[Congressional Record (Bound Edition), Volume 154 (2008), Part 8]
[House]
[Pages 11070-11076]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  THE STATE OF HEALTH CARE IN AMERICA

  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. Mr. Speaker, I came to the floor of the House tonight to 
talk, as I frequently do, about the state of health care in this 
country and some things that may be on the cusp of change and some 
things that will never change. But I want to start off tonight by 
talking about what is going to happen to physicians across this country 
on July 1st, less than a month from now, as far as their Medicare 
reimbursements.
  Now, you may recall I was on the floor of the House last December 
talking about the need for addressing the reduction of reimbursement 
rates for physicians across the country. The best we could come up with 
on the floor of this House was to stall that 10.7 percent reduction in 
reimbursement for Medicare patients. The best we could come up with was 
to stall that for 6 months' time. We told ourselves at the time that 
this gives us a little more time that we can work on a solution that is 
more meaningful. We want to work on a bigger and grander solution.
  But, Mr. Speaker, what has happened? The days and months have ticked 
by, and now we are less than 4 weeks away from that day when physicians 
will wake up and find that their reimbursement for seeing a Medicare 
patient is now 10.9 percent less than it was the day before.
  Is this really a big deal? Well, yeah, it is a big deal, because 
everywhere across the country currently new Medicare patients call up 
physicians' offices trying to be seen and they find the same situation 
over and over again. They can barely get the word ``Medicare'' out of 
their mouths before they are told by that physician's office that we 
are not taking any new Medicare patients. And why? Why is that 
happening? Because of the activities, or, in this case, the inactivity 
of the United States Congress, of the United States House of 
Representatives.
  It is imperative, it is imperative that we address this issue. It is 
imperative that we address it in a forward-thinking way so that we 
solve the problem once and for all and we don't have to come back here 
year after year and face the same problem over and over again, or, as 
is the case this year, every 6 months and face the problem over and 
over again.
  I have advocated for such a fix many different times on the floor of 
this House. It has been very difficult to get colleagues on both sides 
of the aisle to embrace this concept and understand that we must move 
forward from where we are now. We need a short-term, midterm and long-
term solution to this problem.
  What have we done? Again, we find ourselves just about to go over the 
cliff, just about to fall over the precipice, where once again we tell 
the Medicare patients of this country that we don't care about them. We 
tell the physicians who are seeing Medicare patients in this country 
that we don't value your service and we are going to hit you with a 
10.7 percent cut. And that is not the end of it. December 31st, there 
will be another 5 percent reduction, so a grand total of 15 percent in 
reduction of Medicare reimbursement before we reach the end of this 
year.
  Mr. Speaker, can you imagine any other business going into their 
banker and saying, you know what? I have got a great business plan 
here. I am going to start a business, or expand my business, because, 
after all, a physician's office is a small business. I am going to go 
into business or expand my business, and here is my business plan. And 
the banker looks at it and says, I see it says here you are going to 
earn 15 percent less this year than you are earning next year on each 
patient interaction. How in the world could you expect to be able to 
maintain your business with this type of business plan?

                              {time}  2045

  Reality is this type of business plan would not fly anywhere in this 
country, and yet we are asking over and over again our doctors, our 
clinics, our health care providers to live under this regimen.
  Now, when I address the need for a short-term, mid-term, and long-
term solution, let me just lay out for you what I have in mind. The 
short-term solution is available to us right now. We could delay these 
cuts to the Medicare reimbursement rate. We could do that by passage of 
a simple measure that was introduced the last week of May, H.R. 6129. 
This is a bill that is fully paid for, fully paid for and would 
forestall the 10.7 percent cut July 1, and the 5 percent cut December 
31, to February 1. That is not a great length of time, but it allows us 
a little more time to work on this problem, actually gets us past the 
first of the year so that we get to the organization of a new Congress. 
And maybe, if we did our homework and did our legislative work before 
we all went home and campaigned for reelection, maybe if we did that 
work in July and August and September of this year, we could actually 
have ready to go a package for the new Congress to pass shortly after 
the first of the year that would deal with this problem.
  But it is a paid for solution. It doesn't expand the deficit. It 
actually uses the same mechanism that was used by the Medicaid 
moratorium that we all passed. I think there were 300 favorable votes 
for that Medicaid moratorium on the floor of the House a few weeks ago. 
This is the same mechanism of taking the money out of the physicians 
assistance quality initiative to pay for this fix on the physicians 
payment. It would not expand the deficit, and it would get us passed 
the first of the year.
  The cuts that are looming ahead of us under a formula called the 
sustainable growth rate formula are going to be significantly 
pernicious, not just to keep our doctors in business, but to keep our 
doctors seeing our patients, our Medicaid patients, arguably some of 
the most complex patients there will be in any medical practice because 
they have multiple simultaneous conditions.
  We are going to prevent those patients from having access to a 
physician because we are telling the doctors that we don't value their 
service, and we are telling the patients that we don't value their 
ability to have access to their doctors who prescribe their treatments, 
who offer those treatments that are going to keep them living longer 
and healthier lives.
  And there is an unintended consequence to this as well. The 
unintended consequence is that many of the private insurance companies 
across the country actually peg their rates to what Medicare 
reimburses. So they have a contract that says we will pay, in the case 
of TRICARE, 85 percent of the Medicare usual and customary. In the case 
of some of the other private insurers, it is a little more generous, 
they pay 110 percent or 115 percent of Medicare rates. But all of those 
rates are going to be reduced when Medicare rates in turn are reduced 
if we don't act by the first of July. And actually, the way things work 
in Washington, if we don't have something pretty concrete on the table 
by the middle of June, the Center for Medicare and Medicaid Services is 
going to be required to go ahead and put forward their rules and 
regulations for when this new fee schedule goes into effect July 1.
  And make no mistake about it. We can tell ourselves that, oh, we will 
have time to come back in July and fix this and we will make it 
retroactive. But we don't make it retroactive for the private insurers 
who peg to Medicare. And the reality is we are talking about such small 
volumes on every explanation of benefits that comes through the 
physician's office that it becomes extremely tedious and time consuming 
and expensive to track all of these and make certain that the 
government makes good on its promise and comes back and delivers that.
  And how do I know this? I know this because when our side was in 
charge with the passage of the Deficit Reduction Act right at the end 
of 2005, because of a technical problem we didn't get actually the bill 
passed until the first part of January of 2006, and as a consequence 
the language in the Deficit Reduction Act that would have

[[Page 11071]]

prevented a programmed reduction in Medicare reimbursement rates, that 
did not go into effect until well into the month of January 2006. And, 
again, we had to come back and retroactively make all of these 
practices whole. And just as a practical matter it becomes very, very 
difficult for the doctor's office to keep track of that and make 
certain that in fact those reimbursements were brought up to speed.
  The other aspect of this, the mid-term and the long-term aspect, and 
I have advocated for this for some time. We need to pass legislation 
that will put us on a path to repeal the sustainable growth rate 
formula. This is a formula that year over year reduces the rate at 
which physicians are reimbursed. The reality is Congress almost never 
sees that through. We always come in and do something to keep our 
doctors from having to sustain those large cuts in their practice. But 
every year we come up against this precipice, we come up against this 
cliff, and every year the doctors' offices are having to make plans for 
their future. Do they buy new equipment? Do they hire a new partner? Do 
they bring on additional personnel? Well, they can't tell because they 
don't know what we are going to do to them in Medicare at the end of 
the year or, in this case, in the middle of the year.
  So we need a method of repealing the sustainable growth rate formula. 
We have all discussed this. The cost associated with the repeal of that 
from the Congressional Budget Office is high. So what I have 
recommended in the past is we put ourselves on a path; we put ourselves 
on a trajectory to repeal this formula, do it over a couple year's 
time, get some savings in the meantime to offset that cost. And we all 
know that those savings are built into the system and they are accruing 
every day. But rather than having those savings go to part A of 
Medicare, let's hold them in part B and reduce the cost of repealing 
the sustainable growth rate formula. And then ultimately, in 2 years' 
time or so, repeal the SGR formula once and for all and put the 
Nation's physicians on what is called the Medicare Economic Index.
  This is not a formula that I derived; it was created by the Medicare 
Payment Advisory Commission, the MedPAC Commission several years ago, 
and it is essentially a cost of living adjustment, the same cost of 
living adjustment that hospitals receive, the same update that 
insurance companies receive, the same update that drug companies 
receive. Let's put part B, the physician's part of Medicare, on that 
same level playing field with the other participants in part A, part C, 
and part D of Medicare.
  So I did want to get that out there. I encourage my colleagues to 
look at H.R. 6129. This is an important piece of legislation. It is a 
rope to throw to the Nation's physicians and patients that are already 
on their way over the cliff. It is a cliff that we created for them. We 
gave them the push over the edge. The least we can do at this point is 
to offer them a little bit of help so that they don't come crashing 
down at the bottom of that cliff.
  Now, the reality is this is only for 7 months' time. This does not 
take any of the heat off of any of us, that we still need to work on 
that long-term solution. I actually offered this particular bill as an 
amendment to the Medicaid moratorium a few weeks ago in committee, and 
I was told, oh, no, no, no, we can't do that; because if we do that, 
then the people who might be working on solving this problem will know 
that the pressure is off and they don't have to work on it. I beg to 
differ. The pressure will still be on. The mid-term and long-term 
solutions still are out there to be had, and it will be incumbent upon 
this Congress, particularly here we are going into an election year, Do 
you want to go home and talk to your doctor groups around in your 
district and say: You know what? We just didn't think we had the time 
to fix this problem that you all are up against, so shortly after I am 
sworn in next year you will be looking at a 15 percent reduction in 
your payment rates. And, do you really want to go home and talk to your 
patients, who already call up their physician's office and say, I am 
sorry, I am not taking any new Medicare patients; do you really want to 
go home and face those patients in your town halls when they find out 
that you didn't lift a finger, you didn't lift a finger to keep this 
from happening when we all knew it was coming? We knew it was coming 
last December, and the best we could do was 6 months is the best we can 
manage. We knew it was coming all spring. We know it is coming now.
  Let's fix this. This short-term solution is paid for. It is not going 
to expand the deficit. No tax increase has to result. It is there. The 
money is there. We took the money from the same place that the other 
side took the money for the Medicaid moratorium. Let's take that money 
and fix this problem short term, and then get on about fixing it long 
term.
  Mr. Speaker, the real reason I came to floor tonight until this other 
problem took precedence was to talk a little bit about an event we had 
up here on Capitol Hill about 2 months ago now, and it was done to 
capture some of the successes that are happening out there in the real 
world as far as it relates to delivery of health care in this country. 
This was a symposium that was held on April 8 of this year, was done in 
conjunction with the Center for Health Transformation. Many people will 
recognize that organization. This is the organization that was founded 
and is still run by the former Speaker of the House, Newt Gingrich. He 
was very kind and generous with his time that day and came to this 
meeting over in the Rayburn Building, and we talked a little bit about 
some of the things that are working out there in the real world. 
Because, after all, Mr. Speaker, do we really want to give up a measure 
of our freedom in this country? And that is what it would entail if we 
go to a much more restrictive type of delivery of health care in this 
country.
  Freedom is the foundation of life in America, and unlimited options, 
unlimited opportunities are something every single one of us on both 
sides of the aisle takes for granted and will embrace when we give our 
talks at home, whether it be on Memorial Day or Independence Day. We 
like to talk about how the freedom of America makes us the greatest 
country on earth.
  Freedom is transformative. Freedom is the basis for what we should be 
doing when we look at how we can transform the Nation's health care 
system. And innovation goes hand in hand with those choices.
  Come to think of it, Mr. Speaker, when I was a youngster in medical 
school many, many years ago, I would have never thought we would have 
seen the day where you could go on the Internet, just an average 
person, you don't need a doctor's order, you don't need a ton of money; 
you can go on the Internet and get your human genome sequenced for you 
individually for less than $1,000. Never when I was in medical school 
would I have thought you would be able to go on the Internet and get 
such information. In fact, I wouldn't have known what the Internet was 
when I was medical school because Al Gore hadn't invented it then. At 
the same time, today you can go and get that information. We are 
putting that information in the hands of patients, which then they are 
going and sharing with their physicians. And this is powerful 
information for the individual to have.
  The New York Times in October of 2006 published a piece by Tyler 
Cohen when he talked about the ability to innovate and how it has made 
American medicine really the envy of the world. Seventeen of the last 
25 Nobel Prizes have gone to American scientists working in American 
labs, and four of the six most important breakthroughs in the last 25 
years have occurred because of the research of American scientists, 
things like the CAT scan, coronary artery bypass, statins for reduction 
of cholesterol. In fact, the National Institutes of Health will tell 
you statistics that 800,000 premature deaths from heart disease have 
been prevented in the last 25 years because of innovation that has in 
part been developed by the National Institutes of Health and then part 
developed by the private sector in this country.
  So it is truly a good news story, and the reality is America is not 
done. We

[[Page 11072]]

are not done with the advancements in medicine. The next generation of 
breakthroughs, I already alluded to what is happening with the human 
genome. Look at the speed with which information is now processed and 
transferred and disseminated. Who would have ever thought that we would 
be in this phase of rapid learning in which we find ourselves 
currently. This is truly likely to be the golden age of medical 
discovery. And the breakthroughs that occur have been a result of the 
environment that has fostered and encouraged competition and choice.
  It doesn't mean we can't make a good thing better. It doesn't mean 
that everything about our system is perfect. But certainly, when we 
look at ways in which we might change the system, for heaven's sake, 
let's not do things that will harm the innovation that our system has 
brought us. American ingenuity prospers when we strive to be 
transformational. The reason we can be transformational is because of 
the degree of freedom we have. Remember, freedom is transformational.
  So when we are advancing toward a goal and we are not focused on the 
transaction like we do with our Medicare reimbursement; when we are 
focused on the goal of being transformational, that is when good things 
can happen. But the present debate in Washington is focused on dollars 
and cents, and we are not focused on the transformational. We are not 
even looking at ways where we can fundamentally enhance the interaction 
that occurs between the doctor and the patient in the treatment room. 
We are simply looking at ways of moving dollars around on a balance 
sheet, and we do that and we think we have done a good job. And, again, 
I reference what has happened with the Medicare physician reimbursement 
rates that are going to go down so much in just a few weeks.
  Mr. Speaker, I am one of the few policymakers on Capitol Hill that 
has also spent a lifetime in health care. For 25 years before I came to 
Congress, I had my own practice. I have sat in exam rooms with 
patients, I have looked them in the eye, I have taken a prescription 
for them and counseled them as to risks and benefits and costs and 
written a prescription. I figured out how to build my business, how to 
expand my business. I figured out how to build my business in lean 
economic times back in the 1980s in Texas. I figured out how to expand 
my business in good economic times in the 1990s in Texas. I figured out 
ways to pay my employees and keep the lights on. But, again, if we 
don't have a commonsense approach to these health care issues, our 
solutions are going to be far short of the mark.
  This experience gives me the practical knowledge to play some role in 
the development of this policy.

                              {time}  2100

  I think this comes in handy because, as we change health care in this 
country, we want to be certain that we do it in a way that allows 
health care to still be delivered in this country.
  And there's widespread recognition that things need to change. 
There's different ideas as to how to accomplish it. The good news is 
that, regardless of what happens tonight, there is going to be a 
fundamental referendum on health care in this country come November, 
because whoever prevails on the Democratic side, of course Senator 
McCain on the Republican side, the views are distinct from each other, 
and it is going to give the American people a clear choice about the 
direction to go in health care. One is focused on more government 
control, and one is focused on more patient control. I'll give you a 
guess as to which side that I would come down on.
  And again, policymakers are focused on change, and the people who 
care for patients, the people who are involved in their practices, they 
need to be involved in this discussion as well because, in truth, 
health care begins and ends partly with patients, but truly with the 
people who are involved in the delivery of that health care, and 
specifically I reference physicians and nurses, hospital administrators 
and other health care personnel will figure into that equation. But 
those are the individuals who have to be involved in this grand 
national debate we're going to have about health care transformation in 
this country over the next 5 months.
  And many of my friends who are health care professionals don't 
realize the critical role that they must play in shaping the health 
care debate. They must be active, they must be engaged, or otherwise 
you're going to be forced to sit on the sidelines and play by the rules 
that other people are going to make for you.
  And again, I reference the earlier part of my discussion. You see, 
the rules that we'll come up with here in Washington, DC , those rules 
are, let's take 10.7 percent away from our doctors this month, and in 6 
months let's take another 5 percent away from them, and then we'll 
figure something out in the meantime.
  Well, I will just tell my friends who are involved with the delivery 
of health care, whether it's in Washington, whether it's at home in 
Texas, you need to be involved. You've got to act before all you can do 
is react. And if health care professionals don't lead, then we'll have 
to accept what the health care prescription is that is given to us by 
the people who sit in this body, the people who sit on the other side 
of the Capitol, whoever sits in the White House.
  It doesn't make sense to have a body that is what, two-thirds 
lawyers, making all of the decisions about how the doctors are going to 
practice in this country.
  One of the possible prescriptions that's out there, one of the things 
that I find very problematic is expanding the government role for 
health care.
  Mr. Speaker, if I were to pose a hypothetical question, what is the 
largest single payer government health care system in the world? Well, 
you know what? It's right here in the United States of America. Our 
Medicare and Medicaid and all of the other systems that are involved 
and administered by the Department of Health and Human Services 
accounts for pretty much 50 cents out of every health care dollar that 
is spent in this country. That means 50 cents out of every health care 
dollar that's spent in this country originates right here on the floor 
of the House of Representatives. And I would just ask you, are we doing 
such a great job?
  I reference my earlier remarks about what's happening to the Medicare 
system if we don't do something within the next 4 weeks. Are we doing a 
great job with what we control currently?
  Now, the government can play a role by encouraging coverage and maybe 
help incentivizing and encouraging the creation of programs that people 
actually want. Rather than forcing them into a government-prescribed 
program, what if we build something that actually brings value to 
people's lives and offer that as an alternative as we try to expand 
access to health care and health care coverage in this country.
  And the good news is we actually have a model within the very recent 
past that has worked, and worked very well, and that is the Medicare 
Part D program which began in this Congress my first year here in 2003, 
and rolled out on January 1, 2006. And as a consequence, now, 90 
percent of the seniors in this country have some type of coverage for 
their prescriptions. Contrast that to when I took office and that 
number was somewhat below 60 percent. So that has been a good thing. It 
has moved in a positive direction.
  Well, what do people think about this program that has now been in 
effect for a couple of years? Well, current polling shows about a 90 
percent satisfaction rate with Medicare Part D. So that's a good news 
story. We've got 90 percent of the people covered. We've got 90 percent 
positive ratings with various polls.
  Well, what about the cost? We heard a lot about the cost on the floor 
of this House as we debated that bill and in the aftermath after that 
bill was passed, but the reality is when we passed that bill in the 
House, the Center for Medicare and Medicaid Services projected the cost 
per enrollee per month to be about $37.50. The reality is, the cost 
currently is about $24.50, and it has been stable over the time that 
this program has been in effect.

[[Page 11073]]

  So here's a Federal program that, yeah, it has been a joint public/
private partnership, but 90 percent coverage, 90 percent acceptance 
rate, and came in at a cost two-thirds of what was originally 
projected. I would say, from the limited time I've had here in 
Washington, that's the definition of a success story with a Federal 
program.
  So 29 people are enrolled as of 2007, and the average cost is less 
than $24 a month. The first Federal program to rein runaway medical 
spending by restoring savings incentives and leveraging the power of 
that public private competition.
  So overall, some of the best things that government can do is, when 
they recognize that there's a problem in say the delivery of health 
care or even in arenas such as health care information technology, we 
can kind of set the stage and tell people what our expectations are, 
and then get out of the way. Don't put a lot of regulation. Don't put 
new causes for liability out there. Get out of the way, and let the 
private sector do what they do best, what they do every day of the 
week. If we can do that by creating the right environment to let the 
private sector deliver the kind of innovation, the kind of cost savings 
and the type of quality that realistically has been delivered to other 
industries over and over and over again, if we can do that then maybe 
we have done something worthwhile.
  You know, these are the same market forces that took us from a single 
black rotary telephone to these fancy electronic devices that all of us 
carry with us 24 hours a day now. We cannot imagine being without our 
iPods and iPhones and BlackBerrys. But it wasn't too many years ago, in 
fact, the year I started in private practice where it was a single line 
black rotary telephone, and we thought it was the height of high 
technology when we got those little push buttons on our phone.
  Look at the change that's happened in aviation in literally what has 
been now the first century of aviation, going from the type of plane 
that the Wright brothers flew to the Boeing 787 dream liner that is 
coming on-line now. We have seen fantastic change.
  I already mentioned the inventor of the Internet, and in the short 
period of time, we've come to the age that's brought us things like 
iTunes and YouTube, things that most of us now would find 
indispensable. If someone said we're going to take this away from you, 
we'd say that's not a good idea. We'd rather the government wouldn't do 
that.
  But here's the secret. Here's the deal. The free market is delivering 
this same kind of value every day, day in, day out. Innovation and 
efficiency are hallmarks of what they're able to do. So why not? Why 
not allow them to participate in this grand plan that we call 
transformation of the Nation's health care system?
  I've experienced it, and I'm excited about experiencing more of it 
and learning more about it, both as a legislator and as a professional 
in medicine.
  But I just have to tell you, this past fall, Health Affairs did a 
symposium in downtown Washington, and I went to that symposium. I 
largely went because Dr. Mark McClellan was going to talk about his 
experiences with the Medicare program, Medicare Part D Program. Dr. 
Elias Zerhouni was going to talk about his experience with the National 
Institute of Health. But I had really no intention of sitting and 
listening to Ron Williams talk about--the new CEO of Aetna talk about 
what was happening within Aetna because I thought, well, Aetna's one of 
those private insurers who really, as a provider, we've oftentimes been 
at odds. But I listened to Dr. Zerhouni and I listened to Dr. 
McClellan. But it was Ron Williams who really talked about the biggest 
changes that are coming in medicine, particularly in the arena of 
health information technology, and the things that he was talking about 
were truly transformative.
  So my question to him later was to ask why is--what would you 
require, what is the environment that you require to be able to do 
these great things that you're talking about? And he outlined perhaps a 
program where there would be some certainty as to what the privacy 
regulations are.
  We all talk about privacy in this body. We're going to have a hearing 
about it tomorrow. But does anybody really understand what we mean when 
we say we want some privacy provisions? What about the STAR clause that 
prevents a hospital from putting a computer line in a doctor's office? 
Is that really a good idea as we go forward with wanting to develop 
more and better situations where we can have advancement in health 
information technology? Is that truly such a good idea?
  Maybe we would do better if we relaxed some of the regulations, if we 
provided some certainty in the areas of liability, provided some 
certainty in the area in the definition of things like privacy, maybe 
that would be a better way to go about it.
  During that discussion with the CEO of a large insurance company, he 
talked about things, about the different algorithms they've developed 
purely from using financial data, no clinical data involved, but the 
types of anticipation that they could now have about very expensive 
diseases that they might have to pay for and the clues they could get 
very early on in the process of this, and how they might be able to 
moderate or modify activities so that they didn't have to pay for that 
very expensive care at the end stage of the disease, they could 
actually work on that at an earlier stage and not only prevent the 
large expenditure for the more expensive disease, but also improve the 
quality of life because, after all, we're increasing the amount of time 
that a person has in a state of relative good health.
  Another company that I talked to recently talked about a new test 
they're going to have for a disease called preeclampsia, pregnancy-
induced hypertension. When I was in practice, and even just a few years 
ago, if you saw a patient where you were worried that this might be 
happening, about the only option you have was to put the patient in the 
hospital and observe them over time and see whether this was a real 
phenomenon or just a one-time event. But the price you paid for being 
wrong was severe, and certainly could result in severe injury to the 
patient and/or her baby. So we always erred on the side of caution with 
that.
  But now there may be a new blood test that will elucidate very 
quickly whether someone is truly at risk for this problem, or if 
perhaps this one indication of elevated blood pressure was just an 
outlier, and, in fact, they aren't truly at risk for this problem. This 
would be a tremendous tool to put in the hands of clinicians. And look 
at the savings, not just in eliminating some of the unnecessary 
hospitalizations, but making certain that the people who really need 
the intensive care get that intensive care and get the intensive 
observation and scrutiny that their particular situation demands.
  And a recent study out of Dartmouth outlined how hospitals can 
deliver better care and do a better job at a lower cost by embracing 
some measures of efficiency. This study demonstrated that Medicare 
could save as much as $10 billion a year if all United States hospitals 
followed the example of the most efficient hospitals. These facilities 
didn't cut costs at the expense of patient care, but focused on better 
coordination of care and better avenues of communication between 
doctors and specialists and better avenues of communications between 
hospitals.
  Now, again, earlier in the month of April I was fortunate to co-host 
a panel with former Speaker Newt Gingrich which focused on some of the 
real world examples of success in health care transformation. And Mr. 
Speaker, I'll just tell you, it's no secret to people in this body that 
former Speaker Gingrich is a real leader when it comes to leading the 
charge for change in the arena of health care. He's involved in a great 
many other things, but certainly, in the arena of change in health 
care, former Speaker Gingrich has really pushed this to the forefront, 
and has really--I am so grateful for his involvement in that, and his 
bringing new ideas and new people to the table on a constant basis that 
help us, are going to help us evolve into this system that we all would 
like to think that we can help deliver to our country.

[[Page 11074]]

  Now, he brought in several companies that demonstrated how free 
market choice and competition can lead to more options at a lower cost, 
when it comes to health care. And let me just share a little bit about 
what we learned that day. Since there weren't many Members who were 
able to attend, let's talk a little bit about some of the companies 
that are relying on innovation to save lives and save money and to 
actually save time in the process.
  Overall, there was agreement that we can get better results with 
what--we don't have to pay more money. With the money that we're paying 
right now, we can get better results by actually engaging patients in 
their own care. And you know, this goes back to what Dr. Zerhouni has 
talked about at the National Institute of Health.
  Because of what we've learned about the human genome, medical care is 
going to be personalized to a level that no one ever thought about 
before. You're going to be able to know, no longer will it be a course, 
a question of, well, we're going to try this particular medication 
because we'll see how it works. If it doesn't work, we've got an 
alternate.

                              {time}  2115

  You will actually know that beforehand because of knowing about a 
person's genetic makeup. So medicine will become a great deal more 
personalized.
  Because of that, it's going to be also, it's going to be, of 
necessity, focused on prevention. We know what diseases you're at risk 
for so we're going to recognize that and focus on the preventive 
aspects of that. And as a consequence, it has to become more 
participatory. That is, the patient can no longer simply be a passive 
recipient of health care services and the expense of health care 
doctors. The patients themselves need to be involved in the maintenance 
of their health and the decisions surrounding the delivery of health 
care.
  Now, in industry circles, this is what is known as consumer-directed 
health care, consumer-driven health care. The goal of consumer-directed 
health care is to kind of eliminate the middleman, in our case the 
government, or it could be the insurer in the private sector who tries 
to find their way in as a wedge.
  Remember I talked about that fundamental interaction between the 
doctor and patient in the treatment room? What of the barriers to 
enhancing that relationship? Well, it can be the government, it could 
even be a private insurance company. If we can somehow remove the 
middleman, number one, the patient will not be so insensitive, so 
anesthetized as to the cost of their care; and they will be more in 
tune to the benefits that can accrue to them should they work harder on 
participating in their own health care.
  If people are anesthetized, Mr. Speaker, they're anesthetized to the 
true cost of health care. All they want to know is when and if they can 
see their doctor and what their co-pay will be and if you order 
expensive tests, like a CAT scan or an MRI, the only question is is it 
covered; not is it necessary, is it truly something I need, how is this 
truly going to benefit my care in the future. It's, well, will 
insurance pay for it, and if it does, do I have to pay a co-pay.
  Now, I know from personal experience, and certainly my staff has told 
me this as well, you know, you receive one of those forms. It's called 
an EOB, explanation of benefits. You receive one of those from the 
insurance companies. Most people toss it. It's so confusing. It really 
has no bearing on reality anyway. It doesn't have anything to do with 
the ultimate cost or the ultimate bill that was paid either by the 
insurance company or the individual so most people just simply pay no 
attention to that; and yet this is the one piece of paper that actually 
tells the patient what it costs to deliver the care that they have just 
received.
  So that means they're consuming health care services but they're not 
conscious of the costs. So there's little incentive on their part to 
modify their behavior to do things better next time, to be active 
participants in their own health care.
  So consumer-directed health care says if people aren't anesthetized, 
if people are fully awake and fully conscious, they're more likely to 
make sound and wise decisions about their lifestyle and about 
maintaining their own health.
  Now, there was a McKenzie study that found that consumer-directed 
health care patients were twice as likely as patients in traditional 
plans to ask about costs and three times as likely to choose a less 
expensive treatment option, and chronic patients were 20 percent more 
likely to follow their outlined regimen very carefully.
  Now critics argue that consumer-directed health care will cause 
consumers, particularly those who might be less wealthy or less well-
educated, to avoid appropriate and needed health care because of the 
cost burden and the inability, the inability to make informed and 
appropriate choices.
  Now, one of the companies that was at the panel we did in April had 
data that actually contradicted that criticism. The Midwestern Health 
Care Company introduced a consumer-directed health plan to its 8,600 
employees. They also left their traditional PPO, their regular 
insurance, in place. In the first year, 79 percent of employees chose 
one of four consumer-directed health plans. These health plans had 
several important features, but two of those were preventive care was 
free and employees received financial incentive to change behaviors 
like smoking and weight control.
  In addition, they also received some incentive to manage chronic 
conditions like asthma and diabetes, that is, see their physicians at 
the prescribed time, take the prescribed medicines according to the 
directions and do the appropriate follow-ups.
  So this has been in place for a couple of years. Do we have any 
statistics, are there any metrics that would indicate an overall 
direction of improvement? And in fact, 7 percent of health care dollars 
were spent on prevention compared to a national average of a little 
less than 2\1/2\. So that's a significant increase. And nearly 40 
percent of the employees now take an annual personal health risk 
assessment and earn $100.
  Nearly 500 employees have quit smoking, and as a group, that 8,600 
employees have lost 13,000 pounds through weight-management programs.
  From a cost standpoint has there been a difference? And the answer is 
yes. The average claim increase of 5.1 percent in the past 2 years 
compared with those who are in traditional PPO-type insurance where the 
claims increased 8 percent. So a 3 percent reduction for an increase in 
claims activity for people who were taking a more active role in the 
involvement of their own health care.
  This company has a lot of impressive data. Policymakers can, in fact, 
learn from the example that was brought to us that day. And we can 
learn from some of the other companies as well.
  One of the largest for-profit health insurance companies featured on 
the panel described their incentive-based health benefit design. Now, 
they have a plan that is a high-deductible plan. It's a $5,000 
deductible for a family. I don't think anyone would argue that that's a 
fairly high deductible for a family to have to face if they have an 
illness. But the good news is that family, with that $5,000 deductible, 
and of course they get a break on their premium with such a high-
deductible plan, their premium costs less than some of the other plans. 
So they do save money on the premium.
  But also if they're willing to participate in some things like weight 
control, smoking cessation, cholesterol screening, exercise management, 
if they're willing to participate in those, they can reduce that $5,000 
deductible in $1,000 increments down to a $1,000 deductible with no 
increase in their premium. So they still have the very low premium 
associated with a $5,000 deductible plan, but now they've reduced their 
deductible to $1,000 for that family, which is a much more manageable 
figure.
  And how did that they do that? Because they voluntarily enrolled in a 
smoking cessation plan, they voluntarily enrolled in a plan to measure 
cholesterol, and because they voluntarily enrolled in a plan to 
actively

[[Page 11075]]

manage their weight and increase their exercise. So positive things 
that the individuals can do themselves that result in an actual benefit 
as far as the insurance expenditure is concerned.
  Now, there were also some very positive results from some of the 
other consumer-directed health care options. 88 percent of health 
savings account holders carried a balance from 2006 into 2007. That 
means they didn't spend all of their money that was set aside for 
health care expenditures, and they were actually able to carry that 
forward into the next year. And you can imagine doing that year over 
year over year along with the miracle of compound interest, as long as 
you start young, that can be a powerful way to put some savings in 
place for payment for health care later on.
  I actually say this from personal experience. I was one of the first 
people to get a medical savings account. This Congress, under the 
leadership of former chairman Bill Archer of the Ways and Means 
Committee, passed a medical savings account bill in 1996. In 1997, I 
signed up for one. I had it until I came to Congress at the beginning 
of 2003, and that money now sits there and grows year in and year out 
and is a substantial amount of money that is now available for treating 
health-related conditions well into the future. That is a powerful tool 
to put in the hands of someone. And the actuality is the earlier you 
start, the more powerful is that concept.
  So 88 percent of health savings account holders had a carryover 
balance from 2006 to 2007. And the average balance among people who 
were judged to be of low income was almost $600, $597 on average. So 
that's not insignificant.
  Now, how many Americans are encouraged to live healthier lives and to 
conserve their health benefits like these individuals that we've just 
described? People that are making personal decisions about prevention 
and lifestyle and managing chronic conditions and cost. Most people 
with other private health insurance are not because there is no reason 
for them to. They just simply pay their insurance premium every month. 
They hope that they don't have to use it. They hope that their health 
is not threatened and they have to rely on this insurance company, and 
if they do, they hope that they will in fact be covered when that 
illness strikes.
  In fact, Mr. Speaker, within my own family, I have a youngster who 
teaches school. He teaches middle school there in Denton, Texas. Once I 
said, You know, you have gotten to an age where you need to think about 
preventative health care. You need to think about going to see the 
doctor once a year for a physical and having some lab work done and 
having a few things checked. He said, I don't need to do that. I 
thought he was going to tell me because he was young and 
indestructible. He said, I don't have to do that because they came to 
our school and did a bunch of blood tests and told me I was fine.
  I said, What do you mean they came to your school and did a bunch of 
blood tests? He said, Yeah. If we went out and had the nurse draw our 
blood, they would actually give us $20 a month off of our health 
insurance premium, and I did the math. That's $240 a year. I'll take 
that in exchange for having a little blood work done.
  How forward-thinking for this independent school district to provide 
that type of service. That way if someone in fact does have an elevated 
cholesterol but it's entirely silent and they have no idea that they 
have it, that person can be identified and have some treatment started 
that will prevent the problem down the road. And in fact if there are 
no problems, then the school district also benefits because they know 
they have a very healthy workforce, and they are very fortunate to have 
a very healthy workforce working for them.
  But the closet diabetic, the person with high cholesterol that is 
otherwise not known, the person with other medical conditions that is 
otherwise not known, the person with even illnesses that would lead to 
electrolyte imbalances may be discovered by those types of screening 
tests.
  So this, all in all, is a good thing and a way for, yes, the 
independent school district to save money on some of those higher 
dollars, just like the CEO at Aetna described, being able to save money 
on those higher-dollar diagnoses by paying a little bit of money on the 
front end to, in this case, to elucidate those conditions, and then if 
they are found, to encourage that person to perhaps seek some treatment 
for that.
  So there is, of course, a quote that we're all familiar with about 
the fundamentals of learning being reading, writing, and arithmetic. 
Perhaps for Congress our fundamentals for health care should be risk, 
responsibilities, and rewards. And if we will focus on those--after 
all, on both sides of the aisle, who can be opposed to more care, lower 
cost, better quality? I mean, how can you be opposed to those three 
things? That's what we all talk about in all of these lofty terms about 
what we're all for.
  Well, let's be for that. Let's be for that and ensure that we put the 
tools in the hands of the American people so that they can actually 
participate themselves in the blessings that the American health care 
system is likely be able to provide for them in the years to come.
  So, that's the right prescription for health professionals, and it's 
the right prescription for them to push for when it comes to real 
system reform, and it's the right prescription for Members of Congress 
to subscribe to as well.
  So let me just finish by once again stressing the importance that 
we've got some immediate work in health care ahead of us. Forget all of 
the stuff that's going to happen in the presidential election. If we 
don't fix this problem with the Medicare physician reimbursement rate, 
if we don't fix or stop those cuts that are going to go into place in 
just a few weeks time, then a lot of this discussion will be for nought 
because we will have driven doctors out of practices and we will ensure 
that patients don't have access to care of any type. Whether it is 
expensive care, whether it is quality care, it doesn't matter. We will 
just have ensured that our Medicare patients don't have access to that 
care.
  So I do urge my colleagues to please pay attention to this. Look into 
whatever bill you want. I urge to you look into H.R. 6129, which is a 
paid-for short-term solution to the cliff about which we're fixing to 
go over the edge. And I do want to encourage my colleagues to focus on 
this because this is extremely important. This is important to the 
doctors and patients back in your district.
  Nothing is more personal to a person than their medical care and 
their relationship with their physician, and this hits right at the 
heart of that relationship if we allow these cuts to go into place and 
oh, yeah, by the way, there's another 5 percent reduction where that 
came from waiting for you at the end of the year.

                              {time}  2130

  Make no mistake about it, Mr. Speaker, this is a presidential 
election year. All eyes tonight are going to be on what is billed as 
the last presidential primary, and then we'll start the fall campaign 
literally tomorrow morning.
  Make no mistake, it's going to be difficult for things to rise to the 
top of the national discussion, which is why I encourage my colleagues 
to take the time and trouble now to look at this legislation, look at 
H.R. 6129, do the right thing and get behind this bill, if you can, and 
let's deliver to the Speaker of the House of Representatives a 
significant number of cosponsors, 200 or 300 cosponsors, so that we 
will actually get this legislation done in what remains of the days 
between now and the 4th of July break. And perhaps we can also, too, 
get some attention over in the other body on the other side of the 
Capitol so they will take this up as well.
  There's probably no more important thing, perhaps with the exception 
of passing the Foreign Intelligence Surveillance Act, but there's 
probably no more important or intense piece of legislation that we can 
take up these next 4 weeks. This is an immediate concern. This is a 
clear and present danger to the physicians who practice in this

[[Page 11076]]

country and the patients who depend on those physicians for their 
health care, the access for those patients to their physicians. This is 
the number one issue of this Congress this month, and we should not 
shirk our responsibility.
  Please, let's don't do what they did in December and just simply walk 
away from this responsibility. Let's take charge of this. We have it 
within our power to affect this.
  Again, this is a paid-for provision. This is not going to expand the 
deficit. It doesn't create a tax increase. It doesn't take money away 
from anyone else. This is the right thing to do. And this Congress, 
this Congress ought to stand up and do the right thing when it comes to 
the patients and the physicians of this country.
  On the larger issue of the health care referendum that we're going to 
be facing in this country, I urge my colleagues to listen very 
carefully to the arguments that are going to come from both political 
parties as we go into the fall presidential election. Please remember 
that that which grows the government side of health care may not be in 
the best interests of patients in the long term. And those programs 
that tend to encourage the involvement of the private sector and tend 
to encourage the participation of the patient in the maintenance of 
their own health care, those are programs that are likely to deliver 
value and allow us to continue what has been the greatest health care 
system the world has ever known.

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