A Conversation with Congressman Phil Roe

Brent R. Moody, MD

A Conversation with Congressman Phil Roe

Dr. Phil Roe
Phil Roe, MD, was elected to represent Tennessee's first congressional district in 2008 and assumed office in January 2009.Dr. Roe is a Tennessee native and attended Austin Peay University and the University of Tennessee College of Medicine. He trained in obstetrics and gynecology at the John Gaston Hospital in Memphis. His training was interrupted with service in the U.S. Army in 1973 and 1974 where he spent 13 months in Korea in a medical battalion and at the 121st evacuation hospital in Seoul. After completing his military service and residency training, he began his practice in Johnson City.


NMN: What prompted your transition from the practice of medicine to politics and public service?

I remember while I was president of the Tri County Medical Society, the Tennessee Medical Association sent a representative to talk to us. The message was that like it or not we as physicians are involved in politics.

I was always involved in local races and then got very involved in Fred Thompson's race in 1994 and helped him. About 10 years ago someone came to me and asked "would you like to be on the planning commission?" I didn't even know what a planning commission was, but I said yes. I later chaired that committee and then eventually ran for the city commission.

In early 2006, Congressman Jenkins decided not to seek re-election. I decided to seek the seat, but we didn't kick off until the first week of May. I did fairly well, but I lost by about 3000 votes.

I was then faced with the decision of should I run again in 2008. I was in the process of making the decision to run for Congress and some people came up to me who had not supported me the first time and they said "Phil if you'll run we will help you."

Basically the story was that I was going to be fiscally and socially conservative. I am a pro life, pro second amendment person, as are many Tennesseans. Also, I wanted to be part of this great healthcare debate that we are going to have in this country.I ran and had a primary victory in August by about 500 votes and then went on to win the general election. Beating an incumbent in their own party only happened four timesin the United States this year and only twoof those candidates made it to the U.S. Congress.

NMN:What are your committee assignments and what issues related to those particular assignments are most interesting to you?

The committee assignments are based on seniority so as a freshman you really have none. I'm on the Agriculture, Veterans Affairs and Education and Labor committees.

I am the only freshman congressman on the Veterans Affairs committee and I'm the ranking Republican member on oversight investigation. The reason that they wanted me on this is because of concerns about quality of care – we all remember the Walter Reed debacle – they wanted someone who could say yes this is a quality care issue or no it's not. In Agriculture what I've found fascinating so far is that we oversee futures trading. Education and labor is going to be very interesting because no child left behind comes up this year. I've already started talking – the very first people I've talked to about No Child Left Behind are teachers. Not the administrators, not the bureaucrats, but the classroom teachers and I've already got a plan together.

On the Veterans Affairs committee, I'll be going to Afghanistan in April. Since I was in a medical battalion, they want me to go to Afghanistan and start out with a battlefield injury and follow that injured serviceman or woman to Germany, and then to the Dept. of Defense, probably Walter Reed or Fort Sam Houston.

NMN –What are your thoughts on the economy and the stimulus bill.

When I went to Washington, the first thing that hit us was the stimulus package. Obviously the economy is in trouble and we had just gone through a $350 billion dollar bail out. Nobody knew exactly where the money went, which I found fascinating. You can take $350 billion and not know where it went, but that was the case. The first stimulus bill we saw was 450 pages and being the compulsive medical type that I am, I read all 450 pages of it. There were things in there that had absolutely nothing to do with stimulus.

The infrastructure part I thought was okay but should have been separate legislation. For infrastructure, I put my old mayor's hat on. In Johnson City, Tenn., we had with no tax increase and invested $122 million; that's a lot of money for a city our size, into water, sewer and roads. So I know how to do that. I know a lot about infrastructure. If we had looked at the infrastructure needs of this country and determined this on a local level, that would make sense. I don't have any problems with that. I have a big problem with borrowing for one time spending and have that go on our grandchildren's bill. What I didn't have a problem doing was something they could use, a school that their children would go to, a road or a bridge or water and sewer that would bring business in and have them help pay for that in future generations.

Massive government spending has never gotten us out of any economic jam.

What I would recommend we do is cut marginal tax rates 15 to 10 percent or 10 to 5 percent so that everybody knew they were going to have more money at the end of the month. You knew you were going to get it. Number two, take 20 percent of the net revenue of a small business and exempt that from taxes. If you make $200,000, just take $40,000 off the table and boom your taxable income starts at $160,000, take that $40,000 and reinvest it into a job, plant equipment, however you want to invest it. Third, I would not tax unemployment benefits. In other words, you get an unemployment check and then you have to write a check back to the Federal government. How dumb is that? What I would recommend you do, is just extend the benefit. Give the people a little bit less money and extend the benefit. I would have made healthcare tax exempt for an individual to deduct their taxes just like a business can.

The current stimulus package, if you believe the estimate of 3 to 4 million jobs, costs anywhere between $250,000 and $300,000 dollars a job to put somebody to work. The private sector can do that for about $50,000.

The other thing that was not good about this particular bill was it was not debated. It did not go through the normal vetting process; it didn't go to subcommittee, to committee, back to the floor for debate. There really was no debate on this bill.

NMN: Let's shift gears and discuss healthcare issues. In your assessment what are the most pressing issues facing the provision of medical care in this country?

I am more concerned going forward with the availability of care than the affordability of it. We'll somehow figure out how to pay for it. My concern is we are not training enough people to take care of us. In the next 10 years, over half of the registered nurses in America will retire. That is staggering. We need a million more nurses by 2016. In 10 to 12 years we'll have more doctors retiring or dying than we are producing in America. Well, who is going to take care of us? So I think the availability of care is a huge issue.

Another facet of healthcare jobs is they don't go anywhere, you don't export these jobs and they are good paying jobs with good working conditions.

What I've been doing in the Congress, so far, is to dedicate at least one to two hours in my office each week to have think tanks or other organizations come in to share their ideas and expertise with me. Recently, I had the Cato Institute come in tell me what they would do to fix healthcare. I'm meeting with the Brookings Institute, the Heritage Foundation, the AMA, every organization I possibly can get in, so I can learn what their thoughts are.

Congress has an informal physician caucus and I think that our congressional colleagues are going to look toward this caucus for guidance. There are 15 physicians in the US Congress.

NMN: Physician'shave concerns about Medicare and the SGR. Weface a 21 percent reduction in fees starting in January. MedPac has proposed to recommend a 1.1 percent increase. What do you think is going to happen with Medicare fee schedule?

The next big crisis, if we don't get to it, are payments to physicians and there's going to be a cut of either 10 percent or 20 percent, up to 40 percent by 2013 over current payments. That kind of cut is notgoing to happen and I tell you why it's not going to happen, because there aren't going to be any doctors to see anybody.

NMN: So obviously Congress is aware of this, but it will take a legislative fix.

Everything done in Congress is by a crisis. I'm afraid what's going to happen is that we are going to put it off, because nobody likes to talk about it. I think there is going to be a broad healthcare debate this year. What I hope is we have just the debate. We don't need to do this fast, because if we do it fast we'll get it wrong. What we need to do is put the policy that we are going to look at out there and then take it out across the country and start talking to people about it.

You need to find a lot of different input, from a lot of different people to help you make the right decision. This is extremely complex.

NMN: What are your thoughts on turning the whole thing over to the government; having a single payer nationalized approach?

I think that's a horrible, terrible, catastrophic option. Take a step back and think, do you want the people who managed Hurricane Katrina, who managed the bank bailout, to control the most important decisions in your life or your family's life, your personal medical decisions. I don't want that. Those decisions should be made between the physician and the patient. Obviously, it's a little worrisome in this current stimulus package that there's verbiage about paying for outcomes based medicine, and basically the translation of that is we'll invest so much money in a disease, and no more. You're already doing that now, because of budget constraints. You and I know if you budget so much money for healthcare, just like if you budget so much for gas, you can only buy so much gas, depending on what the price is. If you budget so much money for healthcare when you've used those resources you create waste. You ration care. That's what it is. You may as well just say it, because that's what is going to happen. There is always going to be more demand for services than there are funds to pay for it.

NMN: You mentioned some of the health related provisions in the stimulus bill.A big thing in there was health IT. The message that I'm hearing is that Congress is very excited about this. What are your thoughts on health IT? Are the current systems we have ready for roll out?

We took our 70 person group and did an EMR, so we are completely paperless now in our practice. Remember back in the 80's and managed care first got in? Managed care was going to solve all the problems of healthcare. It was going to fix it. The premise was that there was so much waste in the system that we were going to manage it and it was all going to work out with the dollars we had. I remember all that. Well we have the same logic now with IT.

The premise is that we are going to do so well to prevent duplication of services, and we are going to save money because we can put it on the computer. It's nonsense.

There are some good things about an electronic medical record. It's good for tracking people who have a complex disease. However, it is not going to save hundreds of billions of dollars. I've got some bad news flash – that ain't gonna happen. That's the hope – mark it down right now; it will be colossal failure.

The doctors have been reluctant for a number of reasons; one is cost. Doctor's have no capital for this. It comes out of a practitioner's hip pocket when they do it, and if you pick the wrong system, you are just out of luck. IT is not going to solve our problems.

NMN: What are your thoughts on medical liability?

It is even bigger than medical liability; it's liability in general in this country. It's run the cost of business up and certainly the cost of healthcare up. There is no question about that;I mean how many unnecessary tests are done?

We should be able to compensate injured people when we make a mistake. This current system doesn't do that. We do it in everything else, in automobile wrecks, you can do that. No one has ever argued about paying actual damages of medical costs. When I started practice in 1977, malpractice insurance was maybe $4000 a year and that was a significant amount of money then, but it wasn't back breaking. Now, for a new OB/GYN it could be $70,000,and that is back breaking. You can't even open a practice.

We need to be able to have a solution to this problem. I challenge our attorney friends, and I have many. I say to them, "you have to help us solve this problem." We need a way to solve this problem because, if not, and the malpractice premiums for an OB/GYN go above $100,000, I can tell you they are going to quit in droves. They are going to do something else.

NMN: Are there other healthcare issues you want to talk about?

Well, I think the big gorilla out there is healthcare reform. I want to be right in the middle of this debate, and I intend to be. I think the physician caucus will be important in this debate. I think you'll see us on television talking about it; we'll be writing about it. I think just from what I know, I can see the single payer government system expanding an already failed Medicaid and Medicare system. If you look at Medicaid/Medicare and Social Security, in 30 years it consumes the entire federal budget. There will be not one discretionary dime left; not for defense, not for anything else. So it has to be reformed.

Why do we keep putting it off? Because it is hard. If you do something meaningful, you're liable to lose an election.But for me, I was perfectly happy before I became a Congressman and I'm happy now, and if I lost, I would still be happy. So that's why I want to be in this debate.