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Doctor's Caucus

Floor Speech

Location: Washington, DC


Mr. HARRIS. I want to thank the gentleman from Tennessee and the gentleman from Georgia.

Following up on what the gentleman from Georgia said, Mr. Speaker, the President stood there and told America that health care costs have gone down. Now, I don't know if the President has been in a pharmacy lately or been to the doctor or bought a health care insurance policy lately, but the fact of the matter is the price has gone up--in some cases, dramatically--and it's going to go up more, especially for the young, who actually are the highest percent of the uninsured of any age group.

Look, it's just the facts. Folks, when they're 18, 19, 20, 25, they don't think anything is ever going to happen to them, so they don't buy a policy. And the policies now, I sat down with someone whose daughter was insured, and she had one of the HSA accounts, those health savings accounts, and $2,500 goes into the health savings account. The first $2,500 she would pay, and above that, the insurance would kick in. It was an affordable policy. It used to be less than $100 a month. Imagine that, $100 a month, guaranteeing that young person, God forbid they get into a bad accident, God forbid they develop a tumor at an early age, they have coverage for the really expensive things that you may need. That was affordable. I think most people would say $80 a month is affordable.

That policy went up to $110, and this time the renewal was 22 percent more than that. And it's going to get worse because the President now, in the Affordable Care Act--ObamaCare, as he prefers it to be called--actually reduces the amount that those health savings accounts can hold. It's now limited to $2,500. You can't get your premium lower by saying, Okay, I'll take a little more risk, increase my health savings account. So those costs are going to skyrocket. And when they skyrocket, the gentleman from Georgia is absolutely correct, a young person is going to say, I'll pay the penalty.

So a young person who may have had insurance before because it was only $80 a month--and it protected us from having to pay for those medical costs, God forbid that young person had a catastrophic illness or injury. That person is going to make what looks like a logical choice now and say, You know what; I'll pay the penalty and drop my insurance. It's going to have exactly the opposite effect of what was intended, and predictably so, when you force those premiums up.

Again, the President stood here and said that health care costs went down. I've got to tell you, I still have yet to run into someone at one of my town hall meetings that says, Good job, ANDY; my health care costs or my insurance is going down. It's not, it's going up.

Let me address, because the gentleman from Tennessee touched on it, one of the problems that the President didn't consider--tort reform. You have three physicians here, two of whom spent their professional lives in the labor and delivery suite delivering babies, practicing obstetrics. I practiced obstetric anesthesiology, do those epidurals, those spinals, relieve women of their pain in childbirth.

Over my career, my generation--I finished my training in 1984, 28 years ago. At that time, to show you what the effect of not having tort reform is, the cesarean section rate for American women having a baby was 15 to 17 percent. One in six to one in seven women would have to have a cesarean section. Now, 28 years has passed. I don't know if the Speaker is aware, but the cesarean section rate is now 33, 35 percent, in some hospitals 40, up to as high as 70 percent in some hospitals. That's in one generation.

I will tell you, as a physician, not much has changed to patients in one generation. What has changed is that you don't find an obstetrician who's willing to take the risk of doing a delivery in a high-risk patient, a normal delivery, because of the medical malpractice exposure--not that they would commit it, but they would be charged with it, that a baby doesn't come out perfect, because that's the way the world is. Yet they would be charged, brought into a court of law, and lose millions of dollars in a settlement. So what do they do? They choose, when there is any question, to do a cesarean section, and who can blame them to do it.

Mr. Speaker, those women who are watching, they know exactly what I'm talking about, because they know if it was their daughter or granddaughter or a friend of theirs, they all know someone who has had a cesarean section. If the women who are in the audience now think back to one generation ago, it was much more rare. So what's happened? We haven't had tort reform.

But that's not all. By the way, the cost to the system is billions of dollars a year for those extra cesarean sections, billions of dollars direct cost to the health care system.

If that was all, we'd say maybe we can tolerate that, a doubling of the rate of cesarean sections, but that's not all. When those women go to see their obstetrician now, one generation ago when I started, when I had my first child, my wife went to an obstetrician. It was a solo practice. And that obstetrician apologized to my wife and said, You know what, I'm sorry, but every other weekend someone may have to cover my practice, so I may not be able to guarantee you that I'm there with you at your delivery.

Let's fast-forward one generation, 28 years. You can hardly find an obstetrician in solo practice anymore. They simply cannot afford the medical malpractice premium. They may never have been sued in their life, and they may have to pay over $100,000 a year just for the medical malpractice premium, never having been sued in their life. So what happens? They're all forced into large groups.

Now, that same conversation, if my daughter now goes in to see an obstetrician, that conversation would run like, You know, ma'am, you're going to have to see everyone in the group during your pregnancy, and we have seven or eight people in the group. So every time you're going to have to see someone else so that everyone gets to see you because we don't know who's going to be there the day you deliver.

Now, is that good care? Is that a good relationship that woman develops with her obstetrician when she doesn't even know who's going to be there to deliver her? In fact, she doesn't even know who might see her the next time she's in the office, one of the most important times in her life. We have completely changed the doctor-patient relationship because we don't have tort reform in this country.

If it was just the rate of cesarean section doubling or just the fact that you have to see seven or eight people and you don't really know who's going to deliver you on a given day, we might accept that, but it goes beyond that, Mr. Speaker. Because what's happened now, a good, highly trained obstetrician stops delivering babies in their forties or fifties because they have developed their practice, they have seen those patients. They just take care of their gynecology problems and they spend the last 20 years in their career not delivering a baby. Having delivered them for 20 years, gaining all that experience, the most experienced obstetricians don't deliver our babies anymore. And why don't they? Because if they stop delivering babies and promise their insurance company they will not deliver a baby, all of a sudden that $100,000 premium becomes $20,000. If you were in your forties and fifties and could afford to do that in your practice, you might say, You know what; it makes sense for me to stop doing this.

So when you add up all the things that have happened because the President, in his Affordable Care Act, refused to have real tort reform--and it's possible, because it happened in California. I mean, there are areas in the country that have it. But nationally, he refused to have it--and the gentleman from Georgia is very familiar with this because his bill deals with this. Because of that, we have a cesarean section rate that's twice as high as it ought to be, and some people will tell you it might be three or four times as high as it ought to be. We have women who never develop a close doctor-patient relationship with their obstetrician because you really can't. I mean, you're seeing a group of seven or eight purely because the malpractice premiums are now spread out. Frequently, somebody else even pays. They may be part of a hospital group, for instance.

Finally, our most experienced physicians for women in a time--you know, you talk about taking care of children. You've got to start right at the beginning. You've got to have the most experienced person there. See, I've been at thousands of deliveries.

Ninety-nine percent of the time they go all right. But when they don't go all right, you want the most experienced person there. And, Mr. Speaker, our lack of tort reform means we no longer have it. We have entirely changed the way we deliver obstetric care. So if you even said, look, we're not even going to worry about costs, let's not talk about costs, let's talk about access to experienced, personalized care for our women having babies, it's virtually gone because the President and our counterparts across the Capitol in the Senate refuse to take up the issue of tort reform and restore some commonsense, good medical care to Americans.

Obstetrics is an example. We could go into neurosurgery and many other examples, and I'll leave it with that. We have so many opportunities to reduce the costs and improve the quality and access to medical care, and it was lacking in the State of the Union Address.


Mr. HARRIS. I thank the gentleman from Tennessee for yielding. To follow up on his point, Mr. Speaker, I don't know if Americans realize, the gentleman is absolutely right. If you have a case litigated, a birth injury claim, and it goes to a jury and there's an award, let's say, of $6 million--not an unusual award--40 percent of that award, $2.4 million plus expenses, goes just to the attorney. Is that fair? You have an injured baby--and we're not going to decide what the injury is. But is it fair that when the court renders a decision that half the money doesn't go to take care of that baby? It doesn't seem fair.

I want to briefly go back to some of the issues in the Affordable Care Act. One that really struck me is the medical device tax. Now, I know the President likes taxes. There are 21 in the Affordable Care Act. He stood up there 2 days ago and talked about taxes, increasing taxes as a solution to our problems. But let me tell you what the problem with that medical device tax is. And I'm going to hearken back to my experience, again, over 28 years. I remember training in the early eighties. Some of the people watching, Mr. Speaker, might know if they had a kidney stone 30 years ago and had to have an operation for that kidney stone just how serious that was. And I remember, I did anesthesia for many of them. There were big incisions on your back, on your side, a week in the hospital, and you could get infections from it. It was a terrible experience if you needed an operation to remove a kidney stone.

So 2 years ago, I had the opportunity to work in one of the urology operating rooms. It was a kidney stone removal. And here I'm going, wow, I haven't seen one in a while, I'm going to give the anesthesia for it, I'm going to prepare for a big operation. The surgeon said, no, no, no, no. We're doing this with a laser. I said, a laser? That kidney stone is deep inside. It's inside your body. He said, no, you've got to see what we got.

They brought a laser machine in, and I apologize I didn't bring a sample of these catheters. It's a catheter, a wire that's about a yard long, and it's fiber optic. Oh, my gosh, it's thinner than the lead in a pencil, and it's flexible. They thread this up--and I won't go through the exact anatomy--they thread it up to where that kidney stone is. They fire a laser through this, and they break the kidney stone up into tiny little pieces, or evaporate it, and it just comes out. There's no incision. These patients go home the same day.

Why? Because of medical innovation, because some company took a risk to develop that laser product. I tell you, it's not cheap. I'll also tell you it's a whole lot cheaper than several days in the hospital.

The President stood there and said, We don't want to pay by the hospital day; we want to pay by the quality. Let me tell you something: if I have a kidney stone, my hand is going up for that newest method because it's the quality method. What does the Affordable Care Act do? It taxes it. If that person had the old operation, there's no taxes involved; but if they have that new device, there's a tax on it.

I learned in the legislatures that there's a saying that if you want to discourage something, tax it. We have these arguments over tobacco. You want to discourage tobacco? Let's tax it. Most States have taxed it, the Federal Government taxed it, and sure enough we have less. I don't understand. Is that the same thinking we have about innovative medical devices? Are they all of the sudden not a good idea? That's exactly what this bill does, it taxes them.

One of two things is going to happen: either that tax is going to be passed on--because that's what businesses do: when you tax businesses, they pass them on--or we won't innovate as much. That would be a disaster because the key to improving our health care quality, going into the future, especially with American ingenuity and innovation and expertise, is innovating. We're taxing innovation. It makes no sense, Mr. Speaker.

I hope we move a bill through this Chamber to remove that taxation. It's a very bad idea for the quality of health care in the United States because some of these new products, whether it's for treating diabetes or whether it's for treating kidney stones, are amazing new technology.


Mr. HARRIS. I thank the gentleman from Tennessee for yielding.

The gentleman is absolutely correct. We made a promise to our seniors. To the people who've worked all their lives, we made a promise that we're going to take care of you, but we have to be honest with how long we can do that. What are we going to do for my children? for people who are in their twenties or thirties? How are we going to preserve that system and preserve their ability to choose their physicians and allow their physicians to choose what's best for them? Because that's really what's critical, that we preserve that in the system.

The gentleman is right. For the seniors who are watching this afternoon, they know that, in many parts of this country, if their primary care providers, their internists, their family doctors retire or move to other States, it's going to be hard to find someone, not because doctors don't want to take care of Medicare patients. We all do--we've taken care of thousands of them in our lives, in our professional careers--but the fact of the matter is that, every year, the government threatens to cut the reimbursement, the payment for services, by 25 percent, and it hasn't had an increase for inflation in 10 years.

This kind of uncertainty means that we may end up looking like the other program the Federal Government runs, Medicaid, where the statistics are dire and where fewer than one-half of specialists can afford to see a Medicaid patient because the government simply has decided we're just not going to pay. It's where fewer than half of the primary care providers don't see Medicaid patients because the government has said we just can't pay, and we're not going to. It's where hospitals now are wondering how they're going to staff and how they're going to keep up with the best medical equipment and the best medical delivery because they're afraid the government is not going to pay. Who can blame them? Every year, the government threatens to cut the pay to our seniors' doctors 25 percent, and, every year, the government threatens to cut the pay to our hospitals that are taking care of our seniors. Every year, this goes on. It has to stop.

I hope the Speaker and the gentleman from Tennessee will agree that we have to address this seriously, honestly, with a view to two things: preserving the benefit for people who are in retirement and keeping the system going for every American. An American born today, February 14--a child born today--should have a system that he knows is going to be there, not bankrupt, but a system that's there when he reaches those golden years, and we can do it if we all work together.

I was hoping I'd hear more from the President. I didn't. The President is still not willing to come and talk about preserving Medicare, because, Mr. Speaker, you know that the trustees have said it goes bankrupt in 10 years. The current system will not be there for everyone retiring. The 10,000 people retiring today, February 14, enter Medicare. That system will not be there in 10 years. It will be bankrupt. So the current system doesn't even protect our current seniors, much less a baby born today.

We have to deal with it. Mr. Speaker, I urge the President to step up to the plate, be serious. Our colleagues on the other side of the Capitol, step up to the plate. This program is too important to let go bankrupt within 10 years.


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