[Extensions of Remarks]
[Pages E383-E385]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

REPRESENTATIVE CAPPS REMARKS TO THE AMERICAN MEDICAL ASSOCIATION

______

HON. JOHN D. DINGELL

of michigan

in the house of representatives

Tuesday, March 19, 2002

Mr. DINGELL. Mr. Speaker, I want to pay tribute to the skill,
tenacity, and leadership of our colleague and my friend, Rep. Lois
Capps. I have served with many fine people over the course of my career
in the House of Representatives and she is among the best. She fights
every day for the people of her district, and for causes that affect
virtually every member of our society. She does this with great skill
and even greater courage. I have come to admire her strength,
compassion, commitment, and drive. It is with great respect and
affection that I request that a copy of her recent remarks to the
American Medical Association be included in the Record. I recommend
that all of my colleagues read them with great care.

Statement of Rep. Lois Capps, American Medical Association Conference,
March 10, 2002

Opening

Thank you very much for inviting me here to speak today. It
is an honor to spend some time with my colleagues in health
care.
I have been asked to speak to you about the Democratic
Party's agenda on health care.
But I am not sure there should be a separate ``Democratic''
or ``Republican'' agenda on health.
Though politics often suffuses the debate about health
care, we should not come at this issue from a political
perspective.

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I have only recently in my life become an elected official.
And I do not consider myself as simply a politician.
Instead, I think of myself in the terms that defined the
forty years of my career before I came to Washington.
I am a nurse. I am a health care provider. It is my
calling. And I think of myself in my new job as just a
different kind of health care provider. I may have traded in
my nursing uniform and medical equipment for legislation and
committee action. But my goal is still the same. I am obliged
to care for the health of my patients, whether they are the
students in the Santa Barbara school system, the patients in
Yale New Haven Hospital, or the seniors on Medicare across
America. And I am proud to bring the benefits of this
lifetime of nursing experience to the halls of Congress. And
I think my experience has taught me well. As medical
professionals we have learned that we need to carefully
examine symptoms, check vitals, run tests, and thoughtfully
consider our options. Then we select the best course of
action we can think of.
We don't look at the label on a medication to see if it has
a D or an R on it. We don't look to see if Tom Daschle or
George Bush recommended a particular treatment. We call on
all of our medical training and professional experience. We
often consult other doctors and nurses, because we have
learned that health care is better when provided by a team.
And this is how the Congress needs to approach the challenges
facing today's health care system.
Most of my colleagues, on both sides of the aisle, are
genuinely interested in reaching across party lines to come
up with good solutions. But a few are more interested in
opposing the other party's members than in solving our
problems. They are unwilling to engage in a debate on the
issues, but would rather stymie their opponents ideas, be
they Republican or Democrat, for political gain.
I am a nurse. Sen. Kyl is a lawyer. My colleague, the
Ranking Member of the Health Subcommittee, Sherrod Brown is a
teacher. Rep. Ganske is a doctor and Rep. Norwood is a
dentist. Some of us are Democrats and some of us are
Republicans. It is going to take all of our varied
experience, expertise, and perspectives to develop real
solutions to the challenges we face today.

Overview

And we face real challenges. A few minutes ago I suggested
that Congress should treat health care problems the way a
doctor treats a patient. So let's do that now.
Let's check our nation's health care vital signs and look
at some of its symptoms. There are 125,000 vacant nursing
positions across the country. Physician fees under Medicare
have grown 13% less than the costs of practice since 1992.
Approximately 56 million Americans are not protected by any
state or federal patient protections. 40 million Americans
are on Medicare. 78 million baby boomers will start to join
them in the next decade. Annual spending on prescription
drugs by seniors has grown 116%, from $18.5 billion in 1992
to $42.9 billion in 2000. And 43 million Americans are
without health insurance of any kind.
These are not strong and stable vital signs. They point to
several problems we must address in order to get our patient,
the health of our nation, out of critical care.

Nursing

First of all we have to make sure that the health care
infrastructure is there to care for all Americans. This leads
us to the nursing shortage. I admit I have a bias when I talk
about this issue. I think nurses are terribly important to
our health care system.
I know first hand the challenges facing the nursing
profession and the consequences if we fail to meet them. And
today the nursing community is facing a dire situation. With
an aging nursing workforce approaching retirement, and a
dwindling supply of new nurses, we are facing an incredible
shortfall of well trained, experienced nurses. To make
matters worse this will peak just as the baby boom generation
begins to retire and require a greater amount of care.
I have written legislation, the Nurse Reinvestment Act, to
deal with both the immediate and the long-term problems we
face. This legislation included proposals: To improve access
to nursing education, to entice young people into nursing, to
create partnerships between health care providers and
educational institutions, and to support working nurses as
they seek more training.
This past December, the House passed a slimmed down version
of my bill, and the Senate passed legislation more like what
I originally envisioned. We are now trying to work out the
differences.
I deeply appreciate the support of the AMA for my
legislation. We are close to finishing it and we would not be
here without your support.

Physician Fees

And just as we need to make sure patients have nurses, we
also need to make sure they can see their doctors. As you are
all aware, the reimbursement rates for physicians' services
under Medicare saw a disastrous cut of 5.4% this year. This
cut has already had a terrible impact on health care in my
district and, I am sure, across the country. If these cuts
are not corrected quickly they will be devastating to medical
professionals and our ability to provide quality health care.
I know you have been deeply frustrated by these cuts, as have
I. And you have begun changing your practices to accommodate
new economic reality.
A doctor's office is usually a small business. But as you
well know, unlike most small businesses your decisions have
life and death consequences.
Some doctors in my district have left private practice
altogether. Others are threatening to. Many who stayed in
private practice said that they could no longer afford to
accept new Medicare patients. And others simply left Medicare
all together.
This has meant that many seniors across the country are
scrambling to find new doctors so they can continue to get
the care they need and deserve. Along with a couple of my
colleagues I introduced legislation to freeze physician fees
at the 2001 level until Congress could find a long-term fix.
And when Chairman Bilirakis, Ranking Member Brown, Chairman
Tauzin, and Ranking Member Dingell introduced their own
legislation to keep the cut minimal. I was pleased to join
them in their efforts and was able to get 146 of my
colleagues to ask the Speaker for a vote on this issue.
But, in spite of the bipartisan agreement on this issue,
the bill has not been brought to the House floor. I know you
will keep the pressure on the House leadership to bring this
issue to a vote. I will too. We need to solve this problem
now.

PBOR

But making sure there are enough doctors and nurses will
only take us so far. We must also make sure that patients can
get access to the benefits they need. We must pass a
Patient's Bill of Rights.
Again I want to take my hat off to you and your
organization for your steadfast commitment to this. The AMA
and its members have been critical to our progress so far
toward real patient protections. We live in an era of
astounding new medical developments but also rising health
care costs. The insurance companies and managed care plans
are understandably looking for ways to control those costs.
This can have a positive effect on health care by making it
more affordable.
Years ago in California I saw this lead to more coverage of
preventive care. But the pendulum has swung too far towards
cost control. Now there is too much pressure to cut corners
and to skimp on care. Abuses of patients' rights to quality
health care are too common. There needs to be a counter-force
on the side of quality care--on the side of the patients. And
that counter-force is the Patient's Bill of Rights.
We have to make sure that medical decisions are made by
medical professionals and their patients, and not by
accountants. This is why I have supported this legislation. I
am very proud to be standing by the AMA on this issue. And I
remain confident that we can get this bill through this year.

Medicare Rx Benefit

Unfortunately, I am not so optimistic about passing a
Medicare prescription drug benefit for seniors. In the last
twenty years we have seen a revolution because of
prescription drugs. They are virtually miracle treatments.
But they have also become brutally expensive and are a much
larger percentage of health care costs than we ever expected.
The high cost of these medications has been a problem for
many people. But it has particularly hit our seniors. They
routinely take several medications for various everyday
health concerns. But their fixed incomes cannot pay for them.
And Medicare offers little help. You and I would not even
consider taking on health insurance that does not cover
prescription drugs. But seniors are left looking to Medicare
+ Choice to pay for their prescription drugs. Medicare HMOs
were promoted as an avenue of hope, but have increasingly cut
back on benefits, raised premiums and copayments, and often
just packed up and left areas deemed as ``unprofitable''
leaving seniors with no where to turn.
We hear again and again about seniors choosing between food
on the table and life saving medication. We really can and
should do better than that for older Americans. They expect
it and they deserve it. I believe we must establish a benefit
that is universal, voluntary, affordable, and accessible to
all. Unfortunately, the Administration has continued to focus
on expanding the failed Medicare HMO program and helping the
poorest seniors. I think about the countless seniors on the
Central Coast of California who have shared their personal
stories with me about crushingly high drug prices, I know in
my heart that prescription drug coverage is not a political
issue. It is simply the right thing to do.

Uninsured

Another critical issue is the 43 million Americans with no
insurance coverage whatsoever. For them, health care, with or
without prescription drug coverage, is nothing but a fantasy.
These are people like you and me, who are being forced to
gamble with their health and with their livelihoods. They
have to bet that they will stay healthy and not require
health care. Each day, they wonder if today is the day that
their luck will run out. Is today the day that they or a
loved one will contract a terrible disease? Will today be the
day that they or their family are stricken by something that
will fill their life with pain and bankrupt them? They should
not have to face these fears without the security that
insurance can provide.
In my time as a school nurse in Santa Barbara, I saw too
many families without insurance. I saw the defeated look of
shame on their faces as they struggled to figure out how to
get their children and themselves

[[Page E385]]

necessary health care. This is something we can fix if we put
our hearts and minds to it. Some people believe that the best
way to address this problem is through tax credits. I have to
say that I am skeptical. I am concerned that tax credits
might not cover the costs of insurance and may inadvertently
draw people out of employer-based insurance, driving up
premiums for those left behind.
Others have called for Medical Savings Accounts, but these
may end up pulling healthy people out of insurance plans and
leaving the ill in, again raising the costs to those most in
need of help. I think we might be better off pursuing an
expansion of existing health care programs or helping small
businesses get access to the low rates that large businesses
get. But any of these solutions will cost a great deal of
money. And so it is essential that we find the best, most
cost-effective method. That is why it is absolutely necessary
to keep up dialogue and debate, without shutting out ideas,
You and I may disagree on the best way to help the
uninsured. But we will help them faster if we are willing to
hear from each other and work towards a consensus. We cannot
afford the arrogance of the idea that there is no way but our
own.

Bush Budget

We will see this clearly as we set the budget for next
year. The President has laid out some laudable priorities in
his health care budget. He calls for more funding for the NIH
and efforts to prepare communities for bioterrorism. But at
the same time the budget cuts funding for community health
coordination, chronic disease programs, and efforts to train
doctors and other health professionals. I think these cuts
are counterproductive. So I will work with the President and
my colleagues on this budget, hopefully without the partisan
bickering that has filled past debates.

Closing

Our patient, the health of America, is faced with too many
diseases and conditions to simply lie on its hospital bed as
we engage in petty squabbles about who came up with what
idea. We will only be able to solve our problems if we are
willing to work together, respect and embrace our opponents,
and clamber for a common ground to meet on.
I thank you for listening to me, and I look forward to
working with you to accomplish these goals.

____________________