[Congressional Record Volume 156, Number 23 (Tuesday, February 23, 2010)]
[House]
[Page H736]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 HEALTH CARE BILL NEEDS EXPERT OPINION

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Pennsylvania (Mr. Tim Murphy) is recognized for 5 
minutes.
  Mr. TIM MURPHY of Pennsylvania. Mr. Speaker, when the White House 
summit occurs at Blair House to talk about health care, I am 
disappointed that not a single Member of the House of Representatives 
who has a background in health care has been invited, despite the fact 
that Medicare and Medicaid alone spend several hundred billion dollars. 
It would be nice if someone who has actually diagnosed a patient, 
prescribed medication, or treated a patient would be there, but so be 
it, it's not.
  But also, as the discussions are coming forth, there are great 
differences between what one is looking at and the other party may be 
looking at for interventions here. We cannot have a system that simply 
is based upon raising taxes to pay for a broken system. There are 31-
some taxes that my friends on the other side of the aisle have 
proposed, such as taxing employers for providing health insurance, 
taxing them if they don't provide it, tax you if you own insurance, tax 
you if you don't. If you spend money on health care, charitable 
contributions, alcohol, mortgage interest, pollution, oil, prescription 
drugs, payroll, capital gains, smoking, health care, and now a tanning 
bed tax. This does not change the system. In fact, it is something that 
is akin to just saying ``take two taxes and call me in the morning.'' 
That is not real health care.
  Now, Republicans have talked about a number of things, such as 
allowing people to choose plans across the country, to join groups. I 
also believe people should be allowed to choose a basic plan, that is, 
choose a plan that is what you need instead of the government telling 
you what you need. But most important of all is the number of quality 
reforms which are not being addressed yet. In a $2.5 trillion system, 
we waste from inefficiency, we waste from changes, perhaps between $800 
billion and $1 trillion.
  An article published by Wennberg, et al., in Health Affairs a couple 
of years ago described it well. Wennberg, Fisher, Skinner, and Bronner, 
all from Dartmouth University and Medical School, they said that part 
of the nature of the problem is the present value of projected lifetime 
Medicare costs for a 65-year-old in Los Angeles is $84,000 greater than 
for a 65-year-old in Seattle. The difference between Portland and Miami 
is $125,000 in a lifetime.
  ``Much of the health policy is based on the assumption that 
geographic variation and utilization is driven primarily by the local 
prevalence and severity of illness. In reality, prevalence of illness 
doesn't drive spending; only about 4 percent of the variation in 
Medicare spending among groups is associated with the regional 
variation in the prevalence of severe chronic illness.
  ``When we look at utilization,'' they go on to say, ``among academic 
medical centers which care for the sickest of the sick, we see the same 
pattern; equally sick patients receive different care depending upon 
which academic medical center they routinely use for care.''
  I read on here: ``Higher spending might be justified if more 
intensive use of in-patient care resulted in better quality of care or 
better health outcomes, but it does not appear to do so. At the 
population level, research has shown that patients with severe chronic 
illness who live in communities where more intensive use of in-patient 
care is the norm do not have improved survival, quality of life, or 
access to life. Indeed, outcomes appear to be worse.''
  They go on to propose a few changes here which are the things I have 
talked about at some length over time--that we need to make sure we are 
doing disease management. They say such things as, ``We recommend that 
the Federal Government fund a program of clinical research designed to 
transform the management of chronic illness to a system where care is 
based primarily on illness level, valid science, and patient 
preference.''
  Detailed specification of the clinical pathways for caring for the 
chronically ill--for instance, when hospitalizing a patient with 
congestive heart failure, which patients with chronic obstructive 
pulmonary disease will benefit from steroids, when to schedule patients 
for a revisit, or when to refer to a specialist for additional 
diagnostic testing are all important. Unfortunately, in the bills 
proposed by the House and Senate, they cut the funding for the very 
things that could do that, Medicare Advantage, cutting out $500 billion 
from Medicare from the very programs that invest money in disease 
management where we can save money.
  They go on to say as another strategy that the transition for Pay for 
Performance should be based upon cost-effective care. The endgame is 
the establishment of prospectively managed, cost-effective and 
coordinated care. The enrollment of patients and the cohorts for 
prospective care management requires risk adjustment methods that 
account not only for illness level, but also socioeconomic status, 
adherence patterns, and social supports. This care would be supported 
by adequate infrastructure, information technology systems, electronic 
medical records to provide clinical guidance through care coordination, 
and a program for monitoring quality and efficiency.

                              {time}  2130

  Mr. Speaker and my friends, we cannot continue to pay for a broken 
system. There is a lot of great health care in this country, but as 
long as we have a system that continues to say we will pay doctors for 
procedures, whatever that might be, as opposed to paying doctors or 
hospitals, which are helping to treat patients to get better, then we 
will continue to see costs spiral.
  I hope that the House and Senate work on really reforming health 
care, on really reforming health care and pushing for coordinated care. 
That, my friends, is the answer of how we lower health care costs.

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