Doctor's Hour
Floor Speech
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Mr. CASSIDY. Mr. Speaker, we are pleased to be here. We call this the Doctors Hour because there is a fair number of us on the Republican side who are physicians or in some way health care providers, optometrists, a practicing psychologist, or in some other way connected with the health care field. So we give our own perspective.
Now, my own bio, if you will, aside from being a physician, I have worked with the uninsured in my State of Louisiana for the last 20 years.
That's almost 90 percent of my practice, working with the uninsured in a public hospital. And so, when I speak of what we need to do to help the uninsured, it is purely flowing out of my life experience. I think that as the others come up I'll give them a chance to speak as to it what they're about. I'll start off with a couple of comments. I've learned in my 20 years of, whether private practice or public practice, that the only thing that lowers costs is if you make things patient-centric. If the government is in charge, or the insurance company or a bureaucracy run by anybody is in charge, it becomes something that doesn't work for the patient. The patient's separated from costs. They have a harder time accessing benefits. It just doesn't work.
On the other hand, if you put the patient in the middle, if you tell that woman, listen, you can go see the physician you wish to see and when you go in there there's minimal administrative hassle. And if you don't like that physician, you can go see another physician. It really works. The patient's satisfied, and typically, the patient/physician relationship is stronger. And key to getting good health care is having a strong patient/physician relationship.
Now, frankly, I think the only thing innovative that we've heard from the other side, although their plan kind of is changing on a day-by-day basis, is in one sense, the only thing about that plan which is radical is that it nationalizes health insurance. I was a little amused by my Democratic colleagues earlier who were saying, Oh, my gosh, Republicans are defending insurance companies. No, actually I think they're defending insurance companies. They like insurance companies so much they want to nationalize it and have a national insurance company.
Now I'm thinking, now we have an insurance company run by the private sector that, if it doesn't work, constituents call Congresswomen, Congressmen, we pass a law that changes that, changes that so that the private insurance company plays by better rules. Now, though, it's going to be both the referee and the player. Now the government will make the rules, but also compete. And as it does that, in some way, we're supposed to expect that the government-run insurance company is going to be kinder and gentler, more cost-effective, higher value product than is the private insurance company.
I think it's the triumph of hope over experience. We hope it will be better. We know Medicaid and Medicare don't work as we wish; in fact, they're going bankrupt, and their bankruptcy is what's driving this plan. And so we're going to believe that the third try is going to be the charm and that this time we get it right. Well, without going further, I'll yield to my fellow physician from Louisiana, JOHN FLEMING.
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Mr. CASSIDY. Now, Congressman Fleming, how many Democratic cosponsors do you have?
Mr. FLEMING. I'm sad to say to my friend, and I thank you for yielding back, that so far we have no Democrats, goose egg, zero Democrats.
Mr. CASSIDY. Now, reclaiming my time, because we heard a presentation prior to this that, by golly, this is the best thing since sliced bread; this is the plan that's going to fix everything, and why wouldn't you be on it. So I'm kind of asking you, Dr. FLEMING, why wouldn't they want to be on it.
Mr. FLEMING. Well, I think that is the $100,000, or shall I say, $1.6 trillion question, because apparently they're not so enthralled with it that they would like to be in it themselves. And in fact, I put it to the test by actually putting it on my Web site and asking people if they would like their congressman to support it, that they would actually reach out. We have 150,000 Americans who signed the petitions, and the number is growing drastically every day.
And so I would say that, as we go through this debate, that we simply ask our constituents out there to hold us in Congress accountable by contacting your Congressperson or Senator or even the President and say, Mr. President, Mr. or Ms. Congressperson, Mr. or Ms. Senator, will you go to fleming.house.gov and sign up, cosponsor or whatever, House Resolution 615, that simply says that if you're willing to vote for it you're willing to join it.
Mr. CASSIDY. Now, reclaiming my time, and I appreciate that because, again, what we've heard before is that this plan does not put government between the patient and their physician. And yet, I would have to think, if that weren't the case, why wouldn't anyone agree to your bill? I think your amendment was proposed in our committee, and it was defeated on party line votes. So I think Dr. Roe, from Tennessee, may have some thoughts as to what would come between the patient and the physician. I keep emphasizing that because if something's patient-centered, we know the closer it is to the patient, the more likely it works. So let's ask Dr. ROE, a physician from Tennessee, what might come between the patient and the physician. Dr. ROE.
Mr. ROE of Tennessee. Thank you, Dr. CASSIDY. This evening members of the GOP Doctors Caucus want to talk to you about health care solutions. All of us are physicians who ran for Congress, in part, because we saw challenges in our health care system and wanted to be part of a debate on how to improve it. This is my first term. And when I first arrived I was energized by the opportunity to reform how the health insurance industry works and help make health care more affordable, which are probably the two biggest complaints about today's system.
I quickly realized, however, that the House Democratic majority had a radically different vision of how health care should be delivered. Rather than allowing patients and doctors to make health care decisions, House Democrats' plan is to have Washington bureaucrats decide what is and is not allowed based on its cost effectiveness.
Mr. CASSIDY. Dr. ROE, can I reclaim my time?
Mr. ROE of Tennessee. Yes.
Mr. CASSIDY. Can you show me up there where there is a Washington bureaucrat on that chart? Where might there be a bureaucrat on that chart? Show me where the patient is and show me where a bureaucrat is.
Mr. ROE of Tennessee. Well, the patient, Dr. CASSIDY, is here and here. These are the patients over here. And this person right here, whoever this may be, will be one of the most powerful people in the U.S. This will be a health care commissioner who will decide what is adequate and not adequate insurance coverage. This bureaucrat right here will be very much in those health care decisions.
Mr. CASSIDY. So unlike the Republican plans, which are patient-centric, what you're telling me is this is kind of a top-down, let's figure it out from Washington and lay it on the rest of the country.
Mr. ROE of Tennessee. That's correct. And the solution should come the other way, from the grassroots up. Absolutely. In addition, they, the bureaucrats would create a system so complex that today's system would look like a walk in the park. And then to put the framework in place for government-run health care, the plan called for creation of a government-run insurance company, the so-called public option, which would, over time, bleed out the private insurance industry, because it would be mandated to pay rates less than the cost of care.
In my district, the First District of Tennessee, they call this socialized medicine, and they've sent me here with a very clear message to deliver. Please defeat this bill. People in my district want health care reform. They really, really do. I talk with people all the time who hate insurance companies, and in my time as a doctor, as you all have, I've often spent more time on the phone getting an insurance company to approve a procedure than I did actually doing the procedure. I also talk with people all the time who believe that reform is possible and that results in them getting the same care for less money. And I tell them it's possible, if we focus on rooting out waste in the system.
But even with this desire for reform, people in my district are clear that increasing Washington bureaucrats' roles in health care is not the direction they want our health care system moving in.
Mr. CASSIDY. Dr. ROE, can I reclaim my time?
Mr. ROE of Tennessee. Yes.
Mr. CASSIDY. Of course we don't want this to be a partisan issue. Now frankly, as far as I know, Republicans have not been invited into the discussion. And there are actually some things in that Democratic plan, those thousand pages, that I think are very good. But there's other things, and I think they kind of general concept top-down. But it's not just us.
David Brooks is a columnist for The New York Times. You see him on TV, a very thoughtful man. I have a quote here. The health care system is as big as the entire British economy. There's no way something that big and complex and dynamic can be run out of Washington. We have to set up a dynamic system, not trying to establish a set of rules to be imposed by fiat. Now, I think what you're telling me is that this is a big, complex plan run out of Washington, and not the dynamic system, but rather a set of rules, and whoever that really powerful person is in that purple box, that person will be establishing the rules by fiat. Is that a fair statement?
Mr. ROE of Tennessee. That is correct. And one of the things, Dr. CASSIDY, I think that's very important, that I've heard, and I've got some other comments in a minute. But I think it's very important when you hear about the cost of this health care plan. This plan's somewhere around $1 trillion over 10 years, which doesn't start paying any money out in the plan till 2013. So really, it's $1 trillion over 5 1/2 years. Now, let me just explain why that is an extremely low number.
Mr. CASSIDY. Hang on. Hold that thought. Let me give one more David Brooks quote and call on our colleague, Dr. FLEMING okay? Another David Brooks quote talking about the CBO report, speaking about how much it would cost. This is devastating. The plan was sold as a way to bend the cost curve to reduce the rate of health care cost growth. Instead, the cost of the plan to the Federal budget would rise by 8 percent a year, and there wouldn't be anything close to offsetting revenues to pay for it.
Now, Dr. FLEMING, can you sustain a health care system which has out of control inflation, if you will?
Mr. FLEMING. Well, my answer to the gentleman is that I would look to the experience of other health care systems in other countries. If you look at Medicare and Medicaid, we've not been able to do that. Medicare is running out of money. We don't have a solution to that. The States all across the country are having tremendous difficulty figuring out how they're going to pay for Medicaid budgets, their part of it. And then if you look at the U.K., you look at Canada, countries around the world who have these systems, none of them have been able to claim that they can control costs. They're inflation rates are 10 percent or more.
Mr. CASSIDY. Reclaiming my time, part of this plan is to increase Medicaid eligibility, i.e., put more people on to Medicaid. Yet what we've just heard is that Medicaid is bankrupting States, or causing them to raise taxes.
Mr. FLEMING. Absolutely.
Mr. CASSIDY. So going back to my question, if you cannot control costs, can you sustain a health care system?
Mr. FLEMING. In my opinion, no, because, again, if you can't do it for a smaller system, how can you enlarge the system and somehow make it mysteriously work, particularly when there are no models? Massachusetts, Tennessee, TennCare, and so on and so forth, no one has an example of a government-run system that works.
Mr. ROE of Tennessee. Will the gentleman yield?
Mr. CASSIDY. I will yield.
Mr. ROE of Tennessee. Let me just tell you the folks out there, and we're going spend about the last half of this hour talking about the positive solutions and what we do agree on. But when I first came to D.C. and I heard of this public option I said, I've heard this before. And in Tennessee, in the early nineties we had managed care that was going to control the cost. We got a waiver from HHS and formed a program called TennCare, where we had about 8 different managed care organizations competing for your business. Now we have one.
In the 1993-1994 year, the State of Tennessee spent combined Federal, State revenue, $2.5 billion. Eleven years later, 10 to 11 years later, that had gone to over $8.5 billion. It had tripled and took up almost a third of the State's entire budget. We were complaining about 17 percent now. This took up almost a third and almost every new dollar that the State took in.
Mr. CASSIDY. Reclaiming my time, let me just praise the motivations of the people in Tennessee. They clearly cared about the uninsured, as our Democratic colleagues, are. But it was a flawed model and couldn't be sustained, and we know that those patients were now uninsured again, probably worse off than before the experiment.
Mr. ROE of Tennessee. Well, actually, what happened, just to go over that a little bit, over that period of time, in Tennessee, it was a noble goal to cover as many of our people in our State as we could. But over a short period of time, 45 percent of the people who got on TennCare had private health insurance.
Our Governor is a Democrat, Governor Bredesen. As you all know and as everyone in this Hall knows, in a single-payer system, the way costs are controlled is by rationing care. Well, what we did in Tennessee was, about 200,000 people were removed from the rolls, and what did a significant number of those people do? They went back on their private health insurance.
There is another thing that, I think, you have to ask yourself. By tripling the amount of money you spend on health care, what kind of outcomes will there be? Ultimately, that is what you're really interested in.
What we ended up with in Tennessee was the highest per capita prescription drug use in the Nation, and number two, we were 47th in health outcomes.
I yield back.
Mr. CASSIDY. Dr. BOOZMAN, I would like your opinions on this. You're an optometrist from Arkansas.
Mr. BOOZMAN. Well, thank you very much.
You know, it's interesting. I think we bring up a good subject. When I'm home, one of the things that I hear very, very much from the seniors is, we have a Medicare system that's functioning pretty well. Yet, when you look at it in 2017, it has all kinds of fiscal problems. Their question to me is: Why aren't you fixing the government program you have now before you expand it greatly to millions of people? You guys can correct me or can add to this: I've heard anywhere from 10 percent of the Medicare bill that we pay is just waste and fraud. Why aren't we addressing that?
Mr. CASSIDY. Reclaiming my time, 10 percent in Medicare, a generally accepted figure, is in waste and fraud. So we hear from our colleagues across the aisle that Medicare has lower overhead costs. If you include in that the 10 percent, which is a common way to define ``overhead,'' actually, that 3 percent becomes at least 13 percent. A fair statement. I think an economist would say, if your overhead is so meager that you can't watch out for fraud and abuse, then you need to lump the cost of the fraud and abuse into your overhead.
Mr. BOOZMAN. I agree. As a guy from Arkansas, I just know that there's a heck of a lot of fraud and waste in the system. Rather than expand it like we're talking about doing now, why not fix that first? We hear about the pizza parlors that are charging for dialysis and, you know, things like that.
So, again, I would say that we need to get our act together there and reform the Medicare system that we've got.
I know I'm in a situation now. It's not uncommon at all for me to have people my age call and say, My mom has moved to town, and I can't find a Medicare provider because the fees are so low for physicians that people have started either limiting the slots that they use for the Medicare practice or they've simply discontinued the practice in their clinics.
Mr. CASSIDY. Thank you.
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Mr. CASSIDY. Now, Dr. Broun, if I could reclaim my time, earlier, Dr. ROE had suggested--we spent the first half in kind of a critique of what our folks, our colleagues across the aisle, have put forward; but we've set aside our second half to kind of talk about what works. This is kind of a nice segue because I think, one, we know that lowering administrative costs will help, and we know that malpractice reform can also address some of these issues.
I'll go back to the central theme, which has to be that any effective reform has to put the patient in the middle; and when you put the patient in the middle, you've got to give them transparent costs so they know what they're buying before they go in there, and you need to encourage them to make the lifestyle changes because, ultimately, a patient, she or he, is ultimately responsible for his own health.
I know that, Dr. Fleming, in your business--because you're not only a physician, a congressman, husband, and a father, but you're also a small business man--could you relate your experience with health savings accounts? Perhaps define them for us and say how it worked in your small business.
Mr. FLEMING. Absolutely. I will tell you, approximately 5 years ago, and this is when health savings accounts really----
Mr. CASSIDY. Will you define what that is, please?
Mr. FLEMING. Yes. A health savings account is really very simple, where either the subscriber--the employee--or the employer, as in our case, puts part of the subscription costs into a savings account.
Mr. CASSIDY. Reclaiming my time, you put a portion of that health premium into a bank account of sorts that the patient/employee then controls?
Mr. FLEMING. Not only does he control, but it is nontaxed, and he can use it to buy prescription drugs, to pay the deductible or whatever.
And we were up against a situation where, like many small businesses, our premiums were going up 9, 10 percent, sometimes 15 percent per year, and we were pulling our hair out trying to figure out what else we could do. And this idea of health savings accounts came out, and we said, Well, let's try this. I had some reluctance from my employees, but we increased the deductible, and the extra amount that we would have paid for the increase in subscription costs, we put it into a health savings account for each and every one of them.
The results were dramatic. The costs flatlined. They did not go up. And since then, they've never gone up more than 3 percent a year. It's empowered the employee, the patient, the family, to buy medications at will.
And it was very interesting. I had one employee who was complaining as we implemented. She said, Well, gee, I spend $200 a month for inhalers, and how is this going to help me out because I'm going to be spending a lot of time. I said, Well, let me suggest that you stop smoking, and with the money that you save by not having to use inhalers, you will have plenty of money left over. She took me up on it, and now she doesn't need them.
Mr. CASSIDY. Reclaiming my time, could she have used her HSA to buy the medication to help her get off of cigarettes?
Mr. FLEMING. Absolutely.
Mr. CASSIDY. Now, I like that because it puts the patient, the empowered patient in the middle so that she's making the best decisions not only for her wallet, but also for her health and, by the way, for her job because you are able to keep your costs down and keep her employed.
Fair statement?
Mr. FLEMING. Absolutely.
Mr. CASSIDY. Dr. Roe, I think also you've had experience with putting patients in the middle with these health insurance plans. Can you relate that, please.
Mr. ROE of Tennessee. In our own practice, we had traditional health insurance, as most people did, 80/20 cost. As Dr. Fleming was saying, costs were continuing to go up, and about 3 years ago we introduced this plan for the physicians. There are 11 of us in the group, and all of us decided to go on this plan. And 2 years ago, we have a group that has 294 employees that elected to get their health insurance through our plan at the office: 294, 70 providers, doctors, and extenders. Eighty-four percent of those, of our people, our employees in our office, chose this plan because it put them in control of the dollars.
Let me explain to you how that is. If you believe in wellness and prevention--and the way our plan worked was you had a $5,000 deductible. That scares everybody to death. But our group put $4,200 per person in there.
Mr. CASSIDY. Reclaiming my time, you had a savings account for the patient, $4,200, that you put in there to help pay that high deductible?
Mr. ROE of Tennessee. Yes.
Mr. CASSIDY. But now it's coming out of their pocket if they buy the expensive medicine as opposed to the insurance company.
Mr. ROE of Tennessee. And guess what the empowered person does? At the end of the year, they've been healthy, they've taken care of themselves, they keep that money. But let's say they have an illness or a wreck or something happens to them. Anything above that deductible is paid 100 percent. So you have catastrophic coverage, but you're in control of the first dollars. And by doing that, again, I think as you pointed out in our Education and Labor meeting, that particular type of insurance protection is 30 percent lower than standard.
Mr. CASSIDY. Reclaiming my time, for a similar-size family, similar benefits, with a health savings account costs are 30 percent lower relative to traditional insurance.
Now, we've talked about and quoted David Brooks talking about the Congressional Budget Office comment that the plans being presented to us do not bend the curve; they elevate the cost curve. And yet here is something which has been proven--it's not a hope, but it's experience--to lower costs by 30 percent.
Mr. ROE of Tennessee. That is correct. And when you empower consumers, as I've said, how many of us have driven across four lanes of interstate to buy gas 3 cents a gallon cheaper? Americans are great shoppers, and they will look after it, as opposed to--when they're spending their own money, they are very careful with it, as opposed to the government up here which is not careful with their money.
Mr. CASSIDY. Reclaiming my time, John, if I can ask you, those patients we talked about earlier, and maybe they haven't had the same educational opportunity, the same economic opportunity, but nonetheless, if gas were cheaper 3 cents a gallon on the other side of the interstate, do you think they would go over four lanes to get it?
Mr. BOOZMAN. Very much so. I was looking on the chart, and it's not up there. But other things, the associated health plans, where if you're a florist, a small business man and you've got your little store and you go in and try to negotiate with the insurance company, you don't have a very strong negotiating position. But if we would allow them to go in with others, thousands of florists, then they could negotiate as a group and get a much better rate like a major corporation.
Mr. CASSIDY. May I add, that is part of some of the Republican alternatives that are being proposed. Allow those small business women and men to band together perhaps to purchase one of these empowering HSAs.
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Mr. CASSIDY. Reclaiming my time, you always give me these nice bridges to segue into. Some of the Republican alternatives--and you're actually addressing all of those very nicely. And if you're a member of Rotary, you can do that. Now, I like that.
So can I call on my good friend, Dr. Fleming, if he can initiate some of the discussion of just what the Republican Study Commission is putting forth, not necessarily what Mr. Ryan has put forth or others, but even this step plan.
Mr. FLEMING. You often hear rhetoric from the Democrat side of the aisle that we are the party of the status quo, the party of no, we don't want reform. That is the main thing I ran on to come to Congress. I want health care reform. But I want commonsense reform, not nonsense reform, and that's what the Democrats are offering us.
The first completed bill--there are different versions of bills on the Republican side, but the first completed bill that's actually been dropped because we've been working behind the scenes for weeks and months to get it perfect, is the Empowering Patients First Act, which I am a proud original cosponsor, and here are some basic parts of it.
No. 1, access to coverage for all Americans. It covers preexisting conditions, and that is the big problem that everybody is talking about here tonight, risk pools.
Mr. CASSIDY. Reclaiming my time, so if you will, what's being said by our colleagues across the aisle to misrepresent our positions, we absolutely favor insurance reform to allow folks with preexisting conditions to get coverage, correct? That's what you just said, correct?
Mr. FLEMING. Yes.
Mr. CASSIDY. So next time someone gets up to the podium and says we don't believe that, that is incorrect; am I correct?
Mr. FLEMING. You are correct.
Mr. CASSIDY. The fact is that is misleading. And that is one thing I like in their plan and I like in our plan.
I yield back.
Mr. FLEMING. It also protects employer-sponsored insurance. But on the other hand, it actually gives ownership of the plans to the individual, and also the individual can buy it outside of their employer.
Mr. CASSIDY. Reclaiming my time, the anecdotes that you gave and Dr. ROE gave regarding the empowered patients by giving them these health savings accounts or something such as that, we empower patients. That's in our plan. It's not the government bureaucracy between our friends up there; rather, it is empowering patients.
Mr. FLEMING. This does not exist. This matrix that you see there with Dr. BOOZMAN, that does not exist in this plan.
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Mr. CASSIDY. If I may reclaim my time, one, it's a tremendous testament to the faith of that family, their love for their son and to those fine physicians at Vanderbilt. I think all of us share the hope to have high-quality health care affordable, accessible to all Americans. Our concern is that the solutions being brought upon us are going to not only not achieve that but interfere with that relationship, and it's not just folks who are conservatives.
I have an editorial in my local paper by Susan Estrich. You will recall that Susan Estrich was chief of staff for Walter Mondale--I think I have this right--when he ran for President. I don't agree with her, but I respect her thoughts. She's a bright woman. She wrote Don't Risk Your Health Care.
She begins:
The President is ``not familiar'' with the bill. No one can explain how it will work yet, as Senator BEN CARDIN told a contentious town meeting. There are various plans, and negotiations are still in the early stages. But whatever it is, we should be for it.
She goes on to say, ``Am I missing something?''
Then she describes the relationship that she and her family have with their physician. They are not sure.
She wants to be reassured and has seen nothing that reassures her yet that that relationship will be preserved. So it isn't just folks in this arena. It's folks across the country.
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Mr. CASSIDY. If you would yield back, because I just want to mention that one thing. There are some physicians, a lot of them on the west coast, that have a practice that is so patient-centered, it works beautifully. In that practice, the patient pays $50 to $100 a month and gets all the primary and preventive services cared for. If the patient doesn't like it, they find another doctor the next month. It's like Target or Wal-Mart. If my wife doesn't like the sale at Target, she goes over to Wal-Mart; and if she doesn't like the service at Wal-Mart, she will go back to Target. The fact is, is that the physician, knowing that those folks can go, is going to be more patient-sensitive.
Mr. BROUN of Georgia. And the Republican plan allows patients to do that, where the Democratic plan does not.
Mr. CASSIDY. Thank you all very much.
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