Date: 2009-04-27
Speaker: TIM MURPHY (republican)
Chamber: H
State: Pennsylvania

I thank my friend Dr. GINGREY for yielding. Of course. Dr. GINGREY. you are well aware as a practitioner of how Medicare works. I want to lay out for a few moments here. as many people will start to say that we should use Medicare and Medicaid as examples of how to expand health care because they are run so well. I want to point out a few things about how I disagree with that premise and those that say that Medicare has a very low cost overhead. In part. that is because some of the administrative fees are set. but there are several other things we need to know about that. and that is that they pay very low fees to hospitals and physicians. and perhaps that is why so many physicians do not participate in MedicareMedicaid payments. Another aspect too. is. understand that Medicare covers only about 58 percent of beneficiaries health care expenses. So when you leave that much in other fees on the table unpaid. what happens? Well. hospitals use some of their own coverage to cover that gap in Medicare coverage. Patients also carry their own supplemental insurance on their own to cover it. and many times it is left that the actual cost of Medicare that we are told does not anywhere near describe what the real cost is. The Medicare Payment Advisory Commission. otherwise known as MEDPAC. said the way Medicare is going. its wellknown design deficiencies and financial problems will certain inhibit the delivery of high quality care. in its June 2008 report to Congress. They said. "Without change. the Medicare program is fiscally unsustainable over the long term and is not designed to produce high quality care." Let me give you a couple of examples of where I think Medicare is a particular problem. and Medicaid as well. A constituent of mine has multiple sclerosis. and some of you may know_ that multiple sclerosis affects -nerve cells and really affects the ability of those nerve cells to communicate with one another. There is a membrane over the arM of nerve cells called a myelin sheath. and what happens is the sclerosis or scarring of that sheath affects the ability of one nerve to communicate with another. In multiple sclerosis. a person may have discrete attacks or longterm attacks that may affect their motor skills. their muscle skills or their thinking and cognition. At _times it goes away completely for long periods of time and then comes back. The annual cost per patient. however. for treating such patients may be $30.000 or $40.000 or $50.000 a year. And yet how does Medicare and Medicaid handle that? Well. they have this strange notion that says. for example with Medicaid. if you want to have some payment for that. you must be disabled. But to be disabled you have got to go 24 months of disability. which is not a characteristic of this illness. And. of course. to be disabled means you cant work. If you are not working. you cant pay for your medication. If you stop working and they find out. you really are without symptoms. it is a problem. So. you see. it is one of those catch22s we put people in with this. There is also something here that Medicare and Medicaid does not pay for: Disease management. This is particularly important. because disease management for people on Medicare is extremely important because of the complexities of their illness. And these complexities are not small. Nearly 80 percent of Medicare beneficiaries have at least one of the following chronic conditions: Stroke. diabetes. emphysema. heart disease. hypertension. arthritis. osteoporosis. Parkinsons disease. urinary incontinence. And because of this. 5 percent of Medicare beneficiaries account for about half of all Medicare spending each year. Among this top 5 percent. nearly half had congestive heart failure and 35 percent had diabetes. . You see. there is such complexity among people with chronic illness. it is a wonder they can manage it at all. That is why people with severe illness do better if the doctors and nurses can work with the patients to manage this complex care. You dont have to be a member of our GOP caucus to notice how difficult it is. and hopefully some of the comments made by some of my colleagues tonight can illustrate that. But I know patients that I have worked with. sometimes it is absolutely overwhelming for them to have multiple visits and dealing with so much with their illness. and yet Medicare and Medicaid wont pay one penny to have anyone from that medical practice work with that patient. So what happens? They forgo their treatments. they make mistakes in the medications. there are many difficulties that come up. and it could lead to unnecessary hospitalizations. And those. Mr. Speaker. those issues are ones that cost so much in the area of health care. I am sure my colleagues. no matter what branch of medicine or health care they are from. know this full well. When you have a patient with multiple complications. if. they cannot deal with it. well. the complications increase. Part of the reason that this is even more of a problem is that what happens. these complexities go on. If you have Medicaid and Medicaid plans that say we are going to pay for what they call quality of care. and it is only based on a narrow measure of outcome. then what happens is that patients stop to be compliant and hospitals may discharge some of them early because they are not paying for actually managing these difficult cases. This is a serious. serious problem. and one of the reasons why out of this -$2.4 trillion health care system we have no less than $700 billion or $800 billion worth of waste. It is because of that. Mr. Speaker. that what we ought to do is. before we say lets have the government expand Medicare and Medicaid and make it available for all. we ought to say lets use all of our abilities to fix these broken systems. It is wasteful. it is harmful. it is difficult for patients. and it is not effective health care. And because of that. I would certainly encourage what Congress should do with all full speed is instead of saying lets just replicate this broken system and expand it for everyone. we ought to fix this system. Medicares hospital payment system doesnt encourage or reward hospitals to reduce readmissions. It is a matter that we almost have like 18 percent of admissions results in readmissions within 30 days of discharge. What is wrong with a system that has those kinds of problems? So. Mr. Speaker and my colleague.