[Congressional Record Volume 156, Number 25 (Thursday, February 25, 2010)]
[House]
[Pages H911-H917]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE SUMMIT
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized
for 60 minutes as the designee of the minority leader.
Mr. BURGESS. Thank you, Mr. Speaker.
Well, we have had quite a day here in Washington, D.C., in your
Nation's capital. The 6\1/2\ hour health care summit that was held down
at the Blair House right adjacent to the White House has mercifully
concluded. And as the saying goes up in Washington, everything's been
said, everyone has said it, so it was time to go home. But for those
who haven't had quite enough discussion about health care today, maybe
we can spend just a little while longer talking about some of the
things that we heard today and some of the things that we maybe perhaps
didn't hear today.
One of the things that I do want to stress, we heard several times in
the past several weeks that the Republicans don't have ideas. In fact,
that was one of the admonitions of the President on starting this
summit was that the Republicans didn't have ideas, and he wanted to in
fact show the country that the Republicans were devoid of ideas. But
nothing could be further from the truth. If anything, we saw today
abundant Republican ideas. Some may say there are too many Republican
ideas, too many to fit in one room.
I wanted to spend a few minutes tonight talking about some of those
ideas on our side. I have a Web site, Mr. Speaker, that is devoted
entirely to health care policy. It is from the Congressional Health
Care Caucus. The Web address is www.healthcaucus.org. And under the
Health Caucus Web site, under the Issues tab, I think it is the second
heading, is a Prescription for Health Care Reform. Anyone is free to go
to that site and click on the Prescription for Health Care Reform,
follow the links, and they will be taken to a one-page description of
nine different bullet points on health care reform.
In fact, there is even a little segment to record comments if someone
would like to leave their ideas or their thoughts on the paper. Or if
someone thinks of other things that might in fact be included, we
welcome those comments on the Web site.
I am just going to briefly go through this list, and then I have got
some other observations that I want to make on the summit that occurred
today. And we will be joined from time to time by other Members of
Congress, and I want to give them an opportunity to speak. But under
the Prescription for Health Care Reform, certainly everything I heard
this summer was, we don't want a 1,000-page bill. People really didn't
want a 2,000-page bill after we came back and revamped it after the
summertime. But what did people want Congress to do on health care?
There are people who have legitimate concerns that the system is not
functioning in an optimum fashion. We do have great health care here in
America, but there are distributional issues. The employer-sponsored
insurance system does work well for the 60 to 70 percent of the
population that is therein covered, but in fact there are problems for
people who are outside the employer-sponsored insurance system, and
there are certainly problems that all of us face with the advancing
cost and complexity of health care.
So just running down the list, insurance reform that would include
limitations on insurance companies excluding people for preexisting
conditions, and guaranteeing access to insurance. Now, one of the
fundamental differences on the Republican and Democratic approach to
this is that the Democrats want to have, and the President wants to
have, a mandate. That is, you are required to buy a product, an
insurance product.
It is interesting because during the campaign in 2008, President
Obama, when he was a presidential candidate, actually moved away from
mandates. Candidate Hillary Clinton during her candidacy was in favor
of mandates. Barack Obama was less enthusiastic about mandates. He did
feel that there should be a mandate for children. We don't hear much
discussion about that anymore. In fact, I don't think I heard that
during the 6\1/2\ hours of debate today.
{time} 2030
But mandates really have no place in a free society. There's some
argument as to whether or not it would even be constitutional for the
Federal Government to require someone to purchase an insurance product
that they might
[[Page H912]]
not want. So there are legislative products out there. And this is the
point I want to make. When people say, oh, we can't start all over,
this would be too taxing. There are a couple of bills out there that I
would encourage, Mr. Speaker, people to look at. H.R. 4019, a bill
introduced by Nathan Deal of Georgia; H.R. 4020, a bill introduced by
myself. Those two bills, taken in conjunction, would go a long way
towards eliminating the problems with preexisting conditions.
Another bill to address the tax fairness or the tax inequity that
exist in the health insurance market today introduced by John Shadegg,
H.R. 3218, the Improving Health Care for All Americans Act, that would
allow the same benefits, no matter where you get your insurance,
whether it's through employer-sponsored insurance or in the individual
market, the same benefits should accrue to an individual as accrue to a
business.
Medical liability reform. Texas and California have taken big strides
in medical liability reform. So why do I care? If Texas has fixed their
problem with medical liability, why would I care about that? Well, I
care because the cost of defensive medicine is significant. And since
the Federal Government is the purchaser of about 50 percent of all the
health care in this country, the costs of defensive medicine that drive
up the price of Medicare and Medicaid, those costs need to be brought
back under control, and medical liability reform is a way to do that.
Portability. Allowing patients to shop for health insurance across
State lines, again, a bill introduced by Mr. Shadegg is H.R. 3217, the
Health Choice Act.
To back up for just a moment to medical liability reform, H.R. 1468,
the Medical Justice Act.
We're about to bump up against an important deadline on Sunday night,
and that is the expiration of the prevention of a reduction in payment
to doctors who take care of Medicare patients. We go through this time
and time again. It is time for Congress to fix the physician payment
reform, and H.R. 3693 would do just that.
Do we need to be worried about if there are going to be doctors there
to see us when we get sick in the future? I think that is a concern,
and I think that is something where Congress might play a role. Doctors
to care for America's patients, the Physician Work Force Enhancement
Act, H.R. 914. People ought to be able to know what the cost is when
they go to the doctor or the hospital.
How about a bill for ensuring price transparency? H.R. 2249, the
Health Care Price Transparency Promotion Act. Prevention and wellness
programs, we all agree, during the hearings this summer, the
individuals that come in who worked at Safeway and talked about how
health promotion and wellness was saving them money, firms like
Allegiant in Omaha, Nebraska, brought in great stories about how they
had involved their employees in living healthier lifestyles and reaped
the benefits from lowered insurance costs.
An odd thing about the way we do things at the Federal Government,
we're actually going to have to change the HIPAA laws, the privacy
laws, a little bit in order to have this type of legislation be passed.
But that's certainly within the purview of Congress and within the
ability of Congress to do that.
But prevention and wellness programs, although I do not have the bill
number attached to this, we had several amendments in committee and in
the Rules Committee leading up to the passage of the Democrats' bill
this fall that dealt with prevention and wellness. The legislative
language is written. It is not in bill form right now because it would
require a simultaneous modification of the HIPAA laws in order to allow
that to happen.
And finally, I mentioned before, mandates. No place in a free
society. And this is one of the fundamental differences between the
President and myself. He wants to force everyone to buy an insurance
policy. He said that's the only way to bring costs down. I would submit
that if the insurance companies know you have to buy their product,
their prices are not likely to go down. In fact, if you're required to
buy their product under the penalty of law, with the IRS as the
enforcer, it is very likely that the cost will go up because no one
wants to run afoul of the Internal Revenue Service.
And then we make insurance companies lazy. Why bother to compete with
a better product? Why try to create a program that people actually
want? You've got to buy it anyway. The government's going to force you,
you're going to buy my product, I don't even have to make it something
that you want, and I can charge you more for it. Mandates make
insurance companies lazy.
We actually have a model for what works in this endeavor, and that is
when the Medicare part D program rolled out, then Administrator of the
Center for Medicare and Medicaid Services, Dr. Mark McClellan,
required, out of six classes of pharmaceuticals, there were six
protected classes of drugs. Within each class, an insurance company had
to offer two choices, and using that as the parameter, the companies
did produce the plans that people wanted. The product, part D, has been
very popular. Ninety-two percent of seniors now have credible drug
coverage under Medicare because of the flexibility and the desirability
of these programs. The cost came in way under budget, and 92 to 94
percent of seniors are satisfied or very satisfied with their
prescription drug coverage, so a program that indeed worked. And the
whole emphasis was to make this look more like insurance and less like
an entitlement.
Creating products people want is a better way to go about getting
meaningful change in the insurance market than giving the insurance
companies a license to steal, which is what a mandate would be, in my
opinion.
I have some other observations on the day's activities, but I wanted
to yield such time as he may consume to my good friend from
Pennsylvania, Mr. G.T. Thompson, who in a former life was a health care
administrator. I know it's odd that a doctor and a health care
administrator would get along, but the two of us do get along very
well.
G.T., I will yield to you such time as you may consume.
Mr. THOMPSON of Pennsylvania. Thank you, Dr. Burgess. I really
appreciate what my good friend from Texas is doing in terms of his
leadership with the Congressional Health Care Caucus. It's refreshing
in this Chamber to deal with folks who have the facts and have the
experience to make informed decisions when it comes to such important
topics like health care. I think of all the issues that come before
this Chamber, there are probably few things as intimate to our
individual lives as health care. And to observe this process over this
past 14 months, where bills are written as I look at these bills,
1,000, 2,000, 3,000 pages, which has been special agendas for, you
know, just misled government-run health care, it's apparent to me that
those who are writing those bills have very little experience, if any
experience in health care. And so it's been a real privilege to be able
to work with you and under your leadership to really look at the
solutions that we need to have.
Now, as I travel around, and I did, my background was 28 years
nonprofit community health care where I, in the hospitals, the health
systems I come out of, we work very hard to be partners with our
physicians.
And so what am I hearing? As I travel in my congressional district
and I listen to folks throughout the country, I haven't met anyone that
says, just don't do anything. The commitment is that, as I talk with
folks, that they feel that they like the health system we have. Can we
improve it? I think there's an acknowledgment that we can do that. And
I've certainly spent my professional career serving my patients first
as a therapist and a rehabilitation services manager and ultimately as
a nursing home administrator. And looking at four dimensions of health
care that we should always continue to strive to improve. Number one is
cutting cost. And that's just not cost for a certain segment or a
certain group, but cutting cost of health care for all Americans, which
we're committed to that with the solutions you've talked about. It's
about improving access, increasing access and improving quality and
strengthening that decisionmaking relationship between
[[Page H913]]
the patient and the physician, not allowing government or a bureaucrat
to be that wedge in between.
As I talk with people about health care, and I've been doing that
since I came to Congress, that's what they're asking for. The people I
talk to, they like the solutions. They like the bills that we've
introduced as far back as last July that dealt with medical malpractice
reform, tort reform that drives the cost of the health care up for all
Americans through both the premiums for medical liability insurance
that has to get absorbed into the cost of doing business, those premium
costs get passed along as a part of the fees, and not just the premium
fees, but then there's the cost of defensive medicine that occurs, with
extra tests that are ordered, not so much maybe to serve our needs and
whatever particular illness or disability we come to the doctor for,
but to provide a record that shows that the physician has exhausted
every possibility.
It's things like many of the solutions you talked about, allowing to
purchase across State lines. It fascinates me that you can go to the
Internet and you can go on a Web site, some of them got little critters
like lizards on them, and you can purchase car insurance and get the
best value, the best product for the best cost. You make that decision
as an individual. And yet we are barred from purchasing health
insurance across State lines.
In States like Pennsylvania, especially rural Pennsylvania where I'm
from, if you have choices, you have just a couple of choices. Maybe if
you're lucky, you have three choices to pick from. And a lot of people
say, well, I want the insurance that you have as a Member of Congress.
Well, I'm quick to tell people, I worked nonprofit community health
care for hospitals for 30 years. I'm paying more today as a Member of
Congress than what I ever paid for health care. But what I would like
every American to have, certainly every constituent in my district that
I have today are just lots of choices. And we do that by allowing
purchasing across State lines, more competition. That's a good thing.
Competition brings the cost down and raises quality. I don't care what
you're purchasing, that's a principle that lasts.
Certainly, a formation of association health plans, and preexisting
conditions, as you've talked about. I mean, those are all just a few of
the different parts of the proposals that Republican Members have
introduced and are pending bills that are right here that the Speaker
could elevate to the floor at any moment so that we could actually take
an up-or-down vote on these. I think the American people would vote
yes. I see a thumbs-up from the American people as we talk about these
different proposals.
Preexisting conditions, that's a tough issue, but we're addressing
that within the proposals we have. Just because you're born with a
preexisting condition or you happen to have the misfortune to develop a
disease such as breast cancer or prostate cancer in the course of your
life doesn't mean that you shouldn't be able to afford to be able to
purchase affordable health insurance. We address that in the solutions
that we put forward. I'm so very proud of all of the representatives
from the Republican Caucus who were at the Blair House today. I thought
they did an outstanding job of representing the American people and
ideas that the American people are looking for.
You mentioned about workforce issues, and to me that was something
that I came to Congress just looking as a crisis. Starting with rural
America and underserved urban areas first, the baby boomer generation,
my generation, we're beginning to retire in tremendous numbers. And in
those areas where our physicians, our nurses, therapists, technicians
are retiring, this payment system will get changed if we don't
proactively address those workforce issues. If you don't have a
physician in your community to provide services, you do not have access
to quality care. And so because we've been misled with these 1,000,
2,000, 3,000 pages, all the attention's been drained in the wrong
direction, we're missing the bigger issues that, frankly, we've been
talking about. We've got bills that address some of the workforce
issues, and so it's time to get beyond the misinformation and the
misdirection that my Democratic colleagues have been putting together
in these 1,000, 2,000-page bills, and get to the business of really
addressing the real health care issues.
Mr. BURGESS. I thank the gentleman for his work on these issues. I
thank him for always being willing to be involved in these. These are
tough problems. These are complex problems.
You know, the activity today, I referred to it earlier today on a
radio show as the Blair House project, not to be confused with the
Blair Witch project. There were times when it did seem to be that there
probably were some spells being cast.
The other thing that really had to strike you in watching the
discussion today is that there are fundamental differences as to the
role in government, fundamental differences as to the involvement in
government.
{time} 2045
You know you can't help but be struck. Here we've worked on this
concept now for 13 months. The President was sworn in the 20th of
January of last year. Here we are at the end of February, and still no
bill is across the finish line. Boy, I thought it would have happened
much, much more quickly. In fact, had the energy that was put into the
stimulus bill been put into a health care bill, in all likelihood they
could have passed whatever they wanted in February of last year.
Instead, they chose to work on the stimulus first and then cap-and-
trade and then gradually, gradually, gradually, their capital bled away
to where they did not have the votes necessary on their side to pass
one of these bills.
And this is the fundamental problem that is happening with the
President's plans and the Democrats' bills in the House and the Senate
right now is they do not enjoy popular support. Pick your number: 56,
58, 75 percent of the American people who do not support this 2,000-
page monstrosity that literally required bribes to bring Senators down
to the well to pass this bill Christmas Eve. The American people saw
that and they rejected it.
They might trust us--I am not sure that they will--but they might
trust us to work on some of these individual concepts one at a time.
But at the very end of the summit today, the President decried
incrementalism and said we have to be bold and we have to move forward
with a large bill.
Why? Why do we have to do that? The programs to deal with preexisting
conditions would involve risk pools to be sure. Reinsurance options for
States, yes, it's going to require some Federal subsidy. The
Congressional Budget Office has estimated $25 billion over 10 years.
They may be a little bit light on that, but still we're nowhere near a
number like a trillion dollars, which is scaring Americans to death.
We could provide some help in that market. The States could provide
some help in that market. We could ask our partners in the insurance
industry to voluntarily or by law cap their premiums at some level so
that the person who was in this market did not find the costs so
daunting that they simply gave up and did not get insurance.
Now, all of these great programs that the President and the Speaker
talk about that they're going to give to the American people at no
charge, none of these programs start for at least 4 years.
Now look, here we are 13 months into a new administration and the
administrator at the Center for Medicare and Medicaid Services is not
there. He hasn't even been appointed, much less confirmed by the
Senate. That is the individual who is going to be responsible for
taking this 2,700 pages of legislation that we give them and turning
the legislation into rules and the Federal rulemaking process. That is
going to be an enormously difficult task. It is going to take 4 years
to work through all of that and impugn all of the legislative intent
and make those Federal rules and leave the rulemaking period open long
enough so that people can comment on it. That is an enormous task. It's
not going to happen overnight.
So the people that come to us and say, My premium's going up too
much, I want you to take it over, they're not getting anything for at
least 4 years.
Now, in the meantime, what if we took an approach--and, in fact, it
was an approach that was talked about by
[[Page H914]]
Senator McCain in the fall campaign of 2008. What if we took the
approach of we're going to take existing risk pools of the States--34
States have already created. We're going to emulate the best practices
of the best States. We're going to allow for some reinsurance options
if companies are willing to take on higher-risk individuals so that no
individual insurance company is tasked with too much in the way of
financial loss, and we're going to cover this group of individuals.
I heard it over and over and over and over again this summer at town
halls, Stop what you're doing. We don't want you to destroy the system
that is working well for 65 or 75 percent of the country. We want you
to concentrate on those individuals who, through no fault of their own,
have suffered a tough medical diagnosis, have lost their job and
employer-sponsored insurance, couldn't keep up with the COBRA payments
and now find themselves having fallen into that dreaded category of
uninsured with a preexisting condition.
While we're at it, we might look at the COBRA system. COBRA was
placed as a protection to help people who had employer-sponsored
insurance but they lose their job. So employer-sponsored insurance
means the employer generally pays about two-thirds of the premium; the
employee pays about one-third of the premium. When you lose your job,
you can't continue that insurance. But in all likelihood, your employer
is not going to pay their two-thirds any longer because you're no
longer their employee. But for 18 months, you can pick up the whole
premium and pay that with a small administrative charge--I think it's
102 percent of the premium--and you can continue your insurance for 18
months and not fall into the category of uninsured. And if you have a
preexisting condition, you continue to be covered at that cost.
But that's a tall order for someone who just lost their job to
continue to carry that degree of premium. What if we allowed people--
instead of you had to keep that same insurance your employer provided
you, what if we allowed them into a lower-cost, high-deductible plan
for those 18 months and still preserved their insurability during that
time, so that when they found employment, they would not fall into that
same category again. Or they might even decide to continue that high-
deductible policy with a lower premium and continue to have the
protection of health insurance without falling into a preexisting
category.
But we never really worked on those issues. We just decided we were
going to do this big bill, and it was going to have mandates, and it
was going to have a public option, and this is the way it was going to
be. But to tell you the truth, for 4 years there is no help. There is
taxes. For 4 years there is the immediate Medicare cuts, but the
benefits don't start until year 4 or 5 or possibly even 6. We don't
even know how long it's going to take to set up those programs. And
again, we don't even have the administrator at the Center for Medicare
and Medicaid Services. The President needs to nominate one. The Senate
will then have to confirm them. We may still be months away from
filling that very important bureaucratic job over at the Department of
Health and Human Services.
I'll yield back to my friend from Pennsylvania
Mr. THOMPSON of Pennsylvania. Some of the observations of just
watching the summit, as I guess it was called--I have a question for
you. I will come back to you for that.
Some observations of the proceedings that I watched today when I had
an opportunity to tune in in my office--I wasn't on the invitation list
to be there. It was pretty limited invitations. But I heard--and I
don't know which leader it was, whether it was the President or the
Speaker or whom, made comments there were absolutely no Medicare cuts
that are involved in this. And yet the fact is the Congressional Budget
Office Director, Doug Elmendorf, back on December 19, just a month ago
or 2 months ago, noted that there were Medicare cuts, and those
Medicare cuts built into this impact all areas of health care from
hospitals to skilled nursing to home health to hospice. Hospice, which
is a wonderful service for people who are in the final stage of dying,
where they have the support of compassionate health care professionals
surrounded by family to be able to die with dignity, and yet that is an
area, one of many areas of Medicare cuts that are slated for under
these proposals.
In my responsibilities across many different settings of health care,
I have to say that there is a lot of reasons why commercial health
insurance is expensive. Tort reform I would put right on top of the
list.
But maybe even higher on the list, I would say, is the Federal
Government. The Federal Government pays--underfunds and has
systematically underfunded the costs of health care--the physician, the
hospital for Medicare payment. For every dollar of cost of providing
care, the Federal Government pays 80 to 90 cents. For medical
assistance, it's maybe, if you're lucky, 40 to 60 cents. It depends on
the State. The commercial health insurance pays, on the average across
the Nation, 135 percent of costs. And the primary reason for that is
the hospitals' physicians have to negotiate at that rate. If they
don't, they can't make up for what the government does not pay.
So what are some of the other costs that I heard today that really
intrigued me?
I heard the Democratic leadership claim that it was going to bend the
cost curve, meaning it's going to bring the cost down for everyone.
Yet, what we saw was the administration's actuarial--the professionals
that work for the White House, that look at those numbers and do those
cost projections--have found the Senate bill, in fact, will not
decrease health care costs. The Center for Medicare and Medicaid
Services, who you just talked about, the Medicare professionals, their
finding was that those were going to increase expenditures by $222
billion, with a ``b,'' billion; not hold costs, not cut costs, but will
expand the costs of health care.
And the President today was very up front in his comments where he
said that, yes, this proposal will increase premiums for the average
American and American family by 10 to 13 percent. Well, I thought the
number one thing we were looking at here is decreasing the cost of
health care, making it more affordable. How do you truly get access to
greater health care? Well, you bring the costs down so people can
afford it.
So I was curious to get my good friend's opinion. This morning when I
woke up and I knew this was going to occur, it struck me as I was
walking to the Capitol, was this going to be a health care summit today
or a health care plummet? And to me, the indicator was whether the
President showed up with either a white board, a large white board that
was blank that we could start over and do what the American people
want, and that would be what today's events would be--it really would
be problem solving, because that is what Americans are looking for,
problem solvers--or would he show up with a rather large hammer and
really try to hammer through, push through Big Government, bad ideas
that the American people, in a large majority, have rejected.
So I yield back to my good friend just to get your impressions of do
you think it was a health care summit today or a health care plummet.
Mr. BURGESS. I was criticized on a news show earlier today referring
to this exercise as a 6-hour photo op. Probably I would fall into the
category as a ``plummet.''
Isn't it interesting that, yes, premiums for the average family may
increase for 10 to 12 percent, but that's okay. Instead of an apple,
you get an orange, so you're coming out better in the deal.
Now, yesterday, in our Committee on Oversight and Investigations, we
hauled in Anthem Insurance Company in California. And Anthem, to their
great discredit, chose right now as a time to increase their premiums,
and they have become the whipping boy and the poster child. And I will
concede, I think they raised their premiums too fast. They were tone
deaf. Their highest premium increase was 39 percent. Their average was
25 percent. Twenty-five percent. Okay, that seems high, but the
President's already said 12 percent. Yeah, that's okay because you get
an orange instead of an apple, so after all, you're good in that
transaction.
[[Page H915]]
So I guess if Anthem wanted to raise their rates, they probably
should have stayed at that 12 percent rate. They would have been right
in line with the President of the United States. They could have raised
their rates and all been happy about the transaction. Instead, they
overshot. They hit an average rate of 25 percent and, as a consequence,
found themselves sworn in under oath in our committee having to absorb
the ordeal that we put people through when they come before our
committee.
Mr. THOMPSON of Pennsylvania. I have to wonder with that because I
see premiums like announcements, and they are going up. And this is why
we're committed to doing the right type of smart government solutions
to bring the costs of health care down, the premiums down. Giving a
license to 12 to 13 percent additional increases, that's unacceptable
to me for the American people.
I have to wonder how much of what's going on in Washington and these
health insurance companies as America is watching the debate here,
that--you know, giving this approach that the Democratic leadership, my
good friends and colleagues on the other side of the aisle are taking,
how much is that driving up premiums right now because they don't know
what's coming. They don't know the premiums. There is a lot of
uncertainty.
I mean we, not too long ago, passed a credit card bill under similar
circumstances. It was going to provide all kinds of limitations and
impose new conditions on really what has been kind of a free market
type of process, and what I have seen, actually, as a result one of the
unintended consequences, is some of those interest rates--before the
new regulations kicked in, some of those interest rates went way up as
an unintended consequence of government overreaching, government-run
approach.
{time} 2100
I have to wonder if what we are seeing with some of these more
recent--like the situation you just talked about, may be an unintended
consequence of just the wrong-minded direction that our Democratic
colleagues are taking this health care debate in, as a reaction by the
health insurance industry.
Mr. BURGESS. It's interesting, perhaps the one thing that would
provide the right impetus in the competition to hold down those costs
we are not going to do, and that's the ability to buy across State
lines.
In the individual market, buying a policy for a family of four in New
Jersey is $10,000 a year. Your State of Pennsylvania, $6,000 a year, my
State of Texas, $5,000 a year. As long as people know what they are
purchasing, I don't see why it is reasonable to restrict someone from
having a policy that may be more affordable.
My insurance premiums have decreased by about 50 percent over the
last 2 years. Not because I am a Member of Congress and I get a special
deal, but I said, you know what, I can no longer afford this high
option PPO insurance that is available to us in Congress, so I have
elected to go into what's called a high deductible health plan with a
health savings account. I actually had one several years ago when I was
in private practice. I liked it.
I liked the fact that I was the one who got to choose which doctors
and facilities I got to use. I didn't have to call 1-800-California to
get an X-ray preapproved. I wrote the check and I controlled the money,
and I made the decision about who I saw and when. So I have gone back
to that type of policy, and I will tell you I am very satisfied.
We have improved from the old medical savings account in 1986 to the
Health Savings Account improvements that started in 2003 and continue
to this day. Preventive care is now included as part of the benefit in
a high deductible health plan because the insurance company has an
interest in making sure if you have a problem that it is diagnosed
early, while it is less expensive to treat, and I think ultimately
that's a good thing.
I have chosen a plan that does not have prescription drug coverage
because after we passed the prescription drug benefit in Medicare in
2003, one of the unintended consequences was we changed the market so
that now many generic medicines are available at Wal-Mart for $4 a
month. I try to find those bargains for those medicines if I should
need one. I try to find those bargains at Wal-Mart or go to an over-
the-counter variety, which is much cheaper than the name brand that is
bought at the pharmacy, and you can actually achieve significant
savings.
I am motivated to do that because it's my money that I am spending
for those compounds. Yes, I could have paid more for PPO insurance and
then, yes, I could have had a nice mail order, even gone down to my
pharmacy and gotten brand names, but I have found that, hey Prevacid is
over the counter now. It costs a fraction of what it used to cost a few
years ago. Even before that, Prilosec was a similar medicine, not quite
the same thing, but that was available in a generic form over the
counter at that time at a fraction of the cost of the 30-pill bottle of
Prevacid that I was taking before.
So it makes the consumer more informed and motivated. Here is how you
hold down health care costs: Let me be the decisionmaker about that.
Don't tell me from a comparative effectiveness board that, hey, this
medicine is just as good as this medicine, and so this is all you get
because this is what we are buying for you this month.
Let me have some of that money back to spend myself, the premium that
I pay every month, a portion of that goes into the medical savings
account. Every year that it accrues and grows larger it's tax deferred
until--if I don't spend it on health expenses I would obviously have to
pay taxes on it when I took it out. As long as I spend it for
legitimate medical purposes, hey, that's pretax dollars. That's
probably the best deal you could do in the individual market. So these
are changes that we actually ought to encourage.
I was stunned today to hear the Democrats admit, you know, we agree
on a lot of this stuff that we have got here on these sheets, but,
well, we don't do the health savings account thing. My goodness, that
is the one way to really start to bring--you talk about bending the
cost curve, that's one way. Get a motivated patient, educate them about
some of the options that they have, and, oftentimes, not oftentimes,
almost always they will make the right decision. I cannot tell you how
many times in my medical practice if I recommend a test, a CT or MRI
scan, a CAT scan or an MRI scan, and the next question from the patient
back to me was not, Doctor, is it really necessary, or, Doctor, is this
safe to do this, the next question was, well, does insurance cover it?
If it did, there were no more questions. Go ahead and have the test.
I, on the other hand, with the type of policy that I have, yes, I may
have hurt my knee or shoulder bad enough to go get a CAT scan, or I may
make the decision that, Doctor, with a little ice and tincture of time
would this not perhaps resolve on its own? Yes, it could, and if it
doesn't get better in a week we could still do the CAT scan and we
won't have delayed beyond the therapeutic interval, so it is okay to do
that.
I am happy to take that advice and not have the test. If I don't feel
better in a week or 10 days or whatever the prescribed time limit is,
fine. Go get the test, and I will still be able to write the check and
have that done. Here is how you bend the cost curve down. You get the
patient involved, put the power back in the hands of the patient. Let
the patient and the doctor make those decisions.
Don't make them buy the insurance at 1-800-California, but don't make
them buy across the street at Health and Human Services. Let the
patient and the doctor make those decisions. Every doctor has had the
unpleasant experience of having called a preapproval number and have
their patient denied a test or a procedure or a surgery, and then you
have got to go to bat for them and prove all of these things. It is an
enormous nuisance, and I hated it every time it happened.
On the other hand, in the Medicare and Medicaid system, they go ahead
and cover that, but maybe 3 or months from now, maybe a year from now,
they call you back and say, you know, we don't think that
hospitalization was actually necessary, and we are going to deduct what
we pay to you from the next round of payments that we give you for your
next round of Medicare and Medicaid patients.
[[Page H916]]
That is beyond frustrating because at that point you may not have at
your immediate disposal the documentation that you at least would have
had with a preapproval process. Neither is a good occurrence in a
doctor's office. We need to come to some sort of consensus. But, as
much as I hated the preapproval process, I see now, dealing with these
large, large Medicare and Medicaid outlays, why it is necessary
sometimes to assess medical necessity and why it is necessary sometimes
to seek that preapproval, perhaps in our Medicare system.
If we really were serious about bending the cost curve, instead of
just cutting doctors' payments--and that's what we do, we say, well, we
will pay 20 percent less this year than we did last year--what's
the practical effect of that? Well, the doctors' costs are fixed. He is
not paying less for electricity to light his office this year than he
was last year. His office help certainly didn't come in this year and
say, hey, you know what, we can all take a pay cut because we love
working for you.
That doesn't happen. His costs go up every year. The reimbursement
rate goes down because Congress says, hey, we are spending too much
money. What is the practical effect of that? The practical effect of
that is, you know, I was able to pay my bills and take something home
last year seeing 18 patients a day. But you know what, this year I have
got to see 25 patients a day. And maybe if I can squeeze an extra
procedure or two out, maybe I should do that because I have got to make
up that difference somewhere.
So we have gone about this the wrong way. We are ratcheting down
costs at the provider, and yet the doctor, he or she is the one who
picks up the pen and writes the prescription, orders the
hospitalization. The most expensive item in the doctor's office is
their ballpoint pen most of the times because the doctor is the one
making the decisions about that medical care.
Wouldn't a different way to look at this might be to say, Doctor, we
are not going to cut your pay this year. We are, in fact, going to pay
you a little bit more. We hope you will see fewer patients and maybe
take a little bit more care and a little bit more preventive medicine
and education with those patients along the way. It would be a
phenomenal thing to look at but we never tried. We just cut the
doctor's pay and said, whew, we got through it this year, the doctors
are all mad but maybe they won't remember come November, and we will
cut them again at the end of the year.
We are probably going to bump up against the clock. I do want to make
this point from what we talked about the cost of insurance at the
hearing we had yesterday.
It is important to understand, I think, that Speaker Pelosi, Harry
Reid, President Obama, their health proposals would not make health
insurance significantly cheaper for America's families. Under the bill
passed by the House in November, H.R. 3962, a family of three making
just under $55,000 a year and buying now a plan in this new exchange
that's going to be set up and created by the bill, they would have to
personally contribute after a tax credit about $5,500 a year in
premiums. Additionally, this family would also pay $4,000 of out-of-
pocket costs exclusive of the premium--copays and drugs that weren't
covered--so this family would pay about $9,500 for a family of three
that earns $55,000 a year in the Health Insurance Exchange.
I think it's important for people to understand that when we pass
these bills and it's all settled and done, it doesn't mean free
insurance. It doesn't mean free health care. It means, yes, you have
got a government option here for buying insurance, but it's still going
to cost something. It is still going to be an expensive item in that
family's budget every year, and we are misleading people by telling
them that, hey, we need to pass this bill because too many people don't
have health care.
True enough, the person who has no income and no job will now have
access to Medicaid, which they may not have had before, but the average
person earning a reasonable salary is still going to find that the
cost, the expense they paid for health insurance, is going to be
significant. Here is the rub: If we pass this bill, this won't be an
optional expense in their budget. They will be required to buy this,
and the enforcer is going to be the Internal Revenue Service.
Now, Mr. Thompson, you brought up the online purchase of insurance
for automobiles that has the cute little lizards and cave men on the
logos. People will sometimes bring up to me, well, why, why not have a
mandate. After all, there is a mandate to buy car insurance in your
State, so, what would be the matter with having a health insurance
mandate?
Here is the key. In my State, this is a State decision that in the
State of Texas, people have to carry insurance if they are going to
exercise the privilege of driving on the roads of the State of Texas.
Health insurance is a different animal, and for the Federal Government
to require, not a State government, but the Federal Government to
require the purchase of health insurance is taking us in the direction
of loss of liberty that none of us have really ever encountered before.
It is a new concept.
So if a State wishes to exercise a mandate, which they have done in
Massachusetts, then that's a State decision and that decision will
either be supported or rejected by the voters in that State, but for
the Federal Government to create for the first time a mandate, a
requirement that a person purchase a product just for the privilege of
living in this country, again, we are going down the road of loss of
freedom that, again, I don't think people really want to go there.
Now, you will also hear, and it's so strange to hear the comparison
of we have got to have a mandate as you do with automobile insurance,
and you know what, you can buy that consumable insurance online. What
if, instead of, if we had our thinking right, we would let the health
insurance be available online, let the plan finders be available online
and, if people think it's necessary to have a mandate, let that be a
State decision. Let that be a State decision if the exchange is--right
now you have, and I don't know the precise number, 30 or 34 States
whose attorney generals are drawing up legislation to prevent their
States from or prevent their citizens and their States from being
required to follow an illegal Federal mandate.
Mr. THOMPSON of Pennsylvania. Pennsylvania being one of those,
absolutely.
Mr. BURGESS. It just shows you the type of tension that we are going
to set up between the State and Federal Governments if we were to pick
up and pass either the House or the Senate bill and send it down to the
President for his signature.
Mr. THOMPSON of Pennsylvania. Well, you have touched on so many very
important issues during that time, during the course of this hour. I
certainly want to come back to--you know, when I started in health
care, I mean, the patients were not a part of the treatment team, they
were, you know, everyone kind of focused their energies on the patient,
the individual, the consumer, but they weren't included in health care
decisions. So much has changed in at least three decades.
Today, I don't know of any health care professionals that don't
consider the patient themselves a very important part of the treatment
team, and it's so important that individuals take that, exercise that
self-responsibility to be informed and to make decisions and to take
control of their health care, extremely important.
You also talked about, you were talking about the stress on
physicians, and it's significant. In Pennsylvania, the average age of
physicians in Pennsylvania is 50. Many that I talk with, they look at
the challenges of practicing medicine today. In Pennsylvania, we have
terrible medical malpractice costs. We export our physicians. We train
a lot of them, but we export them to States like Texas. You know, we
don't keep them. And many of the physicians I talk with that are 50 and
older, they look at what they have accumulated in their lives, and they
look at how much they are spending each year, whether it's medical
malpractice, these additional costs or regulations that are coming, the
extra costs they had to put into practice to comply with Federal
mandates like the HIPAA law from the 1990s.
{time} 2115
And they are saying, you know what? Why don't I retire now while I
[[Page H917]]
can at least retain a little bit of what I've earned so I can have some
type of future enjoyable retirement? That would contribute so much to
our access issue in States like Pennsylvania where citizens are not
going to have access to quality care. I see that as a significant
unintended consequence as a part of what my friends across the aisle
are proposing and pushing at us.
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