[Congressional Record (Bound Edition), Volume 155 (2009), Part 6]
[House]
[Pages 8252-8259]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      HEALTH CARE REFORM IS NEEDED

  The SPEAKER pro tempore (Mr. Driehaus). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Georgia (Mr. Gingrey) is 
recognized for 60 minutes.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank you. And I thank our 
side of the aisle for having the opportunity to speak to our 
colleagues, both Republicans and Democrats tonight, about a very, very 
important issue. The team that just spoke, Mr. Speaker, on the floor of 
this House about much of the spending and the plans and the too much 
spending, too much taxing, too much borrowing theme, which is 
absolutely what the American public, Mr. Speaker, needs to know about, 
including the plans and the spending and to have a comprehensive health 
care reform plan that we would vote on, we literally, Mr. Speaker, 
would vote on before this body and the other body goes on the 
traditional August recess. That is what, just barely a little more than 
4 months away. And the big question is not do we need health care 
reform? I think my colleagues, and particularly my colleagues on this 
side of the aisle, who are doctor Members of this body, who are with me 
tonight to discuss this, the issue of health care reform, we do not 
disagree, Mr. Speaker, and my colleagues, that this needs to be done.
  Nobody, whether Republican or Democrat, whether majority or minority, 
would want to see 47 million people in this country to have no health 
insurance whatsoever, and maybe another 25 million that are 
underinsured. And, yes, indeed, it could happen to one of my adult 
children and their young families. They all have decent jobs, but one 
major illness away from being under-insured and possibly ending up in a 
bankruptcy court, facing foreclosure on their homes and these kind of 
crises that we all agree we need to avoid.
  So the reform of the health care system is not really a question of 
whether or not this side of the aisle agrees. We do agree. It is a 
matter, though, of how we do it and when we do it, and what we can 
afford to do. And I think that what the President has proposed so far 
is, just as we hear about his overall budget in a 10-year projection, 
and the numbers that we received over the weekend from the 
Congressional nonpartisan budget office, of unsustainable debt, 
deficits that will lead to possibly doubling of the national debt 
within 10 years. It is something that really has to be addressed.
  Well, Mr. Speaker, tonight, we are here with, I am leading the hour, 
but I am very pleased that some of my colleagues on the GOP Republican 
Doctors Caucus have joined with me. And I wanted to set the tone for 
what we will talk about during this hour, and that is about physician 
work force; and will we have the manpower, when those 47 million 
hopefully do have health insurance, and the under-insured are fully 
insured, where are we going to come up with the doctors, the health 
care providers, to be able to provide that care?
  Having a plastic card, Mr. Speaker, that says you are covered and you 
have access doesn't guarantee any individual that they are going to be 
able to have a provider who is going to see them.

                              {time}  2200

  And my fear is that they will not be able to have that access, 
particularly if the majority is successful in their plans to have a 
government default option to go along with, let's say, Medicare and 
Medicaid and TRICARE and veterans' health care benefits and the CHIP 
program. It is just adding one more responsibility of the Federal 
Government to control all of health care, and that is really what we 
are going to talk about tonight.
  As I walked over here, Mr. Speaker--I was walking in the building, 
into this great Capitol House Chamber, the people's House--there was an 
emergency, and I saw physicians from the office of the House 
physician--paramedics, nurses--sprinting to the ambulance that is 
parked right outside this building for just such an emergency. I 
thought to myself, you know, thank God for the health care system that 
we already have. We definitely can improve upon that, and we will talk 
about that tonight, but thank God that we have that ability to respond 
in that manner.
  It makes me think, Mr. Speaker, of the tragedy that occurred up in 
Canada in regard to this famous actress--and I will not mention her 
name--the tragic death of that actress after what seemed like a fairly 
routine, snow-skiing fall in which she got up, dusted herself off and 
said: I am fine. I do not need any medical care. Let me just go back to 
my resort hotel room. I am fine. Of course, that is what she did, and 
we all know now that 2 hours later, when she began to get into trouble 
and, maybe, passed out and a 911 call was made, it was 4 hours later 
that she was finally seen at a major medical center that could respond 
to this subdural hematoma that she obviously had developed. By that 
time, she was brain dead, and a life was lost, not just a life of a 
famous person and a prominent person but a mother of young children and 
of a devastated family.
  So when we, Mr. Speaker, hear this talk about a single-payor system, 
of a government-run system not unlike the Canadian system--I am not 
necessarily picking on Canada. They are our good friends and neighbors 
to the north, but the same thing could be said, I think, about the 
system in the U.K. or in Taiwan or in any of the other countries that 
have a national health insurance,

[[Page 8253]]

government-run program. If this accident had occurred, I think, out in 
Colorado in the United States, that young mother and famous actress 
would be alive today.
  So these are some of my thoughts as we begin to discuss. I call on my 
colleagues, the doctor colleagues, who are with me tonight. I want to 
ask my colleagues to focus their attention on this first poster. It is 
titled ``A Second Opinion,'' and then, of course, it is subtitled 
``Strengthen the Doctor-Patient Relationship.'' That is what we want to 
do, and that is what we will talk about.
  With this second opinion theme, I think, most people associate a 
second opinion with a medical opinion, and understand that, when they 
go to the doctor, sometimes a second opinion is very, very valuable. In 
fact, I think almost always it is very valuable. So it is important 
when the other side of the aisle--when the majority party--says or some 
of their news media, coconspirators, if you will, who support a 
national health insurance program or any major issue that the majority 
party is promoting says, well, the Republicans, all they are is a party 
of ``no,'' they do not have another alternative. They are just saying, 
well, we are going to stand in the way of something that we do not like 
because the majority party has presented it, and this is all political.
  Mr. Speaker, nothing could be further from the truth, and that is 
certainly true in regard to the health care of this Nation. This second 
opinion theme could apply to energy; it could apply to what the 
previous team was talking about in regard to the budget and spending. 
We do have a plan on the Republican side on all of these issues and, if 
you will, a second opinion Republican plan on health care.
  So, with that sort of setting the theme, I want to go ahead and 
recognize my colleagues. I am going to first call on the gentleman from 
Pennsylvania, my classmate who has been with me here in the House--and 
we are now serving our fourth term--and that is Dr. Tim Murphy from the 
great State of Pennsylvania.
  Dr. Murphy, I would like to give you an opportunity to talk about 
some of the issues that you have been focusing on, not just as part of 
the Republican Doctors Caucus but since you came to Congress some 6\1/
2\ years ago. I will yield to the gentleman from Pennsylvania.
  Mr. TIM MURPHY of Pennsylvania. I thank the gentleman from Georgia, 
not only for your leadership in health care but for your time here.
  You know, we have many times discussed the issues involved in health 
care, and although I hear many people talk about the issue of 
accessible and affordable quality health care, very often the solution 
offered in this body by government is more government, and that is 
health care is expensive, so let's have someone pay for it--the 
government. Along those lines, Medicare and Medicaid oftentimes list it 
as, because so much is spent there--and I think Medicaid is $350 
billion a year there. Between Medicare, Medicaid and the VA, almost 
half of the Federal mandatory budget is spent.
  The question is: Are they effective? Are they efficient? Does it have 
quality-based health care?
  I want to bring up just a couple issues here and emphasize the 
importance of that doctor-patient relationship. I am a psychologist. 
For many years, I have worked for hospitals in the Pittsburgh region in 
the pediatric, maternity and general medicine settings, but I have 
always had a strong relationship in working with a wide range of 
physicians and with other health care specialists, recognizing it is a 
team and in letting the team do their work that you really end up with 
some significant savings in quality of care. Let me talk about a couple 
of ways that that does occur.
  A recent report sent out by the New England Health Care Institute 
noted that the U.S. really spends more on health care than any other 
nation on Earth, and many times people talk about the negatives of our 
health care system in terms of higher rates, for example, of infant 
mortality, but there are concerns about how that data is reached. I 
will not go into that now.
  What I do want to point out, however, is that out of this $2.3 
trillion health care system, which is very expensive and gets in the 
way of a lot of families affording health care, one of the deep 
concerns, perhaps, is that 30 to 40 percent of those health care 
dollars are wasted. $600 billion to $700 billion is what is listed in 
this report. Let me name a couple of things that go into this. If we 
let the doctor-patient relationship take supremacy over this and let 
physicians make decisions for what patients need, there are some 
changes we might see.
  First of all, unexplained variations in the intensity of medical and 
surgical procedures, including but not limited to end-of-life care, the 
overuse of coronary artery bypass surgery and the overuse of 
percutaneous coronary procedures has the potential of avoidable costs 
of $600 billion. The misuse of drugs, overprescribing and 
underprescribing: some $52 billion. The overuse of non-urgent Emergency 
Department care: the savings could be $21 billion. The overuse of 
generic antihypertensives: a potential savings of $3 billion. The list 
goes on.
  Now the question is: Why would these conditions exist?
  Well, actually, government, itself, stands in the way in many cases, 
and sometimes, well, it is the way health insurance is set up, but if 
the issue were instead that physicians could be the ones who are moving 
forward in this, I believe a lot of savings could take place. I believe 
what we should be doing as a legislative body is finding ways to break 
down those barriers and really helping to improve. One of the points to 
be made by a number of the doctors here on the floor tonight is about 
having more physicians involved. Let's take one of those aspects.
  Having a health care home is important, and one of the health care 
homes for people in some areas has to do with having a community health 
center. Now, community health centers provide great quality of care 
with a wide range of medical services, as my colleagues note. Yet there 
is a shortage of physicians, in part, because it is not the best paying 
position in the world, but many physicians want to help. The strange 
thing about this is that, in a wide range of health care areas, if you 
work at a community health center, your medical malpractice insurance 
is paid. If you volunteer, you are on your own, and so these clinics 
say, We cannot possibly afford that. There are different kinds of 
malpractice insurance that is not important to get into at this point. 
We have tried a number of times to allow it so physicians could 
actually volunteer--so psychologists could volunteer, so dentists, 
podiatrists, social workers, and nurse practitioners--but no, the 
government says, We cannot let you do that.
  There are also areas, too, that come up here in terms of how we could 
let disease management work. Here is one of the strangest things that 
happens with Medicaid:
  You know, one group that has a great deal of problems is that of 
people with severe diabetes. The severe diabetics, if they have 
problems with the circulation in their feet, for example, the real 
tragedy might be that they might have their feet amputated, but isn't 
it strange that Medicare and Medicaid will not pay for that physician 
or that nurse to monitor the patients closely--to call them, to work 
with them, to do more than just give them a pamphlet, but to work 
closely with them to keep them out of the hospital, to make sure that 
they are getting their insulin, to make sure they are monitored for 
their weight, et cetera, but we will not pay for that? We will pay 
$50,000 for that tragic surgery that could have been avoided, but we 
will not pay money to help when they manage the care.
  Now I might say that there is a recent study that came out that, I 
believe, is filled with methodological flaws, saying that disease 
management has some questionable applications. Unfortunately, they 
focused on those who oftentimes had the most severe illnesses. As I am 
sure many of the physicians here tonight can attest, the real value is 
getting to that patient early or when the complications begin to show 
up rather than to wait until the

[[Page 8254]]

end. I know, in my career as a psychologist, I had a patient who is now 
a deeply depressed, suicidal inpatient. When you could have been 
working with them years before, it makes a big difference in their 
outcomes.
  We have to make sure that the system that we allow here with health 
insurance and with physicians working with patients really allows for a 
great deal of predischarge planning, of working closely and 
individualizing that care and for making sure that it is there.
  Let me mention a couple of other things as we proceed forward. Recent 
legislation under the House set aside nearly $2 billion to help 
physician practices have health information technology. A good idea. 
The question is how it is done. If that health information technology 
is merely paying for keeping hospital records on a computer, that is 
not going to be enough because that is a passive system that only makes 
it a little easier to pull up records rather than having to wait for 
the records to arrive.
  What we need is a smart, interactive system that is portable for the 
patient so that records follow the patient, not so that patients follow 
the records. We have to make sure it is private, that confidentiality 
is protected, and we have to make sure it is personal so that the 
relationship between doctor and patient is what is paramount here. That 
physician and information they are obtaining and what they are writing 
whenever they have a diagnosis is a smart record that also helps 
provide information to that doctor about best practices, about 
feedback, about prescriptions, and even about the feedback of whether 
or not that patient got that prescription and if he is following 
through. It is all of those things. In today's world, because there is 
a shortage of physicians and because insurance with Medicare, Medicaid 
or private insurance oftentimes does not pay for having the physician 
actually work to follow up with the patient, then that health IT is 
just one, big, expensive thing on the desk of the physician, and it is 
not really providing the care they need.
  Let me mention one other thing here, and that has to do with point of 
care lab tests. The system we have designed is one where--and because 
some physicians have been found when they own the labs--the concern was 
were they overprescribing lab tests. I would love to hear some input 
from my physician colleagues on that, too. So what did they say? They 
said, Let's not allow physicians to do this at all, where sometimes the 
most valuable thing is if the physician says, I need an x-ray; I need a 
lab test; I need this information right away. Instead, they have to 
send that patient out to a lab or send the information out. It could be 
a couple of weeks before they would get it back.
  The best way to improve patient compliance is quicker information. 
Even to allow, for example, pharmacies and drug stores to provide some 
of this lab information would be more valuable. All this feeds into the 
system that part of the way to save the $600 billion or $700 billion 
worth of loss in the health care system is to put the tools in the 
hands of those who provide the health care. Make sure there are enough 
physicians. Make sure they have the tools they need so that as they 
diagnose, as they prescribe, as they work with other colleagues in the 
health care field that that information is shared in an effective way 
that is personal, that is private, that is portable, and actually that 
is permanent, too. These are not records that are lost as a person 
moves on to another health care plan or whatever they do in life.
  Part of what we are doing here as the GOP Doctors Caucus is operating 
on the idea that we are all gathered together here to really work on 
making sure that we are developing patient-centered, patient-driven 
health care reforms based on quality, access, affordability, 
portability, and choice. Over the coming months, you will hear from us 
continually speak about this because we believe we have a health care 
system that can be based upon those, that can save massive amounts of 
money and that can save hundreds of thousands of lives. That needs to 
be our goal, not only to do no harm but to make sure we put health care 
back in the hands of those making those health care decisions. In so 
doing, we go at the very thing that people are raising the concerns 
about, and that is making health care more affordable and more 
accessible with quality as the underlying point.
  With that, I yield back to the gentleman from Georgia.

                              {time}  2215

  Mr. GINGREY of Georgia. I thank my colleague, my co-chairman of the 
GOP Doctors Caucus and of all of the important points, Mr. Speaker, 
that Dr. Murphy brought to us. That point he made about the doctor-
patient relationship being paramount I think is the most important. And 
that is our concern that if we go to a government-run, totally 
government-run system, that that will be sacrificed and that will be 
sacrificed badly.
  Before I yield to my colleague, Dr. Fleming from Louisiana, Mr. 
Speaker, I wanted to draw my colleagues' attention to this next slide 
in regard to the supply/demand crisis.
  Even if nothing changed under the current system, we already have a 
shortage. And it will only get worse as we approach the year 2025. 
There are a lot of reasons that. Growth in an aging population. There 
is an immense physician shortage on the horizon. It is expected by 2025 
to be a shortage by 125,000 physicians, and the demand for care by that 
time will increase by 26 percent.
  Now, the bulk of the shortage--and these are statistics from the 
Association of the American Medical College; this was a center for 
workforce studies back in 2008, so just a year ago--but the bulk of 
that shortage, in fact, 37 percent of the projected shortage, is in 
primary care physicians. And I don't disagree with President Obama and 
the majority party in regard to the need to get more primary care 
physicians, to have these medical homes that we talk about, to stress 
wellness. And that is so important.
  So it couldn't be more timely for me to call on Dr. Fleming, who--he 
specializes in family practice, and has for a number of years, in south 
Louisiana.
  And it is indeed a pleasure to yield time now to Dr. John Fleming.
  Mr. FLEMING. I thank the gentleman for yielding. And also I want to 
thank Doctors Murphy and Gingrey in your leadership on this subject and 
your years in Congress.
  I want to say first of all, Mr. Speaker, that health care in the 
United States is among the best in the world, but the financing of it 
is a basket case. We have 47 million uninsured Americans and they are 
not who you think they are. They are not the poor; they have Medicaid. 
They are not the elderly; they have Medicare. They are not workers for 
large corporations or the government, such as us tonight. They are 
owners of small businesses and their employees. They have tremendous 
difficulty acquiring affordable insurance. And I see this every day.
  I, myself, am a small business owner apart from being a family 
physician with still an active practice. And what is, in fact, going on 
in this situation is this: the risk pool for a small business is very 
small, and all it takes is one heart transplant or certainly renal 
dialysis and it can blow the whole plan up; everybody in the company 
can find themselves without insurance.
  Well, I think that we, on the GOP side, we Republicans, and certainly 
we Republican physicians, agree with the other side and also with our 
President that we do need comprehensive health care. We need access to 
health care and coverage for all Americans.
  And in fact, when you think about it with the entitled laws in the 
1980s, every American today is entitled to health care regardless of 
his ability to pay. And if you don't believe me, go to an emergency 
room demanding care, and you will receive that care without anyone 
asking about your ability to pay. And that is certainly an honorable 
and laudable value that we have.
  The problem is that that same individual probably has an illness such 
as diabetes or hypertension, which, if they had received care early in 
the disease or maybe in a stage of prevention,

[[Page 8255]]

would not only not be in the emergency room, but the outcome would be 
much better and the cost would be much lower.
  So, you see, when someone goes to the emergency room or staggers into 
an emergency room perhaps on their death bed and we providers have to 
pull them out, somebody gets a bill for that. And that bill is going to 
be many times higher than what it would have been otherwise. This, of 
course, creates bankruptcies. Many families end up filing bankruptcy 
after going through a major thing like this. So who absorbs that cost? 
The cost is absorbed by those who pay insurance premiums and taxpayers.
  So it is not free medicine. So since we're already providing the 
resources, why not front-load that into preventative and early 
diagnostic care?
  I am a strong believer in health care reform, and I will just tick 
through several of them that I think need to be implemented with all 
dispatch.
  First, we need to have portability. Dr. Murphy mentioned that before. 
We do need to go to electronic health records in a way that is going to 
make practices more efficient. We need to do away with archaic 
insurance laws which cause these small risk pools. We need to create 
large risk pools and make ``pre-existing illness'' a term that is no 
longer in the American lexicon.
  We need to make sure that everyone gets basic private health care 
insurance, and I think that family physicians should be the linchpin in 
health care because it has been proven time and time again that family 
physicians, the primary care providers, create a much more efficient 
form of health care, but they also work very closely with their 
colleagues to ensure that they get uploaded or downloaded or whatever 
is necessary in order to get the best.
  But let me comment on one more thing before I yield. And that is that 
we're right now in a crossroads of decision making. We all agree that 
we need comprehensive health care reform. The question is will it be a 
single-payer governmental system such as what we have today with 
Medicare or Medicaid, or will it be a private health care system?
  Now if we expand Medicare to include everyone, as some have suggested 
in this body, what is going to absorb that overflow and cost?
  You see today, Medicare is somewhat successful in that the fraud, 
abuse, and the waste is being absorbed by the taxpayer and also those 
who pay private subscription rates. When we go to an entire system that 
is a single payer Medicare system, there will be nobody to pick up the 
tab at that point. So what are we left with?
  Well, number one, we know that when you have a government-type 
system, a micromanaged system from the top, you end up with spot 
shortages, which we already have today; and I am sure that Dr. Gingrey 
will discuss that further. But also you have a situation beyond the 
spot shortages that is how do you control costs? And government can 
control costs only one way, and that is rationing. That means that 
somebody is told ``no'' when there is in fact something that can be 
done.
  On the other hand, you take a private system, even if it's funded by 
government entities, either partially or in whole, if it's administered 
privately, it is far more efficient. And I will just give you a quick 
example.
  Today, we talk about fraud and abuse and waste. And how can we find 
this fraud and abuse and what do we do about it? Well, we have to go 
after it legally to prosecute it. It is very expensive. You only find 
the tip of the iceberg. In a private plan, everyone works to build 
efficiency in the system, and if someone is just a little bit off the 
graph, you reeducate, you help them, or if they don't respond. You 
terminate them. You don't have to worry about finding someone who is 
manufacturing health claims or any of that kind of nonsense. It just 
doesn't happen.
  So the bottom line is we need to get physicians, all providers, on 
board with working towards a much more efficient system, and we need to 
get the patients involved as well.
  For many years, as my colleagues here, I know, have experienced, you 
couldn't talk patients into accepting generic drugs. Today with the 
tiered payment systems, the incentives are in favor of generic drugs, 
and now you can't beg patients not to take generic medications because 
they are much cheaper.
  So there is a lot of work that we need to do, Mr. Speaker, and these 
are just some of the suggestions.
  But finally, I would just like to say that we need to do a lot more 
to improve the availability, particularly of primary care providers, 
and we're going to have to do that by increasing the reimbursement 
rates because what we're really getting is a paradoxical effect. The 
more we clamp down reimbursement rates for family physicians and 
others, the more they have to do other things to make up the 
difference, which echoes costs throughout the system.
  So thank you.
  Mr. GINGREY of Georgia. I thank the gentleman from Louisiana, the 
good doctor.
  And, you know, again, stressing this theme of going forward, the 
shortage of manpower, it has a lot to do with physician satisfaction in 
their chosen profession. And I think that is basically what we want to 
make sure, Mr. Speaker, that everybody, all of our colleagues 
understand on both sides of the aisle, that as Dr. Fleming was saying, 
if you have access to an affordable health insurance policy, as we all 
hope and pray for those 47 million, if it's a system that is run by the 
government and we crowd out the private market completely--and that is 
one of my big fears and I think that of my colleagues--then these young 
men and women that normally would--our best and brightest who would 
normally want to go to medical school and maybe become a family 
practitioner and provide this care, they are not going to do it. They 
are going to choose another profession. They are going to maybe become 
lawyers, but not doctors. And I think that is a big concern.
  And I don't think anybody knows more about this than the next person 
that I will yield to, Dr. Phil Roe, a fellow OB-GYN physician, who has 
provided women's care and delivered lots of babies in the Tri-City area 
of Tennessee--Kingsport, Bristol, Johnson City--and he knows of what he 
speaks. And I think he's going to talk to us a little bit about what 
probably everybody in this Chamber is aware of, and that is something 
called TIN care in Tennessee, and I am happy to yield to my colleague, 
a freshman representative doing a wonderful job, Dr. Phil Roe.
  Mr. ROE of Tennessee. A couple of things to historically go back 
over, and I might mention that if the public out there that is watching 
this tonight thinks that the government's management of AIG is good, 
then they are going to be thrilled to death with the government 
management of health care, I can tell you that.
  I am going to go through a couple of historical things.
  You and I went through the managed care in all of the 1990s and all 
of the promises that were going to occur, the cost savings and so 
forth, that didn't show up; and one of the things that concerned me 
about health care going forward is accessibility, not just in 
physicians but in other health care providers.
  For instance, our nursing staff. By 2016--that is 7 years from now--
we're going to need one million more registered nurses in this country. 
And in the next 8-10 years, more physicians will be retiring and dying 
than we're producing in this country.
  And let me go back a few years to read this to us just briefly. It is 
a 1994 report to both Congress and the Secretary of Health and Human 
Services, the National Council on Graduate Medical Education noted, 
``In a managed care dominated health care system, the Bureau of Health 
Professions Commissions projects a year 2000 shortage of 35,000 
generalist physicians and a surplus of 115,000 specialist physicians'' 
and recommended that the ``nation `produce 25 percent fewer physicians 
annually.''' That was just 13 years ago.

[[Page 8256]]

  ``In 1995, the PEW Commission recommended medical schools `by 2005 
reduce the size of entering medical school class in the U.S. by 20-25 
percent,' arguing further that this reduction should come from the 
closure of existing medical schools.''
  Have you ever heard of anything as ridiculous as that? And think of 
what a catastrophe that would have been had we followed this.
  The Institute of Medicine committee ``recommended `no new schools of 
allopathic or osteopathic medicine be opened, that class sizes in 
existing schools not be increased, and that public funds not be made 
available to open new schools or expand class sizes.'''
  Now, to give you an example just to reiterate what you said, if 
physicians don't retire--and there are over a quarter of a million 
physicians over the age of 55; that is a third of the practicing 
doctors in America--do retire in the next 10 years, which they most 
certainly will, this number--and the reason that is so important for 
the folks listening is is the access to care. What happens will be that 
patients won't have access to their physicians, and I have seen that.
  I have practiced and trained in Memphis, inner-city Memphis and a 
rural area where I am now, and you all know inner-cities and the rural 
areas are the two most underserved areas in America now.

                              {time}  2230

  Patients in those areas are now not only having a difficult time 
paying for care, just finding someone to give them the care. So this 
particular recommendation that was made, if it had been followed, would 
have been an utter disaster for the American health care system.
  We need to encourage more and more young people. The community where 
I live has a Quillen College of Medicine, has 26 students. It hasn't 
increased the class size in 20 years. Why? They don't have funding to 
do it, and we have a tremendous shortage of primary care physicians.
  At the end of my practice last year when I was still in the operating 
room, one of the most difficult things I had to do was find a primary 
care provider for a post-surgical patient. It is difficult to do now, 
and it is going to get much, much, much worse.
  I will mention a couple of things about our TennCare system, and it 
was a system that was started with noble objectives, to provide care 
for all Tennesseans. It was rapidly put together, and I heard you say 
at the beginning of this, we don't need to do this fast; we need do 
this right. It's to important.
  The health care that we provide affects every citizen in this 
country. Every one of us is going to have to abide by this system, and 
who should be in control of that system are the patients and the 
physicians. That's who should be making these health care decisions.
  Now, in a survey that was done in the current budget crisis in the 
State, the State was about $1 billion short before the stimulus package 
came along. And what the stimulus package does is simply put off these 
hard decisions for about 2 years in our State. But that survey showed 
that nearly half the physicians in the State of Tennessee would end 
their participation or consider ending their participation in one or 
both of the MCOs in the State--that's the medical care organizations--
if those cuts were enacted to ease the State budget crisis, and another 
31 percent said they would reduce the number of TennCare patients 
they're seeing. That's 80 percent either would stop or reduce the 
number that they're currently seeing.
  I spoke to one of our large hospital administrators this past 
weekend, and right now, we have TennCare covering 60 percent of 
hospital costs. Medicare covers about 90 percent of hospital costs. The 
uninsured obviously cover none of the costs, and the private payers 
have to make up that difference to keep the hospital open.
  You hear that your medical benefits are tax deductible and so forth. 
Well, I would argue they're not. If you go ahead, that's a hidden tax 
right there that a person who has private health insurance has to pay 
when they pay it. Now I know this year because in the past year, I 
bought my own policy. I've a health savings account, and to buy this 
health savings account, I was fortunate to be able to do that. It is 
about $1,000 a month, but I had to earn about $18,000 to pay that after 
taxes. So, for a person with a health savings account or a small 
business or whatever, they're on your own, you're in real trouble in 
this country now.
  And I think the health care plan in this country should have about 
four principles. One is a basic health plan for all Americans, and we 
can define that a lot of ways, but I think one of the ways you could 
define it is the least expensive government plan.
  And number two, illness should not bankrupt you. If you get sick, if 
you develop multiple myeloma or a malignancy or something or at no 
cause of your own, you should not be bankrupted by that illness.
  And number three, it should be portable. You should be able to move. 
If your lose your job, as many people have done during this current 
recession, you should be able to carry your health benefits along and 
not have COBRA payments that people with expensive, who let's say Bill 
Gates would have a hard time paying.
  So I look forward to continuing this discussion in the future.
  Mr. GINGREY of Georgia. Well, I thank the gentleman from Tennessee 
and the words of the wisdom that he brought us to.
  Before I yield to my colleague from Georgia, I want to just make a 
few comments, Mr. Speaker, about some of the statistics in regard to 
physician workforce shortage. Any my State, my home State of Georgia, 
it's ranked 40th in the Nation with respect to active physicians per 
100,000 people. In Georgia, there are 204 per 100,000. National average 
is 250.
  Georgia also has the dubious ranking of 44th in the Nation with 
respect to active primary care physicians. You just heard that from Dr. 
Fleming, and you will hear it in just a minute from Dr. Paul Broun, a 
family practitioner in Georgia.
  Seventy-three primary care physicians per 100,000 in Georgia; the 
national average, 88.1. Eighty-nine percent of job seekers graduating 
from Georgia medical residency programs received and accepted job 
offers in 2004 but only 54 percent of them stayed in my great State of 
Georgia.
  So just kind of bringing home some of the statistics from where we 
live and represent.
  At this time, I'm proud to yield to Dr. Paul Broun, the gentleman who 
represents my hometown of Augusta, Georgia, and Athens, Georgia, the 
home of the University of Georgia, the great bulldog nation and many, 
many wonderful counties in between.
  I yield to the gentleman from Georgia, Dr. Paul Broun.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey. I appreciate you 
bringing these very important points to the floor tonight.
  I want to talk about the issue that you just brought up about the 
lack of primary care physicians in our home State of Georgia, but 
before I do that, I wanted to remark about something Dr. Murphy brought 
up tonight, and that's the cost of regulatory burden on the health care 
system, particularly as it deals with lab and X-ray and those types of 
things.
  I want to give an example. Back a number of years ago, I was 
practicing medicine in rural south Georgia, and Congress passed a bill 
called the Clinical Laboratory Improvement Act. It was signed into law. 
It's called CLIA. I had a small lab in my office, totally quality 
controlled, wanted to make sure that the tests that I did there were 
accurate so that I could give the best quality care to my patients that 
I possibly was trained to do.
  And CLIA shut down that lab. Well, why? Well, the reason that CLIA 
shut down the lab was that the people here in Congress decided that it 
was a conflict of interest for doctors to own labs and that they may be 
an overutilization. But the thing is, what this has done is it's 
markedly driven up the cost of health care for all of us, the cost of 
insurance, and it made insurance less affordable.

[[Page 8257]]

  Now, to show you how that works is that in my lab, if a patient came 
to see me with a red, sore throat, maybe had little white patches on 
their throat, running a fever, coughing, aching all over, runny nose, 
this could be a strep throat, need a penicillin shot or some 
antibiotics. It could be a viral infection. They look exactly the same. 
I would do a test in my office called the complete blood count, or CBC. 
It took 5 minutes to do the test. I charged $12 for the test. I made 50 
cents on it, if any at all.
  Well, CLIA shut down my lab. I couldn't do those tests any longer. If 
patients came in with those same symptoms, I had to decide whether just 
to go ahead and give them antibiotics and expose them to the 
overutilization of antibiotics that, not only the exposure to them 
which could create superinfections, also increases the cost, because 
the overutilization of antibiotics markedly drives up the costs for all 
of us. Or I would do the test, and to do so, I would have to send them 
over to the hospital to get that done. It would take 2 to 3 hours to do 
a test I could do in 5 minutes, and it cost $75 whereas the test in my 
office cost $12.
  You can see what that one test, the cost across the whole health care 
system has been for that one test for patients that come in with sore 
threats which is a very common illness that primary care physicians, 
like I, see.
  So the regulatory burden on the system markedly increases the cost 
and makes it less affordable. So if we could get the regulatory burden 
off of the health care system, it would literally lower the cost of 
insurance and would make it more affordable.
  We actually hear of about 47 million people in this country not 
having health care. Well, everybody has health care. As Dr. Fleming was 
talking about, entitlement laws made it so that people could go to the 
emergency room and get health care. So everybody has access to health 
care. Everybody can get health care. The question is where do they get 
it, at what cost, and who pays for it.
  Well, if we go to a socialized medicine system--and the code word for 
socialized medicine in this body here is comprehensive health care 
reform--if we go to socialized health care, it's going to make it less 
affordable and be harder for people to get health care, provided to 
them.
  But in Georgia, we have a tremendous lack of primary care doctors. In 
fact, in more than one-third of the counties--we have 159 counties in 
the State of Georgia. Fifty-eight of those counties, over a third, are 
officially designated as primary health professional shortage areas. 
This means on average that there is less than one doctor per 3,500 
people in those counties. About 1.5 million people in the State of 
Georgia alone are affected by the shortage of doctors.
  We need in Georgia 259 more doctors to serve those underserved areas, 
just to fill that official estimate of shortage, and ideally, in fact, 
the experts say that there should be one doctor per 2,000 people. To 
attain that goal, we would need another 421 doctors, primary care 
providers, to face that shortage.
  Now, the Medical College of Georgia, my school that I graduated from, 
is just expanding and developing new campuses. There's one that's going 
to start accepting their new class in Athens, and they're going to have 
other communities around the State of Georgia to try to train 
physicians. But we've got to give doctors the freedom to practice 
medicine, not put constraints on them, not to shackle them. We've got 
to get the regulatory burden off of their practices so they can 
practice medicine without all this government intrusion so they can 
give the care that they're trained to give.
  And going down this road of socialized medicine that this 
administration and that the liberal leadership here in Congress is 
pushing us towards is going to hurt the health care system. It's going 
to create a larger doctor shortage, and it's going to mean that people 
have less access to care, particularly good, quality care.
  So we need to have a patient-focused health care reform and not a 
government-focused health care reform, which is what we and the Doctors 
Caucus, what the Republican party is bringing forth as the solution to 
the health care crisis, which is actually a health care financing 
crisis, not a health care crisis in itself.
  So I thank the gentleman for bringing this up tonight. I thank the 
gentleman for yielding, and I look forward to working with our 
colleagues so that we can actually find some commonsense, market-based 
solutions that we propose and, hopefully, the American people will 
demand it from their Member of Congress so that we can continue to give 
good, quality health care here in America.
  I thank the gentleman for yielding.
  Mr. GINGREY of Georgia. I thank my colleague, Dr. Broun, for joining 
with us in this hour, talking about the issue of strengthening the 
doctor-patient relationship and not destroying it.
  And as Dr. Broun pointed out in some of his statistics, those 
shortages that he was talking about in the State of Georgia--and this 
is applicable to 49 other States as well--we're talking about under the 
current system. But once we cover the 47 million uninsured, and these 
numbers just get that much more difficult, and actually the shortage 
increases by 4 percent, and these statistics are frightening.
  And before I introduce the next speaker, my colleague from Texas, my 
fellow OB/GYN colleague, I wanted my colleagues to see this next slide. 
And part of the reason of this physician shortage--and as I say, it 
will only get worse in the future--is declining reimbursement ranked as 
the number one impediment to the delivery of patient care.
  Sixty-five percent of physicians surveyed said that Medicaid pays 
less than the cost of providing that care, and 35 percent of the 
physicians surveyed said Medicare pays less than cost of providing that 
care. Nobody in this House of Representatives has worked harder than my 
classmate, the good OB/GYN doctor from Plano, Dallas-Fort Worth. He has 
worked so hard to try to provide a reimbursement based on a reasonable 
formula and not this current sustainable growth rate.
  Nobody can really understand how that's ever figured, but doctors 
know that every year it's figured in a cut in their reimbursement, and 
that indeed, Mr. Speaker, is not sustainable.
  And with that, I yield to my colleague from Texas, Dr. Burgess.

                              {time}  2245

  Mr. BURGESS. I want to thank my friend for yielding. I should 
mention, of course, you know we passed out of our committee, the 
Committee on Energy and Commerce, just 2 weeks ago, H.R. 914, which 
would have, for the first time, increased the number of primary care 
residencies available. It was a self-replenishing loan program. 
Oftentimes, the biggest barrier to entry for a hospital that doesn't 
currently offer a residency program, the biggest barrier for entry is 
the cost for getting into that residency program. This will provide an 
ongoing self-replenishing series of loans.
  We have been held up a little bit by the Office of Management and 
Budget. It is one of the weird things that happens to you here in 
Washington. Last year's Congressional Budget Office said this bill was 
not a problem financially. Last year's Congressional Budget Office is 
this year's Office of Management and Budget. And this year's Office of 
Management and Budget says, Wait a minute. If you make more primary 
care doctors, they're going to see more folks and they're going to send 
in more bills. It's going to cost more money. So we can't have that.
  We've kind of reached a little bit of an impasse there. I hope to get 
past that. It just underscores sometimes the futility of working in 
this environment in which we find ourselves.
  Now, just a few weeks ago I was fortunate enough to be asked down to 
the White House to participate in the health care summit, and President 
Obama, to his credit, as he was wrapping things up said, Look, I just 
want to figure out what works.
  Well, I'm here to help him. I'm so glad to hear him say that. He 
says, The cake was not already baked. We would work through this in our 
congressional

[[Page 8258]]

committees. He'll provide guideposts and guidelines. At the end of the 
day, it's going to be a congressional decision.
  I applaud him if that's the case. I still have some reservations deep 
down inside that this bill has already been written in the Speaker's 
office. But I will take the President at his word because, after all, 
we are charged in the practice of medicine for following evidence-based 
practice. We are told to practice evidence-based medicine. We as 
policymakers should also practice evidence-based policy as well.
  The reform discussion has centered primarily on the number of 
Americans who lack insurance. That's understandable. It's a good 
reason. The number is astonishingly high--and growing.
  But, honestly, we do have to look beyond just the single knee-jerk, 
silver bullet response to, We want to fix the number of uninsured. 
Because that may not solve our problem.
  We have a grand national experiment going on in the State of 
Massachusetts right now. A great increase in coverage because of an 
individual mandate. But we have a problem. We don't quite have the 
number of primary care physicians required to render the care to all 
those folks who now have that coverage.
  So, across the Nation issues with the medical workforce are going to 
continue to loom large and, like my colleague from Tennessee, I can 
remember sitting in those medical meetings 15 years ago and hearing the 
stories about how we were over providered. I didn't even know that was 
a verb, quite honestly. We were over providered in health care in this 
country, and we needed to scale back the number of doctors we were 
producing.
  Now, 15 years later, that sounds like nonsense. When you consider the 
length of time that it takes to make one of us, those of us who are on 
the House floor late tonight. I don't know. Certainly, 12 years after 
college and my professional education, it is not at all an uncommon 
story. It takes a long time to make one of us.
  So changes in that pipeline really can have a dramatic effect down 
the road. It's so important for us to get the policy right.
  Another point on our Energy and Commerce Subcommittee on Health. Last 
fall, we heard from a woman who's a pediatrician in rural Alabama. It 
sticks in my mind because she went into practice the same year that I 
did--1981. She has worked her heart out there taking care of poor kids 
in rural Alabama.
  Her practice currently has reached a point where it's 70 to 80 
percent Medicaid. And she can't keep her doors open. She's having to 
borrow from her retirement plan in order to pay the overhead for her 
office to keep the clinic doors open.
  Well, I learned that lesson a long time ago with managed care back in 
the 1990s. If you're losing a little bit on every patient, it gets 
harder to make it up in volume. The harder you work, the more behind 
you get.
  That was exactly the situation that she had found herself in. It's 
because we require such a significant amount of cross-subsidization. 
The private sector has to cross-subsidize the public sector--Medicare 
or Medicaid--or doctors cannot afford to keep their doors open. 
Precisely the information you have up on your slide.
  Government-administered health care misleads Americans into thinking 
that they have coverage. But the reality is they're denied care at the 
out end because there simply is not the doctors offices there to 
provide it.
  Well, you have been very generous with your time. I'm going to yield 
back so we can hear from some of our other great colleagues who are on 
the floor with us tonight. I thank you for bringing this hour together.
  Mr. GINGREY of Georgia. I thank my colleague on the Energy and 
Commerce Committee, Dr. Burgess.
  I want to yield to another of my physician colleagues from Georgia, 
Dr. Tom Price, an orthopedic surgeon who represents the district 
adjacent to mine, the Sixth District of Georgia.
  Dr. Price is going to tell us a little bit about these 47 million 
uninsured, many of whom are employed and simply cannot afford what is 
offered by their employer, their portion of the premium, and many of 
them of course work for very small employers that can't afford to offer 
coverage at all.
  At this point, I am proud to yield to my colleague, the chairman of 
the Republican Study Committee, Dr. Tom Price.
  Mr. PRICE of Georgia. I thank my friend from Georgia, Dr. Gingrey, 
for yielding and for his leadership in this area and for organizing 
this hour this evening.
  Mr. Speaker, you have heard a lot of conversation tonight about 
health care and about access and affordability and quality and primary 
care physicians. I think it's important to talk about the thing that 
all of those affect, and that is patients. Patients are what this is 
all about.
  I'm pleased to join my physician colleagues on the Republican side of 
the aisle tonight to talk about patients and the effect of health care 
and national health care policy on patients.
  If I think about the eight physicians who are here on the floor 
tonight, we probably have seen a half million patients in our 
professional life and get a sense about what it means to take care of 
people and make certain that they get well, depending on the malady 
that befalls them.
  We all have our different principles about health care. Mine are 
five--the usual three: Access and affordability and quality. Then I add 
innovation and responsiveness. I think it's imperative we have a system 
that has the greatest amount of access, the greatest amount of 
affordability, the highest quality, and the most responsive and most 
innovative system.
  I would suggest, as I know my friend would agree from Georgia, and my 
other physician colleagues here, that governmental intervention and 
increasing involvement doesn't improve any of those things. It doesn't 
improve access, it doesn't improve affordability, it certainly doesn't 
improve quality, doesn't improve innovation or responsiveness.
  So what's the solution? What's the solution for the patients across 
this Nation who are maybe watching this evening, Mr. Speaker, and 
saying: What are you going to do?
  Well, the solution, I believe, as I know my colleagues do, is to make 
certain that patients have ownership of the system. The only way to get 
the system to move in the direction that patients want it to move is to 
have a patient-centered system so that patients own and control their 
own health insurance policy.
  Everybody's got to have health insurance. You can get to that system 
in a way that most of us support, which is through the Tax Code. Making 
certain that it makes financial sense for all patients to have health 
insurance. But, once they do, how do you make the system move in the 
direction it ought to move, and that is the direction that patients 
want it to move. It's to allow for patients to own and control their 
health insurance policy, regardless of who's paying the cost.
  That's important because that changes the relationship between the 
insurance company and the patient. Right now, when the patient calls 
the insurance company and says, You're not doing what I need to have 
done, or my doctor recommends, the insurance company, by and large, 
says, Call somebody who cares. Because you aren't controlling the 
system.
  When patients own and control the system, then the system moves in 
the direction that patients want it to move.
  We are working diligently to come up with a product that will allow 
the American people to look to Washington and say, Hey, those guys are 
doing what we think ought to be done in our health care system.
  I'm so pleased to be able to join you tonight and talk about positive 
solutions for our health care system that puts patients in control.
  I yield back.
  Mr. GINGREY of Georgia. Dr. Price, thank you so much.
  Mr. Speaker, I realize that we are running very close to that 
witching hour. Maybe I saved the best until last. He probably thinks 
that I'm shorting him on time because his LSU Tigers

[[Page 8259]]

whipped up pretty badly on my Georgia Tech Yellow Jackets in the Bowl 
game. That's is not the case at all.
  I'm proud to yield to the internist and gastroenterologist from Baton 
Rouge, Dr. Patrick.
  Mr. CASSIDY. You're so bitter about that loss, you call me Patrick 
instead of Cassidy.
  I actually teach residents. I'm still on faculty with LSU Med School. 
It's not accidental that we end up having too few specialists.
  For example, just to put the issue into focus, only about 2 percent 
of medical school grads in 2007 planned to go into a primary care 
career. That's 2 percent.
  Now, it's not accidental why this is. As it turns out, the Federal 
Government gives more money to train specialists. It gives less to 
train a generalist and more to train a specialist.
  When you're out, reimbursement is less for visits, but more for 
procedures. So the primary care physician that we don't have enough of 
gets paid less for the amount of effort he or she puts into their job.
  So I say this to say that it's Federal policies that have gotten us 
here, and there are wise Federal policies that can get us out. But I 
want to just give a little bit of humility to the people who want to 
remake our system, assuming that a top-down approach will benefit.
  I echo what Dr. Price said--it's better to have that patient in 
charge of the system. When it's top down, we end up with systems which 
end up skewing us towards more specialists and fewer generalists. I 
think if we take history as a guide, we will say that we will be much 
better if the patient have the power as opposed to CMS or another 
Federal bureaucracy having the power.
  With that, I yield back.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank Dr. Patrick. And I thank 
all of my colleagues. You can see the level of interest of the GOP 
Doctors Caucus. But we want to work with the physicians, the medical 
providers, the nurses on the other side of the aisle, and work in a 
bipartisan way.
  In this area of a second opinion, we will continue to bring other 
issues forward as we continue in the 111th Congress.
  Mr. Speaker, with that I yield back.

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