[Congressional Record (Bound Edition), Volume 151 (2005), Part 18]
[House]
[Pages 25264-25271]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2005, the gentleman from Pennsylvania (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY. Madam Speaker, tonight, a number of the members of the 
Republican Conference are going to speak on an issue we know all 
Americans are concerned about and Members of the Congress are deeply 
concerned about and that has to do with health care.
  I would like at this point perhaps to step off from the comments just 
made by the gentleman from Texas (Mr. Burgess), my co-committee man, 
who just spoke about influenza, the avian influenza, and use that as a 
stepping off point to talk about some areas that we need to be working 
on in Congress and some areas we are working on when it comes to 
dealing with concerns about infections and infectious diseases. The 
reason I want to start from this point is to show what we need to do 
and what we are doing in Congress to deal with a number of potentially 
large issues.
  Everyone will remember just a couple of short years ago we had the 
concerns about the SARS virus, which quickly spread throughout parts of 
the world. Luckily, it did not stay around very long; but because 
people who had the disease treated other folks who then traveled 
throughout this country and others, we saw that disease spread quickly.
  We also remember just a few years ago the Ebola virus and the worries 
about that. We worry also about mad cow disease, and of course, we are 
concerned about bioterrorism.
  In all of these instances, how Health and Human Services, how county 
and State health departments, how hospitals, physicians, nearly all 
health care providers, handle such instances around the world makes a 
huge difference in containing the diseases and also with regard to 
saving lives.
  Recently, President Bush made some comments in calling for $7 billion 
in congressional appropriations to help deal with a number of aspects 
of concerns about avian flu. Buying enough inoculations for that, so 
the people could have some immunizations against the flu; working on 
other areas of research; preparing health plans, all these are part of 
it.
  What we are going to be talking about tonight will be some aspects of 
how we can be better prepared, what our health care system needs to be 
doing, and how even such things as changes in Medicaid, we are going to 
be using the clout of the Federal Government to make some changes.
  Actually, I would like to, as long as the gentleman from Texas (Mr. 
Burgess) is here and the gentleman from Georgia (Mr. Gingrey), my good 
friend, is here, too, I would like to use a few moments to open up a 
dialogue with them about some issues about the avian flu, if I may, and 
ask about a couple of aspects here that have to do with how this really 
works; and as physicians here, I thought I would perhaps start off with 
the gentleman from Texas (Mr. Burgess) and ask a question or two, if I 
may, if the gentleman would not mind standing for a colloquy on this.
  A lot of Americans are very concerned about what happens with the 
transmission of this disease, in many cases do not understand, well, 
how can I have a flu one year, but the Spanish flu, the avian flu have 
something very different.
  My understanding of this is that many times people have the flu, 
those who are at risk for severe problems and death are perhaps the 
very young, the infirm, those with chronic diseases, the very old, 
because this flu tends to weaken the system and there could be other 
bacteriological problems such as pneumonia would take them over.
  But there is something really virulent or bad, deadly, about avian 
flu that is the concern; and you were mentioning a little bit about 
that. Could you talk about how that is so different that we need to 
understand it is more of a concern, the deadliness of it.
  I yield to the gentleman from Texas (Mr. Burgess), my friend.
  Mr. BURGESS. Madam Speaker, I thank the gentleman for bringing this 
topic to the floor tonight and for including me in the discussion.
  In the Spanish flu outbreak in 1918, one of the observations was, 
instead of the very young, the very old and the infirm who were the 
victims of this illness. It was, in fact, young people age 28 to 45 who 
appeared to be the primary victims of this illness.
  Undoubtedly, part of that is related to the fact that we do not have 
any underlying immunity to this disease and people who are, as a 
general rule, exposed to a lot of other people, that is, people in 
school, people in the workplace, in other words, your 20- to 45-year-
old age group, would have a greater chance to come down to exposure to 
this virus, which was very virulent, had a high ineffectivity rate, and 
simply a cough in the room was enough to expose someone to the virus; 
and, again, with no native immunity, it could overwhelm their system 
fairly quickly.
  There is no question it is still a deadly virus to the very young. It 
is still a deadly virus to the very old, but I think one of the 
striking epidemiological features of the 1918 flu was that people who 
were generally regarded as being in good health also seemed to fall 
victim to this illness.
  Also bear in mind, we were in the last months of the First World War 
so there were a lot of recruits who were stationed together in barracks 
and tents, and the virus seemed to be particularly virulent in its 
outbreaks in those types of situations.
  So some differences from 1918 to now and certainly our ability to 
know about an outbreak. Syndromic surveillance will be an important 
part of the pandemic plan that the Secretary has unveiled.

                              {time}  2030

  The other important concept, since this disease is so widespread, 
about a quarter of the globe right now is affected with the bird flu. 
Because the geographic footprint is so large and because birds can fly 
from place to place and people travel from place to place so easily, an 
outbreak anywhere has to be regarded as an outbreak everywhere. So if 
the disease appears to travel easily from person to person in Vietnam, 
in Indonesia, that means that our full pandemic plan has to come into 
play in this country.
  The gentleman mentioned the experience with SARS, when we first came 
to Congress in 2003, a deadly, deadly illness that previously was only 
known in an animal host in China. The transmissibility of SARS was with 
a little more difficulty than with influenza; that is, you had to get a 
little closer to the infected person with SARS than with the flu, which 
meant that health care workers and close household contacts were the 
types of people who were most at risk.
  But bear in mind, we conquered SARS, we beat back SARS without 
developing a vaccine for the virus and

[[Page 25265]]

without any specific treatment for the virus. This was accomplished 
through studies of epidemiology, knowing where the outbreaks were, what 
travel patterns were and then very careful quarantine of those 
individuals in whom the disease was suspected and very careful 
isolation techniques for health care providers when it was suspected 
they were dealing with a case of that disease. The few times we forgot 
those principles in dealing with SARS is when the outbreak was allowed 
to, in fact, reignite or reengage.
  Quite different from our current situation. No vaccine for the virus, 
although the virus was identified by the use of genomics. The virus was 
identified very quickly, but no vaccine was developed and no effective 
treatment. With the avian flu, there is a vaccine that is already now 
available; it has been developed, it is in testing. And, of course, 
there are antiviral medications that are effective in treating the H5N1 
virus. So some differences there between those two.
  If I could make one last point, and I did not make it during my 
previous remarks, and I should have: Although the regular flu shot will 
provide no protection against the bird flu, we should all still get our 
regular flu shots and keep the appearance of regular flu to a minimum 
this year, this flu season, because the fewer people who are sick and 
the fewer people are who are debilitated by the regular flu virus, I 
think that will improve our overall odds in keeping the pandemic flu at 
bay.
  I yield back to the gentleman and thank him for his time.
  Mr. MURPHY. Madam Speaker, I thank the learned gentleman on these 
issues, so important to understanding infectious disease. I know one of 
the aspects of this, too, and I will ask my friend and colleague, Dr. 
Gingrey of Georgia, to comment on this, and that is helping us in 
Congress put this in perspective.
  Back in 1976, an 18-year-old Private David Lewis came into his base 
at Fort Dix, staggering in, was given some resuscitation, and soon 
afterwards they determined that he had something called swine flu. Soon 
after that there was a declaration that this would be a deadly virus, 
perhaps reaching the level of the Spanish flu of 1918. Even at that 
time, President Ford went on television saying, ``I have just concluded 
a meeting on a subject of vast importance to all Americans. I have been 
advised there is a very real possibility that unless we take effective 
counteractions, there could be an epidemic of this dangerous disease 
next fall and winter here in the United States.'' At that time 
President Ford asked Congress to appropriate $135 million to fight it; 
and of course, huge problems did not develop with swine flu.
  I always have the concern that when we are engaged with a public 
health activity, we have two possible dangers. One is that the disease 
really does have an outbreak and there is great deal of harm; and two 
is that if it does not occur, it will leave the public feeling much 
like the boy who cried ``wolf,'' and then saying there is no concern, 
we do not really need to do anything.
  And from your perspective, Dr. Gingrey, I wonder if you could comment 
on how the public best needs to put this in the perspective of what we 
need to be thinking of here, and comment on how Congress can best 
handle that. And I yield to the gentleman.
  Mr. GINGREY. I thank the gentleman for yielding, Madam Speaker, and 
am happy to be with him during this time and conducting this special 
order. My colleague, Dr. Burgess, of course, just did a 5-minute on 
this issue of avian flu, and also engaged in a colloquy with the 
gentleman from Pennsylvania just moments ago.
  We are in a situation, Madam Speaker, where you are darned if you do 
and you are darned if you don't in regard to what is the proper level 
of response to this avian flu outbreak in the Far East. I was 
interviewed recently on television, and the very first thing the 
reporter asked was, Congressman, do you think that what the President 
is recommending in regard to this potential, in combating this 
potential pandemic of flu is just a make-up call for his slow 
inadequate response to Hurricane Katrina? I immediately challenged him 
in regard to what he was suggesting.
  But it is important, I think, that the media get it right. I do not 
think, quite honestly, they got it right in regard to Katrina. There 
was terrible, terrible loss, and the loss of any lives is tragic, but 
at one point they were predicting 10,000 lost lives along the gulf 
coast; and it was closer to 1,000. They missed it pretty badly. It is 
important they understand their need to get it right, Madam Speaker. 
Because while we want to be prepared, and I commend the President and 
Secretary Leavitt for bringing this plan to us, we do not want to 
create a pandemic of panic.
  The gentleman from Pennsylvania, Dr. Murphy, was talking about 1976-
77 and the so-called swine flu. Well, at that time, as Dr. Murphy 
pointed out, the government actually purchased something like $150 
million worth of vaccine, subsidized that, and began to administer 
vaccine for swine flu. Lo and behold, what happened shortly after that 
was people started getting some side effects, which may or may not have 
been related to the vaccine, but there were some cases of a neurologic 
condition called Gillian Barre syndrome where all of a sudden you 
became paralyzed. Fortunately, it is usually a temporary condition, but 
the Federal Government, assuming all liability for this vaccination 
against swine flu, not only had the $150 million cost, but ended up 
spending about $90 million more settling hundreds of claims of 
liability.
  So we really need to be very careful, particularly, I would say, in 
regard to a mass immunization against avian flu, bird flu, H5N1, as Dr. 
Burgess described it, that type of flu.
  Now, we have, and there has been some money suggested and 
appropriated for the NIH to develop something like 20 million doses of 
this vaccine to the bird flu, when as yet there have been no, and I 
repeat no incidents of human-to-human transmission. There have been a 
total of about 125 cases in the Far East where humans have contracted 
this so-called bird flu. But in every instance it was people working 
very closely with poultry, maybe in their back yard slaughtering 
chickens with unsanitary conditions. But absolutely no incidents of 
human-to-human transmission.
  So while I commend the President and the Secretary of Health and 
Human Services for the plan and do not necessarily say that they are 
asking for too much money, I think we need to look very closely at how 
this money is spent. I think it is appropriate, I say to my colleague 
from Pennsylvania, to spend money to develop a technique where we can 
go from egg-based vaccine production to a cell culture technique, which 
is much more efficient. But it is going to cost some money, and I think 
in the $7.1 billion it calls for about $2 billion to develop that 
technique.
  Also, as Dr. Burgess said, it is very important that we are better 
able to vaccinate against the routine, I think he described it as H3N2-
type virus, against the typical garden variety flu and not just 
vaccinate children under 2 and seniors over age 65 or first responders. 
We need to be able to do better than that. We are losing 36,000 people 
every year dying from influenza in this country, and I think we can do 
better than that.
  So, again, I think the President does find himself in a Catch 22 
situation. This is the worst possible time for us to have to deal with 
this, but we do have to deal with it. And whether it is $7 billion or 
something less than that, hopefully not more, I think we, the Congress, 
are going to have to step up to the plate and realize there is 
something that has to be done.
  Mr. MURPHY. Madam Speaker, I thank the gentleman. One of the ways 
that our Nation needs to be dealing with this potential and other 
issues is to have a better health care system overall. The gentleman 
mentioned Hurricane Katrina, and I would like to use that as a 
stepping-off point to talk about some of the work this Nation needs to 
be doing in some of the things we are doing.
  When Hurricane Katrina hit and, subsequently, Hurricane Rita, we saw

[[Page 25266]]

something we had not really been prepared for, not only the huge 
devastation of 90,000 square miles, almost double the size of 
Pennsylvania, but we also saw hospitals were closed, records were 
destroyed, physician offices were inaccessible and patients were 
inaccessible. Patients by the hundreds of thousands traveled around the 
country, many without their medications, without their medical records, 
and in some cases not even knowing what their medications were. We had 
to essentially reinvent for many of them a system of health care.
  Now, let me take this on another smaller role here too with regard to 
individuals. When a person goes to their own physician, many times you 
have what I refer to as 21st century medical technology kept track of 
in a 19th century system, and that is paper and pen records. Now I have 
seen these myself through many years of working in hospitals and in my 
own practice settings where you write your notes down, and when lab 
results come, you stick them in the chart, and it could be for a 
typical patient perhaps the pile of papers could be much thicker than 
this.
  Yet, when a person goes to the hospital, it is not unheard of, for 
example, I was talking to someone at one hospital; and I would be 
interested to hear if my colleague's experiences are the same. But say 
a woman showed up in an emergency department in labor. Some notes may 
be made there. She then may go up to the delivery area to deliver. 
After that, she goes to recovery and her baby goes to pediatrics. And 
each time separate mounds of medical records are made, which may not 
really be collated together for hours, sometimes days afterwards simply 
because of what is happening there, not to mention her own medical 
records from her own obstetrician back home. That is the way the system 
operates every day.
  Let us take another scenario. Take a single mom who has a son who has 
asthma. And perhaps because of whatever housing, perhaps she is on 
Medicaid, low income, and she finds a situation where she has to move 
to a different part of town and it becomes difficult for her to get 
across town to see her other doctors, so she goes to a new doctor. And 
they have to essentially reinvent what has been done for this child or 
call for those records and have them shipped over.
  Now, if one has the luxury of days, sometimes that can be done, with 
the situation of establishing new relationships with new physicians and 
new nurses. But you also have the situation, if the child goes into 
acute distress with something like asthma, of showing up in an 
emergency department and having to have all the medical staff there 
trying to track down what is the child's medical history, what 
prescription drugs is he on, are there any particular allergies he has, 
if he is on other medications will there be drug interactions, what is 
his blood type. Even the most basic information is important to have, 
but they do not have it.
  Now, in some hospitals around the country we see some changes being 
made. University of Pittsburgh Medical Center, where I am from, is one 
that is doing this, but there are other centers, at Northwestern, and 
other States have this, where they are emerging towards the technology 
of electronic medical records and electronic prescribing. I want to 
talk a little about how that is done and show some things that are 
being done on Medicaid.
  Imagine going to a medical office and filling out a clipboard with 
your name, address, phone number, your medical history, and allergies, 
if you can remember it all. Very often, it is tough. Certainly my 
colleagues in Congress, I think we would all be hard-pressed to 
remember every doctor we ever saw, every medication we ever took, or 
every diagnosis that was ever placed in our chart, but it is important 
information. Add to that every x-ray we have ever taken, every lab test 
that has ever been done. Those are oftentimes lost to the ether.
  Some studies have indicated that perhaps as much as 14 percent of 
medical records are missing, some important information, important 
enough that it would change the direction of what the provider would 
diagnose or call for treatment in those cases, and in some cases, 
physicians say major changes in how they would diagnose.
  Perhaps a patient was set up for a blood test and they never showed 
up for the blood test. Or perhaps they did show up, and the information 
was never forwarded to the physician's office. Or if it was forwarded, 
maybe it was misfiled or placed somewhere else. A whole host of things 
can go wrong when you are dealing with reams and reams of paper 
filings.

                              {time}  2045

  Then the moment of truth comes when the doctor needs it, where is the 
information. If it is missing, they may have to call for repeat tests 
or write a prescription and then find out that it causes problems with 
the patient, which can cost lives as well as money. It is estimated 
that 150 million times a year pharmacists call physicians to double-
check medications. Perhaps they cannot read their handwriting, or 
double-check the decimal point on the medication dosage level, or 
perhaps to say Mr. Smith is on another medication from another doctor 
which is identical, or it is one that would have a bad drug interaction 
with this other medication. That is a grave concern, how do we fix 
this.
  Well, by using electronic medical records, the medical record could 
actually be placed on a computer, perhaps in the physician's office. In 
some cases, individuals can carry their own. I brought a sample, 
smaller than a stick of gum. This is a 64-bit memory chip. It happens 
to be on a key ring. It is quite possible in the near future we may be 
seeing individuals who carry their own extensive medical records that 
can fit into their wallet or on a key ring. If an emergency came up and 
if something came up, they could, at a moment's notice, hand it to a 
doctor. They plug it in and pull up the records right away.
  This is critically important for those with complicated cases. That 
involves a huge investment in the medical infrastructure in America, 
but if we use a situation like Hurricane Katrina or an outbreak of a 
pandemic in this Nation where the medical system of this country would 
be taxed beyond anything we can imagine. Again with Hurricane Katrina, 
hundreds of thousands of patients moving about, many psychiatric 
patients let out of hospitals with no recall of their medications. 
People had to start from scratch and diagnose them.
  What if we had medical records on file that people could use in a 
secure and confidential way and could tap into. Or what if some 
individuals carry their own medical records in their wallet. It would 
be incredibly valuable in moments of need and help reduce health care 
costs.
  This is not something that should just be in the best of hospitals or 
in the hands of those who can afford it. If we are going to lower 
health care costs, we need to put it in the hands of every American. 
RAND Corporation released a study a few weeks ago that said if our 
Nation switches to electronic medical records, we could save in the 
nature of $160 billion-plus per year. $160 billion per year. In a 
health care system where we are so concerned that costs are moving 
completely out of control, where people cannot afford health care, 
where businesses can no longer afford the double-digit increases in 
costs, we need something major, something comprehensive, something that 
completely shifts how we provide health care in this Nation. And 
electronic medical records is just that treatment.
  Not only does it save money in terms of doctors not having to take 
time to review the chart, worry about mistakes they may have made, call 
for new MRIs, X-rays, CT scans, blood tests, not only that reduction in 
costs, and not only the savings of lives, because a mistake has not 
been made or a delay has not occurred in care; but Rand goes on to say 
you save massive amounts of money in terms of jobs, people not losing 
work because of complications or having to go back to a doctor to have 
tests done again.
  Think of it this way: If a doctor asks for an X-ray and it is done, 
and he says did you bring the X-ray, no, they did

[[Page 25267]]

not give it to me. The doctor says, we will take another one. You pay 
for that X-ray, the person's time who has to have another test done, 
all of that is duplication of work. But what if, again, that individual 
carried the X-rays, films of their surgeries, all of those details on a 
chip, or if it was on a computer screen in the physician's office. Not 
only would the doctor have instant access, but he would not be going 
page by page through the medical records, what did I prescribe before, 
because nobody can possibly remember the details of all of the patients 
they see.
  But in an instant, tapping a button could call up those X-rays. Added 
to that, if the physician had questions and needed a consultation, he 
does not just call his old mentor in medical school, I need to call Dr. 
O'Hare and get his consult and mail him the X-ray and ask him to 
comment back. Literally, at the stroke of a key, he can have another 
doctor look at the X-ray, consult with him, and provide valuable 
information back in time faster than the speed of light. It saves 
valuable time, critical information, and saves lives.
  But how do we get that into Medicaid, is my question. Well, first of 
all, let us look at what Medicaid has done here and look at some costs. 
In 2006, the Federal Government is spending in billions, about $190 
billion. This is going to increase by $66.4 billion, or 34.8 percent, 
over the next 5 years. We are up to $200 billion in 2007; 2008 to $217 
billion; 2009 is $237 billion; and by 2010 it is $257 billion. The 
Federal Government general increase in what it is spending on Medicaid 
is going to increase 7 percent over the next several years.
  The budget package that Congress is putting together now to try to 
reduce some of the deficit is going to do some things that the 
Governors of States have asked for. The Governors of States have said 
that Medicaid spending, in some cases, is almost 20 percent of the 
State budget. They need some mechanisms by which to control this.
  I was pleased that a bill I introduced has been put into the Medicaid 
package of our deficit reduction package, which will put $100 million 
in grants to go to hospitals that have high Medicaid populations, 
perhaps inner-city hospitals, perhaps community health centers, and 
nursing homes and other centers that have high Medicaid populations so 
they can partake in electronic medical reports.
  Basically, a hospital has to convert their files into computer 
programs and be able to pull those up. There are a couple of nuances 
that go on. You have to make sure that different offices of doctors and 
hospitals can all speak to each other on this because otherwise there 
can be a medical Tower of Babel, that is, one hospital may use one type 
of computer program for their records and another hospital another type 
of record.
  But I want to call upon my colleague and ask the gentleman from 
Georgia (Mr. Gingrey) from a physician's standpoint on what he says our 
Nation can be doing to assist this transition, how it helps medical 
practice, and perhaps some experiences of your own work. I believe you 
have delivered 5,000 babies or so in your time, so how it makes a 
difference from being able to have information instantaneously as 
opposed to waiting for files or trying to make a best guess on a 
patient.
  Mr. GINGREY. Madam Speaker, there is no question what the gentleman 
from Pennsylvania is talking about is very important. He mentioned the 
potential of saving $160 billion a year. I am not sure if that figure 
includes the savings that would be affected from cutting down on 
medical errors and the liability costs, not just for the physician 
health care provider, but also for the facility provider, for the 
hospital systems, many of which are essentially what we call going 
bare. They have a huge deductible. In some instances, a huge hospital 
system, it would not be unusual to have $20 million for no insurance 
coverage for some of these claims for medical errors. So that $160 
billion may be a very conservative estimate.
  I think it is absolutely essential that we move in this direction. I 
know my colleague is a member of the Committee on Energy and Commerce, 
and they are working closely on trying to develop a system. We are 
working closely in Congress with Secretary Leavitt of Health and Human 
Services to make sure that we have one system. We have to have this 
ability to communicate.
  I think it is important and I want to mention this, there are a lot 
of private vendors out there. There is a very excellent company in my 
district, the 11th Congressional District, which is essentially west 
Georgia. In the heart of my district there is a wonderful company, the 
Greenway Company. They have been working on this for a number of years. 
They have this software package, and we refer to it as electronic 
medical records; and we are not just talking about billing. That is 
kind of old hat. That has been around for a while, but this is taking 
it much beyond that so that no matter where you are in this country, 
indeed in the world, when you have that little radio frequency ID card 
that he is talking about or swipe card, if you can charge something on 
American Express when you are visiting India, certainly you ought to be 
able to go to the hospital if an illness overcomes you or you fall 
victim to some accident out of country, they would be able to clearly 
identify your entire medical record almost in an instant.
  Some of these companies, like Greenway and others that have developed 
these systems, they want to make sure that they can connect and 
communicate with a hospital as well. So as our committees of 
jurisdiction, which of course would be Energy and Commerce and the 
Committee on Ways and Means, and our appropriators, we want to make 
sure whatever money we spend, that we give an opportunity for 
entrepreneurs to connect and be part of this; and it not just be 
hospital driven.
  I have heard some discussion about giving some incentives to staff 
members who practice at a certain hospital so there is some benefit to 
get them to communicate with a hospital. But again, competitiveness, 
the free marketplace is usually important, but they have to have a 
similar system, at least one that speaks to the other. That is usually 
important.
  Madam Speaker, the opportunity to communicate with Dr. Murphy on this 
issue, and let me just say this, we cannot overemphasize the importance 
of this. The gentleman described the cost of this Medicaid program 
which is running wildly out of control. In 2010 it is $257 billion. We 
all know there is a price to pay in the State budget, and in some 
States, of course, the Federal match can be as high as 75 percent. But 
that is just a couple of States, and many, many are 50/50. We have got 
to get this working and save money out of this system.
  And more importantly, it is not just cutting down on the cost of 
these entitlement programs. It is also a matter of saving lives and 
increasing and saving productivity. You mentioned both of those points, 
and I think those are extremely well taken.
  Mr. MURPHY. Madam Speaker, I would like to shift to a couple of areas 
of health care here and some other things that we are moving on and we 
need to continue to push for.
  One has to do with some mental health issues. I mentioned earlier 
about Hurricane Katrina and some of the folks who had psychiatric 
illnesses, and as the hospitals were emptied, people did not know their 
medications; and I mentioned how those problems occurred.
  We also have to pay attention not only in terms of using electronic 
medical records so people can find their record when they need to, but 
making sure we have the security so that people cannot get into the 
record when they do not need to. Part of what Dr. David Brailer, who 
the White House appointed to work on this issue, along with many 
companies, such as in Pittsburgh, the University of Pittsburgh Medical 
Center, and there are many private companies trying to come up with 
solutions, so we have a great many other aspects that we are working 
towards in order to make sure that these records are secure and 
confidential.

[[Page 25268]]

  I want to ensure my colleagues that this is something that I am in 
complete agreement with, what Secretary Leavitt is working on in HHS 
and also Dr. Brailer, that these electronic records need to be secure 
and confidential so people can always trust that their records are not 
going to be viewed by somebody who should not get into them.
  In the Committee on Energy and Commerce, we are working on some other 
technological aspects. We are working with the committee to offer some 
amendments to make sure we also have reporting.

                              {time}  2100

  Interestingly enough, one of the areas we find loopholes as we are 
moving forward on issues is that right now if there is a breach in 
security of some kind of records, health records, unless someone 
reports that there is not something that is done and what we really 
want to make sure is happening is hospitals are regularly scanning 
their records as many of them do now and look for any sort of attempts 
people may have to get into those computer files. Similarly when we 
have our own paper records in our own office, we have to keep those 
under lock and key. We have to make sure that those who are not 
authorized to see them don't get in there to see them.
  In the mental health area, I want to talk for a few minutes about a 
couple of aspects and again give my colleague time if he has some 
issues he wants to get into, but I want to talk about mental health 
care treatment for chronic diseases and how they can lower health care 
costs. For many individuals with chronic diseases like asthma, 
arthritis, heart disease, cancer, diabetes, lupus, and many other 
areas, interestingly enough, the incidence of depression can be double 
that of the general population. Whereas in any given life span, perhaps 
about 16 percent of the population may suffer from some severe 
depression, when you have a chronic illness like heart disease, those 
rates can double. And some cardiologists tell me that the numbers would 
really be even much higher than that. After all, when you are told you 
have a debilitating disease or something that can be life threatening, 
it is expected that a person would have a severe reaction. Many times 
it is overwhelming stress. Sometimes that can move into a sense of 
depression.
  Depression is not just a sad feeling as we all feel at times. We have 
a bad day, the loss of a loved one, job stress. Depression is part of 
life in terms of having some sense of sadness. It reaches a point, 
however, in some folks where it really becomes a wall around them. It 
affects them physically. It affects them mentally. Thoughts are 
sluggish. Oftentimes they have a hard time getting out of bed in the 
morning but then a hard time sleeping once they are there. They may 
find themselves with no appetite. They may find themselves overeating. 
They may find themselves seeking other things to alleviate their 
depression such as drugs and alcohol. And I am not talking about 
prescribed drugs. It may be things where they are angry, they are edgy, 
they are moody. It may be that they are withdrawn. All sorts of things 
can happen. What is interesting is how this really becomes not just a 
mood and an emotional reaction and this is not something that is just a 
sign of weakness, it is a real chemical, neurochemical reaction that 
occurs in the brain then that becomes debilitating. For someone who has 
heart disease or diabetes, I was mentioning, double the incidence, 
think of this: That the stress can be so prolonged on their body and 
their system and it depends on the individual, it is almost as if there 
is a point at which the body says, We can't handle the stress anymore 
and depression begins to overcome.
  Why does it increase so much with things like heart disease? Perhaps 
because of the stress, but here is an interesting factor. Patients 
diagnosed with depression have higher rates of chronic medical illness 
and use health care services more often. Patients with chronic medical 
illness and untreated depression have higher health care costs in 
several categories of care: primary care, regular doctor visits, 
medical specialty care, medical inpatient care, pharmacy, lab costs, 
all increase, when compared to those with chronic medical illness and 
treated or with no depression. Much higher.
  As I said before, clinical depression affects about 16 percent of the 
population at one time or another in their lives. Unlike the normal 
experience of sadness or loss or mood states, it becomes much higher. 
For example, 31 percent with diabetes have depressive symptoms. 
Interestingly enough, the increased psychological stress or depression 
increases platelet reactivity to thrombosis, or blood clotting. In 
other words, when you have heart disease, untreated depression in ways 
we are not quite clear yet can actually lead to an increases in 
clotting of those little blood cells, the platelets that we have. This 
can in turn lead to almost doubling the cost of health care for folks 
with heart disease.
  Again, you have folks with and without heart disease. Those with 
heart disease may have double the incidence of depression. And those 
with untreated depression or not responding to treatments can have 
double the health care cost. Some are intuitively obvious: Perhaps the 
person is not following up with doctor visits; perhaps they are not 
following the treatment plan; they are not going through and taking 
medication; maybe they are not seeing the doctor; exercising; all the 
things they should be doing. But even in that case if they are doing 
that, there is something physical that is taking place in those 
patients that may actually contribute to increased medical 
complications.
  Very often treatment for mental illness is not provided by a mental 
health professional. A person does not see a psychiatrist for their 
medications, maybe does not see a psychologist for other behavioral 
therapies that may go with that. Actually psychiatric medications are 
prescribed by nonpsychiatrists 75 percent of the time, most frequently 
by primary care, general and family physicians. But when we combine 
medical and behavioral health services to coordinate the diagnosis and 
treatment of the full spectrum of diseases, we can see some huge 
changes in that.
  When you have, as I said before, untreated depression, it has been 
found to increase health care costs by complicating symptoms and 
treatments of such things as back pain, diabetes, headache and heart 
disease annually from $1,000 to $3,000 per patient. Very, very 
important when you are dealing with someone, for example, who is an 
employee who has some of these problems, when you see this untreated 
depression in them, increased costs. Untreated depression costs 
employers more than $51 billion per year in absenteeism and lost 
productivity, not including higher medical and pharmaceutical costs.
  When we use information technology and much of what we have been 
talking about this evening, it can be used to track diseases and 
intervene with appropriate care. So now with a physician seeing a 
patient with a chronic illness and into that computer he types in or 
she types in the diagnosis, up in the screen should not only appear, 
here is confirmation of the diagnosis of this disease but up also arise 
some questions as prompts to the physician. Again if he types in 
coronary heart disease, what may also show up is, ask the patient the 
following questions: Ask about mood, ask about appetite, sleep 
problems, problems in their relationship with their spouse, to see if 
there is any indication of other psychiatric or psychological disorders 
for which that patient could be referred over for help. This 
information about provider system performance will be extremely 
valuable to have this. But unfortunately in many cases a physician may 
not have those prompts available and if they may only have a handful of 
moments to see a patient, it becomes very, very difficult.
  If we saw depression as a medical condition for what it is and other 
psychiatric illnesses for the medical conditions they are, we could 
reduce health care costs and save lives. Unfortunately, and I know our 
colleagues as well, there are some folks here who believe there is no 
such thing as mental

[[Page 25269]]

illness and I have heard such statements made, saying, oh, it's just a 
chemical reaction in the body, or there really are no other emotional 
components. We have heard Hollywood stars talk about this with an 
incredible amount of prejudice and ignorance. But it is true. There is 
such a thing as mental illness. As much as we want to pretend it is not 
there, as much as we want to ignore it, it does not make it go away. It 
does not help if we continue to treat mental ilness with the same level 
of insight and ignorance as the Salem witch trials. There are times 
that we have not advanced much beyond that. But when on the other hand 
we recognize this incredible integration between mental health 
treatments and other medical treatments, I say other medical treatments 
because they are both medical, we can see with those patients huge 
changes and huge cost savings. Increased psychological stress or 
depression increases platelet reactivity, as I said, thrombosis. But 
there are also aspects, too, with treatment here that we find really 
can save a great deal of money.
  A 2000 report by the Office of Personnel Management for Federal 
health employees provides an example of several major employers who 
through managed care programs have discovered they can offer mental 
health benefits to their employees in order to maintain a higher 
quality workforce. These employers included companies like AT&T, 
American Airlines, Eastman Kodak, General Motors, IBM, Massachusetts 
Group Insurance Commission, Pepsico. The list goes on. The most 
important finding of this report was that employers who provide 
generous mental health and substance abuse benefits to their employees 
and their families are committed to providing these benefits because 
they are convinced that doing so is essential to the corporate bottom 
line. What they indeed found was the mental health coverage put on par 
with physical health coverage only costs employers about 1 percent or 
$1.32 per enrollee per month according to a 2004 analysis by Price 
Waterhouse. But they also found it actually saves a great deal of money 
for individual businesses.
  As we are proceeding through efforts to save money through Medicaid, 
as we are looking at such things as Medicare, I call upon our 
colleagues to make sure we are saying, you don't just save money by 
cutting rates of growth. It is important we do that. It is important we 
work with States to reduce that. But it is also important we work with 
States to help them understand and employers to understand that when 
you deny an aspect of critical care, and that is mental health care, 
you can actually be harming the patient. And so it is vitally important 
that we look in all these areas now and other bills that may be before 
us in the future, that we use them in such ways, this huge amount of 
spending the Federal Government gets involved with health care, but 
also encouraging employers to do the same thing.
  Congress budgeted $20 million for the development of comprehensive 
State mental health plans to improve the mental health services 
infrastructure in 2005. The amount we need to, however, spend is 
probably much more than that. Unfortunately, the way the Congressional 
Budget Office works in this Federal Government, it only tells you what 
you spend. It does not tell you what you saved. It would be much like 
if we looked at how much we are going to spend in immunizations but did 
not see what we saved in lives and money for flu. It would be 
ridiculous if we did not say that that indeed would be a savings. We 
have to keep working at these aspects here. We have to look at how 
Medicare and Medicaid reimburse. We have to look at pay-for-performance 
incentives to help physicians and mental health professionals work 
together in a comprehensive and integrated way. We have to make sure we 
are helping businesses understand that these Medicaid transformation 
grants, for example, that I mentioned earlier are, I believe, going to 
be $100 million invested, but when we use these for such things as 
county nursing homes, skilled nursing facilities, federally qualified 
community health centers and similar facilities and inner city 
hospitals, we will see tremendous savings come through this whole 
system here.
  Just to wrap up my comments and I will turn back to the gentleman 
from Georgia if he has some other thoughts he wanted to say in wrapping 
things up tonight, it is so vitally important that we work together, 
not only the handful of health care professionals that are here in 
Congress but it is so important that as Members of Congress we work 
together to understand that health care is not just about what you 
spend, it is also about what you save by your spending. If we are ever 
going to get control of this juggernaut of health care costs, it is not 
just going to be by having the discussion go in terms of who is 
spending; it is not just a matter of saying we are going to have health 
care savings accounts so people can pay more attention to what they are 
spending, that is important; and it is not just in terms of saying, 
nobody can afford health care so let's have the Federal Government take 
over. It is about not just who is paying but what we are paying for. 
That is why the comments we have made tonight about what we are 
spending money and how we are going to spend it on dealing with the 
concerns about the avian flu be done in a careful and thoughtful 
manner. That is why other aspects I mentioned before about medical 
records, electronic medical records and also integrated health care and 
other aspects we can get into, too, about prevention, et cetera, it is 
so important we deal with these in a comprehensive manner to look at 
those savings.
  I wish that we could get the Congressional Budget Office to do more 
aspects of looking at how we can save money in this, but that is going 
to be something that we are going to have to carry the torch on. I know 
my colleague has carried the torch on many of these aspects here. I 
think we have about 7 or 8 minutes left. I know you have a number of 
other aspects you would like to talk about. I always enjoy these 
colloquies with you about looking at this. It is an important aspect 
that we team up together on here to get this Nation thinking about 
other ways of saving lives and saving money by, and I will leave with 
this chart here, about the health transformation. We cannot just make 
reforms within the current framework. We have to look at our current 
health care system and if we fail to change, it will decay into a 
system we cannot afford anymore. If we work toward real change to a 
21st century health care system, that is where we should be going. I 
believe our Nation, whether it is private employers or the Federal 
Government, will see tremendous changes that save tens of thousands of 
lives and tens of billions of dollars. I thank my colleague for being 
such an adamant supporter of moving this health care system forward.
  Mr. GINGREY. I just want to say that what you have brought to the 
Members tonight regarding what I think you would agree we could call 
mental health parity is a hugely important issue. I think my colleagues 
in the medical profession who are still practicing, especially those 
whom I know so well back home in Marietta, Georgia, expected when I 
came to Congress that I would have all of the answers and be able to 
solve all of our problems but the truth is I have learned just about as 
much as I have contributed and realizing today after being out of the 
practice of medicine, the bedside care of patients for almost 4 years 
now, how important this issue of mental health parity is that you bring 
to our attention tonight. You are right, absolutely. There are so many 
people who suffer from mild, moderate, severe depression, they are not 
psychotic, they do not need to be institutionalized, they do not even 
need to be hospitalized, but their illness, their depression, results 
in decreased productivity. You mentioned that. Away from their job. It 
also is detrimental to their physical well-being whether, as you point 
out, it is heart disease, diabetes, or whatever. You talked about the 
effect on platelets. There is no question about that. And, of course, 
the very important point you made about their compliance with medical 
treatment,

[[Page 25270]]

again, whether that is heart disease or diabetes. If they are 
depressed, they are not going to follow the regimen they need to follow 
and it is going to end up costing this country, particularly when the 
money is coming from the Federal revenue and John Q. Taxpayer, it is 
going to cost more.

                              {time}  2115

  As the gentleman points out, we get more credit for the fact that we 
are, overall, going to reduce health care costs by paying more 
attention to something like this.
  I know a lot of my colleagues will try to treat mental illness and, 
really, I will use the expression ``on the fly,'' I think Dr. Murphy 
knows what I am talking about, in a hurry. You do not have time and you 
do not do a prolonged mental health inventory, a counseling session, 
with the patient, you just write a prescription for some 
antidepressant, whether it is Effexor or Zoloft or whatever, in many 
instances, not all. Certainly some general physicians, internists, 
family practitioners, even gynecologists take a special interest in 
mental health care and know a good bit about medications. But I think 
in many instances, those patients are better served by a mental health 
professional, a psychologist or a psychiatrist, but I really appreciate 
the gentleman bringing that point to us.
  Madam Speaker, if the gentleman will allow me to continue, I did want 
to just shift just for a few minutes to the issue of the Medicare Part 
D, the prescription drug part that is part of the 2003 Medicare 
modernization program. We are in tough budget times. My colleagues 
understand this, and of course we talked earlier in the hour during a 
colloquy about avian flu and the fact that the President has no choice 
but to bring to the Congress a request for money, in this instance an 
additional $7 billion, to help prepare for the possibility of a 
worldwide pandemic right on the heels of the need to spend $150 billion 
to $200 billion on the horrific hurricane that struck the gulf coast, 
Hurricane Katrina.
  We just had tornadoes in Indiana and Kentucky with the loss of life. 
Last summer we had four hurricanes strike Florida, and we continue to 
spend necessary money fighting this global war on terrorism. I mean it 
is a tough, tough time. And people in my district, the 11th District of 
Georgia, and I feel sure the gentleman's constituents from 
Pennsylvania, are very concerned with fiscal responsibility and 
hopefully look for some offsets.
  That is what we are about in the Congress this week. Hopefully, we 
will have an opportunity to exercise some fiscal discipline in regard 
to the growth rate. Not cutting mandatory spending, but just limiting 
the rate of growth from 5.7 percent to 5.6 percent, looking for $50 
billion in savings over the next 5 years. These things are hugely 
important, and our constituents are demanding it.
  But this suggestion that we find some savings by delaying or indeed 
canceling the Medicare Part D prescription drug benefit as a part of 
Medicare modernization I think would be a huge mistake, Madam Speaker. 
Because, as Dr. Murphy pointed out, we have heard this estimate of $750 
billion additional Medicare costs over 10 years, but that is giving 
absolutely no credit to the fact that if this program works, and I 
truly, in the deepest depths of my being, feel that it is the right 
thing to do and that it will work and will shift some cost away from 
Part A and Part B, that part that pays for open heart surgery, it pays 
for an emergency room visit if you had a stroke. Indeed, it pays a 
little money under Part A and Part B for prolonged skilled nursing home 
care, possibly for the rest of your life.
  Mr. MURPHY. Madam Speaker, if the gentleman will yield, one of the 
things that is in this Medicare bill we passed a while ago now, that 
many people are forgetting, has to do with the entry physical that 
people get, but there are also elements in there that have to do with 
some patient management, the pharmacist is working more monitoring the 
medication, and communication. I would ask my colleague to speak on 
that, because that may be a thing that we really are not quite used to, 
physicians and pharmacists working more closely together as part of 
that Medicare bill so that there is less hospitalization.
  I know one hospital in my district, Washington Hospital, really found 
that by doing careful patient management of those with heart disease, 
they reduced rehospitalizations by 50 percent. That is a massive 
savings in costs and certainly much better for the patients, in many 
cases saving some lives. I wonder if the gentleman could comment about 
that.
  Mr. GINGREY. Madam Speaker, I am very familiar with Washington 
Hospital, although I did not realize it was in the gentleman's 
district, the great work that they did. But there is no question about 
it, this issue.
  I mentioned the cost-shifting from Part A and Part B, and I think 
that will be substantial. But this emphasis, and the gentleman is 
right, it is part of this bill, not just prescription drugs Part D, but 
also that entry level physical, that focus on disease management and 
making sure that people, whether they do it through Medicare Advantage, 
whether an HMO-type program, or even traditional Medicare, in screening 
for things like colon and rectal cancer, breast cancer with mammograms, 
prostate cancer screening, cholesterol screening so that we do not wait 
until the person has a heart attack and has to have that quadruple 
bypass that is very expensive. So again, I wanted to make sure, and I 
appreciate the gentleman from Pennsylvania giving me the opportunity to 
have time to discuss that, because we are hearing it. We are hearing it 
on the floor of the House, maybe from both sides of the aisle, and 
folks back home, naturally they want us to spend what we have to spend, 
but not a dime more, and I agree with that.
  But I think this will be clearly the wrong message to send to our 
seniors. I mean, this President and this Congress were not the first 
elected folks to promise to deliver a prescription drug benefit for our 
seniors. Indeed, Medicare started in 1965, so what are we talking about 
is about 40 years of the program, and they have been waiting a long 
time. And to ask them to wait a couple of years or indeed maybe 
indefinitely so that we can offset some of these costs of responding to 
the bird flu or responding to Hurricane Katrina, I think would be a 
huge mistake.
  Mr. MURPHY. Well, Madam Speaker, I think it is one of those areas 
that, again, I think that when one just looks at the numbers of costs 
up front, and we have some of those frightening numbers, I do not know 
how many hundreds of billions it may be. And I understand the concern 
of our colleagues who may have opposed the Medicare bill for Part D 
because they were concerned about the cost. But I believe this has some 
innovative aspects in it and some that we have to pay attention to.
  Oftentimes, people say that one of the definitions of insane behavior 
is doing the same thing over and over again, expecting the same 
results, but this patient management aspect and the integration of care 
between physicians and pharmacists is vitally important. I am hoping 
that as people review their Medicare Part D options that they also ask 
questions about that, when they call 1-800-Medicare or go to 
medicare.gov, or particularly when they call 1-800-Medicare, feel free 
to ask about that, or ask Members' offices to talk about that. It is 
something that is so very, very important. It is going to be a 
different aspect of health care that we follow up on.
  Mr. GINGREY. Yes. And I think too it needs to be said that when we 
had this debate, a huge debate, in December of 2003, as my colleague 
recalls, we were freshmen at that point in our political careers, both 
of us, but there were a lot of folks, particularly on the other side of 
the aisle, that were very angry, very angry with AARP, the American 
Association of Retired Persons, because they had the unmitigated gall, 
the audacity to support this President and this Republican leadership 
in trying to get this Medicare modernization prescription drug bill 
passed and to fulfill this promise that

[[Page 25271]]

was made. They even suggested that people tear up their AARP card as an 
act of defiance and protest against this bill, and discourage people, 
the working poor who could get the prescription drug discount card in 
that transitional program, and get $600 worth of credit for each of 2 
years during that program's existence, $1,200. To think that they 
discouraged people, and many of them were discouraged and did not get 
that benefit. I hope now that for Medicare Part D, and the sign-up is 
beginning soon, that they will be encouraging them, not discouraging 
them, to sign up.
  Mr. MURPHY. Madam Speaker, I thank the gentleman for his time tonight 
and also the indulgence of our colleagues in listening to this. We will 
continue to push these health care issues so vitally important for the 
health of our constituents and of all Americans.
  On my own Web site at 
murphy.house.gov I have further information on health care, FYIs, as I 
call them and sent to my colleagues every week. I hope people will look 
at that, and I hope my colleagues will continue to work with us, but 
really all Members of Congress, not only those with a health care 
background, but together, we will see some major changes in not only 
saving lives, but saving money.

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