Thank you, Mr. Pallone. Here we are in Washington DC, the Nation's Capital and there is a good number of people tonight celebrating St. Patrick's Day. And for us, for you and I, it has come down to wearing green ties on the floor of the…
Thank you, Mr. Pallone. Here we are in Washington DC, the Nation's Capital and there is a good number of people tonight celebrating St. Patrick's Day. And for us, for you and I, it has come down to wearing green ties on the floor of the House tonight talking about health care.
But I was in my office, and I heard you talking, and I appreciate all the work you have done through so many years now talking about this issue.
I just want to share two or three stories, if I might, and they are somewhat personal stories. As you know, 3 months ago my wife had three babies, three baby boys, Wyatt, Sullivan and Aubrey, in addition to our 2-year-old boy, Penn Snyder.
Then shortly after the delivery, about a week later, my wife ended up in the coronary care unit and had an extended hospitalization of about 11 days. So I remember going back home one day, running back from the hospital and talking to one of my neighbors. She said, ``How is everything going?'' And I said, ``Well, two-thirds of our family of six is in the intensive care unit,'' because I had three babies in the neonatal care unit and my wife in the coronary care unit. I thought, okay, that's quite a burden for a family.
But my wife has insurance, she is a Methodist minister, she has good insurance through where she has worked. You and I are Federal employees, and we have insurance. We pay for our insurance like all Federal employees do. We have good insurance.
And one of the things I did not worry about during that period was who was going to pay the horrendous cost of the incredibly good care that we can get in this country. So all evening my wife has been sending me pictures of our four boys out on the lawn wearing green outfits with shamrocks on them, I guess just to brag about how nice the weather is in Arkansas this evening. But it brought home, here we are 3 months out and everybody is doing great and she is doing well.
Last week, I met with a young women that I think if anyone in Congress would meet with, we would say she is just a gifted young woman, a medical student in her mid-20s, in her final year of medical school making decisions about where she is going to do her residency. We got to talking about some of the issues of medical students like they have got too much debt.
We are expecting them to pay for all this in medical school on their own. They are ending up with tremendous six-figure debt coming out of medical school. They don't get paid a lot as residents.
But in the course of the discussion it came out that while she was a medical student she was diagnosed with insulin-dependent diabetes and, of course, she is in a medical school. She knows where good resources are. She is at the best resource in Arkansas, except the health insurance that she has, by being a student, doesn't cover the cost of an insulin pump.
So she doesn't have it, and five shots a day doesn't give her the kind of control that we know helps prevent long-term problems. So here is this wonderful young woman, gifted young woman. She is our future, she is going to be taking care of you and I. And yet we, as a country, are not taking good care of her, even though she is in one of the medical centers of the world.
So I contrasted what happened with my family and me, and we do have health insurance, with what happens with a person who has health insurance, but it's just not the kind of coverage that they need. So I applaud you tonight for talking about this topic. I hope that we will make the kind of progress that you have been yearning for probably a couple of decades.
In the olden days, I was a family doctor before coming to this job here, and I always remind myself, people always come to me and say, oh, you are a doctor, you understand all this about health policy. I said, no, I used to do sprained ankles, nosebleeds and urinary tract infections. Health policy is that kind of mysterious nebulous world that many, many people don't understand. We are health care providers, we are patients, we are family, we are business people who try to go provide for our employees.
But we have this opportunity right now for all of us, whether we are providers or patients or business people or legislators or business people, to get up to speed on these topics. Because I think there is a real opportunity, with the mood of the country, with the international challenges we face from our economic competitors, that don't have the same kind of health care plan that we do and with the commitment of President Obama and his administration to do something.
I also think this really needs to be worked through with all components of our country. We talk about being across the aisle. Across the aisle is fine, but we need the business community and the providers and the hospitals and the insurance companies and patients and providers and all the advocacy groups and the research advocates to come together as best we can.
This is not going to be a 435-0 vote on whatever we do, but as best we can to listen to each other and move ahead. I think you gave an excellent outline on the kinds of issues that we need to be talking about.
But I believe that it is a very doable challenge that we have. I commend you for talking about this this evening.
I have seen that myself as a family practice doctor. I never owned a clinic, I worked at other people's clinics and met some wonderful people. But health care providers are business people too. They have got to pay their employees. Some health care programs don't reimburse as well as they would like.
Some clinics are in places that they may end up giving free care or have a group of patients that are not able to pay so well, and so it's like any business. It can be a strain to find the money for health care. It's one of the challenges we have to have.
You mentioned the economic issue, the one of our ability to compete internationally. I think that's an important one.
I want to also mention the national security issue, and I don't think this one has gotten as much attention as it probably deserves. We have had a lot of discussions about, you know, mental health coverage for our young men and women that come back that we think needed their families. The reality is we are expecting the military health care plan, or military health care programs and the VA health care programs to solve a national problem, which is we do not have a good network of mental health care in any of our States, particularly rural areas. But it's just difficult to find the kinds of providers you want for that kind of care.
I want to go before they go over. We had an issue, when we first started mobilizing our troops to go to Iraq and Afghanistan. When we were mobilizing our reserve component forces, about one-third of our troops were on some kind of a medical hold.
Now, a lot of it was for dental, a lot of it could be taken care of reasonably quickly. But the reality was, we had a situation. These are men and women who have been going on their weekends once a month for their training.
They go every 2 weeks in the summer and yet they are showing up on mobilization orders. We are finding out that they were not, under military standards, medically fit to be mobilized. I think for a lot of us that were on the Armed Services Committee, that was a bit of a wake- up call too.
Because one of the issues for dental, although I was in medical and not dental school, I actually think my teeth are part of the body and should not be divorced from the whole system, because we know it has tremendous ramifications on the overall health. Dental health is part of this overall picture.
And here we have a situation where you make a pretty good argument, our national security efforts were slowed down and more inefficient because of the kind of health care plans that we have.
Now, having good health insurance doesn't necessarily get everybody to the dentist, but I guarantee you, if you don't have good health insurance or dental insurance you are much more likely not to get preventive care. So that's an issue too.
I took my little boy to the State Fair in Arkansas this year. Me and my littles boys. Anyway, we're walking down the Midway and a couple were coming the other way in the crowd there, and he was a paraplegic in a wheelchair. And he stopped me. A very polite young man. And he obviously had had some significant health issues that he was dealing with--had been dealing with.
But he said, Man, is there anything you can do to help me with this. And he had an obvious need for dental work. But here's a man you would think would be in the system somehow--our system. But it just pointed out once again the inadequacy of the coverage in the country that can do the best job of solving his problem if we get him to the right person.
I want to bring up another issue, and I think it's one that you have had an interest in, too, and it's the issue of medical education. I think it's one that we will need to pay attention to as we go through the very important democratic process of looking at changing our health care system.
We need to be sure that we recognize at our hospitals that are involved in medical education that it is more inefficient and more expensive to teach while you're doing something. It is much quicker for a doctor, an experienced doctor, to come in and see the patient and get on to the next patient.
We have to recognize that there are additional costs for our teaching institutions. We make allowances for that through some of our government health care programs, probably not as well as we could or should, but it's certainly something that we need to watch to be sure that our teaching institutions, whether it's for nursing or doctors, that we recognize that there is an extra expense and inefficiency for them to provide the kind of quality teaching that takes additional time to sit down, not with the patient, but with the student.
It's particularly a poignant issue for you and me, Mr. Pallone, as we get older, because a lot of our doctors are going to be retiring and we are expecting these generations coming to take care of this big swell of the aging population as the Baby Boomers retire. So it's really important.
We are not going to get to where we want to go though in this process of doing health care reform and trying to find ways to save money, which we all want to do, if we don't recognize the cost of medical education.
I think this issue of the health information technology is really important. I notice that since the bill passed and the bill has been increasingly studied by people in the press and policymakers, that the health IT part, the health information technology piece of that bill, is starting to get a lot more attention.
There's been articles in the papers in the last couple of days. Wal- Mart is starting to look at doing some things.
The challenge--I mean, I'm somebody who most of my career was working for doctors who had small practices. And so there have been hospitals that have moved in this direction, large practices have moved in the direction of having a modern electronic medical record.
The problem has been that most doctors are in small offices of maybe one to five or six people. When the studies have been done about what does it take for that kind of an office to move to an electronic medical record, the kind that most patients will want, it takes several months from the time they start until it's where they want to be.
It takes several months to get back to that same level of efficiency as seeing patients; the installation, learning the new ways of doing things, just figuring out how to do things.
Now everyone recognizes, even the ones who don't have it, that ultimately it makes it more efficient, it's safer for their patient, safer for them because no doctors want to make mistakes, nurses don't want to make mistakes. There's nothing worse than having to have a clerk sit there and Xeroxing medical records off because you have got a patient that you have had for 40 years that's moving across the country. You can do it electronically and it just moves things.
I think the money that is in this bill is really going to motivate both physicians, physicians' offices, the folks that manage their practices, but also those kinds of business people out there who say, Wait a minute. Here's a chance to move America forward, to invest in our health care infrastructure and, by the way, create some new jobs, make some money for my business, and do some good things for the American people in anticipation of these changes that I hope will come in our health care system as part of President Obama's proposals. So I think that is very exciting.
I was talking to one of my Republican doctor friends who voted against the bill. I certainly understand his reasons for voting against the economic recovery bill. But I said, I want to know, what do you think about the health information technology piece? He said, Oh, I like that. He might quibble with little details of it.
But we have liked the bill before, as doctors. The problem has been for the last several years is finding the money to pay for it, and the opportunity came along through the stimulus package. And I think this is a real opportunity to be a good investment in the change that our health care system needs. So I find that very exciting.
I want to say a point about prevention. And I recognize that I am probably in the minority on this view. My own view is that we ought to not sell preventive measures, which I think are so important, but I think we ought to not sell them or oversell them as ways to save dramatic amounts of money.
My own view is that prevention is a quality of life issue. If I can work with a patient when they're 25 years old to get them to stop smoking, I know, I know their quality of life is going to be better. I know there are diseases they are not going to get when they quit smoking or if they never start smoking because of good health education programs when they're 16, 17, and 18.
Now, where I have a problem with this prevention-saves-money argument is if somebody lives to be 90, I know at
some point they are going to need health care. But, God bless them, that is a good problem to have. I would so much rather deal with the infirmities of a 90-year old than the emphysema and COPD and heart disease of a 45-year old who smoked for 25 years, since they were 20.
So I have a little different view on that. I think you can find arguments on both sides. But I don't think that we should ever be defensive about saying, You know, some preventive things cost money. But the quality of life, if you can keep a family from losing a family member from cancer, if you can cut down the number of kids that go to emergency rooms because their parents smoke, or whatever it is, it's a quality of life issue, and that can really turn into additional years of life and the pursuit of happiness for that family in this great country.
So I'm pleased that prevention is part of this.
This will be a true confession here tonight about a mistake that I made practicing medicine one time. It was about 15 years ago, I had a young boy, I think he was about 7 or 8, kind of a quiet boy, brought in by his grandmother. And he was there for a cold or something. I dealt with his cold or ear infection.
Then his grandmother started talking about some behavioral stuff he was having. We talked about it for a few minutes, and I didn't have much to offer.
It was like about 2 months later I was reading an article about Tourette's syndrome. And I thought, That's what that little boy had.
Well, the clinic I worked at had a wall about as big as the wall behind the Speaker here tonight that was all handwritten medical records. One of my nurses aids and I--we did it on Saturday because we were slow enough when we worked on Saturday, we could do this--we began systematically going through every one of those handwritten charts to see if we could find that little boy because I was going to call his family and say, Hey, I think I figured what you were talking about with this little boy. The reality is in Tourette's syndrome a lot of time they are underdiagnosed and, unfortunately for the family, it takes a while to sort it out sometimes.
We never did find that chart even though we systematically went through every handwritten chart. Well, if we had had a computer system we would have been able to pull up the names of appointments seen in the last period of time or probably could have pulled it up by approximate birth date.
There's so many tools that a good health information technology system gives you for the benefit of patients.
Efficiency of doctors, more prompt payment of doctors, less mistakes, but ultimately it is for the benefit of patients; and I think that is what you were talking about, looking ahead to doing things differently, doing things better. It is not just figuring out how to pay for the kind of care we are getting now, but it is better care in the future as part of this. And I think that is important.
It is interesting, we have a good number of physicians in the House now.
Physicians have figured out more and more, number one, that this Nation wants us to do something about health care. And I always tell my doctor friends, we can either do it with you, or we can do it to you. And most doctors have figured out they would like to have it done with them.
The other thing, though, is, and I have clearly seen this change in the time I have been in medicine, doctors have figured out that the programs that help people are the programs that help doctors. So they are here to help make those programs better. Now, we may have philosophical differences about how to get there and how to pay for it, but we recognize that there is a role for government in trying to make sure that whatever that number is, 47 million, 48 million people who don't have health insurance over a year's time actually are able to participate in this system that we call American health care.
I want to ask about another topic, Mr. Pallone, medical research. We had a pretty good run there for a time under the leadership of Speaker Gingrich and President Clinton in terms of increasing the research dollars available for NIH. My own view of the last administration over the last 8 years has been very poor with regard to research, all kinds of research. There are, and I am talking now specifically about medical research, medical research funds in a variety of different budgets, from the military budget, veterans budget, NIH, agriculture budget, Department of Agriculture, they have research. Well, this is another place that is part of the kind of quality care we want for all of us. We need to be investing in that kind of research, because the reality is medical jobs are good jobs.
In fact, when you look at the numbers, as people have been losing jobs, the thing that stands out the most in terms of who is gaining right now is health care. It is kind of counter-cyclical. There are medical jobs out there that don't get filled that people will look at. Now, we need to do I think a better job of helping nursing home aides get paid and all. But there is a tremendous opportunity to create the kind of technology and new jobs and new treatments that this country can be selling all over the world, and we need to be the leaders in a lot of these things.
I think the whole issue of stem cells has gotten a lot of attention. Regardless of where you come down philosophically on the issue of stem- cell research, there is a ton of things out there that would benefit from more research dollars, and it has to be part of this picture, too. You mentioned the comparative effectiveness. That is probably too fancy a name. It kind of got bad-mouthed in some of the media when that bill came out. The reality is, why wouldn't we want to see what
works the best for the least amount of cost? We would do that as a family.
If I go in to my doctor and he said, here is my prescription, it is $180. And I say, well, is there anything better? Oh, yeah, there is a generic. It is like $14. Why don't I take the generic for $14? I mean, why not go for something that would work as well, perhaps even better, but be dramatically less expensive? I mean, we all are responsible as a country for these health care plans and making sure we pay for things. And somehow the idea that we would actually want to pay attention to what things cost and what works and what doesn't work, and are we prescribing things that we don't really need? I mean, that is just common sense, and I think families want that. They don't want us to prescribe things that are not effective or there could be something cheaper that would work just as well. So I think that is part of this picture.
Maybe I am making the universe bigger than it needs to as we are talking about health care and health care coverage, but it is all part of this investment in our future. And medical researchers will do better with a health information technology system. Those people who are responsible for paying the bills, who are processing claims will do better if that health IT system is more efficient. All this stuff builds on each other. Ultimately, we want to lead to better coverage for the best price that we can give.
We also have learned in a very difficult way for a lot of American families the challenges of what happens to our men and women in uniform overseas with the traumatic brain injury and some of the kinds of injuries that have occurred. And what happens in every war is, sadly, we have opportunities to learn new things and get better at treating these. And there are some real opportunities of helping these families in terms of looking at traumatic brain injury and how we respond to them.
Looking over the long run, we are just a few years into this thing, what impact will this have on their lives 10 years and 20 years and 30 years and 40 years from now? And what opportunities will there be for them 10 and 20 and 30 and 40 years from now depending on what we do in terms of investing in research? And we have had these discussions before, both in the Armed Services Committee and the Veterans Services Committee. There are research projects out there that can be funded if we have adequate funding for them. And that is not part of civilian health care for them; that is part of our responsibility as a government to be sure that we adequately fund medical research. And a lot of it is going to be done in our civilian facilities, also, whether it is medical schools or veterans hospitals. The research needs to go on, and it needs to be well funded.
If I might intervene for a minute. I think it is perfectly consistent for somebody to have been opposed to the plan in 1993 and be for something now. There is a broad spectrum of ideas out there. I am hoping that, and I think President Clinton would acknowledge, that we have learned from that experience 15 years ago, 16 years ago.
So I think that is a very important point you make, because we don't know what the ultimate product is going to be; but, hopefully, it is going to be something that will be shaped so you won't have somebody out there doing a huge media bite trying to kill a plan when the country is trying to come together to make something work. And I am not sure if everybody will be happy, but I am hoping that almost everybody can live with the ultimate result, because we all come from different perspectives.
May I close out my contribution here this evening. I want to tell you another story. And I appreciate your talking about this evening.
I began by talking about my four little boys who are age 3 months, three of them are 3 months and one is 2 years old, and how much we benefited not only from the quality of health care we had but also from the quality insurance plans that my wife and I had.
Over the weekend, Senator Blanche Lincoln had an event in Little Rock, and Vice President Biden was there and her family was there and there were a lot of people there. I was looking for her grandmother-in- law. Her grandmother-in-law, her husband's grandmother, is Mrs. Ruth Lincoln. Mrs. Ruth Lincoln is 111 years old. She is delightful. And I thought, well, surely she would be here. Well, she had fallen about a month ago and broke a bone I think in her pelvis. And I thought about that and felt badly about that, and then I thought later, well, of course I assumed she is going to bounce back from that, get healed up, and I am going to see her again. On her birthday she always does something special like cross the Arkansas River on a bridge. She always does a very special thing. And when you talk to her, she talks about how she loves growing old. She has loved growing old at age 111. And I think in a way that is what we aspire to through this health care reform. We want everyone to say, whether they are young with young children who benefit from our health care system, or people who go through the very frail years, that throughout they can say that I have loved growing old. Now, maybe we won't live to be 111, but if we all do this right, we will increase the chances of more people being able to have those kinds of long, long years.
I applaud you once again for spending this time this evening.