[Congressional Record Volume 158, Number 25 (Wednesday, February 15, 2012)]
[House]
[Pages H788-H794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   GOP DOCTORS CAUCUS: SAVE MEDICARE

  The SPEAKER pro tempore (Mr. Berg). Under the Speaker's announced 
policy of January 5, 2011, the gentleman from Louisiana (Mr. Fleming) 
is recognized for 60 minutes as the designee of the majority leader.
  Mr. FLEMING. Mr. Speaker, once again the GOP Doctors Caucus comes 
together to discuss important matters regarding health care. Tonight 
we're going to focus on saving Medicare. This has been a very 
interesting discussion going back to the days of the ObamaCare debate 
where we talked about how we would finance ObamaCare. And lo and behold 
in the middle of the debate, we find out that the Members of the other 
side of the aisle decide that they're going to help finance ObamaCare 
by taking out over $500 billion--half a trillion--$500 billion from 
Medicare over the next 10 years in order to help finance ObamaCare.
  Now if you think about this, the CBO states that Medicare may become 
insolvent as early as 2016. So I think the focus right now with regard 
to Medicare, an important part of our entitlement program, has got to 
be how are we going to save Medicare. I have an array of colleagues 
here this evening that are going to help me develop that issue.
  Again, I'll go back to the financing of ObamaCare, and that is 
cutting out over half a trillion dollars from Medicare in order to help 
finance ObamaCare. And there are some other pieces of the financing as 
well--the individual mandate which is soon to go to the Supreme Court. 
And if that is struck down, that will be another piece of the financing 
that won't be available. Tax increases, increases of taxes, excise 
taxes, taxes on equipment, taxes on tanning beds, many different new 
taxes, as much as $800 billion over 10 years of new taxes in order to 
finance ObamaCare.
  Then there was the CLASS Act, which was long term health care, which 
the actuaries said from the beginning would not work. It would not 
finance anything.
  And then last, but not least, is the student loan program, which was 
nationalized in order to siphon off profits from that in order to help 
finance ObamaCare. And we hear talk now about forgiving those loans 
which means that it'll probably be another bailout, like the mortgage.
  So, Mr. Speaker, I have to speak out tonight on the fact that 
ObamaCare is going to bankrupt this country if it is actually fully 
implemented. But more importantly, Medicare will become insolvent as 
early as 2016. We're going to be talking about how that's happening, 
how we're seeing skyrocketing costs. And some of the things perhaps 
that will be discussed tonight will be how we can save Medicare.
  Again, in closing my initial comments here, I will have to emphasize 
to you that our colleagues from the other side, inasmuch as they 
somehow want to blame us for ending Medicare, which not a single Member 
on the Republican side wants to do, of course, but they accuse us of 
this, but in fact they have yet to submit a plan that will save 
Medicare, will prevent it from becoming insolvent by 2016 or 2022, 
depending on whom you believe.
  So with these opening remarks, I would like to open the floor to my 
good friend, Dr. Harris from Maryland, and would love to hear some of 
your comments about saving Medicare and other matters having to do with 
health care.
  Mr. HARRIS. Thank you for yielding to me to speak on this very 
important issue.
  Mr. Speaker, as the gentleman from Louisiana has said, we really have 
to talk about saving Medicare. Medicare is under assault in a way that 
it has never been under assault before. The gentleman from Louisiana 
mentioned quite accurately that the President's health care bill passed 
2 years ago would take $500 billion from Medicare spending on our 
seniors who are currently receiving Medicare--$500 billion. Now, how 
are they going to do that? What are we not going to deliver to those 
seniors?
  Well, the way it's done is the President appoints the Independent 
Payment Advisory Board, 15 appointed, not elected members, no appeal 
from their judgment.

                              {time}  1900

  What they're going to do is they're going to say in a year when it 
looks like we're going to spend a little more

[[Page H789]]

on Medicare than the country can afford by the budget, we're going to 
decide what can and can't be delivered. The President's budget he just 
released this week makes it even worse because it sets even a lower 
budget target for Medicare spending. And, of course, the President 
doesn't even deal with the issue that's before the House this week, 
which is what are we going to do about physician payments.
  Now, Mr. Speaker, I represent a rural area of Maryland, Maryland's 
First Congressional District, where it's already very difficult for 
seniors to find a physician who is willing to take a new Medicare 
patient because, to be honest with you, they're afraid that their pay 
is going to be cut 30 percent at the end of this month, on February 29. 
And the President, in his budget, doesn't even deal with this issue. 
The President doubles down on the President's health care act. He 
sticks to that $500 billion in cuts that are going to occur. And not 
only that, he lowers the threshold for that Independent Payment 
Advisory Board to begin rationing care to our seniors. We have got to 
save Medicare.
  Mr. Speaker, some of the people listening are going to say, well, 
we're not going to believe these people. They all wanted to vote 
against the President's health care bill. Mr. Speaker, they don't need 
to believe us. Go to the Congressional Budget Office's Web site. It's 
nonpartisan. It doesn't pick sides. It says that the Medicare plan is 
going to go broke by the end of this decade. And if you don't believe 
them, go to the Medicare trustee's Web site. Just go to Google and 
search Medicare trustee's report. They say it goes bankrupt a few years 
after that.
  Mr. Speaker, the gentleman is right. We have to address Medicare, and 
we have to address it now before the President's health care act 
destroys health care for seniors. My mother, who is 88 years old, 
depends on her Medicare. She depends on her prescription drug coverage. 
She depends on it to have access to the physicians that she needs for 
her health care. And, Mr. Speaker, I'm afraid that under the 
President's plan, my mother, and millions of other Americans, our 
seniors receiving Medicare, are just not going to have the care they're 
used to and that they deserve. We need to save Medicare.
  Mr. Speaker, I think we're going to hear about some of the ideas 
tonight about how we're going to do that. So I want to thank my 
colleague from Louisiana for yielding me these few minutes, and thank 
you for coming to the floor and doing this work tonight so that we show 
our Members and show the public who's watching how we have to save 
Medicare for our seniors. Thank you for yielding to me.
  Mr. FLEMING. I thank the gentleman from Maryland, my good friend, who 
is an anesthesiologist, a practicing anesthesiologist for a number of 
years and very experienced.
  Before I recognize my friend from Georgia (Mr. Gingrey), I did want 
to point out a couple of things. Remember I said a moment ago the CMS 
actuary in this case projects the Medicare program could be bankrupt as 
early as 2016. This is 2012. That's 4 years, Mr. Speaker.
  Where is the Democrat plan to save Medicare? Republicans, on the 
other hand, we've already passed a budget last year. We're working on 
another one this year that would do that. We just could not get Harry 
Reid to even salute it, much less have a vote on it.
  Also, Medicare costs are projected to grow substantially from 
approximately 3.6 percent of GDP in 2010 to 5.5 percent by 2035. The 
physician payment formula in Medicare needs to be fixed or seniors may 
lose their doctor as it costs $316 billion. And that's what Dr. Harris 
was referring to, that it's already very difficult for doctors to make 
it on what they're paid, and they're looking at a cliff of a 30 percent 
reduction in their pay. If that goes into effect, Mr. Speaker, a lot of 
seniors out there will not have access to health care.
  So I want to show you, before I recognize my good friend, what this 
means in graphic form. And as you can see, the purple aspect of this is 
Social Security. The green is Medicaid and other health care. You see 
it rising very fairly steadily, but plateauing. But look at the red. 
That's Medicare. That is Medicare.
  And in out-years, going all the way out to 2080, it just goes 
straight up. Of course, that's largely due to an aging population, baby 
boomers like myself getting older. But everything about this program 
has way outdistanced any projections of what those costs are. So this 
really takes it up to a point where Medicare alone, if not dealt with, 
not reformed and saved, will eventually displace all of our budgetary 
spending, that alone. And of course that means no defense, no nothing 
else, no running government whatsoever.
  With that, I would like to recognize my good friend, Dr. Phil 
Gingrey, a gynecologist-obstetrician from the great State of Georgia.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank my colleague from 
Louisiana for yielding. And as I look out over this packed House 
Chamber, and I see seven of my colleagues who are in these, that are 
participating in this Special Order hour on saving Medicare this 
evening, I'm estimating that there are about 175 years of clinical 
experience in the aggregate among these doctors.
  I am very appreciative, Mr. Speaker, of the Republican leadership and 
the leadership of our committees that deal with health care, and I'm 
referring mainly to Ways and Means, Energy and Commerce, and Education 
and Workforce. And many of the Members here tonight serve on one of 
those three committees. So our work in the Congress, although not 
exclusively on health care, I think each and every one of us is a 
member of the House GOP Doctors Caucus, came to Washington, gave up our 
medical careers with mixed emotions, I guess, but feeling that there 
was a need--there was a need--that we had to try to address. 
Thankfully, our leadership has committed to the House GOP Doctors 
Caucus that we will be part of the discussion, and we will be part of 
the solution to saving Medicare.
  I think I can speak for my colleagues, Mr. Speaker, in regard to our 
universal opposition to this new entitlement program, the Patient 
Protection--and I call it the un-Affordable Care Act, sometimes 
referred to as ObamaCare. We are opposed not solely because of its 
threat to Medicare, but to a large part because of that. And my 
colleague from the Eastern Shore, Dr. Harris, spoke of the amount of 
money that was taken out of the Medicare program, something north of 
$500 billion, and from a program that he also emphasized, as did Dr. 
Fleming, that by a date certain, it could be as early as 2016, Medicare 
part A, the hospital trust fund, will be broke. It will be insolvent. 
There won't be any money there to honor those claims.
  Mr. Speaker, the gentleman from Maryland, Dr. Harris, referenced his 
aging mom, and I hope she's in good health. And we love our moms. His 
mom is 88; my mom is 94, Mr. Speaker. And my mom's life is just as 
precious to her as anybody's life in this Chamber that may be 60 years 
younger than Mom Gingrey, Helen Gingrey, at age 94. But she depends on 
this program. She wouldn't be alive today if it weren't for the 
benefits that were available to her, whether it's medication under part 
D or whether its the ability to be treated for cancer, which she 
recently was and had a surgical procedure.
  So I don't want to take too much of the allotted time tonight 
because, my colleagues, I want to hear from them; but I just want to 
say this, that we as the House GOP Doctors Caucus, in conjunction with 
the physicians in the Senate, sent a letter 2 weeks ago to the AARP, 
American Association of Retired Persons. I don't know how many people 
age 50 are retired, but when you include all of these folks that join 
AARP under the senior status, you're talking about 35 million or more 
that are in that organization.

                              {time}  1910

  So we felt very strongly, Mr. Speaker, that we needed to reach out to 
this organization--which we did. I think some 26 Members, House and 
Senate, signed a letter and asked them to meet with us. By the way, Mr. 
Speaker, we did hear back from the executive director, Barry Rand, just 
within the last couple of days.
  So what we want to do is say to them, no matter where we have been in 
the past in regard to issues of Medicare part D, the support of or 
opposition to ObamaCare, clearly, surely we can all agree in a 
bipartisan way that we have

[[Page H790]]

to save Medicare. That's what this hour is all about, to talk about 
that. And I look forward to the opportunity, without a lot of public 
fanfare, until we decide what we can agree on and what we can come 
forward with in regard to saving Medicare.
  We, the physicians, the health care providers in the House and 
Senate, in conjunction with the American Association of Retired Persons 
and other retired groups, the one that Jim Martin leads--one of my 
colleagues will mention that in a few minutes. All of a sudden, I'm 
having a senior moment on the name of that group, but a great group, a 
great organization. We're going to work together on this. We're going 
to go forward to the American people in a bipartisan way and say, you 
know what, we're going to do it now. We're not going to worry about the 
results of the next election. That will take care of itself. The 
American people understand who they want in Congress and who they want 
at 1600 Pennsylvania Avenue based on what we do to save these legacy 
programs.
  I thank my colleague for yielding me the time.
  Mr. FLEMING. I thank the gentleman from Georgia, my colleague and 
physician.
  Let me say parenthetically here that what are some of the things that 
we in this Chamber, we Republicans from the Doc Caucus--which, by the 
way, is 23 strong, which includes three nurses, two dentists, and one 
psychologist.
  So what are some of the things that we agree on moving forward that 
we really need in terms of saving Medicare?
  Well, I can tell you one thing that everybody agrees on, and that is 
that we need robust competition among providers--doctors, hospitals, 
insurance companies. There is no reason why they shouldn't have to deal 
with the competition of market forces. And why? Because everything in 
America that we see improves improves because of the marketplace; that 
is that when you compete, it makes you work harder; it makes you try 
harder; it raises the level of effort; and, ultimately, you end up with 
better quality service products and you end up with lower cost to the 
consumer.
  We also agree that we want choices for Americans. Today, there are a 
lot of choices even for Medicare recipients that just aren't there, and 
we want that to occur.
  We also want to move away from a top-down bureaucratic system where, 
again, a 15-member appointed board of bureaucrats--nameless, faceless, 
unelectable, unaccountable people who are selected and who will not be 
there to answer your call. We all agree that that is not a good thing. 
Instead, we want a program, a system in which you can change health 
care systems, you can change hospitals, doctor, insurance companies, 
whatever you want to do, and there's lots of transparency in order to 
do that. That's going to make the quality of care improve and the cost 
go down.
  I would now like to recognize another gentleman from Georgia. 
Georgia, like Louisiana, is flush with physician Members in Congress, 
but we'd like to have a few more, in fact. So I would like to recognize 
my good friend Dr. Broun, the gentleman from Georgia.
  Mr. BROUN of Georgia. Dr. Fleming, I appreciate you yielding me some 
time.
  Mr. Speaker, the American people need to understand very clearly that 
this administration, this President's policy on Medicare, as well as 
our Democratic colleagues here in the House and the Senate, can be 
summarized by four Ds: They want to deny that there's a problem; they 
want to delay fixing it; they want to destroy Medicare as we know it 
today; and they want to demonize those of us who want to fix it so that 
it is a good and solid program for the future generations of this 
country.
  That's exactly what we're trying to do here tonight is focus upon the 
fact that, number one, they do want to deny it. They even deny that 
there's a problem. They keep saying that they want to save Medicare as 
we know it today, but Medicare is not sustainable as we know it today 
because it's going broke. And it's going broke because of failed 
policies of this administration, and it's getting worse and worse.
  Hopefully, we'll see the Supreme Court throw out the Affordable Care 
Act, the President's reform bill, which is going to be disastrous. It's 
going to destroy the doctor-patient relationship. It's going to destroy 
budgets, from individual budgets, businesses' budgets, States' budgets, 
even the Federal budget. IPAB, as Dr. Harris was talking about, is 
going to be disastrous because we're going to have rationing of care.

  Our Democrat colleagues and this President want to deny that there is 
any problem. They want to delay doing anything about it. In fact, the 
Ryan budget, our budget that we passed last year, started the dialogue, 
started the process of looking at trying to fix Medicare for future 
generations. But our Democrat colleagues don't want to do that. They 
want to delay fixing it. They just want to posture. They want to try to 
do anything that they can to not face the fact that we've got to deal 
with Medicare and the financial problems it has that my good friend 
from Maryland, Dr. Harris, talked about.
  Their policy is going to destroy Medicare. They're already destroying 
Medicare Advantage. We've seen, as Dr. Fleming talked about, we've 
already seen the President's Affordable Care Act has destroyed Medicare 
Advantage and has cut $500 billion, one-half trillion dollars out of 
Medicare. And then they want to demonize us who want to do something 
about it.
  I introduced my Patient Option Act, which is a comprehensive health 
care reform plan. It deals with Medicare. It helps to save it for 
future generations. I introduced it in the last Congress. We 
reintroduced it to put in place a repeal section to repeal ObamaCare 
and replace that disastrous law that we have in place, the Affordable 
Care Act, for something that makes sense, that will lower the cost of 
all health care services and products for everybody in this country.
  We are tweaking it, and I'm going to reintroduce my Patient Option 
Act just in the next week or two. It's just a little over 100 pages. 
It's a comprehensive bill. It's market-based, and it puts the doctor 
and patient in charge of making all health care decisions, not some 
bureaucrat here in Washington, D.C., that the President and our 
Democrat colleagues want to have in every single doctor-patient 
relationship. Whether you're on Medicare or not, they want to insert a 
bureaucrat from Washington, D.C., to make those decisions for you.
  The American people need to know, Mr. Speaker, that our colleagues on 
the Democratic side and this President, if they have their way, they're 
going to deny there's a problem. They're delaying fixing it. They're 
going to destroy Medicare as we know it, and they want to demonize us 
that want to fix it.
  We're not going to sit still. We're not going to have it. We're going 
to continue to fight to make Medicare available, make insurance 
available for everybody at a lower price. That's exactly what 
Republicans are doing.
  We have a plan--many plans. Actually, there have been numerous bills 
introduced by many colleagues on our side, physician colleagues. Dr. 
Tom Price from Roswell, Georgia, orthopedic surgeon, one of our Georgia 
colleagues, introduced his plan. We've got many plans here.
  So we're fighting to save Medicare. Our Democrat colleagues and this 
administration, this President, are going to destroy it.
  Mr. FLEMING. I thank the gentleman, my good friend from Georgia, a 
family physician of note, and also one who has actually reentered the 
U.S. Marine Corps as a reserve physician as well. I admire him for 
that.
  Before I recognize my friend from Tennessee, also another physician, 
I want to point out something about Medicare that is very important for 
everyone to think about.
  Medicare was started in 1965 with a lot of promises, and the promises 
have been fulfilled to those recipients who get the benefits of 
Medicare. However, this big, beautiful apple, if you will, of Medicare, 
unbeknownst to a lot of people, has been slowly rotting and decaying 
from the inside financially in ways that the public can't see, in a way 
that is very soon going to be evident. And why? The reason is because 
even though folks pay their premiums into Medicare, they do not nearly 
cover the cost of Medicare. In fact, they only cover about one-third. 
The other two-thirds come from the providers themselves, and also from 
the taxpayers.

[[Page H791]]

                              {time}  1920

  And that's all well and good. There's nobody we would rather do more 
for than those who are from the Greatest Generation, those who lived 
through the Great Depression, World War II.
  But the fact is, we cannot continue the same way. It will totally 
bankrupt the country. And therefore we have got to heal this patient 
and, that is, we've got to save Medicare.
  I want to recognize my good friend from Tennessee, also an OB GYN, 
one who came here in 2009, as I did. We've grown to be great friends. 
And certainly, the best doctors are from the South, mostly from 
Louisiana and Tennessee, I think you would agree.
  With that, I yield to my good friend, the gentleman from Tennessee, 
Dr. Roe.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  Mr. Speaker, I want to thank all of my colleagues for being here 
tonight. And one of the things in the Health Caucus we are so blessed 
with are three new additions of registered nurses, psychologists, 
dentists. We really cover the whole spectrum of health care in, I 
think, 21 or 22 members of the Health Caucus now, 15 physicians. And 
this is the first time probably in years that the House has had this 
kind of support from the health care community around the Nation.
  This weekend I had an opportunity to talk to my wife a little bit 
about what my purpose was here in this House. I'm a veteran, as you 
are. I served as a practicing physician, as almost, I think, every one 
of the Doctors Caucus on the Republican side has been out for years, 
decades, myself 31 years of private medical practice.
  Medicare came along in 1965 when I was a college student. And the 
reason it came along at that point was because half of our citizens, 
when they retired, didn't have access to any health care coverage. So 
there was a problem noted. And at that point in time, that plan started 
as a $3 million program, really a skeleton program in the Federal 
Government.
  The government estimators--there was no Congressional Budget Office 
then--but they estimated that in 25 years this would be a $12 billion 
to $15 billion program. The actual number was $110 billion. Today it's 
over $500 billion, and a very important program because you and I, Dr. 
Fleming, have seen incredible advances.
  I could sit here the rest of the night and talk about the last 30-
plus years of medical advances that have been applied to our patients, 
and medications, surgical procedures that have improved the quality of 
life of every American citizen.
  One of the strange things that happened when I was a very young 
doctor, 31 years old in Johnson City, Tennessee, I noticed that 30-
something years later my 40-year-old patients were in their seventies, 
and they were on Medicare. And I have had a chance to follow them 
throughout, really, most of their adult lives and see the care that 
they got.
  And one of the things I think that our Health Caucus and our 
Physicians Caucus is absolutely committed to is saving Medicare. It's a 
great program, but it is not sustainable.
  One of the frustrations I've had here on this House floor is how can 
you solve a problem you can't even talk about. When you're demagogued 
and told that you're going to dump Grandma off a cliff, and you're 
going to do this, that's not solving problems, that's throwing bombs.
  I think this group of men and women are here to solve these problems. 
Otherwise, I don't really have a purpose here in this Congress. And so 
I'm going to commit myself, as I think our entire Health Caucus is, to 
saving this vital program for our seniors.
  It's been pointed out, pick your number; the estimators have been 
wrong before. But what if they're right? What if they're even close to 
being right? We've got to start solving the problem today and not wait.
  The President's plan is to simply do nothing. Well, what are we 
talking about doing? What are we planning on doing?
  Before I get to that, I want to mention IPAB a little bit. This is 
hard to explain in a minute or two on a TV interview we might do. But 
the Independent Payment Advisory Board takes health care decisions away 
from where the health care decisions ought to be made; and those health 
care decisions ought to be made between a physician, the patient, and 
that patient's family, not between the insurance company and not 
between, certainly, a bunch of bureaucrats here in Washington, D.C.
  Quite frankly, I don't want a Republican President putting them on 
there, and I don't want a Democratic President putting them on there. I 
want those decisions made in the examining room and the doctor's 
office, between the family and the patient and the doctor.
  Now, the IPAB, as Dr. Harris a moment ago mentioned, are 15 
bureaucrats appointed. Look, we have 224 cosponsors to repeal this 
bill, from Barney Frank to Phil Roe. There's a lot of room in that camp 
to fill in, so all the Congressmen can be on this because it is a bad 
idea.

  My colleagues over here on the other side of the aisle, quite 
frankly, did not have this in the House version of the bill, as you'll 
recall. That came in the Senate version of the bill. So we need their 
support, in a bipartisan way, to repeal this.
  And why do we want to repeal it? We want to repeal it because it is 
based not on quality of care and not on access of care. It is based 
strictly on costs, and to squeeze more money out for the Affordable 
Care Act, that's why our seniors need to get involved in helping us get 
the Affordable Care Act, or the so-called ObamaCare plan, overturned 
because they are interlocked, and the money will come out of Medicare.
  So we have a bureau up here, a board that says you've spent this much 
money, and if you spend more, then it's going to come out of the 
providers. That's hospitals, doctors and other health care providers, 
meaning that you will decrease access because they won't be able to see 
their doctor. And when you decrease access, you decrease quality of 
care, and no one in this country wants it.
  Has it been done anywhere else in the world? Absolutely. It's done in 
England right now. And we can go on with the horror stories of 
rationing of care, because that is ultimately what happens. And who 
gets rationed? Is it based on a certain age? Is it based on a certain 
disease?
  I don't think any physician in the world, I know morally I can't, and 
ethically I can't do that. If a patient comes in, we have that 
conversation with the family, we put out a treatment plan, and we 
execute that plan.
  Now, how do we save it? I know we're going to talk about that in a 
little bit, but I want to point this out since I am on Medicare.
  I got on Medicare last year. The day before I turned 65 years of age 
I had a health care plan. And in this health care plan was a 
hospitalization. It had a drug benefit; it also had the ability for me 
to go see my doctor. So it was a health care plan.
  Medicare has part A, part B, part C, part D. The only reason it's 
chopped up in parts like that is because politicians put it together, 
not an access, not a way to see your doctor.
  What I think should happen to you when you're 65 is you should have a 
health care plan. It has prescription drug benefits, hospitalization, 
doctor benefits, and testing benefits like any other.
  And so what will we do, and how do we plan on doing this? It's not 
hard at all. The premium support that we're talking about is, just act 
like the Federal Government, the day before, when your business, your 
employer paid that part of the premium, the Federal Government will pay 
that premium, and the other part will be paid by you, as an individual. 
And higher-income seniors like us right here are going to get a bigger 
piece of that. And lower-income seniors are going to have a small piece 
to pay.
  Or if you want to stay on traditional Medicare, you're allowed to 
stay on traditional Medicare. In doing this, we can save this very 
vital program for our seniors. And I'm willing to sit down, as anybody 
in this caucus is, to talk to our seniors about how we're going to help 
save this.
  I want to thank you, Dr. Fleming, tonight for holding this Special 
Order, and my colleagues for coming down here.
  Mr. FLEMING. I thank the gentleman, Dr. Roe, for his very insightful

[[Page H792]]

comments. And we're beginning to pull the cover back on what some of 
the solutions are.
  I will point out this evening that, you know, it's interesting the 
way physicians are trained. We're trained to be problem solvers. We're 
trained to look for solutions. And sometimes it's like mixing oil and 
water up here in Washington because there are a lot of people who've 
been up here a long time who don't think in terms of solutions.
  So we're committed, all of us, our physician colleagues and nurses, 
psychologists, dentists, to continue to apply the pressure to move 
forward in solving problems for the American people.
  I'd now like to yield to another physician from Louisiana. He's 
actually a hepatologist. And I know that some who may be hearing me 
speak right now may not know what that is. It's basically a specialist, 
a physician specialist in liver disease, and also a gastroenterologist 
as well.
  With that, I will recognize the gentleman from Louisiana, Bill 
Cassidy.
  Mr. CASSIDY. Thank you, Dr. Fleming. I always tell people 
hepatologist--no, I don't do snakes. I do liver disease. We have to 
make that correction.
  I just want to kind of pick up where Dr. Roe left off. A lot of folks 
say, heck, how did we end up with Medicare going bankrupt when they've 
paid into it their whole life? Well, if you work backwards, it began, 
if you will, or maybe the most recent insult, was the fact that the 
President's health care plan, the Affordable Care Act, took $500 
billion from Medicare. Instead of putting it back into Medicare to 
support the program, it used it to create their new entitlement.

                              {time}  1930

  Now, that's important because as the graph you had earlier showed, at 
our current rate of going forward, by 2030, I think it is, Dr. Fleming, 
you have it right there, roughly 2040, 2045, Social Security, Medicaid, 
and Medicare will take up the entirety of our Federal budget. Whatever 
tax dollars we receive by 2045 will be entirely consumed by those three 
entitlement programs.
  Do you have that graph where there is the debt on there as well?
  Mr. FLEMING. This is the only graph I have.
  Mr. CASSIDY. So by 2030, I think it is, if nothing changes, Social 
Security, Medicaid, Medicare, and the national debt will consume 100 
percent of our tax revenue. Clearly, we have to preserve this important 
program.
  The other thing I'd like to point out to people is, in 1964, when 
Medicare was conceived, people were having, on average, four kids per 
family. So the folks that came up with Medicare said, Well, people are 
having four kids per family now, most likely they'll continue to have 
four kids per family going forward. Let's make this a pay-as-you-go. 
There will always be four people paying for the two people ahead of 
them. It turns out families have shrunk.
  Now I'd point out in most crowds, most people have more brothers and 
sisters than they do children. Families have decreased in size. Instead 
of on average four kids per family, now there's about 2.5. That 
demographic shift has made all of the difference. Instead of a pay-as-
you-go program where there is always as much money coming in as we 
needed to pay out, what has happened is families have shrunk, you have 
a large number of baby boomers, and then their parents, and beneath it, 
you have kind of a tree, if you will, where it goes straight down. 
Instead of the pyramid originally thought that would occur, we now have 
something that looks like that and then goes straight down.
  There is no longer this broader base of people paying in.
  We're not the first to recognize this. John Breaux, the former 
Democratic Senator from Louisiana, was appointed by President Bill 
Clinton to say, Listen, the demographics are changing. How do we 
preserve Medicare? It was actually John Breaux, a Democrat, who first 
came up with the premium support model.
  Now, we speak of it sometimes as a Republican plan. No. It was 
originally a Democratic plan, and it was a bipartisan commission. It 
came up with this premium support model as a thing that would save 
Medicare. As it turns out, President Clinton became distracted with the 
Monica Lewinsky affair, if you will, and it kind of got pushed to the 
wayside.
  This same Breaux carry model conceived of in the nineties is the 
basis for what is now the bipartisan Wyden-Ryan plan.
  Now, although Dr. Roe spoke of it earlier, it's worth going back 
over. If you're 55 and above, nothing changes from the Medicare program 
you've always known. If you're 55 and above, if you're already on 
Medicare because you're disabled, nothing changes. If you're 54 and 
below, like I am, the program changes to premium support.
  Now, in the premium support model, it works kind of like Medicare 
Part D. I find the program that best fits my need. I choose the program 
that I want. If I'm very wealthy, I pay a little bit more. If I am 
poor, I pay nothing at all. But if I'm middle class, I pick the program 
I like. If it's a frugal program, then I pay less out of pocket. If 
it's a bells and whistles program, I may pay a little bit more out of 
pocket--much like the Medicare Part D program that seniors now get 
their drug benefit from. By the way, a Medicare Part D program that has 
an 80 percent approval among seniors.
  Mr. FLEMING. If the gentleman will yield.
  Mr. CASSIDY. I yield to the gentleman.
  Mr. FLEMING. By Medicare Part D, you're referring to the drug 
program, which is the last piece that was added where there was a lot 
of debate about top-down, government commanded pricing or a market-
based system. They ended with a market-based system, and that reduced 
the cost by 40 percent.
  Mr. CASSIDY. If I may reclaim my time, because of market forces, not 
only is Medicare Part D incredibly popular among seniors, but its costs 
are 40 percent cheaper than originally conceived. That is the power of 
giving the patient the ability to go from plan to plan. If she doesn't 
like that plan, next year she chooses another, and the bad plan goes 
out of business if enough seniors do that. That's the same concept 
behind Medicare Part D.
  We have other colleagues to speak. I'll add one more thing. I'm 
always struck when our Democratic friends say they want the American 
people to have the same type of plan that Members of Congress do. The 
premium support model is the same type of plan you and I have. We pick 
among an array of programs. We pick the one that works best for us that 
matches our pocketbook.

  If we're poor, we pay nothing at all. If we're rich, we pay a little 
bit more. But most of us in Congress are in this middle range, we get 
the plan that most fits our needs. That is the Wyden-Ryan plan totally. 
We actually give the American people the same sort of deal that Members 
of Congress get.
  So that said, thank you for allowing me to join you, Dr. Fleming.
  Mr. FLEMING. Just to reiterate, we in Congress, despite what a lot of 
people think, we don't have any kind of special health care plan. We 
have the same plan as all other Federal workers, and that is simply to 
go on a Web site or in a booklet and choose from hundreds of excellent 
health plans that are competing with each other for our business. We 
pay part of the premium; our employer, the Federal Government, pays the 
other part, and that is precisely what we want for everyone in America 
to have.
  But in order to do that, you've got to take down the walls from one 
State to another, the State borders, when it comes to insurance. You've 
got to make sure that all of these providers of services--doctors, 
hospitals, insurance companies--are competing with each other, driving 
up the quality and driving down the cost.
  With that, I would like to recognize one of our freshman members 
who's really come on fast, again another physician, a family physician, 
Mr. DesJarlais from the State of Tennessee.
  Mr. DesJARLAIS. I thank my colleague. I'll be brief tonight.
  I just wanted to point out the fact that I'm proud to stand here with 
my physician, nursing, dental colleagues, all of the members of the 
Doctors Caucus, because I can say I think for all of us that none of us 
chose Congress as our career path in life. Our first passion in life 
was to help people.
  We know that we have a problem facing us. Nobody can deny on either 
side

[[Page H793]]

of the aisle that Medicare is going broke. As Dr. Roe said, we can't 
afford to wait to solve this problem. It's there. It's not a partisan 
issue. It's a people issue. It's about my parents and your parents and 
our grandparents. We just can't afford to let partisan bickering get in 
the way of solving this problem.
  So what I guess I would ask people to do if you're a Member of AARP, 
if you've not contacted your Congressman or your representative or your 
senator, pick up the phone and make sure you know where they stand 
because they can't answer you that Medicare is not going broke in the 
next 10 years. We've offered up a lot of solutions to try to stave this 
off. But we want to make sure that we help you save Medicare, and we're 
going to do all we can from our end, but we can only do so much.
  So if you're a Member of AARP, call AARP, tell them to get on board. 
The GOP Doctors Caucus will help lead the way. I can say that all of us 
in this caucus, as we treated patients over the years, we never looked 
at them as Democrats or Republicans. We just looked at them as patients 
and people. That's what we're here to do tonight. We're here to help 
save Medicare, but we need your help, so pick up the phone tomorrow, 
call your Member of Congress, and make sure you know where they stand, 
and they need to get on board, and they can't deny that this problem is 
coming.
  Mr. FLEMING. I thank the gentleman.
  Did you hear that? Did you hear what the gentleman said? The 
gentleman said that he's never treated a patient that was either a 
Republican or a Democrat. It doesn't matter to us who we're providing 
care to.
  We've got three wonderful nurses here, and we all appreciate what 
nurses do. Often times, the nurse is the first health care worker you 
encounter when you open your eyes after whatever has happened to you. 
So we appreciate our angels so much.
  But again, we providers, we don't care, we don't ask whether you're a 
Democrat or a Republican. All we care about is that you have a need.
  I would now like to recognize Congresswoman Ann Marie Buerkle from 
the great State of New York. We're actually moving above the Mason-
Dixon line this evening, and we're talking to folks from New York.
  Ms. BUERKLE. I thank my colleague. I feel a little bit out of my 
element. We've only dealt with Tennessee and Louisiana. So it's good to 
be here, and I appreciate the opportunity to stand here with my 
colleagues.
  I think it's so important that the Doctors Caucus have this 
conversation with the American people because we stand here tonight not 
as politicians but as people who care deeply about the health care 
profession and about patients getting the kind of care they need.
  So I hope that when we speak to the American people, and particularly 
our seniors, because tonight we're talking about saving Medicare, that 
they look at us as people who are deeply committed to making sure that 
they have the health care and the Medicare benefits that they deserve 
because they've paid into it.

                              {time}  1940

  I guess briefly, because we have so many other colleagues here, I'd 
like to make just a couple of points to the American people.
  Number one, unfortunately, because of the current health care law, 
Medicare has been changed. When we talk about saving Medicare, it 
really means restoring it to what the American people know Medicare is, 
especially our seniors. I am so saddened when I see some of the senior 
groups like AARP. In fact, I've got a whole box of letters from people 
who belong to AARP, saying, Don't cut Medicare.
  I want to assure the American people and say to them that we are not 
cutting Medicare. For those who are 55 years and older and, as was 
mentioned earlier, for those who are on disability and getting SSI, 
their plans don't change. They remain the same. For those who are 54 
and younger, we're talking about a premium support. The reason we're 
talking about that is, if we don't, there will be no Medicare for 
anyone.
  So we are intent on saving Medicare. We want to make sure that our 
seniors have what they deserve and what they've paid into all of their 
lives, which is good Medicare coverage. I'm not only a nurse; I'm also 
the daughter of a 90-year-old mother. She and I know very well how 
important Medicare is, so we have no desire to change Medicare as the 
seniors know it now. We're talking about making a change for those who 
are 54 years and younger.
  The sad part about this is that the health care law has changed 
Medicare, and now our seniors will have to be dealing with IPAB, and 
they'll have to be dealing with cuts in their Medicare services. We 
implore them, as my colleagues have said, to reach out to their senior 
groups and to say, Wait a minute. The real threat to our Medicare is 
the health care law, and that's what needs to be changed.
  Just before I end, I would say to all the American people that we are 
committed here in the Congress and on this side of the aisle in making 
sure that you get the Medicare services you've paid into all of your 
lives and that you so richly deserve and count on. We in the health 
care profession stand together, and we want to make that pledge to our 
seniors, not only to them but to all the American people.
  Mr. FLEMING. I thank the gentlelady from New York.
  I would now like to yield to another gentlelady, to a person with 
whom I've become good friends, who is also from New York State. She is 
a person who has a vision for America. Not only that, she is someone 
who has been taking care of the vision of other people as well. She is 
an ophthalmologist, and she has come to Washington to apply her vision 
to what she feels--and we agree with her--the future of health care 
should be like as well as many other things in life.
  With that, I yield to the gentlelady from New York, Nan Hayworth.
  Ms. HAYWORTH. I thank the gentleman so much for holding this Special 
Order session, which is so important.
  One thing, the comments by my distinguished colleagues have been 
perceptive and enlightening and moving. There is one aspect I might be 
able to add, although they have said so much.
  I would like to invite our seniors and those who love them and who 
may accompany them in the course of their care, as I have had the 
privilege of doing for my own parents, both of whom have relied on 
Medicare for many years, to talk with their doctors about what it means 
when Medicare changes the way it deals with the doctors' practices and 
what it will mean for our seniors in their having the ability to be 
cared for by the doctors they prefer and in the places where they are 
comfortable and that are familiar and that they like and trust as well 
as what may happen if Medicare loses the funds that now exist in the 
trust fund, which are running out very, very rapidly.
  I think it's important for patients and doctors throughout the United 
States to have that conversation and for our doctors to hear their 
patients' perspectives and for patients to hear from their doctors how 
tough it may be for a lot of doctors' practices to keep their doors 
open if Medicare loses the funds that it needs and if that's 
accelerated through the Affordable Care Act, which does, as we've 
mentioned many times but is so important to say, take an enormous piece 
of crucial funding away from Medicare. We can't afford that. A half a 
trillion dollars is an enormous amount of money. So there are lots of 
threats looming on the horizon for our doctors' practices.
  I had the privilege of practicing ophthalmology in Mount Kisco, New 
York, for 16 years. I took care of Medicare patients and I cherished 
them. It was a privilege, as you mentioned, Dr. Fleming, to care for 
those patients, so many of whom have done so much for our country and 
for our communities. Yet I can attest to the fact that it can be very 
difficult to keep your doors open when Medicare keeps ratcheting down 
what it will pay for certain services even in the face of the fact that 
doctors have rent to pay and staff to pay and that they have insurance, 
including malpractice insurance, which can be very expensive in a State 
like my own home State of New York.
  It can become very, very difficult to balance all of those things, 
and that's why it's so important to make sure that Medicare has the 
funds it needs

[[Page H794]]

and that we protect Medicare for the future in the way that we handle 
its premium structure. Premium support will be a great help to us, but 
those are the things that we need to hear about from our patients and 
our doctors. So I would like to urge everybody to talk with your 
doctors, to find out the stories, to find out what they want to tell 
you so that the patients and doctors can take that message home to 
their Members of Congress, to their Senators and to the President.
  I thank you, Dr. Fleming, for all you're doing to support a wonderful 
cause.
  Mr. FLEMING. I thank the gentlelady from New York, Nan Hayworth, for 
all of her contributions both here in Washington and certainly back 
home.
  We've saved the best for last here. We have Dr. Benishek, the 
gentleman from Michigan, who actually managed the time for our last 
Special Order and did a great job. As I understand it, he is a 
wonderful surgeon.
  So I would like to yield to the gentleman in the last few minutes 
that we have tonight.
  Mr. BENISHEK. Thank you, Dr. Fleming. I appreciate the opportunity to 
be here tonight to express my feelings about our cause to save 
Medicare.
  I've been taking care of patients in northern Michigan, in a rural 
setting, for the last 30 years. It certainly means a lot to my patients 
to have Medicare there to help them get through their medical problems 
in their elder years. I am kind of surprised that I've been castigated 
for voting to end Medicare when, really, I voted to try to save 
Medicare because of the crisis that's coming forward due to the 
demographics of our country and the pending bankruptcy of the Medicare 
trust fund. As I see it, there are really four reasons that Medicare is 
in trouble.
  Number one, there is an increasing number of patients on Medicare 
every year. There are 10,000 patients a day who are added to Medicare. 
There are approximately 50 million people today who receive Medicare. 
In 20 years, I think that number will be 80 million people. That's one 
reason.
  The second reason is that there are a little over three persons 
paying into Medicare for every person receiving that benefit today; but 
in 20 years, there will be a little over two people paying. Not only 
are there going to be 30 percent more people, but there are going to be 
a third fewer people paying in.
  The third problem, of course, is just the general rising costs of 
medicine. This is an issue where, in our plan to save Medicare, which 
is a premium support plan in which there are options in your insurance, 
I think it will help keep those costs down.
  Of course, the fourth problem is the Affordable Care Act. The 
Medicare that people are familiar with today, that the seniors of today 
have, will not be the same Medicare going forward because the 
Affordable Care Act has taken $575 billion away from Medicare. That's 
over $100 billion from hospitals; I think it's like $40 billion from 
home health care, $30 billion from hospice care, and over $100 billion 
from Medicare Advantage.

                              {time}  1950

  Well, I know in my rural district, we have many small community 
hospitals that depend on their Medicare payments; and $100 billion 
taken from each of those small hospitals--you know, those hospitals 
operate on a razor-thin profit margin. If we take that money away from 
the small hospital in my district, they may not be there tomorrow. So 
how would my senior population come see me? They wouldn't be able to 
come to their local hospital. They may have to go to Green Bay or 
Marquette or, you know, drive hundreds of miles to get evaluated in an 
emergency room, for example.
  The way things are now is just not sustainable, especially with the 
Affordable Care Act's impact on Medicare. And to think that if we do 
nothing, everything will be okay is just wrong.
  We've put forward this plan about premium support where you have a 
choice. It is similar to Medicare Advantage, where in Michigan there 
are 20 or 30 different plans you can choose from, the one that suits 
you the best. I think that's a reasonable option. There may be another 
plan out there somewhere that's equally as good. I haven't seen that. 
But I'm certainly willing to listen to a plan of how to fix it.
  Doing nothing is unacceptable, and I just think that it's just wrong 
to castigate those of us who are trying to find an answer that will fit 
most people and be affordable and, like many of the advantages that 
people have talked to previously this evening, you know, different 
people's situations. But to do nothing, though, to put your head in the 
sand like an ostrich and pretend there's no problem is not an option.
  So like the speakers before me, I encourage people to speak to their 
physicians about what the situation is. I'm going around my district in 
the next several months and am putting together a little Medicare meet-
and-greet at the senior citizens' centers at various locales in my 
district to try to explain this to patients because they don't really 
seem to have an idea--I said patients; I guess I mean constituents. I 
was speaking in doctor terms--but they don't have an idea how serious 
the problem is. And I think part of our problem is getting that message 
out to other people that this is not something we can ignore, that this 
is not something that's just going to go away by not dealing with it. 
And it's certainly not going to go away by castigating people that are 
trying to find an answer.
  So I encourage those people, as Nan mentioned, to speak to their 
physician. Feel free to call my office to get further information, but 
realize that we're trying to fix a problem, not ignore a problem.
  With that, I thank the gentleman for yielding.
  Mr. FLEMING. I thank the gentleman from Michigan, the physician.
  In the closing moments here, what have we learned? We've learned that 
we have a Medicare system that's highly bureaucratic, highly expensive 
and, as the graph showed, is going to be insolvent as early as 2016. 
That's 4 years away. And we desperately need a solution to that. We've 
got this side of the aisle which has already come up with a solution, a 
premium support plan that basically offers to Americans the same 
opportunity we, in Congress, have, an excellent health care plan. And 
then we have got this side of the aisle, Democrats, who absolutely have 
come up with no solution. As the gentleman says, they bury their heads 
in the sand and offer nothing.
  I would submit to you, Mr. Speaker, that we can't continue going this 
way. We have got to move forward. We've got to find solutions by, 
again, putting health care providers in the arena, having them compete 
with each other, always doing that. If it's a level playing field--and 
that's our responsibility in government--the quality of care goes up 
while the cost goes down.
  I want to thank my colleagues here tonight. We have had a great 
discussion, and I look forward to doing this again very soon.
  With that, I yield back the balance of my time.

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