 2005, was ground zero for the
strongest hurricane probably to ever hit the continental United States
in anyone's memory. And the flooding that followed that hurricane
obviously dealt a severe blow to infrastructure all over the City of
New Orleans, and the basement of Charity Hospital was, in fact,
underwater for a significant amount of time. So all of these records
were submerged.
This photograph was taken in probably October of 2005. So 2 months
after the hurricane, a month, maybe 5 weeks after the city was
dewatered, that is a verb I learned from the United States Corps of
Engineers, I didn't know it was a verb before they used it, but the
city was dewatered.
Here the medical records sit. Now we have black mold growing on the
manila folders. Probably the ink on many of these records was actually
just washed off in the flooding. Who knows? It wouldn't be safe to have
anyone go in there and look at those records, because look the at the
mold spoors that are ready to be blown off in a big cloud waiting to be
inhaled by a pair of unsuspecting lungs and cause great damage.
{time} 2245
So these medical records are in fact lost forever. And who knows what
is in there, someone waiting for a kidney transplant, someone's
hypertension that has been under treatment for two decades; someone's
diabetes that was carefully monitored but not so much anymore. All of
these records have been lost forever.
Electronic medical records and medical records that are then
controlled in an electronic fashion in a secure fashion up on the
Internet where they can be accessed, all of these patients that had to
leave the city. Many came to the Metroplex area in north Texas, and
many of them were cared for by physicians at Parkland Hospital, John
Peter Smith Hospital, and private physicians
[[Page H16830]]
in the area. None of their medical records were available, and many of
these patients had very complex medical conditions and were on multiple
medications at the time. And if it had not been for the good graces for
some of the pharmacies that actually had patient records electronically
that were able to set up outside some of the triage centers to provide
that data to physicians who agreed to see these patients as they came
off of the transportation from New Orleans and arrived in Dallas, you
can construct a pretty good medical history just going to the
pharmaceutical history, and those pharmacy records were invaluable in
providing good care and immediate care to those patients.
But it certainly made a believer out of me in January, or when this
picture was made after the flooding in New Orleans that paper records
have inherently within them a fundamental flaw, and that is, in time of
great natural disaster they are not going to be there to provide useful
information for those patients if they are suddenly displaced, as these
patients were, the medical records themselves. They could have been
destroyed in a fire, they could have been damaged in an earthquake in
some other parts of the country. And, unfortunately, these types of
tragedies do happen, and electronic medical records does take some
aspect of that tragedy away because it does provide a way for that
record to be accessed in a different location, and all of that data can
be pulled off the Internet and be made available to the now receiving
physician who is treating that patient.
Mr. Speaker, a little preventive medicine would go a long way in this
entire Medicare policy debate. I just can't help but note the irony:
November 1, when the Center for Medicare and Medicaid Services came out
and said, Doctor, 10.1 percent cut, unless Congress does something
before the end of the year. About that same time, the conference Chair
on the majority side had an op-ed in The Washington Post that said, you
know what, we have done such a good job with providing government
health care and Medicare and we are doing a great job now with what we
are doing in SCHIP. We know how that has turned out so far. We want to
extend Medicare benefits to people who are down to the age of 55. We
want to drag and drop this population into what is happening in the
Medicare policies right now.
I would just argue, before we expand the program to that degree,
shouldn't we ask ourselves are we doing a good job with what we have
right now.
I think the mere fact that we are here at the 11th hour of this
Congress and we have not dealt with the problem of physician
compensation, doctors' offices across the country are looking at
Congress and saying, what gives, guys? How am I going to prepare for
next year? Do I hire that new doctor or not? Do I buy that piece of
medical equipment or not? Do I take out a loan to improve my office or
not? Because they don't have any certitude about what the activity of
this body is going to be. And even at the best, the best we can do at
this point is say we are going to punt for 6 months, and we will see
you in June.
Mr. Speaker, that is not acceptable. This Congress has an obligation
to this country's physicians to behave in a responsible way. And
certainly, certainly let's quell the talk of expanding the reach and
grasp of the Federal Government until we take care of what we already
have.
Mr. Speaker, I yield back the balance of my time.
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