[Congressional Record (Bound Edition), Volume 157 (2011), Part 8]
[House]
[Pages 11957-11963]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           GOP DOCTORS CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank my leadership, the 
majority leader on the Republican side, the Speaker of the House, and 
our conference chairman, Representative Jeb Hensarling, for giving us 
the opportunity--us, the House GOP Doctors Caucus--to have the Special 
Order hour this evening.
  It's kind of convenient, Mr. Speaker; my colleagues on the other side 
of the aisle, the well-respected Members, my friends from the 
Congressional Black Caucus, were talking about the budget and what 
we're trying to do with regard to moving forward, talking, of course, 
about safety net programs and entitlement programs, such as Social 
Security and Medicare. And that's a great segue into the topic of our 
discussion this evening because it's going to be about the Medicare 
program.
  We, on our side of the aisle in the Republican-passed House budget, 
take a responsible approach to solving the Medicare crisis, which the 
trustees have said to all Members of Congress--not Republicans, not 
Democrats, not House Members, not Senate Members, but all of us--that 
according to the trustee report, by the year 2024, if we don't do 
something about the Medicare program as it currently exists, as it's 
currently funded, the amount of spending that occurs year after year--
and will only increase as more and more of our baby boomers are 
reaching age 65--if we don't do something about that, then that 
Medicare part A hospital trust fund is not supported by any constituent 
premiums, it's going to go broke. It absolutely is going to go broke.
  So I say to my Democratic colleagues who just spoke, the 
compassionate thing--and I know they have great compassion for those 
who, maybe through no fault of their own, can't help themselves; but 
the compassionate thing, Mr. Speaker, is to save the program, to 
guarantee, preserve it for current Medicare recipients. Indeed, even 
for folks that are only 55 years old today, Medicare, as we know it, 
would be protected, would be strengthened for all of those individuals. 
And by the time those who are 55 years old today become 65, in 10 
years, around 2024, there would be something like 65 million seniors 
and a smaller

[[Page 11958]]

number of disabled individuals in the Medicare program as we know it. 
They would be in that Medicare program as we know it for the rest of 
their natural lives. And thank God, because of good health care in this 
country, women, I think, are living on average to age 82 and men maybe 
to age 78. So these 65 million people will be on Medicare for a long 
time. Medicare as we know it.
  My colleagues didn't mention this in their hour; but what we do in 
our budget is go forward with a plan for younger folks--indeed, even 
for my grandchildren, my 10 grandchildren, the oldest two are 13-year-
old twins--but let's say them, or 25-year-olds, 35-year-olds, 45-year-
olds, indeed, we create the adult approach, the mature approach to 
solving the Medicare problem so that it will be there for them instead 
of nothing come 2024. And maybe some of us have paid for 25 years that 
FICA tax that's taken out of our paychecks every week or every month.
  So I say to my friends, this idea that President Obama has and the 
leadership of your party of just simply kicking the can down the road 
doesn't get the job done. It's what we call sometimes--and I know all 
of us know the expression ``whistling past the graveyard,'' in other 
words, pretending that a problem doesn't exist. And that's an 
unconscionable approach.
  I am very pleased tonight, Mr. Speaker, to have a number of my 
colleagues who have joined with us. Some of them are a part of the 
House GOP Doctors Caucus. We are mostly medical doctors. There are a 
number of registered nurses in our caucus. We have a lot of health care 
providers. There are dentists. But in the aggregate, the members of the 
House GOP Doctors Caucus are medical professionals who spent a lot of 
their lives practicing medicine and providing care, indeed, under 
Medicaid and the Medicare programs, seeing those patients mostly at a 
financial loss, but still very willing to try to help those folks who 
need us to be there for them in these safety net programs.
  I think in the aggregate, the membership of the House GOP Doctors 
Caucus may have over 350 years of clinical experience. Some of us are 
getting a little long in the tooth and a little gray by the sideburns. 
But we are now Members of Congress, and we are trying to do things for 
our constituents and the seniors of this great country of ours to make 
sure that we preserve and protect programs like Medicare and Medicaid. 
And that's what this is all about tonight.
  I want to first yield to my friend from Tennessee, my co-OB/GYN 
doctor. Dr. Phil Roe has been a Member of this body now for 4 years and 
has been a great asset. And I know that Dr. Roe has a bill that he 
wants to address concerning some problems that were enacted under 
ObamaCare.
  I would gladly yield to Dr. Roe from Tennessee.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. It's a 
pleasure to be here tonight.
  Mr. Speaker, I go back to when Medicare first began. In 1965, there 
was a problem identified in America where we had a group of our 
citizens, as they became 65 years of age and older, that didn't have 
access to quality health care. So a plan was put in place, along with 
Medicaid for our poor citizens at that point, to access quality care.
  In 1965, the Medicare program was a $3 billion program. There was no 
Congressional Budget Office at that time. The estimates were in 25 
years that this would be a $15 billion program. It actually turned out 
to be over a $100 billion program in 1990. In 2010, it will be 
somewhere about $550 billion.
  We also have, as has been pointed out in our previous hour by our 
friends from the Congressional Black Caucus, that we have a tremendous 
deficit. We're borrowing 42, 43 cents of every dollar that we spend in 
this country. So that's why the discussion was started.
  I came to Washington--really, I practiced medicine, as Dr. Gingrey 
said, for over 30 years and realized that we had a serious problem not 
just in Medicare but in health care. So we came to work on health care 
reform. In the Physicians Caucus in the previous Congress, there were 
nine of us in the caucus. Not one of us was consulted on the Affordable 
Health Care Act. I mean, decades worth of experience, over 200 years of 
experience in the Congress at that time, and no one--not one of us--was 
actually consulted.

                              {time}  2040

  The way I looked at the problem in our health care system was we had 
three problems:
  One is we had a problem where the system was too expensive. When you 
go to the doctor, it cost too much money to go see a physician. Number 
two, we had a group of people out there who didn't have affordable 
health care coverage. Maybe the husband is a carpenter, as in our area, 
maybe the wife worked at a local diner or somewhere else that didn't 
provide insurance coverage. Thirdly, we had a liability problem in this 
country.
  So what did we do? We had an over 2,000-page bill that got through 
the House and got to the Senate and failed. The Senate dusted a bill 
off that was 2,500-plus pages, that never went through a committee 
hearing, that nobody on the House had a chance to do, and I know that 
the three physicians that are here tonight all read that bill. When I 
read that bill, Mr. Speaker, I found some things in there, as did my 
colleagues, which greatly worried us.
  How do they fund this bill? Only Washington could fund anything like 
this. Dr. Gingrey has pointed out that we're trying to save Medicare. 
Medicare is a system that the Congressional Budget Office says by 2020 
will be out of money; 2024, by the actuaries at CMS say will be broke.
  There are four parts of Medicare:
  Medicare part A, which is paid for by your premiums. That's your 
hospitalization.
  Medicare part B, that's doctor services and some lab services. That's 
only funded 25 percent from your premiums. The other 75 percent comes 
from the general fund, the taxpayers.
  Medicare Advantage, which was cut drastically by the Affordable Care 
Act.
  And Medicare part D, which is a prescription drug plan, also is only 
funded 25 percent by our premiums. I'm a Medicare recipient myself, as 
of last year.
  So what did the administration do and the Senate do to fund this 
Affordable Health Care Act? They took out of an already underfunded 
program, as I just pointed out, $500 billion, and Dr. Gingrey just 
pointed out moments ago that we're adding about 3 million baby boomers 
per year, so 10,000 per day or more. We're adding millions of new 
recipients while pulling out of that over $500 billion, and we call 
this ``saving Medicare.''
  We're not talking about tonight, on our hour, the budget impasse. 
We're talking about what's already been passed. And one of the things I 
found in there, Mr. Speaker, was a very little known board called the 
Independent Payment Advisory Board. Before, Medicare has had this board 
in there, which was strictly that, MedPAC. It was an advisory board to 
Congress, to say, hey, we've got some problems here with funding; maybe 
we should look over here. Congress would then have the ability to make 
those decisions.
  Mr. GINGREY of Georgia. If the gentleman will yield, I would like to 
call my colleagues' attention to this poster, because this is exactly 
what Dr. Roe, Mr. Speaker, is talking about now, this IPAB, Independent 
Payment Advisory Board. I want all my colleagues to see this poster 
because this is what Dr. Roe is taking us through at this point.
  Mr. ROE of Tennessee. Mr. Speaker, what I did when I read this, I 
looked at it and thought, how was this created and why was it created?
  This board has 15 members that are appointed by the administration, 
by the President, and, quite frankly, I don't want a Republican 
President or a Democratic President doing this. These people are then 
approved by the Senate for a 6-year term. They're paid about $165,000 a 
year.
  And what is their charge? Well, their charge is, is if Medicare 
spending hits certain targeted limits, that cuts occur first to 
providers and for prescription drugs and then later to hospitals. What 
worries me about this is right now we

[[Page 11959]]

have a problem--and Dr. Paul Broun is here tonight, who's a primary 
care physician--with our patients with their Medicare, finding a 
physician to take care of them.
  What happens is if you hit these targeted limits and physician 
payments are cut, access to care is going to be cut, quality of care is 
going to be cut, and, thirdly, the cost to our seniors is going to go 
up. What also worries me is that this board very much mimics the board 
that's in England called NICE, the National Institute of Clinical 
Excellence. This board makes recommendations to their health board 
there about what care is provided to patients. President Obama has 
taken this board, he's going to use this, and he actually wants to 
increase the power of it to help hold Medicare costs down. Ultimately 
what will happen, when you have more demand for services than you have 
money to pay for it, is your care will be rationed. That's the fear 
that we have.
  Our concern is, and I've gone to seniors in my district and been very 
clear and pointed this out at town hall meetings and have held town 
hall meetings with seniors and said, We want to provide you quality 
access of care. That's what I do as a doctor. I want to be able to see 
those patients and have them help us solve this problem. I think that's 
the issue that we have, Mr. Speaker, is how do we provide the care for 
the money we have and provide quality of care and access for our 
patients? I am extremely concerned that the IPAB will do just the 
opposite of that.
  Mr. GINGREY of Georgia. I thank the gentleman very much for his 
presentation on the IPAB, that board which Dr. Roe describes, Mr. 
Speaker and my colleagues. Again, I'm going to refer back to a previous 
poster that I wanted to present as Dr. Roe got into talking about the 
Democrats' solution to so-called ``save Medicare.''
  They wanted initially to ignore the problem, the fact that Medicare 
is going broke. As I pointed out in my opening remarks, Medicare today 
will be broke in less than 10 years. Without action, the Social 
Security trustees report that Medicare seniors will either see a 22 
percent benefit cut or workers will see a 22 percent hike in payroll 
taxes. So basically, not really completely ignoring the problem, but 
what the Democrats want to do is create this so-called IPAB board, 
which Dr. Roe describes. They say there will be no rationing, yet 
they're restricted in the recommendations that they can make in regard 
to cuts, and those cuts will be to providers; they will be to 
pharmaceutical companies that provide the drugs that so greatly keep 
people alive today that in the past were ending up in the emergency 
room with strokes because of uncontrolled high blood pressure, needing 
amputations because of uncontrolled diabetes or needing to be on a 
dialysis machine because of uncontrolled renal disease. All of these 
have been helped by Medicare part D. So, clearly, the plan that the 
Obama administration and our Democratic colleagues have is not for 
saving Medicare.
  At this time, let me yield the floor to my colleague from Georgia, 
fellow physician and member of the House GOP Doctors Caucus, Dr. Paul 
Broun.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey. I appreciate you 
yielding a few minutes.
  I wanted to kind of break all this down so that the American people 
could understand very clearly what we're talking about tonight. I've 
got a little poster here that shows President Obama's and the 
Democrats' Medicare solution.
  This is their Medicare plan. They deny the problem. They deny the 
problem that the gentleman from Georgia was just talking about with 
this huge, huge problem, where Medicare is going to go broke in a 
matter of just a decade. They want to delay any fixes. In fact, 
Medicare as we know it today exists no longer. ObamaCare took care of 
that. And they want to destroy it. They will destroy it by letting it 
go broke.
  So this is the Democrat Party's health care plan: Deny It, Delay It, 
and Destroy It by letting it go broke.
  Just recently, one of the government accounting groups released 
something that should scare every senior, every taxpayer, and every 
American.

                              {time}  2050

  They said that Medicare, within the next couple of decades--that's a 
lot of zeroes in this; 63 and a lot of zeros. This is the unfunded 
liability of Medicare over just the next several decades.
  Mr. GINGREY of Georgia. If the gentleman will yield, that would be 
$63 trillion, if I'm not mistaken.
  Mr. BROUN of Georgia. Well, I just tried to make it so that the 
zeroes didn't confuse folks. The unfunded liability for Medicare is $63 
trillion. This is unsustainable. There's no way to take care of this.
  We need to shore up Medicare. We need to make sure that it's 
strengthened so that our future generations, not only the senior 
citizens today, can continue to get Medicare, but the future 
generations also.
  Now, what does $63 trillion of unfunded liabilities mean to everybody 
in this country? I mean, that's too big a number for everybody to 
really consider. So I broke it down to every family in the United 
States. Every family's part of this $63 trillion of unfunded 
liabilities for Medicare, as it exists today, is over $500,000 per 
family, $500,000 per family of unfunded liabilities for Medicare just 
in the next several decades.
  Now, I don't know about most families, but my family can't afford to 
pay $500,000 and neither can the government.
  Mr. GINGREY of Georgia. I've got a poster that points out just 
exactly what the gentleman from Georgia, Dr. Broun, is saying.
  If you look, colleagues, at the bottom of this poster, CBO estimates 
individual and corporate income tax rates would have to rise by 90 
percent through the year 2050 to finance Medicare and Medicaid. And if 
Medicare is not fixed, millions of workers today will lose the money 
that they have invested. And, indeed, they have invested with that 
payroll tax over those many years of their employment.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey. What the American 
people need to understand is that we need to strengthen Medicare and 
Social Security for future generations.
  This picture right here is a picture of my two grandchildren, Tillman 
and Cile Surratt. I love these two kids greatly. They won't see 
Medicare, and they're going to see an America that's quite different 
from the one that we see today if we don't make some major changes, 
major changes in Medicare and Social Security. If we don't shrink them 
and make them economically viable for my grandchildren, that are 6 and 
7, my grandchildren won't see Medicare. They won't see Social Security. 
And, in fact, people who are 45 or 50 today won't see Social Security 
or Medicare if we don't strengthen them, if we don't do the necessary 
hard work of bringing about those changes to strengthening Medicare and 
Social Security to make them economically viable.
  I hear our Democrat colleagues all the time talk about it's the 
children. I've heard our former Speaker talk about it's about the 
children so much that I wanted to throw up.
  But the thing is, when you talk about it's the children and their 
future, we've got to deal with this debt. We've got to deal with Social 
Security and Medicare and make them economically viable by 
strengthening them, by making them so that they're still available when 
my kids get grown.
  And we're going down a road right now--this President and the 
Democrats in the Senate and the Democrats here in the House have a 
three-word plan. Their plan is a three-word plan for Social Security 
and Medicare: deny the problem. They're denying it. They're delaying 
doing anything about it. And they're going to destroy it, because both 
Medicare and Social Security are going broke if we don't strengthen it, 
if we don't make it economically viable, if we don't do the necessary 
hard work that this Congress and Republicans are trying to do.
  But what do we hear from our colleagues on the other side? 
Demagoguery and trying to play politics. It's

[[Page 11960]]

time to stop the politics. It's time to stop playing games.
  The American people deserve the truth. No more accounting gimmicks. 
No more playing with numbers. No more double talk, political speak.
  This is the Democrats' plan--deny it, delay it, destroy it--for 
Medicare, Social Security and this country economically. We've got to 
change it, and that's what Republicans are working very hard to do.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman very much. 
And while we're on the ``D'' word, if you will, deny, delay, demagogue, 
I'll use another, D word, and it's really the softest thing I can say 
about the Democrats' plan, and that is disingenuous.
  For them to stand up, or for the President to stand up and say that 
he's going to fix Medicare, at the same time, Dr. Roe talked about this 
earlier in the evening, I'm going to refer back to him in just a few 
minutes, but at the same time, in the creation of a whole new 
entitlement program in March of last year, we know it as ObamaCare. 
Officially, I guess I should say, it's called the Patient Protection 
and Affordable Care Act. I think it's the unaffordable care act in that 
it cost $1 trillion.
  But where did the money come from to pay for this new entitlement 
program that really has nothing to do with seniors?
  Well, my colleagues, look at this poster to my left, your right. 
Here's where at least half of the money came from. Cutting Medicare, 
cutting Medicare by $575 billion. I mean, right out of the Medicare 
program. That included home health care; it included Hospice. But the 
biggest cut was $130 billion, that's bullet point No. 2, $130 billion 
from the Medicare Advantage plans. And my colleagues know this, and I'm 
sure they'll want to comment on it, of the 47 million people, 45, 47 
million people today who are on Medicare, about seven to 10 million of 
them receive their medical care on the Medicare Advantage option, which 
gives them more benefits, more bang for the buck; and it covers a lot 
of preventive services that are not given, not offered in traditional 
Medicare as we know it.
  So that cut, $130 billion, that's something like a 14 percent cut out 
of that program. That means that at least half of these seniors are 
going to have to go back into Medicare as we know it and get a lesser 
benefit.
  In fact, it's been said by the actuary of Medicare, Richard Foster, 
on April 22, 2010, that 15 percent of hospitals, nursing homes, and 
home health care providers will close because Medicare pays less under 
ObamaCare.
  Mr. BROUN of Georgia. Will the gentleman yield?
  Mr. GINGREY of Georgia. I want to yield just briefly again to the 
gentleman from Georgia before I yield some additional time to my 
colleague, our cochair of the House GOP Doctors Caucus, the gentleman 
from Pennsylvania.
  Mr. BROUN of Georgia. I thank you for yielding just a moment to me 
because I want to add to that statistic; 15 percent of hospitals, 
nursing homes, and home health care will close because Medicare pays 
less under ObamaCare. That's absolutely true. A lot of those hospitals 
are going to be in rural communities because rural communities are 
going to be hit the hardest.
  Right now I'm a primary care doctor. As the gentleman knows, I'm a 
family doctor. I've done general medicine for almost 40 years now.
  The American Academy of Family Physicians said right now, today, one 
in eight family docs will not accept Medicare at all. Only one in three 
doctors, according to the American Medical Association limits how many 
Medicare patients that they take.

                              {time}  2100

  That is a marked rise. Back in 2004, only 6 percent of all doctors 
limited their Medicare patients. In 2008, it went up to 8 percent. Now 
it's almost one-third limit the amount of Medicare patients that they 
see. And one in eight family docs don't take Medicare at all; they 
can't afford to because of the low reimbursement rates. And IPAB is 
going to hit those folks that much harder.
  During our Special Order when we were discussing ObamaCare I made a 
comment that somebody may have a free health care card in their pocket, 
but it's going to be as worthless as a Confederate dollar after the War 
Between the States because nobody will take it, and that's exactly 
where we are headed. So I just wanted to add that.
  Mr. GINGREY of Georgia. I thank the gentleman from Georgia.
  I now yield to my cochair of the House GOP Doctors Caucus, the 
gentleman from Pennsylvania, Dr. Tim Murphy.
  Mr. MURPHY of Pennsylvania. Thank you, Dr. Gingrey.
  I want to talk for about 5 minutes here on an issue that you brought 
up, Dr. Gingrey, about the $575 billion from the Medicare program that 
also cuts $135 billion from Medicare Advantage plans, forcing over 7 
million seniors out of their current Medicare plan unless they pay 
more.
  I wanted to help point out that while the President and others are 
out there saying we're trying to cut Medicare and what it does, nothing 
could be further from the truth. What we're trying to do here is show 
how if Medicare is handled differently--not by IPAB or a board of 
bureaucrats, but by letting the plans work and letting doctors work, 
they can drive down cost by improving quality.
  Let me explain what happened in the Medicare Advantage program that 
was gutted in the health care bill that was passed out of the House. 
Well, seniors are able to make choices right now--with Medicare, they 
can get Medicare part D drug coverage and supplemental Medigap policies 
with the Medicare Advantage plan. What the Medicare Advantage plan does 
is allows some management of diseases that are chronic illnesses, which 
is very different from the current fee-for-service where somebody would 
get paid based upon the number of procedures they do. Under the regular 
Medicare fee-for-service plan, hospital readmission rates--that's 30 
days post-discharge for the country--in 2007 was over 18 percent, but 
the average readmission rate across Medicare Advantage was 13.5 
percent. Why? Because it allowed physicians and nurses to talk to the 
patient, to follow the patient, to work with the disease, to make sure 
whatever complication they had--an infection or heart disease or lung 
disease or an orthopedic problem--to pay that physician and staff to 
work for them.
  Here is another interesting thing: The Medicare fee-for-service rate 
of preventable emergency department visits was 15.5 visits per 100 
beneficiary months in 2007. But the average rate across Medicare 
Advantage plans and study was two visits per 100 beneficiary months--86 
percent lower than Medicare's national average.
  Here's another point: Actual cost for the drug plan we know, Medicare 
part D, comes out 40 percent under budget because insurers are forced 
to compete with each other. Now imagine this: Seniors can choose 
Medicare supplemental plans, and those plans compete for seniors' 
coverage. The drug plans compete for seniors' coverage. What happens if 
seniors are allowed to also choose their main Medicare plan? Well, 
listen to this additional issue about drugs: The Intercontinental 
Marketing Services, IMS--I should say this comes from the Deloitte & 
Touche Web site--the Institute for Healthcare Informatics study 
concluded: The average cost for drugs frequently used by Medicare 
prescription drug part D beneficiaries declined since the 
implementation of the program in 2006. Between January, 2006, and 
December, 2010, for the top ten therapeutic classes, part D drugs 
decreased by over one-third, from $1.50 to $1. The study projected that 
costs will continue to decline by 57 percent from 2006 to 2015, 
reaching 65 cents by the end of 2015. That's a massive decline. Why? 
Because plans are competing against each other. Plans innovate, they 
try and do things better and smarter, with better quality, and they ask 
seniors to choose their plan. Seniors then, by signing their name, can 
choose a plan that works for them.
  Why not allow seniors to have Medicare choice with their major 
Medicare

[[Page 11961]]

plan? Why not allow seniors to have Medicare Advantage instead of 
gutting the program? This is the very thing we're saying; by improving 
efficiencies and qualities within the program, a lot of cost can be 
reduced. It can't be reduced, however, by the status quo. As you 
pointed out, Dr. Gingrey, and my colleagues, keeping the status quo 
means there won't be Medicare. There will be Medicare for those 
currently on it. It won't be there for their children and certainly not 
for their grandchildren. We want to save Medicare, but you can't save 
it by the continued way it's being done now.
  Quite frankly, the system that's being done out there now to frighten 
seniors, to say that if we don't simply pass this debt limit increase 
without strings attached, that seniors won't have Social Security or 
Medicare, this is such a falsehood. And it's a serious problem in two 
ways: One, it's serious because it's telling a falsehood to seniors; 
and two, it looks down upon seniors thinking that they're susceptible, 
not smart enough to figure out that this is false.
  It is so important, and we want the American public to understand: We 
are trying to save Medicare because we do want it to be there for the 
future, but it means making it more efficient. And what's wrong with 
letting doctors be the ones who call the shots on improving care?
  Mr. GINGREY of Georgia. Mr. Speaker, I appreciate so much the 
gentleman from Pennsylvania, who has spent his professional life 
providing medical services to his patients, just as so many of the 
doctors in the caucus.
  Talking about this cut to Medicare Advantage, as Dr. Murphy described 
that method of getting care, Mr. Speaker, it is exactly what we 
continue to talk about today of wanting to reward health care based on 
quality and not necessarily quantity. Just strictly fee-for-service--
the number of times you go to see a provider and that provider getting 
paid, albeit a small amount--is not a very efficient way. And certainly 
a much more efficient way--and we continue to talk about this--is to 
provide quality of care. And Dr. Murphy correctly pointed out, Mr. 
Speaker, that's exactly what Medicare Advantage does; it offers a 
quality of care and a wellness provision. Were we paying these plans a 
little too much for those services? I don't know, maybe, possibly. But 
if you're going to cut any amount, certainly 14 percent, $130 billion, 
is too much because that guts those plans.
  But whatever savings you get out of Medicare, shouldn't they stay in 
the Medicare program, if you believe the Medicare actuary and the 
trustees that say that if we don't do something by 2024, the trust 
fund, the hospital trust fund is depleted, there is no more Medicare as 
we know it or any other way. So if you're going to find savings in the 
Medicare program, you don't take that money, $575 billion, and use it 
to create a whole new entitlement program so that everybody in the 
whole country has health insurance whether they need it or not, whether 
they want it or not. I can think of a lot of things in the Medicare 
program where this money could be well spent. How about long-term care, 
extended care facility coverage to keep that money in Medicare? 
Instead, what ObamaCare comes up with is something called the CLASS 
Act--which is a classless act, Mr. Speaker, because it is a misleading 
program that can't fund itself, that absolutely can't fund itself.
  So there are so many things about ObamaCare and Obama's plan to save 
Medicare--which really, as Dr. Broun pointed out, is no plan at all, 
other than what Dr. Roe has pointed out in regard to this Independent 
Payment Advisory Board that is going to cut spending for the most 
vulnerable seniors, those that are the sickest, those that incur the 
highest cost. And they say there is no rationing, but it will indeed, 
as my colleagues have pointed out, Mr. Speaker, be denial of care.
  At this point, I would like to yield back to the gentleman from 
Tennessee to talk a little bit more about that.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  Mr. Speaker, I do want to point out one thing that Dr. Gingrey just 
pointed out, which was one of the reasons that the American people 
don't trust politicians. The CLASS Act may be a good idea. The CLASS 
Act began this year where you have some money taken out of your 
paycheck and put in a savings account over here. It's supposed to be 
about $87 billion in 5 years, and we can't get it out until that 5-year 
period of time occurs and this money has accumulated. At that time it's 
supposed to pay for long-term care, about $50 per day. But guess what 
happens, Mr. Speaker? What happens is that we borrow the money out and 
spend it on current health care and call this an asset.

                              {time}  2110

  We have counted that money twice; two times. We have done that with 
Social Security already. I find this absolutely offensive, on August 2, 
10 days, about a week from now, we have had the audacity to tell people 
who have paid into Social Security for 40 or 50 years they will not be 
able to get their check. Why? Because the Federal Government has spent 
that money. We are doing the same thing again with the CLASS Act. There 
has already been legislation to perhaps overturn that.
  I want to get back to something a little more basic, and that is to 
the examining room with the patient. The people who should be making 
health care decisions should be a family, the patient and their 
physician, sitting around and talking about what their options are, not 
some 15 people appointed bureaucrats in Washington, D.C.
  By the way, Dr. Gingrey and Mr. Speaker, we have over 190 cosponsors, 
including a bipartisanship cosponsorship to the repeal of IPAB, 
including every physician, every health care provider on the Republican 
side and Dr. Christensen, who was down here just a moment ago on the 
Democratic side. It is a bipartisan agreement that we should overturn 
this. The American Medical Association believes it should be 
overturned. Over 270 major medical organizations see through this as a 
very bad thing for patients.
  The reason we are worried about it, we have heard Dr. Broun speak 
about it, and we have heard you speak about it, Mr. Speaker. Ultimately 
it will affect the quality of care. Why? Because if you don't have 
access to your doctor, the quality of your care will go down.
  The other thing I want to mention is we talk about changing Medicare. 
Quite frankly, I'm going to go through just a few of the things that 
already have been changed in this Affordable Care Act. Beginning in 
2010, there were Medicare cuts to hospitals, long-term care and 
inpatient rehabilitation services.
  In 2011, it has been pointed out that the Medicare Advantage plans, 
the seniors did get a $250 check to fill the doughnut hole. The 
wealthier seniors began paying higher premiums for Medicare part D; 
that's in 2011. Medicare imaging cuts, Medicare reimbursement cuts: 
when seniors get a CT scan or an MRI, Medicare cuts for durable medical 
equipment began, ambulance services, ambulatory service centers, 
diagnostic labs, durable medical equipment, wheelchairs. Seniors 
prohibited from purchasing power wheelchairs unless they rent for 13 
months.
  In 2012, elimination of the deduction for the employer expenses for 
Medicare drug subsidies, that is how they raised $4.5 billion. And that 
is not to improve our current underfunded Medicare plan. That is to 
create another entitlement. Medical expense deduction, you raise the 
threshold for deducting medical expenses from 7\1/2\ to 10 percent. 
That raises $15 billion to be spent elsewhere. That is a tax right 
there.
  Hospice care is being cut. Dialysis, Medicare cuts to dialysis 
treatment will be cut in 2012.
  In 2014, this Independent Payment Advisory Board begins. And, by the 
way, they are getting, I believe it's $12 million a year to fund this 
right now. If there is any way we can cut off funding to that board 
right now, it should be done.
  In 2015, a permanent cut to the payment rate to home health agencies. 
On and on. We have felt these cuts because they haven't come to 
fruition yet.

[[Page 11962]]

What we are trying to do with Medicare is to salvage the program for 
future generations.
  A promise made is a promise kept. If you are 55 years and older, with 
Social Security and Medicare, nothing happens. I hear all the time 
about a voucher. This is a voucher system and so forth. Here is what a 
voucher is. A voucher is when I go to my mailbox, something comes that 
says this has so much value. You take this piece of paper and purchase 
something with it. Premium support is where the Federal Government, 
through its massive ability to go out and negotiate prices, exactly 
like they do for you and me, Mr. Speaker, in our health care plan here 
in Congress, they negotiate with numerous companies through the Federal 
exchange. Our plan is called the Federal Employees Health Benefit Plan, 
and they negotiate the best price. And what happens is all during the 
campaign, the last 2 years I have heard seniors and others say, 
Congressman, I want exactly what you have. That is exactly what we are 
trying to do.
  A higher income senior like myself, and you and the others in this 
room, will pay a higher premium. And folks with preexisting conditions 
and lower income will pay much lower. And they will have those choices. 
As Dr. Murphy pointed out, why do we think that will save money and why 
are we doing it. It has been pointed out that it is a catastrophe 
waiting to happen if we do not do something.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman from 
Tennessee, Dr. Roe. What he was describing, if I can elaborate a little 
more on that point to our colleagues because I think some still are 
confused, possibly on both sides of the aisle, but clearly this plan 
that is put forth in the House budget, and it's the Republican budget 
because we are in the majority. It is sometimes referred to as the Paul 
Ryan budget because he is chairman of the Budget Committee. It is 
sometimes referred to as the Path to Prosperity.
  But in that budget which we sent to the Senate; and, unfortunately, 
the Senate majority leader has deep-sixed it, if you will, but in that 
budget plan that Dr. Roe was referring to, it has taken the responsible 
approach based on the trustees' estimate of the Medicare program going 
totally broke by the year 2024, and that information is bipartisan. 
That's the Medicare board of trustees.
  To ignore that, as my colleague from Georgia said in his remarks, the 
``D'' words, to defund, to deny, what were some of the others, Dr. 
Broun? To deny, delay, destroy, demagogue, and I added to those ``D'' 
words their plan is rather disingenuous, but what Dr. Roe was 
describing is to protect and preserve Medicare as we know.
  Whether it is traditional Medicare, maybe we can salvage Medicare 
Advantage, and hold harmless anybody that is over age 55, 55 through 
65. They were 10 years away from being eligible for a Medicare benefit. 
So they will be in those plans as we know it. But this approach that 
Dr. Roe so adequately describes, Mr. Speaker, this premium support 
program, not a voucher, as he pointed out, the premium support program, 
which by the way would be administered by the Office of Personnel 
Management, the same folks that talk to us and find out what kind of 
health care benefit we want, those Members who are under 65, that you 
pick and choose and you negotiate. They will do the same thing for 
future, those under age 55 today, future Medicare beneficiaries. They 
will get the best bang for the buck, the best care for their individual 
needs.
  Now, it is estimated that in 2022 that premium support amount on 
average will be $8,000 a year. Now, our Democratic friends, Mr. 
Speaker, want to say, Well, that's not enough. That's not enough. 
Seniors are going to have to reach in their pocket.
  But what they don't tell you, Mr. Speaker, is that premium will be 
higher for anybody who comes into the Medicare program who is already 
sick, who already has several things wrong with them; and that 
certainly is possible.
  When I got Medicare eligible, I had already had open heart surgery. 
So these people will have a higher premium than the average of $8,000 a 
year. And as they age, even if their health is perfect the day they 
come into Medicare, they become Medicare eligible--they may have the 
Methuselah gene and have wonderful health. They may jog 3 miles a day, 
don't smoke, don't drink excessively, don't skydive--but as they get 
older, that premium support will automatically go up because we know 
statistically that as you get older the chances of something happening 
are greater.
  And last but not least, the higher your income, the lower your 
premium support.

                              {time}  2120

  So our seniors, who need it the most, will get a higher--they won't 
get the average $8,000. They will get a higher premium support. I think 
it is a wonderful plan, Mr. Speaker. I absolutely do. It shows the 
responsibility of the majority party in this House of Representatives.
  Of course, as my colleagues have pointed out, what is the plan from 
the Democrats, the Democrat majority in the Senate and from this 
President: deny it, delay it, destroy it, demagogue it. Or, as my 
colleague from Tennessee has pointed out, kill it by creating this 
Independent Payment Advisory Board, IPAB, which will, without question, 
lead to denial of care and rationing.
  I yield to my colleague from Tennessee.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  One of the things, Mr. Speaker, that I want to emphasize is having no 
plan is a prescription for disaster for our country. We have a solemn 
obligation to provide health care for our seniors. We have made that 
promise. And how do we do it? Again, back to what I said, I do not want 
a board that is appointed by a Democrat or Republican or any 
bureaucrat. What I want is I want health care decisions made by 
physicians, the patient, and their family. The way that is going to 
happen is through this plan where we use premium support to allow 
people choice and to have them make those choices, not insurance 
companies and certainly not the Federal Government.
  From what I have seen up here in my two terms is I don't want a bunch 
of Federal bureaucrats in charge of my bypass operation or my 
gallbladder operation--or my bunion operation, for that matter. I want 
my doctor in charge of it. That is who I want making those decisions, 
along with my family.
  I think this is one of the biggest discussions we will have in this 
Congress is how we do this right. Not only does it affect the budget. 
Forget the budget. Forget all that right now. We are talking about 
people's lives. We are talking about the care that they get. And right 
now, as I mentioned, these changes are already made. This is already in 
the current law that I talked about just a minute ago.
  When you talk about Medicare as it is, folks, it's been changed, big 
time. When this board kicks in--and there's a very good article if you 
are sort of a wonk like I am and want to go back to the New England 
Journal of Medicine, one of our major journals, in, I believe it was, 
May of 2010. Their estimate was--this is one of our major scientific 
journals--that this IPAB board would have kicked in 21 of the last 25 
years if it had been in place. So it's not some idle threat that this 
will happen. If you look retrospectively at what's happened, it would 
have happened 21 out of 25 times.
  What would that mean? That would mean, as Dr. Broun, Mr. Speaker, 
pointed out just a moment ago, as these payments for physicians go down 
and down and down below their cost of providing the care, they no 
longer can see you. You lose access to your doctors, like Dr. Broun.
  Mr. GINGREY of Georgia. What Dr. Roe is talking about, Mr. Speaker, 
is on top of these cuts that our medical providers are currently facing 
under this so-called flawed formula sustainable growth rate, which I'm 
sure I'm correct on this, in the past 9 years every calculation has 
been a cut to provider reimbursement to the point now that while we in 
Congress have had the ability to mitigate that, that if these

[[Page 11963]]

cuts finally in the aggregate come due December 31 of this year, it is 
a 30 percent cut. So we haven't solved that problem yet for our 
providers but yet we are adding on top of that this IPAB board that can 
make additional cuts to provider reimbursement without any ability of 
the Congress, we the Members of Congress, to stop that injustice.
  Mr. ROE of Tennessee. A good point.
  Peter Orszag, who was the previous OMB Director here, said this is 
one of the biggest losses of power the Congress has given up since the 
Federal Reserve. That's been almost a hundred years ago. What we're 
doing is the Congress takes two-thirds to overturn what they recommend 
in this IPAB. We could do it if we get a two-thirds vote. And it is not 
appealable. You don't have any appeal to a court system to do anything 
about this.
  Mr. GINGREY of Georgia. If the gentleman will yield, still, we can 
overrule with a two-thirds vote. But we still have to find cuts in the 
Medicare program somewhere else for the same dollar amount.
  Mr. ROE of Tennessee. The gentleman is correct.
  What would happen is we could make those cuts, but they have to be 
made somewhere else. The cuts have to be made. Nowhere should Congress 
give up its ability to do that. We are, our House, the House side, 
we're the representatives of the people. We are the closest to them. We 
have 700,000 constituents that we go talk to every time we get home. 
And we ought to be beholden to those folks in our districts across this 
country and not to some board up here in Congress that is not 
accountable to anybody.
  Mr. GINGREY of Georgia. I thank the gentleman.
  The gentleman from Georgia is kind enough to have stayed with us 
throughout the hour, and I would like to yield additional time to him, 
if he would like.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey. I would certainly like 
the time.
  The American people need to understand that the purpose of ObamaCare, 
the bottom line really was expressed by the President himself when he 
said he wanted everybody in this country in one pool. What's that mean 
for everybody? It means socialized medicine. That's what all IPAB and 
all these cuts and everything is geared to do is to force doctors out 
of private practice, make them employees of the Federal Government, 
make patients subject to some bureaucrat here in Washington and tell 
them what kind of health care they can get.
  And the Democrats' plan is to deny, to delay, and to destroy Medicare 
by letting it go broke. But I want to just add, Dr. Gingrey, to your 
other ``d,'' the demagoguery that we see. I want to give three examples 
because the facts have really been, by and large, hidden from the 
American people.
  AARP did an ad, a new one, talking about all the places where the 
Feds could cut spending, like treadmills for shrimp--well, I certainly 
want to cut that out--but instead, Republicans insist on cutting 
seniors' Medicare. Well, that's not true. AARP and the Democrats want 
to cut Medicare by destroying it, letting it go broke.
  An ad put out by the Gender Project, a liberal nonprofit group, shows 
an elderly woman being heaved off the side of a cliff, with her being 
in a wheelchair, and asks: Is America beautiful without Medicare? Ask 
Paul Ryan and his friends in Congress.
  That is nothing but bald-faced lies, because we are trying to make 
sure that seniors get, as Dr. Roe said, a promise made, a promise kept. 
We want to shore up Medicare and Social Security. We want to strengthen 
Medicare, not destroy it, like the Democrats are going to do.
  Let me give you a third example, then I will yield back.
  On the Republican budget, President Obama said in his speech at 
George Washington University just last month: ``Instead of guaranteed 
health care, you will get a voucher. If that voucher isn't worth enough 
to buy the insurance that is available in the open marketplace, well, 
tough luck. You're on your own. Put simply, it ends Medicare as we know 
it.'' President Obama.
  It's demagoguery. It's lies, bald-faced lies designed to try to scare 
the American people, particularly senior citizens. We are trying to 
shore up Medicare. We are trying to strengthen Medicare. We are trying 
to save Medicare from going broke. But the Reid-Pelosi-Obama ObamaCare 
is to deny it, to delay it, to destroy it, and to demagogue it.
  Mr. GINGREY of Georgia. As I said earlier, the kindest thing I can 
say is it is disingenuous.
  Stop the Democrats' plan to end Medicare. If left alone, the 
Democrats' Medicare cut plan created in ObamaCare threatens Medicare 
seniors today as well as those who will come into the program tomorrow.
  So, colleagues, how do we stop the Democrats' Medicare cut plan first 
and foremost? We need to repeal ObamaCare. But we need to vote and 
support Dr. Roe's bill to repeal this IPAB board and tell President 
Obama and Democrats that Medicare reform should not rely on restricting 
benefits and access for sick and disabled seniors in need.
  As we conclude tonight, let me just say, colleagues, oppose the 
Democrats' Medicare cut board. Visit the GOP Doctors Caucus Web site 
and sign the online petition. Oppose the Democrats' plan to destroy 
Medicare.
  And here are the Web sites: doctorscaucus.gingrey.house.gov or 
doctorscaucus.murphy.house.gov, the two cochairs of the House Doctors 
Caucus.
  Mr. Speaker, I thank our leadership for giving us an opportunity to 
bring to the American public and to our colleagues on both sides of the 
aisle the true facts of this case--that we have a plan; the President 
has no plan.
  I yield back the balance of my time.

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