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Doctors Caucus

Floor Speech

Location: Washington, DC


Mr. ROE of Tennessee. I thank the gentleman.

Mr. Speaker, we're going to take the next hour or so, the Doctors Caucus, Dr. Gingrey, myself, Dr. Harris, and we're going to speak about the Affordable Care Act, how we got where we are, the plan to save Medicare, and other health care issues.

I came to this Congress after a 31-year medical practice in Johnson City, Tennessee, just a doctor out each day in east Tennessee taking care of patients; and I made a decision that I didn't like the direction that the country was headed in health care, and I wanted to run for Congress to be here for that reason.

Well, it turned out that two Congresses ago we did have a debate on the health care issue. We have nine physicians in our health care caucus, and not one of us was consulted about that health care bill. Not one of us was brought in the loop and said, What do you think?

Well, we had an extensive debate, I will admit, in the House. This bill was passed on a pure party-line vote in November of 2009; and on Christmas Eve, the Senate passed a bill that had not been vetted, had not been heard in the House, was not debated in the House, a completely different bill. But because of the rules in the Senate, it never got heard here and was not debated fully in the Senate.

That bill was passed, it will soon be, 4 years ago--3 years ago, I mean. We thought that we'd have an opportunity after the Supreme Court looked at this--those challenges were brought to overturn this bill--and we're going to spend the next hour explaining why we don't think it was the right prescription for the health care of the citizens of this country.

I bring an extensive knowledge about a health care reform bill we did in our State of Tennessee. The biggest problem with the health care in this country is not the quality of care. Certainly, we can always do better, and physicians want to do better and have new techniques and new innovative medicines that we use. But the biggest problem with health care in America is the cost of that care. I got to see it every day in my practice, where going to the hospital could bankrupt families if they didn't have proper insurance, it was more expensive to come in, and so the number one driver was cost.

Number two, there's no question we had a group of people who worked every single day of their lives and could not afford health insurance. It was not affordable for them. I would see it in my community where you would have, let's say, a carpenter who would work and during the winter they didn't get to work too much. They would work and maybe make $20,000 or $25,000 a year. Their wife may work at a local diner, maybe, and make $20,000 or $25,000. Together, where we live, they could make $40,000 or $50,000, maybe, in combined income and they could live okay. But they could not afford a thousand dollars a month for health insurance coverage. It was just out of their reach. And thirdly, we had a liability crisis in this country.

So what did the Affordable Care Act actually do? Well, it did increase access. But it increased access mainly, the best I can tell, through a massive expansion of a failed system called Medicaid. The Medicaid system right now in this country is broken and needs to be reformed. We did not reform it with this bill. So that's one thing it did.

Two, it did not touch liability. And we can go into that a little bit later. But the liability crisis still exists. My State of Tennessee has done something, as has the States of Texas and California. Other States have been successful in liability reform. And that has helped. But the President was here Tuesday night. We were all sitting in this Chamber. And amazingly, in the seat right below you here on the dais, the President said with a straight face that his bill, his Affordable Care Act, so-called ObamaCare, had lowered costs. I was astonished by that because it clearly has not done that at all. And let me just go through a few things.

I serve as the chairman of the Health, Employment, Labor and Pension Subcommittee in the Education and Workforce Committee. So if you have a private health insurance plan, that issue, that plan will come through my subcommittee. Let me just go over a couple of things that we found. We've had numerous hearings over the past 3 years about this. And this is recent data right here. President Obama's health care law will push about 7 million people out of their job-based insurance coverage, nearly twice the current estimate. That was just in the last week or two, that estimate, according to guess who? The Congressional Budget Office. Not Phil Roe and not some Congressman. But the CBO believes that. So twice what they thought it would do.

Spending on health care is up. And we estimate it's as much as $4,500 per family since this bill has come into play. That is not pushing the cost of health care down. So we see that. And one of the things that this bill did, I think which was good and bad, Mr. Speaker, is we allowed millions of young people under the age of 26 to be on their parents' health care plan. That sounded like a good idea. And if you have a mom and dad that paid for that, it probably is a good idea if they pay for. I know one of the great points of my life were when my three children got out on their own and paid their own health insurance. That was the biggest raise I probably ever got, them getting out of college and paying their own health insurance.

But what happened was, the way the bill was written, actuaries can no longer charge the actual cost of that care. Let me give you an example. If a person my age is out buying an individual policy, it will cost about six times what a young person under 26 pays because actuarially I'm much more likely to need health insurance or need my health care plan. This bill only allows a 3-to-1. So that means a young person is going to pay two to three times, that person out there paying for that health insurance coverage, than they otherwise would have.

I've had a good friend of mine who's in the health insurance market at home, and for all three of my children I bought them individual plans, and I specifically remember exactly how much I wrote the check for. He said, Dr. Roe, I was having these plans for about $100 a month, just a basic health care plan. Some less than that, depending on risk. Immediately after that bill passed, those rates tripled--they were $280 a month. All of a sudden now, if you're an individual, that isn't affordable. Most people don't have an extra $200 or $300 right now in a tight economy to do that. So we've made it less affordable for a lot of young people. More accessible but less affordable.

I'd like to introduce my colleague and cochair of the Doctors Caucus and fellow OB/GYN physician from Georgia, my good friend, Dr. Phil Gingrey.


Mr. ROE of Tennessee. I thank the gentleman for yielding. Just to carry on with what Dr. Gingrey and Dr. Harris have brought up, let me share with you about affordability. When Dr. Harris was talking about young people, it's obvious that the President--I don't know who writes the check for health insurance in his home, but he hasn't looked at the check, whoever is writing it, if he hasn't figured out that costs have gone up.

Dr. Harris, I may be a little more than a generation past where you are, but when I left, when I quit operating and doing obstetrics, I had an 8 percent primary c-section rate. You've seen that. And why did that happen? When I came back from the Army to Memphis, I trained at the University of Tennessee in Memphis. I had 2 years of training, and then I had to go in the military for 2 years and came back and finished my training. All the malpractice carriers left the State of Tennessee. In 1975, they all left. So the doctors and the Tennessee Medical Association set up an organization called the State Volunteer Mutual Insurance Company. This insurance company was a mutual company, so money that we didn't pay in came back to us at the end of a year. It wasn't owned by some stock-traded company. Strictly, it was just to give us malpractice liability insurance coverage, which I've kept until this day.

In the entire time that that company has been in existence, over half the malpractice premium dollars have not gone to injured people. They've gone to lawyers, both plaintiff and defense lawyers. What a terrible system that is; to try to compensate someone who has actually been injured, we have no way to do it. Less than 40 cents on the dollar that we paid in for 35 years has actually gone to people who have been hurt. That's a terrible system. We need a better system.

As Dr. Harris pointed out, when I started my practice, my malpractice premiums were $3,000 a year. Five years ago, when I left, a young physician who replaced me was paying $7,400. And guess what? The patients didn't get better quality and better access. They just got higher costs. So that's why we need to address that issue. I think you're spot on, Dr. Harris. I yield to the gentleman from Maryland.


Mr. ROE of Tennessee. I think we all could stand here for hours talking about--I certainly could--the innovative new devices that I've used through laparoscopy that have helped patients shorten their length of stay, shorten their pain. I hope we don't go into the Middle Ages of health care in technology because we could spend literally hours talking about what we've seen. We're the place in the world that people come for this.

Before I go back to costs, the estimates are that this device tax will cost 43,000 jobs. The fear is that we'll start producing these offshore and lose jobs in this country. That makes no sense whatsoever. Actually, it was Dr. Milton Friedman who said:

If you want more of something, subsidize it; if you want less, tax it.

That's a fairly simple concept.

Back to the initial problem we have in health care, which is cost. Let me just go over a couple of things, and not just behavioral things. In a recent Gallup survey, the top concern cited by small business owners was rising health care costs. Remember, the President stood right here--and I listened to the debate and so did Dr. Gingrey--for hours on end about how this was going to lower the average person's health care insurance premium by $2,500 a year. Remember that? You remember that, Dr. Gingrey. I heard it over and over right in this well and right at this dais. Guess what? Exactly the opposite happened, which is exactly what we predicted would happen. It did not bend the cost curve down, and it's making it less successful and affordable for people.

Anyway, on with this Gallup survey. So three-fourths, 74 percent, of respondents reported that rising health care costs were hurting their businesses; and 61 percent of small business owners, who are not hiring, point to worries about potential costs of health care as a reason for why they're not hiring. That ought to be a clear signal to everyone here that we need to deal with costs.

What I should have stated at the outset of this hour is what we do not need to do. Health care decisions should be made between physicians, the family, and that patient. That's who should be making them. It should not be insurance companies and certainly not some bureaucrat here in Washington or some policy wonk up here that thinks they know what's best, as Dr. Harris just pointed out what is best for that patient. He saw and he knows what's best because that's what he's done for the last 30 years.

I think our cost issue is clearly what we're not dealing with with this care. Are there good things in this bill? Sure. There are things in here that I like in the Affordable Health Care Act, and we can talk about that.

Dr. Gingrey, I would like to yield to you at this point.


Mr. ROE of Tennessee. I thank the gentleman.

I do want to say to the American people that 47 million people, including Dr. Gingrey and I, are on Medicare.

We made a solemn promise to our seniors in 1965. When that program came out, it was a $3 billion program. Why was it put in place? Because many people retired from their business at that point in time, they no longer worked, and they had no access to care. Again, lack of access to affordable health insurance.

It was a $3 billion program. There was no Congressional Budget Office at that time, but the estimators here in Washington said we believe in 25 years this will be a $12 billion program and maybe even balloon to $15 billion. The actual number in 1990 was $110 billion. Today, in 2013, it's going to be over $550 billion.

Now, we've made a solemn promise to people who paid premiums--2.9 percent of their income, basically. The employer pays 1.45, and they pay 1.45. Of all the income you make, all of your paycheck goes to that.

One of the things that we've discovered and found out is that we pay in, as I have--as the average person does--about $117,000 or $118,000 over a lifetime, a family does, but they get out over $300,000 in services. So we know we can't pay $100,000 in and get three times that much service out. What are the reasons? It's the same issue with Social Security. We have fewer and fewer people paying in and people living longer and longer and longer. By the way, each day in this country, over 10,000 baby boomers hit age 65. That's 3.5 million people a year who are getting to be about 65 years of age.

You have to laugh at the lingo up here, when ``savings'' means that you take money out of something and when an ``investment'' means you spend it into something. So you have to learn the language up here to understand what people are talking about.

About $700 billion was taken out of the Medicare program--savings--and we've got 3.5 million more people being added every year. Well, you do the math. How they were going to control this cost was with a little plan called the Independent Payment Advisory Board. What that is is a board of 15 unelected bureaucrats who are appointed by the President and confirmed by the Senate. Here is a little tricky part of the legislation. The President is supposed to be appointing these people this year. If they are not appointed to that board, one person--one--the Director of HHS, Kathleen Sebelius, has the power to enact all this. We have given that bureaucratic power to one person if those members and that board are not confirmed. Most people don't know that.

I've heard all the pros about how wonderful this is. I go back to my scholarly journals, and I want to refer people to the New England Journal of Medicine. An attorney in the New England Journal of Medicine, Timothy Stoltzfus, wrote an article in June of 2011, not pro or con, but just about the Independent Payment Advisory Board.

In addition, my friend Dr. Gingrey just said--and he is absolutely correct--that Congress changed this payment to doctors, the so-called SGR--the sustainable growth rate--so that patients would maintain their access to their doctors. We've had a retrospective look at the last 25 years. Let's say we fix SGR, like we're talking about, so that patients maintain their access. In a retrospective look in his report, the CMS actuary questioned--this is not me saying this--whether this goal is achievable to maintain these cuts, noting that the IPAB-targeted growth rates would have been met in only 4 of the last 25 years and would have approximated the sustainable growth rate, meaning that a cut would happen. We have almost no power to change this.

Now, here is what I found interesting. In the bill, it's absolutely correct that you can't ration care, that you can't do any of those things. That's maybe true, but if patients don't have access to their doctors, you, in effect, have rationed care. It's that simple.

This is what Peter Orszag said, the former Office of Management and Budget Director here in the Obama White House:

The IPAB is the single biggest yielding of power to an independent entity since the creation of the Federal Reserve.

That is an astonishing statement when you hear it. That's one of the reasons I'm so passionate about maintaining the decision-making power with patients and with their families and their doctors and not with some bureaucratic board up here and also, certainly, not with the insurance companies. I agree with that.

Another comment that I've seen made:

The Independent Payment Advisory Board puts important health care payment and policy decisions in the hands of an independent body that has far too little accountability.

That's one of the things. You may like it or not, but we in Congress have been able to change these things, and it would require 60 votes in the Senate to do it. Quite frankly, with my good friends on the other side of the building here, you couldn't get 60 Senators hardly to agree whether the Sun came up in the east, so the benchmark is very, very high.

Mr. Speaker, how much time do I have remaining?


Mr. ROE of Tennessee. I want to finish by spending the last little bit of time on Medicare. It is such an important part of our health care system. I want to strengthen this program--and I certainly know the folks on my side of the aisle and, I think, on the other side of the aisle want to--for future generations. We've made a promise to our citizens in this country that when they are at retirement age they'll have at least an affordable health insurance product available to them.

Let me tell you, the funny thing I found out about myself when I turned 65 was, the day before, I had a health insurance plan. It had a prescription drug benefit plan; it had a hospitalization part; it had a part that paid for my physician services. The day I turned 65, I got a part A, a part B, a part C, and a part D I could have. Well, nothing happened except I got 1 day older. Why, when a person turns 65, wouldn't you just have a health insurance plan that offered you those various options in your plan? You should be allowed to pick what's in your best interest and need.

Remember, in the Affordable Care Act, the Federal Government now decides what's an essential benefits package. You don't make that decision with your family and your doctor. A Federal bureaucrat makes that decision--what you must buy, a good or a service that you must purchase.

Some of the facts I've mentioned already about Medicare, and one of the things that we have to do, I think, in Medicare--and I know my colleagues will confirm this--is that, currently, one in 10 physicians is not accepting new Medicare patients. In some areas, it may be as many as three in 10 primary care or as many as half won't. We have a huge shortage of primary care physicians in this country. We know that the hospital insurance trust fund is insolvent. It may run out of money as soon as 2016.

I yield to my colleague, Dr. Harris.


Mr. ROE of Tennessee. I thank the gentleman. He is absolutely spot on. One of the reasons that he ran for Congress and I ran for Congress is to preserve this great program for our seniors out there, and I am absolutely committed to do it.

Let me give a couple of facts before we end up. The actuary of the Medicare program--this is not me, this is the Medicare actuary--said that congressional action will be required to ensure that our seniors have continued access to care. In May 2012, he said it is reasonable to expect that Congress would find it necessary to legislatively override or otherwise modify the reductions in the future to ensure that Medicare beneficiaries continue to have access to Medicare services.

This is not some right-wing Republican, this is the Medicare actuary, and we're not even talking about it. We have heard nothing from the President about how we preserve this great program other than we just keep doing what we're doing. That's not an honest, fair assessment of where we stand today. The sooner we deal with it, the more likely we are to come to a less painful solution to this.

I do want to finish by saying that I appreciate the hour you've shown us, Mr. Speaker. We will continue this very, very important discussion on Medicare in the future, and I yield back the balance of my time.

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