Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Yes.

Mr. ROE of Tennessee. I thank the gentleman for yielding. This is very simply what's going to happen--what will occur in a government-run plan. First of all, I can assure you it's going to cost you two times what these estimates are. That's what happened in Tennessee with our TennCare plan. Secondly, the way all of these plans work is they ultimately ration care. When you have a certain amount of dollars that you spend on health care and the demand is higher than the dollars to pay for it, you create waste. Just an example. In Canada for a hip replacement it's 2 to 3 years to get your hip replaced. Bypass surgery is 117 days. Here in this country, George Washington University very near here, or Georgetown--it will be done very quickly. So those are things that happen in a government-run plan. And who needs to be making health care decisions are families, patients, and their physicians. That's who should be making those decisions.

Mr. ROE of Tennessee. We have been over that previously. But a couple of things I wanted to bring out. This is from the CBO this afternoon that scored this bill that we're looking at here. It's 1,000-plus pages. After we have this monstrous government takeover in 10 years, we still have 17 million people uninsured. And, I mean, it's astonishing to me that we would look at a bill like this and still have almost half the people uninsured with the government then making health care decisions. One of the things we were talking about, cancer a moment ago, and I think what we want to say is--and I think the gentleman from Arizona has hit it right on the head--you need to have patients in charge of health care decisions. When I began my practice in the early 1970s and in the late 1960s when I was a medical student, 80 percent of children who went to St. Jude Children's Hospital died of their childhood cancer. Eighty percent died. Today over 80 percent live. It's really a phenomenal story to tell a parent. Almost all children with leukemia have lived now. It's unbelievable. And that's happened in the last 35 or 40 years. When I began my medical practice almost half the women who came to me with breast cancer--and we saw too many of those--died within 5 years. Survival rates now are in the high 90s. It's astonishing. It's a wonderful story. When the patient comes in, they're frightened, and you have already mentioned how scary that was when you are diagnosed with cancer. But to know that you are going to get through it, that's what this phenomenal health care system in America has produced. And what is amazing to me is that we're going to have this bill that's a thousand-plus--well, that's the start of it. It will still leave that many people uninsured. And we have heard right here tonight a better way to do it, a much simpler way from the ground up. And let me give you one other example. It's very simple. In my own medical practice back in Tennessee, we have 290-something people who get health insurance through our practice. We have two plans we offer them. One is just your standard Blue Cross plan, 80-20, we all are familiar with. The other is a health savings account, high deductible plan where you have the first $5,000 out of pocket. You pay for that. We put $4,200 away for that. Everything above $5,000 is paid 100 percent. Eighty-four percent of the people in that practice, nurses, technicians, whatever, chose to manage their own health care dollars, not the insurance company but them. They will lose that ability with this particular plan, and I think that was a plan right now that I use and that people all over the country want to be in charge of their health care decisions, not the government.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Will the gentleman yield for a second?

Mr. ROE of Tennessee. Let me go over why it's important for the public and my patients and, as physicians, our patients to understand this. What we're concerned about is if this plan becomes a public option and that's the only option. And the way that occurs is, I've explained, when the cost of the public plan does not pay for the cost of the care, more costs are shifted to your private health insurers, meaning that they'll eventually drop the plan. Now, having a single-payer system like Canada or England, is that necessarily bad? Well, I would argue that it is in America, and the reason is because it's going to limit choices. And I know it was brought up just a moment ago by the gentleman from Arizona about costs, and I'm going to share with you--just a family practitioner in my own district the other day called me up and said, Bill, he said, I have had one lawsuit in my career. A very young woman had a serious problem, probably not preventable. He had a grade by the insurance companies of what a good doctor he was, in the top third, always. After this one lawsuit, and nowhere is medical malpractice mentioned here, his referral to specialists in 1 year went up 350 percent. His lab ordering went up 550 percent. This is not him saying this. This is a grade he got from the insurance companies. So there is the cost side that we were talking about earlier, and who knows, when you extrapolate that across the country, how much that must be. Now, I got this letter right here this afternoon from CBO to Chairman Rangel, 14th of July, today. And in this, it says, Another significant feature of the insurance exchanges is that they will include a public plan that largely pays Medicare-based rates for medical goods and services. CBO estimates that the premiums for that plan would generally be lower than the premiums for private insurance. But on average, the public plan would be about 10 percent cheaper than the typical private plan offered in the exchanges, and therefore, they're saying right here in this document that that's what's going to happen. The other thing about this I found interesting was this plan doesn't start until 2013. And what you're seeing here is only in the last 6 years, this $1.1 trillion plan. It actually is 150 billion per year is what it amounts to. It's not what they're currently saying it's going to be, a trillion over 10 years. It's really a trillion-plus over 6 years. I yield back.

Mr. ROE of Tennessee. Yes. Mr. BROUN of GEORGIA. It's interesting. After our last series of votes I was walking into my office. As I went into the Cannon House Office Building, there was a Democrat engaged in this process.

Mr. ROE of Tennessee. This is where the devil is in the details, right here.

Mr. ROE of Tennessee. It's 1,100 pages.

Mr. ROE of Tennessee. What happened in Tennessee was we had a lot of uninsured in Tennessee, and it was a very noble goal of trying to cover as many people as we could. And we had a standard Medicare plan like most States do now. We got a Medicare waiver from HHS, the Department of Health and Human Services, to form a managed care plan for the State. And what happened was, it was a plan that was very rich in benefits, much like you're seeing in this plan and that we heard discussed last hour. Provided a lot of benefits but not much access, we found out. And what happened was, this plan, this public plan paid only about 60 percent. Now it pays less than, I found out the other day, less than 60 percent of the costs of actually providing the care. Medicare pays about 90 percent. So businesses and individuals made a perfectly logical decision. They dropped their private coverage, and about 45 percent of the people who are on TennCare had private health insurance coverage, but chose to drop it. Well, that was fine until we got the bill in the State. What happened was the bills kept piling up until they consumed more of the State budget than education did.

Mr. ROE of Tennessee. I certainly don't want to take credit for putting that in.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, on Friday, the Democrats on the House Ways and Means Committee announced their intention to finance a Washington takeover of health care by raising taxes. For those of you keeping score, the Democrats' economic plan has been to spend billions of new dollars on programs that generated no economic activity in a stimulus package, increase regular appropriations spending at a rate that is sure to increase inflation, implement a national energy tax, and now, create a tax on those the Democrats call wealthy but who you and I call job creators and entrepreneurs. While I'm no economist, I'm pretty certain that no one in their right minds would call this a ``pro-growth'' agenda. Remember earlier this year when Congress cracked down on abusive practices by credit card companies? Supporters argued this plan was needed because too many saw credit cards as a license to spend with little or no financial repercussions. Well, maybe we need a congressional ``credit card'' reform. While there are some in this Chamber who use the U.S. Treasury like a credit card with no limit, our children and grandchildren will be paying for this shortsightedness. Let's start by rejecting this trillion-plus-dollar fiasco being billed as health care ``reform.''

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Just to amplify what you've said. Madam Speaker, years ago we had a test in our office, which we did about 10,000 of them a year. We contacted a local pathologist and said, We'd like to pay $10 for this test; and they said, Well it's $100,000 of income. We'll be glad to. Well, we couldn't do that because--guess what--it was $5 less than what Medicare paid. So we had to charge all of our patients $15 for this test. So that one little office, that one test ended up costing our patients another $50,000 in one medical practice in little old Johnson City, Tennessee. Now I've seen that already. You can amplify that across the country, and you can imagine the billions of dollars that are being wasted because of a lack of competition in the health care system.

Mr. ROE of Tennessee. I am going to make an impassioned plea to the American people. A week ago we saw a cap-and-trade tax here that was brought before this House, not thoroughly vetted, a very, very important issue, and not read. Let me say this again--and I get angry when I think about this, something that affects every single American. Not one Congressman of the 219 that voted for that ever read the bill, and it will affect every American. I want to challenge this body right here and now not to bring a bill here in 2 weeks which no one has read, which affects the most precious decision, the care of you and your family and your children, and you haven't even read it. The American people need to know every dot and T in that bill before we have the audacity to pass that bill on to the U.S. Senate. I yield back.

Mr. ROE of Tennessee. I would argue that would even do more than that, because it would do just the opposite of what the public plan will do. What it will do is, if you make that available where the uninsured can afford it to this tax break, it will make less people uninsured and therefore less cost-shifting to the people who already have health insurance. I would argue it would do exactly the opposite. I bet you if we try, it will work immediately. The challenge we have in a down economy, there's no question, is when people lose their job, they lose their health insurance. And it can't be COBRA. As you all know, Bill Gates can't afford COBRA, it's so expensive. We have to have a plan that is affordable for people when they're unemployed. That's a real challenge, there's no question. I yield back.

Mr. ROE of Tennessee. Would the gentleman yield?

Mr. ROE of Tennessee. I would like to know the logic. I haven't had anyone yet since I've been in this body give me the logic of why a corporation with multiple assets is allowed to take a--let's say a small businessman. Let's take someone who is in a small landscaping business, who takes care of my yard--I should be mowing it myself--but who takes care of my yard. Why shouldn't he be able to deduct as an individual employer--he's just got himself, is all he works for--why can't he deduct his health insurance just like General Motors does? I've never had anyone yet explain to me. You could help a tremendous number of people in this country if we did that simple thing. I yield back.

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee. I think the thing that I want the American people to understand is that for 30-something years I have had to look at patients, some who had health insurance and some who we had to try to figure out, How do we get this patient care? And that is certainly a patient we want to find out. We're the ones who go to the emergency room at 3 o'clock in the morning and treat a sick child or see a youngster who has a fractured arm or whatever. We're the ones who provide this and go out there along with the other health care providers. We want a way for that system to flourish as efficiently and as cost effectively as we can. And we can do this. We have solutions out there. The solution is not the government running your health care. That will be a problem. It will be a problem as far as innovation is concerned, as you've pointed out. It will be a problem as far as access is concerned. Access is already a major problem that we have to address. I want to tell the American people--I want you to be engaged in this, learn about this. Call us. Tell us what you think. One of the last patients that I saw in my practice was a 60-something-year-old woman who worked, who didn't have health insurance. And quite frankly, that is a problem. She is 60 years old, just before Medicare. It's something that can be dealt with, though, without a complete takeover of the government health care system. The people had better pay attention. These next 2 weeks will be the most critical debate about health care that's occurred in the last 45 years. I yield back.

Mr. ROE of Tennessee. I thank the gentleman for yielding. Madam Speaker, I think when you are looking at health care, and I practiced medicine in the State of Tennessee for over 30 years in an OB/GYN practice, delivered a lot of babies. And I can tell you, having watched this very complex system, it's unfair to the American people. We are not talking about Democrats or Republicans. We are talking about the American people here who are going to be affected, all 300 million of us are. And when we look at the issues out there that we are dealing with, first of all, there isn't any American that doesn't want to have quality, affordable health care for all of our citizens. I don't think any of us in this body, all 435 of us want that. It's how do we get there and how do we afford it when we do get there and not break the bank. We have, if you read various publications, around 47 million people in America who are uninsured. And of that 47 people who are uninsured, approximately 10 million, these are estimates, but are approximately 10 million are illegal in this country. Of the remaining 35 to 37 million, we have about 12 to 14 million who currently qualify for plans that are out there, SCHIP or Medicaid, but who are not on it. So we need to find out who these individuals are and make those assets available for them. About 9 million people make over $75,000 a year and choose not to buy health insurance. Now, in my part of the world, in the First District of Tennessee, that's a lot of money, and I assume in a lot of places in Georgia and other places around this country that's a lot of money. We have about 8 million people who make between $50,000 and $70,000 a year who are uninsured. And certainly for those, if there are families, there are ways, very inexpensive ways to make sure affordable health care is available to them. When I first heard--when I first came to D.C., I heard the argument of the President's plan, and it turns out, I don't think the President had a plan. But the plan that was coming out of the House of Representatives is that we are going to have private health insurance and we are going to have a competitive government-sponsored plan. And I said, What exactly is that supposed to do? And they told me, and I said, Wait a minute. 16 years ago, we did this plan in Tennessee. It was called TennCare. We got a waiver from Medicaid, HHS, to provide health care for as many citizens in the State as we could. And as you know, Tennessee is not a wealthy State. We have a much lower than average per capita income in the country. So it was a noble goal. And it was the government, the managed care plans, put a very rich plan together; in other words, it was very generous in benefits. And what happened was almost 50 percent, 45-plus percent of the people who got on TennCare had private health insurance. And what we found, and for them it was fine. I mean, they had a plan that paid the coverage, paid to see a doctor. The problem with it was it didn't pay the cost. And when I started asking, digging into this plan, I said, How much of the cost of the providers--I am speaking of hospital outpatient surgery centers. What percent of cost does this plan pay? It paid 60 percent. Medicare, another government-run plan, pays about 90 percent of costs. So what happened was you had costs shifted to the private insurers. And these private insurers--that would be the other businesses in Tennessee--their costs went up and up and up when they tried to buy health insurance. So more and more people were dumped into the plan because businesses couldn't afford it. How did the State of Tennessee handle this?

Mr. ROE of Tennessee. Exactly. They made a perfectly logical decision. It was cheaper to go into the subsidized government plan than it was for businesses that were struggling to survive anyway. And when you add this extra cost, they dropped that cost onto the public plan. Well, what happened was the State couldn't even afford even paying 60 percent of the cost of the care. There were so many people on it, the health care part was getting more than all the education and the other things that the State was providing. So our Governor, who is a Democrat in the State of Tennessee, and a Republican legislature, they had to cut the rolls. You only have two choices: You can either cut the rolls or you can ration care. So I predict to you, Dr. Broun and Madam Speaker, that when this public option comes out there, that it will be exactly like that. It will be a very generous plan subsidized by the taxpayers and supported by that. And businesses, especially small businesses first--the ones who provide most of the jobs in this country are small businesses, and you want to make it easier for them to provide the benefit, not more difficult-- they will drop that. And over time, this will morph into a single-payer system. Now, some people, Madam Speaker, would say, Is that a bad idea or a good idea? I think some people would be happy with the single-payer system. I believe health care decisions should be made between patients, their families, and their doctors. And you don't need a bureaucrat, no pun intended, injecting himself into this very important decision, in health care decisions. That's what will happen. In this plan in England, they have a comparative effectiveness, as you well know, called NICE. And what an acronym for NICE, and let me explain that to the viewers out there. What happens in a public system where it's funded by a single payer--for instance, the taxpayer, in England the government--a board or committee is put together by the government to evaluate the outcomes of certain treatments. Well, they have, for instance, if they estimate in England that you are in your last 6 months of life--and a cancer, for instance, a cancer treatment, they might invest as much as $22,000 in you, about what a used Honda would be. Well, I don't think the American people, I know the American people, I know the American people in my district, Madam Speaker, in your District, are not ready to let the government decide that your life and your family's life is worth that. So that is sort of, in a nutshell, where we were or are in Tennessee dealing with this. There are a lot of other options out there. I think these mandates for, in this particular legislation which we haven't seen other than just a synopsis of it, we haven't seen the full legislation. And, of course, the devil is always in the details. So I want to sit here and look at the American people and tell them that the Doctors Caucus, the conservatives in this House, I think both the Republicans and the Democrats, want to be sure that the patient and the doctor are making those very important health care decisions and not the Federal Government.

Mr. ROE of Tennessee. I do. When I began my medical practice, we had the same survival statistics that they did, 50 percent 30 years ago. In stage 1 disease now in America now it's as high as 98 percent 5-year survival. So when the patient comes to us, Dr. Broun and Madam Speaker, and they say, Dr. Roe, what are my chances of living? I am go going to look at that patient, I am going to look at her and say, It may be tough, you may have some down days, you probably will, but you are going to make it. You are going to be okay. And we can provide that kind of hope in this country for our patients. I look at St. Jude's Children's Research Hospital in Memphis where I was a medical student, and when I first went there, 80 percent of children died of childhood leukemias and cancers. Today, over 80 percent live. I had one of the greatest evenings this last Monday night of a young boy I had delivered 16 years ago, and 2\1/2\ years ago his mother called me and said, Dr. Roe, I am afraid my son has cancer. And we were there for that 16th birthday to celebrate. He is cancer free, and that is a wonderful, wonderful thing to celebrate. And my joy goes out to that family and that community. The whole community celebrated. And that's the kinds of things we have seen, I think, in America, with our health care system. And I think back, Dr. Broun and Madam Speaker, when I began my medical practice, we had only five high blood pressure medicines. Three of them made you sicker than high blood pressure did. Today, over 50. Antibiotics, there was one type of cephalosporin antibiotic. Today, over 50. We have all of the new robotic surgeries, laparoscopic surgeries that I was able to do and privileged to do in this Nation and provide everyone. I was at a business meeting not long ago, a year or so ago, and they said the health care system, certainly there are excesses, we need to do a better job of managing the system. They said, You need to run this like Southwest Airlines. I said--well, I was in Washington when I was told that. And I said, I will tell you what we will do. We will go over to Reagan National and we will pick a guy up who lives under the bridge there, a homeless person, and we will show up at Southwest Airlines. And I will go in my pocket, and I will pull my credit card out and I will say, here, I want to fly and the guy with me can fly, but the man that has no money can't. And in America, if we all three get in there and go back to George Washington University's emergency room, day or night, 24 hours a day, 7 days a week, regardless of your ability to pay, in America we will take care of you. Now is that the best way to do it, and I would argue it is not. And that's what this debate should be about is how we better use those resources.

Mr. ROE of Tennessee. That is correct.

Mr. ROE of Tennessee. That is correct.

Mr. ROE of Tennessee. Yes. I know that only you can show up at an emergency at any time, but the only hospital that I have had patients denied care because of some bureaucratic snafu, they didn't qualify, was a government hospital, the VA. I have never had a patient refused care that I have taken care of if I said this patient has to be in the hospital. Our problem is not the quality of the care; it's figuring out a system to best pay for it. That's what we are dealing with here. And we are not going to wrap this up and be fair to the American people in 2 weeks. It's too complicated. I was speaking with a friend of mine this Monday in Kingsport, Tennessee, Dr. Jerry Miller, and he and I were in a very detailed discussion about how complex when you're looking at home health care, oxygen infusion, devices, occupational therapy, physical therapy. All of that goes with increasing and improving the quality of your life. That's what we're dealing with, an incredibly complex system. And I don't believe that the government can best run this system. I think that the private sector is much more equipped to deal with new technologies. I'll give you an example. I think if we were waiting on the government to develop a da Vinci robot, you wouldn't be having your da Vinci robotic surgery right now. We see radical prostatectomies for prostate cancer that now are done in a couple of hours or less with very minimal blood loss. I mean, before radical prostatectomies, it was several hundred cc's of blood. Now it may be 75 or a 100 cc's. Minimal blood loss. Patients are leaving the hospital in a day or two and resuming normal activities incredibly fast.

Mr. ROE of Tennessee. Yes.