Health Care

Floor Speech

Health Care

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Mr. FLEMING. I thank my friend, Mr. Akin.

And as you know, I have been a family physician for 33 years, and I've also been in the private business segment apart from my medical practice for over 30 years. And I've come to learn both inside and outside of health care, looking from the outside in and the inside out, that government does just what you suggest; it tends to bloat things. It has difficulty dealing with the inefficiencies in the system.

And I will just give you one quick example that I deal with every day in my medical practice, and I do still practice, and that is take Medicare, for instance. In a government system like that, if there is fraud or abuse or waste going on, the government has to throw out a wide net, a very expensive net. It has to put a lot of resources in to catch a few people doing very egregious things and maybe doing a little bit to them, maybe a few months or a couple of years in jail.

Mr. AKIN. So things like Medicaid, you always hear about a tremendous fraud level in Medicaid. Would that be an example of what you are talking about?

Mr. FLEMING. Correct. The reason why it's so tremendous is because only a scratch of it is ever detected.

Mr. AKIN. So people get away with a lot of fraud in Medicaid, and that runs the cost up to make it less efficient.

Do you have other examples?

Mr. FLEMING. If you take a private organization, let's say a health maintenance organization, Mayo Clinic, which has been in the headlines lately, or Kaiser, they track their providers very closely. And if they're going off the scale, it doesn't matter whether they are doing something illegal or not. If they're just simply overusing--or in some cases underusing or inappropriately using--or doing things that are not within what we consider a good standard of care, then they're going to be reeducated or they're going to be terminated. You don't have to go through all of the expense to get very few people and really get very poor results.

Mr. AKIN. How many people get busted for Medicaid fraud? Does that happen a lot?

Mr. FLEMING. I don't have a number on that, but I think it's a handful.

Mr. AKIN. A very small number.

Mr. FLEMING. A very small number compared to the literally billions of dollars each year where Medicaid and Medicare fraud occurs.

Mr. AKIN. Another thing that we could take a look at--because this is an assertion that we're hearing the President make that this thing is going to help our economy, and yet the Congressional Budget Office took a look at the first bill that the Democrats trotted out here, and they were looking at $2 trillion.

Now, that's spending $2 trillion. It's hard to make a case that that's going to save money because we're not spending that $2 trillion now, and yet they're saying this is going to be $2 trillion.

Well, they went back to the drawing board, came back and with a little hocus-pocus, and taking some money from some other places, they got it down to $1 trillion. But that doesn't seem like that's spending less. It's a trillion more than we're spending right now.

Mr. FLEMING. Absolutely. And incidentally, where they found the savings was to deeply gut Medicare, which is already underfunded.

Mr. AKIN. So they're going to take the money out of Medicare in order to make it look like it's not really $2 trillion, it's more like $1 trillion.

Mr. FLEMING. Yes.

Mr. AKIN. Now that big cap-and-tax bill that we just passed, which was the biggest tax increase in the history of our country, was only about 780-something billion dollars. So that's less than 1 trillion. So that huge tax increase won't be enough to pay for the system, I suppose.

Mr. FLEMING. That is correct.

Mr. AKIN. Now, the other thing is it's not like we're flying without instruments on this course that we're taking because various States have tried to do what the Democrats are proposing. It's not new; it's just new to do it at the whole Federal level. Various States have tried it. Tennessee was one, Massachusetts was the other. We've got some of the results right here on this chart about what happened in Massachusetts.

In 2006, Massachusetts required universal health care coverage, which is what's being proposed here by the Democrats much like the current Democrat plan. People were required to purchase specific levels of coverage. Now, what was the result of doing that? It's not like this is new. This is something we tried. Health care costs were up 42 percent since 2006. That doesn't look like that's going to save any money. That's where that $2 trillion is talking about. This is very, very expensive. Health care access is down. That is, patients had to wait almost 70 days to see a doctor in Boston. And so are those the kind of results that we want?

Now, health care costs are 133 percent of the national average. So this jacked the cost of health care by a third over what it was before. So it's not like it hasn't been tried. What we're doing is nationalizing a failure.

Now, the results in Tennessee were not much better.

Doctor, do you recall that?

Mr. FLEMING. If the gentleman will yield for a moment.

It's very interesting that the Democrats claim that we need a government-run system to compete with the private system to drive costs down, but if you dig into that, what you find out is just the opposite is happening today. Medicaid, and in the case of TennCare, was putting tremendous pressure on the private insurers and making their costs go up.

So the first thing we could ever do, if this were possible, to slow the rise in costs in private insurance, and that would be to remove the burden of Medicare and Medicaid on them.

Mr. AKIN. In other words, are you saying that the private medical insurance people that are writing medical insurance plans are subsidizing Medicare and Medicaid?

Mr. FLEMING. Absolutely. And if I could give you an example in my own practice, the typical Medicare or Medicaid patient reimbursement is under my cost. So I have to see a certain number, hopefully twice as many private insurance, just to break even. And typically in a medical practice, particularly in a rural area--and this is why you see doctors closing up--as their patient mix of Medicare and Medicaid grows--and again, that's single-payer, government, you know, so-called public plan that exists today. As that percentage grows, their chance of going out of business grows as well.

Mr. AKIN. So in other words, what is going on then is in order to fix the part of health care that the government is already meddling in, which is in terms of medical payments overall, the government handles half the money that is going through health care. If you take Medicaid and Medicare and you add that much money up, I think that's about half of the total of all the money spent. So we already have the government meddling in half of it, and now what's happening is you're asking the privates to support all this public stuff, right?

Mr. FLEMING. Yes.

Mr. AKIN. And that then is adding to the cost of everything. So we have already, talking about nationalizing health care, Tennessee just about crashed their economy trying to do the same thing, is that correct?

Mr. FLEMING. Yes, that's correct.

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Mr. FLEMING. Well, of course, physicians.

Mr. AKIN. Okay, two doctors are here.

Mr. FLEMING. You heard tonight the Democrats talk about how the AMA has come out in support of this. Well, that's true and it's not true. What really happened was last month, the rank-and-file physicians across the country met with the AMA, and they voted not to support it and then after----

Mr. AKIN. So the doctors voted ``no'' about supporting this. So you guys are both doctors, and the other doctors said, No, this isn't a good idea, right?

Mr. FLEMING. Exactly. And then, again, one of those behind-the-scenes, in-the-backroom deals, a deal was cut over the sustained growth rate, the SGR, that would be cast aside if the AMA would sign on to it. And so without consulting physicians, the board of trustees of the AMA cut the deal with the President in the wee hours of night, and then sent them a letter in support. Thus far, 18 State chapters of the AMA and a growing number have come out saying that they do not support this. And I would really I think say with confidence a majority of the physicians across this country do not support government taking over.

Mr. AKIN. We have two groups. I'm going to keep score. First of all, if you're pro-life, you're not going to like this bill. Second of all, in general, the doctors don't like the bill. Even though the AMA cut some deal, their membership told them, We really don't support this thing.

Mr. FLEMING. Absolutely.

Mr. BROUN of Georgia. There have been two other medical groups that have endorsed ObamaCare. One is the American College of Surgeons, and the other one is the American College of Obstetrics and Gynecology. Well, ACOG, the American College of Obstetrics and Gynecology, have been promoting abortion. So go back to your pro-life group; they wouldn't sign on to a plan if we pay, with taxpayers' funds, abortions. That's one thing. Secondly, back to the AMA; I don't think they represent but about 20 percent of doctors here in this country.

Mr. AKIN. So the AMA doesn't represent all doctors, just only 20 percent. Even the 20 percent wasn't in favor of it?

Mr. BROUN of Georgia. That's right. In fact, AMA represents very few doctors in this country. I'm a member of the Association of American Physicians and Surgeons. Dr. Jane Orient is the executive director. It has very ardently opposed a government takeover of health care for years and years, and looking to the marketplace, has presented ideas about how to lower the cost of health care for everybody in this country to make it more affordable. But the liberals in Congress won't hear of that type of philosophy. So the AMA's endorsing this plan, actually I think they have been very shortsighted, because as Dr. Fleming said, they cut a backroom deal by just a little handful of the leadership in they AMA.

They didn't consult any doctor here in Congress that I can find. Neither did any of the other two groups. They didn't consult any of us who serve here in Congress, and cut these backroom deals on the SGR, sustained growth rate, or what we have called ``doc fix'' here.

But they're being very shortsighted because, the thing is, the taxes for all those doctors is going to go up above what they have been promised to be given in not cutting their fees. And so net income for the doctors is actually going to go down, and the doctors ought to understand that the AMA has sold them out.

Mr. AKIN. I'd just like to keep going on the list because we've got one. The people who are pro-life, they don't want this thing. The doctors don't like this thing. We have two doctors here that don't like it.

I want to bring up another category because, when I wake up in the morning sometimes, I'm feeling a little older and achier. I just hit 62. I want to talk about old geezers like me. Seniors. If you were a senior citizen in America, what do you think about the government running health care? Do you think you're going to like that idea very much?

Mr. FLEMING. If the gentleman would yield.

Mr. AKIN. I do yield to Dr. Fleming.

Mr. FLEMING. I would say for two reasons they will not like this. First of all, you heard me just say that part of this plan is to gut Medicare to a great extent, which the elderly depend on. Medicare's already going bankrupt in less than 10 years and is heavily subsidized by private insurance. And so what we're looking at is taking away the subsidy.

Mr. AKIN. So we're going to gut Medicare first. So if you're a senior you're not going to like gutting Medicare.

Mr. FLEMING. Yes. And if I could also add, one other problem is this Comparative Effectiveness Committee that's being created----

Mr. AKIN. Okay. So there's a committee somewhere in this chart that's a Comparative Effectiveness Committee. And what is it going to do?

Mr. FLEMING. Well, it's tasked with the job of deciding who deserves what or what is really too expensive for whom and what sort of diseases. And if you look at the other countries that do this already, the United Kingdom, Canada and others, the elderly are the first ones that are counted out under this program.

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