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Public Statements


Location: Washington, DC

MEDICARE -- (House of Representatives - April 05, 2005)

Mr. JINDAL. Mr. Speaker, we come together in this body to talk about a very important topic, our Nation's Medicare program. Medicare has served our country's seniors well.

However, this is a program that is in serious need of strengthening and improvement.

I was privileged to serve as the executive director of the National Bipartisan Commission on the Future of Medicare. We spent an entire year looking at the Nation's Medicare program, and we heard from dozens of witnesses. We had countless hearings. I can summarize the challenges facing the program in three ways.

First, we have a Medicare program by any measure that is facing a huge financial challenge, a program that is going to go bankrupt, quite frankly, unless we do something differently.

We can measure that as a share of the GDP, we can look at the ratio of workers to retirees, we can look at that as a share of payroll taxes, or we can look at the life of the trust funds. Quite simply, we have got a Medicare program today that goes from about four workers per retiree, it is going to eventually be at about two workers per retiree, a trust fund that will not last even long enough for the baby boomers to not only finish retiring, but to finish utilizing their health care services.

So the first challenge facing the Medicare program is increasingly we have got a program that is facing solvency challenges. Secondly, we have got a program that, as it is defined today, does not truly cover adequately the health care needs of our Nation's seniors, our parents, our grandparents. We have got a program that covers about half the health care costs of our parents and grandparents. We have got a program that until next year does not really even begin to cover prescription drugs, does not provide an adequate long-term care benefit; a program that charges over a $800 deductible every episode, every time our parents go to the hospital; a program that until recently did not cover many preventive care benefits and still lags behind the private sector in terms of what is considered first-class medical care; a program that has no real meaningful catastrophic stop loss coverage; in other words, a program that looks largely like the 1960s insurance product it was modeled after. In the private insurance world, we no longer get our physician insurance separate from our hospital coverage. Yet that is exactly what Medicare continues to do today.

So the second challenge facing our program is that it is a program that does not adequately cover the health care needs, does not adequately provide a modern benefits package for our Nation's seniors. We can see that by the fact that 89 percent of our Nation's seniors have something other than just plain Medicare fee-for-service alone.

Eighty-nine percent have either some kind of wraparound coverage, supplemental coverage, Medicaid, private HMO coverage, have something in addition to just plain old vanilla Medicare fee-for-service coverage.

The third challenge facing our program is it is a program that has not been run all that efficiently. You can look at that by comparing Medicare's growth rates to the private insurance world, to the other Federal programs that we run, by looking at the billions of dollars, not millions but billions of dollars, we waste every year.

We all have our favorite stories. I know my colleagues have heard from their constituents, and we have heard, about the equipment that Medicare will rent but not purchase even when it would be more cost-effective to buy it. We have heard about the times that Medicare would pay for a patient to go to a physician's office to receive an injectable medication, but would not pay for that same patient to receive those drugs orally. We have heard about Medicare not paying for preventive care, not paying for more cost-effective outpatient-based care. Year after year Congress tries to put a Band-Aid and tries to improve the program and tries to catch up with the latest medical technology, but inevitably we are always a little bit behind what people are getting below the age of 65.

So we have got three challenges being faced by our Medicare program: First, a program that, by any account, faces severe financial challenges; secondly, a program that does not adequately cover the benefits that our seniors deserve and need; and then finally, third, a program that is not all that efficient compared to other programs.

The good news in all of this is that Medicare has done a remarkably good job taking care of our parents and grandparents. We do not need to throw the Medicare program out. Rather, we need to improve it, strengthen it, and get it ready for this next century, get it ready for the baby boomers that are beginning to enter this program.

How do we do that? I would like my colleagues to remember just two numbers that came up during the Commission's deliberations and just two numbers that stand out to me in all the hours of testimony that I listened to. The first number is this: The CEO of the Mayo Clinic testified to our Commission. He said, We count 130,000 pages of rules and regulations. There has been some dispute. Everybody agrees there are tens of thousands of pages of rules and regulations. It does not really matter if you believe it is 130,000, or whether you believe it is Ð20-, 30-, 40,000. The bottom line is this: Tens of thousands of pages of rules and regulations telling the Mayo Clinic, telling physicians, telling hospitals how they must provide care.

I do not know about you, but to me this debate really comes down to who do we want in control of our health care. I would much rather my physician, my health care provider, working with me to make those decisions. No matter how well-intentioned, I do not want a bureaucrat making my health care decisions for me.

The American Hospital Association talks about the fact they have documented nurses in many hospital settings spend an hour filling out paperwork for every hour they provide care. At the same time, we have a shortage in this country of about 100,000 nursing vacancies, 100,000 vacancies we cannot fill today, and that number is only going to increase, and we are drowning our health care professionals in paperwork.

The second number I ask this body to remember is that we heard from an economist testifying to our Commission basically in the Medicare program that we are trying to set 10,000 prices across 3,000 counties. We call them parishes in my home State of Louisiana. But the bottom line is this: 10,000 prices in 3,000 counties. We do not buy anything else in the Federal Government that way. It makes no sense that that is how we buy medical services. The problem is sometimes we will be too high, and sometimes we will be too low. We heard so many stories about how this distorts the quality of medical care that our parents receive. This distorts their access to services.

We have all heard the complaints from physicians about the inequities of the sustainable growth rate reductions they are going to face. We heard about physicians leaving the Medicare practice. We have heard the stories of patients, we heard it in the Medicare Commission, about patients going to the hospital. We had a patient that told us a doctor wanted to perform a procedure on him. He was in the emergency room thinking he was about to die of a heart attack. Once the physician found out he was in Medicare, the physician said, I don't need to do that service anymore. It turns out Medicare would not pay for that procedure. Not only that, Medicare would not let him pay for that procedure or his private insurance pay for that procedure. I think most of us, if we were in the emergency room, would not want a bureaucrat to make that decision. We would want our physician to make that decision.

That really is the question facing us when it comes to the future of Medicare: Who do we want making our health care decisions? Do we want our physicians working with us, or do we want bureaucrats? It is as simple as that.

The Federal Government runs a different health care program. We run a health care program that has over 300 plans competing to provide coverage. We run a health care program that has had lower inflation rates; a health care program with incredible approval ratings, over 85, 90 percent approval ratings; a health care plan that does provide adequate prescription drugs, is not going insolvent. It is a very simple plan. Members of Congress are allowed to participate. Federal employees, the very employees that design and operate Medicare, are allowed to participate. The simple concept behind the Federal employees' plan is this: We give people choice. The Federal Government pays the majority of the premiums. If somebody wants to buy a little more expensive plan, they pay a little bit more. If they want to buy a more efficient plan, their premiums go down.

We tried this in Medicare some years ago, except Congress said private plans were not allowed to reduce their cost below the government plan. That makes no sense. If a private plan is more cost-effective, of course they should be allowed to lower their prices. Why in the world would we not want our parents and our grandparents to be able to lower their premiums? Fortunately we fixed that, but we have got a lot more fixing to do.

I was pleased today to learn from CMS, I know many of us were, that our seniors, over 90 percent of Medicare beneficiaries next year may have more choices of how they get their health care, may actually have a choice of how they get their health care plans. For those that want to stay in Medicare, they can continue to do that. Nothing has changed. But the good news is more and more of our parents and grandparents are getting more choices.

I know my time is running out, and we are limited in our time tonight, but I think if we remember one thing about the Medicare debate, it is simply this: We must give our parents, we must give our grandparents more choices.

We had a bipartisan Medicare Commission that was chaired by the gentleman from California (Mr. Thomas) of this body, cochaired by former Senator Breaux of my home State of Louisiana. We came up with good bipartisan findings contained in the cochairman's report. The bottom line is this:

If you remember nothing else but all the numbers and all the facts and all the details, Medicare has done a good job. To make sure it continues to do a good job for our parents and grandparents, let us not be scared of giving them the kind of choices they had before they became the age of 65. If we do that simple thing, not only will it be good for them, it will help us balance our budget, and it will slow down that growth by getting rid of some of those inefficiencies.


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