[Congressional Record (Bound Edition), Volume 148 (2002), Part 3]
[Extensions of Remarks]
[Pages 3548-3550]
[From the U.S. Government Publishing Office, www.gpo.gov]


    REPRESENTATIVE CAPPS REMARKS TO THE AMERICAN MEDICAL ASSOCIATION

                                 ______
                                 

                          HON. JOHN D. DINGELL

                              of michigan

                    in the house of representatives

                        Tuesday, March 19, 2002

  Mr. DINGELL. Mr. Speaker, I want to pay tribute to the skill, 
tenacity, and leadership of our colleague and my friend, Rep. Lois 
Capps. I have served with many fine people over the course of my career 
in the House of Representatives and she is among the best. She fights 
every day for the people of her district, and for causes that affect 
virtually every member of our society. She does this with great skill 
and even greater courage. I have come to admire her strength, 
compassion, commitment, and drive. It is with great respect and 
affection that I request that a copy of her recent remarks to the 
American Medical Association be included in the Record. I recommend 
that all of my colleagues read them with great care.

Statement of Rep. Lois Capps, American Medical Association Conference, 
                             March 10, 2002


                                Opening

       Thank you very much for inviting me here to speak today. It 
     is an honor to spend some time with my colleagues in health 
     care.
       I have been asked to speak to you about the Democratic 
     Party's agenda on health care.
       But I am not sure there should be a separate ``Democratic'' 
     or ``Republican'' agenda on health.
       Though politics often suffuses the debate about health 
     care, we should not come at this issue from a political 
     perspective.
       I have only recently in my life become an elected official. 
     And I do not consider myself as simply a politician.
       Instead, I think of myself in the terms that defined the 
     forty years of my career before I came to Washington.
       I am a nurse. I am a health care provider. It is my 
     calling. And I think of myself in my new job as just a 
     different kind of health care provider. I may have traded in 
     my nursing uniform and medical equipment for legislation and 
     committee action. But my goal is still the same. I am obliged 
     to care for the health of my patients, whether they are the 
     students in the Santa Barbara school system, the patients in 
     Yale New Haven Hospital, or the seniors on Medicare across 
     America. And I am proud to bring the benefits of this 
     lifetime of nursing experience to the halls of Congress. And 
     I think my experience has taught me well. As medical 
     professionals we have learned that we need to carefully 
     examine symptoms, check vitals, run tests, and thoughtfully 
     consider our options. Then we select the best course of 
     action we can think of.
       We don't look at the label on a medication to see if it has 
     a D or an R on it. We don't look to see if Tom Daschle or 
     George Bush

[[Page 3549]]

     recommended a particular treatment. We call on all of our 
     medical training and professional experience. We often 
     consult other doctors and nurses, because we have learned 
     that health care is better when provided by a team. And this 
     is how the Congress needs to approach the challenges facing 
     today's health care system.
       Most of my colleagues, on both sides of the aisle, are 
     genuinely interested in reaching across party lines to come 
     up with good solutions. But a few are more interested in 
     opposing the other party's members than in solving our 
     problems. They are unwilling to engage in a debate on the 
     issues, but would rather stymie their opponents ideas, be 
     they Republican or Democrat, for political gain.
       I am a nurse. Sen. Kyl is a lawyer. My colleague, the 
     Ranking Member of the Health Subcommittee, Sherrod Brown is a 
     teacher. Rep. Ganske is a doctor and Rep. Norwood is a 
     dentist. Some of us are Democrats and some of us are 
     Republicans. It is going to take all of our varied 
     experience, expertise, and perspectives to develop real 
     solutions to the challenges we face today.


                                Overview

       And we face real challenges. A few minutes ago I suggested 
     that Congress should treat health care problems the way a 
     doctor treats a patient. So let's do that now.
       Let's check our nation's health care vital signs and look 
     at some of its symptoms. There are 125,000 vacant nursing 
     positions across the country. Physician fees under Medicare 
     have grown 13% less than the costs of practice since 1992. 
     Approximately 56 million Americans are not protected by any 
     state or federal patient protections. 40 million Americans 
     are on Medicare. 78 million baby boomers will start to join 
     them in the next decade. Annual spending on prescription 
     drugs by seniors has grown 116%, from $18.5 billion in 1992 
     to $42.9 billion in 2000. And 43 million Americans are 
     without health insurance of any kind.
       These are not strong and stable vital signs. They point to 
     several problems we must address in order to get our patient, 
     the health of our nation, out of critical care.


                                Nursing

       First of all we have to make sure that the health care 
     infrastructure is there to care for all Americans. This leads 
     us to the nursing shortage. I admit I have a bias when I talk 
     about this issue. I think nurses are terribly important to 
     our health care system.
       I know first hand the challenges facing the nursing 
     profession and the consequences if we fail to meet them. And 
     today the nursing community is facing a dire situation. With 
     an aging nursing workforce approaching retirement, and a 
     dwindling supply of new nurses, we are facing an incredible 
     shortfall of well trained, experienced nurses. To make 
     matters worse this will peak just as the baby boom generation 
     begins to retire and require a greater amount of care.
       I have written legislation, the Nurse Reinvestment Act, to 
     deal with both the immediate and the long-term problems we 
     face. This legislation included proposals: To improve access 
     to nursing education, to entice young people into nursing, to 
     create partnerships between health care providers and 
     educational institutions, and to support working nurses as 
     they seek more training.
       This past December, the House passed a slimmed down version 
     of my bill, and the Senate passed legislation more like what 
     I originally envisioned. We are now trying to work out the 
     differences.
       I deeply appreciate the support of the AMA for my 
     legislation. We are close to finishing it and we would not be 
     here without your support.


                             Physician Fees

       And just as we need to make sure patients have nurses, we 
     also need to make sure they can see their doctors. As you are 
     all aware, the reimbursement rates for physicians' services 
     under Medicare saw a disastrous cut of 5.4% this year. This 
     cut has already had a terrible impact on health care in my 
     district and, I am sure, across the country. If these cuts 
     are not corrected quickly they will be devastating to medical 
     professionals and our ability to provide quality health care. 
     I know you have been deeply frustrated by these cuts, as have 
     I. And you have begun changing your practices to accommodate 
     new economic reality.
       A doctor's office is usually a small business. But as you 
     well know, unlike most small businesses your decisions have 
     life and death consequences.
       Some doctors in my district have left private practice 
     altogether. Others are threatening to. Many who stayed in 
     private practice said that they could no longer afford to 
     accept new Medicare patients. And others simply left Medicare 
     all together.
       This has meant that many seniors across the country are 
     scrambling to find new doctors so they can continue to get 
     the care they need and deserve. Along with a couple of my 
     colleagues I introduced legislation to freeze physician fees 
     at the 2001 level until Congress could find a long-term fix. 
     And when Chairman Bilirakis, Ranking Member Brown, Chairman 
     Tauzin, and Ranking Member Dingell introduced their own 
     legislation to keep the cut minimal. I was pleased to join 
     them in their efforts and was able to get 146 of my 
     colleagues to ask the Speaker for a vote on this issue.
       But, in spite of the bipartisan agreement on this issue, 
     the bill has not been brought to the House floor. I know you 
     will keep the pressure on the House leadership to bring this 
     issue to a vote. I will too. We need to solve this problem 
     now.


                                  PBOR

       But making sure there are enough doctors and nurses will 
     only take us so far. We must also make sure that patients can 
     get access to the benefits they need. We must pass a 
     Patient's Bill of Rights.
       Again I want to take my hat off to you and your 
     organization for your steadfast commitment to this. The AMA 
     and its members have been critical to our progress so far 
     toward real patient protections. We live in an era of 
     astounding new medical developments but also rising health 
     care costs. The insurance companies and managed care plans 
     are understandably looking for ways to control those costs. 
     This can have a positive effect on health care by making it 
     more affordable.
       Years ago in California I saw this lead to more coverage of 
     preventive care. But the pendulum has swung too far towards 
     cost control. Now there is too much pressure to cut corners 
     and to skimp on care. Abuses of patients' rights to quality 
     health care are too common. There needs to be a counter-force 
     on the side of quality care--on the side of the patients. And 
     that counter-force is the Patient's Bill of Rights.
       We have to make sure that medical decisions are made by 
     medical professionals and their patients, and not by 
     accountants. This is why I have supported this legislation. I 
     am very proud to be standing by the AMA on this issue. And I 
     remain confident that we can get this bill through this year.


                          Medicare Rx Benefit

       Unfortunately, I am not so optimistic about passing a 
     Medicare prescription drug benefit for seniors. In the last 
     twenty years we have seen a revolution because of 
     prescription drugs. They are virtually miracle treatments. 
     But they have also become brutally expensive and are a much 
     larger percentage of health care costs than we ever expected. 
     The high cost of these medications has been a problem for 
     many people. But it has particularly hit our seniors. They 
     routinely take several medications for various everyday 
     health concerns. But their fixed incomes cannot pay for them. 
     And Medicare offers little help. You and I would not even 
     consider taking on health insurance that does not cover 
     prescription drugs. But seniors are left looking to Medicare 
     + Choice to pay for their prescription drugs. Medicare HMOs 
     were promoted as an avenue of hope, but have increasingly cut 
     back on benefits, raised premiums and copayments, and often 
     just packed up and left areas deemed as ``unprofitable'' 
     leaving seniors with no where to turn.
       We hear again and again about seniors choosing between food 
     on the table and life saving medication. We really can and 
     should do better than that for older Americans. They expect 
     it and they deserve it. I believe we must establish a benefit 
     that is universal, voluntary, affordable, and accessible to 
     all. Unfortunately, the Administration has continued to focus 
     on expanding the failed Medicare HMO program and helping the 
     poorest seniors. I think about the countless seniors on the 
     Central Coast of California who have shared their personal 
     stories with me about crushingly high drug prices, I know in 
     my heart that prescription drug coverage is not a political 
     issue. It is simply the right thing to do.


                               Uninsured

       Another critical issue is the 43 million Americans with no 
     insurance coverage whatsoever. For them, health care, with or 
     without prescription drug coverage, is nothing but a fantasy.
       These are people like you and me, who are being forced to 
     gamble with their health and with their livelihoods. They 
     have to bet that they will stay healthy and not require 
     health care. Each day, they wonder if today is the day that 
     their luck will run out. Is today the day that they or a 
     loved one will contract a terrible disease? Will today be the 
     day that they or their family are stricken by something that 
     will fill their life with pain and bankrupt them? They should 
     not have to face these fears without the security that 
     insurance can provide.
       In my time as a school nurse in Santa Barbara, I saw too 
     many families without insurance. I saw the defeated look of 
     shame on their faces as they struggled to figure out how to 
     get their children and themselves necessary health care. This 
     is something we can fix if we put our hearts and minds to it. 
     Some people believe that the best way to address this problem 
     is through tax credits. I have to say that I am skeptical. I 
     am concerned that tax credits might not cover the costs of 
     insurance and may inadvertently draw people out of employer-
     based insurance, driving up premiums for those left behind.
       Others have called for Medical Savings Accounts, but these 
     may end up pulling healthy people out of insurance plans and 
     leaving the ill in, again raising the costs to those most in 
     need of help. I think we might be better off pursuing an 
     expansion of existing health care programs or helping small 
     businesses get access to the low rates that large businesses 
     get. But any of these solutions will cost a great deal of 
     money. And so it is essential that we find the best, most 
     cost-effective method. That is why it is absolutely

[[Page 3550]]

     necessary to keep up dialogue and debate, without shutting 
     out ideas,
       You and I may disagree on the best way to help the 
     uninsured. But we will help them faster if we are willing to 
     hear from each other and work towards a consensus. We cannot 
     afford the arrogance of the idea that there is no way but our 
     own.


                              Bush Budget

       We will see this clearly as we set the budget for next 
     year. The President has laid out some laudable priorities in 
     his health care budget. He calls for more funding for the NIH 
     and efforts to prepare communities for bioterrorism. But at 
     the same time the budget cuts funding for community health 
     coordination, chronic disease programs, and efforts to train 
     doctors and other health professionals. I think these cuts 
     are counterproductive. So I will work with the President and 
     my colleagues on this budget, hopefully without the partisan 
     bickering that has filled past debates.


                                Closing

       Our patient, the health of America, is faced with too many 
     diseases and conditions to simply lie on its hospital bed as 
     we engage in petty squabbles about who came up with what 
     idea. We will only be able to solve our problems if we are 
     willing to work together, respect and embrace our opponents, 
     and clamber for a common ground to meet on.
       I thank you for listening to me, and I look forward to 
     working with you to accomplish these goals.

     

                          ____________________