Health Care Reform

Floor Speech

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Mr. FLEMING. I thank the gentleman. And thank you, Dr. Gingrey, for having this hour. You have shown tremendous leadership over the last few months and even before that, of course, but particularly the last few months in being willing to control time for us to have these discussions. Of course, Dr. Cassidy, my colleague from Louisiana, has been deeply involved in this issue, and we have all worked together, I think, as a great team, the GOP Doctors Caucus.

I will get to that anecdote in just a moment. I think it is an important one. But let me stay with the subject just for a moment about the gimmickry, because I think that is essential to our discussion. I will develop it very carefully, but quickly, and also point out that this is an important part of the macroeconomics of health care that everyone must understand, and that is this: Currently Medicare and Medicaid, which are the current government-run health care systems, do not pay for the service that they are providing.

Let me repeat that: These programs, Medicare and Medicaid, do not pay, at least completely, for all of the services that are provided, because the government requires and forces doctors, if you will, hospitals and other organizations, to provide care for less than the 100 percent reimbursement. Physicians, nurses, hospitals, home health agencies and so forth actually have to settle for less.

So, how is it that we can stay in business, we in the health care industry, and get by on less? The answer is that the private insurance market, a much bigger market, subsidizes to the tune of about $1,700 to $2,400 per year per family. If it were not for that subsidy, it would collapse. Yet and still, Medicare is scheduled to run out of money by 2017.

Now, how long is 2017? This is 2009. That is about 8 years that we are going to run completely out of money. Nobody in Washington is advancing any solutions to that.

All right, where did the gimmickry begin? Remember that in the time period from about 1997 to 2003, Congress decided in its infinite wisdom that Medicare will be subject to a limitation on the budgetary increases from year-to-year. We call that the sustained growth rate, SGR for a lot of people. But because it was recognized even in the first year that such cuts would block access to health care by patients, it has never been enforced. So it has been a bookkeeping gimmickry that now has created an incremental difference of about $250 billion, and growing. And even the other day the Senate attempted to resolve this.

Mr. GINGREY of Georgia. If the gentleman will yield for one second, Mr. Speaker, for clarification, that limitation based on that formula, Dr. Fleming, applies to the doctors, doesn't it, all the health care providers? This is not applicable to the hospitals. They are reimbursed under a different system.

Mr. FLEMING. That is correct. It is just physicians only. It is actually part B, which is mainly physicians. It simply says if you guys can't keep your billing and your costs and everything down in totality, we will just cut across-the-board. Well, that is an impractical solution. It is gimmickry. It would never work. Now we have a $250 billion gap that is not being paid for. The Senate the other day tried to address that and failed to, because they knew it would be dumped on to the budget.

Let's advance, fast forward to this bill today. Right now this plan for approximately $500 billion that will be cut from Medicare, $160 billion or so of that would be a direct cut out of Medicare Advantage, which, as you know, is the more generous private system that is funded by Medicare dollars. If that happens, then those who are on Medicare Advantage, such as Humana Gold, will have to go back into the regular Medicare system and they will have to purchase Medigap insurance that they didn't have to purchase before. Again, seniors taking on the added burden.

On top of that is another $300 billion to $350 billion coming directly out of Medicare on the basis of some future savings, some future efficiencies that no one has been able to figure out.

So where are we today, Mr. Speaker? Basically $250 billion of doctor cuts, which have never been cut and will never be cut and are growing, that is going to end up in the budget at some point, another part of the deficit; another $350 billion which everybody in this room has known will never be paid for, but yet somehow it is being booked by the CBO as some savings. It is just continuous gimmickry. That is the only way this bill will ever be paid for, is gimmicks, which really means it is going to be taxpayers and premium holders.

Then to go back and kind of summarize, my point here is that, as Dr. Cassidy points out, the only way that this is going to be an efficient health care system in terms of cost is the decisionmaking has to be in the exam room between the doctor and the patient, and one of the best methods to do that was a plan started in 2003 or so, Health Savings Accounts.

All this does is allow the employer--and government could do this, too, for Medicare and Medicaid--to put money in the bank that can be used at the discretion of the patient to buy medications or whatever, and it's his money or her money to use efficiently.

Just an example of how it works, we implemented this with my own private health plan with my companies a few years ago, and instead of our rates going up an average of 15 percent per year, they're going up an average of 3 percent per year. I was giving this discussion to my employees one day, and one of my employees piped up and said, Well, look, if we go to this health savings account idea, that's going to mean that I'm going to have to pay out of my health savings account $100, $150 a month for inhalers.

I said, Well, let me suggest to you this: Why don't you stop smoking? You will save money from the tobacco. You will be able to stop your inhalers, and then you'll just be banking all this extra money, which will end up removing any deductible you're going to have in the future. She came back to me 3 months later and said, I stopped smoking. I no longer have to use inhalers, and I've got extra money every week.

I wanted to pull together some of these salient points that have to go with the gimmickry and how we're going in the wrong direction. Expanding government control is going to expand cost. Instead, we should be looking inwardly and bringing it down to the doctor-patient level where the decisions can really be made efficiently.

With that, I will yield back.

Mr. GINGREY of Georgia. Dr. Fleming, thank you for those comments. Before I yield one more time to Dr. Cassidy, just following through on this point that you are making, you may have mentioned one of the companies, Safeway and others who have testified up here--I don't know if they have been before the entire House or Senate, but certainly they have met with Members on our side of the aisle and explained some of the things that they're doing in regard to incentivize people to take care of themselves, to take better care of themselves, to realize there is a personal responsibility issue here. You pointed out in regard to smoking cessation, to not be using recreational drugs, to exercise on a regular basis. Certainly if you are overweight, particularly massively overweight, get on
a good program. In fact, some of these companies, Dr. Fleming, I think they have programs in-house where it's free, and these employees are incentivized by a reduction in their monthly premiums for health insurance, their copay, their deductible.

When we were marking up the bill, the health reform massive H.R. 3200, a 1,200-page bill in the Energy and Commerce Committee of the House of Representatives, we had an amendment on the Republican side of the aisle to actually expand this program that Safeway and others had initiated to allow even more incentives. You know, for the life of me, Mr. Speaker, I do not understand even to this day--and it's been 6 weeks ago July 30 that we passed the bill in the Energy and Commerce Committee--that amendment was voted down strictly on a party-line vote. Maybe one of these days they'll explain it to me. But to actually get healthier employees so there is less absenteeism, they have a longer work life, and to incentivize them with giving them monetary breaks in the cost of their health insurance, why in the world would we not want to do that?

Mr. FLEMING. Would the gentleman yield for a moment?

Mr. GINGREY of Georgia. Yes.

Mr. FLEMING. That is a great point you make. What I would like to say is that something we have all observed as physicians is that while we all recognize collectively that, yeah, we should lose weight, we should exercise, and we shouldn't smoke, we, as human beings, tend to not address those issues until something comes up, until it affects us immediately in day-to-day life. The beauty of systems such as Safeway's is that they implement a financial impact, both positive and negative, that encourages healthy behavior before you ever get to a point where you go, You know what, I'm going to have to have heart stents or bypass surgery. Now I am going to make changes. Why not make the changes 5 years in advance? Then you don't have to go through that. Look at all the money you save and the health that you have as a result of that.

I yield back.

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