[Congressional Record (Bound Edition), Volume 153 (2007), Part 27]
[House]
[Pages 36011-36015]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentleman from Texas (Mr. Burgess) is recognized 
for 60 minutes.
  Mr. BURGESS. We probably won't take the entire 60 minutes because it 
has been a long week and it's been a long year, but I did want to come 
to the floor of the House this evening and talk a little bit about 
health care and talk a little bit about some of the things that are 
going on in Medicare, some of the things that are going on in Medicare 
as it affects our Nation's physicians workforce, and what, perhaps, I 
see over the horizon for the next six to 12 months. It's going to be 
kind of an interesting year. It's an election year in this country, and 
that means we never want for drama during that time.
  This is, of course, the special time of year at the end of the year 
where we all pause and kind of give a little thanks for living in the 
greatest country on the face of the Earth, the greatest country the 
world has ever known. We're blessed with many, many benefits from 
living in this country. Sometimes we take many of those for granted. 
Our health care is one of those benefits that I think we do take for 
granted, we overlook too often.
  It is appropriate to perhaps have a little checkup on that little 
tiny segment of the health care market that is controlled by the 
Federal Government. Of course, I'm being factitious because the Federal 
Government has under its direct control and grasp probably close to 50 
cents out of every health care dollar that is spent in this country. 
That is, 50 cents out of every health care dollar that is spent in this 
country originates right here on the floor of the House of 
Representatives when you configure or figure the expenditures on 
Medicare, Medicaid, the VA system, the Indian Health Service, the 
Federal prison system, the federally qualified health centers around 
the country, 50 cents out of every dollar starts here on the floor of 
the House.
  But Medicare does have some operational problems with its physician 
workforce, it has some distributional problems. There are some areas 
that need attention in our Medicare system. And the problem, Mr. 
Speaker, is not just money. We've heard a lot of folks talking on my 
side, folks talking on the other side about the issue of money, but the 
issue is not just about money, although the money is extremely 
important. It's not just about money. It is the policies that we create 
here on the floor of this House and the rules that are written in the 
Federal agencies under our direction. It's the policies created in this 
House that actually lead to most of the direct problems in that part of 
health care that is paid for under the reach and grasp of the Federal 
Government.
  Now, Medicare was created a little over 40 years ago, the mid-1960s. 
And it was created to make a connection between patients and their 
physicians, patients and their hospitals and places where they needed 
to go for care, care that was becoming very expensive, and for some of 
our seniors was care that perhaps would be out of their reach.

                              {time}  2215

  Now, Mr. Speaker, believe it or not, I was not in practice at the 
time Medicare was instituted. My dad was. And I remember very clearly 
when Medicare was started in this country and some of the concerns 
revolving around that. I don't think anyone would have really thought 
that we would have just done an appropriations bill where here some 43 
years later after the enactment of Medicare, I don't know what the 
total line expenditure for Medicare was, but it is topping $300 billion 
for a year in Medicare. You add the expenses of Medicaid to that, and 
the two together with what is spent at the Federal level and what is 
spent at the State level when you involve Medicaid and we are well over 
$6 billion a year for what we pay for that. So, again, it is really not 
so much a question of money. It is a question of policy.
  But the lifeline that was created between seniors and their doctors, 
seniors and their hospitals, that lifeline that has been depended upon 
by really two generations of Americans now, almost two generations of 
Americans, that lifeline is frayed. Almost every day there is a little 
nick, a little cut. It is death by a thousand scalpels, if you will, 
since we are talking about health care. And it is that constant 
nicking, it is that constant pressure on that lifeline that is causing 
the lifeline to fray for many individuals.
  Now, Mr. Speaker, I have said on the floor of this House before and 
it bears repeating tonight, Alan Greenspan, the former Chairman of the 
Federal Reserve Board, when he left his office as chairman just a 
little less than 2 years ago through one of his sort of exit speeches 
when he came through to talk to various groups, one of the things when 
he came to talk to a group of us one morning back in January of 2005, I 
think it was, and talked about the, well, he was asked about the cost 
of Medicare, how in the world is Congress ever going to keep up with 
the ever increasing cost of Medicare; how is Congress going to deal 
with what is basically an unfunded obligation going into the future. 
And the Chairman thought

[[Page 36012]]

about it for a moment, and as always he is very careful about what he 
says. He said, I think when the time comes Congress will find the 
courage to do what is necessary to keep the Medicare system up and 
running. He said, what concerns me more is will there be anyone there 
to deliver the services when you require them?
  Because, Mr. Speaker, January 1 of 2008 will be the year the first 
baby boomers reach the magic age of 62. They begin entering their 
retirement period, their retirement time; and as a consequence, we are 
going to see a lot of pressure put, not just on the Medicare system but 
on the Social Security system, on our system of long-term care, which 
is basically the Medicaid system under the current construction.
  So there is going to be a lot of pressure put on those Federal 
programs as more and more people of my generation reach retirement age 
and again to seek and ask for and collect those benefits that they 
believe that they have been paying into over time.
  But what happens if the supply-demand equation in regards to 
America's physician workforce, and nurses too for that matter, but what 
if the law of supply and demand has been drastically skewed so that 
there is not the supply, we are not keeping up with the supply of 
doctors and health professionals who are going to be required to take 
care of those patients as they enter their retirement years?
  At the risk of getting too technical, let me just share a few facts. 
Mr. Speaker, I am sensitive to the fact that I must only address the 
Chair and not address people who are here on the House floor with us, 
Members who might be watching from their offices. I know I am not 
supposed to direct my comments to people who might be watching on C-
SPAN so I will confine my remarks solely to the Chair and, Mr. Speaker, 
this is a poster that I have used in the past, and many people have 
seen this poster used on the floor of this House. This is a cover from 
the periodical put out by the Texas Medical Association. Every year 
they come out with a publication called Texas Medicine. And this is 
from March of this past year, March of 2007. And the title article was, 
``Running Out of Doctors.'' It is a concern, certainly a concern of my 
professional organization, the Texas Medical Association back in Texas. 
And it is a concern, I think, or should be a concern for many of us 
here in this Congress.
  Again, it was a concern of Mr. Greenspan's 2 years ago when he came 
and talked to a group of us. And, in fact, Mr. Speaker, I asked Mr. 
Greenspan again when he came back to visit with us just a few months 
ago, I said, I often quote that statement that you made to me about is 
there going to be anyone there to take care of the patients in the 
future, and do you still feel that way, Mr. Chairman? And he said, Not 
only do I still feel that way, I feel stronger about it today than I 
did a few years ago. So this is a very relevant point and something 
that certainly we need to keep in mind.
  Now, one of the things that is still up to be done, one of the things 
that is still on our to-do list here on the House side before we do 
finally draw this year to a merciful close is we do have to address, 
basically, what Medicare pays doctors. For whatever reason, we have to 
deal with that every year, and we don't always do a good job. Certainly 
when my side was in charge, we didn't always do a good job, and this 
year I think that performance is being repeated, and perhaps it is even 
a little bit worse this year.
  The fact of the matter is that if Congress doesn't do something 
before December 31 of every year, there is a scheduled series of 
payment reductions that physicians will experience as a consequence of 
the formula under which they are paid under Medicare. It is not a 
problem that is unique to this Congress. It has been going on for 
years. It has been going on through several administrations. It is a 
problem brought to us by a formula called the sustainable growth rate 
formula which is how physicians are paid under Medicare.
  Now, it is different for hospitals, it is different for HMOs, it is 
different for drug companies. Those expenditures are subject to 
essentially a cost-of-living adjustment every year. So every year there 
is perhaps a little bit of an uptick in what the hospitals receive, 
kind of a what is called a market basket update where the cost of 
inputs, the cost of delivering the care is figured into what Medicare 
reimburses a hospital.
  So part A of Medicare, which is the hospital payment, funded out of 
payroll deductions, part A of Medicare, the hospitals do receive a 
little bit, it is not terribly generous, but they do receive a little 
bit of an uptick every year. For part C of Medicare, which is the 
Medicare HMOs, they are perhaps even a little more generous than the 
hospitals. They get a little positive update so they can continue to 
meet the obligations that they have in taking care of our Medicare 
patients. We are asking the HMOs to provide that care. We are asking 
the hospitals; in fact, we are asking the doctors. Congress asks them 
to provide the care so hospitals, HMOs and now drug companies receive a 
little bit of an additional payment every year under the current 
formula structure.
  But for whatever reasons, physicians have been calculated 
differently. And the physician rate of compensation for Medicare 
patients is based upon something that has a little bit to do with the 
gross domestic product and the idea that we are only going to be able 
to control the expenditure on volume and intensity of Medicare services 
if we really ratchet down what we pay doctors year over year. But the 
negative consequences of that are significant, and the price that 
doctors pay if we do not do our work by December 31, and it looks now 
like we will sort of, and we will get to that in a minute, it looks 
like we will do that work and accomplish that task before December 31; 
but if we don't do that, then this year the Center for Medicaid and 
Medicare Services came out with a report November 1 saying doctors 
would receive payment reductions of a little bit over 10 percent, I 
think it was 10.1 or 10.3 percent, for 2008 compared to what they 
received in 2007. Well, stop and think about that for a minute, Mr. 
Speaker. These are small businesses. The physician practices that most 
of us were familiar with back in our communities, I was a physician in 
my previous life. I am very familiar with this concept. We are small 
businesses. And year over year, it is not costing us less to keep the 
lights on in that office. It is not costing us less to hire our 
employees to be able to provide the services that you want us to 
provide. It is not costing us less for liability insurance year over 
year.
  Yet Congress in its infinite wisdom says that we should be able to 
make do with a little bit less in compensation for the Medicare patient 
year over year. This year that payment reduction was 10.1 percent.
  Now, you might say, well, a physician's practice isn't just Medicare 
patients. There is commercial insurance. There is self-pay. Why are we 
so concerned about the Medicare aspect? What percentage of a 
physician's practice will be taken up by Medicare patients? And the 
answer is, it varies and it depends on different places in the country 
and what the patient mix is in various places in the country. Arguably, 
it might be higher in a State like Florida than it would be in a State 
like Wyoming.
  But nevertheless, the other effect of these Medicare compensation, 
Medicare reimbursement reductions that happen and are scheduled to 
happen every year for the next 15 or 20 years, the other effect is that 
every commercial insurance company in this country, almost, not all of 
them but almost, pegs their rates, pegs what they compensate, the level 
of what they compensate doctors to the Medicare formula. So they pay a 
formula such as 110 percent of Medicare usual and customary. Some will 
pay less than Medicare. But most pay a little bit more, not a generous 
amount more, but a little bit more than Medicare.
  But if Medicare cuts its rates by 10.1 percent, then guess what? The 
commercial insurance company will be only too happy to reduce their 
compensation rates by 10.1 percent. And I don't

[[Page 36013]]

think it was ever the intent of Congress to legislate an improved 
business plan for America's insurance companies. They are perfectly 
capable of doing that on their own. They are perfectly capable of going 
into the physician community and negotiating a lower rate if they need 
to do that if that is what needs to happen so they can continue to 
provide the care for the patients, continue to provide the coverage for 
the patients.
  They are perfectly capable of going to the physician community and 
saying this is what we need to do with the new rate structure; but they 
kind of get a little gift every Christmas from the United States 
Congress that says, well, we are going to reduce our Medicare rates if 
we don't do our work. And guess what? All of you patients who are 
covered under private insurance, your doctors are going to get paid a 
little less even though they are going to do exactly the same work on 
January 3 or 4 that they did on December 27 or 28.
  Again, Mr. Speaker, I know I need to confine my remarks to the Chair, 
and I will keep my remarks confined to the Chair. But it does happen 
that sometimes people actually do watch C-SPAN this late at night and 
they do see these discussions, and I have gotten some feedback, Mr. 
Speaker, when I have put up this poster before. I actually have three 
posters that delineate the actual payment formula for physicians under 
the Medicare system. I have only brought one tonight in the interest of 
time.
  And I bring this not to elicit sympathy but I just want people to be 
understanding and cognizant of just how complicated, how complicated 
this process is under the actual gyrations that we go through to come 
up with these physician formulas.
  Now, this is actually the first part of what really should be three 
slides, but I did promise some people that I wouldn't bring all three 
slides tonight. But the payment for physicians is figured by taking the 
relative value unit for work, geographical factor, a relative value 
unit or the cost of inputs, the practice costs which is the subscript P 
C in the middle parenthesis there, again, the geographic factor that is 
figured in, and then the relative value unit for liability insurance, 
and again a geographical factor figured in. Then the whole thing is 
multiplied by a conversion factor down here, there is a misprint, that 
should be C F, which is ``conversion factor,'' and the calculation of 
the conversion factor is every bit as complicated as this first part of 
the formula
  Again, I don't want to lose people with this discussion, but I want 
you to understand how difficult this is conceptually. As a consequence, 
Members of Congress on both sides of the aisle, when you sit down and 
say, I want to talk to you about how we compensate physicians under the 
Medicare system, literally their eyes glaze over and roll back in their 
head because this is simply too hard for many people to think about.
  Again I have spared, Mr. Speaker, the House from looking at the other 
two slides which also are filled with various parts of the formula.
  And too, let me, Mr. Speaker, this will give you some idea of how 
long I have been doing this particular talk, because actually this 
slide was current this time last year when I was doing this very same 
discussion. And I need to update, because now we have completed fiscal 
year 2007, so no longer will 2007 have an asterisk beside it. We 
actually have the actual figures for that, and the figures for 2008 
need to be added on.

                              {time}  2230

  This illustrates the problem we have. Now, last year right before the 
end of Congress, we hadn't quite figured out what we were going to do, 
so it was projected that doctors would have a little over a 4\1/2\ 
percent payment cut. It turns out that that didn't happen. We actually 
at the last minute came in and held doctors at what we euphemistically 
call a zero percent update.
  Well, I am here to tell you that anywhere else in Washington, if you 
come in saying we are going to hold you at level funding, they will 
say, Wait a minute, the cost of inflation, the cost of doing business 
has gone up so much, that is actually a cut. Well, that is exactly 
right, and doctors did receive essentially a cut, but we called it a 
zero percent update, and we did not score it as a cut, but they were 
scheduled to get a 4\1/2\ percent payment reduction.
  This year, if we don't take up the legislation that the Senate just 
zipped through at the last minute here at the end of the day on 
Tuesday, if we don't take that up and pass that before we leave town to 
have Christmas with our families, this negative projection will 
actually be twice as far, down past the end of the page, because that 
is a 10.1 percent reduction that doctors are facing this next year.
  What happens, Mr. Speaker, is every year that we come in at the last 
minute with that fix, that money that we come in at the last minute to 
provide our physicians, guess what? It gets added on to the end of that 
very complicated formula that I just showed you. So every year that we 
don't fix the fundamental problem, which is to repeal the sustainable 
growth rate formula, every year we don't do that, we make the problem 
harder to solve next year, and at some point we will simply reach the 
point where it is too hard to solve, it's too expensive to solve, and 
people will either restructure the formula because it just collapses of 
its own weight, or just say we are not going to even try to solve it 
any longer because it is just too hard. It's an odd concept because 
it's money that has already been spent.
  Going back to 2002, when there was a 4.4 percent negative update, and 
I was in practice then, and that did happen, but the moneys that were 
paid in the Medicare system in 2002 have already been paid, they have 
already been spent. So when they say it costs more to repeal the 
sustainable growth rate formula every year, it's because we are 
actually going to have to account for that money on our books, but the 
money has already been spent.
  There's not any magic here. We have paid the money to the physicians 
for that given year. We just haven't quite accounted for it on our 
books, and that is why there is that additive factor that goes on year 
after year that kind of makes it impossible to ever dig out of this 
hole. We certainly won't be able to if we don't ever start, and that is 
the direction I have tried to take in the last Congress and tried again 
in this Congress. I wasn't really successful in getting a lot of people 
to understand the significance of this.
  The reality is that as we continue, continue to cut at the 
compensation rate for physicians in the Medicare program, what happens 
is more and more physicians say, You know what? I just can't do it 
anymore. I can't keep the lights on. I can't pay the help. I can't buy 
my liability insurance and continue to see Medicare patients. And worse 
than that, there's the pernicious effect of, come on, we are right on 
top of the end of the year here and we are asking doctors around the 
country to kind of trust us on this; we are going to fix it.
  How do you plan in your business for expansion? How do you plan to 
take out loans, take capital risks? How do you plan when year over year 
over year in the Medicare system you have cuts stretching out ahead, 
and, oh, by the way, commercial insurance is going to follow suit if 
Congress keeps those cuts intact and keeps them in place, because we 
don't really have a free market for health care in this country. We 
have Federal price controls, and it's essentially cloaked in the 
Medicare program, but, nevertheless, the end result is Federal price 
controls on medical reimbursement rates for procedures all over the 
country.
  Now, one of the things that really disturbs me about this is it 
really also is a pernicious effect, a chilling effect on young people 
who might be thinking about a career in health care. I remember as a 
young man in high school and college thinking about what a great thing 
it would be to be a physician, to be worthy to serve the suffering, to 
serve my fellow man. Yeah, I expected to make some money doing it, but 
that wasn't the primary reason for going into the field.

[[Page 36014]]

  But, at the same time, I didn't face the kinds of student loans that 
the young individual today will face at the end of their 4 years of 
getting their BA degree, let alone the loans going through medical 
school, and then they have got to really defer earnings the years that 
they are in residency. Yes, they are paid something during residency, 
but nowhere near enough to pay the freight on those lines they have 
through undergraduate school and through medical school. Basically, we 
are talking about a person who may spend between 10 and 18 years after 
high school getting through all of their education and their training.
  Well, you think about that. Someone is graduating from high school 
and 15 years later some of his classmates have already built and sold a 
business and they are sort of semiretired. You give up. You postpone 
those active earning years by a decade, a decade and a half, and that 
is just one of the things that you expect when you take on a career in 
medicine.
  Well, young people are looking at that and saying, You know what? 
That postponement of my active earning years, and the Federal 
Government being so injudicious with what it is doing in the Medicare 
system, and that affecting other areas in the commercial aspect of 
medicine, maybe that is just something that I shouldn't do. Maybe I 
will do something else with my life, because that is a little iffy, and 
I don't really know if I will be able to afford the liability insurance 
to go into practice.
  So we have got to do something to help young people understand that 
we value, we value their service in becoming a physician or becoming a 
nurse, that this is something that we in Congress encourage them to do 
and want them to do. But right now I have got to tell you they look at 
it and say, I don't know if that is for me.
  One of the other things, and this has come up just in the last two 
weeks here in Congress, is we kind of worked with this concept of what 
are we going to do to make things right for the doctors before we get 
to the end of the year. Along comes this bill to require physicians to 
begin e-prescribing. Well, that is a good concept. Certainly, no one 
wants to argue with the theory. But it reminds me of an old professor I 
had in undergraduate school. When he was asked a question too tough for 
him to answer, he would look you back in the eye and say, Do you want 
the theory or the application?
  This is one of those instances where the theory is pretty good but 
the application, at least as has been discussed in the last two weeks, 
the technical term for it would be it stinks, Mr. Speaker, because we 
want physicians, we want them to come into the 21st century, we want 
them to use electronic medical records and things like e-prescribing.
  Any one of us can cite chapter and verse all of the good things that 
will come from e-prescribing; yet the number one group that we have got 
to get to buy into this concept, well, we don't treat them very well 
when we come at them with legislation, as the legislation that was 
brought out a couple of weeks ago over on the Senate side, but it's 
also been talked about over here on the House side, the so-called 
carrot-and-stick approach. We'll give you a little something nice now 
if you do it and, by golly, we are going to make you pay in a couple of 
years. The carrot-and-stick concept in this case really is more like, I 
don't know what vegetable I would associate with it, probably something 
more along the lines of spinach, or if we're talking about the first 
President Bush, perhaps broccoli. But the other end, the stick, is 
extremely onerous for physicians who are in practice.
  Let me just give you the very quick version of what this legislation, 
as provided to us, would entail. For doctors who participate in the 
Medicare system, we are so anxious for them to prescribe in the e-
prescribing regimen, we are going to generously provide them an 
additional 1 percent, a 1 percent upgrade on what we provide in 
Medicare compensation.
  Well, Mr. Speaker, I don't remember exactly what I received for a 
moderately complex patient return visit. I am going to wage it was not 
as much as $50. But let's stipulate, because the math is easy, let's 
stipulate that that is a $50 reimbursement rate from the Medicare 
system. And a good physician who is practicing careful medicine and 
doing all the right things they are supposed to do as far as history 
taking, good careful physical exam, patient education after coming to a 
diagnosis and a treatment plan, you can probably see that patient in 15 
minutes. So four an hour are what we are talking about, and we are 
talking about a physician generating, not making, but generating $200 
in income for that hour they spend in their office seeing those four 
moderately complex return visit Medicare patients for which the Federal 
Government pays them the generous sum of $50.
  Now, if we add a 1 percent update to that, let's see, each patient, 
that is about 50 cents. So for that hour's work we are going to add $2 
to the compensation for that physician.
  E-prescribing takes a little time. It takes some investment. It takes 
some time to learn. It is not something you can just pick up. It is 
quicker to scribble down a handwritten note. Now, no one may be able to 
read it, but nevertheless you have performed that record-keeping 
requirement, and it is much quicker to scribble down that handwritten 
note in the treatment plan and write out a prescription and rip it off 
and hand it to the patient.
  The reality is e-prescribing takes some time. It adds time to that 
patient encounter. It is time that realistically someone should 
compensate that provider for providing. That would be a fair 
assessment.
  Now, what do we do if, after three or four years' time, the doctors 
just haven't cottoned to this idea that we are going to pay them an 
extra 50 cents per patient on average to do this work for us? Well, 
then we come in with the stick phenomenon, and that will be a 10 
percent reduction on that patient's services. So here we have gone from 
a $2 increase for those four patients for that hour's work, or, perhaps 
if the doctor hasn't done it, then that will be a $20 fine for those 
patients for that hour's work.
  Once again, our physician community is going to look at that and say, 
No, thank you. I don't think I will participate in that. You can keep 
your Medicare patients and you can keep your e-prescribing and I will 
go off and do something else, and the patient is the one that suffers.
  But it is a good concept. It is a good concept, and it is worthy of 
Congress spending the time, and it is worthy of Congress providing the 
proper compensation for physicians who are willing to invest in this 
technology.
  Right now, the bill as rolled out would provide $2,000 to buy the 
equipment. It probably costs $25,000 in reality. Even if you gave it to 
a physician's practice free, there is still going to be ongoing costs 
of the maintenance of the software, the ongoing costs of educating the 
physicians in that particular practice, and it takes longer to fill out 
that electronic medical record and to fill out that form for e-
prescribing than what the doctors historically are used to in an old 
paper system. But we have decided that is not a value and we are not 
going to pay for that.
  Now, some people think that this is such a good idea because they 
are, in fact, going to make a significant amount of money. Certainly 
the people that sell the software are likely to make a significant 
amount of money. Certainly the pharmacy benefit managers, the big 
pharmaceutical mail-order houses, they are likely to reap some benefits 
from this.
  But for whatever reason, all of this good stuff that is going to come 
from e-prescribing, no one is really thinking that it is worthwhile to 
share that with the physician. But the physician is the one we want to 
buy into this new system. And it is a new system. It is a new way of 
learning and it is a new way doing things.
  Now, indeed, if nothing happens, younger physicians, as they go 
through their training, they will be exposed more and more to 
electronic prescribing and electronic medical records. There will come 
a time in

[[Page 36015]]

probably the not-too-distant future where this evolution will just take 
place on its own. But the bill that was rolled out a couple of weeks 
ago was an effort to make it happen a little faster, to get some of 
those good benefits from e-prescribing, and they are significant, to 
get some of those good benefits out there and established early.
  Again, it is going to make a significant amount of money for some 
people who will be involved in this. But again, for whatever reason, 
the Federal Government does not see value in allowing the practitioner, 
the physician, to participate in that distribution of all of that value 
that we are going to derive from this system.
  Now, I don't mean to give the impression that I don't believe in e-
prescribing and electronic medical records. Let me just go with one 
last poster, Mr. Speaker, and then we will wrap this up for tonight.
  I haven't always been a big believer in electronic medical records. 
Again, I have tried a couple of different systems in my time in private 
practice and I didn't find them all that intuitive or user friendly, 
but this is the day I became a believer in electronic medical records.
  This is the basement of Charity Hospital in New Orleans. Charity 
Hospital, one of the venerable teaching institutions in this country. 
Many of the professors I had at Parkland Hospital in the 1970s actually 
did their training in this very building at Charity Hospital.
  Charity Hospital in 2005, August of 2005, was ground zero for the 
strongest hurricane probably to ever hit the continental United States 
in anyone's memory. And the flooding that followed that hurricane 
obviously dealt a severe blow to infrastructure all over the City of 
New Orleans, and the basement of Charity Hospital was, in fact, 
underwater for a significant amount of time. So all of these records 
were submerged.
  This photograph was taken in probably October of 2005. So 2 months 
after the hurricane, a month, maybe 5 weeks after the city was 
dewatered, that is a verb I learned from the United States Corps of 
Engineers, I didn't know it was a verb before they used it, but the 
city was dewatered.
  Here the medical records sit. Now we have black mold growing on the 
manila folders. Probably the ink on many of these records was actually 
just washed off in the flooding. Who knows? It wouldn't be safe to have 
anyone go in there and look at those records, because look the at the 
mold spoors that are ready to be blown off in a big cloud waiting to be 
inhaled by a pair of unsuspecting lungs and cause great damage.

                              {time}  2245

  So these medical records are in fact lost forever. And who knows what 
is in there, someone waiting for a kidney transplant, someone's 
hypertension that has been under treatment for two decades; someone's 
diabetes that was carefully monitored but not so much anymore. All of 
these records have been lost forever.
  Electronic medical records and medical records that are then 
controlled in an electronic fashion in a secure fashion up on the 
Internet where they can be accessed, all of these patients that had to 
leave the city. Many came to the Metroplex area in north Texas, and 
many of them were cared for by physicians at Parkland Hospital, John 
Peter Smith Hospital, and private physicians in the area. None of their 
medical records were available, and many of these patients had very 
complex medical conditions and were on multiple medications at the 
time. And if it had not been for the good graces for some of the 
pharmacies that actually had patient records electronically that were 
able to set up outside some of the triage centers to provide that data 
to physicians who agreed to see these patients as they came off of the 
transportation from New Orleans and arrived in Dallas, you can 
construct a pretty good medical history just going to the 
pharmaceutical history, and those pharmacy records were invaluable in 
providing good care and immediate care to those patients.
  But it certainly made a believer out of me in January, or when this 
picture was made after the flooding in New Orleans that paper records 
have inherently within them a fundamental flaw, and that is, in time of 
great natural disaster they are not going to be there to provide useful 
information for those patients if they are suddenly displaced, as these 
patients were, the medical records themselves. They could have been 
destroyed in a fire, they could have been damaged in an earthquake in 
some other parts of the country. And, unfortunately, these types of 
tragedies do happen, and electronic medical records does take some 
aspect of that tragedy away because it does provide a way for that 
record to be accessed in a different location, and all of that data can 
be pulled off the Internet and be made available to the now receiving 
physician who is treating that patient.
  Mr. Speaker, a little preventive medicine would go a long way in this 
entire Medicare policy debate. I just can't help but note the irony: 
November 1, when the Center for Medicare and Medicaid Services came out 
and said, Doctor, 10.1 percent cut, unless Congress does something 
before the end of the year. About that same time, the conference Chair 
on the majority side had an op-ed in The Washington Post that said, you 
know what, we have done such a good job with providing government 
health care and Medicare and we are doing a great job now with what we 
are doing in SCHIP. We know how that has turned out so far. We want to 
extend Medicare benefits to people who are down to the age of 55. We 
want to drag and drop this population into what is happening in the 
Medicare policies right now.
  I would just argue, before we expand the program to that degree, 
shouldn't we ask ourselves are we doing a good job with what we have 
right now.
  I think the mere fact that we are here at the 11th hour of this 
Congress and we have not dealt with the problem of physician 
compensation, doctors' offices across the country are looking at 
Congress and saying, what gives, guys? How am I going to prepare for 
next year? Do I hire that new doctor or not? Do I buy that piece of 
medical equipment or not? Do I take out a loan to improve my office or 
not? Because they don't have any certitude about what the activity of 
this body is going to be. And even at the best, the best we can do at 
this point is say we are going to punt for 6 months, and we will see 
you in June.
  Mr. Speaker, that is not acceptable. This Congress has an obligation 
to this country's physicians to behave in a responsible way. And 
certainly, certainly let's quell the talk of expanding the reach and 
grasp of the Federal Government until we take care of what we already 
have.
  Mr. Speaker, I yield back the balance of my time.

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