[Congressional Record Volume 158, Number 46 (Tuesday, March 20, 2012)]
[House]
[Pages H1420-H1423]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ONGOING HEALTH CARE DEBATE
The SPEAKER pro tempore (Mr. Gowdy). Under the Speaker's announced
policy of January 5, 2011, the gentleman from Georgia (Mr. Woodall) is
recognized for 60 minutes as the designee of the majority leader.
Mr. WOODALL. I appreciate the majority leader giving me the time to
come down here today, because I've got IPAB on my mind, Mr. Speaker. I
say that like everybody knows what that is because we talk about it
here in this Chamber all day long. IPAB, a word that was not even in
the lexicon of America until the President passed his health care bill.
What is IPAB? I happened to bring down with me today, Mr. Speaker,
the front page of the President's health care bill, the Patient
Protection and Affordable Care Act as he describes it. This was the
900-page law that was passed that completely restructured a sixth of
the American economy.
The question then is, when we're talking about the Patient Protection
and Affordable Care Act and we're talking about how we change the
individual health care decisions that every American gets to make, what
do we get for it? What's the value added there? Because I think, Mr.
Speaker, at the end of the day, when folks are talking about what
motivates them, it really is affordable care. That's why we named the
bill this way, the Patient Protection and Affordable Care Act. We want
patients to be protected, to be able to make their own health care
choices. We want care to be made available to folks at prices that
American families can afford. There are 900 pages in that health care
bill, Mr. Speaker.
Now, IPAB, how would we describe it? We would call IPAB the hammer in
the health care bill, because there are
[[Page H1421]]
lots of ways to save money, Mr. Speaker. You can save money by
introducing competition into a system.
I'm from Atlanta, Mr. Speaker. I've got a soft spot in my heart for
the Coca-Cola Company. But how many Coca-Cola machines do you pass on
the street where the Coke is selling for $3 a can while the Pepsi right
beside it is selling for $1.50? How many? Have you ever seen that
happen? The answer is ``no'' because competition completely moves those
machines out of the marketplace. If the Pepsi is a dollar, the Coke's
going to be a dollar, too. If the Pepsi is $2, the Coke is going to be
$2. Competition controls those prices.
What controls prices in the Patient Protection and Affordable Care
Act? Because we've heard time and time again, Mr. Speaker, on the floor
of this House that the Patient Protection Act restricts my choices as a
consumer. We've heard time and time again on the floor of this House,
Mr. Speaker, that the Patient Protection Act restricts doctors and the
services that they provide. We've heard time and time again, Mr.
Speaker, that the Patient Protection Act restricts the choices that
insurance companies can provide. So, if it's all of these restrictions
on competition, how in the world does the Patient Protection Act save
the money that needs to be saved to make health care affordable?
The answer is this: It's in section 3403. Again, I don't encourage
folks at home to read this bill, Mr. Speaker, unless they've got time
on their hands. There's lots of good summaries out there. It's over 900
pages long, and it's signed into law. I don't think folks are going to
be able to read this back in their offices, Mr. Speaker.
This is about 46 pages that I've put up here just on one in case we
needed to reference it, but 46 pages of law defining this brand-new
thing that we've never had before in America, the Independent Payment
Advisory Board.
If you read these 40 pages, Mr. Speaker, what you're going to find is
that the Congress that passed the President's health care bill--and it
was not this Congress, Mr. Speaker. You were not here in that Congress.
I was not here in that Congress. It did not pass the Congress under
normal rules and procedures. It passed in a manipulated reconciliation
process designed intentionally to thwart the will of the House and of
the Senate. But in that bill, they said Congress can't control these
costs; and, candidly, I'm glad. I don't want Congress controlling my
health care costs.
So what did they do? They went to an independent commission. The
President is going to appoint this commission, Mr. Speaker. The
President will appoint members to sit on this independent Medicare
advisory board, and what they will do is decide where Medicare should
save money.
Now, my mom and dad just went on Medicare, Mr. Speaker. I sit down
with them. I look at their statement of charges that they get back when
they go to the doctor's office. It's not always easy to understand, but
we go through it together. It occurs to me that if Medicare is going to
save money, there is only one way Medicare can do that. If we don't
allow competition in the system, if we don't allow patient choice in
the system, if we don't allow provider choice in the system, there is
only one way that Medicare can save a dime; that is by restricting
services. Now, that comes in lots of different ways, and I want to make
sure I'm absolutely candid, Mr. Speaker, and accurate, because this is
the panel.
Do you remember the death panel discussions? Do you remember that
becoming a part of the lexicon in America, the death panels that
Congress was going to create? This is that. I mean, this is where that
idea came from, because what we have here is a board that makes
decisions, recommendations about how to change Medicare spending.
Well, if we're not going to provide competition, if we're not going
to allow doctors more decisions, if we're not going to allow other
providers more decisions, then the only way to change the financing
structure of Medicare is to restrict either the services that Medicare
provides or the amount of money that is being paid to providers.
Now, I want to give my friends who passed this bill the benefit of
the doubt, Mr. Speaker. I don't believe there is a single Member of
this body who would stand here in the well and say that their decision
about how to save the Medicare program is to restrict the services that
Medicare beneficiaries can access, not one. I don't think one Member,
Republican or Democrat, will come to the well of this House and say
that their proposal for saving Medicare is to find seniors in need of
health care and tell them ``no.'' Not one. But, Mr. Speaker, what's the
effect, then, of the Independent Payment Advisory Board?
Let's look at what folks have said.
This is George Miller, one of my colleagues here on the floor of the
House, a Democrat from California. We're taking up, tomorrow, a bill
that will repeal this Independent Payment Advisory Board, this Medicare
board. We're going to repeal it tomorrow, I believe, here on the floor
of the House. When talking about that, my colleague from California
said this:
IPAB is a critical measure for lowering health care costs.
He's absolutely right. I'm not picking on him at all. I'm endorsing
what he has to say. That's what these 40 pages of law, Mr. Speaker, do.
They are all designed to cut costs. But we've talked about it. If we're
not going to introduce competition, if we're not going to introduce
choices, if we're not going to introduce options, how are we going to
cut costs? We all agree, Republicans and Democrats alike, that the IPAB
board is a critical measure for lowering health care costs.
Peter Orszag, the OMB Director, the first one that President Obama
used, said this about health care costs in Medicare:
The core problem is that health care costs are concentrated
among expensive treatments for chronic diseases and for end-
of-life care.
{time} 1740
Mr. Speaker, let me reflect on that a minute. I've just shown you the
40 pages of law in the President's health care bill that are the cost-
saving mechanism that the President has proposed and that has been
passed into law. The OMB Director, the Office of Management and Budget
Director, for the Obama administration said this:
The core problem is that health care costs are concentrated
among expensive treatments for chronic diseases and for end-
of-life care.
Mr. Speaker, what choices, then, does that give us? If we agree that
IPAB is a critical measure for lowering health care costs and if we
agree that health care costs are primarily concentrated with expensive
treatments for chronic diseases and end-of-life care, how exactly is
this unelected board going to lower those costs?
It's an honest question. If that's what has to happen for Medicare to
be saved, exactly how is this board going to do that? Every American on
Medicare and every American approaching Medicare needs to have that on
their mind. What is it that IPAB, this unelected board, is going to do
to save costs? We all--Republicans and Democrats alike--agree that the
only purpose of IPAB is to control costs. We agree--Republicans and
Democrats alike--that the money in Medicare is concentrated among
expensive treatments for chronic diseases and end-of-life care. So if
IPAB is going to control costs and the costs are here, what choice do
we have but to deny individuals expensive treatments for chronic
diseases and end-of-life care? What else is there?
To me, that's common sense, that this is where the President's
proposal is going. I do not endorse this proposal. I was not here in
this Congress, Mr. Speaker, when this proposal passed. Had I been here,
I would have voted an enthusiastic ``no.''
Nevertheless, it is the law of the land as we sit here today, and our
seniors are at risk. How many times have we heard supporters of the
President's health care bill say, No, IPAB is not a Medicare rationing
board. In fact, if you want to dig deep into these 40 pages, you'll
find that said over and over again. Folks continually say, this is not
a Medicare rationing board. But we know where the costs are, and the
question is how do we control them.
What my friends who support the President's health care bill say is,
no, we're not going to deny care to Medicare beneficiaries; we're just
going to clamp down on payments to doctors. That's what they say: We're
just going to change the payment schedules for doctors.
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I've got news for you, Mr. Speaker. That's been the Medicare plan for
decade, upon decade, upon decade, upon decade; and this is what you
get. This is from a CNNMoney article from January 6 of this year titled
``Doctors Going Broke.'' It recounts the many changes that have
happened in the Medicare system as we continue to do nothing about
choices, nothing about options, nothing about getting the consumer
involved in health care decisions, but continuing to use the same old
broken tools to solve the Medicare issue. It says this:
In 2005, Medicare revised the reimbursement guidelines for
cancer drugs, which effectively made reimbursements for many
expensive cancer drugs fall to less than the actual cost of
the drugs.
You can tell me you don't want a Medicare rationing board, Mr.
Speaker. I don't want a Medicare rationing board either. But if what
we're going to have is a board that is going to cut the costs of
Medicare and they're going to do that by cutting reimbursements to
providers and what we already see is that we're cutting reimbursements
to providers to the point that those reimbursements fall below the cost
of the service, what do you think is going to happen to Medicare
beneficiaries when they go to seek services? I'll tell you.
The President's health care bill, Mr. Speaker, primarily solved the
challenge of the uninsured by dumping them onto State Medicaid
policies. I don't think that is a particularly creative solution, but
it is certainly an option.
My uncle is a primary care doc down in central Georgia. There used to
be a bunch of docs who would see Medicare patients in that part of the
world. Today he's the only one who will see Medicaid. He is the only
one. In five counties, Mr. Speaker, he is the only doc that will see
Medicaid patients. Don't tell me that our goal here in Congress is to
help patients find care if we're going to lower reimbursement rates to
a place where no doctor will accept them. I don't care that you have an
insurance policy if you can't find a doctor who will take it. It does
not matter that the government says you're guaranteed health care if
you can't find a doctor who will provide it.
Mr. Speaker, that's not news to anyone who has had a job in the
private sector; that's not news to anyone who has had to write
paychecks from their business; and it's not news to anyone who has been
a consumer.
I'm a coupon clipper, Mr. Speaker. I cut them out of the Sunday
paper. I go into the store, I've got a big old coupon, I think I'm
going to get a good deal, and the store doesn't carry the product. What
is that coupon worth to me if I can't find the product, Mr. Speaker?
Not a thing. That's what we're doing when we clamp down on costs. Don't
you dare believe that we can continue to cut docs year after year after
year after year and that your family and my family, who are on
Medicare, are going to be able to find care. They cannot.
From that same article, Mr. Speaker, ``Doctors Going Broke.'' Again,
January 6, 2012, from CNN Money Magazine. Dr. William Pentz said:
Recent steep 35 percent to 40 percent cuts in Medicare
reimbursements for key cardiovascular services, such as
stress tests and echocardiograms, have taken a substantial
toll on revenue.
He also says:
These cuts have destabilized private cardiology practices.
A third of our patients are on Medicare.
So these Medicare cuts are by far the biggest factor. Then, Mr.
Speaker, he says private insurers follow Medicare rates. Those
reimbursements are going down as well. You know, he is right about
that. When the Federal Government pays two-thirds of all the health
care costs in this country, Mr. Speaker, and the Federal Government
decides it can get away with paying less, guess what? Everybody else
wants to get away with paying less too. That is a good capitalist
system. I don't fault folks for that. What I fault folks for is
standing on the floor of this House and promising the American people a
program that they pay into all of their life so it will be available
for them in their time of need and then cutting rates to a place where
you cannot find a doctor who will serve you. Mr. Speaker, the hypocrisy
of saying that we're going to care about people in their time of need
and putting the people out of business who provide for them in that
time of need is deafening.
I go again to that same article of January 6, 2012, ``Doctors Going
Broke.'' The same doctor, William Pentz, a cardiologist there in
Philadelphia:
If this continues, I might seriously consider leaving
medicine. I can't keep working this way.
He goes on to talk about how the law of the land is going to provide
even further cuts. He said:
If that continues, it will put us under.
My dad is going in for heart surgery in about 30 days, Mr. Speaker.
We shopped long and hard to find a doctor that we would trust to do
that surgery, just as every American family does.
Who are folks going to trust, Mr. Speaker? Who are folks going to
find if we put the people who provide the care out of business?
IPAB, Mr. Speaker, these 40 pages from the President's health care
bill, the only 40 pages that are designed to reduce costs, do not
reduce costs through competition, do not reduce costs by providing
consumer choices, do not reduce costs by getting consumers involved in
their own health care. They reduce costs by either rationing services
or by cutting reimbursements to a place where the marketplace rations
those services on its own.
Don't believe for a moment, Mr. Speaker, that cutting reimbursements
to doctors doesn't equal cutting services. That's really the hypocrisy,
Mr. Speaker, for lack of a better word, that I hear on the floor of
this House:
Oh, we're going to go out there and we're going to save all this
money. How are you going to do it?
We're going to go out there and cut those reimbursements to docs.
All right. It sounds like you're liable to end up rationing services.
Oh, no. IPAB, that's not going to ration any services. No, no, no.
They don't have the authority to cut out services. That's not what they
do.
Well, what are they going to do?
Well, they're going to cut the reimbursement rates.
Well, what's going to happen?
Well, docs will just keep providing those services.
{time} 1750
We saw it here.
Money magazine tells you, when you are only reimbursing folks at the
cost of the service or less, they're going to quit providing. According
to factcheck.org--those folks who go around and look at all the claims
politicians make and try to figure out which ones are real and which
ones are full of hot air--this is what they said: ``31 percent of
primary physicians restricted Medicare patients in their practices.''
You know what that means. That means that 31 percent of all the doctors
in the land who provide primary care services, those most-needed
services, said they do not take every Medicare patient that comes
knocking on their door. They can't. They restrict how many Medicare
patients they'll take into their practice.
We've already seen that we're putting docs out of business. We're
forcing docs into retirement. Who is going to provide the care, Mr.
Speaker? Who is going to provide the care if we force the people who do
it today out of business tomorrow?
Back to factcheck.org: ``62 percent of family practitioners would
stop accepting Medicare patients if reimbursement rate cuts follow
current law.'' Hear that, Mr. Speaker. Hear that. Let me say it again:
If reimbursement rates follow the current law. I'm not talking about if
some new draconian procedure gets put in place. I'm not talking about
if some crazy future Congress comes in here and tries to further
socialize health care. No, no. If the current law of the land, as
passed before you and I came to Congress, Mr. Speaker, if the current
law of the land continues, 62 percent of family practitioners would
stop accepting Medicare patients.
What is IPAB going to do? It's going to control costs. How's it going
to do it? It's going to do it by cutting reimbursements to providers.
What happens when you cut reimbursements to providers? Sixty-two
percent of all of America's family practitioners will stop accepting
Medicare patients.
Mr. Speaker, what we do here has consequences. This isn't some think
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tank downtown that has the freedom to just pontificate, to make
recommendations, to wonder how things could have been. This is a body
where every single thing that we do has the potential to affect--
positively or negatively--the lives of every single citizen of the
land.
There are no free lunches in America, Mr. Speaker. There is no
something for nothing. You can control costs through competition. You
can control costs through getting consumers involved in their own
health care. You can control costs by providing folks with more
choices. You cannot control costs responsibly by putting providers out
of business and rationing care through the long lines that are then
going to result.
We are going to deal with this bill tomorrow, in fact, and I would be
happy to yield to my friend from the Rules Committee to help make that
happen.
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