John Fleming

Mr. FLEMING

Mr. FLEMING. I thank the gentleman. Great comments. And my experience, Dr. Gingrey, is the same as yours. The teletown halls that I have done on this subject in the last 6 months started out that 85 percent of my constituents were against this. Now it's up to 92 percent. Unbelievable. Let me just touch again on economics, and then I'm going to pitch this back. We have been joined by Congressman Broun also from Georgia. But first let me mention, let us talk about Medicare just for a moment. We hear the other side of the aisle continuing to complain that you're seeing this catastrophic increase in insurance rates, private insurance, and it has been going on for years. And, yes, it has been. It has been faster than inflation. No question about it. But if you look within that, what you find is that because Medicare pays well below break-even for a physician or a hospital and Medicaid pays even half of that, that you have tremendous cost shifting. So you have to raise something; something is going to have to go up to offset the costs that are not being paid. So, Mr. Speaker, in light of all of that, what we have in this bill is we're going to have a dramatic increase in Medicare and especially in Medicaid which is going to make those rates go up, that is, private insurance, even faster. But let's look for a moment at what are the economics of Medicare in this bill. This bill, at least the version we think we are talking about this evening, because we have not even seen the final draft of it and yet we are soon to vote on it, where does it raise revenue? It raises revenue first by taking a half trillion dollars out of Medicare. Speaker Pelosi today said--the way she was asked, How do you do that? And her answer was very simple: You get rid of fraud, waste, and abuse. We've had this program for 40 years and nobody has been able to figure out how to get any dollars out of fraud, waste, and abuse, much less a half a trillion dollars. So I don't believe that is going to happen. Number two, the $500 billion that we're talking about is earmarked to extend the life of Medicare which is going to run out of money in 2017. That is really 7 years from now. But it's also going to be used to help subsidize private insurance. The CBO wrote a letter last week saying, You're counting the same half trillion dollars twice, and to get it, you've got to take it out of something you can't take it out of. So really we're tripling down on the same money, which gives us an error of $1 trillion. So the economics, Mr. Speaker, of this are crazy. They're smoke and mirrors. They don't add up, and there are many other parts of this that we can get into as we go forward. But that is the fundamental problem, as I talked before. Utilization is going to skyrocket, which is not even measured for by the CBO. And then you've got the same dollars counted not once, not twice, but three times. So with that, I would like to welcome Dr. Broun, also a physician, a fellow family physician from the great State of Georgia, and I yield to the gentleman

Mr. FLEMING

Mr. FLEMING. That is correct.

Mr. FLEMING. The other thing is the idea that suddenly you can cover 30 million more Americans using the same resources. Nobody buys that. And finally, another way to say this is that there is going to be an increase of taxes on 25 percent more Americans; they are going to pay more taxes to cover 7 percent more Americans. The Americans are not buying that.

Mr. FLEMING. I think it bears noting that this bill defies common sense. We just talked about the fact that you take a half a trillion dollars out of Medicare, which is already struggling, and no one has ever explained in this year-long debate how in the world they are going to do that except to say fraud, waste, and abuse. But if we had the tools to do that better today, why aren't we already doing it? That is number one.

Mr. FLEMING. Yes. Absolutely. And just one last thing. The way they define emergency surgery in Canada is any surgery that doesn't at this moment save your life. What does that mean? Someone who needs bypass surgery, who has a 99 percent lesion in their artery, unless they are dying that moment, if they get bypass surgery, that is elective surgery. And we saw a recent example where a premier from Newfoundland literally came across the border to get his heart surgery because he chose the United States of America to get his care as opposed to his own homeland. We know people come from around the world. If they have the resources to get care here, they know where the best care in the world is. We've got problems, but these are solvable problems that we can use a scalpel to fix rather than taking a wrecking ball to the entire system and rebuilding it in a socialist view.

Mr. FLEMING. That is absolutely right. Furthermore, just as way of an example, we actually had people from Canada and from the United Kingdom, both patients and doctors, who came to testify before us. And they told us really crazy things that we would never accept in the United States under our system. One is if someone gets cancer, oftentimes they are told, we're going to watch it. We're going to watch cancer. That's crazy. Why would you watch cancer? You've got to treat it. But in their country, in Canada, in some places it is 2\1/2\ years just to get an MRI scan. Then you get in the waiting line to actually get surgery or treatment.

Mr. FLEMING. And if you multiply that times the number of women who get cancer, you are talking hundreds of thousands of women just in that range there.

Mr. FLEMING. Unelected bureaucrats.

Mr. FLEMING. Exactly.

Mr. FLEMING. Free enterprise. That is right. Free choice. The other is to have total government control. And then you are going to have to have long lines and rationing. Now, in the countries that have the latter, that is the long lines and rationing, and these are well-developed countries like Canada to our north, the United Kingdom, the difference in death rates from common cancers, breast cancer and prostate cancer, are unbelievable. We are getting extremely high cure rates, well over 90 percent here in the United States. Let's take breast cancer. Breast cancer affects one in six women. Let me say parenthetically, the other side over there talks about women's rights and all the things we need to do for women, but yet this, if we follow this pathway, we're going to have a lot more women dying of things like breast cancer because here is why. You look at the U.K., the United Kingdom, they don't pay for mammograms. And also the better chemotherapeutic drugs that can cure the more difficult cases of breast cancer, they don't pay for them. Why? It costs too much. It doesn't fit into the budget.

Mr. FLEMING. Let me address that. We were talking a moment ago about the fact there are two ways to save money in health care. One is to have the patient become a savvy consumer and make choices for himself or herself in combination with his or her doctor.

Mr. FLEMING. And then if I could just add to that, addend that, is in theory, well, that's nice; you can have whatever you want whenever you want it. The problem is that taxpayers ultimately end up paying for this, and at some point you run out of taxpayers. You end up with budget limitations. And so every country that's tried this gets back to the same thing. And the only way to control cost, when you have a third payer, a government or whatever, paying the bills, is to set some rate- limiting steps, and that's basically going to be waiting lines and, of course, rationing. And what I like to tell people is, look at Cuba. Cuba has universal health care. It's free. The problem is, it's not available. They have one colonoscope in the whole country. And you may need antibiotics, and it may be free; unfortunately, they don't have any antibiotics.

Mr. FLEMING. Yeah, absolutely. Tennessee had something called TennCare. It I think is a similar model to what Massachusetts has today and somewhat similar to what we're looking at here. And what Tennessee found is the thing that's really a reality that we all need to understand. And that is that if somebody else is paying the bills, then you're going to have an explosion of cost. When I'm in town hall meetings, this is the way I like to put it. I say, I have a credit card here, and of course it's a virtual credit card. It has a $10,000 limit on it. I'm going to give you this credit card, and you can take it to Wal-Mart or Home Depot or anyplace you want, but only buy the things you need. Nothing that you want; only what you need. And, you know, my question is, what do you need? And of course, the answer always comes back, well, I need a new shotgun because hunting season is coming up and I need some more camo, and I need, need, need. I need all kinds of things that I wouldn't pay out-of-pocket for myself; but if somebody else is paying for it, I'm willing to do it. So if you take that and apply it to this, and what I've witnessed over 30 years, when it comes to HMOs, capitated models, traditional insurance, no co-pays, high co-pays, what we find is that the more somebody else, a third party or insurance or government, is paying the bills, the more consumption occurs. And I'm talking about excessive consumption, far beyond anything that's actually needed.

Mr. FLEMING. Well, I thank the gentleman. I've practiced medicine for over 30 years and still have a clinic and see patients from time to time. You know, insurance companies are a bee in my bonnet too. You hear the other side of the aisle talking about how insurance companies are the bad people. They're to blame for all of these problems. Well, I can tell you, insurance companies have been a headache for me, but insurance companies are not the problem here. They are not the problem. And if you don't like the bureaucracy of an insurance company, which you point out very adroitly, you're a customer, and you can always change who provides that service. When you get into this, not only is it 10 times worse than any insurance company and far more powerful, but you can't change. There is only one provider. Now you might say, Well, there will be a number of insurance companies within the exchange, but these insurance companies will essentially become utilities who will simply take the administrative cost for profit and basically do the work of the Federal Government.

Mr. FLEMING. Yes.

Mr. FLEMING. Absolutely. And again, it was only a month or so ago that the Mayo Clinic--I believe their branch in Arizona--announced that they were taking no further Medicare patients. And that's under the current pay system.

Mr. FLEMING. Absolutely.

Mr. FLEMING. Well, if doctors and hospitals are under-reimbursed further--they're at their limit today. If the cuts go even further--and of course $500 billion is draconian by any stretch of the imagination; that's as much as the entire annual budget for Medicare. If you cut it that much, then doctors will have to opt out of Medicare altogether, and the senior citizens won't have doctors to go to.

Mr. FLEMING. Yes.

Mr. FLEMING. It will cut access off to them for health care, and I can prove it.

Mr. FLEMING. That is absolutely correct. And that is not considering Medicaid, which pays more like 30 cents on the dollar, which under this bill will increase by 30 percent. The number of people covered, that is.

Mr. FLEMING. The statistics show that the number one issue for Americans today is jobs, without question. And that health care reform, while it is important to you and me and all of the Republicans and everyone in the House, for that matter, it's only, like, number five or even lower than that on the list. Americans see that the imperative right now is to get jobs back, and we're using a job-killing bill. How in the world are you going to get private insurance if you don't have a job to begin with? A recent poll by CNN--and certainly I don't think anybody could ever claim that CNN is a hard-right institution--says that 75 percent of Americans feel that we should either scrap this bill completely, throw it away and forget about it, or scrap it and start over again. So the American people, as you say, three to one, don't like this bill, and they don't want to see it or hear of it again.

Mr. FLEMING. Well, I will remind the gentleman that currently physicians and hospitals are being paid 80 cents on the dollar, and the mystery that seems to be out there and very few people are addressing is--and you hear the other side talking about the rapid rise of private insurance costs. Well, one of the main reasons for that is to offset the shortfall in the Medicare payments to doctors and hospitals. So private insurance is having to make up the difference.

Mr. FLEMING. Well, I thank my friend from Missouri. You're absolutely right. But you know what's interesting? Everywhere I go, there are a lot of people around Capitol Hill today. I bump into people that I know, people who are just average, everyday people, and it's amazing how much they are keeping up with this even though it is getting boring. They know about this. This is not something that they're not tuned into, and that's for sure. What's interesting, the way I have a mental picture about this, is that this bill way back months ago was being pushed like a locomotive up a hill. And as it got closer and closer to the top, more and more problems began to come out. It weighted it down. Finally as the bill, both in the Senate and now in the House, is getting close to the top, it's lost so much momentum because of the sleazy deals, the Louisiana purchase, the Cornhusker kickback, the carve-out for Medicare Advantage in Florida. These things are turning the American people off, and it's really taking a lot of momentum out of the process. And on top of that is the shenanigans, the fakery, if you will, the smoke and mirrors way of financing it which is, again, $500 billion taken out of Medicare, although no one will actually explain how we can do without $500 billion from Medicare. Then that money is used to extend the life of Medicare, which is going to run out of money in 8 years. It's also used to subsidize the middle class entitlement of private insurance. So it's really the same money counted three times. One is taking it out of something we know good and well you can't do without collapsing the system. Two, extending the system. And then three, paying for other entitlements, and then adding the same amount again, another $500 billion in taxes. The American people are not buying this.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, over months of debate over the government takeover of health care, a growing list of terms created by the Democrats have been added to the American lexicon, terms such as ``Cornhusker kickback,'' ``Louisiana purchase,'' ``Gator aid,'' the ``doc fix,'' ``reconciliation,'' ``nuclear option,'' ``taxpayer-funded abortions,'' and now worst of all, ``deeming a bill passed,'' ``self- executing'' and the ``Slaughter solution.'' The Democrat House members carp that the American people don't care about the process. After speaking to thousands of Americans about this--not only do they absolutely hate this bill 3 to 1 and feel it will damage America forever, they feel the Democrat Party's arrogance of power is unprecedented in American history. Mr. Speaker, process does matter, especially when Members of Congress and a President get themselves elected to power on the promise of transparency and ethics, and then stoop to a system of bribes and creative parliamentarian procedures to ram through a government takeover of one-sixth of the economy, health care, merely to advance their ideology of incremental socialism, which is strongly opposed by the American people.