[Congressional Record (Bound Edition), Volume 150 (2004), Part 18]
[House]
[Pages 24345-24350]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  MEDICAL MALPRACTICE INSURANCE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. GINGREY. Mr. Speaker, we just finished our elections, and we hear 
a lot of browbeating and weeping and gnashing of teeth from the other 
side of the aisle concerning what went wrong. Goodness gracious, what 
in the world went wrong? We thought we ran a good campaign. We were 
ready to elect a President, we were ready to take over the House, we 
were ready to get the majority in the House and the Senate, and none of 
those things happened.
  Of course the pundits are on television every day, 24 hours a day it 
seems, talking about exactly what went wrong. And there is a lot of 
talk, of course, about the issue of moral values, traditional family 
values, and Christianity. I am sure that that had something to do with 
it. But I will stand here today, Mr. Speaker, and say to my colleagues 
that I ran a race in which I won with 57.4 percent against an opponent 
on the other side of the aisle who I think was a very strong Christian 
man, a good man, and one who had great values. But he was running on a 
party platform that did not embrace those traditional values that mean 
so much to I think middle America and those of us where I come from in 
Georgia.
  But I think it goes beyond that. I think it goes far beyond that. And 
I would suggest to my friends on the other side of the aisle, as they 
try to play Monday morning quarterback and figure out what went wrong, 
to think about issues like medical liability reform and the fact that 
the Nation, 75 percent or more, the American people in every poll that 
has ever been done, are very much in favor of medical liability reform. 
And yet an issue like that, which really should not be a partisan 
issue, because there is absolutely no reason why access to health care 
and fixing a broken system should come down along party lines, 
certainly did become partisan. It did in this body, and it did in the 
other body.
  In March of 2003, the HEALTH Act was passed in this House Chamber, as 
my colleagues know, and there were Members of the Democratic minority 
who voted for the bill, but only a few, only a handful, and practically 
none in the other body. So today, as we stand here going into the 109th 
Congress and President Bush's second term, we once again have a chance, 
an even better chance, I think, to get medical liability reform passed 
because we have increased our margins in the other body.
  So there are a lot of reasons you can look back and try to figure out 
why you lost, but that is one, I think, that my Democrat colleagues 
need to take a close look at. When this issue comes before us in the 
109th, if you want to do something positive, if you want to respond to 
the will of the American people, this is certainly a great first step. 
I would encourage my friends on the other side of the aisle and my 
fellow Republicans in the House and the Members in the other body that 
it is time. The American people want this. They need it.
  Access to health care is hugely important. We are seeing more and 
more physicians, and I will get to some specific numbers a little later 
regarding doctors in high-risk specialties, like neurosurgery, 
emergency room physicians, and OB-GYN, which is my specialty. I think 
all my colleagues know that in my prior life I practiced medicine for 
almost 30 years, and as a pro-

[[Page 24346]]

life OB-GYN physician, delivering those 5,200 babies. Many of my 
colleagues in that specialty are dropping out at the very peak of their 
practice productivity, in their late 40s, early 50s. They are literally 
trading their stethoscopes for a fishing rod or a set of golf clubs. 
They do not want to do that, but they have been forced to.
  I have a number of posters here, Mr. Speaker, that I want my 
colleagues to pay attention to, which really give testimonials to the 
statistics. Maybe my colleagues know some of these individuals, or 
individuals just like them, or families who have suffered because, when 
they went to the emergency room, there was no emergency-room physician 
to take care of their injured child or their loved one who had had a 
stroke and needed immediate care from a neurosurgeon.
  Just look at some of these posters. This is talking about women's 
health care in particular. Women's Health in Jeopardy: A pregnant Texas 
woman was forced to drive 80 miles to a San Antonio hospital because 
her family doctor in her rural hometown had stopped delivering babies 
because of malpractice insurance concern. This was in the Fort Worth 
Star Telegram January of 2003.
  Nationwide, doctors are leaving and patients are suffering. Look at 
these people. Look at these physicians. I do not know if my colleagues 
can see some of these posters, but they are not saying ``Vote for 
George W. Bush, or Reelect Bush, or Vote For Kerry and Edwards, or I am 
a Democrat, I am a Republican.'' They are saying ``tort reform now.''
  Insurance rates are driving doctors out of business. What good is 
insurance, health insurance, if you cannot find a doctor to provide the 
care, and on and on and on? Look at some of these headlines, Mr. 
Speaker: ``Doctors Protesting Skyrocketing Malpractice Premiums.'' 
Springfield State Journal Register, February 2003. ``Malpractice 
Insurance Prices Send Physicians to the Streets.'' USA Today, February 
2003. ``Caps on Noneconomic Damages Most Common Solution Considered by 
States in Crisis.''
  There are twelve States in crisis, and 30 more near crisis. If my 
colleagues do a little quick math, that is 42 out of 50 that are either 
in crisis or near crisis today. USA article, February 2003. ``Medical 
Malpractice Premiums Jump 50 Percent, Average Cost Tops $1.4 Million 
Per Hospital.'' PR news wire, January of 2003.
  It is not just the physicians; it is the hospitals that are suffering 
as well, many of whom are self-insured up to probably $10 million, $15 
million, or $20 million; and it is literally driving the small rural 
hospitals out of business. And in so many instances, the hospitals and 
the school system might be the only two employers in a whole county, or 
the two major employers in a whole county. When you shut them down, you 
are talking about job loss.
  So this is really an economic issue. It is a health issue, no 
question about that. Lack of access to health care is a real tragedy 
and a real crisis, but we have heard for the last 2 years, as we led up 
to this Presidential election year, the other side of the aisle talking 
about President Bush being the only President since Harry S Truman who 
actually lost jobs on his 4-year watch. Three million of those happened 
to occur after the dot-com bubble burst and the recession that started 
during the Clinton administration. The rest of it occurred shortly 
after 9/11, which cost the economy of this country almost $3 trillion.
  The other side kind of changed their tactic, Mr. Speaker, as we began 
to grow jobs as those tax cuts for all Americans with their special 
emphasis on small business men and women began to put people back to 
work. All of a sudden, when we gained 1.7, 1.9 million jobs back, then 
they had to change their tactics at the last minute.
  But make no mistake about it, this medical malpractice crisis and 
lack of access to care, and the fact that physicians are shutting their 
offices, it is a job issue as well because it is not simply one 
physician but in many cases it is 15 to 25 people who are actually 
employed in that office and all of them are without a job. Talk about 
outsourcing of jobs.
  We could have done a lot to prevent that right here in our own 
country with some meaningful leveling of the playing field with fair 
and balanced tort reform in regard to medical liability.
  Continuing with some of the posters, these are real-life situations 
that I want to bring to the attention of my colleagues.

                              {time}  2015

  Michelle, a breast surgeon, serving more than 5,000 patients a year, 
experienced a 760 percent increase in malpractice insurance over an 8-
year period of time. That is an average 76 percent increase per year. 
This was a testimonial on 60 Minutes in March, 2003.
  Doctors in rural Mississippi can expect to pay over $70,000 in 
malpractice premiums. Their average salary in rural Mississippi, 
certainly not an affluent State, about $72,000 a year. They are 
literally almost as much, not more, but almost as much in malpractice 
premiums as they are making in income and probably working 70 hours a 
week.
  Lehigh Valley, Pennsylvania, lost one-third of its neurosurgeons due 
to unrelenting problems with medical malpractice insurance. That is in 
Lehigh Valley, Pennsylvania.
  Listen to some of these numbers. Talk about bullet points. This 
really cuts right to the chase. Let me give my colleagues a few numbers 
to ponder.
  America's medical liability crisis, we all pay for a broken system. 
The number 19, as I said at the outset of the hour, the number of 
States in a full-blown medical liability crisis in which the cost of 
frivolous lawsuit settlements and jury awards cost physicians' medical 
liability premiums to skyrocket. As a result, patients lose access to 
care when physicians are forced to give up parts of their practice, 
such as delivering babies or performing high-risk surgery.
  Mr. Speaker, 72 percent of Americans favor a law that guarantees full 
payment of lost wages and medical expenses but limits noneconomic 
damages. That is the point that my colleagues on the other side of the 
aisle seem to miss. We spend all this money on polling. We poll and run 
TV ads, and then we send out mailers depending on what the public 
perception is of an issue. And 72 percent, talk about a plurality, a 
supermajority of Americans understood this issue, and clearly today 
understand that we are a country in crisis in regard to our health care 
delivery system. They want change, they want fairness, and yet my 
colleagues who have a lot of heartburn over this recent election are 
still trying to figure out what went wrong. Certainly they were wrong 
on that issue.
  The figure of $70 billion to $126 billion a year, the cost of 
defensive medicine which could be significantly reduced by medical 
liability reforms. Now we just passed yesterday an increase in the debt 
ceiling of $800 billion. There was a lot of rhetoric from the other 
side and a lot of complaining about the runaway deficits and the 
growing, burgeoning debt.
  With medical liability reform, it is estimated that we would save the 
government close to $40 billion a year. Keep in mind that the Federal 
Government really pays about two-thirds of all of the health care in 
this country with four programs: Medicare, Medicaid, Tricare for our 
military personnel and their dependents, and our VA health care system. 
If we put all of those programs together, we are talking about two-
thirds of the health care costs in this country the Federal Government 
pays. If we had some meaningful tort reform and doctors did not have to 
do all this defensive medicine and add all of these additional tests 
which we know and the hospitals know are totally unnecessary in many 
instances, but doctors are just trying to protect themselves from a 
lawsuit, if we could get all of that out of the system and go back to 
just practicing common-sense medicine, this is the amount of savings we 
would incur. Then we would not have to increase that debt limit.
  I am very pleased tonight, Mr. Speaker, to be joined by one of my 
colleagues on my side of the aisle and a

[[Page 24347]]

fellow physician, not only a fellow physician but also a fellow OB-GYN 
physician. He has not practiced quite as long as I have nor delivered 
quite as many babies as I have, but he is one fine doctor and a fine 
Congressman.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman from Georgia (Dr. 
Phil Gingrey) or Dr. Phil, as we say here in Congress. I need to point 
out that I am just a simple country doctor, and while the gentleman 
from Georgia will spend a lot of money on polling, my operation in 
Texas is far too small for that. But I do talk to a lot of my 
constituents, and the doctor is right that this is an issue understood 
by average, everyday Americans. They understand it very well. They 
understand it is limiting their access to medical care, and they want 
this situation fixed.
  The Subcommittee on Health Policy met this summer and had a hearing 
on medical liability reform. We wanted to bring the spotlight to what 
are some of the successes we can point to in this country in this 
arena, not just simply rehash and recover old territory but what are 
some of the solutions. We were fortunate to be joined by a doctor from 
California who was actually practicing medicine in California 1975 when 
the California Medical Injury Compensation Reform Act of 1975 was 
passed.
  Of course, he talked about the night-and-day difference that it made 
in his State as far as being able to practice medicine with the 
noneconomic damages capped at $250,000 and how that held down premiums 
and allowed doctors to continue in practice and not leave the State 
because they were in a crisis in 1975.
  Let us remember the governor who signed this bill into law from the 
California legislature was none other than Jerry Brown, not known for 
his conservative thoughts or principles. It was truly landmark 
legislation when it was passed in California now some 28 or 29 years 
ago.
  In Texas, we passed legislation this past legislative session that 
also limited noneconomic damages, put a cap on noneconomic damages. It 
was a little bit different. We might say it was a 21st century 
variation of capping noneconomic damages. There is a cap of $250,000 
for the physician's component, a cap of $250,000 for the hospital 
component, and another $250,000 if a nursing home is involved. But 
altogether, the noneconomic damages in a case would be capped at 
$750,000. This has had an enormously positive impact on the State of 
Texas as far as liability reform is concerned.
  Consider this: When I was practicing medicine in the late 1990s, 
there were 17 insurers who would write a liability policy for doctors 
in the State of Texas. As the medical liability crisis mounted in my 
State, the number of insurers dropped out and left the State to the 
point that, by 2002, there were two remaining insurers writing medical 
policies in Texas.
  What did this mean for the average medical practitioner and their 
patients? When I was campaigning in 2002, when I would do speaking 
events, I remember a young woman came up to me. She was probably in her 
early 40s. She said, ``I am a radiologist who studied at State schools 
and I did my residency at a State-supported institution. My insurance 
carrier left the State 3 months ago, and now I cannot buy liability 
coverage at any price, and I cannot afford to jeopardize my future, my 
husband's future, and my children's future by continuing to practice 
medicine without a liability policy, so I am a stay-at-home mom.''
  That is an admirable thing for someone to do, but the State of Texas 
had made a significant investment in her college and medical education. 
In addition, she did her residency at a publicly funded hospital. 
Again, a good investment made in this bright individual to practice her 
craft of radiology, a lot of investment was made by the State of Texas, 
by the people of Texas, in her medical career, and she was unable to 
practice her profession because of the unavailability of liability 
insurance at any cost, let alone liability insurance that might have 
been quite costly.
  One of the people we heard from at that hearing was Texas Insurance 
Commissioner Jose Montemayor. This hearing was in June. Commissioner 
Montemayor talked about some of the improvements that had come to Texas 
as a result of this law that was passed by the Texas State legislature. 
We had gone down to two liability insurers. We were now up to 13. Of 
those that had come back into the State in 8 months time, they had done 
so without an increase in their rates, contrasting with the neighboring 
States of Oklahoma and Louisiana where those insurers were able to show 
and justify an increased rate of 50 percent in Oklahoma and 80 percent 
in Louisiana. So this is a big difference this law has made in Texas.
  In addition, Cristus, a Catholic not-for-profit health care system in 
south Texas that self-insures, has been able to, by June of this year, 
6 months into this fiscal year, had posted a $20 million savings in 
their insurance premiums that they were then able to directly invest in 
hiring nurses, direct patient care, and capital improvements in their 
hospitals there.
  So this is a tremendous gift or tremendous savings for the people in 
the State of Texas, and one of the things that we were able to showcase 
in that hearing is one of the proven successes in the country for 
medical liability reform.
  We also heard from an individual, and I apologize. I am blocking on 
his name. He was the administrator of the hospital in Uniontown, 
Pennsylvania, and there the story has not been as benevolent. 
Pennsylvania has not managed to pass medical liability reform in their 
last legislature. Because of the peculiarities of their State system, 
they will have to pass that legislation two times in the form of a 
constitutional amendment. So 2007 or 2008 is the soonest time they can 
expect any type of relief from their medical liability crisis.
  The administrator at Uniontown Hospital told us he is down to one 
ear, nose and throat doctor who is now responsible for about 140,000 
patients in that area. I did some quick math, that is about 300,000 
ears for one doctor. That is a lot of work for one ENT doctor, and they 
cannot bring in another doctor to help him because of the cost of their 
liability insurance.
  About a year and a half ago, we were at a field hearing up at ANWR, 
and we came back home through Nome, Alaska. When a group of congressmen 
come through Nome, Alaska, it is a big deal, and a lot of people turn 
out for that. They heard that one of the congressional representatives 
was a physician representative, and the entire medical staff of their 
hospital came out to lunch with us.
  Over lunch, they asked questions. What it was like to serve? And one 
said we hope Congress gets that medical liability law passed because we 
cannot afford an anesthesiologist for our hospital here in Nome.
  I asked what kind of medicine he practiced. He said I am an OB-GYN, 
just like you.
  Mr. Speaker, what a deal. Practicing OB-GYN in your hospital without 
an anesthesiologist in Nome, forget pain relief during childbirth. We 
are talking what do you do if you have to do a c-section. He said, 
well, we get that patient on an air ambulance as soon as possible and 
get her to Anchorage for her c-section. Well, Anchorage is an hour and 
a half a way, and I am given to understand there is poor weather 
sometimes in Nome, Alaska.
  I cannot understand how we feel that we are furthering the cause of 
patient safety by allowing this system to continue.
  People do ask me back in Texas, they say, we have done a good job 
here in Texas. Why are you worried about medical liability insurance 
anymore? It is not an issue for us here in Texas. But as Dr. Gingrey 
has pointed out so clearly, it costs our country billions of dollars 
every year.

                              {time}  2030

  In the Medicare system alone, the cost of defensive medicine from a 
1996 Stanford University study was estimated to be between $30 and $50 
billion a year in the cost of defensive medicine. Do the math on that. 
What is the

[[Page 24348]]

average of $30 to $50 billion? It is $40 billion a year. Dr. Gingrey is 
quite right. We were criticized last night about increasing the debt 
limit. We were criticized a year ago for passing a Medicare bill that 
costs $40 billion a year for prescription drug coverage. We basically 
would save that amount of money if we would only pass meaningful 
medical liability reform. That is why it is a national issue, because 
we are all paying for that. Every taxpayer in the country is paying 
that freight for this medical liability system. $230 billion a year in 
direct costs for medical liability and about 20 percent of that 
actually goes to injured patients.
  Do not tell me that by capping noneconomic damages that we are 
keeping money out of the hands of patients. The system is keeping money 
out of the hands of patients today under the present system and the 
only parties that are enriched by today's system are the trial lawyers.
  With that, I see my time is about up. I appreciate so much the doctor 
organizing this Special Order this evening. It is of critical 
importance that we get this done. We did not manage to do it this year. 
There has been a little bit of a change across the Capitol rotunda, and 
I am very optimistic that as we start into the 109th Congress, this 
will continue to be an issue of pressing concern for it, and we will 
get this job done for the American people.
  Mr. GINGREY. I thank my colleague from Texas for joining us this 
evening for this discussion, and I appreciate his very accurate 
remarks. I know one thing he was talking about, physician access and 
which specialties doctors choose today based on this liability crisis.
  I want my colleagues to listen very carefully to this number: 48 
percent, the proportion of American medical students in their third or 
fourth year of medical school who indicated that the liability crisis 
was a factor in their choice of specialty, threatening patients' future 
access to critical services. I am sure that Dr. Burgess would agree 
with me that when we were in medical school a few years ago, OB-GYN was 
one of the most popular specialties. It was the one that everybody 
wanted to go in. It was the compassionate, the feel-good specialty, 
delivering babies, being with a family, at what usually is the happiest 
day, the happiest moment of their lives, the birth of a child.
  Yet today because of this crisis, as he well knows, we are having 
fewer and fewer, not only fewer and fewer of our best and brightest 
students from college wanting to get into medical school and go into 
the practice of medicine in any specialty but particularly OB-GYN and 
general surgery and neurosurgery and some of these higher risk 
specialties.
  Mr. BURGESS. If the gentleman will yield, about a year ago I was 
having a discussion with a woman who was in charge of the residency 
program at a northeast hospital. I trained at Parkland Hospital, 
arguably the best residency program in the country, but this one in the 
northeast has a good reputation as well, and she said that they were at 
the point now where they were taking people into their OB-GYN residency 
program that 5 years ago they would not even have asked in for an 
interview, such has been the dropoff in the quality and caliber of, as 
you put it, the best and the brightest not going into the specialty. 
These are children's doctors. These are the doctors that are going to 
be there for the next generation of Americans. Again, I fail to see how 
allowing this system to continue is furthering the cause of patient 
safety or excellent patient care.
  Mr. GINGREY. The gentleman is absolutely right. I am pleased to have 
another physician Member with us tonight in my colleague from Florida, 
Dr. David Weldon. Dr. Weldon is an internal medicine specialist. I 
think I am recalling correctly that he is about to begin his sixth term 
in this august body and has certainly been a great mentor to both Dr. 
Burgess and myself as we came in 2 years ago as freshmen and really 
needed to get up to speed on the Medicare law and all the nuances of 
that. It is certainly a distinct honor and a pleasure to have Dr. 
Weldon join us this evening.
  Mr. WELDON of Florida. I thank Dr. Gingrey for his kind words. I must 
confess that he did not need a lot of mentoring. All his years in the 
State senate prepared him quite well for the busy work that we are 
about here. I just want to amplify a little bit on what our good 
friend, Dr. Burgess, the gentleman from Texas, was talking about, 
specifically the high cost of defensive medicine. As you mentioned, I 
was a full-time practicing internal medicine doctor. Actually, I still 
see patients about once a month in the veterans clinic on a voluntary 
basis in my district.
  As an internist, internal medicine specialist, I did a lot of 
diagnostic tests. A lot of people come in the office saying I hurt 
here, I hurt there, I can't breathe when I walk. You do a physical 
examination, and you typically send people off for studies and tests. I 
regularly on a daily basis practiced defensive medicine. I would do my 
history and physical, and I would come to a conclusion as to what I 
thought that patient most likely had and then there was always that 
little voice in the back of my mind, what if you are wrong? What if you 
miss something? What if you get sued? What will happen to you if you 
get sued? Will it hurt your practice? Will you lose patients? Will you 
lose your house? These are the kinds of things that go through your 
mind.
  What you do is you order extra tests. We had a special name for doing 
that. But I was one doctor in one town, and there are hundreds of 
thousands of doctors every day in America spending hundreds and 
thousands of dollars each. I was so glad Dr. Burgess mentioned that 
study out of Stanford University. That was the first study that 
conclusively showed that defensive medicine was real and it was very, 
very costly and that was that famous, a famous study now, that came out 
of Stanford University. They looked at expenses before medical 
malpractice and after medical malpractice for just two diagnostic 
codes, two different conditions, and showed a significant reduction in 
Medicare charges, and what is most important in this, no increase in 
what we call morbidity and mortality. In other words, the patients did 
fine, but the charges went down. They said at the end of that article, 
this is the first really good scientific study that shows that 
defensive medicine is real.
  And how much does it cost? Ladies and gentlemen, we are struggling in 
this body to figure out how are we going to keep Social Security 
solvent in the future and how are we going to keep Medicare solvent in 
the years ahead.
  Actually, Social Security gets talked about much more in the press, 
but the real problem is Medicare. Social Security will be solvent for a 
long time to come. Medicare could start going broke before the end of 
this decade. The crisis in Medicare is much more serious. What did that 
study show? It showed that defensive medicine costs us tens of 
billions, maybe as much as $50 billion, $75 billion a year just in the 
Medicare plan.
  How much money could we save over the next 5, 10 years if we on a 
national level can institute some kind of caps on all of this medical 
malpractice? Let me just say as well, the problem that we have in the 
State of Florida is very severe. I know there are many other States 
that are very severely affected, but I just want to share some 
statistics here. In 1975, in the State of Florida, there were 380 
lawsuits for medical negligence allegations. Those 380 lawsuits 
resulted in $10.8 million of settlements. It cost $1.5 million for the 
insurers to defend. In the year 2000, the next year that we have good 
statistics on this, it went up to 880 lawsuits resulting in awards 
totaling $219 million.
  So we have a serious problem. This is not just a Florida problem. 
This is not just a Georgia problem. It is not just a Texas problem. 
This is a national problem. This body, the Congress of the United 
States, we are the fiduciaries of the Medicare plan, and we can save 
the Medicare plan by putting some reasonable caps on medical 
malpractice settlements. Every year that I have been here, and I have 
been here 10 years, going into my sixth term, we have passed some form 
of medical malpractice reform. Typically, we have

[[Page 24349]]

passed this $250,000 cap on what we call pain and suffering claims, or 
noneconomic damages. The important thing there is that if people cannot 
work, they can be compensated for that. If they have medical bills, 
they can be compensated for that. And if they have pain and suffering, 
they can get $250,000. But gone are the days of these multimillion-
dollar settlements for pain and suffering. And why do we have to do 
that? Because we all pay for it.
  I just want to share one other thing that is critically important. 
Most of the job creation in my congressional district over the last 10 
years has been in the small business sector. When I meet small business 
men and women in my congressional district and I ask them, what are the 
problems that you are struggling with now, what can I help you with, 
invariably the first words that come out of their mouths is the high 
cost of health insurance for their employees and that many of them 
cannot afford to insure their employees anymore.
  What can we do to help them? Actually, one of the best things we can 
do is pass medical malpractice reform. I spoke earlier, Dr. Burgess 
spoke earlier, Dr. Gingrey spoke earlier about the high cost of 
defensive medicine. That drives up health insurance premiums. If you 
are a small business and you employ 10 people and it is costing you 
$600 a month per employee to insure all those employees, you can lower 
that premium if we can get reasonable and sensible caps on medical 
malpractice.
  What is going to happen there? It is going to make those businesses 
more competitive. It is going to make those businesses better able to 
hire more people. The other thing is there are a lot of small 
businesses that just have decided they cannot afford health insurance 
anymore. These are the people that I am most worried about, the working 
uninsured. These are people who end up using our emergency rooms for 
their health care services. How can we get some of these uninsured 
people insured? One of the things we can do is pass medical malpractice 
reform.
  This is not just a doctor issue. As a matter of fact, the doctors 
complain about it all the time, but they just pass the costs on to 
their patients. This is really a competitiveness issue for our Nation. 
This is about how do we deal with the uninsured. This is about how do 
we keep Medicare solvent. And it is a national crisis. I want to thank 
Dr. Gingrey for taking the lead on this issue. It is a critically 
important issue. If we can finally get something done in the next 
Congress, it will be good for the uninsured, it will be good for 
America, it will be good for OB-GYNs, one of the most aggressively 
assaulted specialties in the Nation, constantly being sued, many OB-
GYNs getting out of the business of delivering babies.
  In many regions in the country, communities, they do not even have a 
doctor that delivers babies. They have to get in ambulances and drive 
or fly in helicopters to a town where there is a doctor who is willing 
to deliver babies. That is a sad state of affairs. It has been 
precipitated by the failure of the other body to really take this issue 
up and deal with it. We have passed it every year that I have been 
here. We need to do something about it in the 109th Congress. I thank 
the gentleman so much for his leadership on this. I really appreciate 
it.
  Mr. GINGREY. I thank the gentleman from Florida so much. We 
appreciate him being with us tonight and sharing those thoughts. It is 
so important that he pointed out to our colleagues that this really is 
not just about doctors and their practice, Dr. Weldon's practice, Dr. 
Burgess, Dr. Gingrey, or an individual like this Dr. Leon Smith, Jr.
  I happen to know Dr. Leon Smith, Jr. He practices medicine in Athens, 
Georgia. I went to medical school with him. I knew him very well. Both 
he and his brother are OB-GYN physicians. His group, I think six or 
eight of them, recently stopped practicing, had to stop obstetrics and 
curtail their practice drastically because of this crisis. Dr. Smith 
was actually interviewed on ``60 Minutes'' on March 9, 2003. Here is 
what Leon said, Dr. Leon Smith, Jr.:

       We're giving up something I have always wanted to do 
     because of the malpractice crisis after insurance premiums 
     broke a million dollars.

  This is real life. This really puts a face on this problem. But as 
Dr. Weldon points out so vividly, it is a jobs issue because it is not 
just Dr. Smith and colleagues like him that have to give up their 
practices. It is the fact that small business men and women over the 
last 5, 6, 8 years are seeing double-digit increases in the amount that 
they have to pay for health insurance to provide to their employees. 
And they cannot do it. It is becoming the highest cost of them doing 
business. And a lot of small businesses fail. This is one of the main 
reasons that they fail.
  And so we are not just talking about doctors not being available to 
help patients. We are also talking about small businesses closing and 
people being out of work. I think it is so important that we keep that 
in mind as we try to address this crisis and try to do it in a 
bipartisan fashion.

                              {time}  2045

  Mr. Speaker, I want to show this last poster before I go on with some 
additional remarks, but this is pretty telling and the title of this 
poster is ``Show Me the Money.'' ``Show Me the Money.'' And I have 
heard, I am not sure who it was, maybe some wise, erudite talk show 
host recently say, If you want to know what the problem is, just follow 
the dollar. Follow the dollar.
  I can remember during the Medicare Modernization, Improvement, and 
Prescription Drug Act debate that we had on the floor of this House 
last year, this Medicare modernization, which we had not done in 38 
years, and this prescription drug benefit, which seniors have been 
begging for, pleading for, been promised by previous Presidents and 
previous Congresses and nobody ever delivered, we finally delivered on 
that promise.
  And the criticism we received from the other side of the aisle was 
well, it was just a giveaway from the pharmaceutical industry. That is 
all it is. All these Republicans getting all this money from the big 
drug companies. And in fact, it was said, Mr. Speaker, by so many of my 
colleagues on the other side of the aisle that the pharmaceutical 
industry wrote the bill. I guess they think the doctors and hospitals 
wrote the original Medicare bill that was passed in 1965, but I do not 
think the doctors and the hospitals have done too well, but it has been 
a boon to seniors. Medicare has worked well. It is going to work even 
better. But while they were criticizing us purportedly for accepting 
money from pharmaceutical industry lobbyists, look at what is happening 
on this ``Show Me the Money'' poster.
  Why do Democrats put trial lawyers before patients? That is my 
question. That is the question I want my colleagues to answer for me. 
Seventy-four percent of the campaign contributions made by lawyers and 
law firms during the 2002 election cycle went to Democrats. I am not 
sure what the number is in 2004, but I imagine it is probably a little 
higher than that with a couple of lawyers on the Democratic ticket, one 
a trial lawyer who made his living suing doctors like me and my 
colleagues. Seventy-four percent of the campaign contributions made by 
lawyers and law firms during the 2002 election cycle went to Democrats. 
Over $87 million to Democratic candidates during that cycle. Seventy-
four percent came to over $87 million. In fact, the average 
contribution to a House Democrat totaled $57,281.
  I like to think that we cannot be influenced by money, and I think 
that that statement is, in fact, true. I think most of my colleagues on 
the both sides of the aisle would agree with that. Men and women of 
honor and integrity. But these figures certainly have to be 
frightening, and maybe it is some of the explanation why, which has no 
reason to be partisan. A high-risk mom who desperately needs 
obstetrical care, she is not worrying about whether that white coat has 
an R or a D on its shoulders. She is looking for an M.D., of course, 
and this should not be a partisan issue. We need to get beyond that. It 
is too important.

[[Page 24350]]

It is hugely important. Just as Medicare modernization, Social 
Security, these other issues, education, none of that should be 
partisan. So I hope that as we go forward in the 109th that we will all 
join together and finally get this job done.
  I was giving some numbers a little bit earlier, and I would like to 
give a few more. The number 29. Mr. Speaker, 29 is the number of years 
that California's comprehensive medical liability reforms have 
protected the State of California and their patients, physicians, and 
taxpayers. 1975 was when MICRA, Medical Injury Reform Compensation Act, 
was passed; 1975, 29 years ago. Since then premiums in the United 
States, the rest of the 49 States, have grown by 750 percent. In 
California premiums have increased only 245 percent. Another very 
telling statistic.
  Listen to this one. And I want my colleagues to listen carefully to 
this: $778,334, that is the amount a patient would receive for a $1 
million jury award, an injured patient, a patient that deserves 
compensation, and we all are aware of that in many instances, $778,334, 
the amount a patient would receive for $1 million jury award by 
reforming the current contingency fee system. Now without any reform, a 
trial lawyer typically takes $400,000 or more of that settlement. That 
is not right. Mr. Speaker, that is not right.
  The people who are injured, the mom, the dad, the parent, the child, 
in cases that are not frivolous, somebody has practiced below the 
standard of care. Maybe it is one of my physician colleagues. Maybe it 
is a hospital. Maybe something happened in the emergency room. That 
patient has been injured and suffered and has significant economic 
losses, and they deserve fair and just compensation. But they are not 
getting it because of this contingency fee system which causes a 
lottery mentality among a lot of trial attorneys. Not all of them. 
Certainly not all of them. Most, in fact, I think are men and women of 
high integrity and provide a good service to their clients as they 
practice this subspecialty of personal injury.
  Mr. Speaker, 3.9 million, and let me repeat that, 3.9 million, the 
increase in the number of Americans with health insurance if Congress 
were to pass commonsense reform. Almost 4 million more people would be 
able to afford health insurance. We have been talking about that issue 
ever since I have been here in this Congress about the 40 million or so 
mostly working Americans who cannot afford to have health insurance. 
Either they cannot pay their part of the premium or their employer 
cannot provide it for them. It is estimated with meaningful leveling of 
the playing field, not taking away anybody's rights, that an additional 
4 million people would be covered by health insurance.
  I could go on and on with these numbers and statistics, but let me 
just talk a little bit in some of the time that we have remaining. Mr. 
Speaker, there are a number of provisions in the bill that we passed, 
the Health Act in 2003. That bill primarily puts a cap on noneconomic, 
so-called pain and suffering. But what it does not do is it absolutely 
does not limit recovery for injuries, economic losses; and in many 
cases those awards are in the several millions of dollars. But there is 
no way that one can put any estimate on pain and suffering or 
noneconomic losses. And that is the hallmark really of MICRA, the law 
that was passed in California, and it is a model that we know works. 
And as I said before, if this bill is passed, and I feel that we will 
pass it in the 109th Congress, any injured patient would be well 
compensated for the economic losses and any medical care that is needed 
as they go forward in the rest of their lives.
  Another provision in this bill is something that is called joint and 
several liability. I want my colleagues to understand this concept: 
joint and several liability. That is what exists today. That means that 
if 10 doctors are named in a lawsuit, it does not matter who is the 
major culprit or the one who practiced the least close to the standard 
of care. One of those physicians who had very little to do with the 
case could end up paying the whole judgment or the whole settlement 
just simply because they have the deepest pockets. In this law that we 
passed, the Health Act of 2003, it would be proportioned depending upon 
their degree of responsibility, as well it should be.
  Another provision is called collateral source disclosure. Collateral 
source disclosure simply means that a jury needs to know if an injured 
patient has health insurance, has disability income, because their 
injury has been eligible and is now receiving Social Security 
Disability benefits and by virtue of that is now eligible for Medicare. 
Under current law in most States, the jury is not permitted to know 
that as they calculate what a just and fair settlement or award should 
be. And, Mr. Speaker, that is what I would call double-dipping, and 
that is wrong.
  Another provision of course in the bill that I talked about a little 
earlier was contingency lawyer fees, and I think they ought to get paid 
and they will get paid and they will do very well. I do not believe 
there is a shortage of attorneys in the State of California. I do not 
see any of them coming to Georgia, thank goodness. I think they are 
doing well out on the west coast and will continue to do well. But if 
we are going to have a shortage, I think most of the Members of this 
body, my colleagues, would agree it is probably a lot better to have a 
shortage of lawyers than a shortage of doctors because we need access 
to health care. And that is what this is all about, that and job 
creation and to take some relief off the men and women who are trying 
desperately to provide health care to their employees.
  Mr. Speaker, it has been an honor, really, and a pleasure to come 
here tonight and talk about something that is very near and dear to me 
as a physician Member of this body. And in closing, my plea to my 
colleagues on the other side of the aisle and my fellow Republicans and 
those Members of the other body is to think about that statistic that I 
gave them a little bit earlier. Seventy-five percent of the American 
people want this, and they are not going to wait any longer. And if 
they do not get it, they are going to hold them responsible in 2006 
just as they obviously did in 2004.

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