[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[House]
[Pages 3733-3736]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       ONGOING HEALTH CARE DEBATE

  The SPEAKER pro tempore (Mr. Gowdy). Under the Speaker's announced 
policy of January 5, 2011, the gentleman from Georgia (Mr. Woodall) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. WOODALL. I appreciate the majority leader giving me the time to 
come down here today, because I've got IPAB on my mind, Mr. Speaker. I 
say that like everybody knows what that is because we talk about it 
here in this Chamber all day long. IPAB, a word that was not even in 
the lexicon of America until the President passed his health care bill.
  What is IPAB? I happened to bring down with me today, Mr. Speaker, 
the front page of the President's health care bill, the Patient 
Protection and Affordable Care Act as he describes it. This was the 
900-page law that was passed that completely restructured a sixth of 
the American economy.
  The question then is, when we're talking about the Patient Protection 
and Affordable Care Act and we're talking about how we change the 
individual health care decisions that every American gets to make, what 
do we get for it? What's the value added there? Because I think, Mr. 
Speaker, at the end of the day, when folks are talking about what 
motivates them, it really is affordable care. That's why we named the 
bill this way, the Patient Protection and Affordable Care Act. We want 
patients to be protected, to be able to make their own health care 
choices. We want care to be made available to folks at prices that 
American families can afford. There are 900 pages in that health care 
bill, Mr. Speaker.
  Now, IPAB, how would we describe it? We would call IPAB the hammer in 
the health care bill, because there are lots of ways to save money, Mr. 
Speaker. You can save money by introducing competition into a system.
  I'm from Atlanta, Mr. Speaker. I've got a soft spot in my heart for 
the Coca-Cola Company. But how many Coca-Cola machines do you pass on 
the street where the Coke is selling for $3 a can while the Pepsi right 
beside it is selling for $1.50? How many? Have you ever seen that 
happen? The answer is ``no'' because competition completely

[[Page 3734]]

moves those machines out of the marketplace. If the Pepsi is a dollar, 
the Coke's going to be a dollar, too. If the Pepsi is $2, the Coke is 
going to be $2. Competition controls those prices.
  What controls prices in the Patient Protection and Affordable Care 
Act? Because we've heard time and time again, Mr. Speaker, on the floor 
of this House that the Patient Protection Act restricts my choices as a 
consumer. We've heard time and time again on the floor of this House, 
Mr. Speaker, that the Patient Protection Act restricts doctors and the 
services that they provide. We've heard time and time again, Mr. 
Speaker, that the Patient Protection Act restricts the choices that 
insurance companies can provide. So, if it's all of these restrictions 
on competition, how in the world does the Patient Protection Act save 
the money that needs to be saved to make health care affordable?
  The answer is this: It's in section 3403. Again, I don't encourage 
folks at home to read this bill, Mr. Speaker, unless they've got time 
on their hands. There's lots of good summaries out there. It's over 900 
pages long, and it's signed into law. I don't think folks are going to 
be able to read this back in their offices, Mr. Speaker.
  This is about 46 pages that I've put up here just on one in case we 
needed to reference it, but 46 pages of law defining this brand-new 
thing that we've never had before in America, the Independent Payment 
Advisory Board.
  If you read these 40 pages, Mr. Speaker, what you're going to find is 
that the Congress that passed the President's health care bill--and it 
was not this Congress, Mr. Speaker. You were not here in that Congress. 
I was not here in that Congress. It did not pass the Congress under 
normal rules and procedures. It passed in a manipulated reconciliation 
process designed intentionally to thwart the will of the House and of 
the Senate. But in that bill, they said Congress can't control these 
costs; and, candidly, I'm glad. I don't want Congress controlling my 
health care costs.
  So what did they do? They went to an independent commission. The 
President is going to appoint this commission, Mr. Speaker. The 
President will appoint members to sit on this independent Medicare 
advisory board, and what they will do is decide where Medicare should 
save money.
  Now, my mom and dad just went on Medicare, Mr. Speaker. I sit down 
with them. I look at their statement of charges that they get back when 
they go to the doctor's office. It's not always easy to understand, but 
we go through it together. It occurs to me that if Medicare is going to 
save money, there is only one way Medicare can do that. If we don't 
allow competition in the system, if we don't allow patient choice in 
the system, if we don't allow provider choice in the system, there is 
only one way that Medicare can save a dime; that is by restricting 
services. Now, that comes in lots of different ways, and I want to make 
sure I'm absolutely candid, Mr. Speaker, and accurate, because this is 
the panel.
  Do you remember the death panel discussions? Do you remember that 
becoming a part of the lexicon in America, the death panels that 
Congress was going to create? This is that. I mean, this is where that 
idea came from, because what we have here is a board that makes 
decisions, recommendations about how to change Medicare spending.
  Well, if we're not going to provide competition, if we're not going 
to allow doctors more decisions, if we're not going to allow other 
providers more decisions, then the only way to change the financing 
structure of Medicare is to restrict either the services that Medicare 
provides or the amount of money that is being paid to providers.
  Now, I want to give my friends who passed this bill the benefit of 
the doubt, Mr. Speaker. I don't believe there is a single Member of 
this body who would stand here in the well and say that their decision 
about how to save the Medicare program is to restrict the services that 
Medicare beneficiaries can access, not one. I don't think one Member, 
Republican or Democrat, will come to the well of this House and say 
that their proposal for saving Medicare is to find seniors in need of 
health care and tell them ``no.'' Not one. But, Mr. Speaker, what's the 
effect, then, of the Independent Payment Advisory Board?
  Let's look at what folks have said.
  This is George Miller, one of my colleagues here on the floor of the 
House, a Democrat from California. We're taking up, tomorrow, a bill 
that will repeal this Independent Payment Advisory Board, this Medicare 
board. We're going to repeal it tomorrow, I believe, here on the floor 
of the House. When talking about that, my colleague from California 
said this:

       IPAB is a critical measure for lowering health care costs.

  He's absolutely right. I'm not picking on him at all. I'm endorsing 
what he has to say. That's what these 40 pages of law, Mr. Speaker, do. 
They are all designed to cut costs. But we've talked about it. If we're 
not going to introduce competition, if we're not going to introduce 
choices, if we're not going to introduce options, how are we going to 
cut costs? We all agree, Republicans and Democrats alike, that the IPAB 
board is a critical measure for lowering health care costs.
  Peter Orszag, the OMB Director, the first one that President Obama 
used, said this about health care costs in Medicare:

       The core problem is that health care costs are concentrated 
     among expensive treatments for chronic diseases and for end-
     of-life care.

                              {time}  1740

  Mr. Speaker, let me reflect on that a minute. I've just shown you the 
40 pages of law in the President's health care bill that are the cost-
saving mechanism that the President has proposed and that has been 
passed into law. The OMB Director, the Office of Management and Budget 
Director, for the Obama administration said this:

       The core problem is that health care costs are concentrated 
     among expensive treatments for chronic diseases and for end-
     of-life care.

  Mr. Speaker, what choices, then, does that give us? If we agree that 
IPAB is a critical measure for lowering health care costs and if we 
agree that health care costs are primarily concentrated with expensive 
treatments for chronic diseases and end-of-life care, how exactly is 
this unelected board going to lower those costs?
  It's an honest question. If that's what has to happen for Medicare to 
be saved, exactly how is this board going to do that? Every American on 
Medicare and every American approaching Medicare needs to have that on 
their mind. What is it that IPAB, this unelected board, is going to do 
to save costs? We all--Republicans and Democrats alike--agree that the 
only purpose of IPAB is to control costs. We agree--Republicans and 
Democrats alike--that the money in Medicare is concentrated among 
expensive treatments for chronic diseases and end-of-life care. So if 
IPAB is going to control costs and the costs are here, what choice do 
we have but to deny individuals expensive treatments for chronic 
diseases and end-of-life care? What else is there?
  To me, that's common sense, that this is where the President's 
proposal is going. I do not endorse this proposal. I was not here in 
this Congress, Mr. Speaker, when this proposal passed. Had I been here, 
I would have voted an enthusiastic ``no.''
  Nevertheless, it is the law of the land as we sit here today, and our 
seniors are at risk. How many times have we heard supporters of the 
President's health care bill say, No, IPAB is not a Medicare rationing 
board. In fact, if you want to dig deep into these 40 pages, you'll 
find that said over and over again. Folks continually say, this is not 
a Medicare rationing board. But we know where the costs are, and the 
question is how do we control them.
  What my friends who support the President's health care bill say is, 
no, we're not going to deny care to Medicare beneficiaries; we're just 
going to clamp down on payments to doctors. That's what they say: We're 
just going to change the payment schedules for doctors.
  I've got news for you, Mr. Speaker. That's been the Medicare plan for 
decade, upon decade, upon decade, upon

[[Page 3735]]

decade; and this is what you get. This is from a CNN Money article from 
January 6 of this year titled ``Doctors Going Broke.'' It recounts the 
many changes that have happened in the Medicare system as we continue 
to do nothing about choices, nothing about options, nothing about 
getting the consumer involved in health care decisions, but continuing 
to use the same old broken tools to solve the Medicare issue. It says 
this:

       In 2005, Medicare revised the reimbursement guidelines for 
     cancer drugs, which effectively made reimbursements for many 
     expensive cancer drugs fall to less than the actual cost of 
     the drugs.

  You can tell me you don't want a Medicare rationing board, Mr. 
Speaker. I don't want a Medicare rationing board either. But if what 
we're going to have is a board that is going to cut the costs of 
Medicare and they're going to do that by cutting reimbursements to 
providers and what we already see is that we're cutting reimbursements 
to providers to the point that those reimbursements fall below the cost 
of the service, what do you think is going to happen to Medicare 
beneficiaries when they go to seek services? I'll tell you.
  The President's health care bill, Mr. Speaker, primarily solved the 
challenge of the uninsured by dumping them onto State Medicaid 
policies. I don't think that is a particularly creative solution, but 
it is certainly an option.
  My uncle is a primary care doc down in central Georgia. There used to 
be a bunch of docs who would see Medicare patients in that part of the 
world. Today he's the only one who will see Medicaid. He is the only 
one. In five counties, Mr. Speaker, he is the only doc that will see 
Medicaid patients. Don't tell me that our goal here in Congress is to 
help patients find care if we're going to lower reimbursement rates to 
a place where no doctor will accept them. I don't care that you have an 
insurance policy if you can't find a doctor who will take it. It does 
not matter that the government says you're guaranteed health care if 
you can't find a doctor who will provide it.
  Mr. Speaker, that's not news to anyone who has had a job in the 
private sector; that's not news to anyone who has had to write 
paychecks from their business; and it's not news to anyone who has been 
a consumer.
  I'm a coupon clipper, Mr. Speaker. I cut them out of the Sunday 
paper. I go into the store, I've got a big old coupon, I think I'm 
going to get a good deal, and the store doesn't carry the product. What 
is that coupon worth to me if I can't find the product, Mr. Speaker? 
Not a thing. That's what we're doing when we clamp down on costs. Don't 
you dare believe that we can continue to cut docs year after year after 
year after year and that your family and my family, who are on 
Medicare, are going to be able to find care. They cannot.
  From that same article, Mr. Speaker, ``Doctors Going Broke.'' Again, 
January 6, 2012, from CNN Money Magazine. Dr. William Pentz said:

       Recent steep 35 percent to 40 percent cuts in Medicare 
     reimbursements for key cardiovascular services, such as 
     stress tests and echocardiograms, have taken a substantial 
     toll on revenue.

  He also says:

       These cuts have destabilized private cardiology practices. 
     A third of our patients are on Medicare.

  So these Medicare cuts are by far the biggest factor. Then, Mr. 
Speaker, he says private insurers follow Medicare rates. Those 
reimbursements are going down as well. You know, he is right about 
that. When the Federal Government pays two-thirds of all the health 
care costs in this country, Mr. Speaker, and the Federal Government 
decides it can get away with paying less, guess what? Everybody else 
wants to get away with paying less too. That is a good capitalist 
system. I don't fault folks for that. What I fault folks for is 
standing on the floor of this House and promising the American people a 
program that they pay into all of their life so it will be available 
for them in their time of need and then cutting rates to a place where 
you cannot find a doctor who will serve you. Mr. Speaker, the hypocrisy 
of saying that we're going to care about people in their time of need 
and putting the people out of business who provide for them in that 
time of need is deafening.
  I go again to that same article of January 6, 2012, ``Doctors Going 
Broke.'' The same doctor, William Pentz, a cardiologist there in 
Philadelphia:

       If this continues, I might seriously consider leaving 
     medicine. I can't keep working this way.

  He goes on to talk about how the law of the land is going to provide 
even further cuts. He said:

       If that continues, it will put us under.

  My dad is going in for heart surgery in about 30 days, Mr. Speaker. 
We shopped long and hard to find a doctor that we would trust to do 
that surgery, just as every American family does.
  Who are folks going to trust, Mr. Speaker? Who are folks going to 
find if we put the people who provide the care out of business?
  IPAB, Mr. Speaker, these 40 pages from the President's health care 
bill, the only 40 pages that are designed to reduce costs, do not 
reduce costs through competition, do not reduce costs by providing 
consumer choices, do not reduce costs by getting consumers involved in 
their own health care. They reduce costs by either rationing services 
or by cutting reimbursements to a place where the marketplace rations 
those services on its own.
  Don't believe for a moment, Mr. Speaker, that cutting reimbursements 
to doctors doesn't equal cutting services. That's really the hypocrisy, 
Mr. Speaker, for lack of a better word, that I hear on the floor of 
this House:
  Oh, we're going to go out there and we're going to save all this 
money. How are you going to do it?
  We're going to go out there and cut those reimbursements to docs.
  All right. It sounds like you're liable to end up rationing services.
  Oh, no. IPAB, that's not going to ration any services. No, no, no. 
They don't have the authority to cut out services. That's not what they 
do.
  Well, what are they going to do?
  Well, they're going to cut the reimbursement rates.
  Well, what's going to happen?
  Well, docs will just keep providing those services.

                              {time}  1750

  We saw it here.
  Money magazine tells you, when you are only reimbursing folks at the 
cost of the service or less, they're going to quit providing. According 
to factcheck.org--those folks who go around and look at all the claims 
politicians make and try to figure out which ones are real and which 
ones are full of hot air--this is what they said: ``31 percent of 
primary physicians restricted Medicare patients in their practices.'' 
You know what that means. That means that 31 percent of all the doctors 
in the land who provide primary care services, those most-needed 
services, said they do not take every Medicare patient that comes 
knocking on their door. They can't. They restrict how many Medicare 
patients they'll take into their practice.
  We've already seen that we're putting docs out of business. We're 
forcing docs into retirement. Who is going to provide the care, Mr. 
Speaker? Who is going to provide the care if we force the people who do 
it today out of business tomorrow?
  Back to factcheck.org: ``62 percent of family practitioners would 
stop accepting Medicare patients if reimbursement rate cuts follow 
current law.'' Hear that, Mr. Speaker. Hear that. Let me say it again: 
If reimbursement rates follow the current law. I'm not talking about if 
some new draconian procedure gets put in place. I'm not talking about 
if some crazy future Congress comes in here and tries to further 
socialize health care. No, no. If the current law of the land, as 
passed before you and I came to Congress, Mr. Speaker, if the current 
law of the land continues, 62 percent of family practitioners would 
stop accepting Medicare patients.
  What is IPAB going to do? It's going to control costs. How's it going 
to do it? It's going to do it by cutting reimbursements to providers. 
What happens

[[Page 3736]]

when you cut reimbursements to providers? Sixty-two percent of all of 
America's family practitioners will stop accepting Medicare patients.
  Mr. Speaker, what we do here has consequences. This isn't some think 
tank downtown that has the freedom to just pontificate, to make 
recommendations, to wonder how things could have been. This is a body 
where every single thing that we do has the potential to affect--
positively or negatively--the lives of every single citizen of the 
land.
  There are no free lunches in America, Mr. Speaker. There is no 
something for nothing. You can control costs through competition. You 
can control costs through getting consumers involved in their own 
health care. You can control costs by providing folks with more 
choices. You cannot control costs responsibly by putting providers out 
of business and rationing care through the long lines that are then 
going to result.
  We are going to deal with this bill tomorrow, in fact, and I would be 
happy to yield to my friend from the Rules Committee to help make that 
happen.

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