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Public Statements

GOP Doctors Caucus

Floor Speech

Location: Washington, DC


Mr. BENISHEK. Mr. Speaker, as many of you may know, before coming to Congress, I was a physician in northern Michigan for nearly 30 years, and tonight I want to spend a little time talking to you about Medicare, the President's health care bill, and just health care in general.

In practice, many of my patients were on Medicare, and I know how important medical care is to our seniors. It's an important part of their ability to take care of themselves as they get older. Really, the reason I'm here today is to explain that the GOP and the Republicans want to preserve Medicare for our current seniors and for the youth that are coming up because right now the way Medicare is organized, the trust fund will be out of money within 10 to 12 years. Different accountants have different numbers. But basically, unless we do something, we're going to run out of money. We just don't want that to happen. I want to see people still have access to their care.

In discussing this issue, it seems as if we've been attacked for trying to end Medicare. But if you see that there's a problem with a system that is running out of money and you don't want to address it, that's just not right.

The Doctors Caucus in the House is 18 physicians, nurses, and dentists that represent different areas of the country, and we have a good understanding of health care as it exists right now in America. Certainly, there are problems with health care and access to it. And although we have great health care in America, the problem is it's too expensive. Frankly, the President's health care bill makes it more difficult to keep Medicare viable. Those are a few of the things I want to talk to you about this evening, just touch on to let you understand what I think about how the system is working and how we can improve it.

I don't think it's a partisan issue. I think it's something that we need to discuss. Frankly, I just don't think that some of the people that have passed these laws in Congress really understood what they were doing. They admitted the fact that they passed the bill without really knowing what was in it. I just don't think that's really a good idea.

What is really the problem with Medicare? The problem is that the population of our country is changing. There are more older citizens than there were; in other words, there are 10,000 new Medicare beneficiaries being added each day. Right now, a little over three people are paying into the system for every person that is collecting. Because of the large numbers of people that are being added to the roles, within a few years there are only going to be two people paying in for each person collecting. That creates a problem in the fact that there are not as many people paying in as are receiving benefits. With the cost of health care going up, it makes it a fiscal cliff.

The other big problem that we see with the Medicare situation is the fact that the President's health care law, in order to pay for it, takes $700 billion out of Medicare. That's a lot of money to take out of Medicare and still expect it to provide care for our seniors, more and more of which are coming on to it every day. I think that there is certainly some waste, fraud, and abuse that can be eliminated, and that will help, but it's just not enough. We have to change the system.

The system that I think we should change to, frankly, is the system of Paul Ryan and Mr. Wyden of Oregon, who brought together a program where we can put some changes in for those people under 55 that will allow them to choose between different private insurance plans similar to what Federal employees and Members of Congress have. These private plans would be inspected and reviewed by the government to be sure that they're adequate and give people some flexibility in how they spend their money.

One of the problems I see with Medicare is that the government ends up deciding how to spend the money rather than the patient. The patient, to me, is the one whose money it is. The people who are spending the money should be the ones who are deciding how it's spent, not some government person or bureaucrat in Washington.

Show me the slide on the $700 billion. I just want to show people the slide that demonstrates what's happened to this money. I represent the northern half of Michigan. We have many small towns and small hospitals in my district. Every little town has their community hospital, and it's hours sometimes to the next facility.

This slide here shows the $716 billion coming out of the Medicare program, and $294 billion of that money is payments to hospitals. The President describes the Medicare cuts as cutting waste and overpayments to providers. Well, these hospitals are the ones that are providing the care; and as a doctor, I'd be a provider as well.

But when you cut $294 billion from our local hospitals, I know, I served on the board of a hospital. Our hospitals are operating at a razor-thin profit margin. They have to stay in the black, otherwise they go out of business. They can't make their payroll. We've recently had a hospital in our district go bankrupt because of their problems with payments from Medicare.

This is going to continue to happen as we go forward if we allow this President's health care bill to continue with $156 billion cut from Medicare Advantage, $111 billion to be cut by IPAB and other provisions, $66 billion cut from home health care agencies, $39 billion cut from skilled nursing, $33 billion from FFS Medicare providers and $17 billion from hospice care.

These are crucial programs for our seniors. With more and more seniors coming into the program, how are they going to be provided care with less money? I don't see it happening.

What's going to happen is there are going to be fewer hospitals, fewer places for patients to get care, so it's going to be difficult; and in my district we may have to travel hundreds of miles to get seen. I think it's pretty darn scary, to tell you the truth.

Dr. Harris, another member of the Doctors Caucus, is here with us tonight. He's from Maryland, and he's an anesthesiologist.

Mr. HARRIS. Will the gentleman yield?

Mr. BENISHEK. I yield to the gentleman from Maryland.

Mr. HARRIS. On those lists of questions of those $716 billion that's basically going to be transferred from the Medicare program to pay for the President's new health care reform bill, that doesn't even include the over $300 billion to cuts in physician and provider payments over the next 10 years under the payment form; is that correct?

Mr. BENISHEK. That's right.


Mr. BENISHEK. Thank you. I truly appreciate my colleague from Maryland taking a little time to be with us tonight and give us his insight as a physician here on the floor.

I would like to say a few words about IPAB. This is the Independent Payment Advisory Board. This is the mechanism that Mr. Obama's health care plan has for controlling costs. And really, what it is, it's 15 appointed bureaucrats, each making $165,000 a year, with no congressional oversight, whose only purpose is to reduce Medicare spending. So if the Medicare budget goes up too much and is over the limit, these guys in Washington are going to decide what to cut. They're going to decide if you deserve a PSA prostate test or deserve a mammogram or you deserve a colonoscopy. They're going to decide that they may not pay for that. If we don't act, this board could being making these kind of decisions as soon as 2015. Denial of payment for care is going to really lead to denial of care for our seniors. I don't think it's fair for these Washington bureaucrats who know nothing about the patient to be making these decisions.

I'm used to taking care of patients, and sometimes we have to make some really difficult decisions. But those decisions have been made between the physician, the patient, and the family, not some bureaucrat in Washington who doesn't know the patient and can't decide if this patient really qualifies for care and should not be denied. So I just think it's so wrong to allow bureaucrats that don't know the patient to be making these decisions, and I just want to make sure people understand the seriousness of this. There's no appeal from this board. There's no getting somebody off this board once they're appointed. It's really unbelievable.

Tonight, also, I have the pleasure of being joined by my colleague from New York, a nurse, Ms. Buerkle of New York.

Thank you for joining us.


Mr. BENISHEK. I thank my colleague from New York for joining us this evening. I appreciate her insight.

I just want to say a couple more things about this tax that she mentioned on medical device manufacturers.

You know, in my district as well, we have a couple of companies that make the drills for orthopedic surgeons where they put in the screws and that sort of thing. This tax is, I think it's a 2.3 percent tax, not on their profits, but on their gross. So even a small startup company that's trying to innovate, which we have in my district, and create a new device that will help people with care, even if they're losing money, they have to pay the tax on any gross receipts they have. That, to me, is like the most regressive part of that tax.

Besides that, it's forcing our medical innovators to move their companies overseas. I mean, you know, people aren't stupid. They realize that if they're going to be taxed here in this country even though they're losing money, they're going to move that manufacturing capability to Europe, and that's already been happening.

So this law is taking the medical innovators in this country--and everyone knows this country has been leading the way in the world in medical innovation for the last hundred years. It's forcing those people to go overseas to do business. That's not good for America. That's taking highly skilled people and asking them to go somewhere else to do business because we have a bad climate for that.

I want to talk just a little bit longer this evening about some real health care reform.

I mean, as I mentioned, the President's health care bill doesn't fix the problem with health care. The problem with health care is it's too expensive. This bill doesn't make it less expensive. It's becoming more expensive. When Medicare runs out of money, the way they're going to fix it is by decreasing payment to the hospitals and doctors that are providing you with care, so they're not going to want to take care of you either.

So let me just talk a little bit about a couple of, I don't know, commonsense ideas that we're talking about on this side of the aisle.

The first of those is health care insurance. I mean, the problem with insurance is it costs too much. So, what can we do to make it cost less? Well, I mean, I like to compare the difference between health insurance and car insurance.

In car insurance, you can choose from a thousand different companies in this country from Florida to California to Wisconsin to Michigan and pick a company that suits your needs, and if you don't like that company, you switch to another company.

Right now, employers control most of the health insurance. We need to
have a plan that, number one, gives the individual control over their health insurance so that you can pick a health insurance policy that you like even if the employee next to you chooses a different policy. Why should it have to be the same? Why should you have to carry insurance for acupuncture if you never use acupuncture? Some States actually mandate the coverage of acupuncture. This is why insurance costs so much.

Your car insurance does not pay for an oil change. It does not pay for new tires. It does not pay for routine, small expenses that you can expect because that's not what insurance is for. Insurance is for a catastrophic event. If you want your car insurance to pay for oil changes and new tires, it's going to cost a lot of money because that's not the purpose of insurance. The purpose of insurance is to protect you from a catastrophic event.

That's why the Health Savings Account is an important component of free market health care reform because then you have--for example, say you're working for somebody; instead of paying your health insurance, your employer pays into a Health Savings Account, which is then your money to use for health care. And it comes to you tax free, so you're not paying any taxes on it. It would be the same as if your employer was paying for a health insurance policy for you.

So with that money, then, you could be paying for your routine health care out of that. Now, this is money in your account now, so you may want to choose how you spend that a little carefully because that money is in your Health Savings Account, that's money that belongs to you now, and you can use that any way you want for your health care. Or maybe if you don't even use it all, that would be there for you in your estate once you die for your children. So you want to be careful with that.

So when you're going to go get an MRI for your shoulder, you may not just go to the place that your doctor may recommend, you may shop around for an MRI. Because I know, for example, that at some places you can get an MRI for $2,500, at another place you can get an MRI for $600, the same MRI. Unless you actually kind of look around for it, you're not going to be able to find that deal. You're not going to even know about it because right now you don't even care about it perhaps because your insurance pays it and you have a copay that doesn't affect you. But if you're taking this money out of a Health Savings Account, you're going to be shopping more. That's the power of transparency in cost.

So, looking around to see where you can save money to keep money in your Health Savings Account, and then shopping for insurance that suits your needs, not the needs of the person next to you, but suits your needs so that you may choose an insurance company, like for your car insurance, that differs from our neighbor's but suits you just fine. You may have Chevrolet insurance or you may have Cadillac insurance, but it's your choice. Those are just two things that I think would really diminish the cost of medicine and not involve taking over everything by the government and actually decrease costs.

The other thing that nobody really talks about much in the cost of medicine is the cost of malpractice. Malpractice is something that doctors can be very uncomfortable with, but sometimes injuries do occur. Is it a good result for a patient who's been injured to have to go to court for 5 or 6 years and then have to pay fees for attorneys of 50 to 60 percent of the judgment after 5 or 6 years in court? Is that justice for an injured patient? Frankly, it's not something that doctors want to see.

Doctors want to see, if there is actually an injury, let's have it dealt with in a reasonable fashion. Let's have it adjudicated in an administrative law situation when there has been an injury. A panel of people can decide, yes, there has been actual injury, let's make a judgment, and let's give that patient a judgment, and let's get it done with within several months. That would be better. It would eliminate the entire cost of a trial, the attorney fees and all that, and physicians would like it. Patients would like it, I think, because it would give them speedier access to justice. I think that by doing that we would eliminate a lot of the extra costs that come into medicine.

Right now, if you come into the emergency room for something, a pain in your belly, you're going to get a CAT scan pretty much automatically because the doctor is afraid of being sued. And it doesn't cost him anything, it doesn't cost the patient anything, he's going to order a CAT scan, he's going to order the x-ray, he's going to order a lot of tests just to protect himself. These are some of the hidden costs of malpractice that people don't really think about. They just think about the cost of malpractice as simply the cost of the doctor's insurance, which can be expensive.

Right now, different States will have different abilities to attract physicians because they have different means of dealing with malpractice. But I think that for the patient, really, we need to have a better system where they get compensated faster and with less aggravation than the system we have now.

So, I think the main thing that we're talking about on this side, we talk about health care reform, is to talk about having a conversation with the American people. Maybe you don't agree with some of these ideas on how to make our health care system better and more efficient. Well, I can understand that. Let's have a conversation. Let's decide how we can do it better.

Let's try a pilot program in one State. Let's allow States to experiment in how to do things. Let's not write a bill of 2,700 pages in the middle of the night that nobody read and then put it on the American people and say it's going to be great, but we don't know what's in it because we haven't read it, and then go through the next 2 1/2 years realizing that it's a mistake. I mean, there definitely needs to be room for improvement in our system, but can't we have this conversation in an open fashion? I think a lot of people even on the other side would realize that, hey, we made a mistake, but isn't it more important to admit that we made a mistake and try to move forward in a fashion that actually cuts cost? We see it's not cutting costs. It's been devastating to the American economy.

I've talked to small business owners across my district over the past 2 years and they say the same things again and again: There's regulations cost us money and our health care cost us money; it's going to make us not be able to hire more people.

So I think we've made some real mistakes here in the past, but now is the time to address them and move forward and try to make some commonsense decisions. Frankly, I'm happy to hear from people with ideas. I hear ideas from people all the time in the district that really make some sense and are certainly worth trying out.

So with that, I want to thank the members of the Physicians Caucus that were here this evening for our evening hour, and I yield back the balance of my time.

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