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American Medicine Today

Floor Speech

Location: Washington, DC

AMERICAN MEDICINE TODAY -- (House of Representatives - November 05, 2007)


Mr. GARRETT of New Jersey. I thank the gentleman from Texas for yielding. I thank the gentleman also for bringing this issue once again to the floor. I was in my office earlier this evening when you began your remarks, and I have heard you on the floor on numerous occasions speaking to medical topics.

We appreciate very much your background, the expertise that you bring.

And on that point, I should just say that on my 3-hour trip from New Jersey traveling on good, old reliable, semi-reliable, slow Amtrak, I had the opportunity to read a number of your articles that you have written. I would commend anyone who is listening to us here tonight. I should ask the gentleman, is much of this material I read, one a position paper, another is called Addressing America's Health Care Challenge: A Solution, are these articles by any chance up on your Web site? Can I commend the audience here that listens to us tonight to go to your Web site and look to find these things?

Mr. BURGESS. Yes. You're very kind to point that out, and those writings, as well as several other musings and lamentations are available on my Web site. The bulk of the writing on the Web site is devoted to health policy because obviously that is one of my interests and one of my passions. So there's a good deal of information available; will take, scrolling back through the previous stories will give someone an insight as to what's available on the Web site.

Mr. GARRETT of New Jersey. I appreciate that, and just a couple of them, Addressing America's Health Care Challenge, with that and what you've talked about here, as I put the expression, you step back for a moment and look at the bigger picture, which is what I'm going to talk about in a moment. So I think this is a good one.

Another one is the cure to the physician crisis, and I'm not going to get into it here. This article gets into it pretty well to say, you can do all that you want to do when it comes to the issue of health insurance, but if we don't have enough docs out there such as yourself and other docs out there, physicians that are out there taking care of the patients, it's not going to mean anything.

When I'm back in my district and I tour my hospitals, what is one of the first complaints or concerns that I have, and I bet it's the first complaints and concerns that you hear from your hospitals, is a shortage of nurses. And whether it's long-term care facilities, hospitals or clinics, they say we just can't get enough visiting nurses, we just can't get enough trained nurses as well.

If we don't get that aspect of the problem solved, everything else that you and I and the rest of Congress talks here tonight and in the future will mean nothing because we're not getting the providers to the patients.

So, again, I just wanted to start where I should probably end, and I think I will in a little bit, thank you for your work in this area.

Where you left off and some of the points you were touching about goes along this line, and that is, that you have to look at some of the bigger picture.

In my office, I was looking at some data, and one of them is on data from the World Health Organization, and I think this is interesting. Again, regardless of what we do on health insurance and regardless of what we do in the government, whether it's in the Federal level, the State level or anything else, here's what they tell us. Here's what the World Health Organization tells us. That if Americans, and I guess the world community as well, but Americans in particular, would address three areas, smoking, eating disorders and eating, what your diet is, and exercise, if you address those in a logical coherent manner, presumably after consultation with your physician, 80 percent, an amazing number when I read it, 80 percent of Type 2 diabetes could be addressed and resolved. Eighty percent of heart disease could be resolved. Forty percent of cancer issues could be resolved.

Nothing about buying insurance. Nothing about spending more money. Matter of fact, you'd probably end up spending less money if you ate right and didn't go to McDonald's as much as I do. Those three areas.

The one on diabetes, I just had the opportunity in the last week to 10 days to have folks from that organization come and speak to me back in the district, and they pointed out a statistic. Approximately a little less than one-third of the dollars that we spend on Medicare goes to diabetes or diabetes-related injuries or other illnesses that are related to it.

So can you imagine, if we were able to resolve that issue, how we would be able to address our health care costs in this country. Costs being one factor, but obviously, the bigger factor is improving the quality of life.

So you're right on the target when you say how do we improve the health quality of individuals in this country first and foremost; and secondly, how do you do that through a proper physician relationship.

As I come to the floor this night, and I always make reference to this mark, here we are in November, the 11th month of the year, and we have to ask ourselves what has now under the new Democrat leadership wrought when it comes to the issue of health care in this country.

Somebody else pointed out some numbers to me the other day. I think it was this past week. So far the ledger is 106 bills have made its way to the President's desk. Forty-six of those bills have been to do with the naming of post offices and Federal buildings. Forty-four just have to do with Special Orders and special days and the like. That's almost two-thirds. Ninety bills out of 106 of no real major significance, and here we are at the floor tonight I think addressing something that is of major significance, second perhaps only to what our colleague Tim Walberg and others were talking about as far as their faith issues, and that is the quality of life and the health of the citizens.

This, though, is not a new issue. President Clinton, when he was President of the United States, said that he had an answer to this problem, and it goes in a totally different direction that you were addressing before. His solution was larger Federal Government intrusions into this part of the economy. It's approximately what, one-fifth of the overall spending of the GDP on health care. He wanted it to be even larger and more of a centralized control, government-controlled health care, if you will, socialized health care.

And he told us back at that time how he intended to bring this country, that he realized after Hillary's failure to address the issue through her secretive meetings that we heard about later on, he said how can we get there. He said we can get there through a centralized, government-run health care system incrementally. First, we'll insure and control the health care for indigent children, then all children and for indigent adults, and then for all adults. So all of us eventually will come under the control of the Federal Government.

That means we were basically putting that very personal, that you referred to before, and you know as well from the doctor side, we all know from the patient side, the placing of doctor-patient relationship under the control of the Federal Government, bureaucrats, faceless, nameless, maybe very nice people and well-intended, but bureaucrats.

I scratch my head to think when people actually advocate such a government control. This is the same Federal Government that we saw handle the Katrina situation and FEMA terribly, loss of life, loss of homes and what have you, that Federal Government. This is the same Federal Government during this past summer when families were trying to go on vacation and asked the Federal Government to do one of its basic functions, issue visas so families could go on family vacations. The government couldn't get the visas out the door. This is the same Federal Government that to this day we're still arguing and debating on this floor how do we close and secure our country's borders so that illegals and terrorists and drug traffickers can't come into this country. That same Federal Government can't control this, but they want to control our health care delivery system.

So he told us how he was going to do it, and one of the charts up that you have, I have a variation of it, but if I could just ask the gentleman from Texas to put that one chart back up with regard to the coverage. It tells us how he was going to do it, and they're now trying to do it through SCHIP.

By very definition, a middle-class entitlement means that you are going to be providing an entitlement, in this case, health care, for people who are making over or at the middle-class level of income and above. Well, we know that the poverty level is, for a family of four is around $42,000. I'm not sure if that's showing that on that chart, for a family of four is around $42,000. We also know that the median or the middle range of income in this country, again for a family of four in this country, is around $48,000.

So, by definition, if you're going to be providing a benefit to people over that level, over $48,000, then you're providing a middle-class entitlement. It's no longer talking about poor children first. I know there was another chart, benefits should go to poor children first. We're no longer talking about the indigent. We're now talking about just about everyone.

A family of four making over 300 percent makes around $62,000. So by definition we're saying, under the proposal that came before the House with regard to SCHIP, we want to provide benefits to a larger group of people, to a middle-class entitlement. And who is going to pay for that is the next question that should come to mind.

Well, the plan that is in place to pay for those various ranges, and without my far glasses it's hard to see them, says that that is going to come out of various sources, but one of the biggest sources will be smokers. And the interesting thing about this is that in order to get enough money to provide for that level of coverage, not just for the indigent anymore, but people above the 200 level of poverty, 300. As you know, in the State of New York they tried to go up to the 400 level of poverty, which means around $84,000 a year. In order to do that, they will have to look to smokers, which is fine on the one hand until you get into the weeds a little bit on this issue. And the Heritage Foundation did a little bit of study and said how many people do we have to actually have start smoking in this country in order to come up with that money, and they found out at the end of the day that we will actually be looking to find 22,000 more smokers in this country in order to fund this program.

Now, you are a physician and you could probably speak ad nauseam that smoking is harmful for your health, and actually it's most harmful probably for little kids more than anybody else. But in order to fund this program for the indigent poor and also for a middle-class entitlement, a government-controlled health care system, they will be looking to say we need 22,000 more children in this country in order to start smoking tomorrow so that we will have funding for this program down the road for the next few years.

It's an absurd situation, and it's even a little more absurd when you think about who actually does smoke in this country. This is a little bit of a sad situation. Lower income individuals smoke to a higher percentage than upper income individuals. And in fact, if you look at the numbers, it's something like this. People who make under $10,000 a year, so very low-income people, pay twice as much in taxes from smoking than people who make over $50,000 a year.

So what are we really saying? We're saying that we need 22,000 more kids to start smoking to pay for this program. And who are those people that are actually going to pay for it? The lowest of the low-income people who are smoking are going to pay the biggest percentage of their income towards this program.

It's an absurd situation to fund it, and it goes back then to the final point, and I'll close and I'll yield back to the gentleman, as I think our time is coming to a close. It's an absurd funding formula to come up with for a government-run program. And unfortunately for the advocates of the program, the money runs out. The money runs out.

You see on our little chart here, starting, if this program, as proposed by the other side of the aisle, Democrat side of the aisle, it would start in 2008, and there's little kids being encouraged to sign up. Indigent children are being encouraged to sign up for this program. I notice this picture does not have the children smoking. So, to be actually correct, we should have the children smoking, because they're encouraging them to smoke in order to pay for this program, but it would only last for 5 years. Then, after the 5 years, the funding is cut off almost entirely, 80 percent. That's why we have the chart go demographically down, and the kids are left hanging, in this case parachuting.

Why this is bad is twofold. One is because we're leading people to believe that we're actually setting up a program that's going to be paid for perpetually for the children. And two, who is this child that's now left jumping off of this cliff here? As your previous chart showed, he may very well have been a child who was already covered by your insurance. And your chart shows 55, 75, 80, 90 percent of the children had insurance prior to this program coming along, but now they were encouraged to join into this program and go into it, give up their prepaid plans under their father's programs, mother's programs, company plans, what have you. Five years from now under this program, it's designed to fail. They will jump off. They will not have anymore government program, and they also will no longer have any private insurance.

So we are setting up a system, encouraging kids to smoke in order to pay for it, and leading them to have to basically fall off the cliff in 5 years without having any health insurance at all.

At the end of the day, and I'll close on this, I commend the gentleman for leading us to look at this issue from a larger perspective, to ask a basic question. It's not so much about health insurance; it's about health care. And it's not so much of whether you have the coverage to provide you with insurance; it's whether or not you're actually going to have a doctor or a nurse out there to provide those services for you. And it's not so much as whether the government is supposedly going to do it, because we know at the end of the day they can't, by the numbers; it's whether or not at the end of the day we can come up with something to actually make sure that the patient is in control with his doctor of the delivery system and that it's the best care in order to provide the services to them, and at the end of the day the quality of life of those individuals as well.

I commend the gentleman from Texas for bringing this to the American public's attention tonight, and I look forward to reading more of his material, as well both on-line and in person.

Mr. BURGESS. One of the points that I probably did not make eloquently enough tonight is that the practicing pediatrician, not the pediatrician in an academic setting, not the pediatrician in a federally qualified health center, but the pediatrician is out there with a mix of different payer groups in his practice or her practice.

The average reimbursement for a child on the SCHIP program is about 30 percent less in my State of Texas than it is for one of the commercial insurances. If we take those children off of commercial insurance and move them to an SCHIP program, we are negatively impacting the bottom line of the pediatrician who is providing the care. We can only do that for so long before they will decide that they have got something else that they might do.

Mr. GARRETT of New Jersey. You make a perfect point. Again, it goes to what we were saying before. It doesn't matter whether you have insurance or not. It matters whether or not there is actually a doctor who will be there to take the insurance.

How many individuals that you know, senior citizens that you know right now that are Medicare or Medicaid, and they went out to find a doctor to treat them for their ailment, and they found out there are no longer doctors in their community who are taking Medicare or Medicaid patients. They had all the great socialized programs, coverage, that they needed. They just didn't have any doctors who would pick it up.

You are explaining the same thing very eloquently. The same thing will happen to these poor indigent children. We lead them down the road to believe that they actually are going to have coverage now, that think that there is going to be a doctor there to take care of them. If their reimbursement rates are anything like they are for Medicaid, there may not be a doctor there to deliver the services.

Mr. BURGESS. One of the things before the time completely leaves us, I just want to draw attention to a recent poll put out by U.S.A. Today that does show that the plurality of Americans, a majority of American citizens, believe that the benefits in the SCHIP program should go to poor children first, and that's not to the children at the upper-income levels that we were showing on the other slide. That is the group of children for which this program was originally intended, that is children whose parents make too much money to qualify for Medicaid, yet not enough money to reliably afford their health insurance.

When this program was first enacted in 1997, by a Republican Congress with a Democratic President when this program was first enacted, that was a group of children that the Congress was trying to help. The concept of poor children first is one that the American people embraced.

In fact, I introduced legislation earlier this year, H.R. 1013, that would have put the children back in SCHIP and removed adults from the program. Now, I am grateful, very grateful that the Democratic majority has now embraced that concept and at least their latest iteration of the SCHIP reauthorization bill said that there will be no adults on the program within one year of the enactment of the bill.

It's a bittersweet victory because there are so many other aspects of the bill that are flawed that Mr. Garrett has just alluded to. The funding mechanism absolutely disappears in the fourth year of the program. The funding mechanism itself is based on a belief that there will be an increasing number of smokers in this country, and public policies that I support to decrease the number of smokers and decrease the number of young people who begin this habit.

It makes no sense to be saying we are going to fund this entire program based upon that type of tax and, on the other hand, try to put our maximal effort behind trying to reduce the number of smokers in this country. It is certainly a conflicted mindset that the Democratic majority seems to be propounding here.

One of the other things that I do want to bring up just before we close, another poll from U.S.A. Today that the American people are concerned, are concerned that the program as proposed would pull those children off of private health insurance and put them onto a government plan.

Then as Mr. Garrett so eloquently pointed out, then the funding dries up, and where are you then? At the same time, if you have driven pediatricians out of practice because of lower reimbursement rates, you have now the trifecta, the triple whammy, where health care for children may be seriously jeopardized in the mid-term or the long-term because of the fact that we are sacrificing for political expediency today.

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