Health Care

Floor Speech

BREAK IN TRANSCRIPT

Mr. THOMPSON of Pennsylvania. I thank my good friend from Missouri and my good friend from Tennessee for this Special Order tonight that you are doing.

Yesterday was a landmark day. I think it established a pretty confident trend of what the American people like and what they dislike. And what they dislike I think is properly captured and framed in that chart that you have on the tripod, the bureaucracy of a government-run, government takeover of health care.

We need to be approaching health care and we need to be approaching everything we do in this Chamber, I believe, from a principled leadership perspective, of leading with principles. And I have to tell you, and I suppose my colleagues on the other side of the aisle would agree with that. It is just their principles are completely 180 degrees from our principles. I have to imagine, what are the principles behind that health care nightmare that is outlined there? I liken it to a train going down a mountain with no brakes--it never ends well.

What they are trying to shove through is just to get anything, get something. I can imagine how the behind-closed-door discussions are going, which happened again today even after the people in Massachusetts spoke.

Mr. AKIN. All the complaints.

Mr. THOMPSON of Pennsylvania. It has to be something like this: ``We don't care what it is, let's just pass something, whatever it might be.'' The goal is just to get something through to be able to say they did something. Well, that is wrong. That is not the approach we do. The American people need and deserve better than that. They want principles.

The health care principles I believe in and the Republican Party and some of my Democratic colleagues, I think we can work together. There are four principles I have always held dear as a health care professional for almost 30 years, and that is--and my belief is that we have a health care system that is pretty good. In fact, I would rate it one of the best in the world, not that it couldn't be improved upon. And the principles that we dedicate ourselves to are decreasing costs, increasing access, improving quality, and preserving that relationship that Dr. Roe talked about, the decisionmaking relationship between the physician and the patient, not allowing a bureaucrat to insert themselves into that relationship. And this certainly, I think, is regressive, regressive in terms of all four of those principles.

My colleague from Tennessee talked about the impact on the relationship of decisionmaking between the patient and the physician, where the bureaucracy, a bureaucrat is inserted between that relationship. But when you look at all of it, when you look at cost, the cost of the Senate bill, which I believe--I don't know, but that is what will be shoved at the American people and will be shoved at this Chamber to work on. The Congressional Budget Office showed those costs going up significantly. I believe the individual costs were at least, on the average, $300 per year, $2,100 per family. I thought the idea behind that is to lower costs for everyone, yet we know what is out there.

My colleagues have talked about allowing the purchase of health insurance across State lines. That is greater competition. That is a good thing. That brings costs down.

Certainly the whole issue of tort reform; $29 billion a year that is spent in this Nation on tort reform premiums, $29 billion. And we talk about waste and fraud, waste within health care spending. I think that is the biggest waste there is. Those dollars could be going into directly caring for patients. You add on top of that the cost of the practice of defensive medicine, and I understand why that occurs.

A physician comes out of medical school with a quarter million dollars of loans, if they are a specialist, maybe half a million dollars in loans. And at the risk of even a frivolous lawsuit they can lose a practice, lose their family's home. They order extra tests that may not be necessary to treat the illness at hand but does substantiate they followed a standard of practice, a standard of care.

Mr. ROE of Tennessee. If the gentleman will yield, let me just mention a couple of things that my friend from Pennsylvania is talking about.

In 1975, all the malpractice companies left the State of Tennessee. We had nothing. So the physicians there brought together and formed what is called the State Volunteer Mutual Insurance Company. It was a mutual company that anything that wasn't paid out in premiums came back to us. Since the inception of that company in 1975, over half the premium dollars have gone to attorneys. Less than 40 cents on the dollar went to the injured parties, the injured patients, and about 10 cents to run the company.

We have a system that is broken terribly when you can't even compensate injured people. That is the system we have in America now, and that is wrong, because there are events that do occur that need to be compensated. We don't have a system that can even do that.

Mr. AKIN. Reclaiming my time, gentlemen, what you have been outlining here today is, I think, what the American public is eager for. They are eager for people to define specifically what a problem is, and to outline a solution that makes common sense, that isn't going to be that expensive. In fact, the solution should save money. They are going to increase the amount of freedom that consumers have and choices, and improve the quality of health care. That is a way to approach health care. That is to say, we are not going to totally destroy it all; we are going to fix the parts of it that are broken.

That is usually the way we approach most legislative questions. And yet, now, for to whatever it is, eight months, we have been running down this track trying to reproduce in America what has never worked in foreign countries very well.

I think you could say there are a lot of things we could fix in America. But, on the other hand, if you are the guy that lives in Dubai and you are worth a couple hundred million dollars and you get sick, guess where you want to be treated. You want to come to the good old USA.

So why do we want to scrap something that has many aspects? In fact, I would say if you take a look at the American health care system, if you look at what is being provided in care, we are doing pretty darned well. If you are taking a look at how are we paying for that, we have got some problems.

So our problems tend to be more in the pay for side than in the quality of the care that is coming out. And each of you gentlemen have demonstrated, I think very articulately, tonight the fact that there are some certain specific things that could be fixed, yet we seem to be just on this--you called it a train wreck--just trying to replace the whole thing with a Big Government solution.

And I think it is ironic, almost amusing, and a month or two ago would have been unbelievable, to say that this whole thing may well have been derailed by Massachusetts voting for a Republican for the U.S. Senate. If you said that 2 months ago, people would think you needed to be locked up in a little white straitjacket. They would say there is no chance that something like that could happen.

Yet people are starting to pay attention to what is being proposed here, and this, along with a whole series of other incidents and mismanagement, has created a political anomaly. I mean, there wasn't one Republican Congressman in the State of Massachusetts, and yet the State, looking at this kind of thing, along with the tremendous spending that this represents, said, Time out. We are not solving our problems.

I appreciate your time.

Mr. ROE of Tennessee. I would say, when you look at this--I am just a country doctor from east Tennessee, but if you look at the health care problem in America, it is this: One is we have had escalating costs. There is no question of the costs. And we have got people who don't have health insurance coverage. Those are the two problems. How do you solve those problems?

Let me explain to you why having more government will never work and will end up costing more money. And my good friend from Pennsylvania, Congressman Thompson, has hit the nail right on the head.

When you take $500 billion--and I have dealt with Medicare patients for my entire medical practice. When you take $500 billion out of a plan that is already underfunded, that goes upside down in premiums by 2017--and beginning next year the baby boomers hit 3 million to 3.5 million new recipients every year. You take a half trillion dollars out and you add 30 to 35 million people, three things happen: One, you have decreased access; two, because you are not going to get in to see the doctor, number two, you are going to have decreased quality; and three, and seniors get this, their costs are going to go up to get the care that they need.

Mr. AKIN. Doctor, you are so eloquent and you said it so smoothly, but I just think we need to underline what you said.

What you are saying is you are going to take $500 billion out of Medicare. Now, is this a Republican that is going to raid Medicare?

Mr. ROE of Tennessee. No, sir.

Mr. AKIN. We have always been accused of raiding Medicare, but we are not the ones doing this, right?

Mr. ROE of Tennessee. That is correct. Unless you are in Florida, of course.

Mr. AKIN. So we are going to take $500 billion out of Medicare. And what do you think is going to happen? If you take $500 billion out of Medicare, it is going to be harder to provide services for people.

But you are not just doing that alone. You are adding more people and taking money out.

So now you're sort of compounding the problem. And so the result is you're going to get poorer quality care and you're going to have to pay more money on the side, I suppose. Is that right, Doctor?

Mr. ROE of Tennessee. That's correct. What you're going to do is, you're going to create waits. There's no other way around it. And that's my biggest fear as a physician, is that at the bottom line, the end of the day, when you budget so much money for health care and you have more demand for services than you have money to pay for it, you create waits. It happens in England France, and Germany, unless you are wealthy and can buy your way around the system, which is what happens. But I'm talking about for the bulk of the American people.

Over 90 percent of the people who have insurance in this country like it. And they like what they have. They understand we pass all of this right here. When a patient comes to me, am I going to be able to provide better care for that patient? The answer is, No, I can't. And let's look at some numbers.

Mr. AKIN. One other point, Doctor. You said you're just a country doctor from Tennessee. But if I remember right, there were two States that did the experiment of essentially government-run health care. One was the great State of Massachusetts, which has now become my fond friend.

Mr. ROE of Tennessee. Mine, too.

Mr. AKIN. And the second one is Tennessee. So you've had personal firsthand of the State government deciding they're going to take over health care. Is that correct?

Mr. ROE of Tennessee. We had the 17-year experiment called TennCare. And to back up to the beginning of Medicare, in 1965 that great program that was passed started as a $3 billion program. The congressional estimates were at that time that by 1990, 25 years later, it would be a $15 billion program. The actual number, a $90 billion program. It's gone from $90 billion in 1990 to over a $400 billion program. And we're going to cut this much money out. As our population ages, there's going to be more spending involved. Now that's one plan.

In Tennessee, we started with a managed care plan in 1993 to control costs, because costs were going up and there wasn't enough access for our citizens. It was a $2.6 billion program in 1993. In 10 budget years it was an $8 billion program. It took up almost every new dollar that the State of Tennessee brought. And let me go on and fast forward to this Senate bill for a moment, because this is very important for States.

This bill calls for a massive expansion, the Senate bill, a massive expansion of Medicaid. In the State of Tennessee we're looking at three-quarters of a billion dollars of unfunded--unfunded--liability. That's what Nebraska got off the hook for. What you're asking us to do in Tennessee is we, this year, Mr. Speaker, this year we have 50 less highway patrolmen in the State of Tennessee than we had in 1978. And we have 2 million more people. That's the kind of shape that the States are getting in. And we're getting now another unfunded mandate through this health care bill that I don't know where the money is going to come from.

We have no capital projects for our colleges this year in the State of Tennessee. We're not building a new dormitory, a new library, or anything. And yet we're going to get crammed down this massive expansion of government with an unfunded mandate. That's why people are angry.

Mr. AKIN. Doctor, you just made another point. What I'm hearing you say is that the estimate that the CBO has put together of this little treasure here of a trillion dollars, that part of the deal is it's a little more than a trillion, because we're going to do something that's going to make the States pay a chunk of change, too. So we have what's called an unfunded mandate that's going to descend on the States. The trouble is the States don't have the option we do of just busting the budget, because a lot of them have balanced budget amendments. And that's going to be tough.

I'd like to go back over to Congressman Thompson from Pennsylvania. Would you like to join us here?

Mr. THOMPSON of Pennsylvania. Absolutely. I believe, actually, it was the Tennessee Governor, a Democrat, who coined the term that this Senate bill and the Medicaid, the shoving of the increased Medicaid rolls and shifting that over to the State was, ``the mother of all unfunded mandates.''

Mr. ROE of Tennessee. That's what he said.

Mr. THOMPSON of Pennsylvania. Sounds like a very smart man.

Mr. ROE of Tennessee. He is a very good Governor.

Mr. AKIN. That's a Democrat Governor.

Mr. THOMPSON of Pennsylvania. That is correct.

Mr. AKIN. He says it's the mother of all unfunded mandates. That says that trillion may be a pretty conservative number.

Mr. THOMPSON of Pennsylvania. When we look at the State of Pennsylvania, the conservative estimates are that the Senate bill provision with the huge expansion of the Medicaid rolls, which is truly just shifting it to the States without funding, $2.4 billion to the State of Pennsylvania. Pennsylvania went 6 months--at least 6 months without a budget this past year, the State government, because they couldn't make it balance. They're required to, but they just couldn't get it done. The economics, the revenue, and the expenses just did not match up.

I think that there are so many problems with the proposals that our Democratic colleagues have been proposing. And I suspect what we will see as a bill comes out of the closed, dark room to the House floor, that it will be very flawed. But let me just say there are solutions. There are solutions that have been defined. There are solutions that have been introduced going back to July of this year, 7 months ago, and there are solutions that have received even some support but are largely Republic solutions.

The Putting Patients First Act, which addresses the issue of tort reform and takes that $329 billion-minimum of waste, and that would allow the cost of everybody's health care to come down. The Putting Patients First Act, which allows the bidding of health insurance across State lines, which allows the formation of association health plans to give small businesses the opportunity to join together to have a larger voice and more negotiation power. It also addresses key issues, and does it in a good market approach of addressing preexisting conditions.

They allow the States to create high-risk pools. Just because you're born with a preexisting condition or during the course of your lifetime you experience or develop a disease or disability, say breast cancer or prostate cancer, that should not mean that you shouldn't be able to afford to purchase--I'm not saying anybody give you--but be able to afford to purchase reasonably priced health insurance.

The Republican solution does that. And it doesn't do it with massive taxing. Does it with no taxing, does it with no cuts to Medicare, does it with no shifting of tremendous health care cost to the State. It is a win-win and brings down the cost of health care for everybody.

Mr. AKIN. So we've got some solutions. I was just thinking about the voters in all the different States

that are frustrated. They may be listening to us even here on the floor of the Congress, and they're thinking, Do they guys get it or not? Why are they talking about these huge Big Government solutions and spending the money that we don't have. I'm not sure some of them aren't ready to declare independence again.

I was just thinking, if you're going to write a declaration of independence relative to health care, one of the things you say is, it's not going to add a whole lot of money to the big national debt. That's one thing you've got to pay attention to. It's not going to impose mandates on States or employers or individuals. And it's not going to use taxpayer dollars to fund abortions or illegal immigrants.

I think those are all things that have been debated and discussed and people are upset about. It's going to be negotiated, I think, in a free and open format instead of behind closed doors. We're going to reserve that doctor-patient relationship. And we're going to allow freedom, which has worked so well in America for a couple of hundred years, to reign. To actually have some freedom to let people make choices and trust them to make their own choices and then do some of these commonsense solutions that you're talking about to not try to reproduce the failed systems of the Soviet Union or the failed systems of European medicine or Canadian medicine, which are very inefficient and expensive, but rather build on the model of freedom and people's free choices and people making distinctions between what sort of health care they do or don't want and, particularly, allowing doctors to practice medicine without feeling threatened from lawyers or insurance companies or Big Brother looking over their shoulder.

If you go to med school and spend a quarter of a million bucks on education, I think I'd rather have your opinion as to what you ought to do to me. I don't mean to rant here, but it seems like we need some sort of statement or declaration or something about some basic principles that Americans believe in.

I yield to you, Doctor Roe.

Mr. ROE of Tennessee. I think one of the problems that you've seen with this plan is the complexity of it. I think the bottom line, what you saw in Massachusetts yesterday is that the people there do appreciate their own personal freedom. They want their freedom to choose. Also, Massachusetts was being asked, since they've already been mandated to pay for their own policy, which I might add has added tremendous cost, and I will also tell you that half of the primary care doctors in that State are not accepting patients.

This is one of the things that isn't understood about a lot of the government-run plans: They don't pay the cost of the care. We haven't discussed that much here, but in our own State, Medicaid pays less than 60 percent of the cost to the providers; the hospitals and the doctors. Medicare pays somewhere between 80 and 90 percent of the costs. The rest of those costs are shifted to private health insurers, meaning that people out in private businesses are actually getting taxed again.

What Congressman Thompson was talking about, another thing that's left out of this particular plan that's really unfair is that you're not even putting in the so-called ``doctor fix.'' Let me explain that to the viewing public out there. In 1997, there was a bill passed here called ``The Sustainable Growth Rate: How Medicare Pays the Physicians.'' And what happened was, is there was supposed to be cuts every year. This year, there was supposed to be a 21 percent cut to physicians, which if that happens, nobody is going to able to see a Medicare patient. And that's not even here. It's over a $200 billion pricetag that's not even listed in this current trillion-dollar pricetag.

Mr. THOMPSON of Pennsylvania. Will the gentleman yield for a question?

Mr. ROE of Tennessee. Yes.

Mr. THOMPSON of Pennsylvania. So the statistic you talked about, Medicare payments, which it has been my experience in Pennsylvania, for every dollar of cost, reimbursement of 80 to 90 cents. So for every dollar of cost, the physicians are already losing significant moneys. That 21 percent cut that you talked about, that's on top of that.

Mr. ROE of Tennessee. That's correct. That's on top of the 80 to 90 percent. So for patients and what they're concerned with now, I believe what's happened, and just to simplify in my own terms, is what happened in Massachusetts, where people saw they were already paying very high taxes, they were already paying for coverage, and then they were going to have to pay for States like Nebraska, who were opted out of this deal.

Congressmen, I was very proud to be sworn in to the U.S. Congress on the 6th of January, 2009. I woke up on the 23rd----

Mr. AKIN. You didn't know what you were in for, did you? It's been a whale of a ride, brother.

Mr. ROE of Tennessee. It has been a whale of a ride. I woke up on the 23rd of December and told my wife that I was actually embarrassed to be in this House because of the deals that were cut. And who ultimately paid for them are the patients and taxpayers. And that's wrong. It really embarrassed me when you saw this deal in Louisiana and the different deal in Florida.

Mr. AKIN. We've just got about a minute or two. We're going to be followed up by another good friend of mine. We may stay on this topic a little bit. I thought it might be appropriate tonight in the last minute or two to make a tribute to Massachusetts. Now who would have thought Congressman Akin would be making a tribute to Massachusetts? But if you recall our history, Massachusetts used to be the cradle of freedom and innovation in terms of government. It was Massachusetts in 1620 that saw the Pilgrims come. They put together the idea of the first concept of a Republic. A group of free people, under God, selecting their own leadership to preserve their God-given rights. That's a powerful idea that came from Massachusetts. A hundred-fifty years later you had the Massachusetts provincial Congress saying, Resistance to tyranny is your Christian duty.

For the last 50 or 100 years it seems like Massachusetts has been sending us the King's people, always wanting more taxes, more government, more government spending, bigger government, and yesterday the people of Massachusetts reverted back to that great heritage of patriotism and freedom and said, We're finally tired of Big Government. It's time we start to look at solving our problems without thinking every solution means more taxes and more Washington, D.C., control.

I thank you, gentlemen, that your States have stood for freedom and your constituents have elected you to join us here to stand up for just plain, old basic American principles. I think we're going to get the job done. I think that what happened yesterday was about, from a political point of view, quite a stroke of lightning. I think it should get people's attention. I think the public has spoken. And it's time for us to move on with the ideas that you, Doctor Roe, have been making very clear here. It's not like these things are too complicated. And G.T., same thing. You're from Pennsylvania, representing the people with common sense. These things are not complicated. Define the problem, craft a limited solution that fixes it instead of trying to scrap everything and go to the Big-Government-fixes-all kind of model. I think it's really something that the people of Massachusetts kind of came back to their heritage and to their roots in standing up for the country, as they did so many years ago.

When I was a little kid, I lived in Concord and Lexington--actually in Concord, and I saw the place where the Minutemen had stood against the biggest military power in the world. There is a statue that says: ``By the rude bridge that arched the flood, their flag to April's breeze unfurled, here once the embattled farmers stood, and fired the shot heard round the world.'' They stood for freedom, and they stood for the basic principles that America has always stood on. And I am sure glad they joined us yesterday in making a statement and a statement that's going to affect this chart right here. Hopefully this chart goes in the dust bin before it ever becomes law. Last word, GT?

Mr. THOMPSON of Pennsylvania. Well, I just couldn't agree more. I think yesterday was a statement that the American people--what they want and what they expect from our leadership is that we do our best to provide safety, prosperity and liberty, the freedoms within this country. And that's the type of public policy that they've been getting since last January. That has worked against all three of those.

Mr. AKIN. Dr. Roe.

Mr. ROE of Tennessee. Health care should not be a partisan issue. In 30-plus years, I never saw a Republican or Democrat heart attack. I never operated on a Republican or Democrat cancer, just a people problem. We need to get together in this body and not have a partisan solution. There needs to be a bipartisan solution that is simple and addresses problems that we have laid out here today so that patients, their families and doctors can make health care decisions.

Mr. AKIN. And that's certainly what you've been talking about tonight, both of you gentlemen. I understand that my good friend Congressman King is going to be here in just a jiff. He is going to be continuing along the same lines, talking about freedom, talking about the principles that made this country and how those principles can be applied to solving these very practical problems with health care.

I will check to see how we are doing on time. Oh, we actually have 2 minutes. So I don't want to cheat anybody. Are there any last comments? Anything that we haven't covered that you want to catch, Dr. Roe or GT?

Here is one. We didn't talk about all of the cool features of this policy; but this wheelchair tax, it was kind of stuck in my craw. The idea that you are going to tax a wheelchair, the mental picture of that just doesn't seem to be what we want to do. So we're looking for places to dig for money to pay for this Big Government system. So what are we going to do? We're going to pose a 2.5 percent excise tax on medical devices, which includes wheelchairs, to try to raise some money.

Mr. THOMPSON of Pennsylvania. If the gentleman will yield, my background is rehabilitation services. I have seen where these types of medical devices--and it is not just wheelchairs. That is an understatement. It is insulin. It is crutches. It is canes. It is prosthetic limbs. I mean, there are just so many different things that this applies to. And this 2.5 percent excise tax, that is going to get passed right along to the consumers.

Most of the consumers who utilize these types of medical devices are older adults. They're individuals on very fixed incomes. Those who are surviving on maybe $800 to $1,200 a month of Social Security, and the very things that maximizes their independence, maximizes their quality of life, we're going to tax that? That's a quality-of-life tax, actually, because the people who use those medical devices, they are medically necessary. They're not luxuries. Those are devices that make their lives possible, that allow them to be able to live in the communities, to be able to live in their own homes, to not live in an institution. That's a quality-of-life tax.

Mr. AKIN. So if it moves, tax it. If it doesn't move, tax it anyway. It might be dead.

Thank you very much, Mr. Speaker, and thank you, gentlemen, for joining me.

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