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Doctor's Caucus: Health Care

Floor Speech

Location: Washington, DC


Mr. WENSTRUP. I would like to take a little time to discuss a portion of the Affordable Care Act known as the Independent Payment Advisory Board. As you look at this chart, it's one of the agencies that has been developed here on this chart.

I'd also like to point out on this chart that right down here is the physician, and over here is the patient. It seems to me that all we're really trying to do is get the patient to the physician. It behooves me to be able to explain why we need all this in between when we are just trying to get a patient to the physician. I would also like to point out that I think at the center of our health care in America should be the patient, not the Secretary of Health and Human Services.

But let's talk for a minute about the Independent Payment Advisory Board. Who are they? Who are these people? Well, they're actually 15 unelected bureaucrats appointed by the President. To date, as this law is being enacted, no one has been appointed yet.

What do they do? Well, they limit options. They limit care options. They limit access to care. They drive a wedge between the doctor and the patient, and they're responsible for denials of payment for certain types of treatment. I contend to you that really this is a wedge that we cannot afford if we are to have the best health care in the world, which we have been known to have.

I would like to share with you a little story that I experienced in my 26 years as a doctor, as a surgeon. I had a patient who came in one time, and she explained to me that she's had a problem for 10 years. For 10 years she's had a problem, and she's had multiple treatments. She explained to me what those were. Between cortisone shots and physical therapy, she's had previous X-rays, she had paddings and strappings, different things that might put the painful area to rest and make it better, but none of it got better. They were all acceptable treatments, but for 10 years, they failed.

So I said, Well, your X-ray looks normal. Have you ever had an MRI? She said, No. So I said, I don't want to repeat all the things that have failed. Let's go ahead and get an MRI and take a look inside.

Well, later that afternoon, I get a call from the insurance company where I have to speak to a doctor about ordering this MRI. The doctor says to me, Why are you ordering the MRI? I explained it. And he said, Well, you've only seen her one time, so I'm not going to allow it. I'm not going to allow this to be ordered. I said, Well, maybe I've only seen her one time, Doctor, but you haven't seen her at all. You've never seen her. And I said, And you haven't taken the 10-year history that I have taken, and yet you're going to be deciding the care? I said, How can I get this patient to come and see you? The doctor said, Well, you can't do that. I said, Well, what's your specialty? He said, I'm an emergency room doctor. I said, Okay, fair enough. You would probably, in the emergency room then, refer her to a specialist, which is where she is today, and yet you, in your specialty, are denying this care.

I went back and I explained this to the patient. But not until I said to the doctor, I said, I hope this call is being monitored for quality assurance because I want someone to hear what you said to me today.

I went back to the patient and I said, You need to talk to your person at your work, your H.R. person, explain to them that you are being denied care and have them make a call to the insurance company.

Do you know, the next day we got approval for that MRI. I was able to look inside, find out what was wrong and treat this patient, and within 3 weeks, she was better. But the advice from the person who had never seen the patient was, You can't have that MRI.

This is what we are dealing with today. At least in this situation we had the opportunity to have her work call the insurance company and make a case saying, You need to take care of this patient.

But imagine when it is a government agency. What kind of recourse do you think that we will have between the doctors and our patients? At least in this case it was a doctor. The Independent Payment Advisory Board will not be made up entirely of doctors, and they will not have people on there from every specialty with knowledge about everything that comes across medically.

So do we want a third party deciding who gets care? Frankly, I don't think anyone should have the ability to determine someone's care unless they have looked the patient in the eye, they have looked and they've discussed the options, and the patient and the doctor decide together. This is a dangerous course that we're on in America and in Americans' health care.


Mr. WENSTRUP. Just in closing, I would just like to reiterate the importance of decisions being able to be made between a doctor and a patient, because that's what we expect, and that's what Americans deserve in their health care system.


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