[Congressional Record Volume 158, Number 45 (Monday, March 19, 2012)]
[House]
[Pages H1384-H1388]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE ONGOING HEALTH CARE DEBATE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from Arkansas (Mr. Griffin) is
recognized for 60 minutes as the designee of the majority leader.
Mr. GRIFFIN of Arkansas. Mr. Speaker, I've come here to the floor
tonight with my colleague from Wisconsin, Representative Duffy, to talk
about the crisis Medicare faces and to talk about the Independent
Payment Advisory Board. Some call it the IPAB. It's a part of the
President's health care law, and this House is going to address it this
week.
But I want to start out by talking a little bit about the crisis that
we're facing in this country over Medicare and what it means to our
seniors. My mother is 71, and she's a Medicare recipient. She counts on
Medicare. She paid into it and is now using it to take care of herself.
And we've got to make sure that future generations are able to rely on,
count on Medicare.
This first chart here, Mr. Speaker, shows what a significant portion
of the Federal budget Medicare consumes. We have it here, $555 billion,
and that is per year. This is a yearly budget for the Federal
Government.
It is widely agreed upon by Democrats and Republicans that Medicare
is going bankrupt. Some estimate it's 7 years, 8 years, 10 years, but
most everyone agrees, having looked at the numbers, that Medicare is
going bankrupt.
I've got a quote here from Senator Lieberman, who addresses a
criticism that we hear a lot about the Republican reform plan on
Medicare:
We can agree that Medicare is going bankrupt. We then have
to ask ourselves, what are we going to do about it?
What are we doing about it? Well, the House has acted to reform
Medicare. We acted last year, in 2011, as part of our budget to reform
Medicare to save it. The only reason we proposed reforms to Medicare is
because we want to save it. We want it to be there for the next
generation.
I've heard a lot of criticism: You want to change Medicare as we know
it. I say: No, Medicare, as we know it, goes bankrupt on its own. We
have to act to save Medicare, Mr. Speaker.
And in this quote of Senator Lieberman, he says:
The truth is that we cannot save Medicare as we know it. We
can save Medicare only if we change it.
Now, like House Republicans, I think it's fair to say, Senator
Lieberman is talking about what we must do for the next generation.
Like our proposal, I think a lot of us agree that we can make changes
to Medicare for the next generation, and for those, for example, 55 and
over, leave it as it is. Why? Because people have counted on a
particular way the program works, and we won't have to change that to
start saving. We can just change it for the next generation.
[[Page H1385]]
I have another quote here I want to share with you that shows that
President Obama, at least in his words, understands that we have a
problem with Medicare.
If you look at the numbers, Medicare, in particular, will
run out of money, and we will not be able to sustain that
program, no matter how much taxes go up.
This is the President.
He continues:
I mean, it's not an option for us to just sit by and do
nothing.
Unfortunately, those are just words because that is precisely what
the President has done, sit by and do nothing. It's what the Senate has
done. The House has acted to reform to save Medicare.
Now, the President's health care law has a provision in it, the IPAB
that I referred to earlier, that impacts Medicare, but it doesn't save
Medicare. It rations Medicare.
How does that work? Well, this is an unelected board, it's an
unelected board that will make decisions on where Medicare is cut. So
the President has had an opportunity to propose reforms to the way
Medicare works, so that we can innovate and change it to save it for
future generations--reform it, upgrade it, do things better. But
instead, the President's approach is simply to cut the levels of
spending but leave the overall functioning of Medicare the same. So no
innovation, no new approach, no reform, just cut when we run out of
money.
Well, what does that result in? It results in seniors not getting the
care they need, and not just because services are reduced but because a
lot of doctors won't take Medicare patients. This is already a problem
today. Today there are seniors looking for a doctor to help them with
their particular problem, and doctor after doctor says, I'm sorry; we
don't take Medicare. That problem is only going to get worse if the
IPAB, the Independent Payment Advisory Board that's in the President's
health care law, if it does what it is scheduled to do.
Now, what are we doing about it here in the House? Well, we certainly
voted to repeal the President's health care law. That passed the House,
did not pass the Senate. But we've tried a lot of other ways to get at
the problem, and one that we're going to do this week is to repeal the
IPAB, repeal the Independent Payment Advisory Board.
{time} 2000
I yield to the gentleman from Wisconsin.
Mr. DUFFY. I appreciate the gentleman from Arkansas yielding.
I want to take a couple of steps back in this conversation and first
talk about the national debt.
Many Americans are well aware that today we owe well over $15
trillion in national debt. This year alone we're going to borrow $1.3
trillion on top of a trillion dollars last year and the year before
that. There are trillion-dollar deficits as far as the eye can see.
Last year, the House Republicans put forward a budget that showed a
path to balance telling the American people how we balanced the
American budget at some point in the future.
Now, last year and this year, the President put out a budget, neither
of which were ever balanced, never telling the American people what his
plan is to bring American spending to balance with its revenues.
So we look a couple years back when the President and this House
passed the Affordable Care Act, or ObamaCare, which the CBO now states
that over 10 years, the rosiest of projections say it's going to cost
the country nearly $2 trillion more. Even when they put out that budget
or that proposal for health care reform, they're still not willing to
put out a budget that says how we're going to pay for it. That concerns
me.
I'm a father of six. We're spending today and passing the bill off to
the next generation. It's unconscionable.
Let's actually talk about what the President and this House have
passed in ObamaCare: $2 trillion over 10 years in additional spending.
It's a bill that is going to empower bureaucrats in this town to make
health care decisions for Americans in every part of the country
instead of your family, your health care provider, or you making that
decision.
Listen, I'm from Wisconsin, and I know the values that we have in
central Wisconsin. They're probably a little bit different in Arkansas
or Kansas or Kentucky, Minnesota, or Michigan. I think we should allow
people to make their health care decisions instead of bureaucrats in
Washington.
But what concerns me the most is how ObamaCare impacts Medicare.
Now, listen. ObamaCare takes a half a trillion dollars out of
Medicare and uses it to fund ObamaCare. Now, we all know in America
that we have some financial pressures on Medicare. We know that we have
to come together as a country, as a community, both parties, to figure
out how we're going to pay for Medicare, keep the promise to our
seniors.
At a time when we're still having that debate, to think that this
House would pass a bill and take a half a trillion dollars out of
Medicare and use it for ObamaCare, I think that's wrong. Let's first
figure out how we keep the promise to our seniors before you make a
promise to anyone else with their money. That is unconscionable.
What concerns me the most is what the gentleman from Arkansas
mentioned, which is the Independent Payment Advisory Board. It's the
IPAB, and we haven't heard a lot about it, but I think you'll hear a
lot more as the months go on. This is a board of 15 unelected
bureaucrats. What they're going to do is look at reimbursement rates
with Medicare, and they are going to be able to systematically reduce
reimbursements to doctors, hospitals, and clinics for the care for our
seniors.
Let's make no mistake. This is reimbursements for our current
seniors, not for some future generation. The argument by the President
goes like this: Mr. and Mrs. Senior, don't you worry about your quality
of care or your access to care. We're just going to pay your doctor,
your hospital, and your clinic less for your care. If you believe that,
I've got oceanfront land for you in Arizona.
Of course it's going to affect our seniors' access and quality of
care. When you pay less for it, you're going to get less of it. Our
seniors, they worked a lifetime. They bargained. They retired based on
this promise for Medicare. This proposal doesn't meet that obligation.
It takes a half a trillion dollars from Medicare, but then is going to
ration the care of our current seniors--seniors who can't go back into
the workforce and get another job. They retired based on the promise
from the Federal Government, and ObamaCare reduces that bargain that's
been made with our seniors.
Mr. GRIFFIN of Arkansas. Will the gentleman yield for a quick point?
Mr. DUFFY. Sure.
Mr. GRIFFIN of Arkansas. What really scares me is that this
restricted access to health care, to Medicare that you're talking
about, it already exists. The IPAB, the Independent Payment Advisory
Board, that's in ObamaCare that will cut the amount of reimbursement to
doctors when it gets going, it's not even cutting yet and we already
have a problem with seniors getting the doctor that they want because
so many doctors have said, I'm just not going to take Medicare any
more.
Before I yield back, I just wanted to mention an email that I got in
my office this week.
There's a constituent of mine, John Pollett. He's the program
administrator for the Arkansas Senior Medicare Patrol. He goes around
and he talks with seniors about Medicare and how to recognize fraud in
Medicare.
He was at the Sherwood Senior Center this past week, this week, in my
district, and he was giving a presentation teaching Arkansas seniors
about Medicare fraud. A lady, a senior, who's on Medicare, an angry
senior, said to him--she wasn't angry at him--but she said with
passion, I don't understand why I'm forced to pay my Medicare premium
but can't find a doctor who will take me because I'm on Medicare.
So we already have a problem with access to Medicare because more and
more doctors are saying, I'm not going to take Medicare. There are a
host of reasons: the reimbursement rate, the administrative hassle,
what have you.
But IPAB, I hear the gentleman from Wisconsin saying, the Independent
Payment Advisory Board that's in ObamaCare is only going to make the
problem worse because while some of us are interested in reforming the
way Medicare works so that we get more service for our dollar, the
President is only interested in saving money by
[[Page H1386]]
just reducing and cutting without reforming.
We all understand the need to reach solvency; but those of us who
back Medicare reform want to do it through innovative, creative, cost-
saving approaches that avoid rationing, whereas the President simply
wants to cut through an unelected board.
I'm going to yield back now to the gentleman from Wisconsin. I just
thought it would be helpful to give you a real-life example of a senior
in my district who's been impacted by that.
Mr. DUFFY. I appreciate the gentleman for telling that compelling
story. All of us have stories like that from people in our districts,
from our own family members, our friends, our constituents; and this is
a very important issue. That's why I think we have to have this
conversation about what the Independent Payment Advisory Board will do.
I used to be a former prosecutor, and we're used to a system where if
you don't like the decision of a court, oftentimes you're able to
appeal that decision. This board is unappealable. The decisions that
they make, the 15 members when they make a decision, that is going to
be the law, that is going to be the rule, and you can't appeal it, and
you can't have it overturned.
{time} 2010
I just want to close my comments up on the Independent Payment
Advisory Board. We on the Republican House side don't believe that we
should go forward with a plan that is going to systematically reduce
reimbursements for seniors, that's going to affect the quality and
access to care for our seniors. Let's give them what they bargained
for. We in the House on the Republican side, we said put back the half
a trillion dollars, put that back into Medicare, do away with the IPAB
board. If you're going to make changes to Medicare, make it for a
future generation, a generation that isn't near their retirement, a
generation that will have enough time to plan for the changes in
Medicare; but don't pull the rug out from our seniors who have been
given a promise and now aren't going to get it because their Medicare
is going to be rationed.
We think it's fair to do it for a future generation. But let's make
no mistake, when we hear that one party has transformed Medicare or
changed Medicare as we know it, there is one party who has done that
and that is the Democratic Party in ObamaCare. They have changed the
way that Medicare is going to work. They're going to ration it. We
believe we should save it, protect it, preserve it. I know my freshmen
colleagues in this House are going to fight tooth and nail to make sure
that every one of our seniors get exactly what they bargained for in
Medicare. If there are changes, it's going to be for a generation that
can plan for the change in Medicare in due time and in due course.
Mr. GRIFFIN of Arkansas. I thank the gentleman for joining us here on
the floor tonight.
I see my friend Mr. Quayle from Arizona here with us on the floor,
and I would like to yield to him at this time.
Mr. QUAYLE. I thank the gentleman for yielding, and I was listening
to his comments about talking with his constituents back home and about
how many doctors are not seeing Medicare patients, not seeing new
Medicare patients, or are not seeing the patients that they currently
provide services to.
I know, like the gentleman from Arkansas, he does a lot of teletown
halls and town halls just like I do. The other week I was on a teletown
hall with my constituents back home, and there were a number of people
who raised the concerns that their doctors were not going to provide
them the medical services that they had in the past because they were
uncertain about the payments that the Medicare system would be giving
them.
This is a constant refrain that we hear back home from our seniors,
that they are consistently getting turned down by their physicians
because of the lack of payment from Medicare. This is a system that we
need to fix. This is a system that we need to make sure that we keep
the promises to our seniors and reform it for future generations so
that it will be there to protect them when they reach the retirement
age.
If you look at ObamaCare, it is really filled with provisions that
confer arbitrary power, that raise costs. It cuts benefits, it harms
access, and it restricts choice. Against this really sorry backdrop,
the Independent Payment Advisory Board, or IPAB, has the dubious
distinction of being one of the absolute worst provisions in the entire
health care bill. Indeed, this single provision causes all the problems
that I just mentioned. This board of 15 unelected, unaccountable
bureaucrats would have the power to impose price controls that will cut
senior access to care. To make it worse, this board would not have to
meet in public or listen to public input. Amazingly, ObamaCare even
leaves the door wide open for IPAB members to receive gifts from
lobbyists. In other words, the public has no right to talk to IPAB, but
lobbyists willing to shower them with gifts do.
President Obama claims his rationing board will solve the real
problem of Medicare's rising costs. It doesn't. The only mandate the
board has to cut costs is by restricting payments to doctors that
provide health care. It is already the case that 12 percent of doctors
will not take Medicare patients due to the unreliability of government
payouts. That is twice the number of doctors who refused to see
Medicare patients in 2004, which is a frightening statistic on how
quickly that is rising. Additionally, a recent survey showed that 60
percent of doctors have or will restrict their medical practices as a
result of ObamaCare. Of those doctors, 87 percent said they would be
forced to restrict the amount of care they offered to Medicare
patients.
ObamaCare utterly ignores the laws of economics in this instance. You
can't cut the cost of a service by cutting the number of people
supplying it, and that's exactly what IPAB would do. By forcing doctors
to turn away Medicare patients, the costs will go up as fewer and fewer
doctors see to the needs of the growing number of seniors. Either that,
or IPAB will directly ration care. It is astounding that the President
would look at an important issue like caring for our seniors and decide
that the best way to handle rising costs is by attacking senior access
to health care and the doctors who provide it.
Medicare does need reform, as my friend from Arkansas knows, and has
been on the floor numerous times talking about the reforms that are
necessary. It needs real structural reform that protects access for our
current seniors and fixes the system for future generations. As with so
many other issues, the President punted on making these needed reforms.
Instead, he chose to give us a rationing board that would make the
problem worse.
Let's repeal IPAB and give our seniors the care they deserve.
Mr. GRIFFIN of Arkansas. I thank the gentleman from Arizona.
I wanted to just point out that 70 House Democrats opposed IPAB when
it was being debated in the President's health care law. Before I ever
got to Congress, there were 70. In fact, it wasn't in the House
version. I'm hopeful that some of the Democrats who have come out
against IPAB will join us in repealing it so we can move on to truly
reforming Medicare to save it.
We're lucky and fortunate to have some physicians, many physicians,
serving with us here in the House of Representatives; and they bring an
expertise in this area that really helps us when we're working on
solutions to the problems with Medicare and Medicaid. One of them has
joined us here on the floor tonight. I would like to yield to my friend
from Tennessee.
Mr. DesJARLAIS. I thank the gentleman, and I think it's great that
we're taking time tonight to discuss such an important issue that is so
near and dear to all of our seniors because this last year, quite
frankly, has been a very confusing time as we try to reform and fix the
problems that face Medicare today.
We have, without a doubt, a number of seniors who are having trouble
finding access to care right now for all the reasons my colleagues have
stated, that we have a flawed payment formula in the SGR, sustained
growth rate formula, and we've made attempts to correct that this year.
But, again, as they so often have done now for the past 13, 14 years,
they've just pushed the problem down the road rather than deal with it.
I don't think it hurts to review
[[Page H1387]]
for a minute what problems are facing Medicare.
We can't deny for a second, Mr. Speaker, that Medicare is going
broke. You can talk to any number of agencies. Whether it is the CBO,
AARP, we all know that Medicare is on an unsustainable course. Medicare
is quite simply going to be broke in about 10 years. That's not a
Republican problem. That's not a Democrat problem. That's a people
problem. What we're here about tonight is to make sure that our seniors
don't have to worry where their health care is going to come from.
We must get together and take steps to make sure that their access to
care is preserved and protected. We did this earlier last year with the
Paul Ryan budget. We put forth a sensible reform that would put
Medicare on a path to sustainability. If you're 55 or older, you don't
have to worry about any changes to your health care. That was grossly
distorted in the press and the media. We were accused of--literally,
there were TV ads made of pushing an elderly person off a cliff. This
is just plain and simple wrong to create that kind of uncertainty for
our seniors.
The bottom line is we have 10,000 new Medicare recipients entering
the Medicare pool every day. We have a situation where when Medicare
was first formed in 1965, the average life expectancy of a male was 68.
Thanks to advances in medicine, men and women both are living at least
10 years longer. However, this was not managed in the budgeting for
Medicare and hence we've gone deeper and deeper into debt. Now our
average couple that pays about $109,000 into the Medicare system over a
lifetime extracts about $340,000. That's about a dollar in for $3 out.
Again, there's no denying that we have a problem and this is going
broke.
{time} 2020
Well, the Republicans did offer a solution, as my colleagues and I
have said. However, right now, the IPAB is the only solution we've seen
in President Obama's plan to cut costs, but it is going to gut $500
billion from our seniors; and that's the fact they need to know about.
They need to call their Representatives.
Mr. GRIFFIN of Arkansas. Will the gentleman yield?
Mr. DesJARLAIS. Yes, sir.
Mr. GRIFFIN of Arkansas. I just want to make sure I understand what
the gentleman is saying. What you are saying--correct me if I am wrong,
but what you are saying is the House has a plan to reform Medicare to
save it. As far as I know, I haven't seen any other plan to save
Medicare pass the Senate. I haven't seen the President propose a plan
to save Medicare. There is only one. Now the President has a plan for
Medicare, but it's not to save it, and it really doesn't reduce cost
through innovation and what have you; it just cuts. And the cuts are
decided upon by unelected bureaucrats who are on this IPAB, the
Independent Payment Advisory Board.
You mentioned the television ads. I had television ads run back in my
district. They talked about how I and others want to change Medicare as
we know it. Well, I quoted Senator Lieberman earlier, who said we can't
save Medicare as we know it because it's going bankrupt. So what I say
to folks is we have to reform it. And I'm happy to have a discussion
and debate and compare this reform with that reform. I'm happy to do
that.
What is intellectually dishonest, though, is to compare reforms that
I advocate or you advocate, to compare those to the way it is now.
That's intellectually dishonest. It's actually deception.
Why is that deception?
Because the way things are now is not going to be that way in 7, 8,
9, 10 years. It's unsustainable, the path we're on with regard to
Medicare. So if someone says your reform changes Medicare as we know
it, if that is presented to demagogue, that, in and of itself, is
intellectually dishonest, because Medicare as we know it goes bankrupt
and changes itself.
So I am happy to have a conversation to compare this reform with that
reform. I certainly do not have a monopoly on wisdom in this area. I
think we ought to be having a free and open debate of reform ideas that
save Medicare for seniors. But what we can't do, what we can't do, is
mislead people, mislead seniors into believing that Medicare, as it
currently functions, is sustainable. That's not true. That's not true.
Folks who continue to talk about Medicare as we know it need to point
out that Medicare as we know it ends on its own by itself. The Congress
of the United States could do nothing on this for 10, 20, 30 years,
whatever, and Medicare would go bankrupt with no congressional action.
So our job, as I see it, is to take affirmative steps to save
Medicare, to maintain the quality, to maintain the quality so that
doctors still want to take Medicare patients, and reform it to save it
for people, seniors like my mother. But we've got to start with the
fundamental idea that we could debate reforms. But comparing reform to
an unsustainable status quo is intellectually dishonest.
I yield back to the gentleman.
Mr. DesJARLAIS. My friend is absolutely correct. What we need to do
here, if nothing else, is we need to agree on the facts; and the facts,
as you just stated, are that Medicare is going broke. It is on an
unsustainable course. So Medicare must be changed as we know it, as you
said.
You mentioned your mother. My mother happens to be having her 73rd
birthday today. It's a happy birthday for my mother today, but I hope
that she has many more happy birthdays to come. We all have those
stories. We all have parents, grandparents, people on Medicare who are
counting on us. They are looking at the arguments going on in this
Chamber and they are confused. They don't know what to believe.
So I think if we can agree, as you said, to the facts and then sit
down and have a meaningful discussion of how we can preserve and
protect this program for future generations, then that's half the
battle.
Mr. GRIFFIN of Arkansas. Even a bipartisan discussion, I welcome it.
In fact, I was proud to see that a Democrat from the Senate joined with
a Republican in the House on a Medicare reform plan. And I'm happy to
debate all these different plans as long as they have the ability to
save Medicare and guarantee quality care for seniors.
If we end up debating reforms on the one hand versus the status quo,
the way things are now, Medicare as we know it on the other hand, we
can't have that debate because the whole point is that Medicare as we
know it, the status quo, Medicare as it is now, it's going bankrupt. So
any discussion of the options has to be between the different options
that save Medicare.
The problem is there is only one plan that saves Medicare that has
passed the House or the Senate or that has been proposed by the
President, and that is the House budget plan from last year. And we
will, I am confident, have a plan this year that we will vote on
shortly that will propose changes to save Medicare.
I want to thank the gentleman for joining us here tonight.
Do you have anything else you want to add?
Mr. DesJARLAIS. I agree with what you are saying; and I guarantee
you, any of the seniors watching tonight, listening to this debate,
they don't care whether the Republicans win this debate or whether the
Democrats win this debate. That's irrelevant. What they want to know is
that they are going to have access to care. And I think it's so
essential that we repeal this IPAB.
The gentleman was with me earlier today at a press conference when
they asked about all the rhetoric last year about these being called
death panels. That may sound a little bit theatrical, but I can tell
you, as a physician, that if I'm treating a patient who is 78 or 88 and
they've got some form of cancer and this IPAB board decides in the
government one-size-fits-all mentality to throw a blanket over seniors
of a certain age who have a certain disease--and cancer is probably one
to pick--that they don't necessarily need to spend that expensive money
on chemotherapy or experimental drugs or perhaps they don't even want
me to order the MRI to detect the cancer, now if you are 78 or 88--that
may sound so old to some people, but I know a lot of people that age
that are very active. They have got 15 or 20 grandchildren, and those
grandchildren enjoy their company. So if they make a decision that
these people shouldn't get that treatment, and that's very well what
could
[[Page H1388]]
happen with this board, then you decide what kind of panel or what kind
of name you want to put on it.
Mr. GRIFFIN of Arkansas. I think ultimately the IPAB seeks to save
money by simply cutting blindly without regard to innovation, without
regard to structural reform, simply having a board of unelected
bureaucrats ration care by making decisions on what Medicare will
cover, won't cover, and by how much.
Yes, we need to do what is fiscally right, but we need to keep our
promise to our seniors; and the way that you do both is to reform
Medicare structurally, not to blindly cut, leaving all the rules the
same, just reducing what you are paying doctors.
{time} 2030
That's not the path. That's not the path. That is, in effect,
rationing, and that will continue to exacerbate the problem of Medicare
recipients being unable to find doctors who will take them. The answer
is to take Medicare that has been so good to so many seniors and reform
it and innovate and make changes that won't just cut costs by reducing
the money paid but will actually change the rules so that we are able
to get more value and more services for our dollar. And that's the
approach we have to take.
Mr. DesJARLAIS. I'll just add one more point. I can tell you that
there's not a senior I've talked to that wants a bureaucrat in the exam
room with us making their decisions. We build relationships with those
patients. There's a trust between the patient and their doctor, and
I'll guarantee you the patients don't want bureaucrats overseeing that
exam room making those decisions for them. So when we move forward with
these reforms, we certainly need to keep that in mind.
I would like to thank the gentleman for leading this hour on such an
important topic.
Mr. GRIFFIN of Arkansas. I thank the gentleman from Tennessee for his
service here in the Congress and as a physician. I thank him for
joining me here tonight. And I just want to reiterate what you said.
Whatever solution we come up with has got to be patient-centered and
respect the doctor-patient relationship. Patient-Centered, not
government bureaucracy-centered--patient-centered.
I thank the gentleman for joining me. I thank all of my colleagues
for joining us here tonight.
I yield back the balance of my time.
____________________