GOP Doctors Caucus
Floor Speech
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Mr. ROE of Tennessee. I thank the gentleman for yielding. It's a pleasure to be here tonight.
Mr. Speaker, I go back to when Medicare first began. In 1965, there was a problem identified in America where we had a group of our citizens, as they became 65 years of age and older, that didn't have access to quality health care. So a plan was put in place, along with Medicaid for our poor citizens at that point, to access quality care.
In 1965, the Medicare program was a $3 billion program. There was no Congressional Budget Office at that time. The estimates were in 25 years that this would be a $15 billion program. It actually turned out to be over a $100 billion program in 1990. In 2010, it will be somewhere about $550 billion.
We also have, as has been pointed out in our previous hour by our friends from the Congressional Black Caucus, that we have a tremendous deficit. We're borrowing 42, 43 cents of every dollar that we spend in this country. So that's why the discussion was started.
I came to Washington--really, I practiced medicine, as Dr. Gingrey said, for over 30 years and realized that we had a serious problem not just in Medicare but in health care. So we came to work on health care reform. In the Physicians Caucus in the previous Congress, there were nine of us in the caucus. Not one of us was consulted on the Affordable Health Care Act. I mean, decades worth of experience, over 200 years of experience in the Congress at that time, and no one--not one of us--was actually consulted.
The way I looked at the problem in our health care system was we had three problems:
One is we had a problem where the system was too expensive. When you go to the doctor, it cost too much money to go see a physician. Number two, we had a group of people out there who didn't have affordable health care coverage. Maybe the husband is a carpenter, as in our area, maybe the wife worked at a local diner or somewhere else that didn't provide insurance coverage. Thirdly, we had a liability problem in this country.
So what did we do? We had an over 2,000-page bill that got through the House and got to the Senate and failed. The Senate dusted a bill off that was 2,500-plus pages, that never went through a committee hearing, that nobody on the House had a chance to do, and I know that the three physicians that are here tonight all read that bill. When I read that bill, Mr. Speaker, I found some things in there, as did my colleagues, which greatly worried us.
How do they fund this bill? Only Washington could fund anything like this. Dr. Gingrey has pointed out that we're trying to save Medicare. Medicare is a system that the Congressional Budget Office says by 2020 will be out of money; 2024, by the actuaries at CMS say will be broke.
There are four parts of Medicare:
Medicare part A, which is paid for by your premiums. That's your hospitalization.
Medicare part B, that's doctor services and some lab services. That's only funded 25 percent from your premiums. The other 75 percent comes from the general fund, the taxpayers.
Medicare Advantage, which was cut drastically by the Affordable Care Act.
And Medicare part D, which is a prescription drug plan, also is only funded 25 percent by our premiums. I'm a Medicare recipient myself, as of last year.
So what did the administration do and the Senate do to fund this Affordable Health Care Act? They took out of an already underfunded program, as I just pointed out, $500 billion, and Dr. Gingrey just pointed out moments ago that we're adding about 3 million baby boomers per year, so 10,000 per day or more. We're adding millions of new recipients while pulling out of that over $500 billion, and we call this ``saving Medicare.''
We're not talking about tonight, on our hour, the budget impasse. We're talking about what's already been passed. And one of the things I found in there, Mr. Speaker, was a very little known board called the Independent Payment Advisory Board. Before, Medicare has had this board in there, which was strictly that, MedPAC. It was an advisory board to Congress, to say, hey, we've got some problems here with funding; maybe we should look over here. Congress would then have the ability to make those decisions.
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Mr. ROE of Tennessee. Mr. Speaker, what I did when I read this, I looked at it and thought, how was this created and why was it created?
This board has 15 members that are appointed by the administration, by the President, and, quite frankly, I don't want a Republican President or a Democratic President doing this. These people are then approved by the Senate for a 6-year term. They're paid about $165,000 a year.
And what is their charge? Well, their charge is, is if Medicare spending hits certain targeted limits, that cuts occur first to providers and for prescription drugs and then later to hospitals. What worries me about this is right now we have a problem--and Dr. Paul Broun is here tonight, who's a primary care physician--with our patients with their Medicare, finding a physician to take care of them.
What happens is if you hit these targeted limits and physician payments are cut, access to care is going to be cut, quality of care is going to be cut, and, thirdly, the cost to our seniors is going to go up. What also worries me is that this board very much mimics the board that's in England called NICE, the National Institute of Clinical Excellence. This board makes recommendations to their health board there about what care is provided to patients. President Obama has taken this board, he's going to use this, and he actually wants to increase the power of it to help hold Medicare costs down. Ultimately what will happen, when you have more demand for services than you have money to pay for it, is your care will be rationed. That's the fear that we have.
Our concern is, and I've gone to seniors in my district and been very clear and pointed this out at town hall meetings and have held town hall meetings with seniors and said, We want to provide you quality access of care. That's what I do as a doctor. I want to be able to see those patients and have them
help us solve this problem. I think that's the issue that we have, Mr. Speaker, is how do we provide the care for the money we have and provide quality of care and access for our patients? I am extremely concerned that the IPAB will do just the opposite of that.
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Mr. ROE of Tennessee. I thank the gentleman for yielding.
Mr. Speaker, I do want to point out one thing that Dr. Gingrey just pointed out, which was one of the reasons that the American people don't trust politicians. The CLASS Act may be a good idea. The CLASS Act began this year where you have some money taken out of your paycheck and put in a savings account over here. It's supposed to be about $87 billion in 5 years, and we can't get it out until that 5-year period of time occurs and this money has accumulated. At that time it's supposed to pay for long-term care, about $50 per day. But guess what happens, Mr. Speaker? What happens is that we borrow the money out and spend it on current health care and call this an asset.
We have counted that money twice; two times. We have done that with Social Security already. I find this absolutely offensive, on August 2, 10 days, about a week from now, we have had the audacity to tell people who have paid into Social Security for 40 or 50 years they will not be able to get their check. Why? Because the Federal Government has spent that money. We are doing the same thing again with the CLASS Act. There has already been legislation to perhaps overturn that.
I want to get back to something a little more basic, and that is to the examining room with the patient. The people who should be making health care decisions should be a family, the patient and their physician, sitting around and talking about what their options are, not some 15 people appointed bureaucrats in Washington, D.C.
By the way, Dr. Gingrey and Mr. Speaker, we have over 190 cosponsors, including a bipartisanship cosponsorship to the repeal of IPAB, including every physician, every health care provider on the Republican side and Dr. Christensen, who was down here just a moment ago on the Democratic side. It is a bipartisan agreement that we should overturn this. The American Medical Association believes it should be overturned. Over 270 major medical organizations see through this as a very bad thing for patients.
The reason we are worried about it, we have heard Dr. Broun speak about it, and we have heard you speak about it, Mr. Speaker. Ultimately it will affect the quality of care. Why? Because if you don't have access to your doctor, the quality of your care will go down.
The other thing I want to mention is we talk about changing Medicare. Quite frankly, I'm going to go through just a few of the things that already have been changed in this Affordable Care Act. Beginning in 2010, there were Medicare cuts to hospitals, long-term care and inpatient rehabilitation services.
In 2011, it has been pointed out that the Medicare Advantage plans, the seniors did get a $250 check to fill the doughnut hole. The wealthier seniors began paying higher premiums for Medicare part D; that's in 2011. Medicare imaging cuts, Medicare reimbursement cuts: when seniors get a CT scan or an MRI, Medicare cuts for durable medical equipment began, ambulance services, ambulatory service centers, diagnostic labs, durable medical equipment, wheelchairs. Seniors prohibited from purchasing power wheelchairs unless they rent for 13 months.
In 2012, elimination of the deduction for the employer expenses for Medicare drug subsidies, that is how they raised $4.5 billion. And that is not to improve our current underfunded Medicare plan. That is to create another entitlement. Medical expense deduction, you raise the threshold for deducting medical expenses from 7 1/2 to 10 percent. That raises $15 billion to be spent elsewhere. That is a tax right there.
Hospice care is being cut. Dialysis, Medicare cuts to dialysis treatment will be cut in 2012.
In 2014, this Independent Payment Advisory Board begins. And, by the way, they are getting, I believe it's $12 million a year to fund this right now. If there is any way we can cut off funding to that board right now, it should be done.
In 2015, a permanent cut to the payment rate to home health agencies. On and on. We have felt these cuts because they haven't come to fruition yet. What we are trying to do with Medicare is to salvage the program for future generations.
A promise made is a promise kept. If you are 55 years and older, with Social Security and Medicare, nothing happens. I hear all the time about a voucher. This is a voucher system and so forth. Here is what a voucher is. A voucher is when I go to my mailbox, something comes that says this has so much value. You take this piece of paper and purchase something with it. Premium support is where the Federal Government, through its massive ability to go out and negotiate prices, exactly like they do for you and me, Mr. Speaker, in our health care plan here in Congress, they negotiate with numerous companies through the Federal exchange. Our plan is called the Federal Employees Health Benefit Plan, and they negotiate the best price. And what happens is all during the campaign, the last 2 years I have heard seniors and others say, Congressman, I want exactly what you have. That is exactly what we are trying to do.
A higher income senior like myself, and you and the others in this room, will pay a higher premium. And folks with preexisting conditions and lower income will pay much lower. And they will have those choices. As Dr. MURPHY pointed out, why do we think that will save money and why are we doing it. It has been pointed out that it is a catastrophe waiting to happen if we do not do something.
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Mr. ROE of Tennessee. I thank the gentleman for yielding.
One of the things, Mr. Speaker, that I want to emphasize is having no plan is a prescription for disaster for our country. We have a solemn obligation to provide health care for our seniors. We have made that promise. And how do we do it? Again, back to what I said, I do not want a board that is appointed by a Democrat or Republican or any bureaucrat. What I want is I want health care decisions made by physicians, the patient, and their family. The way that is going to happen is through this plan where we use premium support to allow people choice and to have them make those choices, not insurance companies and certainly not the Federal Government.
From what I have seen up here in my two terms is I don't want a bunch of Federal bureaucrats in charge of my bypass operation or my gallbladder operation--or my bunion operation, for that matter. I want my doctor in charge of it. That is who I want making those decisions, along with my family.
I think this is one of the biggest discussions we will have in this Congress is how we do this right. Not only does it affect the budget. Forget the budget. Forget all that right now. We are talking about people's lives. We are talking about the care that they get. And right now, as I mentioned, these changes are already made. This is already in the current law that I talked about just a minute ago.
When you talk about Medicare as it is, folks, it's been changed, big time. When this board kicks in--and there's a very good article if you are sort of a wonk like I am and want to go back to the New England Journal of Medicine, one of our major journals, in, I believe it was, May of 2010. Their estimate was--this is one of our major scientific journals--that this IPAB board would have kicked in 21 of the last 25 years if it had been in place. So it's not some idle threat that this will happen. If you look retrospectively at what's happened, it would have happened 21 out of 25 times.
What would that mean? That would mean, as Dr. Broun, Mr. Speaker, pointed out just a moment ago, as these payments for physicians go down and down and down below their cost of providing the care, they no longer can see you. You lose access to your doctors, like Dr. Broun.
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