[Congressional Record Volume 157, Number 76 (Tuesday, May 31, 2011)]
[House]
[Pages H3788-H3794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1940
GOP DOCTORS CAUCUS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from Tennessee (Mr. Roe) is recognized
for 60 minutes as the designee of the majority leader.
Mr. ROE of Tennessee. Mr. Speaker, we're going to spend the next hour
tonight discussing basically the health care debate and what has
occurred in the past 2 years here in Congress. And we have asked our
physician colleagues and Health Caucus to come down and spend this hour
discussing this issue.
Now, I think before we start, what we need to do is talk about why
we're having this debate. Obviously, we needed health care reform in
America. And one of the frustrations at least I've had since I was here
was during our last Congress, we had nine physicians in the Physicians
Caucus, M.D.s and then 13 people total in that caucus, and none of us
was consulted about the health care bill.
And when I came to Congress, I asked myself the question, just as I
was seeing a patient, what's wrong with the American health care
system? And the problem with the American health care system is today
still, and getting worse, is that it costs too much money to go to the
doctor and go to the hospital. So when I would see patients in my
office, I could see the costs ever rising. Back in the eighties, we
tried plans called managed care capitation. In our State, we tried to
reform our Medicaid program. All failed to hold the costs down.
The second problem I saw with the American health care system is that
there are a group of our citizens who didn't have access to affordable
health insurance coverage. If it was affordable, we would all have it.
As an example, let's say a sheetrock worker or a carpenter that puts up
studs in a house or a homebuilder may not have a business big enough to
afford health insurance coverage. And maybe this person's wife worked
at a local diner, and together they make $40,000 a year. In our area
you can get along just fine making that amount a year. They couldn't
afford $12,000 premiums.
And the third problem I saw, which is a liability issue, is that we
see ever-escalating health care costs, and I see Dr. Gingrey is here
with us, a fellow OB/GYN as I am, and we saw costs from the time I
began my practice from $4,000 in 1977, which is what the malpractice
insurance was at that time, to over $70,000 today. Who bears those
costs? Our patients.
Again, back to number one. We began this debate on what I think was a
false premise. Basically, the health care bill was to cover those
people who didn't have insurance. And this particular bill, the
Affordable Care Act, so-called ObamaCare, did do a couple of things.
One, it has done nothing so far--it is beginning to be initiated, as
far as lowering the health care costs--it has done nothing. If you look
at every business around, those rates are skyrocketing and making it
less affordable for us.
Number two, it did increase access. And how did it increase access?
At least it appears so far that it increased access by massively
expanding Medicaid. And the one thing about the bill I do like is
allowing young people to stay on their parents' health coverage until
they are 26.
In a committee hearing we had the other day with HHS Director
Sebelius, I asked her how many people would this bill cover, this
2,500-page bill? And she estimated a number, 30 million or 32 million
more American citizens. The CMS's own actuary estimates, the
Congressional Budget Office estimates it will add 15 million more
people to Medicaid, a system that's already bankrupt in the States. The
CMS actuary actually believes it will be 24 million more people on
Medicaid, and you add 6 million more young people to that, and really
without this incredibly complicated bill, in two paragraphs you could
have done exactly what they did with this bill without all this
complicated issue that we're going to talk about later tonight.
So we did nothing to lower costs. We did increase access by
increasing Medicaid and potentially exchanges. And we can talk about
that later. And then lastly, liability, which there is nothing in the
Affordable Care Act for that.
The other thing that is not in the bill, glaringly not in this bill,
which is incredibly important, is the so-called doc fix. And so our
viewers can understand what that is, as a physician, when I see
Medicare patients, the Federal Government pays a certain amount with
Medicare part D and the person getting the care pays for those premiums
also.
In 1997, to help hold health care costs down, there was a formula put
in so that if the costs went above a certain amount, the doctors were,
the providers were cut. Right now, if we hadn't passed a temporary fix
of this, the doctors would have had a 26 percent decrease, and in 2
years that's going to be a 30 percent decrease in their payments. So
what difference does that make if you're out there and you're a
Medicare-age patient, as I became last summer? So I can speak from some
experience. I signed up for Medicare last July.
The problem with it is there's a cost to the physician opening and
practicing in their office. And we don't pay the cost of the care. And
we are already seeing in our area where very fine physicians are no
longer accepting Medicare patients. We believe this could get much,
much worse under the Affordable Care Act.
And as the two past speakers brought out, what this bill also did,
and what we're going to discuss tonight in more detail, is not just the
entire health care bill, but it's going to be Medicare and one specific
part of it called the
[[Page H3789]]
Independent Payment Advisory Board. But to get to that, we have to
explain the problem and why we're having this discussion.
One of the charts I want to show you is this and why we're having the
discussion right here is because right now we're looking at a budget
that if we do nothing at all--and I'll use President Obama as an
example. President Obama just turned 50 years of age. In 2025, he'll be
Medicare age. And guess what? Four things will make up the entire
budget of this country: Medicaid, Medicare, Social Security and
interest on the national debt. And that could come even sooner where
those things make up all, depending on certain economic factors. So
this is the reason we're having this discussion.
And I had a person come up to me this weekend at a Memorial Day event
and said, Dr. Roe, I'm concerned that my children and grandchildren
will not have Medicare. And I said, that is exactly the reason we are
having this discussion. I have that same concern. We want to save this
program for future generations. And he said, well, why don't we just
cut foreign aid? And I said that's fine. And last year we cut earmarks.
That makes up only 2 percent of our budget. If we completely did away
with all foreign aid, which some people I think would agree we need to
do, but if we did that, it would only cover, it would take 15 years of
no foreign aid to take care of Medicare for 1 year at today's dollar
expenditures.
Let me give just a little bit of history on the Medicare program,
which has been very successful and very popular in this country. In
1965 it came out. It was a $3 billion program, and the reason it was is
because we had seniors that didn't have a way to put money back and to
take care of their health care after they had retired from their work.
So this program was started, Medicare part A, which is the
hospitalization part, and Medicare part B, which is the physician part.
It was a $3 billion program at that point. The government estimator
said in 25 years, in 1990, this will be a $15 billion program. The real
number was over $100 billion. And today, just 20 short years later,
it's over $500 billion. So this is a totally unsustainable growth rate
that we have to deal with.
Now, in passing, as our two previous speakers mentioned, we've cut,
this bill cut $500 billion out of Medicare. This one little thing that
was left out of those talks, though, this year, beginning in January
2011, our baby boomers hit retirement age, age 65, Medicare age at 3
million per year, approximately 10,000 a day. And guess what? In 10
years, we're going to have 500 billion less dollars to spend on
Medicare and 35 million more people to take care of. And so you do the
math. How are we going to control this? How are we going to control
these costs?
Well, the President suggests a plan called the IPAB. Right now in
Medicare we have MedPAC, a Medicare advisory board which gives advice
to this body right here, the Congress, about how we are going to spend
our Medicare dollars and suggestions. And the Congress has the right to
make those decisions.
Well, this Medicare board, this IPAB board that's going to be in
effect in 2014, starts this year with some funding; 2014, 15
bureaucratically appointed people will make decisions based on nothing
but cost. Let's say we spend $500 billion on Medicare, and the actual
cost of providing the care to our citizens is $550 billion. We've lost
our ability in this body right here to say how those dollars are spent.
That board will make a decision to cut the spending to $500 billion
based on nothing but cost, not quality and not access.
And I can assure you, if you have 35 million more people or 36
million more people chasing 500 billion less dollars, three things
happen. One is access to your doctor goes down, costs will go up, and
essentially you will have, with this board, rationing of care.
{time} 1950
I have several of my colleagues here. There are many more things we
can talk about. We have the next hour. I want to recognize my
colleague, Dr. Hayworth from New York, for some comments.
Ms. HAYWORTH. I thank my colleague from Tennessee, Dr. Roe, for
yielding me this time.
In New York's District 19, I have been sharing a headline with our
seniors and with all of our citizens, which is that the Affordable Care
Act ends Medicare as we know it. It ends Medicare as our seniors know
it. And you, sir, have stated the reason exactly. The Independent
Payment Advisory Board, which was written into law and passed by the
111th Congress, signed into law by President Obama, the Independent
Payment Advisory Board, will assure that our seniors, starting in 2015,
when they have to make a 0.5 percent cut in Medicare's budget, our
seniors will stop having the access to care that they are accustomed
to. And they will not be happy about it.
And then in every successive year, in 2016 it will be 1 percent;
2017, 1.25 percent; 2018, 1.5 percent, if I have done that math right,
Dr. Roe. Our seniors will find that their access to the doctors they
know, the doctors they prefer, will not be the same.
So when we talk about what we need to do as a Nation, we in the House
majority have pledged to our seniors that we will keep the promises
that America has made to them, to make sure that Medicare benefits
remain secure and safe for as long as they need them, which is why in
the budget that we passed in April, the Path to Prosperity Budget, we
guaranteed that seniors 65 and above, and in fact our citizens age 55
and above, will not see changes to Medicare as they know it. That gives
Americans 10 years at least to prepare for a more secure future for
Medicare for exactly the reason that you have talked about, Dr. Roe,
which is we do have many blessings in this extraordinary country, and
one of them is that we do continue to make wonderful advances in
medical science. They do come at a certain cost. So we have a challenge
that we need to face together. There are certainly ways in which we
can, together as a Nation, figure out how we make our health care more
cost effective, and there are lots of opportunities.
It is true, there is waste, fraud, and abuse in the system. That
needs to be addressed. There are also ways we can protect our health
better in our youth that Americans haven't necessarily had to think
about nearly as much in the past couple of decades, but that they are
starting to think about. So we need to make sure that we are making
those advances together and that our seniors and all Americans who need
advanced care will be able to get it, that the sickest among us will
not be deprived of care because of the arbitrary decisions of a board
that has to cut budgets. Again, that is the headline. The Affordable
Care Act ends Medicare as you know it, but what the budget that the
House Republican majority passed in April does is to restore Medicare
as our seniors know it and allow all Americans time to prepare for a
better future for Medicare.
Mr. ROE of Tennessee. I thank the doctor for being here. And just for
the viewers today, I want to thank all of my colleagues for being here,
and all of you are health professionals, not career politicians. I want
to point out that Dr. Hayworth just joined us in the Congress. I am a
one-term congressman. I practiced medicine for 31 years. I know you did
for a long time. We have OB-GYN doctors, ophthalmologists, family
practice, cardiovascular surgeons, and nurses, in the well tonight.
These are not long-term politicians. These are practicing health care
providers who have been out there.
I think the question I always ask myself when I look at legislation,
having just left the examining room, how does this legislation affect
the care that I can give my patient. I think that is the one that we
all worry about. We worried about it with insurance companies. All of
us have fought with insurance companies about providing care. I believe
at some point in time--we all do this--that care is going to be
rationed. The question is: who is going to do it? Is it going to be a
Federal bureaucrat and a Federal nameless, faceless panel here in
Washington, D.C.? Or is that decision going to be made between a
patient, a doctor, and their family? I believe that is who should be
making health care decisions in America. It should be made in the
examining room in the doctor's office with consultation, not by some
nameless bureaucrat up here in Washington, D.C.
I thank you for being here, Dr. Hayworth, and I now yield to Dr.
Gingrey, my good friend from Georgia, and a fellow OB-GYN.
[[Page H3790]]
Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman for
yielding, and I thank him for leading this hour on such an important
discussion. And of course I thank all of my colleagues on the floor
here tonight.
I understand that Dr. Roe has authored the repeal legislation of
IPAB, this Independent Payment Advisory Board, created under ObamaCare.
Dr. Roe, Mr. Speaker, just said that the doctor-patient relationship,
the provider-patient relationship, be that provider an advanced
practice nurse or psychologist, a physician, even the hospitals, of
course, are huge providers of health care, and who should we be
concerned with as Members of Congress. Well, it is those 700,000 people
that each of us represent all across this country and that doctor-
patient, provider-patient relationship that is most important. Cost, of
course, is important. But, first and foremost, is the sanctity of that
care, and that is exactly what Dr. Roe is speaking of, Mr. Speaker, and
why it is so important that we do vote to pass his bill, and we do it
as quickly as possible to repeal this very bad decision.
In fact, Mr. Speaker, back I think in December of 2009, almost 2
years ago now, our colleague on the other side of the aisle, a senior
member of the Appropriations Committee, the gentleman from
Massachusetts, Richard Neal, offered a letter that many of us in a
bipartisan way cosigned. I think there were over 100 signatories to
that letter literally begging the President and the administration to
forget this idea of creating this exact same board that Dr. Roe is
talking about and my colleagues will be talking about tonight. It was
called something different then in the construction phase of ObamaCare.
But whatever you call it, today of course we understand it as IPAB.
IPAB, Independent Payment Advisory Board; I call it IBAD, Independent
Bureaucratic Absolute Dictators, these unelected 15 people that can
literally, and will, as the gentlewoman from New York just said, Dr.
Hayworth, they will have the ability come 2014 to start making these
cuts and to make them where the biggest growth area and cost is.
Well, Mr. Speaker, we all know, they say that there will be no
rationing. Well, you can say it is not rationing, but if it walks like
a duck and quacks like a duck and looks like a duck, it's a duck. And
it is rationing. What will happen, and we know it, we health care
providers that have spent, what, 500 years of clinical experience in
the aggregate, we know exactly what these bureaucrats will do. They'll
say if someone is above a certain age, let's pick one, say if you're 65
years old and you come down with leukemia, lymphoma, and what you
desperately need when that chemotherapy has failed to keep you in
remission is a bone marrow transplant, but because that is so
expensive, the decision will be made that no, nobody over a certain
age, nobody over a certain age will be eligible for a transplant of a
kidney, of a lung, of a liver, of a heart, indeed. This is something
that is absolutely unacceptable to us. It is unconscionable.
So, Mr. President, and I say this through you, Mr. Speaker, please,
listen to us. Listen to us. We have another letter coming. It is going
to be signed by all 21 of the members of the House GOP Doctor's Caucus.
I wish we had some Democratic members as a part of this group, but hope
springs eternal and maybe they will. But listen to us because we know
of what we speak. Don't make this mistake. Don't go down this road.
This is not the way to solve the Medicare crisis and the insolvency
that is coming very quickly by 2024.
{time} 2000
You say you can't accept the House Republican budget, the so-called
``Ryan budget,'' the path to prosperity that includes some, I think,
significant and very thoughtful, adult, mature decisions regarding what
we need to do on Medicare. All right. Let's get together. Let's get in
a room and let's talk about it. But you want to kick the can down the
road and do nothing except slash Medicare to pay for your new signature
issue, ObamaCare--slash it by $500 billion. Don't put it back into
Medicare, but create this whole new program and force more people on to
Medicaid, weaken Medicare and then just hope for the future. Well, I
think the American people have seen enough of that.
I know there are a number of my colleagues here tonight who need
time, but I thank the gentleman from Tennessee, and I will close with
this:
On the House GOP Doctors Caucus Web site, Mr. Speaker, folks, my
colleagues, you can go to that Web site, and your constituents can go
to that Web site. It's DoctorsCaucus.Gingrey.house.gov or
DoctorsCaucus.Murphy.house.gov. The reason for the ``Gingrey'' and the
``Murphy'' is that we just happen to be the co-chairs now of the House
GOP Doctors Caucus. That, obviously, will change in future Congresses,
but that's the way to go to the Web site. We are going to ask you to
sign a petition: Oppose the Democrats' Medicare cut board, because
that's what it is, a ``cut board.'' Visit the GOP Doctors Caucus Web
site. Sign the online petition: Oppose the Democrats' Medicare cut
plan.
Mr. ROE of Tennessee. I thank the gentleman.
I would like to point out to our viewing audience tonight that when
the House version of this bill was discussed through three committees,
when this was debated 2 years ago, this was not in the House version of
the bill. This was not there. This independent payment advisory board
did not exist. When this bill the House passed through three committees
and then here as debated on the House floor went to the Senate, we knew
that bill couldn't pass over there, so they brought one out that didn't
go through a single committee hearing with this IPAB in it. We have
right here the letter that many, many bipartisan Members--Dr. Fleming
is here. Dr. Gingrey, myself, and others--signed along with many
people. Barney Frank signed this, opposing this bill, as well as Bob
Filner, Dr. McDermott, Jim McGovern, and on and on and on. They all
think this is a bad idea.
Why do we think this is a bad idea?
We believe as the people's representatives--that would be us--that if
there is going to be a cut in Medicare that some faceless, nameless
board shouldn't have the right to do that and that the Congress would
advocate its, I believe, constitutional right to control spending. So
that's the reason we are having this debate now. This should never have
been in the health care bill.
Before I yield to my friend from Louisiana, with regard to this right
here, President Obama said on Medicare reform: Now, we believe the
reforms we propose strengthen Medicare.
That would be taking $500 billion out. I have a hard time believing
that's going to strengthen it when we've got 35 million more people
going into it.
It will enable us to keep these commitments to our citizens.
If we are wrong and if Medicare costs rise faster than we expect,
this approach--that's this IPAB--will give the independent commission,
which is this 15 bunch of bureaucrats that are going to make $165,000 a
year, I might add, the authority to make additional savings.
``Savings'' means we cut the money so you don't get care. Let me
interpret this for you: by further improving Medicare. You tell me how
that improves Medicare if you cut services to people and if they don't
get the care they need.
I would now like to yield to my friend from Louisiana, Dr. John
Fleming, a family practice doctor.
Mr. FLEMING. I thank the gentleman, my colleague, my fellow
classmate, Dr. Roe from Tennessee.
What I thought I would do is take just a moment and discuss the
historical aspect of Medicare and how we got to where we are today.
I began medical school only 7 years after Medicare began. In fact, my
colleague, Dr. Roe, I think you're probably of similar age and station
in life and also Dr. Gingrey who is here, and some of us may even
remember before that.
I watched Medicare grow, and the promise to physicians and patients
at that time was that government, if this is passed, would not mess
with anything. It would all be between doctors and patients. However,
by the time we got to the '80s, we found that couldn't be true. The
costs were exploding far beyond inflation, so the government--Congress,
in fact--began to go through a number of calisthenics in order to make
it work.
[[Page H3791]]
One was RBRVS, which was a formula by which doctors would get paid
rather than by what their costs were--then DRGs, diagnosis related
groups, to tell hospitals exactly what they're going to be paid
regardless of their costs, then CLIA, and then finally SGR, sustained
growth rate, which we're struggling with now.
It basically means, if we miss budget targets, doctors get across-
the-board cuts, which would be up to 25 to 30 percent today. Of course,
Congress keeps kicking the can down the road because Congress knows
that, if we were to actually implement the cuts that are required by
law, physicians would stop taking Medicare patients, and we'd have a
serious, serious problem.
So, if we fast-forward to today, why is it that we can't control the
costs to Medicare? I just have to bring it down to the bottom line
here. You control health care costs by one of two methods:
One is a market-based, patient-centered method in which the patient
is in the driver's seat, working in partnership with his or her health
care provider, making the decisions, but also having a responsibility
to control costs, which means the patient has skin in the game, meaning
through health savings accounts and things of that sort. They have an
investment in controlling costs for them. Therefore, they control costs
for the rest of the system. Fraud, waste and abuse is taken care of by
the user, the consumer in that case, making, in fact, the patient a
savvy consumer.
On the other hand, you've got a command and control, top to bottom,
which is what ObamaCare is. The only way that you can control costs,
Mr. Speaker, by doing that is to use a system like IPAB, this
independent payment advisory board--15 appointed officials who have
absolutely no accountability to anyone. They are unelected and unknown,
for the most part; and if you have a problem with their decision, there
is nobody to go to. No one is going to answer the phone.
So what does this relate to ultimately?
We get an inkling of where we're going with this through funds going
into this comparative effectiveness board, where studies will be
determined to see how effective various treatments are and for whom.
This comes down to what is already implemented in Great Britain, NICE,
which stands for the National Institute of Clinical Excellence. For a
lot of people, it's not so nice.
So how does it work? It goes like this:
There is a certain number of procedures, diagnostic-or treatment-
wise, and there is so much money that can be spent on those. Then there
are the needs, the people who actually need these. So a determination
is made based on a graph, if you will, or on a matrix as to someone's
value to society, as to the value of one's life. In fact, they actually
have a numerical value each year for what one's life is worth. They go
to this matrix, and they determine in Great Britain whether or not it's
worth that investment for them. That may mean a hip replacement, it may
mean renal dialysis, or it may mean that your cancer doesn't get
treated.
In fact, if you look at the comparative statistics between the
survival rates of prostate and breast cancer, which are two of the main
cancers we deal with in this country, against Canada, which also has
socialized medicine--and Great Britain--there is absolutely no
comparison. The death rates are much higher in those countries.
So today I would submit to you, Mr. Speaker, that if we continue down
the ObamaCare road, the implementation of IPAB, which is controversial
even among the left of the left and is very concerning for everyone, I
think this is sort of the last shoe to drop when it comes to the
creating of a government-run, socialized health care system in which
bureaucrats, rather than you and your physician, will be making
decisions about your individual life.
We very much want to repeal ObamaCare; but even if for some reason we
can't or until we do that, we desperately want to get rid of this IPAB,
which we view to be toxic for our health care system and for our
culture in general.
With that, I want to thank the gentleman for having this discussion
tonight, and I look forward to many more.
{time} 2010
Mr. ROE of Tennessee. I thank the gentleman.
We are blessed to have not only physicians in our Health Caucus but
registered nurses with years of experience in health care.
I would like to now yield to the gentlelady from North Carolina for
her comments.
Mrs. ELLMERS. Thank you, Dr. Roe. My comments are coming to you as a
nurse in health care. And, Mr. Speaker, I know you understand the
situation that we're discussing tonight as well.
The situation at hand tonight, there are so many to choose from. We
are all vehemently against ObamaCare, and we know that it must be taken
down. We voted to repeal it only to fall on the steps of the Senate
with nothing forward, so we are taking it apart piece by piece.
This Independent Payment Advisory Board, let's think about that for a
moment. One of the points that my colleagues have made is that this is
an independent board that is going to make decisions about your health
care, the American people's health care. If they receive Medicare, a
board somewhere in this country--I guess I would imagine here in
Washington--will come together. Your situation, your diagnosis will be
sent in, and they will convene and they will decide whether or not
you're going to receive the procedure that's being put forward or
whether your physician will actually get paid for that procedure. So
not only does this limit the health care that you might be able to
receive, but it also dictates to physicians what they can and cannot
do.
Imagine a physician sitting down with a patient and discussing the
possibility of hip surgery after a broken hip only to find out a day
later that that surgery cannot be done because this independent board
has decided that that patient's age is too progressed, or maybe the
patient takes too many medications, or they just feel that this isn't
going to be a positive outcome. Imagine that patient, imagine that
family looking into that doctor's eyes and saying, You cannot do my
surgery? You cannot fix my hip? I was a normal functioning individual 2
days ago, and now I cannot have surgery? This is what ObamaCare has put
in place. It has cut $500 billion out of Medicare, and it's going to
put a panel in place to limit the amount that can be spread around.
$500 billion, that is an incredible amount of money.
I just want to elaborate on my comments. The board, itself, is just
unbelievable. But let's face it. Right now in America, physicians are
closing their doors. Physicians are dropping patients with Medicare
because they simply cannot afford to do business any longer. All of
these things that we're facing right now--we talked about the SGR. We
talked about how physicians are being paid. There is so much
uncertainty in the health care world directly because of ObamaCare.
Hospitals are scrambling to figure out and crunch the numbers on how
they're going to be able to continue to provide care throughout the
years moving forward.
We must follow through on this legislation because it is going to
affect every American; it doesn't matter how old you are. This is just
a start. This is just a foot in the door. A board like this is
dangerous beyond all imagination. I applaud you, Dr. Roe, for all of
the work that you have done because this is the right step to take, and
I thank you.
Mr. ROE of Tennessee. Before the gentlelady leaves, let me just point
a couple of things out that concern me about this bill, and again, back
to my premise that health care decisions should be made between
patients and their doctor.
I have had patients in my practice who have been in their seventies
or eighties who are much healthier than someone who may be 40 years of
age. I have seen them. As a matter of fact, at home, one of the folks
who helps cut wood and clean and take care of the Appalachian Trail,
does trail maintenance, is 92 years old. And he's out hiking on the
trail, a very healthy gentleman. And we see this over and over.
This Independent Payment Advisory Board--and I'm going to run down it
real quickly just to let you know what authority this U.S. Congress
right
[[Page H3792]]
here, and I think this is a bipartisan agreement that we're doing away
with--it's created under ObamaCare. The Senate version. Not from the
House of Representatives, remember. It creates targets, and it requires
Medicare to make those cuts when those targets are reached not based on
quality and access but just a specific number. And it targets only
senior benefits and providers.
And here's the other little thing that's not known that we haven't
even talked about tonight. This IPAB will start out for the first 5
years affecting prescription drugs and physician providers, but at the
5-year mark, your hospital is also included in that. That means that
they can cut the payments to hospitals, and maybe many rural
hospitals--we fear, where I live in a very rural area in America--may
close because of this very provision right here. And it's targeted at
high-growth areas.
Seniors are shut out when IPAB selects Medicare cuts. And there is no
one they can go to to even complain about this. They can't go to their
doctor, and they can't go to their Congressman because the Congress
gave up its ability to control those decisions.
So one of my great frustrations is this Congress right here is giving
up its constitutional authority. And we are beholden to the people who
elect us to do what's right, not some nameless bureaucratic board.
I would now like to yield to the gentleman from Indiana, our new
Member here, Dr. Larry Bucshon, who is a cardiovascular surgeon. He
brings great expertise in cardiovascular surgery.
Welcome to the floor tonight, Dr. Bucshon.
Mr. BUCSHON. Thank you, Dr. Roe, for yielding.
I was a cardiothoracic surgeon just recently, last year, prior to
coming to Congress. I helped patients and their families make informed
decisions regarding the care they needed or the care their loved ones
needed. I provided a professional opinion based on the facts and
sometimes had to convey information and news to patients and their
families that they didn't want to hear.
Mr. Speaker, I came here to tell the American people the truth that
sometimes can be difficult to hear, but the American people deserve the
truth about what's happening with health care in this country.
The majority of my patients were Medicare patients. We know that
Medicare is one of the main drivers of our long-term systemic debt.
I want to reiterate that on May 13 the Medicare Board of Trustees
released their annual report on the program's financial status. In it,
the Medicare Trustees stated that the Hospital Insurance Trust Fund
will become insolvent in 2024. That's within 13 years, Mr. Speaker, 5
years sooner than last year was predicted.
And from a physician's standpoint, according to the American Medical
Association, one in three primary care doctors is currently limiting
Medicare patients in their practice, and one in eight physicians is
forced to refuse Medicare patients altogether due to the cuts already
that have been made in the Medicare program. And with the Medicare
population estimated to double by 2030 to approximately 70 million
Americans, imagine the access problems we're going to have then.
Today, the average couple that turns 65 has paid in over $100,000 to
the Medicare program but is receiving over $300,000 in benefits. Mr.
Speaker, this is not a sustainable model. Without significant reforms,
beneficiaries in the future are going to be at risk for limited access
to quality care they deserve and they count on, and ultimately face
rationing of care, waiting lists, and dramatic cuts to current seniors
based only on the cost, not based on what Dr. Roe has said, the quality
of care or what type of care they need, but based on the money alone.
Anyone promoting the status quo is dooming Medicare to failure, and
soon. It's coming up in 2024. Our plan doesn't affect any American over
age 55. They have counted on these benefits. But what it does is
preserves the program for future Americans. Again, the status quo is
dooming Medicare to failure, and soon.
Congressional Democrats and the current administration have offered
no plan to date except the Independent Payment Advisory Board that Dr.
Roe and others have been talking about in the ObamaCare bill; again, I
want to say again, 15 unelected Washington, D.C., bureaucrats making
decisions about Medicare, making decisions about the future of health
care for our seniors.
IPAB was thought to be maybe the silver bullet--if you listen to them
tell the story--to control costs. But what IPAB really will do is will
recommend cuts be made to the program--not savings, cuts, we're talking
about here. CMS will then make those recommendations to Congress unless
we get a two-thirds vote. They go in play. They start to happen. We
have given up, as Dr. Roe said, our congressional authority to do
something about the future of health care for our citizens.
This is a misguided approach that will, again, empower this group of
unaccountable bureaucrats to determine the type of health care you may
receive based on your age and your health. Health care decisions are
best made when left up to the patient and their doctor.
{time} 2020
You and your doctor and your family know what's best for you, not the
government.
And I want to finish by saying, for me, personally, Mr. Speaker, this
is about the future of health care for the American people. I fear for
what the future may hold--access problems, waiting lists, rationing of
care. Look at other countries that have socialized medicine. All of
these things are occurring. This may be based on your age, based on
your health. We don't know what they're going to be based on in the
future. It could be based on other factors.
Do we really want this type of health care for the American citizens?
I would answer ``no'' on behalf of my patients and on behalf of all
Americans and, especially in the case of IPAB, on behalf of our
American seniors.
Mr. ROE of Tennessee. Dr. Bucshon, let me throw this question at you
a little bit.
When you are seeing patients in your practice and basically those
health care decisions are made between you and them, when you look at
their relevant clinical data and their symptoms and you can see that
there is a lesion, maybe a heart surgery that you can do to help them,
and it's based on what their needs are--and I have never understood
since I have been in this Congress why health care has ever been a
partisan issue--have you ever seen a Republican or a Democratic heart
attack in your life? No. And I've never operated on a Republican or
Democratic pelvic cancer in my life.
Why in the world--so this is one where there is bipartisan support
because both sides of the aisle understand this is a very bad idea to
get on this slippery slope where you allow Washington bureaucrats, and
they can be called ``experts'' if they want to be, but they're going to
be making clinical decisions for people they never have placed an eye
on or a stethoscope on their chest.
And I, for one, am going to go down swinging on this because I
believe this affects all the people in this country, and potentially in
a very negative way, including the President, because he will be under
this same plan.
And, unfortunately, many people will probably try to opt out. We're
already seeing all of the opts out for the private health insurance
plans. But I, as a 65-year-old, can't opt out. I'm in. I'm going to be
part of this. And I know what my patients have wanted. And I just
wondered if you feel the same way I do about that.
Mr. BUCSHON. I feel exactly the same way, Dr. Roe.
For me, again, I've never seen a Democrat or a Republican patient. I
see a patient. In fact, in my practice as a heart surgeon, frequently,
I didn't even know what type of health care coverage that patients had.
For a doctor, like you or me, for any health care professional, what
matters is what's the right type of health care to provide for that
patient regardless of ability to pay. And what we're looking at here is
the potential where these bureaucrats may tell you, Dr. Roe, that you
cannot treat this patient based on their decision about whether or not
it's affordable for the American people. They're going to make
decisions based on money, not based on what needs to be done.
[[Page H3793]]
Mr. ROE of Tennessee. What I believe will happen in that situation is
that the Federal Government will have overpromised, and what we, as
physicians, will do is provide that care and shift that cost somewhere
else until there is nowhere else to shift it; because I know how if I
see a patient that needs care and they are 75 years old, let's say, and
they have needed surgery and I can improve the quality of their life
with that, we're going to do it in some kind of way. And you know;
you've done it. We just figure out later how to pay for it. That's not
the way to do this.
I thank the gentleman.
I'd now like to yield to the gentleman, my colleague and good friend
from Tennessee, Dr. Scott DesJarlais, also a new Member of Congress.
Welcome to the House floor tonight.
Mr. DesJARLAIS. Thank you, Dr. Roe. I appreciate you leading this
discussion.
I rise tonight in support of my many physician and other health care
colleagues that are in the Chamber tonight to discuss what I agree
should be a bipartisan issue. It has been so disturbing to me after
being in Congress just 5 months to see some of the disrespect that goes
on across the aisle on the floor back and forth. But when it comes to
our seniors' health care and health care in general, it's something I
take very personally.
I think I can speak for all of my physician colleagues, nursing
colleagues, our dental colleagues, that are in the Doctors Caucus, that
none of us went to medical school or nursing school or dental school to
become politicians. We went into those fields because we care about
people, and we're now here for that exact same reason. And to sit in
this Chamber and listen to accusations about this plan of Paul Ryan's
to help save Medicare is just more than I can stand to not get up and
at least share my thoughts. Because the bottom line is, as some of my
colleagues have mentioned tonight, the CBO states that the cost of
doing nothing is that Medicare will be broke in 9 years.
We've also heard that 10,000 new Medicare recipients are entering the
pool each and every day. We also have talked about the fact that the
average age of a Medicare recipient in 1965 in terms of life expectancy
was 68. So, at that time, you were expected to be on Medicare, Dr. Roe,
for approximately 3 years. Well, thankfully, due to advances in
medicine, men and women are both living on average at least 10 years
longer.
And I think Dr. Bucshon mentioned that the average couple pays in
about 100,000, or 109,000 into Medicare taxes but are extracting
343,000. So it doesn't take a mathematician or CPA to figure out that
this program has been severely mismanaged.
So when we step up as a conference and as conservatives to help save
the Medicare program but yet we watch, one after another, Members from
the other side of the aisle get up and use scare tactics on our seniors
saying that this plan is cutting their Medicare, that's just simply
untrue, and I think that we need--and we need to set the record
straight and people deserve to hear the truth as has been spoken here
tonight.
So I join you in my concerns that these are patients we're talking
about. These are people. And seniors deserve to know the truth that if
they are 55 and older, this plan does not affect their Medicare.
I know that the message has been unclear because I conducted a tele-
town hall just last week before the Memorial Day weekend, and we had
over 20,000 people call in. And the majority of the questions that we
were asked was, Why is my Medicare being cut?
So I think that we need to reiterate the fact that, if you're 55 and
older, there are no changes. If you're under 54, we're taking steps to
make sure that your Medicare will be preserved and saved and protected
for future generations. Anything else would be simply irresponsible.
Another claim that was disturbing to me was the special election in
New York. Some claim that the reason that the conservative candidate
lost was because of our attempt to save Medicare. And it was spun as
that cutting Medicare is something you just don't touch politically.
But I know a lot of us, including yourself, Dr. Roe, didn't come here
to play politics. We came here to do the right thing, and the right
thing is to tell the American people the truth. And what we're trying
to do is protect that plan.
The plan that is going to cut Medicare that has been mentioned
already is the ObamaCare plan. And that seems to have been pushed to
the back burner, and that's a dangerous thing. The IPAB bill that you
sponsored, and I'm proud to cosponsor, is a great example of that.
So we need to speak boldly and let the people know the truth so our
seniors are not afraid and scared by political tactics. I'm proud to
join you tonight in this discussion.
Mr. ROE of Tennessee. Will the gentleman yield?
Mr. DesJARLAIS. Yes, sir.
Mr. ROE of Tennessee. Let's go back to what you were saying, Dr.
DesJarlais, just a moment ago. We've discussed tonight this Independent
Payment Advisory Board in some detail, about what it does. We've also
discussed the Ryan plan, about what is in the future.
Well, why are we having that discussion? Well, we're having that
discussion because we see Medicare as it is being unfundable in 2024,
13 years from now, and that could be a moving target and change. So we
want to sustain this--I think both sides want to sustain Medicare as it
is.
So we know that people are 55 and older--if you're 70 years old now,
nothing changes. My mother is 88 years old and nothing will change for
her. But if you're 54, what happens to you? And why do we think that
will work?
Well, what happens to you at 54 is you're offered exactly the same
health care plan that I have and you have right now. Maybe you have. I
have Medicare part A. I would like to still have the plan I had. But
you'll have exactly the same plan that Dr. DesJarlais has. And what
plan is that?
Well, basically what the premium support is is that a person just
looks--when you turn 65, you'll look at your health care plan as if--
say the Federal Government is your employer. They pay that part of your
premium and you pay some other. Now, a higher-income senior like you or
myself, we're going to get a bigger chunk of that. So it's going to be
indexed based on what your income is. If you're 65 years of age and
you're--let's say you have multiple health problems and you're going to
have a more expensive plan, you'll pay less than that.
{time} 2030
If you are a low income senior, you will pay less than that. Why do
we think that will work? We've heard all these things about insurance
companies. Why do we think that will work? Well, the one single plan
that has ever come in under budget that the Federal Government runs
that I know of in health care is Medicare part D.
Now, whether you believe in doughnut holes or not doughnut holes, but
in the 10-year budget estimate, Medicare part D, which is the
prescription drug plan, was estimated to cost about $630 billion or
$640 billion over 10 years. It came in about $337 billion, a 41 percent
decrease. So when patients have choices, and people can go and it is
not one shoe fits all, one size fits all, people have choices to be
able to go out and pick out what kind of health care plan is best for
them--for me, I like a health savings account. Someone else may pick
another plan with a 20 percent copay. But those patients, those
Medicare recipients at age 65 will be able to make that choice, not
some nameless board deciding what kind of care you get.
Now, I will say that we do need to help control the costs. That's why
we're having this discussion. But again, I believe who should be making
those decisions are patients and their families and their doctors.
I want you to stick around for a minute because I've got some more
questions. But right now I would like to yield to Ann Marie Buerkle, a
great new member of our Health Caucus, a nurse, and an attorney. I
won't hold that against her. She is from New York, and welcome to the
meeting tonight.
Ms. BUERKLE. And I thank you. Thank you for this time.
Mr. Speaker, I rise here tonight, along with my colleagues and other
members of the Doctors Caucus, with
[[Page H3794]]
such concern about what is being proposed in the health care bill and
what is now law. I think we need to have a frank discussion with the
seniors, Mr. Speaker, because of the demagoguing and the fearmongering
that has gone on by proponents of this health care bill.
The fact is this health care bill, Mr. Speaker, is law. If it goes on
without being interfered with, Medicare as we know it will be
decimated. Five hundred billion dollars in cuts. That's going to affect
the seniors. That's the law, and that's what's in place right now.
What we are proposing on the Republican side is that: it is a
proposal. But it is a place to begin the discussion about how we are
going to save Medicare. And we must say over and over again to our
seniors this bill will not affect you if you are 55 years and older.
You will retain the exact same benefits that you have now. But we as
health care providers, we as those who went into health care as
advocates because we care about people, we want to protect and preserve
Medicare. That's what this proposal is that the Republicans put forth
in the budget.
I think, Mr. Speaker, the irony in all of this is those who pushed
this health care bill, organizations who pushed it on seniors and said
this is a great bill, and vote for this health care bill, they now have
waivers from the health care bill. They now are saying, well, it's good
for all of you folks, but it's not so good for us. That should raise
red flags.
So I am so pleased to be here tonight with my colleagues to be able
to have this conversation with the seniors, Mr. Speaker. They need to
know the truth. They need to know that we want to preserve Medicare. We
want to make Medicare better for us, for our children, and their
children. And that's what this is about.
I thank you for this time.
Mr. ROE of Tennessee. I thank the gentlelady.
Who more than anyone than the Health Caucus and the physicians caucus
wouldn't want to maintain Medicare? And one of my frustrations that I
have had in this body is, how can you solve a problem if you can't
discuss it? And right now we're not even able to discuss in a logical
way how we reform Medicare. And those Medicare changes, we've only
mentioned a few of them I might add. There are many others in here. In
2012, that will be just next year, there will be Medicare cuts to
dialysis treatment. Medicare cuts to hospice begin in 2012. And on and
on.
And it's one thing to have a problem. It's quite another to not even
be able to discuss the problem. So let's just summarize it briefly
here, and then I will yield to you that are still here. We had a
problem in this country with health care costing too much and a group
of people that couldn't have access to care and a liability crisis. We
did nothing with this ObamaCare bill to curb the costs.
How we helped pay for the Affordable Care Act is we took money out of
Medicare. And to control spiraling Medicare costs, we set up a board,
this bill set up--not we, but this bill set up a board called the
Independent Payment Advisory Board. Most people, including many
physician friends of mine, don't have any idea what this is. It is a
very bad idea. It's not a good idea in England, where it's being used.
That's where the group that wrote this bill got it.
And you know why they want this? Why the people that signed this, the
Senate and others? Because they don't have to be accountable. They can
blame somebody else when needed care isn't given. Oh, it isn't my
fault. This board did it. Well, it is our fault. If we give up that
right, it's our fault if those cuts occur to our seniors and we cannot
provide the care that they need.
So why we are having this discussion is we have got a budget problem.
We have got a $1.6 trillion budget deficit in this country we have to
close. And how do we do that? We look forward and see where are the
costs going forward? As I mentioned, when the President of the United
States is 65 years of age, 15 years from now, four things will take up
every tax dollar that we take in. So it's mandatory that we begin now
solving this problem.
I think the plan is a great plan, the Ryan plan. It allows people to
plan. It also, I believe, will allow you more choices. And I believe
that that's exactly what the American people want in health care, is
not someone up here in Washington making those choices for us and
our patients, but the patients and the doctors making those choices.
I will yield to the gentleman, Dr. DesJarlais, if you would like to
have some comment about that.
Mr. DesJARLAIS. You are correct, and I agree with everything you
said. The point that a lot of folks made on the campaign trail is there
is simply too much government medicine. There are unsustainable costs.
I know our colleague from New York, Ann, as an RN, probably recalls the
day where she spent more time on patient care than documentation. And
now most nurses will acknowledge that it's just the reverse; they spend
much more time on paperwork and bureaucratic issues than taking care of
patients.
And I think that it's important that we remember that just a short
time ago, when the Affordable Health Care Act, more commonly known as
ObamaCare, was being pushed forward, Americans vehemently opposed this
bill. I don't want them to forget all the reasons why they opposed it.
They didn't ask for it. We can't afford it. And we don't need it.
There were approximately 30 million uninsured people, according to
the President, at the time. But yet up to 75 percent of people rated
their health care as good or excellent. So we're taking a system that
has flaws and excessive costs, and trying to completely turn it upside
down with this Affordable Health Care Act, which we all know is going
to lead to rationing of care, decreased quality of care, and increased
costs. You can't add people to a system and decrease costs without
rationing care.
So I think it's important that the people stay engaged and speak out
and acknowledge that they want the relationship to be between
themselves and their doctors, and not between Washington bureaucrats
such as what the IPAB is proposing. That's exactly what we're going to
see. And we need to stand firm. The American people don't need to
forget why they were opposed to the ObamaCare bill in the first place.
Mr. ROE of Tennessee. I thank the gentleman.
I yield now to Congresswoman Buerkle from New York for closing
comments.
Ms. BUERKLE. Thank you very much.
I think it's so important to have this conversation with the seniors.
We want to preserve your relationship with your physician. There is
nothing more sacred than that relationship. This IPAB panel will
disrupt that. It will come right between you and your physician.
It's so important that we get the facts out, that we have this
conversation with seniors, that you understand that we are fighting to
preserve Medicare, fighting to preserve Medicare as we know it, and
Medicare and the patient-physician relationship.
With that, I thank you for this opportunity.
Mr. ROE of Tennessee. I thank the gentlelady.
I will finish by saying that I know that the Health Caucus and the
physicians caucus are totally committed to this bipartisan bill, this
repeal of this IPAB.
Again just to summarize what it is, it is 15 bureaucratically
appointed people approved by the Senate, submitted by the
administration. I don't want a Republican President or a Democrat
President appointing these people. What they will do is make a decision
based totally on cost. The Congress then requires a two-thirds override
to change or they have to make the cuts, we have to make the cuts
someplace else. CMS will be in charge of how those cuts are taken care
of.
{time} 2040
I think that responsibility, that fiduciary responsibility, is right
here in the elected body that meets with the people.
I thank the gentleman for being here tonight, I thank the gentlelady
for being here, and I yield back the balance of my time.
____________________