[Congressional Record (Bound Edition), Volume 157 (2011), Part 13]
[House]
[Pages 18565-18572]
[From the U.S. Government Publishing Office, www.gpo.gov]




           GOP DOCTORS CAUCUS: MEDICARE SENIORS AND OBAMACARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Louisiana (Mr. Fleming) is 
recognized for

[[Page 18566]]

60 minutes as the designee of the majority leader.
  Mr. FLEMING. Thank you, Mr. Speaker.
  I come before this House tonight to talk about a very important 
issue--it's been important for years, and it's going to be increasingly 
important and increasingly a part of the debate--and that is health 
care, and particularly health care for our seniors. We've got lots 
going on. ObamaCare, of course, was passed in 2010, and we're running 
into all sorts of problems. Of course, I and my Republican colleagues 
here tonight voted against it.
  I'm joined tonight, by the way, by two of my colleagues, Dr. Phil 
Roe, an obstetrician from the great State of Tennessee, and Dr. Scott 
DesJarlais, who is, like me, a family physician.
  I thought I would just give a brief introduction about Medicare and 
how that fits into the budget. I know that Dr. Roe is going to talk in 
more detail about that.
  No speaker would be complete without a chart, and I have several 
tonight. This is one I think that's important for everybody to 
understand. This pie chart breaks up spending for the Federal budget. 
If you will notice, the vast majority of this pie is in what we call 
permanent mandatory or so-called entitlement spending and interest. 
What makes up a large part of mandatory spending is Social Security, 
Medicare, and Medicaid. The size of this pie, this section of the pie, 
is growing. In fact, if you recall, back in the nineties we actually 
balanced the budget. The last time we balanced it, I think was in the 
late nineties. It was a lot easier to do back then because entitlement 
spending, permanent spending, was not in place to the extent that it is 
today. It was growing, but not as big.
  What is the difference between mandatory spending and discretionary 
spending, which is the other two pieces of this pie? Mandatory means 
that if you qualify for a certain type of service or payment, whether 
you're on Medicare, Medicaid, whether you earned it or not, if you 
qualify for it, the government must pay. No matter who shows up or how 
many people show up, the government must pay. So, therefore, the 
government cannot per se control that cost.
  Discretionary cost, on the other hand, is split into two: defense, 
which is around $600 billion to $700 billion a year; and nondefense 
discretionary, which is what we run the government on. That we can 
adjust, although we've not done a good job in controlling this. In 
fact, that's increased probably 25 percent just in the last 2 years 
under President Obama.
  But I want to illustrate for you what the problem is, and that is 
that the entitlement spending, which we don't control, with an aging 
population and the fact that it's dependent on government spending, is 
growing at a much faster rate than our revenues and inflation.

                              {time}  1910

  This is a chart that outlines where we are today with Social 
Security, Medicaid and Medicare, the part of entitlement spending. Now, 
let me say, first of all, Social Security is down here in the purple, 
and you notice that it slants upward and then it flattens out. Social 
Security is not our problem. Let me repeat that: Social Security is not 
our problem.
  And people who are on it or will be on it, in my opinion, have 
nothing to worry about. Now, we may have to tweak it, we may have to 
adjust it, but you'll notice that the cost really rises relatively 
slowly, and that's just a matter of demographics. And we can adjust 
this, as we have in the past, and make this sustainable. There are 
other ways to do it, in terms of allowing Social Security recipients to 
invest some of their money and so forth, but that's beyond the scope of 
discussion tonight.
  The next group in green is Medicaid and other health care. You'll 
notice it's going up faster. And Medicaid is health care for the poor. 
And then finally in red you see Medicare, and you see how that explodes 
and it goes up continuously. Medicare alone will completely displace 
all the budgetary spending eventually if we don't bring that under 
control. And that would mean we'd have to give up on government itself, 
we'd have to give up on a national defense--everything--unless we begin 
to control that.
  Now, at the rate things are going, Medicare will run out of money, 
become insolvent by 2020. And that is straight from the CBO, the 
Congressional Budget Office. Another way to look at it is that our 
spending is now equal to 15 percent of the total Federal spending is 
Medicare, blowing out of control. What has made this worse is ObamaCare 
actually cut $500 billion, that is, half a trillion dollars, out of 
Medicare to use for subsidies for middle class health care plans.
  So let me repeat: Medicare is running out of money; it's exploding 
through the roof. And what does ObamaCare do, the Members who voted for 
it, it actually cuts money out of it and depletes it of money in the 
future so that it becomes insolvent. And here's where the cuts are: 
$135 billion for Medicare Advantage, which is the private health care 
version of Medicare, $112 billion, which was taken from hospitals, 
$39.7 billion from home health, $14.6 billion from nursing homes, and 
$6.8 billion from hospice care. These are very real cuts.
  And the only explanation that the other side gave us, our Democrat 
friends, is that somehow we'll cut out fraud, waste and abuse. Well, 
let me warn you, any time a politician tells you he's capable of doing 
that, watch out, because I've never seen it done and I don't expect to 
see it done in the future. Because, you see, in order to cut out the 
massive fraud, waste and abuse, you have to spend even more money to 
find all the bad actors. The best way to do away with fraud, waste and 
abuse is to make the system much smaller, perhaps even privatize it, 
and make the system accountable rather than a Big Government 
bureaucracy, which wastes money, whether we're talking about the 
Department of Defense or Medicare. So that should give you kind of a 
beginning of where we are with Medicare.
  Let me just close my opening remarks by saying that there's basically 
two options when it comes to making Medicare again solvent and 
available for us in the future. There is a Republican plan, which would 
allow you, if you are currently on Medicare or 10 years from becoming 
on Medicare, to keep Medicare as it is. And it is sustainable, as far 
as the CBO tells us, indefinitely.
  However, we would have to reform that for younger adults today who 
will be senior citizens by opening up the insurance system, creating a 
marketplace for seniors to buy insurance, and then let government help 
them with what we call ``premium support,'' and allowing competition in 
private care to drive the cost down and raise the level of service. In 
fact, what we in Congress have today is the very same thing.
  The Democrats, their plan is this: goose egg, no plan whatsoever. 
Under their plan--or non-plan--Medicare runs out of money in 8 years. 
And they've failed to present an idea, much less a bill, as we have, 
that would even solve that. Well, that gives you an idea of some of our 
opening discussion.
  First tonight, I want to introduce my good friend, Phil Roe. Dr. Phil 
Roe, as I said, is an obstetrician. I think he has some comments about 
the financing of Medicare and other things as well.
  Mr. ROE of Tennessee. I thank you, Dr. Fleming, and I appreciate you 
hosting this hour tonight and a chance for us to discuss in detail the 
health care of this Nation.
  You know, about 4 or 5 years ago I made a decision, after 31 years of 
practice, to think about running for Congress. And one of the reasons 
was I knew that the health care issue was going to be huge in the 
debate in this Nation's future. And, boy, has that turned out to be 
prophetic.
  Secondly, the thing that I noticed in my patients when I practiced, 
the single biggest factor for both Medicare patients and my other 
private patients and patients without health insurance, was it was too 
expensive; it cost too much money to go see the doctor and go to the 
hospital. If it were more affordable, more of us would have health care 
coverage.

[[Page 18567]]

  Thirdly, we had a group of patients in my practice that couldn't 
afford expensive health insurance premiums. They both worked. Let's say 
it was a carpenter, perhaps his wife worked at a local diner or at a 
local retailer that may not provide health insurance coverage, and they 
make $35,000 or $40,000 a year, but they could not afford $1,000 a 
month for health insurance coverage. And, lastly, we have a liability 
crisis in this country.
  The other thing that we're going to get into a little later in this 
discussion today--and this is the absolute sacrosanct in health care--
is that health care decisions--and I'm going to say this a couple of 
times--health care decisions should be made between a patient and the 
doctor and that patient's family. It should not be made by an insurance 
company, and it should not be made by the Federal Government. And we're 
going to talk a little bit later about the Independent Payment Advisory 
Board that will be making those decisions in the future.
  Do we need health care reform in America? Absolutely. Do we need this 
type of health care reform? Absolutely not. It's a disaster. And we'll 
go into that a little later about what my major concern is for my 
patients that I left in Johnson City, Tennessee, which was how are they 
going to access a Dr. John Fleming, how are they going to access a Dr. 
Scott DesJarlais, who are family practice primary care physicians. And 
the group I have at home that I'm in that I left to come here had over 
80 primary care providers. How are they going to access those?
  Well, let's go look at where we were in the sixties when I was a 
young college student, which was that we had a group of people, my 
grandparents and so forth, who would be retiring. And at that point in 
time, because their insurance was tied to their employment--if they had 
health insurance coverage--there was no way for them to get any 
coverage. They couldn't buy it; there was no way it could be provided 
for. So the Federal Government then got involved in this by forming 
Medicaid and Medicare in 1965.
  Our Medicare program in 1965 was a $3 billion program. There was no 
Congressional Budget Office at that time, but the estimates were that 
in 25 years--so in 1990--this program was going to be a $15 billion 
program. The actual number was $110 billion. They missed it by seven 
times. And in your initial graph right here, if you had placed in that 
graph, Dr. Fleming, interest on the national debt--the one you showed 
with Medicare, Medicaid and Social Security--by 2020 or 2022, even at 
current interest rates, it will absorb the entire Federal budget. And 
that is why we're having this discussion today, to save Medicare.
  I want to mention just briefly, because we'll kick this off later, in 
the current health care bill there have been many changes to Medicare. 
There are increased taxes on medical devices. The President said the 
other day--and we're going to talk about it next week, I think, and 
debate the payroll tax--about how he was a tax cutter. Well, I would 
suggest that the President read his own health care bill because there 
are massive tax increases in that bill.
  The Independent Payment Advisory Board is a bureaucratically 
appointed board, 15 people appointed by the President--and I don't want 
a Republican President appointing them and I don't want a Democrat 
President appointing them--approved by the Senate to do what? To look 
at this Medicare, as we've pointed out, with millions of Medicare 
recipients each day and--as Dr. Fleming pointed out--$500 billion to 
$550 billion less going into the system. More people going in, people 
living longer--much longer, which is a very good thing--we're looking 
at a catastrophe for our Medicare program if we don't make some 
proactive changes now.

                              {time}  1920

  And how can you talk about how can you fix a system that everybody in 
this Chamber knows is broken--all 435 of us know it--if you can't even 
discuss it, if you're accused of dumping Grandma off a cliff if you 
even talk about a system that--I personally am on Medicare. Right now 
I'm a Medicare recipient, so I have a vested interest in seeing that 
this program works for current seniors.
  I was at Furman University Monday night speaking to a group of 
college students on health care. It was a privilege to be there. It's a 
great college. A big turnout of young people. And it was embarrassing 
for me to look at those young people who are just beginning their 
careers and to think that we're going to not leave them the same access 
to care that I have available to me right now.
  If you look at these numbers, Dr. Fleming, you see that it is not 
sustainable, so we have to have this conversation. I want to thank you 
for holding this 1-hour.
  I see we have numerous other colleagues here tonight.
  Mr. FLEMING. I thank the gentleman.
  We have also been joined, in addition to Dr. Scott DesJarlais, by Dr. 
Phil Gingrey, also an OB-GYN; Nurse Ann Marie Buerkle; and Nan 
Hayworth, an ophthalmologist from New York. So we've got a full cadre. 
If anybody here has a headache or, certainly, a heart attack, I think 
they would be very well taken care of on the floor of the House.
  With that, I'm going to ask Dr. DesJarlais to talk to us a little 
bit. I think you have an interest in some of this discussion on IPAB 
and perhaps other things, so I'd love to hear what you have to say, 
sir, on that.
  Mr. DesJARLAIS. Thank you, Dr. Fleming. And I, like Dr. Roe, 
appreciate you holding this tonight because I think there's so much 
fear, frustration, and confusion among our Nation's seniors right now 
about what's really going on. There's a lot of misinformation out 
there. And I think it's good that we, as health care providers, can get 
together and help clear up some of the misinformation because, as Dr. 
Roe said, we should never let the government or bureaucrats get between 
the doctor and the patient. That's a very important relationship, and I 
think most all patients would agree.
  How did we get into this mess?
  It's really kind of mind boggling that it has come this far. And as 
you stated earlier, the Democrat plan is doing nothing; and we know 
that the consequences of that as, per the CBO, the actuary of CMS, Mr. 
Foster, has said Medicare will be bankrupt by 2020. So we cannot afford 
to do nothing. And we got into this mess really just by kind of the 
head-in-the-sand approach that sometimes occurs here in Washington.
  As Dr. Roe mentioned, Medicare was initiated in 1965, and at that 
time the life expectancy for a male was 68. Well, thankfully, through 
good medicine, good follow-up, good care, better drugs, better 
techniques, the life expectancy has gone up at least by a dozen years. 
But that being said, there really wasn't any planning for that 
increase. A program that was designed for, on average, 3 years of 
coverage is now 12 years more, and so that's part of the problem.
  A second big factor is we all knew about the baby boomers. Everyone 
knows about them. And the bottom line is they have started hitting the 
system at an alarming rate. Ten thousand new members every day are 
entering the Medicare system. Again, something that we've all seen 
coming, but it wasn't accounted for in terms of cost; and Dr. Roe 
explained how it was underestimated greatly what it would cost in the 
first place.
  We know that people pay into Medicare because that is going to be 
their health care plan when they retire. That's what was promised to 
them. So we can't do nothing.
  In the Paul Ryan plan, we laid out that those 55 and older won't have 
to worry about it. We know that we can't do nothing, so those 55 and 
under will have to make changes, as you discussed, and I'm sure we'll 
discuss more.
  But for those seniors out there that are concerned that the 
Republican plan is cutting them off or killing Medicare as we know it 
simply isn't true. We're trying to preserve, protect, and save it for 
future generations as well as take care of them.
  Right now you can take an average couple who makes $80,000 a year and 
they pay, over a lifetime, about $109,000 in Medicare taxes into the 
program.

[[Page 18568]]

But with health care costs the way they are now, the average extraction 
for that same couple is $343,000.
  Mr. FLEMING. If the gentleman will yield on that point, I want to be 
sure that that's not missed, and that may be the most important 
statement made tonight. I believe you said that, through a lifetime, a 
Medicare recipient will pay in an average of 100,000 or so dollars but 
will take out, on average, $300,000.
  So what we really have with Medicare is somewhat of a subsidy system 
which does not subsidize according, necessarily, to need. My point in 
saying that is: Warren Buffett, today, because he's over 65, qualifies 
for Medicare, and if he gets care, I assume would get the same 
subsidized care, subsidized by whom? Taxpayers--middle-class, working-
class people who pay the private insurance rates.
  In some ways, Medicare has become not just help for the poor and the 
elderly, but just subsidy for people over 65. And so we're going to 
have to look at: Is there a way in the future that we can even this 
out, where we're not necessarily subsidizing for those who are capable 
of paying some of their own costs?
  Mr. DesJARLAIS. Right.
  As you say, it's clear that $1 in for $3 out doesn't add up by 
anybody's math, even Washington's math. So those factors make it very 
clear that Medicare is on an unsustainable path.
  I find it very frustrating that so many people are living in fear 
right now with this misinformation. And if any of the other Members--
I'm sure they experienced, as my office did, the AARP here, a few weeks 
ago, had seniors calling Congressmen to say, you know, Don't cut our 
Medicare. They're referring to the SGR cuts, which actually pertains to 
the doc fix. But the seniors are confused thinking that their Medicare 
was actually going to be cut 30 percent or 29, 27 percent, whatever it 
is. And so when they were calling my office, I was glad to tell them, 
Yes, we get it. That actually is a cut to physician reimbursement.
  But what it does to seniors, more concerning, is that it's going to 
limit their access to care, because physicians right now are in a 
position where they can't afford the overhead to even keep their 
practices open.
  I think it was good that the AARP brought that to their attention, 
but it certainly is great that we have the opportunity tonight to clear 
that up for our seniors, that it's not a cut, a direct cut to their 
Medicare benefits, but it is going to directly impact their access to 
care.
  Mr. FLEMING. Absolutely. I thank you for the wisdom of your 
experience, Dr. DesJarlais.
  I'd like to turn to Dr. Gingrey here. He's joined us and, of course, 
has conducted a number--I can't even count the number that I've 
participated in with Dr. Gingrey with respect to Special Orders that 
we've had.
  And before doing that, just to follow up on what Dr. DesJarlais said 
about the 100,000 in, 300,000 back, I can recall one day in my own 
practice sitting there and thinking about the three patients that I 
just saw. In Room 1, I saw a little lady who's on Medicare who could 
barely scrape by by the end of the month, and she's on Medicare and 
getting the benefits of Medicare, and God bless her, she was getting 
them. And then I thought about the second room where there was a 
gentleman who's a multimillionaire. But you know what? My charge to 
both of them and what Medicare did for both of them was precisely the 
same.
  I just couldn't quite understand that, especially when I thought 
about the little mother in Room 3 who's on private insurance, two-
paycheck family, baby, barely scraping by, paying far more in their 
premiums than someone in Medicare and having to raise children. It was 
her insurance premiums that were subsidizing both the little old lady 
who was poor and the multimillionaire.
  We're going to have to do something about that to make the economics 
of this system work. It is unsustainable, as we know.
  Dr. Gingrey, I would like to ask you if you could give us a few 
words, sage wisdom on what your perspective of where we are with health 
care, ObamaCare, Medicare, and all the other cares that we're talking 
about.
  Mr. GINGREY of Georgia. I thank the gentleman from Louisiana, Dr. 
Fleming, for yielding, Mr. Speaker, and I thank our leadership for 
giving us this hour to focus in on Medicare and ObamaCare, formally, I 
guess, called Patient Protection and Affordable Care Act. We all know 
it to be the Unaffordable Care Act.
  But I think it's very important, Mr. Speaker, and instructive for the 
folks back home, especially our seniors, to look at this body and the 
other Chamber as well, Congress as a whole, and you look at the Members 
who are health care providers. In this House of Representatives, there 
are 435 Members, and 21 of them on the Republican side are health care 
providers: nurses, doctors, psychologists, dentists.

                              {time}  1930

  On the Democratic side of the aisle, three. You look at the other 
body, at the Senate, and you see four doctors on the Republican side. 
None on the Democratic side.
  So as we get into this season, this political season, of course the 
Presidential election cycle, Mr. Speaker, you know, we all know, that 
we're already seeing the ads. I think Dr. DesJarlais referred to this 
add about cutting Medicare 30 percent. Don't let Congress cut Medicare 
30 percent. And who cares more about seniors.
  And I think those statistics are pretty darn telling in regard to who 
cares more about our seniors. Many of us, in fact, have practiced so 
long that we're seniors. Thank God we've got good health and vigor and 
enthusiasm for giving up what has been a wonderful profession, whether 
we were nurses or doctors or whatever, but caring for people and the 
compassion that goes with it, to come to Congress, come here inside the 
Beltway and really work on behalf of our seniors, work on behalf of 
getting the health care policy right. But particularly in regard to our 
senior citizens and the millions that depend on Medicare either because 
of a disability or their age.
  So it's the Republican Party, Mr. Speaker. It is the Republican Party 
that is really working on behalf of our seniors.
  What did the Democrats do when they were in control for that brief 
period of time and Ms. Pelosi was the Speaker? They brought the country 
a whole new entitlement program, ObamaCare. It had nothing to do with 
seniors. It had nothing to do with the poor, who are covered by 
Medicaid and the Children's Health Insurance Program, the SCHIP 
program. In Georgia it's called PeachCare. They did nothing to 
strengthen Medicare.
  In fact, to pay for this new entitlement program, health insurance 
for all, young and healthy people, they gutted the Medicare program.
  Mr. Speaker, the gentleman from Louisiana has a poster before us 
right now, the first slide, if you will, and we need every one of us on 
both sides of the aisle to focus on that. And as he points to the first 
bullet point, cutting $575 billion from the Medicare program. And most 
of it, in the next bullet, is from the Medicare Advantage program. And 
of the 40 to 45 million people that are on Medicare, most of them, 
because they're 65, maybe 10 million of them because they're disabled 
and younger, but so many of them, Mr. Speaker, get their health care on 
the Medicare program through something called Medicare Advantage. And 
that's the key word.
  Why is it Advantage? Because it gives them comprehensive care, it 
gives them an emphasis on wellness, prevention. It's not just treating 
disease. It gives them a drug benefit even before Medicare Part D was 
enacted by a Republican Congress back in 2003. And what do the 
Democrats do? They took--what was it, Dr. Fleming?--$135 billion out of 
the Medicare Advantage program over a 10-year period. That is a 14 
percent cut.
  And President Obama says if you like what you have you can keep it. 
Well, you can keep it if it's still available, but it won't be.

[[Page 18569]]

  We're here tonight to let the American people know and let our 
colleagues know, and if we have to hit them over the head with a 2-by-4 
to get their attention, we're going to do it. Because they are ruining 
a great program. And we're health care providers. It breaks our heart. 
We know. We see the patient. We are at their bedside in sickness and in 
health when they come to our office for routine checkups.
  But we're here now I guess as policy wonks. It's our colleagues back 
home--we want to keep them in the Medicare program, particularly 
primary care doctors seeing those patients. It just breaks my heart to 
see what's happening.
  I thank the gentleman from Louisiana for managing the hour tonight on 
behalf of our leadership to make sure that these points are made and 
made very clear to the American people, particularly our seniors.
  Mr. FLEMING. I thank the gentleman. Dr. Gingrey serves on the House 
Energy and Commerce Committee, a committee that has oversight and 
jurisdiction in this area, very important, looking at a lot of 
legislation.
  Next, I want to turn to another of our freshmen. We've had a 
wonderful cadre of freshmen we appreciate so much and a wealth of 
physicians and dentists as well bringing in their years of experience, 
training, and education.
  Next I would like to recognize Dr. Hayworth, Nan Hayworth from New 
York, and would be very interested to hear what you have to say this 
evening.
  Ms. HAYWORTH. Thank you, Dr. Fleming, and I add my thanks to our 
distinguished colleague from Georgia in gratitude for your hosting and 
managing this session tonight.
  We just had a Medicare telephone town hall today with our 
constituents in the beautiful Hudson Valley. We had a Medicare 
administrator with us because it's open enrollment season for Medicare 
throughout the country, I believe, up through December 7. So we were 
very grateful to have a Medicare administrator with us who helped 
answer some of the questions about some of the complexities of Medicare 
because there are a number of them, as you might imagine.
  But we did get one question that was conspicuous because the 
gentleman asked me, and it's one that we've all been asked, as Dr. 
DesJarlais was saying not long ago, ``Nan, why are you against 
Medicare?'' I explained to my constituent that gosh, sir, it's exactly 
the opposite. I want to preserve and protect Medicare. I want to make 
it secure and sound. This is very important to all of us, to me as a 
doctor. I had the privilege of practicing for 16 years. I'm an 
opthamologist. So many of my patients were seniors. I'm the daughter of 
two elderly parents, both of whom rely on their Medicare benefits. So 
the last thing that I would want to do, the last thing that any of us 
want to do is to harm Medicare. We know how important it is.
  More specifically, this nice gentleman was asking about our vote on 
the budget this past spring. And as all of us here know and as our 
listeners may not be fully aware, we did pass a budget in the House of 
Representatives this past April. They may not have heard quite as much 
about it as they otherwise should have, if you will, because the Senate 
did not pass a budget. They did give ours 47 more votes than the one 
proposed by the President. Nonetheless, that was not enough to pass a 
budget so we've been waiting now, the American public, for at least 
2\1/2\ years for the Senate to pass a budget.
  But in our budget, and Dr. Gingrey and Dr. Fleming have just been 
referring to the $575 billion that was removed from Medicare by the 
massive 2010 health care overhaul. In our budget, we restore those 
funds to Medicare. That is a very, very important fact.
  We all voted here as doctors, as caring legislators, as 
representatives of our districts to restore funding to Medicare, to 
strengthen Medicare, not to weaken it. That's the last thing we want to 
do and the last thing we can afford to do.
  So I think it's very important for the American people to understand 
that as things stand now, the Medicare benefits that people are 
counting on are threatened in ways that they don't have to be.
  So that's something that people should think about, people who 
cherish Medicare, who receive Medicare and who have loved ones who 
depend on Medicare; that Medicare is, unfortunately, as our colleagues 
have discussed, running out of funds.
  When we think about payroll taxes, and we hear a lot about payroll 
taxes in the news these days, payroll taxes go to pay for Social 
Security and for Medicare. And the way these programs were set up, as 
we all know but just so that everybody understands, they were supposed 
to be, people would contribute from their paychecks, and the money 
would be kept by the Federal Government and then returned to them in 
their benefits in their senior years, when they would need them.

                              {time}  1940

  That could be a very helpful thing; but as Dr. DesJarlais has pointed 
out, thank the good Lord, people are living much, much longer than they 
were when Medicare was first made law.
  So we are facing a challenge because, for several decades, 
contributions to Medicare from the payroll taxes were built up. People 
weren't taking out as much in their Medicare benefits as they were 
paying in. The baby boomers were not part of the Medicare-eligible 
senior group yet, and now they are. Now our seniors are living many 
years longer, thank the good Lord--and I wouldn't trade a day with my 
parents nor with any of our seniors--and our health care is wonderful 
in the United States, but it is costly for a number of reasons.
  The Medicare funds that were built up have now started to be 
depleted, and they're going to run out, it's projected, anywhere from 
2024 to now 2021. What we all know is that the estimates are probably 
off the mark. So, to take an extra $575 billion out of Medicare is the 
last thing we want to do.
  It's very important for everybody to understand that because, 
although there are workers in this country who are contributing their 
payroll taxes now--and those are going to help fund Medicare--when 
those folks become retirees, Medicare is going to be very different in 
terms of the funds it has. That Medicare trust fund is going broke.
  So folks have been thinking about--Dr. DesJarlais in particular 
mentioned it, I think--and may have heard three letters, SGR, about the 
doc fix. What is that? What does that mean?
  When patients go to visit their doctors and when they receive 
Medicare, as Dr. Fleming was saying, our Medicare patients have a 
certain fee schedule that we are obligated to follow. In a lot of 
cases, depending on their insurance and other factors, that fee 
schedule is far less than the fee schedule that is set up for our other 
patients. So Medicare pays doctors and other providers, and it 
generally pays less than other programs do. We accept that when we 
participate in the Medicare program, but to provide Medicare in the 
United States is very expensive. We have staff that we have to pay. We 
have overhead. Everybody who has a business--and I had my own practice, 
a small business--has rent and supplies and staff and insurance to pay.
  One of the unique aspects of America in terms of our medical care is 
that we do have what's called a ``liability system,'' which is very 
costly, to cover lawsuits for malpractice. We should, indeed, do 
everything we can to prevent malpractice, but lawsuits in this country 
are very expensive.
  Mr. FLEMING. If the gentlelady would yield, I think Dr. Gingrey has 
something he would like to add.
  Mr. GINGREY of Georgia. I thank the gentleman from Louisiana for 
allowing me to take up a little time--maybe just a minute--to interrupt 
the gentlelady from New York.
  Ms. HAYWORTH. Absolutely.
  Mr. GINGREY of Georgia. She has made such great points.
  The thing that I wanted to mention to my colleagues is that if we do 
nothing--and I think Representative Hayworth pointed this out--it is 
really not an option. She talked about those

[[Page 18570]]

dates--2024, maybe, but probably closer to 2021--when part A becomes 
fiscally insolvent. If we do nothing, then what would happen is our 
seniors under the Medicare program would take a 22 percent cut in their 
benefits package, or else we would have to raise the payroll tax 22 
percent.
  I'll yield back after making this comment as I think this is 
important.
  Medicare was enacted as an amendment to the Social Security Act in 
1965. I guess it's title XVIII. We didn't have all of the information 
we needed back then. As Representative Hayworth points out, situations 
were different. Back then, people were not reliant so much on 
medication. It was more surgery and that sort of thing. Now we have 
Medicare part D. The point is that things change; and if we hadn't 
changed with the times, we would still be watching analog television. 
It's just as clear and as simple as that.
  For people to criticize what the Republican budget called for in 
regard to making changes to Medicare so that it remains solvent for our 
children and grandchildren--and, as Dr. Hayworth pointed out, to 
protect it, preserve it and strengthen it for those who are already on 
it--it would not do anything in regard to them but would be a phased-in 
change for our children and grandchildren so they'll have it like we've 
had it.
  I thank the gentlelady for letting me interrupt briefly.
  Mr. FLEMING. Since we are beginning to run a little short on time--
and I want to make sure we get to all of our doctors and nurses--I'm 
going to recognize Ms. Buerkle, a very excellent nurse and a wonderful 
addition to our freshman class.
  Ms. BUERKLE. I thank my colleague from Louisiana.
  Mr. Speaker, I just want to say what an honor it is to be here 
tonight on the floor with my colleagues and the members of the Doctors 
Caucus.
  I do stand here as a nurse and also as the daughter of a 90-year-old 
mother. So Medicare for her, I know how she depends on the system.
  One of the things we didn't talk about and one of my roles in life 
was as an attorney, as an attorney who represented a large teaching 
hospital. About 2 weeks ago, I joined with some of my colleagues on the 
House floor, and we talked about what this health care law is going to 
do to our hospitals. When our hospitals and our doctors are affected by 
reimbursements, by Medicare cuts, that really affects our seniors. That 
reduces their access to care.
  So the first thing I want to do tonight as a health care professional 
and as someone who cares deeply--and I think that's the beauty of this 
tonight, of our getting together as people who have invested their 
lives in health care, who love people, who care about people. This 
isn't a Republican or a Democratic issue. This is an American issue 
because health care affects all of us. This is a group of people who 
really believes that there is a better way, that there is a much better 
way to provide access to health care in our country without 
jeopardizing that access and without jeopardizing the quality of care 
that our country has to offer.
  So the first thing I want to do tonight is reassure our seniors that 
we are talking about protecting and allowing the Medicare system to 
continue on. What they need to understand is that the health care law 
has changed Medicare forever. Medicare is different now than it was 
before the health care law passed. The health care law cuts, Mr. 
Speaker, $500 billion from Medicare.
  I just want to make clear on this graph what happens to Medicare 
reimbursements from 2012. You can see where we are. It's a minus, a cut 
of 9.7 percent; but here in 2018, the cuts to Medicare and the 
reimbursements to our hospitals are down 28.6 percent. I've had all the 
hospitals in my district come to me, and they were proponents of the 
health care law. They wanted reform. They've come to me and they've 
said, This health care law is going to bankrupt us because not only is 
the health care law affecting their Medicare reimbursements; it's 
affecting their disproportionate share reimbursements, which keeps many 
hospitals afloat that treat indigent patients and that treat Medicaid 
patients. It also affects their GME and their IME, which we talked 
about in the last Special Order we had in regards to how we're going to 
keep our teaching hospitals and keep all of our hospitals viable.
  So I just want to leave the message tonight with the American people 
that we care about preserving Medicare for our seniors. We are not 
proposing anything in our budget proposal that would affect our seniors 
and those back to age 55. We want to assure the American people that we 
care so deeply about health care and about the quality of health care; 
but we are very concerned about this health care law, and it's why we 
voted to repeal it several months ago. One of the first things we did 
when we came to Washington was to repeal the health care law because we 
know what it will do to our seniors and to our health care providers.
  I thank my colleague for organizing our time here tonight on the 
floor. Again, we just want to reassure the American people that we care 
about our seniors. We want to make sure they have access to quality 
care, to good health care.

                              {time}  1950

  Mr. FLEMING. I thank the gentlelady for a very compelling discussion, 
both as a health care provider and nurse, but also as a daughter of an 
elderly mother. Those words are very heartfelt, and obviously it means 
as much to you that we protect Medicare and health care in general as 
it would anybody. There's no reason why, just because you're a Member 
of Congress, that you would love your mother any less, so I think those 
are important words.
  We're going to move now from a nurse to a surgeon. Dr. Benishek from 
Michigan has joined us this evening, and let's hear from you, Doctor, 
and see what you have to tell us.
  Mr. BENISHEK. Thank you. Mr. Speaker, it's my pleasure to be here 
this evening to join my colleagues to talk about Medicare.
  As you may know, before coming to Congress, I served as a general 
surgeon in my district for the last 30 years, and many of my patients 
were on Medicare. And as a practicing physician, I often expressed to 
my patients--and my understanding wife--about our broken health care 
system here in America. In fact, that's one of the reasons I decided to 
get more involved in the political process and actually run for 
Congress.
  Most Americans don't understand that Medicare will be bankrupt within 
the decade if we don't do something to fix it. I didn't make this up. 
The actuary for the Centers for Medicare and Medicaid Services actually 
provided this number. You know, I think if you ask most 65-year-olds 
just beginning to use Medicare, most would be very worried to learn 
that their primary health care provider was projected to be bankrupt 
within the decade.
  In fact, according to a recent Social Security Trustees report, 
Medicare seniors should expect to see a 22 percent benefit cut or 
workers should expect to see a 22 percent hike in their payroll taxes 
unless some action is taken. The bottom line is, if action isn't taken 
today, seniors in the program today, not to mention those looking to 
retire in the near future, begin to lose their benefits.
  Despite these facts, the other side of the aisle has spent the last 6 
months attacking us, often saying that House Republicans' attempt to 
protect and preserve Medicare was, in fact, destroying it.
  Are you kidding me? Accusing myself and my fellow physicians in the 
House of wanting to end Medicare? We spent our careers caring for 
Medicare patients and are proud now to call them constituents.
  The real truth of the matter is that President Obama was elected in 
2008 with the promise of hope and change. He did accomplish change in 
America's health care system, but I don't think it's the kind of change 
that Americans bargained for.
  Mr. Obama's health care law cut $575 billion from an already ailing 
Medicare system. The name of Mr. Obama's health care bill is the 
Patient Protection and Affordable Care Act. Mr.

[[Page 18571]]

Speaker, I ask you: What type of patient protection cuts $14.6 billion 
from nursing homes, $112 billion from hospitals, and $135 billion from 
Medicare Advantage?
  While I'm on the record extensively for balancing the budget, I do 
not believe that our health care system should be made affordable on 
the backs of America's seniors.
  If the $500 billion in cuts made by ObamaCare were not bad enough, 
this bill did nothing to address the nearly 28 percent cuts to 
physician payments scheduled for January 1 of 2012. I believe in 
providing access for America's seniors, not taking it away.
  I am happy to announce here tonight that I'm working with members of 
the Doctors Caucus, House leadership, and Members across the aisle to 
develop legislation that will solve this issue once and for all. Mr. 
Speaker, tonight I call on all my colleagues to work together to ensure 
America's seniors that America will continue to be there for them in 
their time of need.
  I have made a pledge to seniors in my district that I will not 
support any changes to Medicare benefits for those 55 years of age or 
older. It is my belief that for those age 54 years of age or younger, 
some reforms will be necessary to guarantee that Medicare remains 
solvent in the long term for our children and our grandchildren. Mr. 
Speaker, we are here tonight to show that, as physicians, we want to 
preserve Medicare for the future.
  I thank Dr. Fleming for organizing this Special Order hour.
  Mr. FLEMING. I thank the gentleman from Michigan.
  Again, we're getting a world of experience here tonight, all the way 
from OB-GYNs, ophthalmologists, family physicians, nurses, so much in 
the way of words of wisdom, and we have so much on our side of the 
aisle with Republicans, as my friend points out, a dearth of available 
physicians, health care workers on the other side of the aisle. It 
seems a shame that we were completely closed out of the creation of and 
passage of the health care reform act, which certainly suggests that we 
need to go back and do it.
  We also are joined tonight by our colleague from Arizona, Dr. Gosar, 
who is a dentist and a very valued member, as well, of the conference. 
I would love to hear from you this evening.
  Mr. GOSAR. Dr. Fleming, thank you so very much for organizing this 
hour and being able to have a fireside chat with the American public 
about health care and what really is coming about and what actually is 
going on with a broken health care system. I also want to take the time 
to educate, to understand--have the American people understand what it 
is about a vibrant economy that actually helps our Medicare system.
  Now, I know the holidays are coming up and we're going to be 
discussing giving a continuation of a tax holiday for many Americans, 
about the thousand dollars for an individual on their FICA, on their 
withholding tax, and to employers; but I also want to take the time to 
explain to the American public that there is a cost involved here. And 
part of that cost when a withholding tax is taken out goes into Social 
Security and partly to Medicare, and part of this is particularly 
Medicare part A, the hospitalization act, which is the closest one to 
insolvency of all parts of Medicare.
  Now, we lost 5 years, particularly on Medicare part A, the 
hospitalization act, just from the years of 2010. We have yet to start 
looking at the disastrous parts of the economy to 2011 to be added into 
the insolvency. But what ends up happening is this takes a further hit 
in the numbers and amount of money that is actually part of the 
equation for our seniors in Medicare, so it's going to get worse before 
it gets better. And when you couple that with this administration 
taking--I call it stealing--over $500 billion away from the current 
Medicare program to build another entitlement, that's just not right.
  I came into Congress because I was concerned about health care. As a 
dentist, I love seeing a smiling face, because a smiling face tells me 
something about vibrancy, about health, and participating in the 
greatest things that this life gives us. But it also tells me that it 
has to be a participating sport and that what we have to have is a 
patient taking care of and being involved actively in the choices and 
decision processes in their health care, and that's what I want to see.
  I'm flabbergasted, to be honest with you, that we see a program 
rectifying Medicare, or attempting to, through ObamaCare, but then we 
leave the SGR fix or the physician fix completely separate. It doesn't 
make sense to the average person why these aren't all integrated and 
part of the same equation.
  I also want to remind the American people, this is not an easy 
solution. We didn't get here overnight, because we didn't do our due 
diligence like we had talked about earlier. We didn't change with the 
times as we grew older. We changed our participation and age and the 
variables that we had.
  We also enveloped technology, unbelievable things that no one in 1965 
could have even imagined, they could have dreamed but couldn't have 
actually imagined. And that's what the other part is is that we also 
have to look--I come from a very rural district, and what is happening 
back in my neck of the woods is the primary care doc who was that 
gatekeeper, they're no longer around. They either are associated with a 
hospital or a federally qualified health center--if you can get them to 
see you. And that's the part that also makes me tell the American 
public we have got another problem.
  You were involved in this Joint Committee that had Democrats and 
Republicans, 12 of them, trying to figure out some type of a debt 
solution for $1.2 trillion.
  I want to remind the American people there's another consequence in 
this, not only to our military, but to our health care providers as 
well, because the sequestration, when it goes through, is also going to 
tap, once again, the providers who are no longer being able to afford 
to see patients, and our hospitals, particularly those rural hospitals 
that will be going out of business. So there won't be an access to 
care. We won't have the ability to be a part of our own health care 
because there won't be a health care provider out there.

                              {time}  2000

  This is the dynamics that we have to look at. This is the equation 
that is so immense. What I have always said is start a little bit at a 
time. Make sure that the playing field is level and all of the 
participants are actually there, increasing the competition, making 
sure the public health and the private health are all in balance, and 
then making sure we have some tort reform.
  We have to have that. That was absolutely missing within this health 
care system. That is what we are going to have to get back to. And 
we're going to have to have sunset clauses that we reactivate and 
reevaluate each of the process as our aging population gets older and 
as our technology gets better and there are new advances in medicine. 
We have to empower people to be part of their health care solution and 
empowering them to get back with their physician and their health care 
system. That's what we need to do.
  And that's the most vibrant aspect that I can challenge our seniors 
with. We're here for Medicare. We're here to change Medicare in the 
right way. We're here to change it for you
  Mr. FLEMING. I thank the gentleman, Dr. Gosar. I'm just going to make 
a couple of closing comments; and in the few moments we have left, I'm 
going to allow some of our other physicians to give closing comments.
  One of the important things we have learned here tonight is under 
ObamaCare, $575 billion was cut out of Medicare. Medicare is going 
broke, becoming insolvent, according to the actuary in 8 years. The 
Republicans passed a budget earlier this year that would have fixed 
that for good. And the Democrats have yet to even talk about it or even 
acknowledge that it exists. But they do know it. So I want to be sure 
that we leave here tonight with an understanding of the seriousness of 
the challenges that we have before us.
  Now I would like to recognize Dr. Roe for some parting comments.
  Mr. ROE of Tennessee. Dr. Fleming, thank you. I was just looking 
here,

[[Page 18572]]

over 200 years of experience. What a diverse group. We have nursing, 
dentistry, family practice, OB-GYN, surgery, and so on. I think one of 
the greatest frustrations I had when I came to Congress, and Dr. 
Gingrey has been here longer than you and I have, and one of the things 
that I noticed in the health care debate that we had, now going on 3 
years ago, was this: with nine physicians, M.D.s in the U.S. Congress, 
in the 111th Congress, not a single one of us was consulted about this 
health care bill. This was done on a completely partisan basis.
  I have to kind of chuckle. I have never seen a Republican or a 
Democrat heart attack in my life. I have never personally operated on a 
Republican or a Democrat cancer in my life. These are people problems, 
as Congresswoman Buerkle said a moment ago. These are people problems 
that affect all of us in this country.
  What we wanted to do, as I stated when we started, was to make the 
cost of care go down. This is not going to do this. Look, this is very 
simple. When we talked about the IPAB, and I think we'll have to use a 
different time to discuss the Independent Payment Advisory Board 
because it is so detailed, but just very briefly, this is how this 
works.
  Several of us have pointed out that $575 billion was taken out. Three 
million seniors a year going into Medicare, reaching Medicare age, and 
this group, this group of bureaucrats up here appointed, and I don't 
want them appointed by a Republican or a Democrat. I think Congress 
ought to be accountable, and we ought to be accountable to the American 
people about what happens to Medicare, not push it off to some 
bureaucrats that are going to make these decisions, and then we say, 
oh, I'm sorry, we can't do anything when care is denied because when 
you have $575 billion less, and 3 million more people added per year, 
that's 30-something million people in 10 years, you know what that 
leads to, Mr. Fleming.
  It leads to a rationing of care. Decreased access. And if you have 
decreased access to your primary care provider, it means decreased 
quality of your care and the cost is going up. That's what's going to 
happen with this plan. That's why it's imperative, not just Medicare, 
but that we overturn the Affordable Care Act because it's not good 
medicine for patients.
  If we simply had been included in the debate, this would not be a 
plan that you had to run through and get rid of the 1099 form, the 
IPAB. It's a bipartisan bill now with 214 bipartisan cosponsors. Those 
folks realize it's a bad idea. I could go on and on and on.
  One of the good parts of the Affordable Care Act, let's point it out, 
it costs more money, but allowing a 26-year-old to stay on their 
parents' health care plan, that's a great idea unless your parents are 
not paying the bill. Currently, if a young person, 22 or 23 years old, 
gets health care, they'll pay one-sixth what I do. Now what happens 
with this, it has to be a three-to-one ratio, so their health insurance 
plan costs double.
  We could go on and on about the inconsistencies. I think the previous 
Speaker, the current minority leader, had it right when she said let's 
pass it and then find out what's in it. Well, I read it, as most of us 
physicians did, and we found out all of the things that were in there 
that were not good for our patients. We're just now discovering it's 
going to be more costly for businesses out there, and we need to have 
an entire hour on that.
  Mr. FLEMING. I thank the gentleman. Before I recognize another Member 
in the last minute or two that we have, I would just like to say that 
we are going to be having a lot more of these sessions. So we've just 
started. We've just scratched the surface. We're running out of time, 
so just to wrap things up, we have just barely scratched the surface. 
And these are not all the physicians or health care workers we have on 
our side. There are others here who could have been here, but had some 
other commitment tonight, but will be here next time.
  I would love to talk more on IPAB. Even many Democrats see that was a 
very big mistake. It will be one way that you can get the door closed 
on your health care and getting the right sort of care in the future.
  I thank everyone for being here tonight, and I look forward to doing 
it again very soon. God bless you all.
  I yield back the balance of my time.

                          ____________________