Phil Gingrey

Mr. GINGREY

Mr. GINGREY. Mr. Speaker, I thank the gentleman from Louisiana (Mr. Tauzin) for yielding me this time. Mr. Speaker, 35 million senior Members of AARP, 330,000 physician members of the American Medical Association who are providing care to hundreds of millions of Americans and 40 million Medicare beneficiaries, the American Hospital Association, the Rural Hospital Association, the United States Chamber of Commerce; Mr. Speaker, with so many for a prescription drug and Medicare modernization for our beloved seniors, who could be against it, and why? The answer to that first question is pretty obvious, obstructionist Democrats. And why? Because they are more interested in attempting to embarrass President Bush and the Republican leadership of this House than they are in doing the right thing, the compassionate thing. To suggest that this bill is nothing but a windfall for the pharmaceutical industry is like suggesting that Medicare Part A is nothing but a windfall for the hospital. Who is going to provide the prescription drugs, the chocolate chip cookie company? Give me a break. But I say to my colleagues on the other side, stop the alliteration, stop the bizarre logic, the Mediscare rhetoric. Vote with us, vote for our seniors and make this truly a bipartisan victory.

Mr. GINGREY

Mr. GINGREY. Reclaiming my time, Mr. Speaker, for just a moment, I wanted to touch on that point and maybe get the gentleman to elaborate, because I think he really, really hit the key point here, and that is that the major emphasis, as we understand the bill, the major emphasis is on those who need it most.

Mr. GINGREY. Mr. Speaker, I thank the gentleman from Colorado for being with us and helping to bring a little bit sharper focus on this bill. Because our seniors need to know, they need to be well-informed, and I think they are going to feel a lot better, those who have a little insomnia tonight and maybe had an opportunity to watch this late-night show on the medicare modernization and prescription drug act. Mr. Speaker, there are so many people that are supporting this bill, so many organizations. As I mentioned earlier, the AARP and 35 million seniors; the American Medical Association, which represents 330,000 physicians. But even more important than that, they treat 280 million Americans and lots of seniors. Listen to this letter. I want to real briefly read this letter. Real quickly, this is one from the United States Chamber of Commerce. Here is what they say: The United States Chamber of Commerce applauded word that House and Senate leaders, along with the administration, have reached an agreement to bring a Medicare conference bill to the floor for a final vote. Quote: ``With employers being the source of retirement health care for 12 million seniors, it is critical this bill allows businesses the flexibility to integrate the new prescription drug benefit to their existing retiree health benefits, while allowing opportunities to partner with Medicare. The Chamber is pleased this bill is nearing final approval and welcomes congressional and administration action to modernize the Medicare program and ensure its long-term viability for future generations. The final Medicare conference report is expected to include significant reforms to modernize the Medicare program structure and delivery system by emphasizing quality care, establish a much-needed prescription drug benefit, and offer preventive health care services and disease management.'' Mr. Speaker, in conclusion, as I said last night, this bill, this bipartisan effort; and yes, it is bipartisan, and we will have support on both sides of the aisle, this is all about compassion. We hear concerns about cost and certainly we are all concerned about cost and wanting to keep that down as much as we can. But this $400 billion new benefit under Medicare, I say this: it is going to only cost $400 billion if it does not work, and this is what I mean by that. You spend the money on taking timely prescription medications, and some of our neediest seniors need three or four pills a day, could be spending $600, $700 a month on prescription drugs. But if that will keep them out of the hospital, if that will prevent them from having a stroke; we heard earlier tonight from the Congressional Black Caucus talking about the fact that African Americans are more prone to have high blood pressure. Well, they ought to be so enthusiastic about this bill, we ought to have 100 percent support from the Congressional Black Caucus, because it is true, it is true that they suffer, particularly African American males, more from hypertension. And what happens? They end up in too many cases, far too many cases suffering from a stroke. What kind of life is that, no matter how long they live after, possibly not able to move one side of their body or utter a word. So as this President has said to us, Mr. Speaker, this is all about compassion and caring, and caring for the most precious seniors that are so important to all of us. So, yes, I am very excited. I will probably leave here in a few minutes and go home and lay awake for another couple of hours because I cannot wait to vote for this bill tomorrow. I am an OB/GYN physician, and I want to be able to say to my constituents and to the seniors of America, The real Dr. Phil, he delivered. Mr. Speaker, I yield back the balance of my time.

Mr. GINGREY. Mr. Speaker, it is good to be back tonight to talk on an issue that is really very, very dear to my heart. We have got an exciting day. In fact, I do not think I could even, though it is a late hour, I do not think I could go home and sleep tonight in anticipation of a historic moment tomorrow when we will finally deliver on a promise that has been made to our seniors, and that is a prescription drug benefit under Medicare. Mr. Speaker, I would like to start out by maybe addressing some of the remarks that I just heard made from the other side, and it is the kind of remarks which I would really refer to as ``Mediscare'' comments. I just heard the gentlewoman from Texas refer to the government not being able to set prices. I think that is exactly what the Democrats tried to do in 1993 under ``Hillary care.'' They wanted the government to set prices. They wanted a one-size-fits-all, essentially a national health insurance program, and the people of this great country rejected that. Another comment I have heard them say just repeatedly is this business about, well, who is going to benefit from this prescription drug availability for our seniors, who is going to benefit the most, and they keep saying, well, it is the drug companies, the evil, greedy drug companies. Well, of course, no duh. Who makes the drugs? Who has made this country the greatest Nation on Earth in regard to having access to life-saving drugs? The pharmaceutical industry. Who do we expect? Who does the other side expect to provide these drugs? The chocolate cookie company or the potato chip factory? No, it is the pharmaceutical industry, of course. Did they say the same thing in 1965, 40 years ago when Medicare was first enacted, that gosh, you know, we cannot do this, this program because who is going to benefit the most from Medicare part A, the evil hospitals, the evil skilled nursing homes; or who is going to benefit the most from Medicare part B, the doctors? Absolutely the doctors. They are the ones that provide health care. So this argument about the drug company being the big beneficiary, it is absolutely bogus. Sure they are going to provide drug coverage, sell more drugs certainly, but the price of those drugs, Mr. Speaker, is going to come down. Their profit margin per sale is going to be drastically reduced. So, again, we hear these arguments over and over again, and it truly is nothing but ``Mediscare.'' Another argument we hear, and we have been hearing it today, we will probably hear it all day tomorrow and as long as this debate goes on, is the Republicans want to take Medicare away; they want to destroy Medicare as we know it. Of course, they like to throw in the infamous ``P'' word. As far as destroying Medicare as we know it, let us talk just a little bit about Medicare as we know it and what my seniors in the 11th Congressional District of Georgia have told me about Medicare as we know it. It is a good program. It served us well, but it is not 21st-century medicine; and I say that, Mr. Speaker, because, first and foremost, there has never been a prescription drug benefit under Medicare. There has really never been any real meaningful, preventive care under Medicare. It is all episodic. If you get sick, you get to go to the doctor, and the visit is paid for. If something catastrophic happens to you, like a heart attack or a stroke, you get to go to the hospital, and you certainly have the benefit of that hospital stay. If you have a family history of heart disease or you have high cholesterol and you develop coronary artery disease, sure, you get admitted to the hospital; and there is some coverage for you to have that open heart surgery. It is the same thing for a diabetic patient who unfortunately under Medicare, many of those patients cannot afford to buy their insulin, cannot take their medication, glucophage, something to lower that blood sugar, to keep that disease under control. So they end up going to the hospital; and, yeah, it is paid for, if they have to have a leg cut off or they have to go on dialysis for years because of end-stage renal disease that probably would not have occurred if that diabetes had been checked with timely medication. So when my colleagues talk about destroying Medicare as we know it, I want to just say to my colleagues on the other side of the aisle and who are opposed to this bill in contradistinction to the opinion and the feeling of 35 million seniors who are members of the American Association of Retired People, the AARP, of which I am proudly a member, they can talk all they want to about burning their membership cards and sounds like back in the 1960s, the people burning their draft card or burning the flag. I mean, if they want to do that, that is fine, but I will guarantee my colleagues that the seniors in this country respect that organization, as we all do and should, because they have certainly delivered for seniors and have a proven track record, and we are not talking about an organization, Mr. Speaker, that is necessarily a bastion of conservatism, that is known for their deep and unending support of Republican issues. That is not true at all. We all know that. The other side knows that, but they are talking about again ``Mediscare,'' trying to scare people when clearly what we are trying to do is not destroy Medicare, but just improve it, improve it with a prescription drug benefit that is long overdue. The other way we are going to improve it, Mr. Speaker, is we are going to finally put some emphasis on preventive care. We are going to give our seniors a chance to get into a managed care system, an HMO or a PPO, really very similar, in fact, exactly what 435 Members of this House of Representatives and probably 100 Senators in other Chamber, the kind of health care they have. It would be interesting to take a poll and see what they do have. I will guarantee my colleagues, it will be 95 percent or higher have that kind of a coverage where they can go in or their wives or their spouse can go in and have screening tests done for high cholesterol, elevated lipids, osteoporosis screening, colonoscopies, timely mammograms. These are the kinds of things that until just recently none of that was covered under Medicare as we know it, and there still is not really any catastrophic coverage for part A and part B. Unfortunately, a senior goes into the hospital in any one episode of illness and can only stay a certain number of days. There is a very high copay, but once you have exhausted those days in the hospital or, God forbid, in a skilled nursing home, it happens so often, if a patient has had a stroke, then what happens to our seniors who have worked all of their lives to save up and hope and pray that they will be able to leave a little something to their children or more likely their grandchildren, so that their lives would be a little easier? For the seniors to lose all of that and end up in poverty and end up basically as a ward of the respective States because they have gone broke because of a long stay in a hospital or skilled nursing home, Mr. Speaker, there is something wrong with that picture. Democrats on the other side of the aisle, they can complain all they want to and try to scare our seniors and talk about taking away Medicare as we know it. We are not taking away Medicare. Traditional Medicare, fee-for-service, that option will remain. It will be there for our seniors, and I am sure there are some that kind of get used to the old system, and they may not want to change. I think we all understand that. Do not for a minute think that they will not have the option to also get this prescription drug benefit if they stay in traditional Medicare. That is what the other side is trying to do. They are trying to scare seniors into thinking that if they do not move into managed care or Medicare+Choice or advantage type program, that they will not be eligible; they will not get the prescription drug benefit. Mr. Speaker, we know on this side of the aisle, we absolutely know that that is not true. Again, this is one of the greatest times of my life, and I am so much looking forward tomorrow to this historic piece of legislation and voting enthusiastically for it and for its passage. Make no mistake, I feel every confident that it will pass, and I think at the end of the day we are going to have our colleagues from the other side, no, not all of them, but I think this will be a bipartisan-supported bill because I know that they love the seniors as much as I do. I am often asked in the districts, Dr. Gingrey, you had a great medical practice and you delivered all those babies, and do you miss it? The answer is, of course I miss it, absolutely. In fact, just yesterday on the floor of this House, my cell phone rang on the silent mode, on the vibrate mode, and I went out to take the call, and it was from the husband of one of my patients whose two children I had delivered. She is now pregnant with their third in about 8\1/2\ months and was starting to have some problems, and he just wanted to call Dr. Phil, even though she has got a great doctor, one of my former partners, back home in Marietta, Georgia. I talked to him, an old friend and a patient about his wife. It, of course, made me realize once again how much I do miss that, but this opportunity to come to the Congress of the United States, this 108th Congress and be a part of this great body and have an opportunity tomorrow to cast a vote, to give finally a prescription benefit and to modernize Medicare for 40 million seniors, a third of whom are probably living right at or below the poverty level, who have nothing, nothing, Mr. Speaker, to live on other than Social Security and no health care except basic Medicare. They cannot afford Medigap or their former employer did not offer a health care plan. So that is what it is all about. That is why I am so excited to be here, and even though I miss my practice, I feel in many ways that this is a high calling, and I am really proud to be here, proud of being part of this majority and working with the leadership of this Congress, with our great Speaker and our great leader and answering the call of President George W. Bush when he said, Men and women of the Congress, we have got to keep this promise. We tried so hard last year to do that, tried so hard to pass this bill last year, and it did pass the House with the Republican leadership, but what happened on the Senate side? It gets over to the Senate where the Democrats had control, and again, I heard one of my colleagues just a few minutes ago talking about, well, we need to send this bill back for more study, it needs more study. Well, we can study things to death. That is exactly what they did last year. They studied it to death, and we had no bill until we finally now have the leadership in both the House and the Senate, and I think we are going to get the job done this time. It is like the president of AARP, Mr. Bill Novelli, said, We cannot wait for a perfect bill. There are no perfect bills. Seniors need our help now. They have been needing it for a long, long time. And this business about waiting for the perfect bill is a total farce. This is a good bill. It is not perfect, but it absolutely is a good bill. Mr. Speaker, I would now like to yield to one of my colleagues and good friends, the gentleman from Colorado (Mr. Beauprez), who has worked very hard on this bill, and I know he is just as excited about its impending passage as I am.

Mr. GINGREY. Mr. Speaker, I am glad that the gentleman asked about that because in the hospital payment system, there has been this disparity for a long time. The rural hospitals and the rural physicians, those doctors who are practicing in an area outside of a metropolitan service area or a big city, they are reimbursed for the exact same service at a lower rate than a doctor who might be practicing in Boston or Atlanta or Denver, and there is just something wrong with that system. Again, that has been addressed. In fact, if the gentleman will allow me to read here, there are hospitals referred to as disproportionate share facilities, by that I mean a disproportionate share of Medicare and Medicaid patients in their population. Some of these hospitals are in small towns, and I know in my district and probably the gentleman's district, but I know for sure in southwest and northwest Georgia, the 17 counties that I represent, in some of the towns in the county, the hospital is the major employer in town. It is the only source of revenue and health care. When they are seeing mostly Medicare and Medicaid patients, and there is not much industry so there is not much good, private health insurance, they do not have full pay rather than deeply discounted pay that we have under Medicare and Medicaid, and if we continue to treat them in an unfair manner, not only does health care go away, but jobs go away as well. Here is one thing that I wanted to read in regard to what we are doing about this problem: ``The bipartisan agreement modifies Medicare's payments for those hospitals that furnish care to a disproportionate share of low-income and uninsured patients. Currently, the disproportionate share hospital adjustment paid to rural and small urban hospitals is capped at 5.25 percent. The bipartisan agreement increases the rural and small urban cap to 12 percent.''

Mr. GINGREY. As Members know, the gentlewoman from Connecticut (Mrs. Johnson) is the chairman of the Subcommittee on Health on the Committee on Ways and Means. What many Members may not know is her husband is a retired OB-GYN physician. She is very knowledgeable about this issue. I have told Members if they do not understand the bill, and it is 1,100 pages, parts of it are arcane, and it is not necessary for every Member to understand every bit of minutia, but of course they need to understand the things that are important, and the gentlewoman has been a great resource to me. In regard to medication, let me get personal. I had open heart surgery right after I won my election, just a month before we were sworn in. I think back and wonder if a senior, I am not there yet, I am getting pretty close, but if a senior at age 65 who was used to managed care and that attention, which has been described as prevention, not just episodic, let us say that they had the same kind of coverage that most Members of Congress have today, all of a sudden they turn 65 and Medicare, as we know it, and we have heard it before, we will hear it tomorrow, I am sure, and Medicare as we know it is taking over their care, and they have been on a cholesterol-lowering drug, we call them statins, or maybe they have been on something to prevent osteoporosis, and then all of a sudden they do not get that. All of a sudden they are on Medicare, and Medicare is primary. They do not have Medigap. Their employer did not give them health care in their retirement, and all of a sudden they are on Medicare and they have no coverage. Those are the very patients that were getting the benefit of the drug for osteoporosis prevention or to lower cholesterol. I am telling Members within 5 to 10 years, they will end up with coronary artery blockage. And when they go in the hospital then, sure, it will pay for open heart surgery. Or if they fall and break their hip and have an extended stay in the hospital, it will pay for that, but who wants that? That is why I have said a lot of times about this bill in commending the President for bringing this to us, this is compassionate conservatism, and I emphasize compassionate in its finest hour.

Mr. GINGREY. Mr. Speaker, it is my understanding too that in these accounts, that money that the gentleman described is growing at compound interest, the tax on that is deferred, and that this money of course can be used, as I understand it, for anything related to health. I mean, it can do the things that a lot of people are now spending money on for the so-called Medigap insurance. It could take care of that. It is my understanding also that one could pay for long-term care, to purchase a long-term care policy out of that account. Is that also the gentleman's understanding?

Mr. GINGREY. Mr. Speaker, as the gentleman points out, we are saying that this Medicare Prescription Drug and Modernization conference committee report of 2003, which we are going to vote on tomorrow, it is not just to the benefit of our seniors. Of course that is very important to provide this prescription drug benefit, as the gentleman pointed out, especially to the neediest. But it helps our younger workers as well, does it not? I think there are maybe 40 million, maybe it is 43 million now uninsured. I started to say unemployed, but the truth is 65 percent of the uninsured, no health insurance, are employed. They have got jobs. They are working hard. They go to work every day. But their employer, maybe it is a small shop, five, 10, 15 people, they cannot go out in the marketplace and afford to buy that policy, that first dollar coverage or $500 deductible. It is just too expensive, and they cannot individually afford to do it either. But this opportunity the gentleman describes is going to be a tremendous help to our workers at whatever age and, finally, they are going to get an opportunity to get health care. As the gentleman pointed out, or I heard someone say earlier in the week that in the history of the rental car industry, nobody has ever paid to have their oil changed. And, of course, what they are implying is that if you do not have some ownership, you are not going to be as good a shopper, you are not going to do the due diligence, you are not going to take care of yourself quite as well as if it is your money and it is growing and it is in that account, and you know that later on you might need that for, as the gentleman pointed out, long-term health insurance. So you are going to shop. You are going to go out in the market. You are going to make sure that you find the best doctors and the best hospitals. And just because they are lower-priced, that does not mean they are not good. In many instances, lower is better.

Mr. GINGREY. Of course, certainly.

Mr. GINGREY. Mr. Speaker, absolutely. The gentleman is asking about the choice issue, and that is what is so important. Mr. Speaker, back in 1988, we were not here. We just got here as freshmen. But I do remember when there was some attempt to include catastrophic coverage under Medicare. I think that was an important thing to look at. But the mistake that Congress made at that time is they passed a law that included, for the first time, catastrophic coverage. But there was no choice. All seniors had to have that coverage. Their Part B, Medicare Part B premiums just went through the roof. And there was much, much concern about that. We learn lessons. This program, this Medicare modernization and prescription drug program, is all about choice. It is all about choice. In fact, a senior, and I am sure some will, will decide to stay in traditional Medicare, something they have been used to; maybe they turned 65 20 years ago and they just do not want to go to the trouble, if you will, and get out of their comfort zone. They may decide not to even take the prescription drug benefit. Certainly they can; they have that option, as well as the option to remain in the Medicare fee-for-service, the traditional Medicare program. But as the gentleman points out, and I am so glad he asked the question, it is all about choice. We know that a third of our 40 million plus Medicare beneficiaries, they do not have any health insurance. They do not have that employer plan. They are not retired military. They do not have Tricare. They cannot afford Medigap insurance. Their only income is a Social Security check, and their only health coverage is your basic, traditional fee-for-service Medicare. So we are giving them the opportunity, and I think under the circumstances it is so important that the gentleman brings that up. That is what is going to make this program so successful. It is not a one-size-fits-all. We are not forcing anybody into anything. Now, certainly, I would love to see seniors, and when I turn 65, I am going to look very carefully at a managed care, Medicare advantage where I know that I can go and get disease management benefits and a lot of screening for things and, hopefully, some catastrophic coverage. So the gentleman is absolutely right. The keystone of this thing is choice, from start to finish.

Mr. GINGREY. Mr. Speaker, that is exactly right. The gentleman was talking about rural hospitals, and we talked about the disproportionate share, and I explained that, but let me just read a letter that was written to our Speaker from the Rural Hospital Coalition in regard to the gentleman's question earlier: `` Dear Speaker Hastert, The Rural Hospital Coalition, which is comprised of more than 150 rural hospitals in America, applauds your leadership in working in a bipartisan fashion to achieve a compromise Medicare bill. We support your efforts to modernize Medicare and give senior citizens a prescription drug benefit that they deserve. ``Most importantly, this bill strengthens health care in rural America. For that alone, you should be proud. ``We urge all Members of Congress to support the compromise Medicare Prescription Drug and Modernization bill. It reforms a Medicare system that has for far too long reimbursed rural hospitals at a lower rate than their urban counterparts for the exact same services. Passage of this conference report will give rural physicians, nurses, clinics, and hospitals a fair shake when it comes to the Medicare payments. It will create a financially stronger hospital for rural communities, provide more jobs, and provide more services. ``Thank you again for your leadership to get this legislation this far. The Rural Hospital Coalition appreciates your strong leadership on rural health care issues and looks forward to working with you to see it is enacted into law in the very near future. ``On behalf of the Rural Hospital Coalition, sincerely yours, William F. Carpenter, senior vice president.'' This is really exactly where we are. And I said when we began our colloquy that I wanted to ask the gentleman from Colorado (Mr. Beauprez) an important question as well. As a businessman, having been in the banking business and very successful in what he does, I wanted to get his opinion about the health savings accounts. There are a lot of things in this bill that people do not want to talk about; they do not want to talk about the good. They want to just kind of confuse folks with, as I say, ``Mediscare'' rhetoric; but there are so many things in this bill, we could probably talk about it for 2 hours. But would the gentleman tell us a little bit about health savings accounts and what he thinks that will mean to the uninsured in this country.

Mr. GINGREY. Well, Mr. Speaker, the gentleman is asking a great question. And, of course, what they are saying too, as the gentleman from Colorado has asked, is what is it going to do; what is this bill going to do to their patients? Not so much their bottom line, but the patients who are stricken with cancer. And, of course, a lot of those cancer patients have been here, have been to Washington, and some of them, God bless them, in the midst of their chemotherapy; having lost their hair and maybe not looking as good as they would like to look physically. They got on that plane, flew up to Washington, and a lot of them came along with their doctors and talked to us about that. They wanted to make sure that we understood that, yes, they agree that certain changes needed to be made in regard to how they were reimbursed for cancer care, but they wanted to make sure, though, that they could keep their offices open and continue to provide that community cancer care. Because if they could not, if they had to close their doors and be denied the opportunity to see those patients, where would they go? Would they go back to the hospital? I am not sure. I think it is very likely that many of them would not get care; would not get care in a timely fashion. So we have worked very closely with and we have listened to these patients, patients suffering from leukemia and breast cancer and bone cancer. We know, of course, that today there are medications that in some instances can yield a long remission for these patients and, with the help of God, occasionally a cure. Here again, years ago, when Medicare first started, there was no cancer chemotherapy. That just did not exist. And it would be a shame today if one of these seniors who is receiving chemotherapy, and that is actually one of few drugs that is covered under current Medicare Part B, because it is administered by a physician in an intravenous fashion, but if we did not have these kinds of benefits, what would happen? These patients would die, pure and simple. So we have listened to the doctors, we have listened to their patients, and the answer to the question the gentleman from Colorado is asking is, I think they are pretty satisfied. They are going to take a significant hit on this bill, but I think they understand that for the overall good, for the greater good, they are willing to make those sacrifices. So I think they are going to be fairly pleased with the bill.

Mr. GINGREY. Well, Mr. Speaker, I appreciate the gentleman stating that, but, of course, it works both ways, and the gentleman from Colorado is a former farmer and very successful banker and successful businessman. Of course, we physicians need to understand that we are businessmen and women, but far too few of us do understand that. I will be glad to answer any questions on the medical issues that the gentleman might have, but I am going to ask him some business questions, particularly in regard to the health savings accounts. And he knows a lot about that, having employed a lot of folks. But, yes, I will be happy to respond to any questions the gentleman might have on medical issues.

Mr. GINGREY. Well, the gentleman is so right, Mr. Speaker, and physicians who take Medicare patients really do so out of great compassion. I do not think they would be doctors if they did not love people and want to care for them. But, of course, as I just mentioned a few minutes ago, they are businessmen and women and they have got practice overhead, not the least of which, as the gentleman knows, is the high cost of malpractice insurance. We tried to address that issue, did we not, earlier, way back in February or March; trying to get some meaningful tort reform; just trying to balance the playing field? And we got practically no help from the other side. And with those kinds of escalating expenses and decreases in Medicare reimbursement, as the gentleman knows, I think the physicians were scheduled in 2004 and 2005 to take another 4.5 percent cut in Medicare reimbursement for each of those 2 years, on top of what has already happened in a downward trend when their practice expenses are going up. I have often said to people that ask me about this, the excitement about getting a prescription benefit under Medicare, and the reason why we cannot just do that as a stand-alone part D of Medicare, if you will, run by the government and price setting by the government, the reason we cannot do that is because we just cannot afford it. We literally cannot afford that. And if we do that, and we continue to cut the reimbursements to the physicians, what will happen is there will be no physicians out there, except in Medicare patients. The primary care physicians, the general internists, and these are the physicians who are on the lowest income scale of our profession, they are just going to throw up their hands and say we cannot continue to lose money doing this, and all of a sudden our patients, our seniors, have prescription benefits but nobody to write the prescriptions. So I am so glad the gentleman asked the question, because in this bill that is part of the modernization piece. We are going to make sure that we keep these doctors in the system. Are they getting rich off of Medicare patients? Absolutely not. The other side wants to suggest that there are winners and losers in this modernization of Medicare and the prescription drug benefit. I suggest to them that we are all winners. Very modest winners. The major one, of course, as it should be, are our seniors, and especially our neediest seniors.

Mr. GINGREY

Mr. GINGREY. Mr. Speaker, I thank the gentleman for yielding me this time. Mr. Speaker, once again we are debating a motion to instruct Medicare conferees. I find it odd that we are doing so after a bipartisan group of Medicare conferees has reached an agreement that has been strongly endorsed by numerous organizations, including AARP and 35 million seniors. This motion to instruct conferees, as the gentleman from Florida (Mr. Bilirakis) said, like so many that the minority has offered before, serves no useful purpose in this debate. It is a solution in desperate search of a problem. They are simply political tools used in a desperate attempt to divert attention away from the fact that the Republican House will, in a matter of days, deliver on its commitment to providing seniors with access to meaningful, affordable, and comprehensive prescription drug coverage. Mr. Speaker, I support properly reimbursing physicians and hospitals. The House bill does that, as does the bipartisan Medicare conference agreement, which is why it is supported by a number of organizations, including the American Medical Association, the American Hospital Association, and the Federation of American Hospitals. I also believe it is a false choice to suggest that we need to choose between properly reimbursing providers and finding a way to ensure Medicare's long-term financial viability, because this bill does both. The AMA agrees with me, and here are some of its thoughts on a motion that was offered earlier this week by the gentlewoman from Nevada (Ms. Berkley). ``The American Medical Association strongly supports passage of the Medicare prescription drug conference report, which currently includes historic and critical provisions for improving choice and access for Medicare seniors and disabled patients. ``In addition, the conference report would halt 2 years of impending Medicare payment cuts to physicians and other health professionals and replace these cuts with payment increases of at least 1.5 percent per year. ``Because the Medicare conference report includes these critical provisions for improving choice and access, the AMA strongly opposes the Berkley motion to instruct and urges Congress to pass the pending Medicare conference report before they adjourn.'' Let me just say this, Mr. Speaker. If the gentleman from Washington is serious about wanting to help our Nation's providers, let me suggest and urge to him to reconsider his opposition to medical liability reform legislation, tort reform, such as H.R. 5, the HEALTH Act, a bill that was strongly supported by the American Medical Association. Mr. Speaker, I am sure that the physicians in the State of Washington would be very appreciative of that support. While we should all be pleased about the fact that we are about to provide our seniors with Medicare prescription drug coverage, I would note for my colleagues that spending on Medicare is projected to nearly double over the next decade just as our baby boomers begin to retire. Social Security, Medicare and Medicaid currently comprise more than 40 percent of the Federal budget. By the year 2030, the General Accounting Office estimates that these three programs, once again Social Security, Medicare and Medicaid, could consume 75 percent of the Federal budget if we make no changes and we keep Medicare as we know it. This level of entitlement spending is unsustainable and it will crowd out other essential functions of government. Reforms must be made to ensure that Medicare continues to exist for future generations, the children and the grandchildren that the gentleman from Washington was talking about. As we add a $400 billion drug benefit to a program that already has $13 trillion in unfunded liabilities, we must enact real reforms that will place the program on sound financial footing for the future. To modernize Medicare and ensure its long-term fiscal viability, the bipartisan Medicare conference agreement will provide for a limited pilot project that will help test to see if the competitive reforms included in the House bill will help to ensure the long-term viability of this program. Under the bipartisan Medicare conference agreement as under the original House-passed bill, seniors retain complete freedom to choose a private plan or remain in the traditional as we know it fee-for-service program. Medicare will continue to offer every beneficiary with access to Medicare's defined benefit. Mr. Speaker, I strongly support the bipartisan Medicare conference agreement which we will soon consider on the House floor. This motion to instruct no longer serves any purpose and the gentleman from Washington knows that. Indeed, the provisions relating to Medicare competition that the gentleman references in his motion are not even part of the final conference report. I urge my colleagues to join me in rejecting this motion to instruct and supporting in a bipartisan fashion the final Medicare conference agreement.

Mr. GINGREY

Mr. GINGREY. Mr. Speaker, that is correct.

Mr. GINGREY. Mr. Speaker, I thank the gentleman from South Carolina (Mr. Wilson). I especially am grateful for him sharing that very personal anecdotal information with us about his son. Mr. Speaker, what the gentleman from South Carolina (Mr. Wilson) is talking about is so true, that medications that are available today we did not have in 1965. God forbid maybe if his son had had that leukemia in 1965, he would not be alive today. I know my mom who was suffering from cancer several years ago would not be alive today if it were not for the chemotherapy that basically completely put her cancer in remission. Just imagine now, just imagine someone that is in their late 60s or maybe even mid-70s that has no insurance coverage for prescriptions who comes down with cancer that could very well be successfully treated if only they could afford, if only they could afford to take a very expensive medication that would cure that cancer, put that cancer in remission, and let them continue to live and enjoy life. So that is why it is so important in this 21st century that we finally have a coverage for prescription drugs. It gives me a lot of pleasure at this point, Mr. Speaker, to yield time to the gentleman from Georgia (Mr. Burns), my colleague and friend from the 12th Congressional District.

Mr. GINGREY. Mr. Speaker, I want to thank my colleagues on this side of the aisle for joining with me tonight in discussing over the next hour one of the most important issues to come before this great body, this United States House of Representatives, probably in the history of the Congress, and I am talking about, Mr. Speaker, the impending passage of the bipartisan Medicare Prescription Drug and Modernization Act of 2003. Mr. Speaker, Medicare is a good program. Medicare had done a lot of things since its inception, of course, when it was first put into place almost 40 years ago, but it is not perfect. Medicare, although it is a good program, is not perfect. Two of the main problems, Mr. Speaker, with Medicare are these: number 1, it has never had a prescription drug benefit. Yes, it covers hospital expenses. Yes, it covers major surgery and, certainly, it allows some time to be spent in a skilled nursing home if that is necessary. But it has never had any emphasis on preventive therapy which, of course, is what prescription drugs is all about. Now, maybe back in 1965, when I was a freshman in medical school, we were not prescribing as many drugs. There were not as many lifesaving drugs on the market. In fact, back then, there was a penicillin antibiotic if you had an infection. There was a heart medication called digitalis if your heart was not beating properly. There was maybe codeine if you had a bad headache. But there were not the lifesaving drugs that are available to us today in the 21st century. Medicare also does not do anything about preventive care, and there is no catastrophic coverage, Mr. Speaker. Under part A of Medicare, after a patient has expended a certain number of days in the hospital for a covered illness, then everything is out-of-pocket, and the same is true for an extended stay in a nursing home. That is why so many of our seniors find themselves in their twilight years having to go on Medicaid, having to become literally wards of the State because of this lack of catastrophic coverage. So, Mr. Speaker, the main two problems have finally been addressed in the Medicare Prescription Drug and Modernization Act. We are finally going to deliver on a promise to our seniors and include under Medicare a prescription drug benefit, and also make sure that our seniors have an opportunity to get the preventive care and disease management they need. Mr. Speaker, not covering for a prescription and covering for major surgery is really akin to having a service contract on your car that covers to have the transmission replaced, but not to have the oil changed. It makes absolutely no sense. So finally, Mr. Speaker, we have come to the point in the history of Medicare where we have got to change, we have got to bring it into the 21st century. Other people, Members of Congress, the health coverage that we have, has a strong emphasis on prevention and wellness and, in the long run, this is less expensive. Certainly, managed care understands that, that it is in their best interest to keep people healthy. When we think about it, so many of us; in fact, most of our citizens who are on that type of plan, including probably all Members of Congress, they are used to that preventive care. They have that catastrophic coverage. And, all of a sudden, they turn 65, and Medicare becomes primary, and if they cannot afford, or if they do not have an employer-provided health benefit for a retiree or a very expensive maybe Medigap plan and they are just relying on Medicare, then they have gone from a coverage that gave them protection, that gave them catastrophic protection and, all of a sudden, at age 65 and beyond, they do not have that anymore, and that makes no sense at all. The point is, Mr. Speaker, that we have not modernized Medicare, and that is what we are going to do here within the next couple of days in this 108th Congress. I am very proud, as a Member and as a physician Member, to be a part of this historic time in our Congress. I am, as I say, very pleased that members of my caucus are here with us tonight in this late hour, but they understand the importance of this issue, and they understand the need to make sure that the public and, hopefully, some are watching tonight, especially our seniors, have an opportunity to see exactly what we are going to do for them with this passage of this historic piece of legislation. At this time, Mr. Speaker, I yield to the gentleman from South Carolina (Mr. Wilson), just across the border from my home State of Georgia, my good friend and colleague.

Mr. GINGREY. Absolutely.

Mr. GINGREY. I am so glad that the gentleman asked that question, and I have actually been speaking on the floor of this House for the last month on a weekly basis talking about that very thing that the gentleman speaks of. Physicians have been suffering severely over the last several years. They have taken deep cuts in Medicare payments, and the projected cuts for the next 2 years were 4.5 percent, 4.5 percent less per year in Medicare reimbursement at a time when their practice expenses, especially the cost of malpractice premiums, are literally going through the roof; and the answer to my colleague's question is that under this bill, physicians not only in the next 2 years will not suffer that 4.5 percent cut, but in fact, they will have a 1.5 percent increase.

Mr. GINGREY. Mr. Speaker, I thank the gentleman from Texas (Mr. Burgess) and the other Members for joining us tonight. An hour goes by very quickly. I think we need about three to really talk about everything that we need to talk about. In conclusion, let me say that we proudly support this Medicare Modernization and Prescription Drug Act of 2003. We talk about compassionate conservatism, and that is a pledge upon which our 43rd President ran, and he promised that we would deliver. And some pun intended, I might add as an OB-GYN, but the President promised, and this leadership promised, this Republican Congress promised that we would deliver. Finally, at long last we have overcome a lot of obstructionism to get to the day that we are going to deliver to American seniors, and they deserve it. It is compassionate because there are people in this society who through absolutely no fault of their own need our help, and that is what compassionate conservatism is all about. Mr. Speaker, I say this is its finest hour. Let us get this bill passed with support from both sides of the aisle and make this truly a bipartisan success for our seniors.

Mr. GINGREY. Another great question, and I am sure the gentleman from the 12th, from southeast Georgia, as he has had town hall meetings in his district all the way from Augusta to Savannah, is hearing the same concerns that I have been hearing. In fact, these were the major concerns and have been the major concerns of the AARP, and that is, what happens to these retirees who have had a great health insurance plan after their retirement that includes a very generous prescription drug benefit from their employer. There was this great fear, has been a great fear, that all of the sudden employers may, since there is an opportunity, an option under Medicare, drop their plans; and so we have made sure that we incentivize employers to keep those plans, to keep providing for those men and women who in some instances have worked 40 years for the company, very loyally working for the company. This Medicare Modernization and Prescription Drug Act actually gives 28 percent, 28 percent of coverage up to $5,000 per individual to employers, a tax-free supplement to incentivize them not to drop those plans. The AARP and its 35 million seniors are quite happy with that, and I think we have solved that problem.

Mr. GINGREY. As the gentleman said at the beginning of his remarks, the most important part of this legislation is that it helps our needier seniors. It gives them probably the greatest benefit. Most of our seniors who are not low income, yes, they get significant help with this bill, particularly in regard to catastrophic coverage when they get above $3,600 out of pocket in any 1 year, but the point the gentleman is making is such a good one. It is so important for the public to understand, and that is that we are taking care of our neediest seniors first. If they have an income, an individual, of less than $12,000 give or take a few dollars per year or a couple at the $16,000 income level per year, then they pay nothing for their deductible. They do not pay a copay. They do not have to pay those monthly premiums. All of that is taken care of, and they are only liable for maybe a dollar for a generic drug or $3 for a brand-name medication or, if they are above 135 percent of the Federal poverty level, that goes to $2, $5. So minimum, and that is where the emphasis is, as the gentleman from the 12th is pointing out, on our most needy seniors.

Mr. GINGREY. Mr. Speaker, I thank the gentleman from Georgia for those very, very timely and accurate comments in regard to this bill. In fact, the gentleman from Georgia mentioned the health savings account, and I think that is one of the many parts of this bill that is so good. It is something that we have waited for a long time to have what we might call a universal health savings account opportunity. Mr. Speaker, at this point, I would like to yield to my colleague and friend, the gentleman from Indiana (Mr. Chocola), who is a small businessman and understands this issue just about as good as anybody that I have discussed it with.

Mr. GINGREY

Mr. GINGREY. Mr. Speaker, I rise today in support of the market basket update to hospitals provided for in the House-Senate Medicare agreement. This legislation will supply a full update for hospitals that submit data for a set of 10 quality indicators. Those hospitals that do not submit data would receive updates of 0.4 percent less than the market basket level. It is imperative that our hospitals and especially, Mr. Speaker, our rural hospitals receive this full update in order to ensure that they maintain the ability to provide needed goods and services. I stressed the importance of this issue by offering a letter to the Medicare conferees urging them to reject the proposed market basket reduction to hospitals and ensure that the final Medicare legislation delivers unfettered improvements for rural health care and a full market basket update for hospitals. Over 120 of my colleagues joined me in that effort. I urge my colleagues to continue to back this provision in the final version of the bill and show support for our hospitals by its passage.