Preserving Seniors’ Access to Physicians Act of 2023

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on the topic of this Special Order.

Mr. Speaker, before I yield time to my colleague from Utah, I want to quickly highlight and reiterate the importance of what we are doing here as the House GOP.

House Republicans, during the holiday break, took the time, over 60 of us, to go down to the border to be able to share what is truly going on. We get to hear, hopefully, today a little bit more about this.

At no point in our Nation's history has the situation on the southern border reached the levels of policy failure, humanitarian disaster, and security threat that it has under the Biden administration.

Many of my House Republican colleagues witnessed firsthand the tragedy at our border last week. It is out of control, and the Biden administration has completely dropped the ball on this issue and threatened the safety of every American community in the process. The issue is, it is more simple than this.

To President Biden, the gig is up. You took office and thought: Let's just reverse everything that the Trump administration had been doing. Let's not necessarily evaluate whether it was successful, whether it was the right policy. Let's just kind of use our executive pen to reverse everything.

It is very simple to consider Migrant Protection Protocols, the remain in Mexico policy, catch and release. These are simple policy changes that would have an immediate positive impact.

Many of my colleagues were able to see this, to witness this, again, firsthand this past week, and I look forward to hearing from Representative Burgess Owens from the great State of Utah for more on this issue.

Mr. Speaker, I yield to the gentleman from Utah (Mr. Owens).

Mr. Speaker, I thank Representative Owens for his firsthand look.

I spent time at the border--I believe it was in the late spring--and the same situation continues on. The solutions are right in front of us, and we just need the Biden administration to recognize that.

Mr. Speaker, I yield to the gentleman from California (Mr. LaMalfa).

Mr. Speaker, I thank the gentleman from California for speaking very plainly and very simply. These solutions are right in front of us.

Mr. Speaker, I yield to the gentleman from North Carolina (Mr. Murphy).

Mr. Speaker, Dr. Murphy and I sit on the same committee, Health in the Ways and Means Committee, and if his remarks seem personal, it is because they are. He has had such a close experience with this, and no one makes the point better that all of our providers' costs continue to go up because of bad the monetary policy that we have seen, particularly in the last few years. When we constantly tell these providers, You are going to have to do more with less, they have to make decisions, and this is ultimately the worst possible thing for our patients.

The crowding-out effect that we have going on in our economy right now, particularly with things related to government funding, there is no situation where it is worse than this. The inability for us to get after our true debt and deficit drivers will continue to crowd out, so these types of cuts are forced on providers, and we have to be willing and adult enough to be able to figure that out.

So thank you for that, Dr. Murphy.

Mr. Speaker, I yield to the gentleman from Indiana (Mr. Bucshon).

Mr. Speaker, I thank the gentleman, Dr. Bucshon, for another incredible perspective on this looming issue that seems to just be year over year over year, and we cannot continue to put our medical providers in this situation.

Mr. Speaker, I yield to the gentleman from Tennessee (Mr. Rose).

Mr. Speaker, I thank the gentleman from Tennessee for his remarks.

Mr. Speaker, I echo the gentleman's sentiments, and I will continue to speak on it today. The solutions at the border are simple. We have got actual data that can just be reimplemented and we can get rid of the politics involved and just do something right by our Nation. We look forward to an opportunity to leverage this moment to get this border policy through. The things in H.R. 2 make absolute sense.

I am looking forward now to the remarks of my colleague from Pennsylvania (Mr. Joyce).

Mr. Speaker, I thank Dr. Joyce for coming down over the holiday break.

Mr. Speaker, I yield to the gentleman from Georgia (Mr. Carter).

Mr. Speaker, I thank the gentleman from Georgia for his remarks emphasizing the need for good healthcare.

I hear this from several of my friends, family, and constituents back home. I think one of the most alarming things that we are seeing right now in the healthcare provider world is that--when I grew up, a lot of my friends' parents were physicians. They would always encourage their child to go into medical school and pursue a career that they loved so much. This may just be an anecdote, but I am literally seeing that next generation of current providers saying: Try something different.

Again, that may just be my experience. I don't think it is because I have heard a lot of it from other colleagues of mine. We can't look back at this time and say we didn't address this issue of not doing right by our providers, by our rural healthcare and making sure that they have what they need to be able to navigate the costs that are continually increasing and being able to provide for their patients.

As Dr. Murphy also talked about, we have to have private practices being able to stay nimble and focused on their specific community and not just build big conglomerates. Small business is the backbone of our Nation, and that needs to exist also in our healthcare market.

As I close here, let me just turn to the other topic that we talked heavily about today which is the border. I spent some time at home the last few weeks, and as I met with and had different forums back home with constituents, I explained to them that one of the biggest problems is the way that policy works in Washington, D.C.

It is in a very partisan and difficult circumstance back here. I don't think anybody on either side of the aisle would disagree with me that it becomes very difficult. When we factor in the Senate that requires a 60-vote threshold--every bill needs to be bipartisan in the Senate--that requirement isn't here in the majoritarian rule House, but that is what we live with. Particularly when there is split government, then we have difficult decisions and difficult things to navigate.

The point that I made to them was that with my Democratic colleagues, we often can find the first three or four provisions of a particular issue that we agree with, but then that is when it becomes difficult because if Democrats want the fifth, the sixth, and the seventh item, then they will say, no, we are not going to vote on any of the things we agree on until we get some of these things we want, even though we agree on the baseline.

We do it too. We have certain things that we want to make sure we get so we are going to leverage that so we don't get the basics done.

I can't think of a scenario where this applies more than our border crisis right now. I don't want to make this political. I remember a little while ago when there were 34-odd migrants that suffocated in the back of a truck. It was like a blip on the news feed. It was so quick. It came out as a news cycle. That is the danger of what is going on right now. We have empowered the cartel networks that we should be united against. We have empowered the cartel networks to own the border.

I heard a staggering statistic--I don't have the number in front of me--on what we have calculated on how much money those cartels are making on a weekly to monthly basis. It is terrifying because that number is going directly into the drug trade.

The fentanyl crisis is one of the biggest impacts this has on our community. I held this huge roundtable back in Utah with the caretakers, law enforcement, and advocacy groups. It was a very nonpartisan conversation, and it was so, so concerning on what was going on.

This is what I want to tell the American people: We actually agree that we should do a lot of the elements in H.R. 2. We should shore up that protection and border security. However, then we need to make sure we streamline the visa process, and we need to make sure we get a stronger workforce here.

I am here to tell you, Mr. Speaker, we actually largely will agree on that aspect of a comprehensive immigration reform.

My biggest criticism of President Biden and his administration has been that he immediately removed or reversed the Migrant Protection Protocols, the remain in Mexico policy that the Trump-Pence administration had done. ``Well, we are a new administration. We have to reverse all those things.''

A lot of the energy things were done by executive order. It was also this border policy. I think we are seeing now it is okay to have made a mistake if you are willing to be the adult and say: ``Look, we actually should reimplement some of this stuff.''

It is what the American people need. It is what the polling will tell us. It is what we largely agree, that there are some basic things that we can get done.

I think not telling the cartels: ``Hey, if you just get folks to the border and get them across, they are going to get lost in the system. You are going to be in there, and you are going to be fine.'' That is what they are telling them. The immigrants who are coming here, it is not the experience they are having because they get lost in the system and then are forced to go into the drug trade or forced to be part of the workforce of the Sinaloa cartel once they rush the product through the borders however they get it, whether it is a port or nonport. I don't care how it comes through.

Once that product gets here, then these individuals get leveraged to do that because they have no other options because they were lied to by the cartels.

If we can agree on some basic stuff, let's implement it. If we shore up and get back to times that we saw in previous Presidencies, we can then go and actually work on some of the other immigration policies that also need reform.

I am committed to doing that, and I hope that we can address that. If we leave the border with this type of policy that we have seen create a beacon for these cartels, then we will not be able to accomplish anything.

If it has to be done all in one bill, that is unrealistic because it is just a bigger beacon. It is just more opportunity for the cartels to try to get more people through, and it is nonsensical.

I hope for every opportunity to tell the Biden administration that this is actually better for you politically. I hate to say it, but this is what the American people need.

That is what my colleagues are trying to emphasize. That is why over 64 of my colleagues last week spent time down there. The same things that I saw months ago when I visited Eagle Pass are continuing. They are not getting better. There has to be policy change.

Mr. Speaker, I appreciate my colleagues for attending today's Special

Order and sharing their thoughts on these very important issues, and I yield back the balance of my time.

Mr. Speaker, I appreciate the time to be able to weigh in on these issues in a little more relaxed manner here and spend some time.

I want to talk a little bit about legislation we are working on here known as S.J. Res. 38. In this case, it would ensure our taxpayer dollars are used to buy American-made products, something that has had bipartisan support, nonpartisan support, in the past around here.

Certainly, when we are talking about having something domestically produced or buying it from a foreign competitor or ally, one thing we shouldn't be doing is buying more and more things from China.

What is the sense of exporting so many of our dollars over to somebody who is such an adversary in so many things on the world front, with the funding of countries that are helping to sponsor terrorism and the unrest they are helping fund in the Middle East? There are constant threats to Taiwan and the other islands in the South

China Sea that are possessions of Japan and others, constant aggression on that. They sink many other smaller countries into huge debt by dangling out loans they know they can't repay, and pretty soon, they can take over the resources of that country.

As the United States of America, we can produce anything we want here. We can produce it well, usually of the best quality, using the best practices, by far, yet what are we doing? We are hamstringing our own ability to strengthen our own economy with the energy we need to produce in order to do that, with environmental policies that 50 years ago were well intentioned but have been completely weaponized against industries and farming, mining, and timber. The West burns each year massively. In California and Utah, it is endless.

A lot of this currently comes from Biden administration policies, and I jump back 3 years to 8 years to the Obama-era policies that have put us in this spot.

Currently, President Biden wants to shoot down the waiver to eliminate the buy in America requirements for, in this case, electric vehicle chargers. That is what this bill, S.J. Res. 38, is about, which would be purchased under the Infrastructure and Jobs Act, another boondoggle itself.

If the money is going to be forced to be spent, and we have to buy these electric chargers for electric cars, at least can we have them be American produced, American made.

Don't get me mixed up with the electric car crowd. I don't think we should be forcing that on anybody. At the same time, they are tearing down the California power grid with the dams they are removing on the Klamath River up in the north part of my district and one across the border, and then threatening the Snake River farther up and one down in Mendocino County.

It is just one thing after another, getting rid of hydroelectric power and also the ability to store water and for the water to be retained during flood control season and for some recreation--yes, even water available to let out for fish when they need to. When they tear these dams out, we lose that green, renewable, clean, CO2- free power by these policies.

An addendum to that, CO2 is not a problem. It is only 0.04 percent of our atmosphere. The left wants to keep playing these games like we are talking about here. They want to export jobs to China to build these electric car chargers. They want to tear down the dams that produce CO2-free, green, renewable power and try and build even more batteries and more windmills that chop up the birds and only run when there is a little bit of wind and the solar plants that only run during the daytime when it is not a cloudy or rainy or snow-covered day. It is amazing how dumb these ideas are.

In 2021, the Democrats included $7.5 billion of taxpayer money for electric vehicle charging stations in their pie-in-the-sky idea that we are going to electrify everything in the next few years. This is the Infrastructure and Jobs Act.

I don't support the forced purchase and proliferation of electric vehicles, but doggone it, if we are going to do this, we need to buy American.

Why do we have to steamroll our own laws? Why is the administration backstabbing our American manufacturers and sending billions over to China and other Asian markets?

In the process, it also destroys our immigration laws and fosters more chaos at the border when we have this continued policy by the Biden administration of basically ignoring the border.

As mentioned earlier, 64 of my colleagues went to the border. I have paid a couple of visits myself in Arizona and California and such. It is indeed chaos. They are just walking right past you when you go visit the border. Some of these are nice folks from Central America, families and such. We keep putting out the magnet, the green light to come across.

We have talked many times about the numbers coming across the border, like 10,000 per day just in the month of December, 300,000 for a month.

The burden is being borne even by our Democrat-run cities, even they are starting to cry uncle. We have the Governor of New Jersey saying we need to check with these bus companies and see where they are all coming from. No, you need to check over here at 1600 Pennsylvania Avenue. That is where the policy is coming from. It isn't bus companies from Texas or Florida or something. That is who you need to be talking to because that is where the problem is.

Indeed, the administration is shifting from pushing our jobs overseas to then having our jobs here filled by people who are coming here illegally. It is the chaos they have had at the border coupled with these other policies and fentanyl coming across the border.

Who knows what kind of terror cells are being built by people coming across the border illegally and the gunrunning and everything else that can happen? It has even resulted in the housing of illegal immigrants in our National Park System, including a national park right there in New York City, so people can't use it.

Now, you have seen the stories more and more recently that they are going to be housing them in schools. Kids are getting kicked out of schools in New York right now because they have a supposedly temporary problem where they have to house them in the gym. The kids can go online, back to Zoom learning, like during the height of COVID, which was manipulated in my own home State of California, which took an extra year to allow kids back into school.

What a mess. Why are these people entrusted with power?

When you talk to the American public, this is all preventable. We don't have to live like this, when we are talking energy, when we are talking domestic production. No, we would rather export it, I guess, and have kids in Africa mine the products in order to have your electric car and electric gadgetry.

The National Park Police have testified that these encampments on our National Park lands endanger the people that would normally enjoy and use them. Also, in the wintertime, these areas can end up being a floodplain, like the one in New York City, endangering the illegal immigrants that are being attracted--until recently, when it seems maybe the light is starting to turn around for the Governor of New York and the mayor of New York City and such.

I don't know. I don't know.

Mr. Speaker, we have a porous border. We have a massive problem with the encounters that we have at the border here that are overwhelming our demoralized Border Patrol folks. How are they supposed to do their job?

On my visit down to Arizona, they actually had, and still have today, government-provided vans go over and just pick people up at the gaps in the border and get them to the processing center sooner. We know that 85 percent of them are not going to be heard at their asylum trial any time soon.

One thing after another is wrecking our economy, wrecking people's confidence in government, and the ability just to conduct their own lives. There is no reason we need to have such costly ways of doing business with energy, with procuring food; everything else that is happening under this Biden administration.

Mr. Speaker, just 3 years ago, things were looking pretty good on the cost of fuel, cost of groceries, and employment until they used COVID as a weapon to attack our economy at that time and tried to make it look bad in order to win the 2020 election.

We have a lot of complex issues, but the solutions really aren't that tough when you get down to it: enforce the border laws that we have.

We don't need comprehensive immigration reform. We already know what we are supposed to do about the border. We just need to enforce the laws that we have and have common sense applied to asylum.

At the same time, let's not exploit American jobs that we could be doing if we have to produce these electric vehicle charging stations. At least let Americans produce them instead of sending them to China.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, in 1965, a program called Medicare was incepted. It was offering health benefits to those over age 65.

At first, physicians were very suspicious of allowing so much government intervention in medicine. After a while, more and more physicians doing their duty to take care of patients accepted it.

The sad fact and the problem is that Medicare now is what they, in 1965, were very afraid of, that so much of government has gotten into medical issues.

This is the main problem. Medicare does not reimburse the cost of care for patients. This is a real access issue. We are not really talking about paying physicians. We are talking about access to care.

This year, CMS is proposing a 3.37 percent cut to the physician fee schedule. It would be about a 20 percent cut over the last 20 years.

Doctors want to see Medicare patients, but they simply won't be able to, and this is going to affect access to care.

Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Joyce), my good friend who is board-certified in internal medicine and dermatology.

Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess), one of the doctor co-chairs. He has been a stalwart in the Chamber for 20-plus years as a physician, a retired OB-GYN.

Mr. Speaker, it is about access. Physicians want to see Medicare patients, but if you do not pay the bills, they can't keep the doors open.

Mr. Speaker, I yield to the gentleman from Ohio (Mr. Wenstrup), my good friend and a board-certified podiatric surgeon.

Mr. Speaker, we are experiencing a doctor shortage, and it is going to get worse and worse, driving physicians out because they no longer are able to be paid for their services or forcing them into employment that destroys the historically great quality of medicine in America.

Mr. Speaker, I yield to the gentleman from California (Mr. Panetta), my good friend from the Ways and Means Committee.

Mr. Speaker, as you can see, this is obviously a bipartisan issue. We care about our constituents, but we also care about the health of our constituents.

Mr. Speaker, 10,000 Americans each day are added to the Medicare rolls. Again, with such a doctor shortage, you are adding more and more individuals where Medicare doesn't pay their bills, and it is harder and harder to take care of them.

Mr. Speaker, I yield to the gentleman from California (Mr. Bera), another physician friend of mine from the great State of California, to discuss the difficult problem we are facing today.

Mr. Speaker, the gentleman points out a perfect issue. We are depriving access to patients and developing more and more concierge medicine, which is wonderful for those who can afford it, but for those who can't afford to go and see one of these cash doctors, and you can't get into a doctor's office because they can't take more Medicare patients, guess what happens? They get driven to emergency departments where a more costly care goes on.

We have to stop this nonsense.

Mr. Speaker, I yield to the gentlewoman from Washington (Ms. Schrier), a pediatrician.

Mr. Speaker, if you owned a hardware store and sold hammers that cost $1 apiece but you had to sell them for 40 cents apiece, how long would you sell hammers?

You wouldn't sell them very long because it just doesn't make financial sense, and you literally can't just give money and walk money out the door.

Unfortunately, this is what is happening with Medicare patients. Physicians want to take care of their patients. They are caring individuals, but when the numbers don't matter, you just can't do it.

Mr. Speaker, I yield to the gentleman from Georgia (Mr. McCormick), and emergency room physician, to talk on this issue.

Mr. Speaker, may I inquire how much time I have remaining?

Mr. Speaker, I have seen Medicare patients for more than 30 years. I have had individuals come in my office after I have operated on and cared for them in the hospital and apologized, flat out apologized for the lack of payment that we received from Medicare.

I tell them I do it because I love operating and taking care of people, but there comes a point where you have to keep the lights on, you have to pay your nurses, and pay your mortgage.

Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs. Harshbarger), a doctor of pharmacy, to talk about the ridiculous cuts that are facing our colleagues as physicians.

Mr. Speaker, we submitted a bill, H.R. 6683, a couple weeks ago, and while ENC was able to keep the cut at 1.25 percent, we are actually desiring to not allow the cut at all. We are taking money from the Medicare Improvement Fund, which is what the money is for, to solve problems within Medicare.

Unfortunately, as this was a wonderful bipartisan discussion this evening, we are oftentimes imprisoned, if you will, sometimes to the will of some of the leaders over in Senate, sometimes even here in the House.

Leaders over in the Senate didn't want anything for a doctor fix. The Democratic leader said, no, we want this huge wish list of things done, and we will trade that for the doctor fix.

Well, guys, you can't take poison pills to try to help physicians. This is where there should not be politics whatsoever. We saw both sides tonight, Democrats and Republicans, speak about the healthcare of patients in this country.

Mr. Speaker, at some point it is going to snap. At some point, whether it be what Obamacare was trying to do, absolutely starve private practice so that everybody would either be bought out by private equity or have to be assumed by hospital systems. Where, by the way, physicians don't work as efficiently, physicians cost more, and they see fewer patients. It is a closer ownership care of patients.

When I was practicing full-time, if another doctor called me and said, hey, can you see somebody? My response was always: Do you want me to see them today or tomorrow?

The sad fact is once physicians become employed, not only do they cost more to the system, but the work ethic is not as good. That is just point-blank what is seen.

What we need to understand is that private practice is the most efficient way of delivering healthcare in this country, but it is also the one where we care the most, and we follow up. We are always happy to see that next patient and make sure that we keep our doors open.

At this point, Mr. Speaker, we are going to approach a calamitous cliff, if you will, in the next 3 to 5 years with the number of surgeons that are available to take care of patients.

I am a urologist. I take care of disorders of the kidney, prostate, and bladder--those type of things. We are the most critically short specialty in the country.

Right now, the median age of individuals practicing urology is my age, the age of 60. If now we are not paying doctors enough to stay in business, they are going to quit. We are going to make a bad shortage even worse. We have to pay those who take care of patients what they need to be paid.

Mr. Speaker, I appreciate that this was a bipartisan discussion this evening, something that is easy for our leadership to fix. I ask that they do that.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I rise today to honor an incredible man and former constituent, the late Sergeant Juan Eric Cantu.

Sergeant Cantu honorably served our Nation as a member of the U.S. Army during the war in Vietnam with the 228th Aviation Battalion associated with the 1st Cavalry Division. He deployed to Vietnam from 1966 to 1968 and was a tail gunner on a Chinook helicopter and a fixed rotor mechanic.

He served as commander of Veterans of Foreign Wars, president of Vietnam Veterans of America Chapter 892, and a founding member of AMVETS Post 1111.

Additionally, Mr. Cantu founded the legendary GI Joe's Living Military History Museum in Kinston, which displays memorabilia, uniforms, weapons, and photos from all major conflicts starting with the Revolutionary War and became a place of comfort and solace for veterans to share their stories and heal their wounds.

Those who knew Mr. Cantu described three principles that best defined him: his legendary work ethic, his optimistic nature, and his love for his fellow veterans.

We honor him today. We remember him today. Sergeant Juan Eric Cantu was a humble servant, community leader, and remarkable human.

May he rest in peace and may God bless his family and friends.

Medicare Fee Cut

Mr. Speaker, I rise today in opposition to the proposed 3.37 percent Medicare fee cut. When a physician sees a Medicare patient, they do so out of the goodness of their heart. They care for the patient. It doesn't make financial sense.

When you see a Medicare or Medicaid patient, you actually lose money. It

costs more to see patients than you are getting for the cost of care.

When I ran a private practice, I stayed up many, many nights, Saturday nights, trying to find out how to squeeze out money--to find each paper clip, make sure that we knew where the staplers were--just to make sure that we made payroll and that we paid the light bill.

Oftentimes I did not take a salary when we could not do that, but that was private practice. We were our own destiny. We knew how to take care of patients. We had an ownership in patients.

When adjusted for inflation over the last 20 years, the Medicare fee schedule for physicians has been cut by 20 percent.

What other profession expects to be cut year after year rather than receive raises, especially during this inflationary period?

One of ObamaCare's directives was to starve private practice, to force them, to drive them into employment. My former practice is employed now by a hospital. They have done well, but this is an entirely different tenet with patient care.

Physicians are being cut every year in their pay. Hospitals, albeit smaller, get raises every year.

While this still may not be much to carry the cost of care in these hospitals, but why are the people who are providing care to the patients the ones who are being cut?

Why is this a bad model?

It is because I think employed physicians tend to be a different bird from private practice physicians. They tend to be more working on the clock, they tend to decrease efficiency, and they actually increase the cost of care.

There is much more ownership with private practice physicians. When a private practice physician comes into a community, they establish roots, and they become part of the community. They join churches, and they join civic groups.

Unfortunately, the employed physician model as we see it now is much more transitory. There is a contract, and if that doesn't work out, then they move in 3 years. Then patients are left in the lurch. My doctor--it is always my doctor--took care of me for 20 years. That is starting to stop; that is ceasing.

The Medicare fee schedule cuts must stop. This is why I introduced H.R. 6683, the Preserving Seniors' Access to Physicians Act. The legislation stops this year's cut while we work on a permanent solution.

Mr. Speaker, this is one of the reasons I came to Congress: to fix Medicare. We are experiencing a critical doctor shortage now, but it is going to be off the cliff in 3 to 5 years, especially with surgeons.

No other profession, as I just said, expects to be cut every year rather than get raises. Every day now we add 10,000 new patients to Medicare. Imagine a hardware store, Mr. Speaker, where you bought a hammer for a dollar, and you were paid 60 cents. It doesn't make sense.

Mr. Speaker, I ask my colleagues to support the bill.

Mr. Speaker, I rise today in opposition to the CMS' proposed Medicare cut of 3.37 percent.

Just to put this in perspective, when a physician sees a Medicare patient, they do it because they care about patients. They do not do it for money, because it doesn't make financial sense.

Let me give an example here.

You own a hardware store and you want to sell hammers. It costs you $1 for each hammer. Say, the hammer is on Medicare, or you have to buy the Medicare, and you have to sell it for 60 cents.

How long do you stay in business? It doesn't make sense.

So as we move time and time and time again, the number of physicians who are able to take Medicare patients, out of the goodness of their heart, is falling and falling. You actually lose money on Medicare or Medicare patients that has to be taken up through cost shifting for regular insurance.

When I ran a private practice, I stayed up many, many nights, Saturday nights, searching for paper clips, making sure that I knew where every penny went. I just had to make sure that my staff and the bills got paid before I ever got paid.

My practice was heavily Medicare, so I did not take a salary many, many times because the numbers did not work. In fact, adjusted for overinflation for the last 20 years, Medicare physician fee schedules have dropped 20 percent, and this is in light of the massive inflation we have had over the last 2 years; even worse.

Mr. Speaker, what other profession expects to get a pay cut every year?

This has to stop.

These are the people who are actually up in the middle of the night taking care of your grandmother who has appendicitis, taking care of your daughter, taking care of your child with a broken arm. They are the ones doing this, and here we are rewarding them because they basically have to take government pay patients by cutting and cutting and cutting.

One of ObamaCare's directives was to starve private practices to force physicians to work in hospitals or big conglomerations.

How did they do this? They cut their pay every year while hospitals, although not as much so, got raises every year.

So what does this do? It pushes physicians out of private practice because they can't pay the bills.

Mr. Speaker, I left my private practice when my partner said: We can't do this anymore. We are going to be acquired by a hospital.

Mr. MURPHY: We can't provide the care to the patients that they need.

Why is it a bad model? Private-practice physicians are different birds than employed physicians. It is just very simple. It is a well- known fact in medicine. Those employed physicians tend to be less efficient, cost more, and tend to work more on the clock.

Those who are in private practice put a taproot down in a community. They have stayed there, and they are someone's doctor for 20, 30 years or more. This is not happening now. They have made transitory medicine the rule, not the exception.

The cuts that are going to the Medicare fee schedule absolutely need to stop. This is why I introduced H.R. 6683, the Preserving Seniors' Access to Physicians Act.

This legislation will stop this year's cuts while we work on a permanent solution. This is not something that needs to happen year after year after year where we are cutting and cutting the people who actually take care of patients.

Mr. Speaker, I came to Congress to help work with my colleagues to help fix Medicare. We are facing an absolute calamity with the shortage of doctors, especially surgeons, in the next 3 to 5 years. Those who are reaching retirement age, instead of working like most physicians do, are finally throwing up their hands and saying, we are done.

Sadly enough, the ones coming out of medical school now--because of some of the processes now were not working hard enough--are not nearly coming out in the numbers and the efficiency to take the place of those retiring.

Every day, we now add 10,000 new patients to the Medicare rolls. You are expecting doctors to continue to take more and more Medicare, earning less and less and less. They are going to go out of business or have to go into employment, which we all know is a worse way of taking care of patients.

Mr. Speaker, I ask my colleagues to support H.R. 6683 and help us try to keep medicine back on track.

Thank you.