HEALTH CARE -- (House of Representatives - November 07, 2005)
The SPEAKER pro tempore. Under the Speaker's announced policy of January 4, 2005, the gentleman from Pennsylvania (Mr. Murphy) is recognized for 60 minutes as the designee of the majority leader.
Mr. MURPHY. Madam Speaker, tonight, a number of the members of the Republican Conference are going to speak on an issue we know all Americans are concerned about and Members of the Congress are deeply concerned about and that has to do with health care.
I would like at this point perhaps to step off from the comments just made by the gentleman from Texas (Mr. Burgess), my co-committee man, who just spoke about influenza, the avian influenza, and use that as a stepping off point to talk about some areas that we need to be working on in Congress and some areas we are working on when it comes to dealing with concerns about infections and infectious diseases. The reason I want to start from this point is to show what we need to do and what we are doing in Congress to deal with a number of potentially large issues.
Everyone will remember just a couple of short years ago we had the concerns about the SARS virus, which quickly spread throughout parts of the world. Luckily, it did not stay around very long; but because people who had the disease treated other folks who then traveled throughout this country and others, we saw that disease spread quickly.
We also remember just a few years ago the Ebola virus and the worries about that. We worry also about mad cow disease, and of course, we are concerned about bioterrorism.
In all of these instances, how Health and Human Services, how county and State health departments, how hospitals, physicians, nearly all health care providers, handle such instances around the world makes a huge difference in containing the diseases and also with regard to saving lives.
Recently, President Bush made some comments in calling for $7 billion in congressional appropriations to help deal with a number of aspects of concerns about avian flu. Buying enough inoculations for that, so the people could have some immunizations against the flu; working on other areas of research; preparing health plans, all these are part of it.
What we are going to be talking about tonight will be some aspects of how we can be better prepared, what our health care system needs to be doing, and how even such things as changes in Medicaid, we are going to be using the clout of the Federal Government to make some changes.
Actually, I would like to, as long as the gentleman from Texas (Mr. Burgess) is here and the gentleman from Georgia (Mr. Gingrey), my good friend, is here, too, I would like to use a few moments to open up a dialogue with them about some issues about the avian flu, if I may, and ask about a couple of aspects here that have to do with how this really works; and as physicians here, I thought I would perhaps start off with the gentleman from Texas (Mr. Burgess) and ask a question or two, if I may, if the gentleman would not mind standing for a colloquy on this.
A lot of Americans are very concerned about what happens with the transmission of this disease, in many cases do not understand, well, how can I have a flu one year, but the Spanish flu, the avian flu have something very different.
My understanding of this is that many times people have the flu, those who are at risk for severe problems and death are perhaps the very young, the infirm, those with chronic diseases, the very old, because this flu tends to weaken the system and there could be other bacteriological problems such as pneumonia would take them over.
But there is something really virulent or bad, deadly, about avian flu that is the concern; and you were mentioning a little bit about that. Could you talk about how that is so different that we need to understand it is more of a concern, the deadliness of it.
I yield to the gentleman from Texas (Mr. Burgess), my friend.
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Mr. MURPHY. Madam Speaker, I thank the learned gentleman on these issues, so important to understanding infectious disease. I know one of the aspects of this, too, and I will ask my friend and colleague, Dr. Gingrey of Georgia, to comment on this, and that is helping us in Congress put this in perspective.
Back in 1976, an 18-year-old Private David Lewis came into his base at Fort Dix, staggering in, was given some resuscitation, and soon afterwards they determined that he had something called swine flu. Soon after that there was a declaration that this would be a deadly virus, perhaps reaching the level of the Spanish flu of 1918. Even at that time, President Ford went on television saying, ``I have just concluded a meeting on a subject of vast importance to all Americans. I have been advised there is a very real possibility that unless we take effective counteractions, there could be an epidemic of this dangerous disease next fall and winter here in the United States.'' At that time President Ford asked Congress to appropriate $135 million to fight it; and of course, huge problems did not develop with swine flu.
I always have the concern that when we are engaged with a public health activity, we have two possible dangers. One is that the disease really does have an outbreak and there is great deal of harm; and two is that if it does not occur, it will leave the public feeling much like the boy who cried ``wolf,'' and then saying there is no concern, we do not really need to do anything.
And from your perspective, Dr. Gingrey, I wonder if you could comment on how the public best needs to put this in the perspective of what we need to be thinking of here, and comment on how Congress can best handle that. And I yield to the gentleman.
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Mr. MURPHY. Madam Speaker, I thank the gentleman. One of the ways that our Nation needs to be dealing with this potential and other issues is to have a better health care system overall. The gentleman mentioned Hurricane Katrina, and I would like to use that as a stepping-off point to talk about some of the work this Nation needs to be doing in some of the things we are doing.
When Hurricane Katrina hit and, subsequently, Hurricane Rita, we saw something we had not really been prepared for, not only the huge devastation of 90,000 square miles, almost double the size of Pennsylvania, but we also saw hospitals were closed, records were destroyed, physician offices were inaccessible and patients were inaccessible. Patients by the hundreds of thousands traveled around the country, many without their medications, without their medical records, and in some cases not even knowing what their medications were. We had to essentially reinvent for many of them a system of health care.
Now, let me take this on another smaller role here too with regard to individuals. When a person goes to their own physician, many times you have what I refer to as 21st century medical technology kept track of in a 19th century system, and that is paper and pen records. Now I have seen these myself through many years of working in hospitals and in my own practice settings where you write your notes down, and when lab results come, you stick them in the chart, and it could be for a typical patient perhaps the pile of papers could be much thicker than this.
Yet, when a person goes to the hospital, it is not unheard of, for example, I was talking to someone at one hospital; and I would be interested to hear if my colleague's experiences are the same. But say a woman showed up in an emergency department in labor. Some notes may be made there. She then may go up to the delivery area to deliver. After that, she goes to recovery and her baby goes to pediatrics. And each time separate mounds of medical records are made, which may not really be collated together for hours, sometimes days afterwards simply because of what is happening there, not to mention her own medical records from her own obstetrician back home. That is the way the system operates every day.
Let us take another scenario. Take a single mom who has a son who has asthma. And perhaps because of whatever housing, perhaps she is on Medicaid, low income, and she finds a situation where she has to move to a different part of town and it becomes difficult for her to get across town to see her other doctors, so she goes to a new doctor. And they have to essentially reinvent what has been done for this child or call for those records and have them shipped over.
Now, if one has the luxury of days, sometimes that can be done, with the situation of establishing new relationships with new physicians and new nurses. But you also have the situation, if the child goes into acute distress with something like asthma, of showing up in an emergency department and having to have all the medical staff there trying to track down what is the child's medical history, what prescription drugs is he on, are there any particular allergies he has, if he is on other medications will there be drug interactions, what is his blood type. Even the most basic information is important to have, but they do not have it.
Now, in some hospitals around the country we see some changes being made. University of Pittsburgh Medical Center, where I am from, is one that is doing this, but there are other centers, at Northwestern, and other States have this, where they are emerging towards the technology of electronic medical records and electronic prescribing. I want to talk a little about how that is done and show some things that are being done on Medicaid.
Imagine going to a medical office and filling out a clipboard with your name, address, phone number, your medical history, and allergies, if you can remember it all. Very often, it is tough. Certainly my colleagues in Congress, I think we would all be hard-pressed to remember every doctor we ever saw, every medication we ever took, or every diagnosis that was ever placed in our chart, but it is important information. Add to that every x-ray we have ever taken, every lab test that has ever been done. Those are oftentimes lost to the ether.
Some studies have indicated that perhaps as much as 14 percent of medical records are missing, some important information, important enough that it would change the direction of what the provider would diagnose or call for treatment in those cases, and in some cases, physicians say major changes in how they would diagnose.
Perhaps a patient was set up for a blood test and they never showed up for the blood test. Or perhaps they did show up, and the information was never forwarded to the physician's office. Or if it was forwarded, maybe it was misfiled or placed somewhere else. A whole host of things can go wrong when you are dealing with reams and reams of paper filings.
Then the moment of truth comes when the doctor needs it, where is the information. If it is missing, they may have to call for repeat tests or write a prescription and then find out that it causes problems with the patient, which can cost lives as well as money. It is estimated that 150 million times a year pharmacists call physicians to double-check medications. Perhaps they cannot read their handwriting, or double-check the decimal point on the medication dosage level, or perhaps to say Mr. Smith is on another medication from another doctor which is identical, or it is one that would have a bad drug interaction with this other medication. That is a grave concern, how do we fix this.
Well, by using electronic medical records, the medical record could actually be placed on a computer, perhaps in the physician's office. In some cases, individuals can carry their own. I brought a sample, smaller than a stick of gum. This is a 64-bit memory chip. It happens to be on a key ring. It is quite possible in the near future we may be seeing individuals who carry their own extensive medical records that can fit into their wallet or on a key ring. If an emergency came up and if something came up, they could, at a moment's notice, hand it to a doctor. They plug it in and pull up the records right away.
This is critically important for those with complicated cases. That involves a huge investment in the medical infrastructure in America, but if we use a situation like Hurricane Katrina or an outbreak of a pandemic in this Nation where the medical system of this country would be taxed beyond anything we can imagine. Again with Hurricane Katrina, hundreds of thousands of patients moving about, many psychiatric patients let out of hospitals with no recall of their medications. People had to start from scratch and diagnose them.
What if we had medical records on file that people could use in a secure and confidential way and could tap into. Or what if some individuals carry their own medical records in their wallet. It would be incredibly valuable in moments of need and help reduce health care costs.
This is not something that should just be in the best of hospitals or in the hands of those who can afford it. If we are going to lower health care costs, we need to put it in the hands of every American. RAND Corporation released a study a few weeks ago that said if our Nation switches to electronic medical records, we could save in the nature of $160 billion-plus per year. $160 billion per year. In a health care system where we are so concerned that costs are moving completely out of control, where people cannot afford health care, where businesses can no longer afford the double-digit increases in costs, we need something major, something comprehensive, something that completely shifts how we provide health care in this Nation. And electronic medical records is just that treatment.
Not only does it save money in terms of doctors not having to take time to review the chart, worry about mistakes they may have made, call for new MRIs, X-rays, CT scans, blood tests, not only that reduction in costs, and not only the savings of lives, because a mistake has not been made or a delay has not occurred in care; but Rand goes on to say you save massive amounts of money in terms of jobs, people not losing work because of complications or having to go back to a doctor to have tests done again.
Think of it this way: If a doctor asks for an X-ray and it is done, and he says did you bring the X-ray, no, they did not give it to me. The doctor says, we will take another one. You pay for that X-ray, the person's time who has to have another test done, all of that is duplication of work. But what if, again, that individual carried the X-rays, films of their surgeries, all of those details on a chip, or if it was on a computer screen in the physician's office. Not only would the doctor have instant access, but he would not be going page by page through the medical records, what did I prescribe before, because nobody can possibly remember the details of all of the patients they see.
But in an instant, tapping a button could call up those X-rays. Added to that, if the physician had questions and needed a consultation, he does not just call his old mentor in medical school, I need to call Dr. O'Hare and get his consult and mail him the X-ray and ask him to comment back. Literally, at the stroke of a key, he can have another doctor look at the X-ray, consult with him, and provide valuable information back in time faster than the speed of light. It saves valuable time, critical information, and saves lives.
But how do we get that into Medicaid, is my question. Well, first of all, let us look at what Medicaid has done here and look at some costs. In 2006, the Federal Government is spending in billions, about $190 billion. This is going to increase by $66.4 billion, or 34.8 percent, over the next 5 years. We are up to $200 billion in 2007; 2008 to $217 billion; 2009 is $237 billion; and by 2010 it is $257 billion. The Federal Government general increase in what it is spending on Medicaid is going to increase 7 percent over the next several years.
The budget package that Congress is putting together now to try to reduce some of the deficit is going to do some things that the Governors of States have asked for. The Governors of States have said that Medicaid spending, in some cases, is almost 20 percent of the State budget. They need some mechanisms by which to control this.
I was pleased that a bill I introduced has been put into the Medicaid package of our deficit reduction package, which will put $100 million in grants to go to hospitals that have high Medicaid populations, perhaps inner-city hospitals, perhaps community health centers, and nursing homes and other centers that have high Medicaid populations so they can partake in electronic medical reports.
Basically, a hospital has to convert their files into computer programs and be able to pull those up. There are a couple of nuances that go on. You have to make sure that different offices of doctors and hospitals can all speak to each other on this because otherwise
there can be a medical Tower of Babel, that is, one hospital may use one type of computer program for their records and another hospital another type of record.
But I want to call upon my colleague and ask the gentleman from Georgia (Mr. Gingrey) from a physician's standpoint on what he says our Nation can be doing to assist this transition, how it helps medical practice, and perhaps some experiences of your own work. I believe you have delivered 5,000 babies or so in your time, so how it makes a difference from being able to have information instantaneously as opposed to waiting for files or trying to make a best guess on a patient.
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Mr. MURPHY. Madam Speaker, I would like to shift to a couple of areas of health care here and some other things that we are moving on and we need to continue to push for.
One has to do with some mental health issues. I mentioned earlier about Hurricane Katrina and some of the folks who had psychiatric illnesses, and as the hospitals were emptied, people did not know their medications; and I mentioned how those problems occurred.
We also have to pay attention not only in terms of using electronic medical records so people can find their record when they need to, but making sure we have the security so that people cannot get into the record when they do not need to. Part of what Dr. David Brailer, who the White House appointed to work on this issue, along with many companies, such as in Pittsburgh, the University of Pittsburgh Medical Center, and there are many private companies trying to come up with solutions, so we have a great many other aspects that we are working towards in order to make sure that these records are secure and confidential.
I want to ensure my colleagues that this is something that I am in complete agreement with, what Secretary Leavitt is working on in HHS and also Dr. Brailer, that these electronic records need to be secure and confidential so people can always trust that their records are not going to be viewed by somebody who should not get into them.
In the Committee on Energy and Commerce, we are working on some other technological aspects. We are working with the committee to offer some amendments to make sure we also have reporting.
Interestingly enough, one of the areas we find loopholes as we are moving forward on issues is that right now if there is a breach in security of some kind of records, health records, unless someone reports that there is not something that is done and what we really want to make sure is happening is hospitals are regularly scanning their records as many of them do now and look for any sort of attempts people may have to get into those computer files. Similarly when we have our own paper records in our own office, we have to keep those under lock and key. We have to make sure that those who are not authorized to see them don't get in there to see them.
In the mental health area, I want to talk for a few minutes about a couple of aspects and again give my colleague time if he has some issues he wants to get into, but I want to talk about mental health care treatment for chronic diseases and how they can lower health care costs. For many individuals with chronic diseases like asthma, arthritis, heart disease, cancer, diabetes, lupus, and many other areas, interestingly enough, the incidence of depression can be double that of the general population. Whereas in any given life span, perhaps about 16 percent of the population may suffer from some severe depression, when you have a chronic illness like heart disease, those rates can double. And some cardiologists tell me that the numbers would really be even much higher than that. After all, when you are told you have a debilitating disease or something that can be life threatening, it is expected that a person would have a severe reaction. Many times it is overwhelming stress. Sometimes that can move into a sense of depression.
Depression is not just a sad feeling as we all feel at times. We have a bad day, the loss of a loved one, job stress. Depression is part of life in terms of having some sense of sadness. It reaches a point, however, in some folks where it really becomes a wall around them. It affects them physically. It affects them mentally. Thoughts are sluggish. Oftentimes they have a hard time getting out of bed in the morning but then a hard time sleeping once they are there. They may find themselves with no appetite. They may find themselves overeating. They may find themselves seeking other things to alleviate their depression such as drugs and alcohol. And I am not talking about prescribed drugs. It may be things where they are angry, they are edgy, they are moody. It may be that they are withdrawn. All sorts of things can happen. What is interesting is how this really becomes not just a mood and an emotional reaction and this is not something that is just a sign of weakness, it is a real chemical, neurochemical reaction that occurs in the brain then that becomes debilitating. For someone who has heart disease or diabetes, I was mentioning, double the incidence, think of this: That the stress can be so prolonged on their body and their system and it depends on the individual, it is almost as if there is a point at which the body says, We can't handle the stress anymore and depression begins to overcome.
Why does it increase so much with things like heart disease? Perhaps because of the stress, but here is an interesting factor. Patients diagnosed with depression have higher rates of chronic medical illness and use health care services more often. Patients with chronic medical illness and untreated depression have higher health care costs in several categories of care: primary care, regular doctor visits, medical specialty care, medical inpatient care, pharmacy, lab costs, all increase, when compared to those with chronic medical illness and treated or with no depression. Much higher.
As I said before, clinical depression affects about 16 percent of the population at one time or another in their lives. Unlike the normal experience of sadness or loss or mood states, it becomes much higher. For example, 31 percent with diabetes have depressive symptoms. Interestingly enough, the increased psychological stress or depression increases platelet reactivity to thrombosis, or blood clotting. In other words, when you have heart disease, untreated depression in ways we are not quite clear yet can actually lead to an increases in clotting of those little blood cells, the platelets that we have. This can in turn lead to almost doubling the cost of health care for folks with heart disease.
Again, you have folks with and without heart disease. Those with heart disease may have double the incidence of depression. And those with untreated depression or not responding to treatments can have double the health care cost. Some are intuitively obvious: Perhaps the person is not following up with doctor visits; perhaps they are not following the treatment plan; they are not going through and taking medication; maybe they are not seeing the doctor; exercising; all the things they should be doing. But even in that case if they are doing that, there is something physical that is taking place in those patients that may actually contribute to increased medical complications.
Very often treatment for mental illness is not provided by a mental health professional. A person does not see a psychiatrist for their medications, maybe does not see a psychologist for other behavioral therapies that may go with that. Actually psychiatric medications are prescribed by nonpsychiatrists 75 percent of the time, most frequently by primary care, general and family physicians. But when we combine medical and behavioral health services to coordinate the diagnosis and treatment of the full spectrum of diseases, we can see some huge changes in that.
When you have, as I said before, untreated depression, it has been found to increase health care costs by complicating symptoms and treatments of such things as back pain, diabetes, headache and heart disease annually from $1,000 to $3,000 per patient. Very, very important when you are dealing with someone, for example, who is an employee who has some of these problems, when you see this untreated depression in them, increased costs. Untreated depression costs employers more than $51 billion per year in absenteeism and lost productivity, not including higher medical and pharmaceutical costs.
When we use information technology and much of what we have been talking about this evening, it can be used to track diseases and intervene with appropriate care. So now with a physician seeing a patient with a chronic illness and into that computer he types in or she types in the diagnosis, up in the screen should not only appear, here is confirmation of the diagnosis of this disease but up also arise some questions as prompts to the physician. Again if he types in coronary heart disease, what may also show up is, ask the patient the following questions: Ask about mood, ask about appetite, sleep problems, problems in their relationship with their spouse, to see if there is any indication of other psychiatric or psychological disorders for which that patient could be referred over for help. This information about provider system performance will be extremely valuable to have this. But unfortunately in many cases a physician may not have those prompts available and if they may only have a handful of moments to see a patient, it becomes very, very difficult.
If we saw depression as a medical condition for what it is and other psychiatric illnesses for the medical conditions they are, we could reduce health care costs and save lives. Unfortunately, and I know our colleagues as well, there are some folks here who believe there is no such thing as mental illness and I have heard such statements made, saying, oh, it's just a chemical reaction in the body, or there really are no other emotional components. We have heard Hollywood stars talk about this with an incredible amount of prejudice and ignorance. But it is true. There is such a thing as mental illness. As much as we want to pretend it is not there, as much as we want to ignore it, it does not make it go away. It does not help if we continue to treat mental ilness with the same level of insight and ignorance as the Salem witch trials. There are times that we have not advanced much beyond that. But when on the other hand we recognize this incredible integration between mental health treatments and other medical treatments, I say other medical treatments because they are both medical, we can see with those patients huge changes and huge cost savings. Increased psychological stress or depression increases platelet reactivity, as I said, thrombosis. But there are also aspects, too, with treatment here that we find really can save a great deal of money.
A 2000 report by the Office of Personnel Management for Federal health employees provides an example of several major employers who through managed care programs have discovered they can offer mental health benefits to their employees in order to maintain a higher quality workforce. These employers included companies like AT&T, American Airlines, Eastman Kodak, General Motors, IBM, Massachusetts Group Insurance Commission, Pepsico. The list goes on. The most important finding of this report was that employers who provide generous mental health and substance abuse benefits to their employees and their families are committed to providing these benefits because they are convinced that doing so is essential to the corporate bottom line. What they indeed found was the mental health coverage put on par with physical health coverage only costs employers about 1 percent or $1.32 per enrollee per month according to a 2004 analysis by Price Waterhouse. But they also found it actually saves a great deal of money for individual businesses.
As we are proceeding through efforts to save money through Medicaid, as we are looking at such things as Medicare, I call upon our colleagues to make sure we are saying, you don't just save money by cutting rates of growth. It is important we do that. It is important we work with States to reduce that. But it is also important we work with States to help them understand and employers to understand that when you deny an aspect of critical care, and that is mental health care, you can actually be harming the patient. And so it is vitally important that we look in all these areas now and other bills that may be before us in the future, that we use them in such ways, this huge amount of spending the Federal Government gets involved with health care, but also encouraging employers to do the same thing.
Congress budgeted $20 million for the development of comprehensive State mental health plans to improve the mental health services infrastructure in 2005. The amount we need to, however, spend is probably much more than that. Unfortunately, the way the Congressional Budget Office works in this Federal Government, it only tells you what you spend. It does not tell you what you saved. It would be much like if we looked at how much we are going to spend in immunizations but did not see what we saved in lives and money for flu. It would be ridiculous if we did not say that that indeed would be a savings. We have to keep working at these aspects here. We have to look at how Medicare and Medicaid reimburse.
We have to look at pay-for-performance incentives to help physicians and mental health professionals work together in a comprehensive and integrated way. We have to make sure we are helping businesses understand that these Medicaid transformation grants, for example, that I mentioned earlier are, I believe, going to be $100 million invested, but when we use these for such things as county nursing homes, skilled nursing facilities, federally qualified community health centers and similar facilities and inner city hospitals, we will see tremendous savings come through this whole system here.
Just to wrap up my comments and I will turn back to the gentleman from Georgia if he has some other thoughts he wanted to say in wrapping things up tonight, it is so vitally important that we work together, not only the handful of health care professionals that are here in Congress but it is so important that as Members of Congress we work together to understand that health care is not just about what you spend, it is also about what you save by your spending. If we are ever going to get control of this juggernaut of health care costs, it is not just going to be by having the discussion go in terms of who is spending; it is not just a matter of saying we are going to have health care savings accounts so people can pay more attention to what they are spending, that is important; and it is not just in terms of saying, nobody can afford health care so let's have the Federal Government take over. It is about not just who is paying but what we are paying for. That is why the comments we have made tonight about what we are spending money and how we are going to spend it on dealing with the concerns about the avian flu be done in a careful and thoughtful manner. That is why other aspects I mentioned before about medical records, electronic medical records and also integrated health care and other aspects we can get into, too, about prevention, et cetera, it is so important we deal with these in a comprehensive manner to look at those savings.
I wish that we could get the Congressional Budget Office to do more aspects of looking at how we can save money in this, but that is going to be something that we are going to have to carry the torch on. I know my colleague has carried the torch on many of these aspects here. I think we have about 7 or 8 minutes left. I know you have a number of other aspects you would like to talk about. I always enjoy these colloquies with you about looking at this. It is an important aspect that we team up together on here to get this Nation thinking about other ways of saving lives and saving money by, and I will leave with this chart here, about the health transformation. We cannot just make reforms within the current framework. We have to look at our current health care system and if we fail to change, it will decay into a system we cannot afford anymore. If we work toward real change to a 21st century health care system, that is where we should be going. I believe our Nation, whether it is private employers or the Federal Government, will see tremendous changes that save tens of thousands of lives and tens of billions of dollars. I thank my colleague for being such an adamant supporter of moving this health care system forward.
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Mr. MURPHY. Madam Speaker, if the gentleman will yield, one of the things that is in this Medicare bill we passed a while ago now, that many people are forgetting, has to do with the entry physical that people get, but there are also elements in there that have to do with some patient management, the pharmacist is working more monitoring the medication, and communication. I would ask my colleague to speak on that, because that may be a thing that we really are not quite used to, physicians and pharmacists working more closely together as part of that Medicare bill so that there is less hospitalization.
I know one hospital in my district, Washington Hospital, really found that by doing careful patient management of those with heart disease, they reduced rehospitalizations by 50 percent. That is a massive savings in costs and certainly much better for the patients, in many cases saving some lives. I wonder if the gentleman could comment about that.
Mr. GINGREY. Madam Speaker, I am very familiar with Washington Hospital, although I did not realize it was in the gentleman's district, the great work that they did. But there is no question about it, this issue.
I mentioned the cost-shifting from Part A and Part B, and I think that will be substantial. But this emphasis, and the gentleman is right, it is part of this bill, not just prescription drugs Part D, but also that entry level physical, that focus on disease management and making sure that people, whether they do it through Medicare Advantage, whether an HMO-type program, or even traditional Medicare, in screening for things like colon and rectal cancer, breast cancer with mammograms, prostate cancer screening, cholesterol screening so that we do not wait until the person has a heart attack and has to have that quadruple bypass that is very expensive. So again, I wanted to make sure, and I appreciate the gentleman from Pennsylvania giving me the opportunity to have time to discuss that, because we are hearing it. We are hearing it on the floor of the House, maybe from both sides of the aisle, and folks back home, naturally they want us to spend what we have to spend, but not a dime more, and I agree with that.
But I think this will be clearly the wrong message to send to our seniors. I mean, this President and this Congress were not the first elected folks to promise to deliver a prescription drug benefit for our seniors. Indeed, Medicare started in 1965, so what are we talking about is about 40 years of the program, and they have been waiting a long time. And to ask them to wait a couple of years or indeed maybe indefinitely so that we can offset some of these costs of responding to the bird flu or responding to Hurricane Katrina, I think would be a huge mistake.
Mr. MURPHY. Well, Madam Speaker, I think it is one of those areas that, again, I think that when one just looks at the numbers of costs up front, and we have some of those frightening numbers, I do not know how many hundreds of billions it may be. And I understand the concern of our colleagues who may have opposed the Medicare bill for Part D because they were concerned about the cost. But I believe this has some innovative aspects in it and some that we have to pay attention to.
Oftentimes, people say that one of the definitions of insane behavior is doing the same thing over and over again, expecting the same results, but this patient management aspect and the integration of care between physicians and pharmacists is vitally important. I am hoping that as people review their Medicare Part D options that they also ask questions about that, when they call 1-800-Medicare or go to medicare.gov, or particularly when they call 1-800-Medicare, feel free to ask about that, or ask Members' offices to talk about that. It is something that is so very, very important. It is going to be a different aspect of health care that we follow up on.
Mr. GINGREY. Yes. And I think too it needs to be said that when we had this debate, a huge debate, in December of 2003, as my colleague recalls, we were freshmen at that point in our political careers, both of us, but there were a lot of folks, particularly on the
other side of the aisle, that were very angry, very angry with AARP, the American Association of Retired Persons, because they had the unmitigated gall, the audacity to support this President and this Republican leadership in trying to get this Medicare modernization prescription drug bill passed and to fulfill this promise that was made. They even suggested that people tear up their AARP card as an act of defiance and protest against this bill, and discourage people, the working poor who could get the prescription drug discount card in that transitional program, and get $600 worth of credit for each of 2 years during that program's existence, $1,200. To think that they discouraged people, and many of them were discouraged and did not get that benefit. I hope now that for Medicare Part D, and the sign-up is beginning soon, that they will be encouraging them, not discouraging them, to sign up.
Mr. MURPHY. Madam Speaker, I thank the gentleman for his time tonight and also the indulgence of our colleagues in listening to this. We will continue to push these health care issues so vitally important for the health of our constituents and of all Americans.
On my own Web site at Ðmurphy.house.gov I have further information on health care, FYIs, as I call them and sent to my colleagues every week. I hope people will look at that, and I hope my colleagues will continue to work with us, but really all Members of Congress, not only those with a health care background, but together, we will see some major changes in not only saving lives, but saving money.
http://thomas.loc.gov