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Public Statements

House GOP Doctors Caucus

Floor Speech

By:
Date:
Location: Washington, DC

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Mr. GINGREY of Georgia. Madam Speaker, I thank the majority leader for yielding this time to discuss an extremely important issue facing the patients in this great country of ours that are going to have a very difficult time in finding a physician.

Madam Speaker, in March of 2010, when the so-called Affordable Care Act, or PPACA, was passed into law, the purpose, of course, was to increase access to physicians for all patients across this country and also to bring down the cost of health care. Well, we're 2 years into this bill--which will become fully effective in January 2014--and what are we seeing?

Madam Speaker, the CBO reported just recently that some 7 million people have actually lost their health insurance, the health insurance provided by their employer. For those who do still have health insurance--particularly those who get it maybe not from their employer but from the individual market, a small group policy--the cost has actually increased some $2,500 a year instead of coming down, as anticipated and predicted and promised, in fact, by President Obama, but that just absolutely is not happening.

So what we're going to be talking about, Madam Speaker, is, again, what needs to be done to correct this situation. Because the thing that was never really discussed to my satisfaction when this bill was crafted was, how are you going to get the best and the brightest young men and women in this country to continue to go into the field of medicine, to become the doctors--particularly in primary care, internal medicine, and the pediatricians--to provide that care when the reimbursement system under Medicare, called the sustainable growth rate, year after year after year for the last 6 or 8 years we have actually cut the income to the providers, to the point, Madam Speaker, where they can't provide this care, they can't even break even? So this is what we're going to be talking about, this flawed sustainable growth system. It has certainly contributed to the physician shortage crisis that we see today.

Now, I have a number of slides that I want to present to my colleagues, and we'll go with some specifics on that. But I'm very pleased to be joined today in this House with the cochair of the House GOP Doctors Caucus, my good friend and fellow physician Member from Tennessee, Dr. Phil Roe, and I yield to Dr. Roe at this point.

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Mr. GINGREY of Georgia. Dr. Roe, if you would yield just for a second, I wanted to point out to my colleagues and to Dr. Roe the poster that we have before us. Because this is exactly what the good doctor is talking about right now in regard to what's been going on since the year 2000. Dr. Roe, you may want to refer to this slide.

I yield to the gentleman.

Mr. ROE of Tennessee. Well, the particular slide that Dr. Gingrey has down there is very telling. Basically what it says is that each year that we've recalculated what our physicians will be paid, we haven't met those metrics, which means that we have to cut.

Well, what has Congress done? Well, Congress has realized that what we're talking about is not payments to doctors; what we're talking about is access to care for patients. What happens is if you go back to 2003--I think it was 2003--when there was a 5 percent cut in Medicare payments, we realized at that point right there that if you continue to do that, that access would be lost.

So let's fast forward to 2013, what we're just facing. Doctors were facing a 26.5 percent cut, the providers were.

Mr. GINGREY of Georgia. Dr. Roe, that would be right here.

Mr. ROE of Tennessee. That's correct, that number right there. That was avoided by a 1-year so-called ``doc fix.''

What has happened over the last 15 or so, 16 now, years is that the Ways and Means Committee line--now law--says we have to spend this much money, but we've actually spent this much. That is a deficit in spending that we've got to make up somewhere in our budget or add it to the budget deficit.

Now, I go back to when I was in practice just 5 years ago now in Johnson City, Tennessee. Dr. Gingrey, I don't know about you, but I was having a harder and harder time finding primary care access for my patients that I had operated on, or maybe someone who had been my patient for 30 years--if she was 40 years old when I started taking care of her, in 30 years she's 70 years old and needed a primary care doctor. That was getting harder and harder and harder to do.

Now, when you look at today's young medical students, we're having a much harder time convincing these young people to go into primary care. What is primary care? Well, it's pediatrics. If you want someone to take care of your baby, it's family medicine. It's also internal medicine and also OB/GYN. I certainly served as a primary care doctor, as Dr. Gingrey did for his patients, for many, many years. That would be the only doctor that they would see. But that's getting harder for our patients to do. And Dr. Gingrey, that's my primary concern--access for seniors to their doctors.

Mr. GINGREY of Georgia. Dr. Roe, if you will yield for just a second and then I will return to you, again, I wanted to point out to our colleagues that this poster, this slide that's on the easel before us is exactly what the gentleman from Tennessee is talking about in regard to shortage of primary care physicians. And as he pointed out, primary care is a family practitioner, is a general internist--of course pediatricians provide primary care to our children. But so many of these doctors are the very ones that take the Medicare, take the Medicaid, take the SCHIP, the State Health Insurance Program for children. They see them.

And what Dr. Roe is referring to, before I yield back to him, on this poster it shows in the dark blue the areas of these States, several States, including my own of Georgia--Tennessee is not quite as bad--but in my State of Georgia, there are anywhere from 145 to 508 areas of the State of Georgia where there are an insufficient number of doctors to take care of these folks. Tennessee is a little bit better. There are only 67 to 99 areas. But all of this blue are critical areas, are they not, Dr. Roe? And I yield back to you.

Mr. ROE of Tennessee. That is correct. And so much so that in California, what they're recommending, I don't know whether they've carried it out or not, but they've recommended expanding the definition of ``primary care'' to a lower-level provider, that would be a nurse or nurse practitioner or PA or this sort of thing, this sort of designation.

I think the other thing, Dr. Gingrey, that we haven't talked about, and we probably should spend some time on, is the age of our practitioners. In our State of Tennessee--where you see that we're not quite as dire in need as Georgia, our friends to the south--the problem with it is that 45 percent of our practicing physicians in the State of Tennessee are over 50 years of age. I'm concerned that with the advent of the Affordable Care Act, the complexity of that, the frustration that I see when I go out and talk to our providers is that I'm afraid that many of them are going to punch the button for the door.

I know in my own practice, where we have now about 100 primary care providers in my program, in my OB/GYN group, in the last several years we've had over 120 years of experience walk out the door and retire. That's not a good thing for the American health care system that just lost access. Quite frankly, the crux of it all is that access. If you do not have access, you will decrease quality, and you will increase cost. That is our concern. Ultimately, the cost will go up if our patients can't get in to see us.

Mr. GINGREY of Georgia. I thank the gentleman, because what the gentleman from Tennessee is talking about is having an insurance card, a health insurance card--and indeed even having a Medicare card--does you very little good if you have to spend 2 hours going through the Yellow Pages trying to find some physician, primary care doctor in your area that you wouldn't have to get in your car and drive 50 miles--if you could even drive. If you don't have that access, then you don't have anything.

So here again, this bill, this massive bill was passed 2 years ago at the cost of almost $1 trillion. Unfortunately, a lot of that money was taken out of Medicare to create this new entitlement program, if you will, for younger people so that they can have health insurance. But what we've done is we've just made the crisis in the Medicare system that much more difficult.

What Dr. Roe was talking about, colleagues, is in regard to not just a shortage of the physicians, but what happens in the waiting rooms all across our country. This slide shows the number of primary care physicians per 1,000 population, the number of primary care physicians per 1,000 population.

Now, we've already gone over, we're talking about, again, general internists and family practitioners, primarily, and pediatricians for SCHIP and Medicaid. If you look at that map across the country, again, look at my State of Georgia in the deep red, and there are several States, Texas, Oklahoma, Mississippi, Alabama, Utah, Nevada and Idaho in the West where the number of primary care physicians per 1,000 of the population is fewer than one. So less than one doctor per 1,000 people that need that care. Many other States, including Tennessee, it is somewhere between one and 1.2. Now, I don't know how you get 1.2 physicians. I don't know exactly what that provider looks like. But you know how that math is calculated. Clearly, the shortage is acute, and it's only going to get worse and worse.

With that, I want to yield to one of my good colleagues, good friends on the Energy and Commerce Committee whose father actually was the chairman of the Health Subcommittee of the Energy and Commerce Committee for many, many years before he retired and his son took his place, and now the gentleman from Florida, Gus Bilirakis, is serving on that Health Subcommittee with me on Energy and Commerce.

I yield to Representative Bilirakis.

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Mr. GINGREY of Georgia. If the gentleman would yield, I want to thank the gentleman from Florida because what he is addressing right now goes back to the creation of this law, the Affordable Care Act, PPACA--sometimes referred to as ObamaCare--where money was taken out of the Medicare program, the existing Medicare program, which is already strained almost to the bursting point, and the Medicare Advantage program. Probably 20 percent of Medicare recipients select that model because it gives them more bang for the buck. It gives them more coverage, and it includes things--and the gentleman from Florida knows this, and this is what he is referencing--it includes more than just an annual physical when you turn 65. It includes more than being able to go to see a doctor and have it reimbursed under Medicare when you have an episode of illness.

There is a strong emphasis on Medicare Advantage to wellness. Let's say you do go and see the doctor because of an episode of illness, and maybe several prescriptions were written. It's very important that the patient take the medication on a regular basis and not run out of medication. So under Medicare Advantage, there would be a nurse maybe in the doctor's office who within just a few days of that encounter would call the patient to make sure that he or she could afford to get those prescriptions filled and they were taking them in the right way. That's what the word ``Advantage'' was all about, Medicare Advantage, rather than just a traditional fee-for-service Medicare.

But this new law created 2 years ago, and will go into full effect in January, 2014, literately gutted that Medicare Advantage part, did it not, Representative Bilirakis? It cut that program 12 to 14 percent. I mean, it's just literally gutted. I'm talking about $130 billion was taken out of that one program.

So now seniors that were on Medicare Advantage are having to look for new doctors, look for new programs, try to again go through those Yellow Pages and find somebody that will see their momma who's been going to this other group for years and is totally satisfied.

When the President said to the American public, If you like the health insurance plan you have, don't worry, you can keep it; you will not lose it, that just wasn't true. I don't think he deliberately told an untruth, but it clearly is not true. And as I said at the outset of this hour, some 7 million people have already lost insurance provided by their employer, and many more of these people that were getting their Medicare through the Advantage program, they have lost that through no choice, Madam Speaker, of their own. They have been forced out of those programs.

I yield back to my colleague, and we will continue this colloquy.

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Mr. GINGREY of Georgia. I thank the gentleman from Florida and I thank his dad, Representative Mike Bilirakis, Madam Speaker, who served in this body for so many years with distinction. I hope that he is enjoying a happy and healthy retirement in the Sunshine State. And I hope he's able to find care, but I bet you it's not under Medicare Advantage, as his son just told us.

At this point, I would like to yield back to the gentleman from Tennessee (Mr. Roe).

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Mr. GINGREY of Georgia. If the gentleman will yield for just a second, I want to weigh in on that issue of electronic medical records.

I'm normally, as the good doctor from Tennessee knows, walking around here in a sling, as I have been for the last couple of weeks. Madam Speaker, I probably should have it on right now, but I'm resting my arm on the podium.

But I just recently had rotator cuff surgery back home in Marietta, Georgia. Madam Speaker, I was blessed with a great physician who did a wonderful job and has a fabulous staff, but going through the process of doing the paperwork, I bet I filled out the exact same form four different times. That was wasting my time and that was wasting their time. Of course, what they want to make sure is that no mistakes are made. Obviously, they want to make sure they operate on the correct arm. So I understand why, and I'm sure many of you, your parents, your grandparents, and you yourselves, my colleagues, as patients have gone through all of that.

But what Dr. Roe is talking about--and I will yield back to him--electronic records are indeed, in my opinion, the wave of the future. Honestly, I believe if we had concentrated on that 2 years ago to make sure that it was fully implemented so that duplication of testing, unnecessary procedures, maybe medications prescribed to which the patient had a dangerous allergy, you really do ultimately save lives and save money by having an electronic medical record system.

The other thing is if we had had medical liability reform. The President promised that before this ObamaCare bill of 2,700 pages was put into law, but there was nothing in there about medical liability reform.

Here again, those were two things, and I think the gentleman from Tennessee would agree with me on that.

I just wanted to interject my thoughts about electronic medical records, and I yield back to the gentleman.

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Mr. GINGREY of Georgia. The top of the green line is where we in the Congress mitigated these cuts because we can do that. That's what it says in the Constitution, that we're in charge of the purse strings. So, when there is a recommendation, as Dr. Roe is referring to, Madam Speaker, of the cuts in the pink--below the line, from 2001 to 2012, there is almost every year a 5 percent, 3 percent, 4 percent, 10 percent--then in the aggregate, that number just keeps getting bigger and bigger.

What Dr. Roe is about to explain to us is how we were heretofore able to mitigate, which is by making these changes above the line and by saying, no, we're not going to cut the doctors because we know, if we do that, they won't be there, that they won't be there for our parents and our grandparents and ourselves and our children.

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Mr. GINGREY of Georgia. Dr. Roe, what will happen in reference to this slide right here--if you look at these blue areas, these States that have the acute shortage areas, like Georgia and Florida--is that this whole map of the United States will be blue.

Mr. ROE of Tennessee. That is correct, Dr. Gingrey.

Unless you are very deeply buried into this--meaning, if you're a Medicare recipient out there today--you don't see this. I go home, and I see my physician friends and talk to my friends who are on Medicare. They don't know this has happened or that it could potentially happen to them, but it can and it will, and it is the law right now unless we change the law.

I would strongly encourage my colleagues on both sides of the aisle--and we have bipartisan support for the appeal of the IPAB--to put that constitutional authority back in the hands of the people who are directly responsible and responsive to the American people--us, the Representatives. Let us make those changes and, the Senate, the same thing.

Mr. GINGREY of Georgia. I thank the gentleman, and I want to continue a colloquy with him and maybe even ask a question of him. Dr. Roe, Madam Speaker, explained very clearly how that is a section of ObamaCare, a very important section of a group of 15 bureaucrats appointed by the President.

In regard to the IPAB, they basically can now say from year to year, Well, the doctors and the hospitals are going to be cut so much reimbursement. These cuts are going to occur.

We showed in the first slide how over the years Congress has been able to mitigate. Read the Constitution. We, the Members of the Congress, control the purse strings. So, fortunately, we were able to make these changes into what was suggested; but this IPAB board of 15 bureaucrats, they're not making a suggestion. They're telling us what has to be done.

The question I wanted to ask of Dr. Roe, Madam Speaker, was: when this case went before the Supreme Court, questioning the constitutionality of the law and saying that if a Governor of a State, like the Governor of Georgia, Governor Nathan Deal--an 18-year Member of this body, by the way--makes a decision not to expand Medicaid because the State can't afford it as the State's already going broke on the current Medicaid program, is it constitutional for the Federal Government to say, If you won't expand the Medicaid program, we're going to make sure that you can't participate at all and that all of your current recipients of Medicaid in the State of Georgia are out on the street?

That was a question that was asked of the Supreme Court as well as: was it constitutional to force people to engage in health care if they didn't want to, if they did not want to purchase health insurance? Now, I'm not recommending that they don't; but the question before the Supremes was: is it constitutional under the Commerce Clause to make people engage in commerce if they don't want to do it? The Supremes said, in a very pained, strained, pretzel-like decision, that that was constitutional.

Dr. Roe, do you know whether or not this question about IPAB was addressed by the Supremes: is it constitutional or not? I'm not sure. I'm thinking it wasn't addressed. Would you speak to that.

Mr. ROE of Tennessee. That's correct.

I had the privilege of being in the chambers when a good part of this health care debate was going on in front of the Supreme Court. It was the first time I'd ever been there. Fascinating. I'd totally misread it.

As you pointed out, it was the first time in American history that the Supreme Court said that you had to purchase a good or service--even if it's good for you, that you had to purchase it. We've never forced anybody into commerce before like this. As an individual, I think you have a right to make good decisions and bad decisions. I agree with you. I think a good decision is, if you can afford health insurance coverage, you should purchase it. I think there is no question. I have for my family my entire life, and I would recommend it strongly and encourage people to protect themselves in that way.

But does the government have the right to do it?

This Court said 5-4 that they did. The Court also said that they did not have the right to force States into expanding their Medicaid if they did not want to, and the IPAB specifically was not brought up.

I believe it will be challenged and should be. No one has standing yet because it hasn't gone into effect. In other words, they haven't issued any rulings--or the Secretary hasn't--to say that I've been harmed by that ruling so that, therefore, now I have standing in the Court and that I can bring a case.

Mr. GINGREY of Georgia. So you're saying that it's in the law, but because it hasn't been applied yet. And, in fact, indeed, as Dr. Roe pointed out, Madam Speaker, the board, the IPAB board, 15 bureaucrats, have not even--not even one of them, their salary has been set, I think they're scheduled to make $150,000 a year and probably have a car and a driver and health insurance and retirement plan, and not too bad a gig if you can get it, but not so far I don't think any have been appointed. And so that's what Dr. Roe, Madam Speaker, was referring to when he said there's not standing yet. If you went to the Supreme Court, they would say the case is not ripe. I'm standing here as a physician trying to sound like an attorney, and I'm going to get myself in a lot of trouble here in a minute, Madam Speaker, and Dr. Roe explained that very well, but I do agree with him, colleagues. I do agree with Dr. Roe that that will be challenged and certainly should be struck down. You look at the Constitution, our fifth and sixth graders probably could make that decision, and it wouldn't be a 5-4 split decision; it would be 9-0.

Mr. ROE of Tennessee. Actually, the IPAB board of 15 bureaucrats will make $165,000 a year with a 6-year term, and they can be appointed twice to that term. And it's something, and what bothers me about it is, no, it says in the bill you can't ration care, but we are the elected representatives. We should be able to go back home, as Congressman Bilirakis said, we should be able to go back home and face our constituents, and they're going to say: Dr. Roe, we have a situation where I can't go see my doctor. I can't go in and see them because they aren't accepting patients, and they aren't accepting patients because of this particular board that's cut their reimbursements enough to where they can't afford to see patients.

Now, another couple of things I want to talk about in the Affordable Care Act, not just SGR formula effects, but there is a tax out there in the Affordable Care Act that hasn't been very well discussed, and that tax is on individual insurance accounts. For instance, there are companies out there that are self-insured, and they're going to get a bill for each person that has insurance. Let's say a family of four or five, they'll get a bill for four or five people, and one company in particular, this will add--and they have no reinsurance. They cover everything. They're totally self-insured, but this basically is a tax that will go into a fund to indemnify insurance companies so that they won't have a loss of more than $60,000 a year, and this is billions of dollars when you stretch it across the country.

And these insurance companies are going to not have the loss to encourage them to accept patients on the exchange. That's as wrong as it gets to take a company that is doing everything right, they're going ahead and providing the health insurance coverage for their employees, and to penalize them for that.

So there are many, many issues in the Affordable Care Act we could talk about, but I want to basically finish my comments on the sustainable growth rate by saying in the past, since 2001, just so that our viewers out there will understand this, since 2001, your Medicare doctor at home has gotten an average increase in his or her payments when you come see them of 0.29 percent per year, 0.29 percent per year. When you look at all that graph that Dr. Gingrey has down there and you do all the math, that's how much of an increase. It's a very minimal increase. It hasn't even come near to covering the cost of inflation.

So again, Dr. Gingrey, I want to conclude by saying that the major concern I have, and I saw it in my practice, is the cost of care, and, number two, access to care. I'm concerned as our patients age and our population ages--and look, a good thing is happening in America: almost every 10 years we live, we're adding 3 years to our life expectancy. In 1908, the life expectancy in America was 48 years old, 47-48. In 1922 when my mother was born--and she's still living, I might add. She's living alone, by herself, doing great. She has Medicare. And I'm going to tell my mother now that later today I'm going to call her prescription in. She notified me today that she needed some medicine called in, and so I will do that for her today. I look at her and I think about her need for access to care, and if it's cut off, what does she do.

Mr. GINGREY of Georgia. I thank the gentleman, Madam Speaker. And as he talked about his mom, I stand here thinking about my own mom, who's 95 years old. Her body is getting a little frail, but Mom's mind is perfect. Perfect, Madam Speaker. She has enjoyed the benefit of Medicare and Social Security for many years. Many years. So these legacy programs are hugely important. They're hugely important to our side of the aisle.

Madam Speaker and my colleagues, all of this Mediscare stuff, and things that you get all of this rhetoric about, they don't care about seniors and they're going to push somebody's grandmother over the cliff in a wheelchair, that's just a bunch of bull. I think every Member of this body and every Member of Congress cares about seniors and cares about these programs.

But I also, Madam Speaker, have 13 grandchildren. I have 13 grandchildren, and I want this Medicare program to be there for them some day, just like it has been there for Mom all these years.

So as we talk about these issues, we would do nothing to harm current recipients of Medicare and Social Security. We used the term, the phrase I guess you'd say, ``hold harmless.'' Hold harmless. Any changes that we would make, whether it is the payment system to our doctors and our hospitals for providing the care, it would not take away any benefit. It would not cause our current seniors to have to pay a higher premium or copay or deductible. All we're doing is trying to come up with something that would save the program for them, but, most importantly, for these youngsters that are coming behind us, the next two generations. So that's what we're all about.

My colleague, if he has some more comments, I would like to refer back to him, the gentleman from Tennessee.

Mr. ROE of Tennessee. Dr. Gingrey, I think one of the things I know you did and I know one of the things that I did was to come here to this body, this great body, to work on the repair of our health care system and improve on it.

One of the major pieces of our health care system is our Medicare system. I cannot tell you the patients I have seen in my career that have benefited, whose lives have been helped and saved by the Medicare system and by the doctors and nurses and hospitals and other providers who've cared for them. You have, too. I've operated on them, and I've seen them get cardiac care, renal, whatever it may be, that has improved the quality, improved and lengthened the quality of their life, not just to live longer, but to live better.

My goodness, look at the number of patients that we see of our orthopedic friends that we have that are mobile, that are active who've had joint replacements and so forth. Look, if you're 80 years old, 75 or 80 years old, you understand that your life is not going to be that much longer, but you also want the quality of that life to be the absolute best it can be. And it cannot be if you can't get your knee fixed if you're in pain, or your hip fixed if you're in pain. One of the things that I think our side of the aisle is committed to, I believe the other side, we may have differences of opinion, but one of the things I want to do is to be sure that we shore up and save this great system of Medicare.

I had a meeting today just after lunch about the Medicare part D program that was passed by the Republicans at some political risk for them. That's been a plan that has actually come in under-budget. It came in under-budget because seniors are able to go shop and purchase exactly what they want that meets their needs. That is exactly what we want to do in the Medicare system.

And when our budget is published next week, we are going to look at a system where we help fix and save and sustain Medicare, as you pointed out, not only for your mother, who's 95, and my mother who is 90, but for my two grandchildren who are 7 and 9. They also deserve the same great system, and we're going to have to change it; but I think we can make it better. I really believe it can be more responsive. You see what patients do when they get Medicare Advantage. You saw what they did. There was a little confusion, I admit, when Medicare part D first came out. There is no confusion now. People shop for the best value that meets their needs, and that's exactly what we should do.

Let me give you an example, Dr. Gingrey. I turned 65 a very short time ago. What happened to me when I turned 65? Nothing. I got one day older. Except what happened was I had a plan now that had an alphabet soup--A, B, C, D.

The day before I had a health care plan. Why, when you turn 65 years of age, don't you have a health care plan? And in that health care plan I can pick out I don't need fertility coverage at age 65, thank you very much. And I think that's the kind of thing--allow seniors to be able to pick what meets their needs and meets their family's needs at that particular point in their life; not just one-size-fits-all, but what they need.

And seniors have done that. They do it with everything else in their life. There's no reason it should change when you hit 65. You should pick out what plan--just like you and I can do up here with the Federal Employees Health Benefits plan. There's no reason that a senior shouldn't have exactly the same plan. It will be cheaper. It will be a better plan for them, and that's one of the things I think we're going to be discussing in the next several months when the Republican budget is published.

Mr. GINGREY of Georgia. I thank the gentleman.

Madam Speaker, as we get near the closing of the hour, I wanted to just mention several things. Dr. Roe has alluded to these, talking about the Medicare Advantage and what a beneficial program that was. Unfortunately, it's now been gutted, literally gutted, cut at least 12 percent, $130 billion, to create this whole new program that we call PPACA, or ObamaCare.

Medicare Part D, Madam Speaker, the gentleman from Tennessee is talking about the prescription drug part of Medicare that we did my first year, when I first came here in 2003, the Medicare Modernization and Prescription Drug Act.

Seniors, for many, many years, have wanted to be able to get their prescription drugs covered by Medicare but they couldn't. And of course, when you have to go to the drugstore and get five prescriptions filled, and most of them, brand name, not generic, some generic, maybe, but these brand name drugs are so expensive. And so we finally did this for our seniors.

Now, we spent what--I don't know, maybe $750 billion--creating that program, and we got criticized for it because it wasn't paid for. We didn't offset by cutting spending somewhere else. And I think maybe that criticism, under the current system, is legitimate.

But really, when you think about it, if you scored dynamically, and you realize that if people, seniors, all of a sudden could take their blood pressure medicine and not have to worry about a stroke, could take their diabetes medicine and not have to worry about eventually having renal failure from diabetes or an amputation, in the long run, what I'm saying, Madam Speaker, is this program, Medicare Part D, Medicare Advantage, electronic medical records, if we scored things in the right way, dynamically, at the end of the day, 10 years, 20 years, whatever, we're going to save money because people are not going to have coronary bypass surgery, they're not going to have to have these amputations, they're not going to end up the rest of their lives in a nursing home because they've had a catastrophic stroke that has left them totally incapacitated.

I'm going to yield back to the gentleman from Tennessee to close us out.

Mr. ROE of Tennessee. I have just one quick statement, Dr. Gingrey. And when you brought this up in 2003--and I want to thank you, because I can remember sitting at my desk in my office in 2003 working, and I could take this pen right here, and in about a minute or a minute and a half, I could write two or three prescriptions that might take up a patient's entire monthly income. That was the decision patients were having to have.

And Republicans stepped up to the plate, made a very difficult decision. Like you said, maybe we should have some criticism for not having offsets. But seniors out there today don't have to make that decision about whether I break this pill in half or whether I don't take it today or whether I buy food.

And you ran across that in your practice. I mean, I would look in our area, many widows that I would see would have a $600, $700 a month Social Security check and maybe a $100 or $200 a month pension. And you write three prescriptions, and the first thing they say is, Dr. Roe, it's gone. And you could easily do that. So I want to thank you for your vote.

Mr. GINGREY of Georgia. I thank my colleague.

And Madam Speaker, I thank you, and I thank the leadership of the Republican Party for allowing us to bring this information to our colleagues in a bipartisan way.

We are all about solving these problems. We talked basically about the sustainable growth formula, the way we pay doctors for a volume of care.

Clearly, we're going to have to go to paying for quality of care. We don't have time to get into all the details of that today, but in the next Special Order hour that the Doctors' Caucus leads, we'll get into more details about what we're going to recommend to our committees, to our leadership, to both sides of the aisle in regard to solving this program.

And with that, I yield back the balance of my time.

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