Greg Landsman Asks Medical Professionals: 'Are The Revenues Coming Into Medicare Sufficient?'

Ajouté : 2026-05-30

[00:00:00]I'm in yields. The gentleman from Ohio is now recognized for his 5 minutes.

[00:00:05]Thank you, Madam Chair, and thank you, Ranking Member DeGette.

[00:00:09]Um Medicare is unquestionably one of the most important things we've ever done as a country, and it's now around 67 million Americans over the age of 65 that get their health care from Medicare.

[00:00:26]It's over a trillion dollars uh investments that we make, although it's something that the American people pay for, uh mostly through payroll taxes.

[00:00:36]We're talking about the physician fee structure today, and I was going to ask some questions about it, and then I realized there's this fundamental issue and around whether or not we really are investing or have the money we need, and if we had a different trust fund, if it were funded in a more significant way, we might be having a very different discussion.

[00:01:03]So, the question, and anyone can answer this, do you you know, is it just me, or or are you worried about the trust fund? I mean, it would we be having a very different conversation about physician fee schedules if the trust fund was fully funded or was sufficiently funded?

[00:01:23]Anyone want to answer that?

[00:01:25]Or or let me ask in a less leading way.

[00:01:27]Is there an issue with the fund?

[00:01:31]Uh do we have enough money in in the Medicare trust fund?

[00:01:37]I'll Thank you, doctor.

[00:01:39]>> Take care. Oh, sorry.

[00:01:41]Go ahead.

[00:01:41]>> Um One of the things I This this a lot of this hearing has been around policies in traditional Medicare.

[00:01:48]And uh as important as that is, it is now the smaller part of Medicare outlays, which is on Medicare Advantage, but those Medicare Advantage rates are inflated, tied to, trended by cost growth in traditional Medicare.

[00:02:07]And so, I think these discussions in terms of how we can >> but but Medicare Advantage is is us just paying private insurance to provide insurance to seniors. I'm asking a question about the larger program.

[00:02:23]Are the revenues coming into Medicare sufficient?

[00:02:25]Would we be having a different Are you worried about physician fee payments?

[00:02:32]Uh are they stretched too thin, or do we have plenty of resources, and it's just a policy question? I'm under I'm under the firm strong conviction that this is not an insufficient spending issue. It's a cost-efficiency issue. According to CMS Office of the Actuary, we as a country spent $4.8 trillion in 2023. In 2033, it's going to be $8.7 trillion, 75% more.

[00:02:56]>> worry you that this program was set up, Social Security, too, uh paid for by payroll taxes, and that we now have a tax system that's essentially two-tiered. You have workers, including the working rich, that pay income taxes and pay the payroll taxes, and then you have folks who have wealth, that own wealth, and they don't pay any payroll taxes. Does that bother you?

[00:03:22]I mean, that has to like because sure, spending is up, health care is expensive, but the question is when we get into these policy conversations, are we really just nickeling diming seniors and our physicians who are really struggling because we have such a broken tax system? Does it Let me ask a non-leading a less leading question.

[00:03:42]You've got trillions and trillions of dollars sitting in in in with the the folks at the top who don't pay any payroll taxes. Isn't that a problem for social security Medicare?

[00:03:54]From a funding mechanism, you know, we pay for our health care account, you know, two different commodities, time or money. If you got a lot of money, you pay with a very little time. If you don't have a lot of money, you're going to pay with a lot of time. You're not going to have meaningful access. Per capita, we spend $14,750 per capita in this country. Compared to every other country in the world, we easily outspend every other country in the world, and it's almost by two to three X. Yeah. So, again, it's not an insufficient spending issue. It's a cost efficiency, and a lot of that is driven by the Medicare fee schedule and the other Medicare aid schedules that we are governing the system. I agree that we spend more, and I only got 35 seconds.

[00:04:32]We if we invested in, you know, prenatal care and child care and preschool, you'd have healthier outcomes and health care costs would go down. But, we don't have the, you know, we don't invest that way.

[00:04:41]Other countries do, and they have better outcomes. We're reactive.

[00:04:44]>> And we, yeah, we react, right? And so, now we have But, you know, we have these conversations, and physicians tell me, "I'm struggling." And then what happens, and this is where we spend more, a physician gets bought by a hospital, the hospital takes the same service that that physician was providing, and charges two to three times more. Health care costs go up because we didn't do the right thing because we're essentially broke because most of these folks at the top don't pay all their taxes. Thank you.

[00:05:11]You go back.

[00:05:12]>> Our incentives are not aligned.