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Public Statements

Doctors' Caucus: Health Care

Floor Speech

Location: Washington, DC

The SPEAKER pro tempore (Mr. Cramer). Under the Speaker's announced policy of January 3, 2013, the gentleman from Tennessee (Mr. Roe) is recognized for 60 minutes as the designee of the majority leader.

Mr. ROE of Tennessee. I thank the Speaker. The hour we are going to spend with our Physicians' Caucus is going to be on health care today. I'm joined by numerous colleagues here on the House floor from the Doctors' Caucus to discuss this extremely important issue.

When I was elected 4 years ago to the House, one of the burning issues at that time was health care reform in this country, and the greatest problem with health care in America was the cost. Certainly I could see it every day. I practiced for 31 years as an obstetrician-gynecologist in Johnson City, Tennessee, a small town in northeast Tennessee. I saw where it was becoming harder and harder and harder for my patients to afford care. The major problem was that.

Number two, we had a problem with access. We had working people out every day. Maybe one was a carpenter, maybe the wife worked at a local store that didn't have health insurance coverage. Together they made a living that was livable in northeast Tennessee, but certainly not enough money to pay $1,000 or $1,500 a month for a health insurance policy.

Thirdly, we have a liability crisis. When I began my practice, I thought about it, I began in 1977. I know this is hard to believe, but we would take care of a woman who was pregnant for 1 year and see her for a 6-week checkup and stay as long with her as we needed to when she was in labor, and that cost was $360. And if you had a Caesarean section, it cost another $100. So it was very affordable. Even young families could come in and make payments and pay for it. The hospital bill was more than that, but it certainly wasn't the exorbitant prices that we see today.

The malpractice premium I first paid, and obstetricians and neurosurgeons and others are very high risk, was about $4,000 a year. Five years ago when I retired from my practice to run for Congress, the malpractice premiums had ballooned to the mid-$70,000s, and the patients didn't get anything more for that. They didn't get better care. They just got a higher bill. It didn't improve the quality of their care. So we can see, number one, cost.

I remember when we had the debate down here. I stood in the well of the House the night we debated that bill, in March of 2010, to vote on it. I was one of the last people to stand down here, and I remember the President's remarks: If you like your health insurance, you can keep it. And your costs are going to go down by $2,500.

Now 3 years later, let's see what the reality is. Many of us here in the Doctors' Caucus brought decades, and I do mean decades. I look around, and I wish each speaker as they step up, would tell how many years they practiced medicine. You'll see the experience that's on the floor today. So what happened was the cost has gone up; it didn't go down. And I'm not even sure after this is all implemented that access is actually going to increase because as we discuss during this hour, you'll see that for some people there's more access, but for others it may be cut off; and I think it was unintended. I don't believe that they wrote a bill to actually do that, to actually cut access. But I think the reality is it's going to happen.


Mr. ROE of Tennessee. It reminds me, Dr. Gingrey, of biochemistry in college. Looks like the Krebs cycle, the sugar cycle. It is incredibly complicated, this bill is, and I think we need to spend more time explaining it to the American people.

And one of the frustrations, Dr. Gingrey, that I've had is that I've read the bill, as you have, as many of us have, probably all of us have in the Doctors Caucus.

I went to a hearing the other day on the Veterans' Affairs Committee on which I serve. We spent 2 hours and 15 minutes explaining the effects of the Affordable Care Act on veterans with Dr. Petzel, who is the medical director of the VA. The IRS, the Treasury Department was represented. And when we walked out of that room, I don't think anybody could explain to you the effects of the Affordable Care Act on our veterans.


Mr. ROE of Tennessee. I thank the gentleman.

Dr. Harris, if you would stay there just a moment so that people understand: How could this possibly happen? How could young people--which I have three children, and I think it's a good idea to keep our under-26-year-olds on. I think there were a lot of things we could have all agreed upon. But the thing that we didn't explain to people is: How did you get this number? Why did that happen?

Well, here's why it happened. Young healthy people are going to be subsidizing people who are not as healthy and older. How does that happen?

Well, this bill does not allow you--when actuaries look at it, they know that I'm six times more risky than someone who is my children's age, who is in their twenties. In other words, I've got six times the actuarial risk that they have. The bill only allows an actuary to charge 3 to 1.

So a healthy young person that's 25--Dr. Harris and I were laughing. Having a son--and I know that he has a fine-looking young son. We know that you insure young boys for stupidity. They're going to go out and trip and fall and jump off things, but illness is not it. So we're taking young healthy men and women, 20 to 25 years of age, sometimes doubling and tripling their costs so that someone else's can be a little less expensive.

Now, what would a young person do if all of a sudden they were going to pay $80 or $90 a month for a basic health insurance policy and now it's $300, or they can pay the first year a $95 fine, a $95 fine and they have guaranteed issuance, they cannot be turned away? There can be no preexisting conditions, so they can get the insurance. So what do you think these smart young people are going to do? They're going to figure it out pretty quickly. They're not going to subsidize that, and they're going to be very upset when they look at their first paycheck and realize what's happened to them.

I yield to Dr. Harris.


Mr. ROE of Tennessee. I thank the gentleman.

And before you leave, Doctor, I want to ask you a question. This is an issue that is very near and dear to my heart. I have a bill, H.R. 351, which is to repeal the Independent Payment Advisory Board. When I read that health care law, this was not in the original version of the House version of the bill. This version came from the Senate version. The House version did not. And Representative Neal from Massachusetts wrote a letter to then-Speaker Pelosi, which I signed in a bipartisan way, to not put this in. It was included in this side.

So to better understand, let me sort of go over just a minute and we'll talk about it in just a little more detail. I know you have another appointment, but there

are 15 people on here, and only one of them may be a doctor. These are health care policy people. Basically, all this board does is to determine how Medicare dollars are spent. There's a preset budget in Medicare, and if you spend more than that, this board is charged to give the Congress, they have to cut. If they don't make different cuts, they have to make the ones that this board--and that's how it's going to affect care.

Guess where the cuts are coming from? They come from providers. And if you keep cutting the providers, you will lessen access. I've seen it happen, and I'll go through that after you leave. But that is exactly what's going to happen. If you don't believe me, simply read a New England Journal of Medicine article in June 2011. This is an article that is not for it or against it. It just analyzed it. It looked at the formula, and they looked back 25 years. In 21 of the 25 previous years, this would have cut providers.

Guess what the Congress has been able to do? The Congress has been able to override those cuts in the SGR, the way doctors are paid through Medicare now, and prevent that loss of access. Without a three-fifths majority in the Senate, we've lost that ability; we've given up our constitutional right for the people to come to us and say that we don't believe this is the way it ought to be going. It is a huge mistake.

I believe in that poster of gibberish down there that you're looking at. It's the single worst thing in there because it will ultimately deny access for our seniors. I believe that in my heart of hearts. I've seen it in Tennessee with our TennCare program, which I'll discuss later.


Mr. ROE of Tennessee. I thank the gentleman.

He pointed out something that's clear from his statement down there--he is and has been a practicing physician--because each of us know this, Mr. Speaker, that health care decisions should be made between a patient, the doctor, and that patient's family. It shouldn't be made by insurance companies. It shouldn't be made by organizations, ACOs, the government, IPABs and so forth.

When you're in need, you see the person, the doctor most capable of taking care of your needs, and you make a decision based upon that between you and that family. We're losing that in this country with the doctor-patient relationship, and it is a very, very, very bad thing to happen.


Mr. ROE of Tennessee. I thank the gentleman for yielding. And let me reminisce before I yield to my friend from Indiana.

As a young medical student in Memphis many, many years ago in the late 1960s, my first pediatric rotation was at St. Jude Children's Hospital, a remarkable place. At that point in time almost 90 percent of children died of their disease. I would go in and start an IV, and Dr. Fleming, I can still remember seeing some of those kids, I knew they wouldn't survive. It was very hard for me emotionally to deal with that.

Fast forward today, almost 90 percent of those children live today. And they are treated at no cost, their families are sent there at no cost. I've had children of patients of mine who have gone to that wonderful place. I hope that we don't end up in a Middle Ages in health care, with device taxes and disincentives for new medications.

You and I both remember, when I graduated from medical school there were five or six anti-hypertensives, three or four of them made you sicker than high blood pressure did. Well, today there is a plethora of wonderful new medications to use for people. There wasn't a day that went by that I went in the operating room that I didn't see somebody that needed surgery for a bleeding ulcer--almost every day. It's unheard of now because of new medications.

I just found out today, in my own State of Tennessee--and I did not know this--the largest thing that we export in the State of Tennessee is, guess what? Medical devices. It will hurt my State dramatically in jobs, as you clearly point out--and I know, Dr. Bucshon, in Indiana you're very concerned about that.

You mentioned the IPAB. If the President right yet has not appointed anyone and no one is approved, or they don't have a quorum, they don't have at least eight people confirmed by the Senate, guess who makes all those decisions at the IPAB? One person. That's the Secretary. That's who makes all the decisions. Not the Congress. We have given up, this body--even though it may look funny down here with us debating and contentious, that's what we're elected to do. We are turning over that power--could be--to one single individual. It's Secretary Sebelius right now; there will be a different name 4 years from now. I don't want that person, be it Republican or Democrat--that power should be here.

I yield to the gentleman.


Mr. ROE of Tennessee. Here is what absolutely amazes me about--and I'm glad Senator Baucus mentioned this as a train wreck. I wrote an editorial about it 3 1/2 years ago describing the train wreck of TennCare. But that's not what I want to talk about.

What I want to talk about, Dr. Bucshon, is we have people right now today, for instance, in Medicaid, a system that what did we do? We expanded a system that was already broken.

If you look at surgical outcomes for Medicaid patients, they're worse. The outcome is a huge study--eight hundred and something thousand patients--done by the University of Virginia. Those outcomes were worse than people who did not have health insurance coverage.

Why would you expand a program that's already broken? Why don't we fix that first? I know Dr. Fleming has talked about this at length.


Mr. ROE of Tennessee. I just spoke to a physician today from Massachusetts. He said what had happened there, and what's not clearly understood by the public--unless you're in this line of work you don't--is how the payers pay.

Medicaid, for instance, pays about 60 percent of the cost of actually providing the care. Let's say private insurance is a 1. Medicare would pay about 90 percent.

The people they added in Massachusetts paid about the same as Medicaid. What happened was big insurers, big corporations with lots of employees could negotiate a really good price, but small business could not. So when the hospital had bills to pay, they shifted those costs to private business, forcing their premiums up and up and up and up. That's why you are seeing those premiums for small business escalate until you really force them out of business.

We talk about the exchange, and what absolutely frustrates me is that, on the 1st of October--and this is a person who works in Congress, who is a doctor who understands health care--I can't even tell the people who work for me here in the Washington office and in my office back in the district in Tennessee what their health care premiums are going to be or how they're going to get their health insurance coverage, and that is 90 days from now I can't tell them. You can imagine what other businesses are going through. I can tell them this: that I bet it's going to cost them a lot more money.


Mr. ROE of Tennessee. I thank the gentleman.

It is ultimately about the patients that we take care of. Really, it's not about systems and organizations and insurance--it's about people. That's the frustrating part to me because I think people are going to be harmed by this.

I know Dr. Fleming mentioned small business. I was in North Carolina last Tuesday, a week ago today, holding a hearing, which I hope we have time to go through maybe a little later, on small businesses and how this is going to affect them. It's really eye opening to see businesses that have done everything exactly right. Mr. Horn is someone I want to talk about in just a minute who provided health insurance--all preventative services. He is self-insured. He did everything right. It shouldn't have cost him a nickel, and yet it is going to cost his business thousands of dollars. So we'll go into that.

At this point, I want to yield some time to my good friend G.T. THOMPSON from Pennsylvania, who is part of our Health Care Caucus and who is a health care administrator.


Mr. ROE of Tennessee. I thank the gentleman.

As we finish, I want to go over just a couple of things. One of the things the Secretary stated, Dr. Fleming and Mr. Thompson, is that she needed to use some money, and the prevention fund was one of the things she was going to use to help implement the exchanges. We've now had prevention funds used for massage therapy, kickboxing, kayaking, Zumba and pickleball. I didn't know what pickleball was. But that's tennis, badminton and ping pong. I can go on and on. It's utterly ridiculous. It should have been spent on health care. That's what this bill was supposed to be about.

Let me finish by saying that even with this 1 hour here, we have lots more to talk about. We've barely scratched the surface. It's a complicated issue. Democrats and Republicans should have gotten together in a bipartisan way to work out a health care plan that does the principles that were pointed out here today, which is to increase access and quality, lower costs and to leave health care decisions in the hands of doctors, patients and those patients' families.

With that, I yield back the balance of my time.

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