GOP Doctors Caucus

Floor Speech

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Mr. FLEMING. I thank the gentleman, my colleague, my fellow classmate, Dr. Roe from Tennessee.

What I thought I would do is take just a moment and discuss the historical aspect of Medicare and how we got to where we are today.

I began medical school only 7 years after Medicare began. In fact, my colleague, Dr. Roe, I think you're probably of similar age and station in life and also Dr. Gingrey who is here, and some of us may even remember before that.

I watched Medicare grow, and the promise to physicians and patients at that time was that government, if this is passed, would not mess with anything. It would all be between doctors and patients. However, by the time we got to the '80s, we found that couldn't be true. The costs were exploding far beyond inflation, so the government--Congress, in fact--began to go through a number of calisthenics in order to make it work.

One was RBRVS, which was a formula by which doctors would get paid rather than by what their costs were--then DRGs, diagnosis related groups, to tell hospitals exactly what they're going to be paid regardless of their costs, then CLIA, and then finally SGR, sustained growth rate, which we're struggling with now.

It basically means, if we miss budget targets, doctors get across-the-board cuts, which would be up to 25 to 30 percent today. Of course, Congress keeps kicking the can down the road because Congress knows that, if we were to actually implement the cuts that are required by law, physicians would stop taking Medicare patients, and we'd have a serious, serious problem.

So, if we fast-forward to today, why is it that we can't control the costs to Medicare? I just have to bring it down to the bottom line here. You control health care costs by one of two methods:

One is a market-based, patient-centered method in which the patient is in the driver's seat, working in partnership with his or her health care provider, making the decisions, but also having a responsibility to control costs, which means the patient has skin in the game, meaning through health savings accounts and things of that sort. They have an investment in controlling costs for them. Therefore, they control costs for the rest of the system. Fraud, waste and abuse is taken care of by the user, the consumer in that case, making, in fact, the patient a savvy consumer.

On the other hand, you've got a command and control, top to bottom, which is what ObamaCare is. The only way that you can control costs, Mr. Speaker, by doing that is to use a system like IPAB, this independent payment advisory board--15 appointed officials who have absolutely no accountability to anyone. They are unelected and unknown, for the most part; and if you have a problem with their decision, there is nobody to go to. No one is going to answer the phone.

So what does this relate to ultimately?

We get an inkling of where we're going with this through funds going into this comparative effectiveness board, where studies will be determined to see how effective various treatments are and for whom. This comes down to what is already implemented in Great Britain, NICE, which stands for the National Institute of Clinical Excellence. For a lot of people, it's not so nice.

So how does it work? It goes like this:

There is a certain number of procedures, diagnostic-or treatment-wise, and there is so much money that can be spent on those. Then there are the needs, the people who actually need these. So a determination is made based on a graph, if you will, or on a matrix as to someone's value to society, as to the value of one's life. In fact, they actually have a numerical value each year for what one's life is worth. They go to this matrix, and they determine in Great Britain whether or not it's worth that investment for them. That may mean a hip replacement, it may mean renal dialysis, or it may mean that your cancer doesn't get treated.

In fact, if you look at the comparative statistics between the survival rates of prostate and breast cancer, which are two of the main cancers we deal with in this country, against Canada, which also has socialized medicine--and Great Britain--there is absolutely no comparison. The death rates are much higher in those countries.

So today I would submit to you, Mr. Speaker, that if we continue down the ObamaCare road, the implementation of IPAB, which is controversial even among the left of the left and is very concerning for everyone, I think this is sort of the last shoe to drop when it comes to the creating of a government-run, socialized health care system in which bureaucrats, rather than you and your physician, will be making decisions about your individual life.

We very much want to repeal ObamaCare; but even if for some reason we can't or until we do that, we desperately want to get rid of this IPAB, which we view to be toxic for our health care system and for our culture in general.

With that, I want to thank the gentleman for having this discussion tonight, and I look forward to many more.

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