Dr. Gingrey, thank you, and it is good to be back. I, as you, enjoyed being with family, as I am sure most of our Members on both sides of the aisle did. And I also got the opportunity to view one of the greatest basketball games that has…
Dr. Gingrey, thank you, and it is good to be back.
I, as you, enjoyed being with family, as I am sure most of our Members on both sides of the aisle did. And I also got the opportunity to view one of the greatest basketball games that has ever been, which is the Final Four in Indianapolis, and my hat's off to the Duke Blue Devils and to the Butler team that played such a great basketball game.
One of the reasons I had for running for Congress, I was very happy in a medical practice in Tennessee. I was mayor of our local community, the largest one, Johnson City, Tennessee, the largest community in our district. But I knew that this health care debate was going to occur, and I wanted to be part of that debate.
Unfortunately, none of us on the Republican side were consulted, so we were only in the debate in a peripheral way. And the reason that I wanted to
be a part of the debate was to share some experiences that we had had in Tennessee over the past 17 years or so in our attempt to not only manage health care costs but to cover more of our people.
Tennessee is not a wealthy State. We certainly have one of the lower per capita incomes in the country, and we have a lot of uninsured people. So there was a good reason to try to do something for this.
We have several major medical centers in our State both in Memphis and Nashville, Knoxville, and the Tri-Cities area, where I live; and the idea was that we were going to have a plan in Tennessee that was going to have a competition, much like we heard in the public option, which this plan does not have, where various insurance companies would compete for your business, and when they would compete for your business, this would help drive costs down.
Well, what we did was we actually provided a massive expansion of a Medicaid plan. TennCare is our exemption for Medicaid. What this current health care bill does is massively expand Medicaid.
Now, remember, Medicare is a plan that has premiums which fund it. So there are premium dollars that a recipient gets now who has paid in just like you would for any other insurance plan, whereas Medicaid is not. It's an entitlement. So we massively expanded our entitlements. And how did we do that?
We had about eight plans that would compete for your business. In 1993, we had about a $2.6 billion program in our State. Ten budget years later, that has exploded to an $8 billion program; and in our State that was at that point taking up in 2004 about 35 percent of the State budget. Now, since that time, everyone realized that we couldn't continue on this pathway. Here we were in a plan that we would have been happy with 17 percent of our budget. It was 35 percent of our State budget.
So what did the governor and the legislature do?
And, by the way, our governor is Governor Phil Bredesen, who is a Democrat. He has dealt with this. He has a business background and also has been in the health care business himself.
What we did initially was cut the rolls. We cut about 200,000 people from the rolls of TennCare. And when that didn't prove enough, this particular year during this recession, we have had to resort to some more drastic measures. It hasn't been completely worked out yet.
But we also found out, Dr. Gingrey, that during this time--and I am going to, during this hour, predict what I believe will happen with this plan that we've just passed. I have seen it happen in Tennessee, and I believe it will happen again with this plan. What happened was 45 percent of the people who ended up on TennCare had private health care insurance and dropped it and got on TennCare. Why did they do that? Why did they go on the government entitlement?
Well, it was a perfectly logical reason why they did that. They did it because it was cheaper and it offered first-dollar coverage. It offered prescription drug coverage, unlimited doctor visits.
And what did we get for spending this much money? We got the highest prescription drug use in America, number one in prescription drugs and 47th in health outcomes. So if we had spent the money and had gotten better health outcomes and better usage of those dollars, I would have supported it in a heartbeat.
The other thing that's not known and never discussed, you never hear it discussed on this House floor, are the pay-fors. And as you as a physician know this, and we're willing to do this especially in OBGYN because pregnancy is one of those things that you either are or you're not. So we accepted TennCare in our practice and always did because the patients needed the care and had to go somewhere.
What happened was that at the point that it started, it paid the providers, that is, the hospitals and the doctors, about 60 percent of the cost of actually providing the care. So those other costs, that other 40 percent was shifted to private insurers.
An example I will give you is, I don't know, 8 or 10, 12 years ago, our local hospital put an implantable defibrillator in. You know that's where if you have a heart irregularity and you have an arrest, this will restart your heart. The TennCare plan paid, I think, $800 to the hospital, and the device costs $40,000, just the piece itself, not the care to put it in, the doctors and so forth. So those costs were shifted.
What I predict will happen with this plan when you massively expand the Medicaid entitlement and those costs are not paid, those costs are going to be shifted to private insurers, and over time those costs will be so expensive that the private insurers are going to say, look, we can't pay that, we're going to have to drop it, drop private health insurance. And you're going to hear the other side say, see, we told you so. We need to take over the whole plan. That is exactly what is going to happen. This particular plan right here is designed to fail, and it will fail financially.
Now, will there be some good out of it? Sure, there will be. I mean, you can't spend a trillion dollars and not do some good. The question is, is this the right way to do it? And I believe that is the discussion that we have had this year.
And as you well know, the bipartisan vote on this bill was ``no.'' There were 34 of our Democratic colleagues who elected to vote against this bill and all of the Republicans voted against this bill. And it's not that Republicans don't have ideas. I came here, you came here, Dr. Broun, who has joined us, came with numerous ideas. The problem was we never got to share those ideas with anyone.
I thank the gentleman for yielding. And I think what we need to do, Dr. Gingrey and Dr. Broun, is, why is that a concern? You formed this very well. Why are we concerned about this?
And as I said, I believe this is designed to fail because we saw what it did to our local private insurers in the State of Tennessee, where we had about $1,800 per year shifted in costs. So those costs, it's a hidden tax.
What will happen is businesses now are struggling. And you know that the number one issue in this Nation right now should be jobs; number two, jobs; and, number three, jobs. Everywhere I went in the district this weekend people were fearful and worried about losing their jobs. They were underemployed or either not employed whatsoever.
So we have a system, when this Medicaid expansion occurs, what will happen is private businesses will get, not in addition to all of the taxes that are in here we'll talk about later; but this is absolutely designed to fail. And we're worried about it for what reason?
As physicians we're worried about rationing care.
I attended a conference at East Tennessee State University College of Medicine while I was home, and we had a look at the Canadian health care system, we had a look at the English health care system, we had a look at the VA, and we had a look at our system. All have plusses, all have minuses, all have problems.
One of the things that I listened and summarized in that is that our concern as a physician is that you will eventually, when you have this many dollars and you have more demand for services than you have dollars to pay for it, there is no other option but rationing care. It's happened in every system around the world, and it will happen here.
And my prediction is by 2020 is when we're going to really hit, about 10 years because this plan is phased in, if we don't repeal it and replace it, it's phased in over a period of years. And the reason I believe this is that's what I've seen in Tennessee.
The other part of this plan that's so similar that we've tried also is in Massachusetts. We have no preexisting conditions, and the Republicans had a perfectly good way to solve that problem. It isn't even difficult if you do this. Preexisting conditions are only a problem for the small group market, small business market and an individual.
And when I retired from my medical practice, I had a single insurance plan. If it had been tax deductible, it would have been 35 percent cheaper for me to own health insurance coverage; and high-risk pools, and let you go across State lines and form large groups. You can solve the preexisting conditions without mandates.
In Massachusetts they have a mandate, and there's a tax for a fine if you don't purchase health insurance. And without subsidies, without Federal subsidies, that plan in Massachusetts would be in terrible problems, terrible shape.
So what have we done? We have taken the Tennessee plan, which hasn't worked. And by the way, this year, Dr. Gingrey, we're going to limit patient visits to eight doctor visits per year in the State because that's all we can pay for. And all the TennCare plan will pay for your hospitalization is $10,000. I don't care what the bill is.
So you've got both. We're already rationing care with that system. You've got the Massachusetts plan that's also doing exactly the same thing. And those two together.
One other thing I want to mention before we get Dr. Broun in, actually two things----
I thank the gentleman for yielding.
I think the comment is a government large enough to give you anything you want is powerful enough to take away everything you have.
Just briefly on jobs before I go on with health care, three counties at least in my district of 12 have unemployment rates of 16 percent. I left one yesterday, spending the day there before I came back last night. And 87 percent of the people in the First Congressional District of Tennessee don't think the stimulus package has done them any good, and the reason they don't think it's done them any good is it hasn't done them any good. Their own view of it is it hasn't helped them, and I think they're right.
I know that we had a lot of discussions and a lot of jokes were made about death panels and so on. There is a provision--I would encourage my colleagues to read this bill, and I've already introduced legislation already. There is a panel. In this Senate bill--not in the House bill. The House did not pass this. But the Senate bill did in reconciliation. It's basically the Senate bill with a few tweaks is what got to the President for his signature.
There is a panel in Medicare called an Independent Payment Advisory Board. And before--you know, in this particular plan, the way we fund this, we're cutting $500 billion out of the Medicare plan over the next 10 years. And during the next 10 years, beginning next year, the baby boomers hit Medicare age. We're going to add 3 million baby boomers per year for the next 20 years. Actually, 78 million are estimated to be at Medicare age in the next 20 years. So in 10 years, about 35 million people will reach that age with 500 billion less dollars. And what we did as a Congress was we gave up our purse strings, our control of the purse strings on how Medicare dollars are spent for this Independent Payment Advisory Board.
Well, let me tell you what happens. When you have 35 million more people chasing 500 billion less dollars, this panel will use something called comparative effectiveness research. And we know what that is. We've already seen just the beginnings of it when we talk about, Well, you really don't need to have your mammogram until age 50.
Let me look the camera in the eye and tell people, Dr. Gingrey--and Dr. Broun knows this very well--I cannot tell you how many patients I have seen over the past years less than 40 years of age with no family history with breast cancer. And right now we begin screening mammograms at age 35, and almost every insurance company in the world pays for screening mammograms at age 35 and repeated at 40 and so on. If you have a family history, you get them more than that.
That's what they're going to begin using, and that's what's done in England right now, because they can't afford to pay for the screening mammograms. And you and I both know that we can feel a lump in a breast when it gets about 2 centimeters. And for those of you who don't deal in metric, that is about three-fourths of an inch. You can palpate that. Once a lump gets that big, some of those have actually spread.
So that's a panel that will decide whether you get a hip replacement, whether you have heart bypass surgery when you reach a certain age. We need to relook at that very seriously. And that's something that's not known to almost anyone, but I've already introduced legislation to repeal this.
And, by the way, there was a letter with 50 Democrats on this that also agreed with this before this bill was passed, and I urge my colleagues on the other side of the aisle to help us to replace this current piece of legislation.
I yield back.
I thank the gentleman for yielding.
Just some real-world experience, not textbook and not in academia. I'm
talking about out in my office practicing. The last year I was in practice--and something strange happened over 31 years. My patients got older with me, and they started developing things. I saw 15 breast cancers myself the last year I was in my medical practice. I could feel one of them. The rest of them were picked up on. I could not palpate the mass. They were picked up on screening mammograms. Now, that's something that will be done--and you know if you find that disease that early--it's one of the great stories, Dr. Gingrey, that I like to tell.
When I began practice--and all of us here are pretty close to the same vintage. When I began practice, 50 percent of the patients with breast cancer had a 50 percent 5-year survival rate.
Today, an early diagnosed breast cancer like that has a 95 percent survival rate. It's a wonderful story to tell. There is no reason for us to go backwards. I mean, it would be a tragedy of unbelievable proportions if we did that.
I think what we were told--and you saw lots of manipulations during this particular, incredibly complex bill about the pay-fors and how this is going to be budget neutral. Well, let's just go over some history of these estimates by the government.
Number one, when Medicare was established in 1965, it was a $3 billion program. It was estimated by the government--there was no CBO then--but it was estimated by the government that in 25 years it would be a $15 billion program. The real number, $90 billion, and today, over $500 billion.
Some of the pay-fors are the CLASS Act. I think this would make Bernie Madoff grin from ear to ear, and he probably is right now. The CLASS Act, unless you exempt yourself out of it, it is a payroll deduction to pay for long-term health care services, maybe a nurse in your home or assisted living or that type thing. Probably not a bad idea. And over the next 10 years, this bucket of money will be about $70 billion.
What this plan pays for is it is--have you heard this before? You are going to borrow the money out and spend it on health care, have a $70 billion liability out here that you call an asset, and leave that liability for future generations. We are also doing that with about $54 billion in Social Security. No money there. It is all spent. But my grandchild, who will be 17 in 10 years, will get the bill for that.
The student loan program; it was touted as a savings. And let me just take a minute, because I don't have much time, to let people know why is the student loan program in the health care bill? I mean, you should ask that question.
Well, the Federal Government took over the student loan program. There were two programs, of which 80 percent used the private sector. In the private sector, Dr. Gingrey, 80 percent of the loans were made for students. Eighty percent. I talked to the chancellor at Vanderbilt University in Nashville, Tennessee, a great university. He much preferred the private program, but it has been taken over by the Federal program.
They are going to borrow the money at 2.8 percent, lend it to our students at 6.8, call this interest that they make a savings, spend that on health care. They are not doing that to lower the costs for students to make their education less expensive. In Tennessee, it is going to cost our students about $1,600 to $1,800 over the duration of the loan in more interest payments.