[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[House]
[Pages 3627-3631]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     THE ONGOING HEALTH CARE DEBATE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Arkansas (Mr. Griffin) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GRIFFIN of Arkansas. Mr. Speaker, I've come here to the floor 
tonight with my colleague from Wisconsin, Representative Duffy, to talk 
about the crisis Medicare faces and to talk about the Independent 
Payment Advisory Board. Some call it the IPAB. It's a part of the 
President's health care law, and this House is going to address it this 
week.
  But I want to start out by talking a little bit about the crisis that 
we're facing in this country over Medicare and what it means to our 
seniors. My mother is 71, and she's a Medicare recipient. She counts on 
Medicare. She paid into it and is now using it to take care of herself. 
And we've got to make sure that future generations are able to rely on, 
count on Medicare.
  This first chart here, Mr. Speaker, shows what a significant portion 
of the Federal budget Medicare consumes. We have it here, $555 billion, 
and that is per year. This is a yearly budget for the Federal 
Government.
  It is widely agreed upon by Democrats and Republicans that Medicare 
is going bankrupt. Some estimate it's 7 years, 8 years, 10 years, but 
most everyone agrees, having looked at the numbers, that Medicare is 
going bankrupt.
  I've got a quote here from Senator Lieberman, who addresses a 
criticism that we hear a lot about the Republican reform plan on 
Medicare:

       We can agree that Medicare is going bankrupt. We then have 
     to ask ourselves, what are we going to do about it?

  What are we doing about it? Well, the House has acted to reform 
Medicare. We acted last year, in 2011, as part of our budget to reform 
Medicare to save it. The only reason we proposed reforms to Medicare is 
because we want to save it. We want it to be there for the next 
generation.
  I've heard a lot of criticism: You want to change Medicare as we know

[[Page 3628]]

it. I say: No, Medicare, as we know it, goes bankrupt on its own. We 
have to act to save Medicare, Mr. Speaker.
  And in this quote of Senator Lieberman, he says:

       The truth is that we cannot save Medicare as we know it. We 
     can save Medicare only if we change it.

  Now, like House Republicans, I think it's fair to say, Senator 
Lieberman is talking about what we must do for the next generation. 
Like our proposal, I think a lot of us agree that we can make changes 
to Medicare for the next generation, and for those, for example, 55 and 
over, leave it as it is. Why? Because people have counted on a 
particular way the program works, and we won't have to change that to 
start saving. We can just change it for the next generation.
  I have another quote here I want to share with you that shows that 
President Obama, at least in his words, understands that we have a 
problem with Medicare.

       If you look at the numbers, Medicare, in particular, will 
     run out of money, and we will not be able to sustain that 
     program, no matter how much taxes go up.

  This is the President.
  He continues:

       I mean, it's not an option for us to just sit by and do 
     nothing.

  Unfortunately, those are just words because that is precisely what 
the President has done, sit by and do nothing. It's what the Senate has 
done. The House has acted to reform to save Medicare.
  Now, the President's health care law has a provision in it, the IPAB 
that I referred to earlier, that impacts Medicare, but it doesn't save 
Medicare. It rations Medicare.
  How does that work? Well, this is an unelected board, it's an 
unelected board that will make decisions on where Medicare is cut. So 
the President has had an opportunity to propose reforms to the way 
Medicare works, so that we can innovate and change it to save it for 
future generations--reform it, upgrade it, do things better. But 
instead, the President's approach is simply to cut the levels of 
spending but leave the overall functioning of Medicare the same. So no 
innovation, no new approach, no reform, just cut when we run out of 
money.
  Well, what does that result in? It results in seniors not getting the 
care they need, and not just because services are reduced but because a 
lot of doctors won't take Medicare patients. This is already a problem 
today. Today there are seniors looking for a doctor to help them with 
their particular problem, and doctor after doctor says, I'm sorry; we 
don't take Medicare. That problem is only going to get worse if the 
IPAB, the Independent Payment Advisory Board that's in the President's 
health care law, if it does what it is scheduled to do.
  Now, what are we doing about it here in the House? Well, we certainly 
voted to repeal the President's health care law. That passed the House, 
did not pass the Senate. But we've tried a lot of other ways to get at 
the problem, and one that we're going to do this week is to repeal the 
IPAB, repeal the Independent Payment Advisory Board.

                              {time}  2000

  I yield to the gentleman from Wisconsin.
  Mr. DUFFY. I appreciate the gentleman from Arkansas yielding.
  I want to take a couple of steps back in this conversation and first 
talk about the national debt.
  Many Americans are well aware that today we owe well over $15 
trillion in national debt. This year alone we're going to borrow $1.3 
trillion on top of a trillion dollars last year and the year before 
that. There are trillion-dollar deficits as far as the eye can see.
  Last year, the House Republicans put forward a budget that showed a 
path to balance telling the American people how we balanced the 
American budget at some point in the future.
  Now, last year and this year, the President put out a budget, neither 
of which were ever balanced, never telling the American people what his 
plan is to bring American spending to balance with its revenues.
  So we look a couple years back when the President and this House 
passed the Affordable Care Act, or ObamaCare, which the CBO now states 
that over 10 years, the rosiest of projections say it's going to cost 
the country nearly $2 trillion more. Even when they put out that budget 
or that proposal for health care reform, they're still not willing to 
put out a budget that says how we're going to pay for it. That concerns 
me.
  I'm a father of six. We're spending today and passing the bill off to 
the next generation. It's unconscionable.
  Let's actually talk about what the President and this House have 
passed in ObamaCare: $2 trillion over 10 years in additional spending. 
It's a bill that is going to empower bureaucrats in this town to make 
health care decisions for Americans in every part of the country 
instead of your family, your health care provider, or you making that 
decision.
  Listen, I'm from Wisconsin, and I know the values that we have in 
central Wisconsin. They're probably a little bit different in Arkansas 
or Kansas or Kentucky, Minnesota, or Michigan. I think we should allow 
people to make their health care decisions instead of bureaucrats in 
Washington.
  But what concerns me the most is how ObamaCare impacts Medicare.
  Now, listen. ObamaCare takes a half a trillion dollars out of 
Medicare and uses it to fund ObamaCare. Now, we all know in America 
that we have some financial pressures on Medicare. We know that we have 
to come together as a country, as a community, both parties, to figure 
out how we're going to pay for Medicare, keep the promise to our 
seniors.
  At a time when we're still having that debate, to think that this 
House would pass a bill and take a half a trillion dollars out of 
Medicare and use it for ObamaCare, I think that's wrong. Let's first 
figure out how we keep the promise to our seniors before you make a 
promise to anyone else with their money. That is unconscionable.
  What concerns me the most is what the gentleman from Arkansas 
mentioned, which is the Independent Payment Advisory Board. It's the 
IPAB, and we haven't heard a lot about it, but I think you'll hear a 
lot more as the months go on. This is a board of 15 unelected 
bureaucrats. What they're going to do is look at reimbursement rates 
with Medicare, and they are going to be able to systematically reduce 
reimbursements to doctors, hospitals, and clinics for the care for our 
seniors.
  Let's make no mistake. This is reimbursements for our current 
seniors, not for some future generation. The argument by the President 
goes like this: Mr. and Mrs. Senior, don't you worry about your quality 
of care or your access to care. We're just going to pay your doctor, 
your hospital, and your clinic less for your care. If you believe that, 
I've got oceanfront land for you in Arizona.
  Of course it's going to affect our seniors' access and quality of 
care. When you pay less for it, you're going to get less of it. Our 
seniors, they worked a lifetime. They bargained. They retired based on 
this promise for Medicare. This proposal doesn't meet that obligation. 
It takes a half a trillion dollars from Medicare, but then is going to 
ration the care of our current seniors--seniors who can't go back into 
the workforce and get another job. They retired based on the promise 
from the Federal Government, and ObamaCare reduces that bargain that's 
been made with our seniors.
  Mr. GRIFFIN of Arkansas. Will the gentleman yield for a quick point?
  Mr. DUFFY. Sure.
  Mr. GRIFFIN of Arkansas. What really scares me is that this 
restricted access to health care, to Medicare that you're talking 
about, it already exists. The IPAB, the Independent Payment Advisory 
Board, that's in ObamaCare that will cut the amount of reimbursement to 
doctors when it gets going, it's not even cutting yet and we already 
have a problem with seniors getting the doctor that they want because 
so many doctors have said, I'm just not going to take Medicare any 
more.
  Before I yield back, I just wanted to mention an email that I got in 
my office this week.

[[Page 3629]]

  There's a constituent of mine, John Pollett. He's the program 
administrator for the Arkansas Senior Medicare Patrol. He goes around 
and he talks with seniors about Medicare and how to recognize fraud in 
Medicare.
  He was at the Sherwood Senior Center this past week, this week, in my 
district, and he was giving a presentation teaching Arkansas seniors 
about Medicare fraud. A lady, a senior, who's on Medicare, an angry 
senior, said to him--she wasn't angry at him--but she said with 
passion, I don't understand why I'm forced to pay my Medicare premium 
but can't find a doctor who will take me because I'm on Medicare.
  So we already have a problem with access to Medicare because more and 
more doctors are saying, I'm not going to take Medicare. There are a 
host of reasons: the reimbursement rate, the administrative hassle, 
what have you.
  But IPAB, I hear the gentleman from Wisconsin saying, the Independent 
Payment Advisory Board that's in ObamaCare is only going to make the 
problem worse because while some of us are interested in reforming the 
way Medicare works so that we get more service for our dollar, the 
President is only interested in saving money by just reducing and 
cutting without reforming.
  We all understand the need to reach solvency; but those of us who 
back Medicare reform want to do it through innovative, creative, cost-
saving approaches that avoid rationing, whereas the President simply 
wants to cut through an unelected board.
  I'm going to yield back now to the gentleman from Wisconsin. I just 
thought it would be helpful to give you a real-life example of a senior 
in my district who's been impacted by that.
  Mr. DUFFY. I appreciate the gentleman for telling that compelling 
story. All of us have stories like that from people in our districts, 
from our own family members, our friends, our constituents; and this is 
a very important issue. That's why I think we have to have this 
conversation about what the Independent Payment Advisory Board will do.
  I used to be a former prosecutor, and we're used to a system where if 
you don't like the decision of a court, oftentimes you're able to 
appeal that decision. This board is unappealable. The decisions that 
they make, the 15 members when they make a decision, that is going to 
be the law, that is going to be the rule, and you can't appeal it, and 
you can't have it overturned.

                              {time}  2010

  I just want to close my comments up on the Independent Payment 
Advisory Board. We on the Republican House side don't believe that we 
should go forward with a plan that is going to systematically reduce 
reimbursements for seniors, that's going to affect the quality and 
access to care for our seniors. Let's give them what they bargained 
for. We in the House on the Republican side, we said put back the half 
a trillion dollars, put that back into Medicare, do away with the IPAB 
board. If you're going to make changes to Medicare, make it for a 
future generation, a generation that isn't near their retirement, a 
generation that will have enough time to plan for the changes in 
Medicare; but don't pull the rug out from our seniors who have been 
given a promise and now aren't going to get it because their Medicare 
is going to be rationed.
  We think it's fair to do it for a future generation. But let's make 
no mistake, when we hear that one party has transformed Medicare or 
changed Medicare as we know it, there is one party who has done that 
and that is the Democratic Party in ObamaCare. They have changed the 
way that Medicare is going to work. They're going to ration it. We 
believe we should save it, protect it, preserve it. I know my freshmen 
colleagues in this House are going to fight tooth and nail to make sure 
that every one of our seniors get exactly what they bargained for in 
Medicare. If there are changes, it's going to be for a generation that 
can plan for the change in Medicare in due time and in due course.
  Mr. GRIFFIN of Arkansas. I thank the gentleman for joining us here on 
the floor tonight.
  I see my friend Mr. Quayle from Arizona here with us on the floor, 
and I would like to yield to him at this time.
  Mr. QUAYLE. I thank the gentleman for yielding, and I was listening 
to his comments about talking with his constituents back home and about 
how many doctors are not seeing Medicare patients, not seeing new 
Medicare patients, or are not seeing the patients that they currently 
provide services to.
  I know, like the gentleman from Arkansas, he does a lot of teletown 
halls and town halls just like I do. The other week I was on a teletown 
hall with my constituents back home, and there were a number of people 
who raised the concerns that their doctors were not going to provide 
them the medical services that they had in the past because they were 
uncertain about the payments that the Medicare system would be giving 
them.
  This is a constant refrain that we hear back home from our seniors, 
that they are consistently getting turned down by their physicians 
because of the lack of payment from Medicare. This is a system that we 
need to fix. This is a system that we need to make sure that we keep 
the promises to our seniors and reform it for future generations so 
that it will be there to protect them when they reach the retirement 
age.
  If you look at ObamaCare, it is really filled with provisions that 
confer arbitrary power, that raise costs. It cuts benefits, it harms 
access, and it restricts choice. Against this really sorry backdrop, 
the Independent Payment Advisory Board, or IPAB, has the dubious 
distinction of being one of the absolute worst provisions in the entire 
health care bill. Indeed, this single provision causes all the problems 
that I just mentioned. This board of 15 unelected, unaccountable 
bureaucrats would have the power to impose price controls that will cut 
senior access to care. To make it worse, this board would not have to 
meet in public or listen to public input. Amazingly, ObamaCare even 
leaves the door wide open for IPAB members to receive gifts from 
lobbyists. In other words, the public has no right to talk to IPAB, but 
lobbyists willing to shower them with gifts do.
  President Obama claims his rationing board will solve the real 
problem of Medicare's rising costs. It doesn't. The only mandate the 
board has to cut costs is by restricting payments to doctors that 
provide health care. It is already the case that 12 percent of doctors 
will not take Medicare patients due to the unreliability of government 
payouts. That is twice the number of doctors who refused to see 
Medicare patients in 2004, which is a frightening statistic on how 
quickly that is rising. Additionally, a recent survey showed that 60 
percent of doctors have or will restrict their medical practices as a 
result of ObamaCare. Of those doctors, 87 percent said they would be 
forced to restrict the amount of care they offered to Medicare 
patients.
  ObamaCare utterly ignores the laws of economics in this instance. You 
can't cut the cost of a service by cutting the number of people 
supplying it, and that's exactly what IPAB would do. By forcing doctors 
to turn away Medicare patients, the costs will go up as fewer and fewer 
doctors see to the needs of the growing number of seniors. Either that, 
or IPAB will directly ration care. It is astounding that the President 
would look at an important issue like caring for our seniors and decide 
that the best way to handle rising costs is by attacking senior access 
to health care and the doctors who provide it.
  Medicare does need reform, as my friend from Arkansas knows, and has 
been on the floor numerous times talking about the reforms that are 
necessary. It needs real structural reform that protects access for our 
current seniors and fixes the system for future generations. As with so 
many other issues, the President punted on making these needed reforms. 
Instead, he chose to give us a rationing board that would make the 
problem worse.
  Let's repeal IPAB and give our seniors the care they deserve.
  Mr. GRIFFIN of Arkansas. I thank the gentleman from Arizona.

[[Page 3630]]

  I wanted to just point out that 70 House Democrats opposed IPAB when 
it was being debated in the President's health care law. Before I ever 
got to Congress, there were 70. In fact, it wasn't in the House 
version. I'm hopeful that some of the Democrats who have come out 
against IPAB will join us in repealing it so we can move on to truly 
reforming Medicare to save it.
  We're lucky and fortunate to have some physicians, many physicians, 
serving with us here in the House of Representatives; and they bring an 
expertise in this area that really helps us when we're working on 
solutions to the problems with Medicare and Medicaid. One of them has 
joined us here on the floor tonight. I would like to yield to my friend 
from Tennessee.
  Mr. DesJARLAIS. I thank the gentleman, and I think it's great that 
we're taking time tonight to discuss such an important issue that is so 
near and dear to all of our seniors because this last year, quite 
frankly, has been a very confusing time as we try to reform and fix the 
problems that face Medicare today.
  We have, without a doubt, a number of seniors who are having trouble 
finding access to care right now for all the reasons my colleagues have 
stated, that we have a flawed payment formula in the SGR, sustained 
growth rate formula, and we've made attempts to correct that this year. 
But, again, as they so often have done now for the past 13, 14 years, 
they've just pushed the problem down the road rather than deal with it. 
I don't think it hurts to review for a minute what problems are facing 
Medicare.
  We can't deny for a second, Mr. Speaker, that Medicare is going 
broke. You can talk to any number of agencies. Whether it is the CBO, 
AARP, we all know that Medicare is on an unsustainable course. Medicare 
is quite simply going to be broke in about 10 years. That's not a 
Republican problem. That's not a Democrat problem. That's a people 
problem. What we're here about tonight is to make sure that our seniors 
don't have to worry where their health care is going to come from.
  We must get together and take steps to make sure that their access to 
care is preserved and protected. We did this earlier last year with the 
Paul Ryan budget. We put forth a sensible reform that would put 
Medicare on a path to sustainability. If you're 55 or older, you don't 
have to worry about any changes to your health care. That was grossly 
distorted in the press and the media. We were accused of--literally, 
there were TV ads made of pushing an elderly person off a cliff. This 
is just plain and simple wrong to create that kind of uncertainty for 
our seniors.
  The bottom line is we have 10,000 new Medicare recipients entering 
the Medicare pool every day. We have a situation where when Medicare 
was first formed in 1965, the average life expectancy of a male was 68. 
Thanks to advances in medicine, men and women both are living at least 
10 years longer. However, this was not managed in the budgeting for 
Medicare and hence we've gone deeper and deeper into debt. Now our 
average couple that pays about $109,000 into the Medicare system over a 
lifetime extracts about $340,000. That's about a dollar in for $3 out. 
Again, there's no denying that we have a problem and this is going 
broke.

                              {time}  2020

  Well, the Republicans did offer a solution, as my colleagues and I 
have said. However, right now, the IPAB is the only solution we've seen 
in President Obama's plan to cut costs, but it is going to gut $500 
billion from our seniors; and that's the fact they need to know about. 
They need to call their Representatives.
  Mr. GRIFFIN of Arkansas. Will the gentleman yield?
  Mr. DesJARLAIS. Yes, sir.
  Mr. GRIFFIN of Arkansas. I just want to make sure I understand what 
the gentleman is saying. What you are saying--correct me if I am wrong, 
but what you are saying is the House has a plan to reform Medicare to 
save it. As far as I know, I haven't seen any other plan to save 
Medicare pass the Senate. I haven't seen the President propose a plan 
to save Medicare. There is only one. Now the President has a plan for 
Medicare, but it's not to save it, and it really doesn't reduce cost 
through innovation and what have you; it just cuts. And the cuts are 
decided upon by unelected bureaucrats who are on this IPAB, the 
Independent Payment Advisory Board.
  You mentioned the television ads. I had television ads run back in my 
district. They talked about how I and others want to change Medicare as 
we know it. Well, I quoted Senator Lieberman earlier, who said we can't 
save Medicare as we know it because it's going bankrupt. So what I say 
to folks is we have to reform it. And I'm happy to have a discussion 
and debate and compare this reform with that reform. I'm happy to do 
that.
  What is intellectually dishonest, though, is to compare reforms that 
I advocate or you advocate, to compare those to the way it is now. 
That's intellectually dishonest. It's actually deception.
  Why is that deception?
  Because the way things are now is not going to be that way in 7, 8, 
9, 10 years. It's unsustainable, the path we're on with regard to 
Medicare. So if someone says your reform changes Medicare as we know 
it, if that is presented to demagogue, that, in and of itself, is 
intellectually dishonest, because Medicare as we know it goes bankrupt 
and changes itself.
  So I am happy to have a conversation to compare this reform with that 
reform. I certainly do not have a monopoly on wisdom in this area. I 
think we ought to be having a free and open debate of reform ideas that 
save Medicare for seniors. But what we can't do, what we can't do, is 
mislead people, mislead seniors into believing that Medicare, as it 
currently functions, is sustainable. That's not true. That's not true.
  Folks who continue to talk about Medicare as we know it need to point 
out that Medicare as we know it ends on its own by itself. The Congress 
of the United States could do nothing on this for 10, 20, 30 years, 
whatever, and Medicare would go bankrupt with no congressional action.
  So our job, as I see it, is to take affirmative steps to save 
Medicare, to maintain the quality, to maintain the quality so that 
doctors still want to take Medicare patients, and reform it to save it 
for people, seniors like my mother. But we've got to start with the 
fundamental idea that we could debate reforms. But comparing reform to 
an unsustainable status quo is intellectually dishonest.
  I yield back to the gentleman.
  Mr. DesJARLAIS. My friend is absolutely correct. What we need to do 
here, if nothing else, is we need to agree on the facts; and the facts, 
as you just stated, are that Medicare is going broke. It is on an 
unsustainable course. So Medicare must be changed as we know it, as you 
said.
  You mentioned your mother. My mother happens to be having her 73rd 
birthday today. It's a happy birthday for my mother today, but I hope 
that she has many more happy birthdays to come. We all have those 
stories. We all have parents, grandparents, people on Medicare who are 
counting on us. They are looking at the arguments going on in this 
Chamber and they are confused. They don't know what to believe.
  So I think if we can agree, as you said, to the facts and then sit 
down and have a meaningful discussion of how we can preserve and 
protect this program for future generations, then that's half the 
battle.
  Mr. GRIFFIN of Arkansas. Even a bipartisan discussion, I welcome it. 
In fact, I was proud to see that a Democrat from the Senate joined with 
a Republican in the House on a Medicare reform plan. And I'm happy to 
debate all these different plans as long as they have the ability to 
save Medicare and guarantee quality care for seniors.
  If we end up debating reforms on the one hand versus the status quo, 
the way things are now, Medicare as we know it on the other hand, we 
can't have that debate because the whole point is that Medicare as we 
know it, the status quo, Medicare as it is now, it's going bankrupt. So 
any discussion of the options has to be between the different options 
that save Medicare.

[[Page 3631]]

  The problem is there is only one plan that saves Medicare that has 
passed the House or the Senate or that has been proposed by the 
President, and that is the House budget plan from last year. And we 
will, I am confident, have a plan this year that we will vote on 
shortly that will propose changes to save Medicare.
  I want to thank the gentleman for joining us here tonight.
  Do you have anything else you want to add?
  Mr. DesJARLAIS. I agree with what you are saying; and I guarantee 
you, any of the seniors watching tonight, listening to this debate, 
they don't care whether the Republicans win this debate or whether the 
Democrats win this debate. That's irrelevant. What they want to know is 
that they are going to have access to care. And I think it's so 
essential that we repeal this IPAB.
  The gentleman was with me earlier today at a press conference when 
they asked about all the rhetoric last year about these being called 
death panels. That may sound a little bit theatrical, but I can tell 
you, as a physician, that if I'm treating a patient who is 78 or 88 and 
they've got some form of cancer and this IPAB board decides in the 
government one-size-fits-all mentality to throw a blanket over seniors 
of a certain age who have a certain disease--and cancer is probably one 
to pick--that they don't necessarily need to spend that expensive money 
on chemotherapy or experimental drugs or perhaps they don't even want 
me to order the MRI to detect the cancer, now if you are 78 or 88--that 
may sound so old to some people, but I know a lot of people that age 
that are very active. They have got 15 or 20 grandchildren, and those 
grandchildren enjoy their company. So if they make a decision that 
these people shouldn't get that treatment, and that's very well what 
could happen with this board, then you decide what kind of panel or 
what kind of name you want to put on it.
  Mr. GRIFFIN of Arkansas. I think ultimately the IPAB seeks to save 
money by simply cutting blindly without regard to innovation, without 
regard to structural reform, simply having a board of unelected 
bureaucrats ration care by making decisions on what Medicare will 
cover, won't cover, and by how much.
  Yes, we need to do what is fiscally right, but we need to keep our 
promise to our seniors; and the way that you do both is to reform 
Medicare structurally, not to blindly cut, leaving all the rules the 
same, just reducing what you are paying doctors.

                              {time}  2030

  That's not the path. That's not the path. That is, in effect, 
rationing, and that will continue to exacerbate the problem of Medicare 
recipients being unable to find doctors who will take them. The answer 
is to take Medicare that has been so good to so many seniors and reform 
it and innovate and make changes that won't just cut costs by reducing 
the money paid but will actually change the rules so that we are able 
to get more value and more services for our dollar. And that's the 
approach we have to take.
  Mr. DesJARLAIS. I'll just add one more point. I can tell you that 
there's not a senior I've talked to that wants a bureaucrat in the exam 
room with us making their decisions. We build relationships with those 
patients. There's a trust between the patient and their doctor, and 
I'll guarantee you the patients don't want bureaucrats overseeing that 
exam room making those decisions for them. So when we move forward with 
these reforms, we certainly need to keep that in mind.
  I would like to thank the gentleman for leading this hour on such an 
important topic.
  Mr. GRIFFIN of Arkansas. I thank the gentleman from Tennessee for his 
service here in the Congress and as a physician. I thank him for 
joining me here tonight. And I just want to reiterate what you said. 
Whatever solution we come up with has got to be patient-centered and 
respect the doctor-patient relationship. Patient-Centered, not 
government bureaucracy-centered--patient-centered.
  I thank the gentleman for joining me. I thank all of my colleagues 
for joining us here tonight.
  I yield back the balance of my time.

                          ____________________