Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. That's correct. That's on top of the 80 to 90 percent. So for patients and what they're concerned with now, I believe what's happened, and just to simplify in my own terms, is what happened in Massachusetts, where people saw they were already paying very high taxes, they were already paying for coverage, and then they were going to have to pay for States like Nebraska, who were opted out of this deal. Congressmen, I was very proud to be sworn in to the U.S. Congress on the 6th of January, 2009. I woke up on the 23rd----

Mr. ROE of Tennessee. Yes.

Mr. ROE of Tennessee. I think one of the problems that you've seen with this plan is the complexity of it. I think the bottom line, what you saw in Massachusetts yesterday is that the people there do appreciate their own personal freedom. They want their freedom to choose. Also, Massachusetts was being asked, since they've already been mandated to pay for their own policy, which I might add has added tremendous cost, and I will also tell you that half of the primary care doctors in that State are not accepting patients. This is one of the things that isn't understood about a lot of the government-run plans: They don't pay the cost of the care. We haven't discussed that much here, but in our own State, Medicaid pays less than 60 percent of the cost to the providers; the hospitals and the doctors. Medicare pays somewhere between 80 and 90 percent of the costs. The rest of those costs are shifted to private health insurers, meaning that people out in private businesses are actually getting taxed again. What Congressman Thompson was talking about, another thing that's left out of this particular plan that's really unfair is that you're not even putting in the so-called ``doctor fix.'' Let me explain that to the viewing public out there. In 1997, there was a bill passed here called ``The Sustainable Growth Rate: How Medicare Pays the Physicians.'' And what happened was, is there was supposed to be cuts every year. This year, there was supposed to be a 21 percent cut to physicians, which if that happens, nobody is going to able to see a Medicare patient. And that's not even here. It's over a $200 billion pricetag that's not even listed in this current trillion-dollar pricetag.

Mr. ROE of Tennessee. He is a very good Governor.

Mr. ROE of Tennessee. That's what he said.

Mr. ROE of Tennessee. We had the 17-year experiment called TennCare. And to back up to the beginning of Medicare, in 1965 that great program that was passed started as a $3 billion program. The congressional estimates were at that time that by 1990, 25 years later, it would be a $15 billion program. The actual number, a $90 billion program. It's gone from $90 billion in 1990 to over a $400 billion program. And we're going to cut this much money out. As our population ages, there's going to be more spending involved. Now that's one plan. In Tennessee, we started with a managed care plan in 1993 to control costs, because costs were going up and there wasn't enough access for our citizens. It was a $2.6 billion program in 1993. In 10 budget years it was an $8 billion program. It took up almost every new dollar that the State of Tennessee brought. And let me go on and fast forward to this Senate bill for a moment, because this is very important for States. This bill calls for a massive expansion, the Senate bill, a massive expansion of Medicaid. In the State of Tennessee we're looking at three-quarters of a billion dollars of unfunded--unfunded--liability. That's what Nebraska got off the hook for. What you're asking us to do in Tennessee is we, this year, Mr. Speaker, this year we have 50 less highway patrolmen in the State of Tennessee than we had in 1978. And we have 2 million more people. That's the kind of shape that the States are getting in. And we're getting now another unfunded mandate through this health care bill that I don't know where the money is going to come from. We have no capital projects for our colleges this year in the State of Tennessee. We're not building a new dormitory, a new library, or anything. And yet we're going to get crammed down this massive expansion of government with an unfunded mandate. That's why people are angry.

Mr. ROE of Tennessee. Mine, too.

Mr. ROE of Tennessee. That's correct. What you're going to do is, you're going to create waits. There's no other way around it. And that's my biggest fear as a physician, is that at the bottom line, the end of the day, when you budget so much money for health care and you have more demand for services than you have money to pay for it, you create waits. It happens in England France, and Germany, unless you are wealthy and can buy your way around the system, which is what happens. But I'm talking about for the bulk of the American people. Over 90 percent of the people who have insurance in this country like it. And they like what they have. They understand we pass all of this right here. When a patient comes to me, am I going to be able to provide better care for that patient? The answer is, No, I can't. And let's look at some numbers.

Mr. ROE of Tennessee. That is correct. Unless you are in Florida, of course.

Mr. ROE of Tennessee. No, sir.

Mr. ROE of Tennessee. I would say, when you look at this--I am just a country doctor from east Tennessee, but if you look at the health care problem in America, it is this: One is we have had escalating costs. There is no question of the costs. And we have got people who don't have health insurance coverage. Those are the two problems. How do you solve those problems? Let me explain to you why having more government will never work and will end up costing more money. And my good friend from Pennsylvania, Congressman Thompson, has hit the nail right on the head. When you take $500 billion--and I have dealt with Medicare patients for my entire medical practice. When you take $500 billion out of a plan that is already underfunded, that goes upside down in premiums by 2017--and beginning next year the baby boomers hit 3 million to 3.5 million new recipients every year. You take a half trillion dollars out and you add 30 to 35 million people, three things happen: One, you have decreased access; two, because you are not going to get in to see the doctor, number two, you are going to have decreased quality; and three, and seniors get this, their costs are going to go up to get the care that they need.

Mr. ROE of Tennessee. If the gentleman will yield, let me just mention a couple of things that my friend from Pennsylvania is talking about. In 1975, all the malpractice companies left the State of Tennessee. We had nothing. So the physicians there brought together and formed what is called the State Volunteer Mutual Insurance Company. It was a mutual company that anything that wasn't paid out in premiums came back to us. Since the inception of that company in 1975, over half the premium dollars have gone to attorneys. Less than 40 cents on the dollar went to the injured parties, the injured patients, and about 10 cents to run the company. We have a system that is broken terribly when you can't even compensate injured people. That is the system we have in America now, and that is wrong, because there are events that do occur that need to be compensated. We don't have a system that can even do that.

Mr. ROE of Tennessee. No, we don't.

Mr. ROE of Tennessee. It is not, and it should be.

Mr. ROE of Tennessee. That is correct. And if something were to happen catastrophically, let's say you have an accident or a heart attack and you spend more than that predetermined amount, you buy catastrophic coverage that covers every bit of it. For instance, in my particular case, anything over $5,000 is paid for 100 percent. And you had the $5,000 to begin with, it was your money, so you got to keep it. I think that is a very simple thing that we are currently doing and we should be encouraging people to do, not discouraging.

Mr. ROE of Tennessee. That is correct. So you want to have the incentives built into our health care system. For instance, a health savings account. I have one, a health savings account. Let me explain this to our audience today, the people who are watching this. Before, when you pay a premium in, if you don't use it, who keeps the money? The insurance company does. In my case right here, with a health savings account, you put in X dollars. In our office, it is $3,000. It can be $5,000 that your employer puts in that account for you. You pay everything first dollar, so I am highly motivated to take care of myself, because at the end of the year, if I don't spend that money, I get to keep that money, not the insurance company. And you can roll that money over and use it the following year and the following year. In our group, we have 350 employees in our medical group at home, and for those who get insurance, over 80 percent of them choose a health savings account. They manage their own care, so they are motivated not to smoke and to exercise and to lose weight because they save their own money. You can use that money later in your life if you accumulate many thousands of dollars for long-term care or whatever you want. You are the insurance company.

Mr. ROE of Tennessee. I thank the gentleman for yielding. You're absolutely right, because what you allow it to do is you allow a small business to become a large business. Like I said, the problem with preexisting conditions is, if you have a small shop of 5, 10, 20 employees, which many businesses have--and 70 percent of our employees in this country work for small businesses. If you have one very expensive condition that hits, it breaks them. They can't afford insurance. That's why it's not affordable. Some other things we could easily do are preventative care, and you could do that where you have different incentives to keep yourself well. As a physician, I can tell you all day long how to stay well, but it is up to you as a patient to carry that out. I can give you all the great ideas in the world, but if you don't carry them out, then it doesn't do any good.

Mr. ROE of Tennessee. Reclaiming my time, absolutely. Look, you can buy any other kind of insurance in the world but health insurance across a State line. Why in the world should it make any difference? If I'm living near the State line--and we're surrounded by multiple States in Tennessee--I should be able to buy that insurance across a State line. For instance, let's take Realtors. Almost every Realtor's business is a small business. They have six, eight, ten. Twenty would be a lot in our area. Let them all group together across this Nation, and then you'll have 500,000 or 1 million Realtors who could spread their risks, and you wouldn't have any government involvement. You wouldn't have any subsidies involved. You wouldn't have any complications. You'd simply let the free market system work.

Mr. ROE of Tennessee. Another issue that we deal with all the time-- and as a physician, I would deal with this--are patients who would develop, let's say, breast cancer and lose their jobs. Then they would lose their insurance coverage. Now they have chronic conditions, and they don't have insurance coverage. How do you help those patients? How do you help those folks? Well, this is a very simple problem. Preexisting conditions are a problem but not in the large group market. In other words, if you've worked for a large corporation or let's say--like we get our insurance here through the Federal Employees Health Benefit Plan, the so-called FEHBP. You've got 9 million people who get their insurance through that. If one person has a chronic condition like breast cancer or diabetes, it really doesn't affect our rates because you spread those risks over millions of people. If you would simply get rid of State lines and if you would allow small groups to become big groups, you then solve the preexisting condition problem. The second thing you can do is to subsidize----

Mr. ROE of Tennessee. On one page.

Mr. ROE of Tennessee. Yes.

Mr. ROE of Tennessee. I thank you for yielding. As Congressman Akin has said, I've spent the last 31 years, until a year ago, practicing medicine in Johnson City, Tennessee, and really in a rural area in Appalachia. I've also practiced medicine in Memphis, in the inner-city, while I was in training and in school. We have to back up, I think, and look at what the problem was, what problem are we trying to solve. In this country, I just saw a poll recently that showed among likely voters that approximately 90, 91 percent of the folks had some form of health insurance. What we're getting confused with is there are people out there who don't have access to care. There is no question about that, and we need to address that problem. What we've been hearing in this particular H.R. 3962, aka H.R. 3200 that we began to deal with, is that this is the only solution, which is this very complex health care bill, which I've read--I've read all 2,000 pages of it--and you have very adequately stated some of the problems. What are we trying to fix? Well, we have 40-plus million people in America who do not have--not access to care, because a law was passed in 1986 called EMTALA, and that afforded every American, whether you're legal or not--you could be an illegal citizen in this country--or whether you could pay or not. If you go to a hospital with an emergency room, you have to be cared for. We have no choice. When I was on call in the emergency room--and believe me--I'm the one who had to get up at 3 a.m. in the morning and go see these patients and care for them. So the care was there. It's just not the most efficient way to provide the care. There is no question about that. We have a system in this country now where costs are out of control, and I think that's what this bill doesn't do. It doesn't address the fear that most of us have and that I know I had as a doctor and that I have as a consumer of health care, which is the ever-rising cost of the care. We can do several things. Let me just point out, in the 2,600- or 2,700-page Senate bill, I can cover 20 million people on one page. This is just to show you how simple you can make it. Number one, if you have signed up the people currently who are eligible for the State Children's Health Insurance plan and they've just not signed up for a current plan that's already there in Medicaid, you would cover 10 to 12 million people. There's one thing in this bill that I do like a lot, and that's to allow adult children, when they graduate from high school or college who don't have health insurance, to stay on their parents' plans, their parents' health care plans. You could cover 7 million young people. You could cover almost 20 million people in this country. I don't think either side, the Democrats or the Republicans, would mind doing that. You've covered two-thirds of what the Senate bill is going to do by doing that one thing, and you can do that on one page.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Very quickly, Mr. Speaker, I think what the American people want for us to trust is transparency. The people have to trust us for us to govern, and they can't trust us if they don't know what is going on. I know, Mr. Speaker, you went home, I went home for the holidays; and they said, What is going on with the health care bill? And I told them, You know as much as I do. Because we are in the dark just as you are. And that is not the way it ought to be.

Mr. ROE of Tennessee. I will yield.

Mr. ROE of Tennessee. Where do we go? Do we cut K through 12? We're already in the 40s in education. Here is another unfunded mandate that comes to the State of Nebraska, and the people in Nebraska don't have to pay for that. The people of Texas do. The people of Ohio do. The people of California do. The people of Maine do. This is something that should not be there. When the sun shines on this, this will not happen. That is why it is extremely important for the sun to shine on this process. You mentioned a moment ago, when you peel this onion back and when you begin to read this bill--and I've read every page of the House bill. I have not read the 2,700 pages of the Senate bill--we look at the AARP. When you sell, there will be an insurance exchange, and on this insurance exchange, if a company trades on there--and this is a private company--their CEO will be limited to a $500,000 salary, which is tax deductible. That's fine. That company ought to be able to decide what it pays its CEO. If you pay more than that, you have to pay corporate taxes of 35 percent plus ordinary income taxes of 39 percent. So, for anything over $500,000, the government will get three-fourths of it--except if you are the CEO of AARP. If you are the CEO of AARP, you make $1.55 million a year. The average Social Security recipient receives about $12,000 a year. That's their business, but they are exempted from this bill. They are not included in this bill. So guess what happened? AARP endorsed this bill. I can go on and on.