Health Care Reform Is Needed

Floor Speech

HEALTH CARE REFORM IS NEEDED -- (House of Representatives - March 23, 2009)

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Mr. FLEMING. I thank the gentleman for yielding. And also I want to thank Doctors Murphy and Gingrey in your leadership on this subject and your years in Congress.

I want to say first of all, Mr. Speaker, that health care in the United States is among the best in the world, but the financing of it is a basket case. We have 47 million uninsured Americans and they are not who you think they are. They are not the poor; they have Medicaid. They are not the elderly; they have Medicare. They are not workers for large corporations or the government, such as us tonight. They are owners of small businesses and their employees. They have tremendous difficulty acquiring affordable insurance. And I see this every day.

I, myself, am a small business owner apart from being a family physician with still an active practice. And what is, in fact, going on in this situation is this: the risk pool for a small business is very small, and all it takes is one heart transplant or certainly renal dialysis and it can blow the whole plan up; everybody in the company can find themselves without insurance.

Well, I think that we, on the GOP side, we Republicans, and certainly we Republican physicians, agree with the other side and also with our President that we do need comprehensive health care. We need access to health care and coverage for all Americans.

And in fact, when you think about it with the entitled laws in the 1980s, every American today is entitled to health care regardless of his ability to pay. And if you don't believe me, go to an emergency room demanding care, and you will receive that care without anyone asking about your ability to pay. And that is certainly an honorable and laudable value that we have.

The problem is that that same individual probably has an illness such as diabetes or hypertension, which, if they had received care early in the disease or maybe in a stage of prevention, would not only not be in the emergency room, but the outcome would be much better and the cost would be much lower.

So, you see, when someone goes to the emergency room or staggers into an emergency room perhaps on their death bed and we providers have to pull them out, somebody gets a bill for that. And that bill is going to be many times higher than what it would have been otherwise. This, of course, creates bankruptcies. Many families end up filing bankruptcy after going through a major thing like this. So who absorbs that cost? The cost is absorbed by those who pay insurance premiums and taxpayers.

So it is not free medicine. So since we're already providing the resources, why not front-load that into preventative and early diagnostic care?

I am a strong believer in health care reform, and I will just tick through several of them that I think need to be implemented with all dispatch.

First, we need to have portability. Dr. Murphy mentioned that before. We do need to go to electronic health records in a way that is going to make practices more efficient. We need to do away with archaic insurance laws which cause these small risk pools. We need to create large risk pools and make ``pre-existing illness'' a term that is no longer in the American lexicon.

We need to make sure that everyone gets basic private health care insurance, and I think that family physicians should be the linchpin in health care because it has been proven time and time again that family physicians, the primary care providers, create a much more efficient form of health care, but they also work very closely with their colleagues to ensure that they get uploaded or downloaded or whatever is necessary in order to get the best.

But let me comment on one more thing before I yield. And that is that we're right now in a crossroads of decision making. We all agree that we need comprehensive health care reform. The question is will it be a single-payer governmental system such as what we have today with Medicare or Medicaid, or will it be a private health care system?

Now if we expand Medicare to include everyone, as some have suggested in this body, what is going to absorb that overflow and cost?

You see today, Medicare is somewhat successful in that the fraud, abuse, and the waste is being absorbed by

the taxpayer and also those who pay private subscription rates. When we go to an entire system that is a single payer Medicare system, there will be nobody to pick up the tab at that point. So what are we left with?

Well, number one, we know that when you have a government-type system, a micromanaged system from the top, you end up with spot shortages, which we already have today; and I am sure that Dr. Gingrey will discuss that further. But also you have a situation beyond the spot shortages that is how do you control costs? And government can control costs only one way, and that is rationing. That means that somebody is told ``no'' when there is in fact something that can be done.

On the other hand, you take a private system, even if it's funded by government entities, either partially or in whole, if it's administered privately, it is far more efficient. And I will just give you a quick example.

Today, we talk about fraud and abuse and waste. And how can we find this fraud and abuse and what do we do about it? Well, we have to go after it legally to prosecute it. It is very expensive. You only find the tip of the iceberg. In a private plan, everyone works to build efficiency in the system, and if someone is just a little bit off the graph, you reeducate, you help them, or if they don't respond. You terminate them. You don't have to worry about finding someone who is manufacturing health claims or any of that kind of nonsense. It just doesn't happen.

So the bottom line is we need to get physicians, all providers, on board with working towards a much more efficient system, and we need to get the patients involved as well.

For many years, as my colleagues here, I know, have experienced, you couldn't talk patients into accepting generic drugs. Today with the tiered payment systems, the incentives are in favor of generic drugs, and now you can't beg patients not to take generic medications because they are much cheaper.

So there is a lot of work that we need to do, Mr. Speaker, and these are just some of the suggestions.

But finally, I would just like to say that we need to do a lot more to improve the availability, particularly of primary care providers, and we're going to have to do that by increasing the reimbursement rates because what we're really getting is a paradoxical effect. The more we clamp down reimbursement rates for family physicians and others, the more they have to do other things to make up the difference, which echoes costs throughout the system.

So thank you.

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