[Congressional Record Volume 157, Number 112 (Monday, July 25, 2011)]
[House]
[Pages H5481-H5487]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
GOP DOCTORS CAUCUS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from Georgia (Mr. Gingrey) is recognized
for 60 minutes as the designee of the majority leader.
Mr. GINGREY of Georgia. Mr. Speaker, I thank my leadership, the
majority leader on the Republican side, the Speaker of the House, and
our conference chairman, Representative Jeb Hensarling, for giving us
the opportunity--us, the House GOP Doctors Caucus--to have the Special
Order hour this evening.
It's kind of convenient, Mr. Speaker; my colleagues on the other side
of the aisle, the well-respected Members, my friends from the
Congressional Black Caucus, were talking about the budget and what
we're trying to do with regard to moving forward, talking, of course,
about safety net programs and entitlement programs, such as Social
Security and Medicare. And that's a great segue into the topic of our
discussion this evening because it's going to be about the Medicare
program.
We, on our side of the aisle in the Republican-passed House budget,
take a responsible approach to solving the Medicare crisis, which the
trustees have said to all Members of Congress--not Republicans, not
Democrats, not House Members, not Senate Members, but all of us--that
according to the trustee report, by the year 2024, if we don't do
something about the Medicare program as it currently exists, as it's
currently funded, the amount of spending that occurs year after year--
and will only increase as more and more of our baby boomers are
reaching age 65--if we don't do something about that, then that
Medicare part A hospital trust fund is not supported by any constituent
premiums, it's going to go broke. It absolutely is going to go broke.
So I say to my Democratic colleagues who just spoke, the
compassionate thing--and I know they have great compassion for those
who, maybe through no fault of their own, can't help themselves; but
the compassionate thing, Mr. Speaker, is to save the program, to
guarantee, preserve it for current Medicare recipients. Indeed, even
for folks that are only 55 years old today, Medicare, as we know it,
would be protected, would be strengthened for all of those individuals.
And by the time those who are 55 years old today become 65, in 10
years, around 2024, there would be something like 65 million seniors
and a smaller number of disabled individuals in the Medicare program as
we know it. They would be in that Medicare program as we know it for
the rest of their natural lives. And thank God, because of good health
care in this country, women, I think, are living on average to age 82
and men maybe to age 78. So these 65 million people will be on Medicare
for a long time. Medicare as we know it.
My colleagues didn't mention this in their hour; but what we do in
our budget is go forward with a plan for younger folks--indeed, even
for my grandchildren, my 10 grandchildren, the oldest two are 13-year-
old twins--but let's say them, or 25-year-olds, 35-year-olds, 45-year-
olds, indeed, we create the adult approach, the mature approach to
solving the Medicare problem so that it will be there for them instead
of nothing come 2024. And maybe some of us have paid for 25 years that
FICA tax that's taken out of our paychecks every week or every month.
[[Page H5482]]
So I say to my friends, this idea that President Obama has and the
leadership of your party of just simply kicking the can down the road
doesn't get the job done. It's what we call sometimes--and I know all
of us know the expression ``whistling past the graveyard,'' in other
words, pretending that a problem doesn't exist. And that's an
unconscionable approach.
I am very pleased tonight, Mr. Speaker, to have a number of my
colleagues who have joined with us. Some of them are a part of the
House GOP Doctors Caucus. We are mostly medical doctors. There are a
number of registered nurses in our caucus. We have a lot of health care
providers. There are dentists. But in the aggregate, the members of the
House GOP Doctors Caucus are medical professionals who spent a lot of
their lives practicing medicine and providing care, indeed, under
Medicaid and the Medicare programs, seeing those patients mostly at a
financial loss, but still very willing to try to help those folks who
need us to be there for them in these safety net programs.
I think in the aggregate, the membership of the House GOP Doctors
Caucus may have over 350 years of clinical experience. Some of us are
getting a little long in the tooth and a little gray by the sideburns.
But we are now Members of Congress, and we are trying to do things for
our constituents and the seniors of this great country of ours to make
sure that we preserve and protect programs like Medicare and Medicaid.
And that's what this is all about tonight.
I want to first yield to my friend from Tennessee, my co-OB/GYN
doctor. Dr. Phil Roe has been a Member of this body now for 4 years and
has been a great asset. And I know that Dr. Roe has a bill that he
wants to address concerning some problems that were enacted under
ObamaCare.
I would gladly yield to Dr. Roe from Tennessee.
Mr. ROE of Tennessee. I thank the gentleman for yielding. It's a
pleasure to be here tonight.
Mr. Speaker, I go back to when Medicare first began. In 1965, there
was a problem identified in America where we had a group of our
citizens, as they became 65 years of age and older, that didn't have
access to quality health care. So a plan was put in place, along with
Medicaid for our poor citizens at that point, to access quality care.
In 1965, the Medicare program was a $3 billion program. There was no
Congressional Budget Office at that time. The estimates were in 25
years that this would be a $15 billion program. It actually turned out
to be over a $100 billion program in 1990. In 2010, it will be
somewhere about $550 billion.
We also have, as has been pointed out in our previous hour by our
friends from the Congressional Black Caucus, that we have a tremendous
deficit. We're borrowing 42, 43 cents of every dollar that we spend in
this country. So that's why the discussion was started.
I came to Washington--really, I practiced medicine, as Dr. Gingrey
said, for over 30 years and realized that we had a serious problem not
just in Medicare but in health care. So we came to work on health care
reform. In the Physicians Caucus in the previous Congress, there were
nine of us in the caucus. Not one of us was consulted on the Affordable
Health Care Act. I mean, decades worth of experience, over 200 years of
experience in the Congress at that time, and no one--not one of us--was
actually consulted.
{time} 2040
The way I looked at the problem in our health care system was we had
three problems:
One is we had a problem where the system was too expensive. When you
go to the doctor, it cost too much money to go see a physician. Number
two, we had a group of people out there who didn't have affordable
health care coverage. Maybe the husband is a carpenter, as in our area,
maybe the wife worked at a local diner or somewhere else that didn't
provide insurance coverage. Thirdly, we had a liability problem in this
country.
So what did we do? We had an over 2,000-page bill that got through
the House and got to the Senate and failed. The Senate dusted a bill
off that was 2,500-plus pages, that never went through a committee
hearing, that nobody on the House had a chance to do, and I know that
the three physicians that are here tonight all read that bill. When I
read that bill, Mr. Speaker, I found some things in there, as did my
colleagues, which greatly worried us.
How do they fund this bill? Only Washington could fund anything like
this. Dr. Gingrey has pointed out that we're trying to save Medicare.
Medicare is a system that the Congressional Budget Office says by 2020
will be out of money; 2024, by the actuaries at CMS say will be broke.
There are four parts of Medicare:
Medicare part A, which is paid for by your premiums. That's your
hospitalization.
Medicare part B, that's doctor services and some lab services. That's
only funded 25 percent from your premiums. The other 75 percent comes
from the general fund, the taxpayers.
Medicare Advantage, which was cut drastically by the Affordable Care
Act.
And Medicare part D, which is a prescription drug plan, also is only
funded 25 percent by our premiums. I'm a Medicare recipient myself, as
of last year.
So what did the administration do and the Senate do to fund this
Affordable Health Care Act? They took out of an already underfunded
program, as I just pointed out, $500 billion, and Dr. Gingrey just
pointed out moments ago that we're adding about 3 million baby boomers
per year, so 10,000 per day or more. We're adding millions of new
recipients while pulling out of that over $500 billion, and we call
this ``saving Medicare.''
We're not talking about tonight, on our hour, the budget impasse.
We're talking about what's already been passed. And one of the things I
found in there, Mr. Speaker, was a very little known board called the
Independent Payment Advisory Board. Before, Medicare has had this board
in there, which was strictly that, MedPAC. It was an advisory board to
Congress, to say, hey, we've got some problems here with funding; maybe
we should look over here. Congress would then have the ability to make
those decisions.
Mr. GINGREY of Georgia. If the gentleman will yield, I would like to
call my colleagues' attention to this poster, because this is exactly
what Dr. Roe, Mr. Speaker, is talking about now, this IPAB, Independent
Payment Advisory Board. I want all my colleagues to see this poster
because this is what Dr. Roe is taking us through at this point.
Mr. ROE of Tennessee. Mr. Speaker, what I did when I read this, I
looked at it and thought, how was this created and why was it created?
This board has 15 members that are appointed by the administration,
by the President, and, quite frankly, I don't want a Republican
President or a Democratic President doing this. These people are then
approved by the Senate for a 6-year term. They're paid about $165,000 a
year.
And what is their charge? Well, their charge is, is if Medicare
spending hits certain targeted limits, that cuts occur first to
providers and for prescription drugs and then later to hospitals. What
worries me about this is right now we have a problem--and Dr. Paul
Broun is here tonight, who's a primary care physician--with our
patients with their Medicare, finding a physician to take care of them.
What happens is if you hit these targeted limits and physician
payments are cut, access to care is going to be cut, quality of care is
going to be cut, and, thirdly, the cost to our seniors is going to go
up. What also worries me is that this board very much mimics the board
that's in England called NICE, the National Institute of Clinical
Excellence. This board makes recommendations to their health board
there about what care is provided to patients. President Obama has
taken this board, he's going to use this, and he actually wants to
increase the power of it to help hold Medicare costs down. Ultimately
what will happen, when you have more demand for services than you have
money to pay for it, is your care will be rationed. That's the fear
that we have.
Our concern is, and I've gone to seniors in my district and been very
clear and pointed this out at town hall meetings and have held town
hall meetings with seniors and said, We want to provide you quality
access of care. That's what I do as a doctor. I want to be able to see
those patients and have them
[[Page H5483]]
help us solve this problem. I think that's the issue that we have, Mr.
Speaker, is how do we provide the care for the money we have and
provide quality of care and access for our patients? I am extremely
concerned that the IPAB will do just the opposite of that.
Mr. GINGREY of Georgia. I thank the gentleman very much for his
presentation on the IPAB, that board which Dr. Roe describes, Mr.
Speaker and my colleagues. Again, I'm going to refer back to a previous
poster that I wanted to present as Dr. Roe got into talking about the
Democrats' solution to so-called ``save Medicare.''
They wanted initially to ignore the problem, the fact that Medicare
is going broke. As I pointed out in my opening remarks, Medicare today
will be broke in less than 10 years. Without action, the Social
Security trustees report that Medicare seniors will either see a 22
percent benefit cut or workers will see a 22 percent hike in payroll
taxes. So basically, not really completely ignoring the problem, but
what the Democrats want to do is create this so-called IPAB board,
which Dr. Roe describes. They say there will be no rationing, yet
they're restricted in the recommendations that they can make in regard
to cuts, and those cuts will be to providers; they will be to
pharmaceutical companies that provide the drugs that so greatly keep
people alive today that in the past were ending up in the emergency
room with strokes because of uncontrolled high blood pressure, needing
amputations because of uncontrolled diabetes or needing to be on a
dialysis machine because of uncontrolled renal disease. All of these
have been helped by Medicare part D. So, clearly, the plan that the
Obama administration and our Democratic colleagues have is not for
saving Medicare.
At this time, let me yield the floor to my colleague from Georgia,
fellow physician and member of the House GOP Doctors Caucus, Dr. Paul
Broun.
Mr. BROUN of Georgia. Thank you, Dr. Gingrey. I appreciate you
yielding a few minutes.
I wanted to kind of break all this down so that the American people
could understand very clearly what we're talking about tonight. I've
got a little poster here that shows President Obama's and the
Democrats' Medicare solution.
This is their Medicare plan. They deny the problem. They deny the
problem that the gentleman from Georgia was just talking about with
this huge, huge problem, where Medicare is going to go broke in a
matter of just a decade. They want to delay any fixes. In fact,
Medicare as we know it today exists no longer. ObamaCare took care of
that. And they want to destroy it. They will destroy it by letting it
go broke.
So this is the Democrat Party's health care plan: Deny It, Delay It,
and Destroy It by letting it go broke.
Just recently, one of the government accounting groups released
something that should scare every senior, every taxpayer, and every
American.
{time} 2050
They said that Medicare, within the next couple of decades--that's a
lot of zeroes in this; 63 and a lot of zeros. This is the unfunded
liability of Medicare over just the next several decades.
Mr. GINGREY of Georgia. If the gentleman will yield, that would be
$63 trillion, if I'm not mistaken.
Mr. BROUN of Georgia. Well, I just tried to make it so that the
zeroes didn't confuse folks. The unfunded liability for Medicare is $63
trillion. This is unsustainable. There's no way to take care of this.
We need to shore up Medicare. We need to make sure that it's
strengthened so that our future generations, not only the senior
citizens today, can continue to get Medicare, but the future
generations also.
Now, what does $63 trillion of unfunded liabilities mean to everybody
in this country? I mean, that's too big a number for everybody to
really consider. So I broke it down to every family in the United
States. Every family's part of this $63 trillion of unfunded
liabilities for Medicare, as it exists today, is over $500,000 per
family, $500,000 per family of unfunded liabilities for Medicare just
in the next several decades.
Now, I don't know about most families, but my family can't afford to
pay $500,000 and neither can the government.
Mr. GINGREY of Georgia. I've got a poster that points out just
exactly what the gentleman from Georgia, Dr. Broun, is saying.
If you look, colleagues, at the bottom of this poster, CBO estimates
individual and corporate income tax rates would have to rise by 90
percent through the year 2050 to finance Medicare and Medicaid. And if
Medicare is not fixed, millions of workers today will lose the money
that they have invested. And, indeed, they have invested with that
payroll tax over those many years of their employment.
Mr. BROUN of Georgia. Thank you, Dr. Gingrey. What the American
people need to understand is that we need to strengthen Medicare and
Social Security for future generations.
This picture right here is a picture of my two grandchildren, Tillman
and Cile Surratt. I love these two kids greatly. They won't see
Medicare, and they're going to see an America that's quite different
from the one that we see today if we don't make some major changes,
major changes in Medicare and Social Security. If we don't shrink them
and make them economically viable for my grandchildren, that are 6 and
7, my grandchildren won't see Medicare. They won't see Social Security.
And, in fact, people who are 45 or 50 today won't see Social Security
or Medicare if we don't strengthen them, if we don't do the necessary
hard work of bringing about those changes to strengthening Medicare and
Social Security to make them economically viable.
I hear our Democrat colleagues all the time talk about it's the
children. I've heard our former Speaker talk about it's about the
children so much that I wanted to throw up.
But the thing is, when you talk about it's the children and their
future, we've got to deal with this debt. We've got to deal with Social
Security and Medicare and make them economically viable by
strengthening them, by making them so that they're still available when
my kids get grown.
And we're going down a road right now--this President and the
Democrats in the Senate and the Democrats here in the House have a
three-word plan. Their plan is a three-word plan for Social Security
and Medicare: deny the problem. They're denying it. They're delaying
doing anything about it. And they're going to destroy it, because both
Medicare and Social Security are going broke if we don't strengthen it,
if we don't make it economically viable, if we don't do the necessary
hard work that this Congress and Republicans are trying to do.
But what do we hear from our colleagues on the other side?
Demagoguery and trying to play politics. It's time to stop the
politics. It's time to stop playing games.
The American people deserve the truth. No more accounting gimmicks.
No more playing with numbers. No more double talk, political speak.
This is the Democrats' plan--deny it, delay it, destroy it--for
Medicare, Social Security and this country economically. We've got to
change it, and that's what Republicans are working very hard to do.
Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman very much.
And while we're on the ``D'' word, if you will, deny, delay, demagogue,
I'll use another, D word, and it's really the softest thing I can say
about the Democrats' plan, and that is disingenuous.
For them to stand up, or for the President to stand up and say that
he's going to fix Medicare, at the same time, Dr. Roe talked about this
earlier in the evening, I'm going to refer back to him in just a few
minutes, but at the same time, in the creation of a whole new
entitlement program in March of last year, we know it as ObamaCare.
Officially, I guess I should say, it's called the Patient Protection
and Affordable Care Act. I think it's the unaffordable care act in that
it cost $1 trillion.
But where did the money come from to pay for this new entitlement
program that really has nothing to do with seniors?
Well, my colleagues, look at this poster to my left, your right.
Here's where at least half of the money came from. Cutting Medicare,
cutting Medicare by $575 billion. I mean, right out
[[Page H5484]]
of the Medicare program. That included home health care; it included
Hospice. But the biggest cut was $130 billion, that's bullet point No.
2, $130 billion from the Medicare Advantage plans. And my colleagues
know this, and I'm sure they'll want to comment on it, of the 47
million people, 45, 47 million people today who are on Medicare, about
seven to 10 million of them receive their medical care on the Medicare
Advantage option, which gives them more benefits, more bang for the
buck; and it covers a lot of preventive services that are not given,
not offered in traditional Medicare as we know it.
So that cut, $130 billion, that's something like a 14 percent cut out
of that program. That means that at least half of these seniors are
going to have to go back into Medicare as we know it and get a lesser
benefit.
In fact, it's been said by the actuary of Medicare, Richard Foster,
on April 22, 2010, that 15 percent of hospitals, nursing homes, and
home health care providers will close because Medicare pays less under
ObamaCare.
Mr. BROUN of Georgia. Will the gentleman yield?
Mr. GINGREY of Georgia. I want to yield just briefly again to the
gentleman from Georgia before I yield some additional time to my
colleague, our cochair of the House GOP Doctors Caucus, the gentleman
from Pennsylvania.
Mr. BROUN of Georgia. I thank you for yielding just a moment to me
because I want to add to that statistic; 15 percent of hospitals,
nursing homes, and home health care will close because Medicare pays
less under ObamaCare. That's absolutely true. A lot of those hospitals
are going to be in rural communities because rural communities are
going to be hit the hardest.
Right now I'm a primary care doctor. As the gentleman knows, I'm a
family doctor. I've done general medicine for almost 40 years now.
The American Academy of Family Physicians said right now, today, one
in eight family docs will not accept Medicare at all. Only one in three
doctors, according to the American Medical Association limits how many
Medicare patients that they take.
{time} 2100
That is a marked rise. Back in 2004, only 6 percent of all doctors
limited their Medicare patients. In 2008, it went up to 8 percent. Now
it's almost one-third limit the amount of Medicare patients that they
see. And one in eight family docs don't take Medicare at all; they
can't afford to because of the low reimbursement rates. And IPAB is
going to hit those folks that much harder.
During our Special Order when we were discussing ObamaCare I made a
comment that somebody may have a free health care card in their pocket,
but it's going to be as worthless as a Confederate dollar after the War
Between the States because nobody will take it, and that's exactly
where we are headed. So I just wanted to add that.
Mr. GINGREY of Georgia. I thank the gentleman from Georgia.
I now yield to my cochair of the House GOP Doctors Caucus, the
gentleman from Pennsylvania, Dr. Tim Murphy.
Mr. MURPHY of Pennsylvania. Thank you, Dr. Gingrey.
I want to talk for about 5 minutes here on an issue that you brought
up, Dr. Gingrey, about the $575 billion from the Medicare program that
also cuts $135 billion from Medicare Advantage plans, forcing over 7
million seniors out of their current Medicare plan unless they pay
more.
I wanted to help point out that while the President and others are
out there saying we're trying to cut Medicare and what it does, nothing
could be further from the truth. What we're trying to do here is show
how if Medicare is handled differently--not by IPAB or a board of
bureaucrats, but by letting the plans work and letting doctors work,
they can drive down cost by improving quality.
Let me explain what happened in the Medicare Advantage program that
was gutted in the health care bill that was passed out of the House.
Well, seniors are able to make choices right now--with Medicare, they
can get Medicare part D drug coverage and supplemental Medigap policies
with the Medicare Advantage plan. What the Medicare Advantage plan does
is allows some management of diseases that are chronic illnesses, which
is very different from the current fee-for-service where somebody would
get paid based upon the number of procedures they do. Under the regular
Medicare fee-for-service plan, hospital readmission rates--that's 30
days post-discharge for the country--in 2007 was over 18 percent, but
the average readmission rate across Medicare Advantage was 13.5
percent. Why? Because it allowed physicians and nurses to talk to the
patient, to follow the patient, to work with the disease, to make sure
whatever complication they had--an infection or heart disease or lung
disease or an orthopedic problem--to pay that physician and staff to
work for them.
Here is another interesting thing: The Medicare fee-for-service rate
of preventable emergency department visits was 15.5 visits per 100
beneficiary months in 2007. But the average rate across Medicare
Advantage plans and study was two visits per 100 beneficiary months--86
percent lower than Medicare's national average.
Here's another point: Actual cost for the drug plan we know, Medicare
part D, comes out 40 percent under budget because insurers are forced
to compete with each other. Now imagine this: Seniors can choose
Medicare supplemental plans, and those plans compete for seniors'
coverage. The drug plans compete for seniors' coverage. What happens if
seniors are allowed to also choose their main Medicare plan? Well,
listen to this additional issue about drugs: The Intercontinental
Marketing Services, IMS--I should say this comes from the Deloitte &
Touche Web site--the Institute for Healthcare Informatics study
concluded: The average cost for drugs frequently used by Medicare
prescription drug part D beneficiaries declined since the
implementation of the program in 2006. Between January, 2006, and
December, 2010, for the top ten therapeutic classes, part D drugs
decreased by over one-third, from $1.50 to $1. The study projected that
costs will continue to decline by 57 percent from 2006 to 2015,
reaching 65 cents by the end of 2015. That's a massive decline. Why?
Because plans are competing against each other. Plans innovate, they
try and do things better and smarter, with better quality, and they ask
seniors to choose their plan. Seniors then, by signing their name, can
choose a plan that works for them.
Why not allow seniors to have Medicare choice with their major
Medicare plan? Why not allow seniors to have Medicare Advantage instead
of gutting the program? This is the very thing we're saying; by
improving efficiencies and qualities within the program, a lot of cost
can be reduced. It can't be reduced, however, by the status quo. As you
pointed out, Dr. Gingrey, and my colleagues, keeping the status quo
means there won't be Medicare. There will be Medicare for those
currently on it. It won't be there for their children and certainly not
for their grandchildren. We want to save Medicare, but you can't save
it by the continued way it's being done now.
Quite frankly, the system that's being done out there now to frighten
seniors, to say that if we don't simply pass this debt limit increase
without strings attached, that seniors won't have Social Security or
Medicare, this is such a falsehood. And it's a serious problem in two
ways: One, it's serious because it's telling a falsehood to seniors;
and two, it looks down upon seniors thinking that they're susceptible,
not smart enough to figure out that this is false.
It is so important, and we want the American public to understand: We
are trying to save Medicare because we do want it to be there for the
future, but it means making it more efficient. And what's wrong with
letting doctors be the ones who call the shots on improving care?
Mr. GINGREY of Georgia. Mr. Speaker, I appreciate so much the
gentleman from Pennsylvania, who has spent his professional life
providing medical services to his patients, just as so many of the
doctors in the caucus.
Talking about this cut to Medicare Advantage, as Dr. Murphy described
that method of getting care, Mr. Speaker, it is exactly what we
continue to talk about today of wanting to reward health care based on
quality and
[[Page H5485]]
not necessarily quantity. Just strictly fee-for-service--the number of
times you go to see a provider and that provider getting paid, albeit a
small amount--is not a very efficient way. And certainly a much more
efficient way--and we continue to talk about this--is to provide
quality of care. And Dr. Murphy correctly pointed out, Mr. Speaker,
that's exactly what Medicare Advantage does; it offers a quality of
care and a wellness provision. Were we paying these plans a little too
much for those services? I don't know, maybe, possibly. But if you're
going to cut any amount, certainly 14 percent, $130 billion, is too
much because that guts those plans.
But whatever savings you get out of Medicare, shouldn't they stay in
the Medicare program, if you believe the Medicare actuary and the
trustees that say that if we don't do something by 2024, the trust
fund, the hospital trust fund is depleted, there is no more Medicare as
we know it or any other way. So if you're going to find savings in the
Medicare program, you don't take that money, $575 billion, and use it
to create a whole new entitlement program so that everybody in the
whole country has health insurance whether they need it or not, whether
they want it or not. I can think of a lot of things in the Medicare
program where this money could be well spent. How about long-term care,
extended care facility coverage to keep that money in Medicare?
Instead, what ObamaCare comes up with is something called the CLASS
Act--which is a classless act, Mr. Speaker, because it is a misleading
program that can't fund itself, that absolutely can't fund itself.
So there are so many things about ObamaCare and Obama's plan to save
Medicare--which really, as Dr. Broun pointed out, is no plan at all,
other than what Dr. Roe has pointed out in regard to this Independent
Payment Advisory Board that is going to cut spending for the most
vulnerable seniors, those that are the sickest, those that incur the
highest cost. And they say there is no rationing, but it will indeed,
as my colleagues have pointed out, Mr. Speaker, be denial of care.
At this point, I would like to yield back to the gentleman from
Tennessee to talk a little bit more about that.
Mr. ROE of Tennessee. I thank the gentleman for yielding.
Mr. Speaker, I do want to point out one thing that Dr. Gingrey just
pointed out, which was one of the reasons that the American people
don't trust politicians. The CLASS Act may be a good idea. The CLASS
Act began this year where you have some money taken out of your
paycheck and put in a savings account over here. It's supposed to be
about $87 billion in 5 years, and we can't get it out until that 5-year
period of time occurs and this money has accumulated. At that time it's
supposed to pay for long-term care, about $50 per day. But guess what
happens, Mr. Speaker? What happens is that we borrow the money out and
spend it on current health care and call this an asset.
{time} 2110
We have counted that money twice; two times. We have done that with
Social Security already. I find this absolutely offensive, on August 2,
10 days, about a week from now, we have had the audacity to tell people
who have paid into Social Security for 40 or 50 years they will not be
able to get their check. Why? Because the Federal Government has spent
that money. We are doing the same thing again with the CLASS Act. There
has already been legislation to perhaps overturn that.
I want to get back to something a little more basic, and that is to
the examining room with the patient. The people who should be making
health care decisions should be a family, the patient and their
physician, sitting around and talking about what their options are, not
some 15 people appointed bureaucrats in Washington, D.C.
By the way, Dr. Gingrey and Mr. Speaker, we have over 190 cosponsors,
including a bipartisanship cosponsorship to the repeal of IPAB,
including every physician, every health care provider on the Republican
side and Dr. Christensen, who was down here just a moment ago on the
Democratic side. It is a bipartisan agreement that we should overturn
this. The American Medical Association believes it should be
overturned. Over 270 major medical organizations see through this as a
very bad thing for patients.
The reason we are worried about it, we have heard Dr. Broun speak
about it, and we have heard you speak about it, Mr. Speaker. Ultimately
it will affect the quality of care. Why? Because if you don't have
access to your doctor, the quality of your care will go down.
The other thing I want to mention is we talk about changing Medicare.
Quite frankly, I'm going to go through just a few of the things that
already have been changed in this Affordable Care Act. Beginning in
2010, there were Medicare cuts to hospitals, long-term care and
inpatient rehabilitation services.
In 2011, it has been pointed out that the Medicare Advantage plans,
the seniors did get a $250 check to fill the doughnut hole. The
wealthier seniors began paying higher premiums for Medicare part D;
that's in 2011. Medicare imaging cuts, Medicare reimbursement cuts:
when seniors get a CT scan or an MRI, Medicare cuts for durable medical
equipment began, ambulance services, ambulatory service centers,
diagnostic labs, durable medical equipment, wheelchairs. Seniors
prohibited from purchasing power wheelchairs unless they rent for 13
months.
In 2012, elimination of the deduction for the employer expenses for
Medicare drug subsidies, that is how they raised $4.5 billion. And that
is not to improve our current underfunded Medicare plan. That is to
create another entitlement. Medical expense deduction, you raise the
threshold for deducting medical expenses from 7\1/2\ to 10 percent.
That raises $15 billion to be spent elsewhere. That is a tax right
there.
Hospice care is being cut. Dialysis, Medicare cuts to dialysis
treatment will be cut in 2012.
In 2014, this Independent Payment Advisory Board begins. And, by the
way, they are getting, I believe it's $12 million a year to fund this
right now. If there is any way we can cut off funding to that board
right now, it should be done.
In 2015, a permanent cut to the payment rate to home health agencies.
On and on. We have felt these cuts because they haven't come to
fruition yet. What we are trying to do with Medicare is to salvage the
program for future generations.
A promise made is a promise kept. If you are 55 years and older, with
Social Security and Medicare, nothing happens. I hear all the time
about a voucher. This is a voucher system and so forth. Here is what a
voucher is. A voucher is when I go to my mailbox, something comes that
says this has so much value. You take this piece of paper and purchase
something with it. Premium support is where the Federal Government,
through its massive ability to go out and negotiate prices, exactly
like they do for you and me, Mr. Speaker, in our health care plan here
in Congress, they negotiate with numerous companies through the Federal
exchange. Our plan is called the Federal Employees Health Benefit Plan,
and they negotiate the best price. And what happens is all during the
campaign, the last 2 years I have heard seniors and others say,
Congressman, I want exactly what you have. That is exactly what we are
trying to do.
A higher income senior like myself, and you and the others in this
room, will pay a higher premium. And folks with preexisting conditions
and lower income will pay much lower. And they will have those choices.
As Dr. Murphy pointed out, why do we think that will save money and why
are we doing it. It has been pointed out that it is a catastrophe
waiting to happen if we do not do something.
Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman from
Tennessee, Dr. Roe. What he was describing, if I can elaborate a little
more on that point to our colleagues because I think some still are
confused, possibly on both sides of the aisle, but clearly this plan
that is put forth in the House budget, and it's the Republican budget
because we are in the majority. It is sometimes referred to as the Paul
Ryan budget because he is chairman of the Budget Committee. It is
sometimes referred to as the Path to Prosperity.
But in that budget which we sent to the Senate; and, unfortunately,
the Senate majority leader has deep-sixed it, if you will, but in that
budget plan that Dr. Roe was referring to, it has
[[Page H5486]]
taken the responsible approach based on the trustees' estimate of the
Medicare program going totally broke by the year 2024, and that
information is bipartisan. That's the Medicare board of trustees.
To ignore that, as my colleague from Georgia said in his remarks, the
``D'' words, to defund, to deny, what were some of the others, Dr.
Broun? To deny, delay, destroy, demagogue, and I added to those ``D''
words their plan is rather disingenuous, but what Dr. Roe was
describing is to protect and preserve Medicare as we know.
Whether it is traditional Medicare, maybe we can salvage Medicare
Advantage, and hold harmless anybody that is over age 55, 55 through
65. They were 10 years away from being eligible for a Medicare benefit.
So they will be in those plans as we know it. But this approach that
Dr. Roe so adequately describes, Mr. Speaker, this premium support
program, not a voucher, as he pointed out, the premium support program,
which by the way would be administered by the Office of Personnel
Management, the same folks that talk to us and find out what kind of
health care benefit we want, those Members who are under 65, that you
pick and choose and you negotiate. They will do the same thing for
future, those under age 55 today, future Medicare beneficiaries. They
will get the best bang for the buck, the best care for their individual
needs.
Now, it is estimated that in 2022 that premium support amount on
average will be $8,000 a year. Now, our Democratic friends, Mr.
Speaker, want to say, Well, that's not enough. That's not enough.
Seniors are going to have to reach in their pocket.
But what they don't tell you, Mr. Speaker, is that premium will be
higher for anybody who comes into the Medicare program who is already
sick, who already has several things wrong with them; and that
certainly is possible.
When I got Medicare eligible, I had already had open heart surgery.
So these people will have a higher premium than the average of $8,000 a
year. And as they age, even if their health is perfect the day they
come into Medicare, they become Medicare eligible--they may have the
Methuselah gene and have wonderful health. They may jog 3 miles a day,
don't smoke, don't drink excessively, don't skydive--but as they get
older, that premium support will automatically go up because we know
statistically that as you get older the chances of something happening
are greater.
And last but not least, the higher your income, the lower your
premium support.
{time} 2120
So our seniors, who need it the most, will get a higher--they won't
get the average $8,000. They will get a higher premium support. I think
it is a wonderful plan, Mr. Speaker. I absolutely do. It shows the
responsibility of the majority party in this House of Representatives.
Of course, as my colleagues have pointed out, what is the plan from
the Democrats, the Democrat majority in the Senate and from this
President: deny it, delay it, destroy it, demagogue it. Or, as my
colleague from Tennessee has pointed out, kill it by creating this
Independent Payment Advisory Board, IPAB, which will, without question,
lead to denial of care and rationing.
I yield to my colleague from Tennessee.
Mr. ROE of Tennessee. I thank the gentleman for yielding.
One of the things, Mr. Speaker, that I want to emphasize is having no
plan is a prescription for disaster for our country. We have a solemn
obligation to provide health care for our seniors. We have made that
promise. And how do we do it? Again, back to what I said, I do not want
a board that is appointed by a Democrat or Republican or any
bureaucrat. What I want is I want health care decisions made by
physicians, the patient, and their family. The way that is going to
happen is through this plan where we use premium support to allow
people choice and to have them make those choices, not insurance
companies and certainly not the Federal Government.
From what I have seen up here in my two terms is I don't want a bunch
of Federal bureaucrats in charge of my bypass operation or my
gallbladder operation--or my bunion operation, for that matter. I want
my doctor in charge of it. That is who I want making those decisions,
along with my family.
I think this is one of the biggest discussions we will have in this
Congress is how we do this right. Not only does it affect the budget.
Forget the budget. Forget all that right now. We are talking about
people's lives. We are talking about the care that they get. And right
now, as I mentioned, these changes are already made. This is already in
the current law that I talked about just a minute ago.
When you talk about Medicare as it is, folks, it's been changed, big
time. When this board kicks in--and there's a very good article if you
are sort of a wonk like I am and want to go back to the New England
Journal of Medicine, one of our major journals, in, I believe it was,
May of 2010. Their estimate was--this is one of our major scientific
journals--that this IPAB board would have kicked in 21 of the last 25
years if it had been in place. So it's not some idle threat that this
will happen. If you look retrospectively at what's happened, it would
have happened 21 out of 25 times.
What would that mean? That would mean, as Dr. Broun, Mr. Speaker,
pointed out just a moment ago, as these payments for physicians go down
and down and down below their cost of providing the care, they no
longer can see you. You lose access to your doctors, like Dr. Broun.
Mr. GINGREY of Georgia. What Dr. Roe is talking about, Mr. Speaker,
is on top of these cuts that our medical providers are currently facing
under this so-called flawed formula sustainable growth rate, which I'm
sure I'm correct on this, in the past 9 years every calculation has
been a cut to provider reimbursement to the point now that while we in
Congress have had the ability to mitigate that, that if these cuts
finally in the aggregate come due December 31 of this year, it is a 30
percent cut. So we haven't solved that problem yet for our providers
but yet we are adding on top of that this IPAB board that can make
additional cuts to provider reimbursement without any ability of the
Congress, we the Members of Congress, to stop that injustice.
Mr. ROE of Tennessee. A good point.
Peter Orszag, who was the previous OMB Director here, said this is
one of the biggest losses of power the Congress has given up since the
Federal Reserve. That's been almost a hundred years ago. What we're
doing is the Congress takes two-thirds to overturn what they recommend
in this IPAB. We could do it if we get a two-thirds vote. And it is not
appealable. You don't have any appeal to a court system to do anything
about this.
Mr. GINGREY of Georgia. If the gentleman will yield, still, we can
overrule with a two-thirds vote. But we still have to find cuts in the
Medicare program somewhere else for the same dollar amount.
Mr. ROE of Tennessee. The gentleman is correct.
What would happen is we could make those cuts, but they have to be
made somewhere else. The cuts have to be made. Nowhere should Congress
give up its ability to do that. We are, our House, the House side,
we're the representatives of the people. We are the closest to them. We
have 700,000 constituents that we go talk to every time we get home.
And we ought to be beholden to those folks in our districts across this
country and not to some board up here in Congress that is not
accountable to anybody.
Mr. GINGREY of Georgia. I thank the gentleman.
The gentleman from Georgia is kind enough to have stayed with us
throughout the hour, and I would like to yield additional time to him,
if he would like.
Mr. BROUN of Georgia. Thank you, Dr. Gingrey. I would certainly like
the time.
The American people need to understand that the purpose of ObamaCare,
the bottom line really was expressed by the President himself when he
said he wanted everybody in this country in one pool. What's that mean
for everybody? It means socialized medicine. That's what all IPAB and
all these cuts and everything is geared to do is to force doctors out
of private practice, make them employees of the Federal Government,
make patients subject to some bureaucrat here in Washington
[[Page H5487]]
and tell them what kind of health care they can get.
And the Democrats' plan is to deny, to delay, and to destroy Medicare
by letting it go broke. But I want to just add, Dr. Gingrey, to your
other ``d,'' the demagoguery that we see. I want to give three examples
because the facts have really been, by and large, hidden from
the American people.
AARP did an ad, a new one, talking about all the places where the
Feds could cut spending, like treadmills for shrimp--well, I certainly
want to cut that out--but instead, Republicans insist on cutting
seniors' Medicare. Well, that's not true. AARP and the Democrats want
to cut Medicare by destroying it, letting it go broke.
An ad put out by the Gender Project, a liberal nonprofit group, shows
an elderly woman being heaved off the side of a cliff, with her being
in a wheelchair, and asks: Is America beautiful without Medicare? Ask
Paul Ryan and his friends in Congress.
That is nothing but bald-faced lies, because we are trying to make
sure that seniors get, as Dr. Roe said, a promise made, a promise kept.
We want to shore up Medicare and Social Security. We want to strengthen
Medicare, not destroy it, like the Democrats are going to do.
Let me give you a third example, then I will yield back.
On the Republican budget, President Obama said in his speech at
George Washington University just last month: ``Instead of guaranteed
health care, you will get a voucher. If that voucher isn't worth enough
to buy the insurance that is available in the open marketplace, well,
tough luck. You're on your own. Put simply, it ends Medicare as we know
it.'' President Obama.
It's demagoguery. It's lies, bald-faced lies designed to try to scare
the American people, particularly senior citizens. We are trying to
shore up Medicare. We are trying to strengthen Medicare. We are trying
to save Medicare from going broke. But the Reid-Pelosi-Obama ObamaCare
is to deny it, to delay it, to destroy it, and to demagogue it.
Mr. GINGREY of Georgia. As I said earlier, the kindest thing I can
say is it is disingenuous.
Stop the Democrats' plan to end Medicare. If left alone, the
Democrats' Medicare cut plan created in ObamaCare threatens Medicare
seniors today as well as those who will come into the program tomorrow.
So, colleagues, how do we stop the Democrats' Medicare cut plan first
and foremost? We need to repeal ObamaCare. But we need to vote and
support Dr. Roe's bill to repeal this IPAB board and tell President
Obama and Democrats that Medicare reform should not rely on restricting
benefits and access for sick and disabled seniors in need.
As we conclude tonight, let me just say, colleagues, oppose the
Democrats' Medicare cut board. Visit the GOP Doctors Caucus Web site
and sign the online petition. Oppose the Democrats' plan to destroy
Medicare.
And here are the Web sites: doctorscaucus.gingrey.house.gov or
doctorscaucus.murphy.house.gov, the two cochairs of the House Doctors
Caucus.
Mr. Speaker, I thank our leadership for giving us an opportunity to
bring to the American public and to our colleagues on both sides of the
aisle the true facts of this case--that we have a plan; the President
has no plan.
I yield back the balance of my time.
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