[Congressional Record Volume 150, Number 33 (Tuesday, March 16, 2004)]
[House]
[Pages H1109-H1114]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE TRAGEDY IN SPAIN AND HEALTH CARE REFORM
The SPEAKER pro tempore (Mr. Kline). Under the Speaker's announced
policy of January 7, 2003, the gentleman from Texas (Mr. Burgess) is
recognized for 60 minutes as the designee of the majority leader.
Mr. BURGESS. Mr. Speaker, I too want to touch on a variety of
subjects tonight. There are so many things that are before this body
and before the country, and I think it is important to speak out about
a number of them.
The first thing, Mr. Speaker, that is on my mind, of course, is the
terrible tragedy that happened in Spain last week. And in the sad
aftermath of the bombings in Madrid, unfortunately we see coming from
that some sort of new strategy to deal with the war on terror and it is
a most unwelcome strategy. This is a strategy of capitulation and of
compromise. It is a strategy, in short, of surrender. In that
surrender, what do we give up? We give up security, we give up our
beliefs, and we give up our values.
Mr. Speaker, I am here tonight to say that ``Appeasement does not
bring peace.'' Just ask Neville Chamberlain. ``Compromise with hate
will not work.'' Remember Joseph Stalin?
Mr. Speaker, these terrorists are not seeking peace. They seek to
terrorize. Their desire is to bring ruin and disruption into people's
lives. They want control, but we must stand firm.
The war on terrorism was brought to this country in September of
2001. Our President, George Bush, responded to that act of war in an
address to this House with these wise words: ``The pictures of
airplanes flying into buildings, fires burning, huge structures
collapsing, have filled us with disbelief, terrible sadness, and a
quiet unyielding anger. These acts of mass murder were intended to
frighten our Nation into chaos and retreat, but they have failed. Our
country is strong. A great people has been moved to defend a great
Nation. Terrorist attacks can shake the foundation of our largest
buildings, but they cannot touch the foundation of America. These acts
shattered steel, but they cannot dent the steel of American resolve.
America was targeted for attack because we are the brightest beacon for
freedom and opportunity in the world, and no one will keep that light
from shining.'' President George Bush, September 2001.
Mr. Speaker, I, like everyone else in this House, was greatly
saddened by the attacks in Spain. It is a mournful time for the people
of Spain and for all of Europe as they bury their dead. But in the
midst of this sorrow a more menacing problem is evolving. People are
blaming the war on terrorism for causing the attack, and using this as
a reason to vote out a strong ally in this war. In fact, I would remind
the Speaker that Prime Minister Aznar was in this House and spoke to
the House and Senate just a scant 5 weeks ago and received standing
ovation after standing ovation in this House at the time he delivered
his address.
In voting out the strong ally in the war on terror, the people of
Spain have
[[Page H1110]]
actually handed over their government that will now shrink in the face
of terrorism. The Spanish voters have handed to the terrorists their
largest victory to date. No doubt the terrorists will feel emboldened.
They feel victorious. They were able to cause chaos and disrupt an
entire government. Is this the signal we wish to send the terrorists?
Is this the type of behavior that we would seek to reward?
Quoting an editorial today in The Washington Post; ``The rash
response by Jose Rodriguez Zapatero, Prime Minister Elect, will
probably convince the extremists that they are able to sway Spanish
policy with mass murder, and they succeeded brilliantly.''
Make no mistake, Mr. Speaker, we are winning this war. And, in fact,
an article from my hometown paper, the Dallas Morning News, today
stated, ``The Prime Minister of the Netherlands found that it was
important in the international community that we stand shoulder to
shoulder and show solidarity to fight against these terrible attacks.
We share that same goal.''
Mr. Speaker, last month, I was in Pakistan with part of a
congressional delegation of the Committee on Government Reform and
President Pervez Musharraf spoke to our group. Speaking to Members of
Congress, he said, and I quote, ``The United States and this
administration represents truly the last best chance for peace in this
troubled region.'' Indeed, Mr. Speaker, that is correct.
Both Iraq and Afghanistan have been freed from brutal totalitarian
regimes. Both countries are now functioning under their interim
constitutions, and both will soon hold free elections. America is
winning the war on terrorism. This is no time for our resolve to
weaken. This is no time for the leaders, or those who would be leaders
on our national stage, to exhibit capitulation with the enemy.
Mr. Speaker, we have heard a great deal about health care on the
floor of the House tonight, and I feel obligated to speak to that as
well. Some of the comments that were just offered by the gentleman from
Michigan particularly deserve and, in fact, demand a response. His
vision for the country being under a single-payer, government-run
system is one that, quite frankly, causes me to shudder. I cannot
imagine giving up that degree of control over my life or my family's
life to the Federal Government.
Mr. Speaker, I think back to a time last summer when I was visiting
in Iraq and got to see their health care system. They have been under a
single-payer, government-run system for 20 or 30 years, and the state
of their health care system was below pitiful. So that does not seem to
me to be a valid solution to health care in this country.
Mr. Speaker, we passed some pretty major health care legislation back
at the end of last year, in November, H.R. 1, the Medicare Prescription
Drug and Modernization Act. On December 8, 2003, our President, George
W. Bush, signed into law H.R. 1. This bill will institute sweeping new
changes into the Medicare program, extending prescription drug coverage
for the first time ever, and improving the program in ways that will
make America's health care system healthier, stronger, and happier.
The United States House of Representatives approved H.R. 1 November
22, 2003. The vote was 220 to 215. The United States Senate approved
the bill by a vote of 54-44 on November 25, 2003. When the bill came
before the United States House of Representatives for a vote, I, along
with 220 Members of the House, voted in favor of this measure.
Mr. Speaker, we all know no bill is perfect, but there were several
important provisions included in the bill that will dramatically
improve the Medicare program and seniors' health. And just as
importantly, as we have also heard tonight from the gentleman from New
Hampshire, there were other provisions in this bill that will improve
health care in general for generations to come.
In regards to immediate assistance. Starting this summer, seniors
will have access to a Medicare drug discount card that will provide
discounts of up to 25 percent of their drug costs. Low-income seniors
will have additional assistance through the discount card program,
having an additional $600 annual supplemental along with their discount
cards.
The Medicare prescription drug coverage. For the first time since the
creation of the Medicare program, prescription drug coverage will be
available to all seniors covered by the program. Under the program,
which will go into effect in the year 2006, a majority of seniors will
see dramatic reductions in their drug spending. For a $35 monthly
premium and a $250 annual deduction, Medicare will pay 75 percent of
the prescription drug costs up to $2,250. Seniors are responsible for
costs between $2,251 up to $3,600. When annual drug spending reaches
$3,600 a year, Medicare pays 95 percent of all drug costs after that
point. Low-income seniors will be covered by an even more extensive
drug benefit with little or no cost-sharing on the part of the
beneficiary and total coverage for all yearly drug costs.
The bill itself has several provisions that will speed market entry
of cheaper generic drugs. Key reforms to the Hatch-Waxman Act, the
Federal law governing generic drug introduction, will provide brand
name manufacturers only one 30-day stay for generic production once the
patent expires.
Another way the bill establishes for realistic market controls to
drug pricing is by reforming the average wholesale price structure.
This price structure is reported by drug manufacturers and rarely has
any relation to what physicians actually pay for drugs. Without reform,
overpayment, due to the average wholesale price, could reach into
millions of dollars.
Protecting retiree health benefit plans. A major concern of mine as
Congress considered this bill is how it would treat retiree health
plans. Several of my constituents expressed their deep concerns that
with the creation of a new Medicare benefit that their company would
drop their retiree health plan. I shared their concern, and I worked
with the conference committee members to ensure that the bill did
protect retiree health plans.
The bill will support 28 percent of a retiree's drug costs between
$250 and $5,000. That is equal to nearly two-thirds of the actuarial
value of the standard benefit. The subsidy is also excludable from tax
indication, raising its total value in the bill by $18 billion.
Mr. Speaker, we heard a little earlier about health savings accounts.
H.R. 1 creates new accounts that allows individuals and families to
accumulate tax-free assets devoted to their health needs. The accounts
will allow workers under the age of 65 to accumulate tax-free savings
for lifetime health care needs if they have a qualified health plan.
Health savings accounts require qualified plans that have a minimum
deductible of $1,000, with a $5,000 cap on yearly out-of-pocket
expenses.
These amounts are doubled for family policies. Individuals can make
pretax contributions of up to 100 percent of the health plan
deductible. The maximum annual contribution is $2,600 for individuals
and $5,150 for families, indexed annually for inflation.
{time} 2045
Pretax contributions can be made by individuals, their employers and
family members. Individuals ages 55 to 65 can make additional pretax
catch-up contributions not covered by the insurance policy. Tax-free
distributions can be made for continuation coverage periods by Federal
law such as COBRA payments, health care insurance for the unemployed,
and long-term care insurance.
Health savings accounts will change the face of health care coverage
in the United States. The individual owns the account. The savings
follow the individual from job to job into retirement. The flexibility
and asset accumulation characteristics of these accounts will help
millions of Americans save for their health needs. Health savings
accounts will also encourage individuals to buy health plans that
better suit their needs so insurance kicks in only when it is truly
needed. Moreover, individuals will make cost-conscious decisions if
they are spending their own money rather than someone else's money.
One of the major problems facing the Medicare program is the low rate
at which it reimburses doctors for their services. As the Medicare
program has cut rates, some physicians have stopped providing
treatments to Medicare patients. This reduction in access
[[Page H1111]]
to a wide range of physicians could have a detrimental impact on many
seniors. In order to maintain adequate physician participation in the
Medicare program, H.R. 1 rescinds a cut in physician payments and
increases payments over the next 2 years. All physicians and providers,
such as physician assistants, nurse practitioners, occupational
therapists and other providers paid under the Medicare physician fee
schedule will see a 1.5 percent payment rate increase under the House
bill instead of the 4.5 percent payment cut in 2004. This produces a
net increase of nearly 6 percent in payment rates in the year 2004.
An additional 1.5 percent increase will replace another projected cut
in 2005. To address the volatility in physician payment updates over
time, the bill changes the formula used to calculate payments by using
a 10-year rolling average measure instead of the current single year
measure. H.R. 1 addresses the scarcity of physicians in rural areas of
the country. To help rural and other areas with few physicians with
recruitment and retention, Medicare will pay a 5 percent bonus to
physicians providing care in scarcity areas in 2005 through 2007. Both
primary care doctors and specialists would be eligible for this bonus
if they provide care in scarcity areas.
Mr. Speaker, a question that I am often asked about the Medicare bill
is, why? Why did you undertake such a big, sweeping change to Medicare?
One of the first things I need to say is all of the changes that were
implemented in H.R. 1 are entirely voluntary, that is, if someone in
the system likes what they have in the Medicare system, they do not
have to change. They do not need to purchase a prescription drug
benefit; they certainly do not need to avail themselves of any other of
the other benefits, such as health savings accounts, that are available
in the Medicare bill.
But, Mr. Speaker, from 1965 when Medicare was first enacted in this
country, there was something missing from the program and what was
missing was prescription drug coverage. In 1965, it may not have
mattered as much. The major expenses that a senior faced back then from
the medical system was either undergoing an operation or prolonged
hospitalization for, say, treatment of pneumonia. Prescription drugs
were few and far between. There was only penicillin and cortisone, and
those were interchangeable back then. But a lot has changed since 1965.
In the 21st century, we have an enormous pharmaceutical capability that
was really unimagined 38 years ago when Medicare was brought into
being.
Mr. Speaker, it was crucial that this gap be addressed. We are
spending $287 billion a year on the Medicare program this year without
considering prescription drugs. We are spending a tremendous amount of
money and are scheduled to spend a tremendous amount of money year in
and year out on Medicare, and we are not getting value for our dollar.
As my colleague from New Hampshire pointed out earlier, earlier
treatment of disease can reduce the overall cost for treating an
episode of disease.
Finally, we have heard a lot in regards to the cost of the Medicare
bill and the cost of the prescription drug benefit. Over 10 years'
time, $395 billion was the estimate from the Congressional Budget
Office, and more recently the White House Office of Management and
Budget came out with a figure of $535 billion over 10 years, or numbers
to that effect.
Mr. Speaker, I would like to point out there are some areas for cost
savings within Medicare. We had before this House about a year ago this
week a bill H.R. 5, which would have reformed the medical liability
system in this country. The House passed it. Unfortunately, the
legislation has stalled on the other side of the Capitol. I have great
hopes that someday it will move, but it is not on the horizon right
now.
By reforming the medical liability system in this country and undoing
some of the effects of the cost of defensive medicine, not just the
cost people pay for insurance premiums, but the cost of defensive
medicine, could reap enormous benefits. There was a study done in
Stanford, California, in 1996 that showed within the Medicare system,
just in the Medicare system, the cost of defensive medicine added $50
billion a year to the cost of Medicare in this country.
There is our prescription drug benefit. No matter whose figures we
use, the Congressional Budget Office or the OMB, it is $50 billion in
1996 dollars each year savings from removing the cost of defensive
medicine.
Mr. Speaker, I would like to yield to the gentleman from New Mexico
(Mr. Pearce).
Mr. PEARCE. Mr. Speaker, I appreciate the gentleman yielding me this
time. This subject of exactly why we did take up the Medicare and
prescription drug bill comes up frequently, and it is a question that
people really do concern themselves with.
For me as a business owner, when I came to this body and looked at
the budget and realized that almost all economists agreed that within 4
to 10 years Medicare would put such deep stress on the budget, we may
not have solutions to it.
As a business owner, if I see that kind of problem 5 to 10 years down
the road, I know I must do something today to begin to defuse the
demand, defuse the problem well before it arrives.
As we began to develop the program, the Medicare prescription drug
bill, I began to ask questions and to make requests of my own. One of
the things that several Members did was sign a letter saying if you do
not give equal reimbursement to the rural areas, we will not vote for
any bill.
Mr. Speaker, I campaigned saying we should treat the rural areas of
America fairly, that they needed to be compensated the same way because
that is not the case in the past. We got 100 percent equality for rural
hospitals in this bill, and it is one thing that affects my district
tremendously. It was not just affordability of care that was at stake
in my district; it was the access to care, even having hospitals that
would operate and be in the district, and so this one component of
equalizing the reimbursement rate in our rural hospitals was key.
Another element that caused me to think there were good elements of
the bill and it deserved support was the way border hospitals are
treated. Border hospitals have a mandate by the immigration service
that if an immigrant comes to a hospital with a medical problem, that
hospital at its own expense or the expense of the county in which it is
located, will transfer the person to the nearest facility where
treatment can be given. Hospitals in my district are severely burdened.
My district is on the border of Mexico, and the hospitals complain
about the unfunded mandates to transport and to treat many medical
conditions. Then the immigrants are taken back to the border and
deposited there to return to their homes.
Mr. Speaker, that was another element that I campaigned on saying
that we should get reimbursement for those costs mandated by the
Federal Government. In this bill there is $1 billion to begin to help
border hospitals pay for the costs that they face through an unfunded
mandate by the Federal Government in the immigration department.
Those two things really began to convince me that for rural New
Mexico, the Medicare bill had a good beginning, but it did not stop
there. The disproportionate share hospitals also received an increase
in funding level. Again, that affects most of the hospitals in my
district. We also dealt with the reimbursement for rural physicians in
this bill. Again, a win for New Mexico. So it began to look to me like
we had the elements to build a successful bill on, that we had some
long-term cures that were a long time in coming, and I was proud to be
a part of those.
As we got into the philosophy of the bill, I think that is where we
really began to see the need for change, the need for systemic change.
One example of how we do things upside down in Medicare and in
providing government coverage for Medicare is that we cause incentives
to go to the most high-priced objective. We all know that for a small
copay you can get any pharmaceutical that you would like to have. Once
you reach the copay, you might as well get the expensive as the generic
because there is no difference.
If we turned the incentive upside down and were to provide coverage
for the generic, and if you want then the expensive version of the same
drug,
[[Page H1112]]
you would have to provide the difference, that was a compelling way to
me that we could change behavior and change buying patterns throughout
the country.
One of the things that we did in this bill was we began to limit the
powers of the drug companies. I appreciate what the pharmaceutical
companies have done in this country. They have created pharmaceuticals
that are extending lives beyond belief. The fastest population group in
America is over 100 years old. The second fastest growing age group is
85 to 100. These extensions of life and the quality of life that is
experienced is because of the good work that the pharmaceutical
companies do; but the pharmaceutical companies are just like the rest
of us. They will take advantage when advantage given.
There was a practice of extending patents indefinitely. At the end of
the patent period, they would change a few words and change the patent
again. It was legal, but it was something which many felt was not
right. In this bill, we limited the extensions to one. You get your
original patent period, and then one extension. That will bring generic
drugs to the market sooner. Just to make sure that the generic drugs
come to the market sooner and we get competition sooner, we went ahead
and put provisions in that would encourage the generics to be brought
to market sooner.
We just wanted the drug companies to know that we appreciate what
they do, but we also wanted to give them a small wake-up call that
there were practices that we felt like were not in the best interest of
all Americans. And so those changes were made here. Again, a very
positive component that I felt began to justify this particular bill to
be voted for.
Another thing that we did were health savings accounts. My colleagues
have talked about that tonight, but I will give my brief summary.
Health savings accounts are really medical IRAs. Americans can put in
money tax free at any age, and at any age you can take money out tax
free. That makes the health dollar worth 30 to 40 percent more,
depending where you are in the income spectrum.
So you have a medical IRA that you put money into tax free at any
age, about $5,000 a year, and you can take money out at any age if you
use it to pay for medical benefits. You can pay for your premiums out
of this health savings account; you can pay for your deductibles out of
the health savings accounts, as well as prescription drugs or any other
medical expense.
The nice thing about health savings accounts are they are a part of
your estate. If you do not use it for your medical needs, you are able
to pass it on to the next generation and to the next generation so that
your children and grandchildren have a head start on paying for their
medical needs.
I will tell Members, as a small business owner, the way that I would
have dealt with this, and my wife and I sold our business in October of
last year so I no longer have employees that would qualify for this,
but the way I would deal with this particular situation is I would
begin to give pay and bonuses into that account. So instead of giving
pay increases, I would pay the increase into the health savings
account. I would try to put $5,000 a year for every employee into the
account, where the money was worth 30 to 40 percent more, and also
where they could begin to use it to pay out of an account that has been
put into their name, and they can pay out of that account to pay for
premiums and deductibles.
I think as we build the size of the account, we can all see that we
can begin to shop for higher deductible insurance. Right now most of
the time when I shopped for health insurance, it was either a $500 or
$1,000 deductible. But if a small business has helped pay in $5,000 to
$20,000 into a health savings account, and knows that no one is going
to be disadvantaged, then we begin to shop for maybe $5,000
deductibles. It is at that point the health insurance costs begin to
collapse tremendously and we put the health care, the health insurance
costs back within the reach of the average wage earner.
{time} 2100
Ten percent of my employees had insurance costs of more than $1,000 a
month. With 20 and 30 percent increases, you could look at 3 years from
now having $2,000 a month. There is a point, Mr. Speaker, at which no
one can afford health insurance. The health savings account, this
medical IRA, begins to change the way that we think about health
insurance. It begins to change buying patterns so that long term we
begin to affect the price of medical services themselves. One of the
most important things that we did in this bill is began to understand
that if we will catch problems at the front, at their initiation, they
are far easier and cheaper to take care of.
One of the reasons that Medicare has been so expensive, one of the
reasons it stands to break the budget of the United States, is that we
have no preventive medicine. At least we did not until we passed this
bill. In other words, we would not do screenings but Medicare would pay
for the full cost of operations, heart surgeries, cancer treatments
after they were full-blown.
In this bill with screenings, physical exams and preventive medicines
guaranteed, I think that we are going to begin to collapse the cost of
this Medicare bill overall down below what it has been, rather than the
astronomical increases that we are seeing projected; because I think,
as the good doctor has pointed out, that there are applications in this
bill which will save us money, not cost us money.
The gentleman from Texas explained adequately that the benefit
programs were one of the main questions that he faces in his district.
Benefit programs are a concern to all of us. Many companies have
employees who have retired and are using that company benefit for their
health insurance. I have experienced the same concerns in my district
that the gentleman from Texas has experienced, of people wondering,
well, if you put this in place, then my company is going to drop it,
they are going to drop the coverage that I currently have. That
disappointed them. It concerned them.
I will tell you that we did something in this bill that to me made
sense. We have our opponents, those people who want to criticize the
bill, saying that we are giving corporate welfare. Mr. Speaker, what
they are talking about is that we are giving an incentive, we are
helping these companies that pay retirees' health benefits, we are
giving those companies incentives to keep the benefits in place. We are
saying that if the Federal Government can pay 20 or 25 percent and
cause them to keep that health benefit in place for the retirees, that
that is going to be far preferable to having the company drop the
coverage and having Medicare pick up 100 percent of the coverage. And
so those opponents of this bill who claim that it is corporate welfare
can do so; but when they do so, they have to not be telling the full
truth that we did it in order to encourage companies to keep those
benefit plans open for retirees who really think they have got good
plans.
One of the most important parts of this bill, Mr. Speaker, was the
concept of choice, the ability to choose whether you like the current
plan you are under, the traditional Medicare, or whether you want to
opt out and move into the new plans that will be offered as competing
plans for this program.
Mr. Speaker, I do not see anyone complaining about the right to
choose. I see a lot of people complaining about the potential of being
mandated to move into a complete private sector but not one person has
said, don't give me a choice. I will tell you that the right to choose
is one of the most fundamental parts of our American society and I am
proud that in this bill we have given our seniors the right to stay
where they are, to use Medicare completely as it is without any
changes, but we have also given them a right to choose a different kind
of coverage that meets their needs more.
Mr. Speaker, there are many reasons that I voted for this bill but
the main ones were I believe that systemically it began to address the
long-term changes that are necessary to make Medicare viable for the
rest of this generation, for the next generation and the generations
beyond. Access to affordable health care in rural parts of the country
just cemented my belief that we have done very good work in this
particular bill.
Mr. Speaker, I have more things to say but I would like to yield back
to the gentleman from Texas and let him
[[Page H1113]]
continue and I will wait for the next coverage that he gives to me.
Mr. BURGESS. I thank the gentleman from New Mexico. We heard earlier
this evening the gentleman from Michigan stand up and talk about paying
for health care. Mr. Speaker, an op-ed piece by Ronald Brownstein out
in Los Angeles, California in December talked about that he thought
there were only two ways to pay for health care in this country: One
was an employer-given indemnity insurance plan and the other is a
government-paid system. As a longtime participant in the health care
field, there is a certain segment of health care that is delivered free
of charge. It is uncompensated because someone either cannot pay or
will not pay, and the bill therefore is uncompensated and the hospital
or physician or provider simply eats that charge, and that goes on
every day of the week.
But there is a fourth source and that is, of course, the individual
who is going to write a check themselves, going to pay for their care
themselves out of pocket. One of the problems in the world nowadays is
that medical care has become so expensive so many people find that
daunting, but that is why the health savings accounts not just for
seniors but started at an early age and really making them available to
all Americans, that is why that is such a crucial part of the overall
reform encompassed within the Medicare bill.
Mr. Speaker, the gentleman from Michigan also referenced the
newspaper Roll Call. We are all familiar with Roll Call up here on the
Hill. Certainly the writers in Roll Call are no particular friend of
the President of the United States. In fact, sometimes they are quite
critical of him. On one of those occasions where the gentleman that
writes the column Pennsylvania Avenue was very critical of the
President was right after the State of the Union address, I believe it
was the Monday following the President's State of the Union address,
where in this House he addressed both Houses of Congress and said that
he appreciated what we had done with health savings accounts, he wanted
now to extend that, he wanted there to be full deductibility for a so-
called catastrophic medical insurance policy, that a person would be
able to deduct the cost of that from their income taxes.
Mr. Speaker, combining the power of the HSA with full deductibility
of catastrophic coverage pretty much removes from consideration, that
is, anyone who pays insurance in this country would no longer have an
excuse for not having health insurance. We would have given them every
reason to spend those tax-deferred dollars on the insurance coverage
that they need.
One of the other programs that the President talked about that night,
and I think the gentleman from Michigan also referenced this, was
association health plans. Association health plans are a critical tool
that allows small businesses of a similar business model to band
together across State lines if necessary and get the purchasing power
of a larger corporation, an idea that has a lot of common sense to it.
An organization such as a collection of chambers of commerce, for
example, or a collection of realtors, for example, these would be
businesses of a similar business model, they could group together; a
group of realtors could go in together and get more purchasing power
with the money they use to buy health insurance policies and extend
coverage and keep people from dropping out of providing insurance
coverage to their employees, one of the problems that the gentleman
from Michigan referenced.
Association health plans were again passed in this House in June of
last year and again that is an example of some legislation that sort of
stalled on the other side of the Capitol Building. I hope that it will
get taken up at some point.
There is another measure, Mr. Speaker. The gentlewoman from Texas
(Ms. Granger), my next door neighbor in Fort Worth, has a bill to
provide tax credits for the uninsured. You may say, gosh, that is
great. Somebody who pays income taxes can now afford health insurance.
But what about someone who does not make enough money to pay income
taxes? What are they going to do for insurance? This would be a pre-
fundable tax credit, available to someone at the beginning of the year
to use for the purchase of a health insurance policy.
Mr. Speaker, the combination of these three things, the health
savings accounts with the inclusion of the catastrophic policy, with
full deductibility of a catastrophic policy, association health plans
and tax credits for the uninsured, comprise a fairly significant number
of the uninsured who can be taken off the rolls of the uninsured.
Mr. Kondracke was kind of critical of the President after those three
proposals were sort of wrapped together in the State of the Union
address. Mr. Kondracke said, gosh, that will only cover a quarter of
the people who are uninsured in this country. Mr. Speaker, that is 10
million people, in excess of 10 million people. I submit if we have the
power in our hands, without any heavy lifting, to provide coverage to
10 million uninsured by the end of this year without increasing the
deficit, for heaven's sake that is something we should do. There should
be a moral imperative for us to take up and pass that legislation.
I urge other Members of this body to look favorably on tax credits
for the uninsured when that legislation comes forward. I would
encourage the Committee on Ways and Means to let that be reported out
of committee and come to this House for a vote. Again, good legislation
that has stalled at the other end of the Capitol needs to see the light
of day.
With that, Mr. Speaker, again my condolences to the people in Spain.
I want to finish up tonight by yielding back the remainder of the time
to the gentleman from New Mexico and thank him for his participation in
this hour of debate this evening.
Mr. PEARCE. Mr. Speaker, if I could request how much time is
remaining.
The SPEAKER pro tempore (Mr. Bonner). The Chair advises that there
are 24 minutes remaining for this particular time period for the
majority.
Mr. PEARCE. Mr. Speaker, I would like to discuss even a broader
concept in health care costs. One of the most urgent questions that I
get when I am in my district, people wonder how are we going to afford
health care costs. How can we afford health insurance? What are the
components of that? All of us, myself included, would look for easy
solutions. We would want a bill that we could pass that would just
limit the cost of care. Maybe it is by fixing prices in the
pharmaceutical industry or maybe fixing prices that the doctors are
able to charge. Some people want to go in and limit the capability of
insurance companies to raise their prices to pay for the costs that
they have. Mr. Speaker, anything that we attempt is going to be
simplistic and will be, without doubt, ineffective. The reasons that
our health care is so expensive, is, frankly because we are demanding
it. We have more demand than there is supply. When that is the case,
you can either increase the supply, which is the number of doctors and
the number of hospitals, or you can begin to affect demand.
I would say, Mr. Speaker, that it is imperative, as long as we are
going to try to solve the problem, we may address the supply, we may
address the numbers of doctors, we may address the numbers of
hospitals, but that does not completely deal with the problem that I
see, that is, on the demand side. I think that the first step for us
all is to begin to live healthier life-styles. There is one study which
reports that if we lost nationwide 10 pounds per person that the
incidence of diabetes could be cut by 25 percent nationwide. Nationwide
diabetes is an exploding phenomenon that is going to affect the health
care costs for every single one of us, even though we are not all
affected by it. If we look at our young population, we are finding that
exercise and healthy choices are so bad that youth diabetes is
exploding in the country, also.
I will tell the Speaker and this assembled group that these health
problems into the future raise such tremendous concerns on costs for
budgets, quality of life, that we need to begin to make healthier
choices. We need to make healthier choices in our life regarding
smoking, regarding physical exercise, regarding illegal substances that
we place into our bodies. All of those are things which affect the
demand, the demand which causes health care costs to increase daily.
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I think one of the things that we need to be smarter about in this
country and which would also begin to lower that demand curve for the
medical services and begin to affect the cost shifts upward each year
is in regard to preventive medicines. We all need to be doing careful
screenings, cholesterol checks. We should be doing the cancer
screenings. I heard statistics today about the way that breast cancer
is really spreading in this country. Breast cancer is a curable problem
and one that is affecting, I think, 1 out of every 3 or 4 women. Mr.
Speaker, if we will begin to do the screenings and the preventive
medicines, we will find that long-term our costs will begin to deflate
also.
The health savings accounts, we have already discussed how that can
affect long term the cost of our medical care and the cost of
associated insurance.
One of the things that we are wanting to institute in this particular
bill is more competition.
{time} 2115
If we look at a couple of examples right now in the medical community
of competition, I think Lasik eye surgery is one of the examples, also
reconstructive surgery, the plastic surgery. Both of those elements
have had competition introduced into their sphere in the last couple of
years; and we have seen, I think, 30 percent decreases in the cost of
those particular services. Competition is one of the important aspects
of not only the American way of life but also in any free market
enterprise, and we should see that always competition is never
forbidden but encouraged, and it should be that way in our medical
field.
The gentleman from Texas (Mr. Burgess) mentioned that one of the most
important things we can do to begin to lower costs of medical treatment
rather than to see the constantly inflating and increasing cost of
medical treatment is medical liability. Many physicians in my district
talk about the escalating medical liability costs. Each year we face
the prospect that more and more doctors are going to just stop
practicing medicine. So instead of increasing the supply, we are
actually decreasing the supply, which is going to give more incentive
for prices to go up higher even. Medical liability is one of the most
serious problems in day-to-day costs of health care and needs to be
addressed. This House has addressed it. We feel like it is a thing that
should be pushed on through the full Congress and sent to the President
for signature.
I think, finally, the good doctor mentioned several times, and in
good components, the cost of defensive medicine. Defensive medicine is
not just in fear of lawsuits. Defensive medicine is when our doctors
begin to prescribe more tests than should actually be done because they
are afraid that they will be sued if they do not prescribe every single
test that is available. Defensive medicine is when doctors begin to
order more rather than exactly which tests they believe are the right
ones, which procedures they believe to be right. It is in that
defensive medicine, that overprescribing, that overtreating that we
find, as the good doctor says, $50 billion worth of cost in this
country alone and that one single step of changing that parameter in
our health care costs could pay for, for instance, this Medicare
prescription drug bill.
Mr. Speaker, we are going to make choices in this Nation that are
expensive. In this particular case, this particular bill, it was the
right thing because we have seniors who are having to choose between
food and medicine. There is an immediate impact in this Medicare
prescription drug bill which will give to our low-income seniors right
now this year a $600 card that is good for any purchase of prescription
drugs throughout the rest of the year. Next year the same thing is
going to happen. Those people at lower incomes, $18,000 and below for a
couple, will receive another $600 card next year, which will be good to
help them defray the cost of the prescription drugs.
As we look at the plan itself, we have a lot of critics who are
describing the gap and being very critical of the gap in the
pharmaceutical coverage. I will tell those people that are assembled
here today that the single most important reason we did that was to be
able to afford the bill. We did not want to break the next generations
because we paid for full coverage for every single person in this
Nation.
I have often explained that my mom is one of the people who
experienced the gap. Her income and her assets are high enough that she
will be faced with seeing that coverage up to a point and then a gap
and then the protection for catastrophic coverage. I asked her what she
felt about it. She explained to me that she understood why we were
doing it. She explained that she had felt blessed in her life, that she
would gladly pay more in order to make it where it is affordable for
the next generations.
Mr. Speaker, those people who are being so critical of this
particular aspect of the bill I think are being disingenuous. They talk
about the cost of the bill on the one hand, while complaining about the
gap on the other. I am sorry. They simply have to choose one or the
other. They have to choose full coverage and the high price above $1
trillion versus the $400 to $500 billion that we are facing in this
bill as it stands. Either they choose full coverage and the higher
price, or they give the gap in the lower price. We in this House and in
the Senate and in the bill that was passed and signed by the President
chose to allow those people to pay more who could pay more in order to
make this bill more affordable for the next generations.
Mr. Speaker, I appreciate the President's calm and patient leadership
on this matter. The President never wavered in his commitment to
provide coverage for those seniors who are not able to provide coverage
for themselves. And I think that this House chose rightly in passing
that bill, and I think that the seniors are finding that it is going to
be one of the tremendous changes in the way that we present medical
coverage through the Medicare program in this country.
I appreciate, also, the President's leadership in many other issues.
We have taken on serious issues in this House, and we have passed them.
Not all have made it to the President, but many have made it to the
President. We took bold steps to reinvigorate the economy. The economy,
as we understand, had suffered from three deep shocks: the collapse of
the dot-com industry back in the ending years of President Clinton's
term; 9-11 was the second big shock. The third big shock were the
corporations that were acting improperly. Global Crossing is a good
example. Enron is also an example that has been used. When those
companies began to act improperly, people began to suck their money out
of the stock market and put it into interest-bearing accounts at the
bank. Those three shocks to our economy were ones that were very
difficult, and many economies could not have sustained them. The
President has patiently built our economy back with a series of tax
decreases to the American public. Many of those tax decreases fall on
businesses which are able to maintain profitability, increase their
employment, grow their capacity, increase the capability of competing
with those firms overseas. I will tell the Speaker that we have done
magnificent work in many areas; and I appreciate, myself, the calm and
principled leadership of the President, who has decided to fight this
war on terror, to fix Medicare as he saw the Medicare problems to be,
to deal with the forests that were burning up throughout the West, to
pass the Partial Birth Abortion bill and sign that, to pass the AMBER
alert bill and to get that signed.
Mr. Speaker, we have done magnificent work in this House. The
President has signed much of it into law. But one of the most dramatic
things we have done is to pass this prescription drug Medicare reform
bill, which I think is going to make sure that Medicare is available
throughout the rest of this generation and on into the future for my
children and my grandchildren.
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