[Congressional Record Volume 150, Number 65 (Tuesday, May 11, 2004)]
[House]
[Pages H2809-H2812]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                PROVIDING HEALTH CARE FOR ALL AMERICANS

  The SPEAKER pro tempore (Mr. Chocola). Under the Speaker's announced 
policy of January 7, 2003, the gentleman from Texas (Mr. Burgess) is 
recognized until midnight.
  Mr. BURGESS. Mr. Speaker. I appreciate being invited here to be part 
of the youth leadership hour of tonight's session of the House of 
Representatives.
  There were some interesting comments from the other side of the 
aisle. I am actually here to talk tonight about health care. Certainly 
the concept of voting where you live is one that I endorse, and always 
have. I have several universities in my district, and in fact the NAACP 
awarded a college chapter at the University of North Texas an award for 
their program of Live Here, Vote Here that they ran last year, and I 
certainly salute them in their efforts.
  But let us talk a little bit more about health care. Maybe we can 
talk a little more in depth about health care. I believe the gentleman 
from Alabama, if I am quoting him right, said that his group had a 
profound sense of what is possible. Well, let us spend some time 
talking about what is indeed possible; what is doable right now, this 
year, even though it is an election year.
  Mr. Speaker, I was on the plane coming back from my district in Texas 
back to the Nation's Capital today. I picked up a copy of the Fort 
Worth Star Telegram at the airport, and the headline above the fold was 
``Firms Offer Plan for Uninsured Workers.''
  Now, there is a novel concept. Here is a consortium of large 
companies. ``More than 50 of the country's largest employees said 
Monday that they will band together to offer health insurance to 
workers who would otherwise not qualify, offering coverage up to 4 
million uninsured workers and their dependents by next year. The 
companies include major Tarrant County employers; American Airlines, 
Lockheed Martin, Bell Helicopter, as well as McDonald's, Sears Roebuck, 
Home Depot, Ford Motor and General Electric.''
  I will not read the entire article, but the article goes on to say 
that ``uninsured workers tend to delay medical treatment and avoid 
cheaper preventative care, seeking expensive emergency room 
treatment.'' We know that emergency health care is some of the most 
expensive health care in the world. We know this is a huge driver in 
the cost of overall health care spending.
  So here are these large companies back in Texas, many in my district, 
who are recognizing that the cost of the uninsured is a major cost 
driver for health insurance, and these companies are banding together 
to provide a type of coverage available to their employees, who 
otherwise would not have health insurance available to them. I think 
this is an example of the type of innovative, consumer-driven approach 
that we are seeing in health care.
  One of the really disappointing things to me, to listen to the 
dialogue I just heard on the other side, actually goes back to an 
article written by Mr. Brownstein of the Los Angeles Times last 
December, where he said there are only two ways to pay for health care 
in this country. One is private, employer-based insurance, and the 
other is for the government, State or Federal Government, to pay for 
the cost of health insurance.
  That completely ignores the cost of uncompensated care. As a 
physician, I know I probably gave away much more in medical care than 
any of these young lawyers will ever give away in legal fees. But there 
is a tremendous amount of care that is just simply uncompensated in 
this country, and that needs to be calculated into the overall 
expensing of health care.
  But the other area that was completely ignored in Ronald Brownstein's 
article last December was those individuals who pay for health care 
themselves. We did a great thing in this

[[Page H2810]]

Congress last December with the passage of the Medicare Modernization 
Act, that the other side seemed to not care for. But the creation of 
Health Savings Accounts in that Medicare Modernization Act will allow 
more people to bring their own dollars into the health care system and 
spend their own dollars in the health care system.

                              {time}  2330

  Mr. Speaker, I believe that people, given the option of spending 
their own money in the health care system, will be wiser consumers of 
health care and, ultimately, that too will bring down the cost of 
health care.
  Let me just say a word about HSAs, or the old term for them was a 
medical savings account. I had a medical savings account myself for 5 
years prior to coming to Congress. In fact, it was kind of a surprise 
to me that I could not continue my medical savings account when I 
arrived in Congress, but because of the restrictions placed on medical 
savings accounts, they are only available to people who are self-
employed or who are employed in small groups. So as a member of this 
body, I had to take the type of insurance that was offered to everyone 
else in the Federal Government.
  But we have made some improvements. With the advent of HSAs last 
December, many, many more people are going to have this type of 
insurance available to them and be able to save for their own health 
care. It is going to give more Americans health care coverage 
portability, and it is going to promote savings and wealth generation.
  Mr. Speaker, in January, the President came here and in his State of 
the Union address talked about his health care initiatives. Now, Morton 
Kondracke writes for a magazine or a newspaper up here called Roll Call 
and it is generally no friend of the administration. In fact, he made a 
comment in his column the week after the State of the Union address: 
Usually the only time Republicans ever pay attention to the social 
needs of ordinary Americans is when Democrats force them to do so. But 
he did at least allow that President Bush talked about health care in 
his State of the Union message.
  Now, he was not very complimentary of President Bush, but President 
Bush talked about 3 initiatives in his State of the Union message that 
could bring down the numbers of the uninsured, and when the gentleman 
from Alabama (Mr. Davis) talks about the art of the possible or having 
the vision of being able to do what is possible now, these 3 things do 
not involve any heavy lifting, they are all within our grasp right now.
  One of the things that President Bush talked about, of course, was 
the HSA and how good it was that that was part of the Medicare 
Modernization Act. The President also proposed, as a corollary to HSAs, 
making a catastrophic insurance policy available to any worker who 
wanted it, and allowing them to deduct the cost of that insurance 
policy from their personal income taxes, the same as a corporation or 
business can do if it buys insurance for an employee. This would mean, 
if we combine that catastrophic insurance policy with a health savings 
account, that anyone who paid income taxes who did not have health 
insurance would no longer have an excuse not to have health insurance. 
And, Mr. Kondracke estimated that 7 percent of the 43 million uninsured 
would indeed have access to insurance under that scenario.
  There was another proposal outlined by President Bush in that State 
of the Union address and that was a bill that we passed in this House 
almost a year ago, in June of 2003, H.R. 660, called association health 
plans. Association health plans probably will not by themselves bring 
down the number of uninsured that dramatically, but it will certainly 
keep that curve from continuing upward the way it has for the last 7 or 
8 years.
  Association health plans, again, were passed by this body last June. 
It has languished over in the Senate and it is certainly time that that 
bill receive some more attention and get moving over there. In Mr. 
Kondracke's tally, he estimated that another 2 million people would be 
benefited by the passage of association health plans.
  Finally, a bill that has not passed this House, but one that 
certainly deserves our attention, are what are called tax credits for 
the uninsured. Tax credits are perhaps the best and most immediate way 
to help the so-called working poor; that is, individuals who are out 
there working and earning a living, do not earn enough money to pay 
income tax, so they would not benefit from a health savings account 
necessarily, but do not receive health insurance as a benefit of their 
employment. This would provide for fully refundable prepaid tax credits 
that would give low-income individuals and their families immediate 
purchasing power. In other words, Mr. Speaker, it is not a tax refund; 
it is a tax prefund. It would be available to those families at the 
beginning of the year only to pay for their health insurance needs.
  Mr. Kondracke in his Roll Call piece estimated that again, this would 
provide coverage for another 4 million people, but he did allow that 
this group is perhaps two-thirds of the actual group that is counted as 
the uninsured, so his estimate may have been a little bit low. But by 
combining all of Mr. Kondracke's numbers last January, we come up with 
a figure of 10 million people covered with health insurance who are not 
currently covered. Mr. Speaker, that is almost 25 percent of the 
current uninsured in this country who could be covered right now, this 
year, if we could simply take up and complete the work that we started 
last year and get association health plans, full deductibility for 
catastrophic insurance premiums, and tax credits for the uninsured; if 
we would take that up and pass that this year, those 10 million people 
would enjoy the benefits of insurance and, as a consequence of that, 
health care costs would come down.

  I wanted to make reference to an article that appeared in yesterday's 
Christian Science Monitor. The title of the article was ``A Better Way 
to Pay For Health Care'' by Jonathan Decker, a correspondent for the 
Christian Science Monitor. It is datelined out of Washington. He starts 
out, It is rare when a government program actually earns heaps of 
praise from a taxpayer.
  Mr. Decker is talking, of course, about the health savings accounts 
that were passed by this body last November in the Medicare 
Modernization Act. He goes on to say that HSAs are the latest method 
for controlling health care costs and represent a kind of a 401(k) for 
health care expenses. Since the beginning of the year, the accounts 
have been available to people underage 65 who have a qualifying health 
insurance plan with a deductible of at least $1,000 for individual 
coverage and $2,000 for family coverage. Individuals can dip into their 
plans to cover out-of-pocket health care costs up to $5,000 a year and 
$10,000 a year for families.
  He goes on to say, What makes HSAs so attractive to many is that the 
money in the accounts can be spent tax-free on health care, and the 
funding can be provided by companies, their employees, or both.
  Mr. Speaker, it just goes to point out the power of these so-called 
medical IRAs, these medical 401(k)s that will increase in wealth.
  The thing is, the folks on the other side tonight were talking about 
some of the fundamental differences between Republicans and Democrats. 
Republicans like to own things. We like to be in charge. And if you own 
your own health care dollars, how much more in control are you when you 
become ill, when you go to the hospital, when you go to the doctor. It 
is a sense of power that I, for one, would not want to relinquish to 
the Federal Government for an entirely government-run health care 
system, as some have suggested.
  The tax credits for the uninsured have been introduced in this body 
in a bill called the SAVE Act, Securing Access, Value and Equality in 
Health Care. This bill provides an immediate tax credit to individuals 
and families toward the purchase of health insurance. The credit will 
be $1,000 for individuals, $2,000 for married couples, and $500 for 
each dependent, up to $3,000 per family; also, an additional credit of 
up to 50 percent will be available to families that need insurance with 
higher premiums. The SAVE Act is a way to turn a costly, unwieldy 
bureaucratic health care system into a more personal, affordable, and 
accessible health care system.
  Mr. Speaker, we heard earlier this evening from a group that was 
talking about fundamental tax reform, and

[[Page H2811]]

they spoke about it quite eloquently and they talked about the cost of 
embedded taxation in anything we buy.
  Well, in health care, there is another hidden embedded cost that we 
oftentimes do not acknowledge or do not talk about, and that is the 
embedded cost of our medical justice system, or our medical liability 
system. Medical liability reform has been a big part of the agenda of 
this Congress, this Republican Congress this year. Again, we may notice 
a recurrent theme here. We passed that bill over a year ago, and we are 
still awaiting some action 400 feet across the rotunda on that. We 
certainly hope to see that action happen some time this year.
  There is a direct cost, of course, for medical liability insurance. 
But one of the more pernicious aspects from what has happened with our 
medical justice system in this country with the runaway expenses 
associated with the medical justice system or the medical liability 
system, it leads doctors and hospitals to practice what is called 
defensive medicine. In other words, if I am called to see a patient in 
the middle of the night and something goes wrong down the road, am I 
going to look good if this case goes to court. So if you are called to 
see a patient in the middle of the night and they are complaining of a 
headache, it may not be anything too serious but, on the other hand, if 
it did turn out to be that brain tumor and you missed the diagnosis, it 
is going to look dreadful down the road in court, so let us go ahead 
and get the cat scan, and it leads to the type of environment where you 
tend to order every test, you tend to do every procedure to make 
certain that you are not one day involved in one of those dreadful 
medical liability suits.

                              {time}  2340

  The embedded cost of defensive medicine in our system is significant. 
There was a study done at Stanford University in 1996, so this is 8 
years ago now, almost a decade ago, and these dollar figures would 
probably be higher if the study was done today. It was estimated the 
cost to the Medicare system alone of defensive medicine equated to 
approximately $50 billion a year.
  Mr. Speaker, we were criticized for passing a prescription drug 
benefit last year that cost $400 billion over 10 years or $40 billion a 
year. The cost of defensive medicine is more than the cost of providing 
the prescription drug benefit to our seniors.
  Let me finish up tonight with talking about the Medicare 
Modernization Act since the other side did seem to feel that perhaps 
this was not a wise thing that we did, and they all freely admitted 
that they voted against it. I do not think that was a wise vote, and I 
will tell you during the course of this why I do not think that was 
wise.
  I think the Medicare Modernization Act that we passed here last 
November was, in fact, a significant piece of legislation. It provided 
that missing link, that thing that had been missing from Medicare since 
its inception back in 1965 when another Texan was President, President 
Lyndon Johnson, and signed that bill into law.
  Back in 1965, the major health expenditures that a senior might face 
were if they had to have surgery, if they had to have an operation or 
they got a serious illness such as pneumonia or had an abscess and had 
to be treated in hospital with IV antibiotics for several days. Those 
were the types of serious cost problems that a senior could run into 
the mid-1960s. We did not have much in the way of prescription drugs 
back then. Oh, we had steroids and antibiotics, and some people argued 
those two were interchangeable or at least used interchangeably back 
then, but look at what we can do now.
  The world has changed so much in the 21st century, and the ability to 
cure, without surgery or without a hospitalization, by the use of 
modern day pharmaceuticals is nothing short of astounding.
  So, again, not having a prescription drug coverage in the Medicare 
program, gosh, we were paying $280 billion or we are paying $280 
billion a year for our seniors on Medicare, for those 40 million 
people, 40 million Americans who are on Medicare, but we are not 
getting value for our dollar. This program, providing a prescription 
drug benefit for the first time, allows us to be able to treat things 
on the front end and get value for that dollar.
  It is not just in the realm of prescription drugs. Yes, it is cheaper 
to treat illness; to treat the diabetes when it is merely a problem of 
a chemical abnormality with broad sugar before the retinal damage 
occurs, before the kidney damage occurs, before the vascular damage 
that leads to an amputation occurs. We are going to go do that and much 
more under this Medicare bill.
  Every senior who enrolls in the new Medicare program after January 
2006 will have a Welcome-to-Medicare physical. Health screenings will 
be included as part of the Medicare program. Chronic illnesses, such as 
adult onset diabetes, elevated blood pressure, heart disease, patients 
will have disease management programs available to them, and health 
outcomes will be monitored in a much more proactive way.
  Unfortunately, when the Congressional Budget Office scored the cost 
on the Medicare Modernization Act that we passed last November, they 
could not take any of those things into account. I find it interesting 
that someone who is running for President has proposed a health care 
bill where these same types of things will be included, and yet that 
individual now says that because he is adding disease management and 
health screenings, his plan is going to cost $278 billion less. I read 
that in the Washington Post last Friday.

  The fact is that this is a good program. It was passed by this 
Congress. It is choice-based, it is consumer-driven, and it is 
affordable.
  One of the most exciting things to me is we are seeing the roll-out 
of the prescription drug discount card in just a few weeks, on June 1. 
Already you can go to medicare.gov or if you are a senior you can call 
1-800-MEDICARE. All you need to know, calling 1-800-MEDICARE, if you 
will benefit from getting one of these prescription drug discount 
cards, the only information you are going to need to give to the people 
on the other end of the telephone or be able to type into the Internet 
is your ZIP code and which medications you are currently taking and the 
dosages of those medications. This is going to be a powerful tool that 
develops over the next 18 months as that database is assembled. For the 
first time, seniors can go to the Internet or go to that 800 number, 
say I live in this part of the country, I am on this medication and 
this is the medication and currently I am spending this much money on 
my medicine; would I benefit from your prescription drug discount card, 
and in 18 months time would I benefit from the prescription drug 
program when it does roll out January 1, 2006?
  I am really looking forward to having that type of information at the 
fingertips of seniors. For heaven's sake, we are consumers, if we are 
nothing else in this country, and we are good consumers. We are 
cautious consumers. We compare prices every day. We compare prices for 
airplane tickets. We compare prices for cruises. We will be able to 
compare prices for prescription drugs on-line and be able to make the 
best decisions for ourselves. Again, it puts the senior, it puts the 
patient in the driver's seat, not the Federal Government.
  In fact, I think former Speaker Gingrich talked about a time where 
you would just simply go to a travel-type site and type in your 
medication, and companies would be able to compete for your business 
real-time, on-line, and how powerful would that be.
  One of the most important things about the prescription drug discount 
card is that it is going to be available. It is immediate help that is 
available to every senior, regardless of income, but those seniors who 
are at the 135 percent of the Federal poverty level will also receive 
an additional $600 subsidy for the remainder of this year and for next 
year, and in fact, if that $600 subsidy is not consumed this year, it 
will roll over to next year. So, essentially, a $1,200 subsidy will be 
available over the next 18 months time.
  I have had people ask me what if I take this prescription drug 
discount card and then I do not want to go into the Medicare 
prescription drug program when it rolls out in 2006? You do not have 
to. It is fully flexible. It is fully your choice to do so, and if you 
do not take the prescription drug discount card when it is offered this 
June, you have not lost the ability to go into the

[[Page H2812]]

Medicare prescription drug program, if, indeed, it is to your benefit 
January 1, 2006.
  Mr. Speaker, we did hear again a lot from the other side just before 
I came on this evening. I was particularly concerned that the comment 
was made that the Republican side of the aisle is walking away from its 
commitments. I would submit to you nothing is further from the truth, 
and in fact, if they want to talk about the art of the possible, we can 
cover one-quarter of the uninsured this year with no heavy lifting, 
simply by getting some activity 400 feet to the West of the Capitol 
building and having both sides of this House take up the health credits 
for the uninsured and the full deductibility of catastrophic health 
insurance before this term ends at the conclusion of this year.
  Mr. Speaker, I know it has been a long day for all of us. So, with 
that, I will conclude my remarks.

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