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[Congressional Record Volume 158, Number 122 (Wednesday, September 12, 2012)]
[House]
[Pages H5913-H5917]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                           GOP DOCTORS CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from Michigan (Mr. Benishek) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. BENISHEK. Mr. Speaker, as many of you may know, before coming to 
Congress, I was a physician in northern Michigan for nearly 30 years, 
and tonight I want to spend a little time talking to you about 
Medicare, the President's health care bill, and just health care in 
general.
  In practice, many of my patients were on Medicare, and I know how 
important medical care is to our seniors. It's an important part of 
their ability to take care of themselves as they get older. Really, the 
reason I'm here today is to explain that the GOP and the Republicans 
want to preserve Medicare for our current seniors and for the youth 
that are coming up because right now the way Medicare is organized, the 
trust fund will be out of money within 10 to 12 years. Different 
accountants have different numbers. But basically, unless we do 
something, we're going to run out of money. We just don't want that to 
happen. I want to see people still have access to their care.
  In discussing this issue, it seems as if we've been attacked for 
trying to end Medicare. But if you see that there's a problem with a 
system that is running out of money and you don't want to address it, 
that's just not right.
  The Doctors Caucus in the House is 18 physicians, nurses, and 
dentists that represent different areas of the country, and we have a 
good understanding of health care as it exists right now in America. 
Certainly, there are problems with health care and access to it. And 
although we have great health care in America, the problem is it's too 
expensive. Frankly, the President's health care bill makes it more 
difficult to keep Medicare viable. Those are a few of the things I want 
to talk to you about this evening, just touch on to let you understand 
what I think about how the system is working and how we can improve it.
  I don't think it's a partisan issue. I think it's something that we 
need to discuss. Frankly, I just don't think that some of the people 
that have passed these laws in Congress really understood what they 
were doing. They admitted the fact that they passed the bill without 
really knowing what was in it. I just don't think that's really a good 
idea.
  What is really the problem with Medicare? The problem is that the 
population of our country is changing. There are more older citizens 
than there were; in other words, there are 10,000 new Medicare 
beneficiaries being added each day. Right now, a little over three 
people are paying into the system for every person that is collecting. 
Because of the large numbers of people that are being added to the 
roles, within a few years there are only going to be two people paying 
in for each person collecting. That creates a problem in the fact that 
there are not as many people paying in as are receiving benefits. With 
the cost of health care going up, it makes it a fiscal cliff.
  The other big problem that we see with the Medicare situation is the 
fact that the President's health care law, in order to pay for it, 
takes $700 billion out of Medicare. That's a lot of money to take out 
of Medicare and still expect it to provide care for our seniors, more 
and more of which are coming on to it every day. I think that there is 
certainly some waste, fraud, and abuse that can be eliminated, and that 
will help, but it's just not enough. We have to change the system.
  The system that I think we should change to, frankly, is the system 
of Paul Ryan and Mr. Wyden of Oregon, who brought together a program 
where we can put some changes in for those people under 55 that will 
allow them to choose between different private insurance plans similar 
to what Federal employees and Members of Congress have. These private 
plans would be inspected and reviewed by the government to be sure that 
they're adequate and give people some flexibility in how they spend 
their money.
  One of the problems I see with Medicare is that the government ends 
up deciding how to spend the money rather than the patient. The 
patient, to me, is the one whose money it is. The people who are 
spending the money should be the ones who are deciding how it's spent, 
not some government person or bureaucrat in Washington.
  Show me the slide on the $700 billion. I just want to show people the 
slide that demonstrates what's happened to this money. I represent the 
northern half of Michigan. We have many small towns and small hospitals 
in my district. Every little town has their community hospital, and 
it's hours sometimes to the next facility.

                              {time}  1820

  This slide here shows the $716 billion coming out of the Medicare 
program, and $294 billion of that money is payments to hospitals. The 
President describes the Medicare cuts as cutting waste and overpayments 
to providers.

[[Page H5914]]

Well, these hospitals are the ones that are providing the care; and as 
a doctor, I'd be a provider as well.
  But when you cut $294 billion from our local hospitals, I know, I 
served on the board of a hospital. Our hospitals are operating at a 
razor-thin profit margin. They have to stay in the black, otherwise 
they go out of business. They can't make their payroll. We've recently 
had a hospital in our district go bankrupt because of their problems 
with payments from Medicare.
  This is going to continue to happen as we go forward if we allow this 
President's health care bill to continue with $156 billion cut from 
Medicare Advantage, $111 billion to be cut by IPAB and other 
provisions, $66 billion cut from home health care agencies, $39 billion 
cut from skilled nursing, $33 billion from FFS Medicare providers and 
$17 billion from hospice care.
  These are crucial programs for our seniors. With more and more 
seniors coming into the program, how are they going to be provided care 
with less money? I don't see it happening.
  What's going to happen is there are going to be fewer hospitals, 
fewer places for patients to get care, so it's going to be difficult; 
and in my district we may have to travel hundreds of miles to get seen. 
I think it's pretty darn scary, to tell you the truth.
  Dr. Harris, another member of the Doctors Caucus, is here with us 
tonight. He's from Maryland, and he's an anesthesiologist.
  Mr. HARRIS. Will the gentleman yield?
  Mr. BENISHEK. I yield to the gentleman from Maryland.
  Mr. HARRIS. On those lists of questions of those $716 billion that's 
basically going to be transferred from the Medicare program to pay for 
the President's new health care reform bill, that doesn't even include 
the over $300 billion to cuts in physician and provider payments over 
the next 10 years under the payment form; is that correct?
  Mr. BENISHEK. That's right.
  Mr. HARRIS. So it's in addition to that $700 billion. There's another 
$300 billion that's going to get cut from payments to providers. Here's 
the problem. You know, I think the gentleman from Michigan points it 
out.
  Medicare is going broke, and it's going broke not only because $700 
billion was taken out of it to pay for the President's Affordable Care 
Act, but another $300 billion is going to be taken out in the physician 
payment formula.
  Now, the CMS actuaries, and that's the department that runs Medicare 
and Medicaid, actually projects that the Medicare program could be 
bankrupt as soon as 2016. Four years from now, the Medicare program 
could be bankrupt.
  Now, I'm glad that as part of November's elections we're going to 
discuss the future of health care for our seniors, because it is time 
to say that the emperor has no clothes. Our seniors know it.
  They know that when, God forbid, their physician retires, and they go 
and try to find another physician, and they're on Medicare, they 
already know how hard it is to find a physician who can accept them 
because the reimbursements are already so low.
  The payments to physicians are so low already, it's hard to find that 
primary care doctor. It's hard to find that specialist who needs to 
take care of you, whether it's for your blood pressure or your diabetes 
or whatever problem you have; and the problem is only going to get 
worse.
  Now, the President in his budget doesn't deal with it at all. He 
pretends that Medicare will go on forever and ever just the way it is 
now. That's just not true.
  The Centers for Medicare & Medicaid say it could go broke in as 
little as 4 years. The Medicare actuaries give it the longest lifetime, 
10 more years.
  Well, Mr. Speaker, if you're 55 now, that means by the time you're 
65, it's broke. If you're 61, according to the Centers for Medicare, 
it's broke by the time you reach age 65. And if you're on it now and 
you're 70, it could be broke by the time you're 74.
  So we have to stop pretending that the Medicare program is going to 
work forever the way it is now. It won't, because the President took 
$700 billion from it to pay for the Affordable Care Act. There is a 
scheduled cut to physician payments and to provider payments of over 
$300 billion over the next 10 years, and our seniors are already having 
problems finding those physicians.
  But in the Medicare costs, if we don't do anything right now, we 
don't deal with the program and adjust it for people who are younger--
and I have a son who is 27 years old. He is an accountant. He knows 
numbers, and he knows them backwards and forwards and up and down, 
better at math than I ever was. He's convinced he will never see a 
Medicare program because he's seen the books.

  Medicare payments are projected to grow substantially from 
approximately 3.5 percent of our economy to 5.5 percent of our economy 
by 2035, and the President has no plan to pay for that growth. We know 
because of the maturing and retiring of the baby boom generation that 
this is coming.
  This is predictable. We can project this. We know that if we don't 
change the Medicare program to preserve it for future generations and 
to keep it for the current generation of Medicare recipients, it goes 
broke. As I mentioned, the physician payment formula in Medicare needs 
to be fixed or, starting January 1, payments to physicians and 
providers may go down 30 percent.
  Now, Mr. Speaker, if our seniors think it's hard to find someone to 
take care of them now on Medicare, what do they think it's going to be 
like when the government says to those physicians, we're going to pay 
you 30 percent less starting January 1, and this is all scheduled to 
happen.
  The President has no plan. The President suggested no ideas to 
Congress on how to deal with that. What we need is leadership on health 
care, and we're not getting it from the other end of Pennsylvania 
Avenue.
  Already access is an issue because back in 2008, 12 percent of 
physicians have said they have to stop seeing Medicare patients. We 
know now that a much larger number limit the number of Medicare 
patients they care for.
  As the gentleman from Michigan knows, we didn't go to medical school 
to not take care of patients. We didn't go to medical school to have 
our staff answer a senior calling to say, I'm sorry, but we can't 
afford to take care of you. But that's exactly the position that the 
President's plan for Medicare is putting physicians and patients in 
right now. That's the sad fact.
  This emperor has no clothes. The Medicare program is on a path to 
bankruptcy, and there is no plan from the White House to solve that 
problem. It merely kicks the can down the road.
  We have heard a lot in the last few days and few weeks about Simpson-
Bowles coming to the rescue. That's going to solve our fiscal problems; 
if we just adopt the Simpson-Bowles Commission, all our fiscal problems 
go away.
  Mr. Speaker, as you probably know, Simpson-Bowles decided not to do 
anything about Social Security and Medicare.
  Now, Social Security, it turns out, is pretty solvent. It's going to 
be there for at least another 20 years, giving us a fair amount of time 
to solve the problem for future generations. But, again, the Centers 
for Medicare says we may only have 4 years to solve the Medicare 
problem before it goes bankrupt.
  If our seniors right now think they have problems now getting their 
health care and finding those primary care doctors and those 
specialists to take care of them, imagine when the program goes 
bankrupt.
  Now, we have a choice. We can deal with it, or we can kick the can 
down the road. I'm proud of the Vice Presidential candidate, one of our 
colleagues, Mr. Ryan, who has decided that the time to kick the can 
down the road is over. It's time to tell our seniors and Americans what 
they suspect.

                              {time}  1830

  We've been making promises we have no way of keeping. We have been 
spending money we don't have. And it has to stop. And as the gentleman 
from Michigan knows, we have some principles in our plan to deal with 
the bankruptcy of Medicare because, Mr. Speaker, it's not a question of 
if, it's only a question of when.
  So there are a couple of principles. The first principle is: we don't 
change it for anyone over age 55. If you're in retirement or you're 
near retirement, you get to keep the very same program right now. But 
we deal with the fact that physician and provider pay would

[[Page H5915]]

be cut January 1. We solve that problem. We say you can't do that. That 
will limit access. So we deal with that issue. We say you have to stop 
taking $700 billion from the program to transfer it to pay for the new 
President's health care reform; to cover Americans who don't have 
insurance now by taking it from Medicare patients who do have 
insurance.
  So the first principle, no one over age 55 is affected. The second 
principle is: for those under age 55, Mr. Speaker, if they're listening 
now, the program is going to be bankrupt when you reach age 65 if we 
don't do something. We're going to make some commonsense adjustments. 
We're going to say that you should have access to the same kind of care 
Congressmen and -women have--a broad range of health care plans you can 
choose from with the guarantee that for at least two of those plans you 
will have 100 percent coverage.
  We all turn on the TV. We hear the ads: Mr. Ryan's plan will cost 
$120,000 for every senior, or $200,000 in more costs. Here's the 
problem. People who made the ads didn't read the bill. The bill spells 
it out quite clearly. Our plan is that seniors--again, people age 55, 
when they reach age 65--will have a choice of plans just like we have 
here in Congress. The only difference is we have to pay a part of all 
our plans. They don't pay for the two lowest-priced plans. If they 
choose a plan with more options, they may pay something. But they will 
end up paying even less than they do now.
  That's our solution. Let market forces come in and control the cost 
of health care, control that growth in cost, and allow real coverage 
for our seniors, for our people age 55, when they reach age 65, and 
preserve it for future generations so that my son, the accountant, can 
look at that plan and say, You know what? This balances. You don't have 
to borrow money from the Chinese to pay for this plan. We don't have to 
raise taxes to pay for this plan. We actually let market forces work, 
providing the same coverage that people in Congress get. And it will 
work.
  So, Mr. Speaker, I'm very glad that we have the opportunity to talk 
about this tonight. I'm very glad that this November and in the months 
leading up to it we'll have an honest, frank discussion with the 
American people about the future of health care, the future of health 
care for our seniors, preserving it, and the future of health care for 
everyone else under the President's affordable care scheme. Because we 
know there are problems with it. Americans understand that when you put 
the government in charge of something so vital and personal as health 
care, real problems can occur. And as the gentleman from Michigan has 
pointed out, we know those problems. They're predictable problems. A 
majority of Americans have figured it out. Poll after poll after poll 
says we should deal with the President's Health Care Reform Act by 
repealing it and replacing it, keeping elements that are good.
  Every American either has a preexisting condition or will have one in 
their lifetime. Every American. So our plan will have to deal with it. 
And it does deal with it. And for those people who want to have their 
children on their policies up until age 25, our plan can deal with it--
and does deal with it. But we certainly don't need the Independent 
Payment Advisory Board, which the gentleman from Michigan is going to 
discuss, that is going to run health care for Medicare. We certainly 
don't need the Secretary of Health and Human Services prescribe what 
plans are going to cover what for every single American. Whether you 
want it or not, you're paying for it in your plan. Because we know 
that's only going to drive up the cost.

  I'm glad that we're going to have that discussion with the American 
people because, Mr. Speaker, every American's health care is so 
important to them and their family. They deserve this discussion. They 
deserve the chance to go to the ballot box this November and make a 
choice about what their health care is going to look like in the 
future. And we're going to have a clear choice. It's going to be a 
government-run health care plan run by a bureaucrat where costs and 
access are controlled and rationed, or it's going to be one where the 
patient and their physician make the choice about their health care, 
with the government bureaucrat staying out of it, where they belong.
  I thank the gentleman from Michigan for yielding.
  Mr. BENISHEK. Thank you. I truly appreciate my colleague from 
Maryland taking a little time to be with us tonight and give us his 
insight as a physician here on the floor.
  I would like to say a few words about IPAB. This is the Independent 
Payment Advisory Board. This is the mechanism that Mr. Obama's health 
care plan has for controlling costs. And really, what it is, it's 15 
appointed bureaucrats, each making $165,000 a year, with no 
congressional oversight, whose only purpose is to reduce Medicare 
spending. So if the Medicare budget goes up too much and is over the 
limit, these guys in Washington are going to decide what to cut. 
They're going to decide if you deserve a PSA prostate test or deserve a 
mammogram or you deserve a colonoscopy. They're going to decide that 
they may not pay for that. If we don't act, this board could being 
making these kind of decisions as soon as 2015. Denial of payment for 
care is going to really lead to denial of care for our seniors. I don't 
think it's fair for these Washington bureaucrats who know nothing about 
the patient to be making these decisions.
  I'm used to taking care of patients, and sometimes we have to make 
some really difficult decisions. But those decisions have been made 
between the physician, the patient, and the family, not some bureaucrat 
in Washington who doesn't know the patient and can't decide if this 
patient really qualifies for care and should not be denied. So I just 
think it's so wrong to allow bureaucrats that don't know the patient to 
be making these decisions, and I just want to make sure people 
understand the seriousness of this. There's no appeal from this board. 
There's no getting somebody off this board once they're appointed. It's 
really unbelievable.
  Tonight, also, I have the pleasure of being joined by my colleague 
from New York, a nurse, Ms. Buerkle of New York.
  Thank you for joining us.
  Ms. BUERKLE. Thank you very much to my friend and colleague from 
Michigan. Thank you for having this Special Order tonight. And I think 
it's so critical, Mr. Speaker, when the Docs Caucus has this event, and 
the people who are speaking are people are passionate about health 
care. Many of us actually came to Congress because we were so concerned 
regarding the Affordable Care Act. I spent my life as a nurse and later 
on as an attorney who represented a large teaching hospital. And so I 
am passionate about health care. As my colleague before me mentioned, 
there's nothing more personal than one's health care. And this Nation 
has the highest quality of health care, and we want to make sure we 
maintain the standard that we have.
  I don't think anyone would disagree, Mr. Speaker, that this country 
needs health care reform. And while this law may have been the most 
well-intentioned, I disagreed with it philosophically when I decided to 
run for Congress. But now that I'm in Congress and I have had the 
opportunity to talk to so many folks in my district, this law, this 
Affordable Care Act that was supposed to decrease the cost of health 
care and increase access for Americans, is not going to do that. And 
let me, if I could, talk just briefly about what is going on in my 
district.

                              {time}  1840

  My district is heavy with ``eds and meds,'' we call it. We have a lot 
of hospitals in my district, and they're the major employers.
  Now, the hospitals have spoken to me. They're concerned because this 
Affordable Care Act, this ObamaCare law, will decrease the amount of 
disproportionate share moneys they give because they treat a population 
of patients who may not have insurance or who are underinsured. So 
they're concerned about their fiscal, their financial integrity. Those 
are the hospitals. Those are providers.
  The Affordable Care Act doesn't address the SGR fix, the Medicare 
reimbursements for physicians. So I've got physicians who are 
concerned. It also creates a scenario where we will not have enough 
primary care physicians, internal medicine, psychiatry, those types of 
physicians who can even

[[Page H5916]]

render the care. So the providers are concerned, the actual people and 
facilities who render the care. They're concerned that this law is 
going to adversely affect them. That's my first concern.
  My second concern are my seniors. And in all of this discussion and 
debate, I think the most disingenuous discussion that's going on out 
there is the denial as to what this law will do to seniors and their 
Medicare coverage. I think my colleague ahead of me talked about the 
moral obligation we have to our seniors. We have a contract with them 
that when you retire, when you turn 65, Medicare, you've paid into it 
all your life, and you will be able to have that benefit.
  But this law, this Affordable Care Act, cuts Medicare by $716 
billion. Now, there's no program in the world that will not be affected 
by the loss of that much funding and the funding that's being taken out 
of Medicare, and it's going to be used to fund the rest of the 
entitlement in this law.
  So seniors really need to understand the threat to Medicare as we 
know it is this Affordable Care Act. And it has changed Medicare as we 
know it for our seniors, and this law will affect everyone who's on 
Medicare.
  The discussion about the Ryan budget and the budget we passed out of 
the House, that discussion is only for those who are 54 and younger. So 
anyone who is 55 and above, with the Republican proposal for Medicare, 
can take a deep breath and they can say, My contract with this country, 
my benefit through Medicare will not be touched, and I can rely and 
count on that. That's a very important promise that we can make to our 
seniors.
  But this Affordable Care Act can't make that promise to our seniors 
because it is cutting Medicare, and as my colleague from Michigan 
talked about, this IPAB board will also affect the kinds of services 
that our seniors receive.
  So every American, especially our seniors, should be concerned about 
this law that is in place that will go into effect in 2013 and 2014.
  So, we've heard from the hospitals and the physicians. They're not 
happy with this law. We've heard from the seniors. They're not happy 
with this law.
  I hear from my businesses, my small businesses, those entities that 
we're trying to get this economy going, and they're concerned because 
they don't know how this law is going to affect them. They don't know 
whether or not they're going to have to pay the penalty or pay the tax. 
They're very concerned because of the uncertainty this creates in their 
businesses. So, they sit on cash and they don't invest and they don't 
hire. So my small businesses don't like this Affordable Care Act.
  Now, just recently, and we've had a lot of debate about the tax on 
small medical devices that will occur to any small medical device 
producer in the country. Now, that's a niche sort of industry. It's one 
of the only sectors of the economy that has grown. It requires R&D. It 
requires innovation. It requires real creative production of small 
medical devices.
  I have a well-known company right in my district, and on Monday of 
this week, they announced that they will cut 10 percent of their 
workforce directly related to two things. The first is that 2.3 percent 
excise tax on small medical device producers. Ten percent of that 
workforce will be done away with because of this Affordable Care Act. 
The other reason they are cutting their workforce is because of the tax 
and also because of the fact that, with this Affordable Care Act, 
hospitals and physicians are not buying new equipment because they, 
too, are uncertain as to what the Affordable Care Act is going to do to 
them and their business. So they're not buying new equipment for their 
hospitals and their offices.
  So, now we've got seniors, hospitals, physicians, small medical 
device companies, businesses very concerned as to how this law is going 
to affect them.
  The Court ruled that it's a tax, and that's why it's constitutional. 
There's 21 new taxes in this Affordable Care Act. It's going to affect 
our jobs and our economy. It's going to affect our small businesses. 
It's not the right direction for this country. Only the practical 
listening to people over and over again in the district puts that out 
very, very clearly.
  So I think the right thing to do for this Nation--and this House, I'm 
so proud we have voted to repeal this law twice. We also voted in June 
to repeal the tax on small medical devices. That's the right thing to 
do.
  The responsible thing to do is enact true health care reform that 
will really reduce the cost of health care, that will allow patients 
choice, that will allow them to cross State lines to buy their 
insurance. It will allow them to keep their insurance even if they lose 
their job. It will have tort reform in it and bring down the cost of 
health care. It will repeal the excise tax on small medical devices. It 
will keep the good pieces.
  The two things I hear over and over again: preexisting conditions--
and my colleague from Maryland mentioned it. Preexisting conditions, 
along with keeping your child on your plan until they're 26. Those two 
could certainly be incorporated in a new truly reformative health care 
law in this Nation.
  So I thank my colleague from Michigan for all of his good work, for 
his dedication to the health care profession. I'm proud to be a member 
of the Docs Caucus because we are a group of people who have committed 
our life to health care. We are passionate about making sure that the 
United States of America maintains its high quality of health care and 
also keeps costs and accessibility to the highest standard for the 
people who live in this country.

  Mr. BENISHEK. I thank my colleague from New York for joining us this 
evening. I appreciate her insight.
  I just want to say a couple more things about this tax that she 
mentioned on medical device manufacturers.
  You know, in my district as well, we have a couple of companies that 
make the drills for orthopedic surgeons where they put in the screws 
and that sort of thing. This tax is, I think it's a 2.3 percent tax, 
not on their profits, but on their gross. So even a small startup 
company that's trying to innovate, which we have in my district, and 
create a new device that will help people with care, even if they're 
losing money, they have to pay the tax on any gross receipts they have. 
That, to me, is like the most regressive part of that tax.
  Besides that, it's forcing our medical innovators to move their 
companies overseas. I mean, you know, people aren't stupid. They 
realize that if they're going to be taxed here in this country even 
though they're losing money, they're going to move that manufacturing 
capability to Europe, and that's already been happening.
  So this law is taking the medical innovators in this country--and 
everyone knows this country has been leading the way in the world in 
medical innovation for the last hundred years. It's forcing those 
people to go overseas to do business. That's not good for America. 
That's taking highly skilled people and asking them to go somewhere 
else to do business because we have a bad climate for that.
  I want to talk just a little bit longer this evening about some real 
health care reform.
  I mean, as I mentioned, the President's health care bill doesn't fix 
the problem with health care. The problem with health care is it's too 
expensive. This bill doesn't make it less expensive. It's becoming more 
expensive. When Medicare runs out of money, the way they're going to 
fix it is by decreasing payment to the hospitals and doctors that are 
providing you with care, so they're not going to want to take care of 
you either.
  So let me just talk a little bit about a couple of, I don't know, 
commonsense ideas that we're talking about on this side of the aisle.
  The first of those is health care insurance. I mean, the problem with 
insurance is it costs too much. So, what can we do to make it cost 
less? Well, I mean, I like to compare the difference between health 
insurance and car insurance.

                              {time}  1850

  In car insurance, you can choose from a thousand different companies 
in this country from Florida to California to Wisconsin to Michigan and 
pick a company that suits your needs, and if you don't like that 
company, you switch to another company.
  Right now, employers control most of the health insurance. We need to

[[Page H5917]]

have a plan that, number one, gives the individual control over their 
health insurance so that you can pick a health insurance policy that 
you like even if the employee next to you chooses a different policy. 
Why should it have to be the same? Why should you have to carry 
insurance for acupuncture if you never use acupuncture? Some States 
actually mandate the coverage of acupuncture. This is why insurance 
costs so much.
  Your car insurance does not pay for an oil change. It does not pay 
for new tires. It does not pay for routine, small expenses that you can 
expect because that's not what insurance is for. Insurance is for a 
catastrophic event. If you want your car insurance to pay for oil 
changes and new tires, it's going to cost a lot of money because that's 
not the purpose of insurance. The purpose of insurance is to protect 
you from a catastrophic event.
  That's why the Health Savings Account is an important component of 
free market health care reform because then you have--for example, say 
you're working for somebody; instead of paying your health insurance, 
your employer pays into a Health Savings Account, which is then your 
money to use for health care. And it comes to you tax free, so you're 
not paying any taxes on it. It would be the same as if your employer 
was paying for a health insurance policy for you.
  So with that money, then, you could be paying for your routine health 
care out of that. Now, this is money in your account now, so you may 
want to choose how you spend that a little carefully because that money 
is in your Health Savings Account, that's money that belongs to you 
now, and you can use that any way you want for your health care. Or 
maybe if you don't even use it all, that would be there for you in your 
estate once you die for your children. So you want to be careful with 
that.
  So when you're going to go get an MRI for your shoulder, you may not 
just go to the place that your doctor may recommend, you may shop 
around for an MRI. Because I know, for example, that at some places you 
can get an MRI for $2,500, at another place you can get an MRI for 
$600, the same MRI. Unless you actually kind of look around for it, 
you're not going to be able to find that deal. You're not going to even 
know about it because right now you don't even care about it perhaps 
because your insurance pays it and you have a copay that doesn't affect 
you. But if you're taking this money out of a Health Savings Account, 
you're going to be shopping more. That's the power of transparency in 
cost.
  So, looking around to see where you can save money to keep money in 
your Health Savings Account, and then shopping for insurance that suits 
your needs, not the needs of the person next to you, but suits your 
needs so that you may choose an insurance company, like for your car 
insurance, that differs from our neighbor's but suits you just fine. 
You may have Chevrolet insurance or you may have Cadillac insurance, 
but it's your choice. Those are just two things that I think would 
really diminish the cost of medicine and not involve taking over 
everything by the government and actually decrease costs.
  The other thing that nobody really talks about much in the cost of 
medicine is the cost of malpractice. Malpractice is something that 
doctors can be very uncomfortable with, but sometimes injuries do 
occur. Is it a good result for a patient who's been injured to have to 
go to court for 5 or 6 years and then have to pay fees for attorneys of 
50 to 60 percent of the judgment after 5 or 6 years in court? Is that 
justice for an injured patient? Frankly, it's not something that 
doctors want to see.
  Doctors want to see, if there is actually an injury, let's have it 
dealt with in a reasonable fashion. Let's have it adjudicated in an 
administrative law situation when there has been an injury. A panel of 
people can decide, yes, there has been actual injury, let's make a 
judgment, and let's give that patient a judgment, and let's get it done 
with within several months. That would be better. It would eliminate 
the entire cost of a trial, the attorney fees and all that, and 
physicians would like it. Patients would like it, I think, because it 
would give them speedier access to justice. I think that by doing that 
we would eliminate a lot of the extra costs that come into medicine.
  Right now, if you come into the emergency room for something, a pain 
in your belly, you're going to get a CAT scan pretty much automatically 
because the doctor is afraid of being sued. And it doesn't cost him 
anything, it doesn't cost the patient anything, he's going to order a 
CAT scan, he's going to order the x-ray, he's going to order a lot of 
tests just to protect himself. These are some of the hidden costs of 
malpractice that people don't really think about. They just think about 
the cost of malpractice as simply the cost of the doctor's insurance, 
which can be expensive.
  Right now, different States will have different abilities to attract 
physicians because they have different means of dealing with 
malpractice. But I think that for the patient, really, we need to have 
a better system where they get compensated faster and with less 
aggravation than the system we have now.
  So, I think the main thing that we're talking about on this side, we 
talk about health care reform, is to talk about having a conversation 
with the American people. Maybe you don't agree with some of these 
ideas on how to make our health care system better and more efficient. 
Well, I can understand that. Let's have a conversation. Let's decide 
how we can do it better.
  Let's try a pilot program in one State. Let's allow States to 
experiment in how to do things. Let's not write a bill of 2,700 pages 
in the middle of the night that nobody read and then put it on the 
American people and say it's going to be great, but we don't know 
what's in it because we haven't read it, and then go through the next 
2\1/2\ years realizing that it's a mistake. I mean, there definitely 
needs to be room for improvement in our system, but can't we have this 
conversation in an open fashion? I think a lot of people even on the 
other side would realize that, hey, we made a mistake, but isn't it 
more important to admit that we made a mistake and try to move forward 
in a fashion that actually cuts cost? We see it's not cutting costs. 
It's been devastating to the American economy.
  I've talked to small business owners across my district over the past 
2 years and they say the same things again and again: There's 
regulations cost us money and our health care cost us money; it's going 
to make us not be able to hire more people.
  So I think we've made some real mistakes here in the past, but now is 
the time to address them and move forward and try to make some 
commonsense decisions. Frankly, I'm happy to hear from people with 
ideas. I hear ideas from people all the time in the district that 
really make some sense and are certainly worth trying out.
  So with that, I want to thank the members of the Physicians Caucus 
that were here this evening for our evening hour, and I yield back the 
balance of my time.

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