[Congressional Record Volume 151, Number 134 (Thursday, October 20, 2005)]
[House]
[Pages H9025-H9031]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     HEALTH CARE AND FISCAL ISSUES

  The SPEAKER pro tempore (Mr. Kuhl of New York). Under the Speaker's 
announced policy of January 4, 2005, the gentleman from Georgia (Mr. 
Price) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. PRICE of Georgia. Mr. Speaker, I appreciate the leadership 
allowing me the opportunity to speak this hour and talk about a number 
of issues. We are going to discuss an important issue of health care. 
But before we do, I thought it would be appropriate to correct some of 
the misinformation that we have heard over the past hour. And the 
misinformation is truly remarkable, and so I have been joined by one of 
my colleagues here to address a couple issues and I will do the same as 
well, and then we will get into the discussion about health care. But I 
am pleased to be joined by my colleague from Tennessee (Mrs. 
Blackburn), who is going to tell the rest of the story.
  Mrs. BLACKBURN. I thank the gentleman from Georgia who is doing such 
an extraordinarily wonderful job, Mr. Speaker, as he represents the 
positions that our party holds on so many issues that are important to 
the American people.
  I am going to be heading to my district for the weekend, as most 
Members are, spending some time there, having the opportunity to talk 
with them. But as the gentleman from Georgia was saying, we wanted the 
opportunity to just address and maybe do a little bit of correcting on 
some of the points that our colleagues from across the aisle have been 
saying and stating. Sometimes I think that they are just sadly 
misinformed on some of these issues.
  They said that Republicans are not looking to cut spending. I just 
find that extraordinary. They said that Democrats are the ones that are 
wanting to cut spending. Mr. Speaker, the level of hypocrisy in that 
statement is absolutely astounding. We have a Democratic Party in this 
House whose message, and I honestly believe many days is the only 
message that they have, that message is: Spend more. Whatever it is, 
spend more. Whatever they are wanting to do, if they do not think the 
outcome is right, go spend more. And for years they have held this 
thought that if you just put more money in the pot, then the outcome is 
going to be what they want. Spend more. Spend more.
  And what holds them together? Mr. Speaker, I think that is something 
that is a curiosity to many people, because they are not united on 
foreign policy, they are not united on winning in Iraq, they are not 
united on border control issues, they are not united behind working 
families who tell us repeatedly that what they want is lower taxes, 
lighter regulation, preserving individual freedom, and having their 
shot at hope and opportunity.
  Our colleagues across the aisle are not united on that. The one thing 
that they repeatedly seem to be united on is spending more of the 
taxpayers' money, spending more of your hard-earned money. And it is 
amazing to me, government never gets enough of the taxpayer money. 
Government has this huge, voracious appetite for the

[[Page H9026]]

taxpayers' money. They just cannot get enough of it. There is always 
another program. Many of them are great programs, but one of the truths 
that we all see here in this body: If government moves in to solve a 
problem, generally neither the private nor not-for-profit sector will 
move in and address that problem.

                              {time}  1415

  So you have additional costs that come about. Every time we talk 
about winning in Iraq, our friends across the aisle seem to say let us 
get out, regardless of the sacrifices that are made. Every time we talk 
about controlling the border, they are over there saying no way.
  Mr. Speaker, yesterday, I was on a CNBC program; and a Democrat 
Member of the House said that their party had never been invited to 
offer spending cuts. There are 435 Members of this body, and Mr. 
Speaker, they are waiting for an invitation to come in and participate 
in how to reduce the size of government. This morning, I was on the 
floor and I said please consider this the invitation, come on. 
Everybody needs to work on this. It should be a bipartisan effort. It 
should involve every single Member of this House, how we go about 
reducing what the Federal Government spends.
  I have three bills that would enact across-the-board cuts, 1 percent, 
2 percent and 5 percent cuts; and for all of their talk today about how 
they want to cut spending, Mr. Speaker, not one single Democrat is on 
those bills, not one. We have got 14 Republicans who are on those 
bills, and not one Democrat has signed on to commit to finding 1, 2 or 
5 percent of waste, fraud and abuse in government spending.
  Mr. Speaker, I ask my colleagues, who is really leading on this 
issue? I hear plenty of accusations from the left. I hear plenty of 
complaining, and I see zero action. A lot of talk, no action. They 
controlled this body for 40 years; and in that 40 years, they built 
layer after layer after layer after layer of government. They cooked 
them a big old government cake, layer upon layer.
  We have got programs out there that do nothing but waste our money. 
We have got 342 different economic development programs. There is a lot 
of work that we can do. Everyone is invited to come in and work on 
these issues; and anytime we even try to restrain spending, look at the 
rhetoric that we hear.
  Mr. Speaker, it is our party in this House, it is our leader, the 
gentleman from Illinois (Speaker Hastert), who truly is leading on this 
issue, not the minority leader. It is our leaders who are pushing this. 
It is our party who would like to reduce government spending by 
billions of dollars, billions more in next year's budget. It is our 
party that would like to see across-the-board spending reductions.
  Their solution that they offer is repealing tax relief that is well 
deserved by hardworking American families, repealing that relief and 
raising taxes, period. That is the only thing that unites their party.
  I hope that they will work with us on reducing the spending of the 
Federal Government. I thank the gentleman from Georgia for yielding.
  Mr. PRICE of Georgia. Mr. Speaker, I thank the gentlewoman from 
Tennessee for her leadership and really stalwart stance on the issue of 
budgetary reform and fiscal responsibility. She is one of the champions 
here as it relates to that.
  I just wanted to mention a few other items that we have had presented 
by the other side of the aisle over the last hour; and again, I think 
the misinformation that is being presented is truly astonishing. It 
does a disservice to the American people. It does a disservice to the 
debate because if folks are not interested in being honest and open 
about the debate, then you cannot have a real debate; and when you are 
dealing with folks really who want to distort things so incredibly, it 
is phenomenal.
  My colleague from Tennessee mentioned that the Democrats were 
concerned because they had not been invited to participate. Let me tell 
you what their leadership said when we discussed the possibility of 
opening up the budget that we agreed to in the spring in order to find 
savings to cover the costs for the displaced citizens down in the gulf 
coast after the hurricanes. What the Democrat leadership said, well, 
you may do that but you will not get a single Democrat vote. Now, there 
is leadership for you. There is leadership for you.
  We also heard from the other side recently, just earlier today, that 
they looked for third-party validators, some objective body that would 
say, yes, what you are saying is absolutely correct. As an example of 
the third-party validator, they brought an editorial from the 
Washington Post. Folks in my district, if you had a microphone in their 
living rooms right now, you would hear them guffawing. To consider that 
the Washington Post editorial is a third-party objective body is just 
phenomenal, but it is the backdrop for all of the discussion that they 
have, and that is, to distort and to give a lack of credibility to 
those things that are truly occurring here in Washington.
  I want to point out this chart right here because this is a chart 
that talks about the percentage of Federal personal income tax paid by 
different sectors of our society. All the time you hear the other side 
talking about the wealthy are not paying their fair share and it is all 
on the backs of the poor and on and on and on. Sometimes the picture is 
worth a thousand words.
  What this chart shows is that the top 1 percent, this column right 
here is the top 1 percent of our population in terms of income. The top 
1 percent of our population in the United States today pays 34.27 
percent of the total taxes, 34.27 percent by the top 1 percent. So you 
tell me whether you think that is the right amount or the wrong amount. 
I do not know. All I do know is they are certainly paying their fair 
share.
  The column way over on the other side, way over on the other side is 
the lower 50 percent of income individuals in this Nation, and the 
amount that those individuals are contributing to the total revenue is 
3.46 percent. You see the difference, the lower 50 percent, that is 
half, 50 percent, that is half, compared to the top 1 percent, 3.46 
percent, 34.27 percent, 10 times as much by the top 1 percent as the 
lower 50 percent.
  As I say, you may say that that is not the right amount, but you 
certainly cannot say with a straight face that the individuals who are 
in the top 1 percent are not paying their fair share. That is just 
nonsense, and really, makes it so that you have to be suspect about 
every other word that comes out of their mouths, especially when it is 
talking about budgets.
  So I would hope that what they would do is to engage productively, to 
engage in the process and come with positive solutions and positive 
discussions and not just a just-say-no attitude, which is what their 
leadership has told them as it relates to budgetary issues.
  Let me shift gears a little bit because I did want to thank, once 
again, the leadership for allowing me to participate in this hour and 
wanted to talk about one of the most important aspects and areas of 
every single citizen's life, and that is the area of health care.
  Few things are more important to any individual's life than health 
care; and certainly, the decisions that an individual makes about 
health care are some of the most personal ones that one will make. I am 
joined today by one of the gentleman from Texas (Mr. Conaway), my good 
friends and colleague, who is going to discuss a little bit about 
individual responsibility as it relates to health care; and then we 
will talk about some other items as they relate to Medicare and other 
issues and health care.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Conaway) and 
ask my colleague to talk a little bit about individual responsibility 
in health care.
  Mr. CONAWAY. Mr. Speaker, I thank the gentleman from Georgia (Mr. 
Price) for yielding.
  Let me make one comment about your chart. I am a CPA. I have spent 
30-plus years assisting clients in dealing with our very complicated, 
very convoluted Federal income tax code, whether it is individually or 
corporations or other businesses. Any system that is based on a ``fair 
concept'' is flawed because what is fair to one person's view is not 
necessarily fair to somebody else's point of view. When you base a 
public policy this broad and expansive and quite frankly invasive

[[Page H9027]]

on ``fairness,'' then you set yourself up for a constant argument and 
constant battle about what is and is not fair.
  Clearly, your chart shows a differential between the wealthiest folks 
in this country and the folks that are on their way up to, hopefully, 
becoming the wealthiest in this country. Certainly, they have got that 
opportunity with hard work and applying themselves to that.
  So I would just like to point out that maybe we need a different 
system. Maybe sometime next year let us have this conversation about a 
different way to collect the minimum amount of money needed to fund 
this Federal Government, and we will have that conversation.
  I would like to comment, though, on health care and individual 
responsibility.
  I think it is universally recognized, and that is a hard thing to 
state with a straight face, but I think it is universally recognized 
that Americans enjoy the finest health care delivery system in the 
world. You yourself have been an integral part of that as an orthopedic 
surgeon, and your wife, I believe, is an anesthesiologist, members of 
the delivery system that this country enjoys.
  We have got a flawed payment system, and I am not sure how we got to 
this point and place, but we are here. We have got a system that if you 
ran your car insurance program the same way we run health insurance, 
then each time you needed to change the oil in your car or new tires, 
you would file an insurance claim. That is not how we work our cars. We 
figure out a way to operate our automobiles out of our normal monthly 
budget. We budget for that and take care of those incidentals. We do 
have car insurance for the catastrophes, for wrecks, for destruction 
and theft, those kinds of things, those catastrophic deals.
  Our health care system is flawed in that, quite frankly, I get the 
services, you provide me the services, and someone else pays for those 
services. In that scheme, I am not as concerned about the cost of those 
services as I ought to be because I am not writing a check to help out 
with that. So I have no incentives, so to speak, to ask you are there 
alternatives to what you have proposed, is there another way to do this 
or cheaper way. Can we do it at some other hospital that can be a 
little less expensive than the one you typically practice at, because I 
am writing those checks.
  Getting personal responsibility back into the health care system, 
getting a system in which I have a viable interest in asking that 
question. We may ask that question on every other single thing that we 
do, how much is that going to cost. We may not ask it out loud, but we 
make a cost-benefit analysis each time in our head each time we make a 
purchase on something such as how do I want to pay for that. We do not 
do that in medicine, and it needs to be communicated to all of us that 
that is okay to do in medicine.
  There are some things in medicine you do not ask: emergency or 
catastrophic kinds of things. You go get that thing. There is an awful 
lot of medicine that I think is subject to a circumstance where we can 
ask what that costs, and I think just doing that would begin to drive 
down those costs.
  As the example, I went for an annual checkup a year or so ago and had 
an issue. The physician said, well, I can prescribe a course of 
antibiotics that is about $300 a month and 3 months from now that 
condition will clear up. I have got a prescription drug card so it was 
going to cost me $15 or whatever. I said $900? He said, yeah. I said, 
well, what happens if I do not do that? He said in about 3 months it 
will clear up.
  I made a cost-benefit analysis and decided that I would forgo the 
antibiotic treatment and go with the professional judgment. It was my 
decision. I need to stand behind that decision, and if 3 months later 
my condition had gotten worse and I had other problems that may have 
been fixed if I had taken a different tack, I cannot go back on the 
doctor or should not and sue the doctor or the pharmacy or whatever, 
sue anybody that is still breathing because of a decision that I made.
  Personal responsibility is not only taking responsibility for paying 
for health care but also reclaiming your health care decisions because 
those are yours. You are responsible for that, and you yourself know 
there will be the occasional bad outcome to any procedure, to any 
field, and that is just nature. Doctors are not perfect or hospitals. 
None of us are. Those legitimate just bad outcomes is just the system, 
and we ought to take personal responsibility for that.
  I had several doctor clients, and to a person, if they did something 
wrong, if they created an issue or made something that aggravated 
something with a patient, they were going to fix it, period, no matter 
what it was.

                              {time}  1430

  But in many instances, they used their absolute best professional 
judgment to treat a patient and they just got a bad outcome. That is 
life. So this personal responsibility issue that I am talking about is 
decisions for what health care you do get or you do not get, and the 
costs.
  I think the health savings accounts that we have instituted in 
certain instances will help us do that, so that putting away money in a 
health savings account; if you have a normal monthly kind of an expense 
come up, I have to decide do I take that money out of my health savings 
account that is growing, or do I figure out a way to do it out of this 
month's budget or my normal operating budget. So bringing that personal 
discipline back to the table in the arena of health care is not the 
absolute overall magic bullet, but it is a piece of the fix that is 
health care costs.
  I appreciate this opportunity to share this hour with the gentleman, 
and I look forward to hearing the remainder of the gentleman's comments 
from a learned colleague in an arena that is obviously of vital 
importance to all of Americans.
  Mr. PRICE of Georgia. Madam Speaker, I appreciate the gentleman's 
comments, because they are just so appropriate, and I think it is a 
shame, but they are visionary, that it ought to be the system that we 
currently have in terms of personal responsibility and an opportunity 
to select the kind of health care that we have. But, sadly, that is not 
the case. We will talk a little bit about that and how we got to where 
we are today in our health care system.
  But let me mention, once again, why I think it is so incredibly 
important that we discuss health care. It is a significant portion of 
the Federal budget but, more importantly, it is without a doubt the 
area where the most personal decisions are made. And as we talk about 
health care, I think it is important that we always try to remember who 
is making those decisions, or who should be making those decisions may 
be a better question. Who should be making those personal decisions as 
they relate to health care?
  My passion for this is, as the gentleman from Texas (Mr. Conaway) 
mentioned, I am a physician, I am a third generation physician. My 
grandfather and father were physicians as well. My grandfather 
graduated from medical school in 1908, so he saw a transformation in 
the field of medicine that was absolutely incredible. He practiced for 
over 30 years nearly without any antibiotics at all. When you think 
about that as being a different kind of world, it really was a 
different kind of world, a different kind of health care. He practiced 
medicine until he was 94 years old. So I remember well when I was a 
young boy, some of my first memories are of visiting my grandfather and 
going on what were rounds with him, and rounds at that time meant house 
calls. Some people remember those, but we would get in his car or walk 
through the neighborhood and visit patients. And one of the things that 
I remember so well is the love that was poured out when he would come 
to a house, because it was a very personal relationship, the 
relationship that the patients had with their physician, then my 
grandfather.
  My father was a physician as well and came and practiced during the 
1960s and the 1970s, and it was a different time then also. It was a 
time of great transformation for health care, in a direction that has 
kind of led us to where we are right now. He initially practiced 
internal medicine and then moved into becoming one of the first 
professional physician groups of emergency care. He worked in an 
emergency room in a hospital, and that was part of the transformation 
that medicine was going through, to try to answer some of the real 
challenges of caring for people with new technology and a

[[Page H9028]]

new society that was having challenges in the way that people were 
accessing health care. Many suffered from trauma, which had not been 
the case in the past, primarily related to the automobile and the kind 
of traffic that began sprouting up in so many urban areas across our 
Nation.
  In the 1960s, we saw the changes that came about with the institution 
of Medicaid and Medicare. And when we talk about health care in the 
United States, it is impossible to talk about health care without 
talking about Medicare, because Medicare has truly transformed, for 
better or worse, the whole method of how we deliver health care in our 
Nation. The vast majority of private insurance products today as they 
relate to health care are tied in some way to Medicare. Most folks do 
not talk about that, many do not know that, but it is why the 
discussion about Medicare is so incredibly important.
  There are a couple charts that I have here that I would like to share 
with the body that kind of bring some of that into perspective. This 
first one comes from the Center for Health Transformation, and that is 
an organization that has come about in the past couple of years. It is 
headed by some wonderful people. Speaker Gingrich is leading this 
charge. He recognizes that the aspects of health and health care and 
the costs of health care to our Nation must be transformed in the way 
that they are being delivered right now. And this information comes and 
demonstrates the national health care expenditures as a percent of 
gross domestic product.
  So how much are we in this Nation spending on health care as it 
relates to the entire domestic product that we have? How much money do 
we have and how much are we spending on health care?
  In 1965, that amount was about 6 percent. In 1965, that amount about 
was about 6 percent. It happens that 1965 was the year that Medicare 
began. And there are a variety of reasons for why we see the curve go 
up the way it does, but suffice it to say that we have significantly 
increased the amount of our domestic product that we are spending on 
health care, now to about 13 percent, and the projections are that in 
the relatively near future, we will be at 17 percent. Some of that is, 
I would suggest to the Members of the House and folks who are watching, 
some of that is as a result of governmental involvement, and we will 
talk about that some. Some of that is a result of technology, no doubt 
about it. But the trend is disturbing. The trend is disturbing, because 
we cannot go too much further, and we may be at that point now, where 
we are not able to provide for other priorities that the Nation has. So 
we have gone from about 6 to 13 percent as a percent of gross domestic 
product.
  Now, it is also important to look at who is paying. I often talk 
about the golden rule. Most folks know the golden rule. There are a 
couple golden rules. The finest one is the golden rule that says do 
unto others as you would have them do unto you, but in Washington the 
golden rule is he who has the gold makes the rules. And this chart 
demonstrates clearly one of the challenges that we have as it relates 
to health care.
  This chart shows the percentage of health care expenditures that are 
privately paid or paid for by the government. And one of the dirty 
little secrets that is not really a secret is that whenever the 
government pays for anything, whenever Washington pays for anything, 
there are all sorts of rules and regulations and requirements that are 
in place that go along with that. Sometimes they are good and sometimes 
they are not, but they have to be complied with. Otherwise, you do not 
get the money.

  Now, in 1965, remember that other chart that we had, which showed the 
amount of money that we were spending on health care. This chart shows 
in 1965 that government paid for about 25 percent of all of health care 
expenditures in our Nation. And the private sector, individuals and the 
private insurance, paid for about 75 percent. So about 3-to-1 private 
sector to government.
  Over a relatively short period of time, we are seeing a significant 
change in who is paying for what. Right now we are in a situation where 
the government is paying for about 45 percent, and it continues to tick 
up, of health care expenditures, and the private sector or the private 
market is paying for about 55 percent. That is important not just 
because this side is oftentimes on the backs of hard-working Americans, 
but it is important because remember that golden rule, he who has the 
gold makes the rules.
  Washington, when they are paying for health care, make rules that may 
and oftentimes may not be to the benefit of the system. When I say 
``the system,'' I do not mean the folks providing the care; I mean the 
folks receiving the care. This system is set up not to serve patients, 
and that is the problem. This type of graph demonstrates that those 
individuals who are most, remember, the most personal decisions that we 
make are health care decisions, and this system is set up to not be one 
that is the most helpful to patients.
  My colleagues may say, well, can you give an example of that? Well, 
there are all sorts of examples of that, but what I would like to talk 
about briefly is an example that clearly points out why Washington is 
not the place to make these decisions. We are about to begin a new part 
of the Medicare program on January 1 of 2006, it is part D Medicare 
program which will start January 1, and that program is a program that 
for the first time since 1965 when the program was instituted, for the 
first time will cover prescription drugs, will cover medicines.
  Now, one thinks of a health care system that has incredible 
ramifications for the entire health care system of our Nation, and it 
has been in place for 40 years, and it has not covered a single 
medicine, not one antibiotic, not one drug for diabetes, not one drug 
for hypertension or high blood pressure, not one drug for cancer; it 
has not covered any of them. That is the way that Washington works; 
that is, slowly and with a lack of perspective on who is being affected 
by the decisions.
  Remember, patients are the ones that are affected by the decisions 
that we make here in Washington as it relates to health care all across 
the spectrum. And we have a system in place that is not changing; that 
is, the structure of the bureaucracy in the government, that is not 
nimble, it is not nimble like the private sector. So we have a Medicare 
program that for 40 years has not covered a single drug.
  Now, thank goodness we are moving in that direction. There are some 
challenges I think we have in that program. But we have a system of 
government in Washington that cannot respond to the remarkable changes 
that we have had in the area of progress in science and technology. The 
private sector is so much more adaptable, so much more flexible, so 
much more nimble. So when patients need improvements, they ought to be 
able to look to the private sector for those improvements, because they 
come about so much more rapidly. But the sad story is, they have to 
look to Washington.
  So I think what we need is a transformation of our health care system 
so that patients can make those kinds of decisions.
  The health care model that we have right now really harms people, 
because it is not responsive to the needs of patients. It is responsive 
to a bottom line. It is responsive to a bottom line. In fact, the 
individuals way back in 1965 who wrote Medicare, the Medicare law, in 
this body knew that. They knew that Washington could not be responsive. 
They knew that it ought not be in charge of health care. And how do I 
know that? I know that because what they wrote in the law at that time, 
and this is a quote from the changes to the Social Security Act which 
put in place the Medicare program: ``Nothing in this title shall be 
construed to authorize any Federal officer or employee to exercise any, 
any supervision or control over the practice of medicine or the manner 
in which medical services are provided.''
  Did you hear that? Nothing shall be construed to authorize anybody in 
the Federal Government to exercise any supervision or control over the 
practice of medicine or the manner in which medical services are 
provided.
  Well, I say to my colleagues, I will tell you, and you know this, 
that all sorts of things that Medicare does and all sorts of things 
that we do specifically, specifically, either supervise or control the 
practice of medicine or the manner in which medical services are

[[Page H9029]]

provided. We violate this law all the time, all the time. And why do we 
do it? We do it because we are not patient-sensitive or quality-
sensitive as it relates to health care. Washington, by its very nature 
and by its very being is bottom line sensitive, it is bottom line 
sensitive.
  So we have a model that is in place that cannot, I would suggest 
cannot provide the kind of services that are needed for the patients.
  Think of the contrast. If you think about the ways that our society 
has changed over just the past 20 or 30 years, the way that we do so 
many everyday things, and if you compare that to how health care is 
provided now and how it has changed or not changed, then you have a 
very clear idea I think about the challenges that we have in the area 
of health care.
  Some common, everyday things: buying gasoline at the gas station. 
Now, regardless of what it costs, the way that we used to purchase 
gasoline is that you would pull up at the pump and you would roll down 
your window and somebody would come out, and they would say, would you 
like us to fill it up? And then they would go ahead and put the amount 
of gasoline that you wanted in your car, and you would pull out a 
dollar or two or more and you would pay for that gasoline. Now, how do 
we put gas in our car? We pull up to a pump, we never see anybody, we 
take our credit card out of our pocket or purses and we put it in the 
pump, we select the gasoline, we pump the gasoline, and many of us, I 
am told almost half of us, do not even ask for a receipt any more 
because we trust the system.

                              {time}  1445

  Because we trust the system. It is easy. It is more efficient. It is 
a system that has changed drastically over the past 20 or 30 years. And 
if you compare that to health care, that is stuck in a paper society 
that is no longer existent in so many aspects of our society.
  The same is true of travel right now. If you want to purchase an 
airline ticket, an increasing number, in terms of percentage of folks, 
are now going online. They can go to their home computer 24 hours a 
day, 7 days a week. They pull up the site of the airline that they want 
to utilize, or they can go to something like Travelocity and it will 
pick the different airlines for you.
  You plunk in the starting city where you are going to leave from; you 
plunk in the designation city. It will send back to you, in a matter of 
seconds, seconds, what kind of flights there are, how much it costs, 
whether there is a seat, and then you can purchase your ticket right 
there.
  And you can, within 24 hours of your travel date, you can sit at your 
home computer or at your office and print out your boarding pass. The 
efficiency of that, if you think about it, is mind-boggling. It is 
incredible.
  You as an individual are interacting with the entity that can provide 
a service that allows you to do what it is you want to do in terms of 
travel.
  Now, why is it that in health care we do not have any of those 
things? We do not have any of those things. Think about what happens 
when you go to your doctor. What happens is that you walk in the door, 
and what are you met with?
  You are met with a pile of paper. You are met with a pile of paper. 
And you read through that paper, or most folks go right to the back end 
of that paper, and you sign. And you wait and you get into the clinic 
room or the exam room, and your doctor comes in, and he or she has what 
in their hand? A chart. A paper chart.
  That may have the last notes from your office visit. It may not. It 
is a system that is antiquated. It is a system that is inefficient. It 
is a system that is unresponsive to the needs of patients in a way that 
the rest of our society has transformed completely.
  So health care is stuck in the past. It is stuck in the past century. 
It will take a significant length of time to just catch up to where we 
are, not get into the 21st century, but to catch up to where we are.
  Now, how do we progress from here? What do we need to do to move 
forward and transform health care? I want to talk about some 
principles, and I want to talk about a resolution that I have 
introduced, H. Res 215. It is kind of a 30,000-foot view of health 
care.
  What it says is that we ought to move as a matter of national policy 
from a system as it relates to health care of defined benefits to a 
system of defined contribution. Now, what does that mean?
  Right now most individuals get their insurance through their 
employer, or their previous employer, or through the government, though 
Medicare or through Medicaid. And all of those systems, by and large, 
have what is called a defined benefit plan.
  That means that somebody, in the case of Medicare and Medicaid, some 
government employee, bureaucrat, has gone through and decided what 
ought to be included in that insurance plan, in that package, and what 
you can be treated for and where you are treated and by whom you are 
treated and how are you treated, often times.
  What diseases are covered, what diseases are not covered. Somebody 
else has decided all of those. That is a defined benefit. There is a 
defined package of benefits that are provided to the patient. This is 
true for individuals receiving their health care through Medicare and 
Medicaid. It is also true for most employer-provided health insurance.
  Someone else, the human resources officer or someone in the company 
is deciding what ought to be covered in terms of health care. And what 
that does is remove the patient from that decision-making process. It 
also sets up a system whereby the patient, if the patient is 
frustrated, oftentimes that is the case.
  I heard a statistic the other day that I found fascinating. Four 
percent of the public is accessing the health care system at any point 
in time. Four percent of the population is accessing the health care 
system, having some interaction with the health care system.
  Half of those folks are frustrated in some way. So you say, well, why 
has the system not changed? Well, if only 2 percent of the population 
is mad at any point in time, it is a small amount. It is a small 
amount.
  But what that defined benefit system has in place is a system where 
patients cannot be the ones who are affecting insurance plans easily. 
Because, you know, my colleagues know and patients around the Nation 
know that when they dial up the insurance company and say, hey, this 
plan is not working for me, I cannot get this disease treated, or I 
cannot go to the doctor that I want to go to, or I cannot get the 
medicine that I want, the insurance company says, well, you will have 
to talk to your boss. Right? Talk to your human resources officer. Or 
if you are a Medicare patient, you cannot even get through on the phone 
most of the time. But what happens is that the patient is removed from 
that decision-making process.
  Now, that is not right. These are the most personal decisions that 
people make in their lives, the most personal decisions; and they are 
removed from that process. So moving from a defined benefit system to a 
defined contribution system says that whoever is paying the cost for 
the health insurance, whether it is the Federal Government through the 
Medicare program or the State government through Medicaid, or the 
employer through employer-provided health insurance, or the 
individuals, regardless of who is paying for the insurance policy, the 
patient owns the policy.
  The patient owns the policy. And that is a sea change, because what 
that means then is that patients can vote with their feet. If they do 
not like what one insurance company is doing because they own the 
policy, they can change to another insurance company. And if they do 
not like what that company is doing, they can change to another. It 
also makes it easy so that when the patient gets on the phone with the 
insurance company, the insurance company has to be responsive to the 
patient. Why? Because the patient has power. The patient has control 
and ownership of the insurance policy. It changes the whole dynamic for 
health care.
  It will not change anything overnight; but over a period of time, 
what it will do, if we are bold enough to transform health care in this 
way, it will allow patients to have the power over the kind of 
insurance policy that they have.
  Now, this Center for Health Transformation is really doing some 
incredible, incredible work. And what they have done, I think in a very 
succinct

[[Page H9030]]

and appropriate way, is to identify kind of the principles of our 
current system of health care, and compare them to what a 21st-century 
health care system would be.
  And I would like to just touch on a few of these. The current system 
is provider-centered, or I would say more correctly, it is insurance- 
or government-centered. Remember that the patient is outside of the 
control process, outside of the power process for this. The system is 
price-driven.
  What that means is that it is more interested in the bottom line than 
it is interested in quality, or, said another way, it is more 
interested in money than it is in patients. And that ought not be a 
system that we tolerate. That ought not be a system that we tolerate.
  Medicare is a classic example. Remember, I mentioned that Medicare is 
important to talk about as it relates to health care, because so much 
of our entire health care system, even in the private sector, is driven 
by the decisions that are made in Medicare. Medicare has a system that 
they compensate or pay physicians and other providers with. It is 
called an RBRVS, or a Resource Based Relative Value Scale, RBRVS. And 
what that means is that Washington, the Federal Government, decides how 
much money it is going to spend on health care for seniors.
  It decides what that pot of money is going to be. And it may or may 
not bear any resemblance to the amount of health care that needs to be 
provided, so that when patients go to their doctor, they may or may not 
be able to get at what they need because the decision-making is all 
based on cost; it is not based on need. It is not based on quality of 
care. It is based on how much money we have.
  That is a model that is fraught with problems and, frankly, fraught 
with extreme difficulties for patients. So a price-driven system just 
does not work. It ought to be something completely different. That has 
been defined by the Center For Health Transformation as values-driven. 
We will talk about that in just a minute.
  The current system is knowledge-disconnected. There is not a good way 
to get knowledge between those folks providing the care, slow diffusion 
of innovation. It takes years, literally, for a new drug that is out to 
come on the market, to get to the market. It takes an average of 5 to 7 
years, 5 to 7 years from the time when a new procedure or a new type of 
treatment for a specific disease is described in the literature, in the 
medical literature, to get to be used in the clinic or exam room or in 
the operating room. Five to 7 years.
  That means that the kind of health care that we are receiving right 
now the individual who described the new innovation did so 5 to 7 years 
ago. That is not a system that is responsive to patients. It is a 
system again that is not patient-oriented. The current system is 
dysfocused, instead of being focused on prevention and on health.
  The current system as we talked about is paper-based instead of 
utilizing the technology that is available today. The current system is 
a third-party controlled market, and that is a fancy way to say that 
the patient is out of the loop.
  Remember, the Federal Government or the State government or the 
employer, by and large, is making decisions about what kind of health 
care is being provided, not the patient. The process is focused on 
government. As I mentioned, it is the government that is making these 
decisions has limited choices.
  You know this, Members of the House and all of our citizens know 
this, that often times if you get sick, what is the first thing you do 
if you have not been to a doctor in a while? Well, you do not do what 
you ought to do, what you ought to be able to do, and that is find the 
highest quality physician you can.
  You open up your book and see who you can see. Someone else is making 
that decision about who you can see. That is not a system that provides 
the greatest amount of choices appropriately for patients.
  The current system is a predatory trial lawyer litigation system. The 
lawsuit system, the lottery system of the courts that we have as it 
relates to health care right now is driving up the cost of medicine. It 
is making it so that folks are receiving all sorts of tests and the 
like that they frankly do not need.
  And the problem with this is not the malpractice insurance costs that 
doctors are having to pay, although that is a minor portion. The bigger 
problem is what is called defensive medicine. That means that your 
doctor, when you go see your doctor, he or she often times is ordering 
a test or doing a procedure or something in order to make it so that 
they are less likely to be sued and cover themselves, not necessarily 
because you need them. And you say, well, that is crazy.
  But it happens all of the time. I am an orthopedic surgeon. When 
someone comes into my office with back pain, almost regardless of their 
complaint, if I have not seen them before, every one of them gets an x-
ray. Now, they get an x-ray because if I did not do an x-ray and they 
went out of the office, and they went to another physician and that 
individual took an x-ray and on that x-ray was found to be something 
astronomically wrong, then I could have been sued for not picking that 
up at that very first office visit.
  You say that is probably the right thing to do. Well, 90 percent, 90 
percent of individuals with back pain, standard back pain, will get 
well within a period of 3 weeks. They did not need an x-ray. But 
everybody gets one. Everybody gets one. So you make it so that that 3 
weeks is not lost for the minimal percentage of individuals who have a 
significant problem.

                              {time}  1500

  The legal system is just phenomenal as it relates to health care, and 
it drives this practice of defensive medicine to an incredible degree.
  Overall cost increases. We have not seen the kind of savings in 
health care we ought to see. You remember the graph that showed the 
increase in percent of GDP that we are spending on health care? It was 
6 percent in 1965. Now it is 13 percent, soon to go to 17 percent. We 
have not seen any of the savings in health care that we have seen 
throughout all other sectors of our society.
  What is a 21st-century system? It is centered on the patient. It is 
values-driven, knowledge-intense. It allows for a free flow of 
information between physicians and other providers. It is prevention- 
and health-focused. Electronically based. It gets away from that paper 
system that frankly results in more errors and more problems because it 
is a paper system.
  The Center for Health Transformation calls it a binary mediated 
market. What does that mean? It means that the patient is in charge, 
the patient and the provider are the ones making decisions.
  Outcomes focused on government. Increased choice. That is exactly 
what needs to happen. The patient needs to be in charge. And a new 
system of health justice. All of these things would result in a 
significant decrease in the cost of the health care and making it so 
that the quality of care and quality of life is increased all across 
the Nation for all, frankly, because of a transformation in our health 
care system.
  So what we need is a new vision for health care, one that has more 
choices, more control by patients resulting in higher quality and lower 
costs. And I look forward to working with so many of my colleagues in 
the House on both sides of the aisle who are interested in positive 
solutions, productive solutions, making it so that those personal 
decisions as they relate to health care are able to be made by patients 
and individuals.
  Mr. Speaker, I am honored to be joined now by one of my colleagues, 
the gentleman from Nebraska (Mr. Fortenberry). We thank the gentleman 
so much for coming, and I look forward to the gentleman's comments as 
they relate to health care.
  Mr. FORTENBERRY. Mr. Speaker, I thank the gentleman for the 
opportunity to be here and participate in this important discussion of 
health care in our country. I thank the gentleman so much for his 
leadership today in coordinating this important discussion.
  Mr. Speaker, I believe we have an important opportunity today to both 
save lives and save money. Health care is a pervasive part of American 
society. As we have heard, a major portion of our Federal budget is 
devoted to health

[[Page H9031]]

care costs, and total health care expenditures are a significant 
portion of our gross domestic product.
  The good news is people are living longer with better technology and 
better drugs. That is excellent news. America has one of the best 
health care systems in the world. Yet everyone knows, because everyone 
is affected, that rising health care costs are a growing challenge to 
families, to businesses, and to the government. We need to look at this 
system, and I believe that simple new approaches can make a huge 
difference, as the gentleman has pointed out.
  It is estimated that improvements in health information technology, 
quality patient management and wellness programs themselves promise to 
save up to 20 to 40 percent of costs. Personal ownership of health care 
decisions may minimize the wasteful overutilization of services. 
Incentives to medical providers, as well, to better target expensive 
and excessive testing are all areas that we need to aggressively 
explore in order to appropriately use our public and private health 
dollars.
  Mr. Speaker, today I wish to focus on one aspect of how the rising 
cost of health insurance prevents entrepreneurial individuals from 
pursuing good opportunities. I think we must take the opportunity to 
think creatively, to update outdated approaches, and put consumers and 
families in charge. I have a keen interest in reducing barriers for 
small entrepreneurs. The vast majority of new jobs in our country are 
created by small business. This is where most people are working hard 
to get a little ahead in life and secure their own long-term economic 
well-being.
  I have seen how the lack of available health insurance and rising 
health care costs decreases productivity and distorts social and 
economic decisions. For instance, in my district it is not unusual for 
a spouse in a farm family to drive very long distances to have a job 
simply for health care coverage. The rising cost of providing health 
care coverage for employees is a growing obstacle for small business 
owners or those who may wish to join their ranks.
  It is not surprising that only 63 percent of smaller companies can 
afford to offer health care insurance. This is a primary reason why 
three out of five uninsured persons in our Nation are small business 
owners, their employees or their families.
  Recently, the Committee on Small Business held a field hearing in my 
district. It was an extraordinary turnout. One of the reasons was 
because it was on the issue of small business and health care costs. 
During this forum, we examined the increasing cost of health insurance 
and possible solutions. The hearing emphasized one important aspect, 
the underutilized tool for small businesses known as health savings 
accounts, which were established as a part of Medicare prescription 
drug law.
  These tax preferred accounts, coupled with high-deductible health 
insurance, help alleviate the ever-increasing cost of traditional 
health insurance premiums and empower families to take better control 
over their own health care dollars.
  While the number of individuals using these accounts is increasing, I 
believe we need to do more to give small business owners and 
entrepreneurs the ability to take advantage of this very important 
policy innovation. In fact, of the new policies, 37 percent were taken 
out by individuals who were previously uninsured, and 27 percent were 
taken out by employers who previously did not offer health care 
insurance to their employees.
  Now, one concern regarding health savings accounts is the initial 
funding. I have introduced legislation that will allow individuals to 
roll over portions of their retirement accounts into health savings 
accounts. This rollover would not subject the retirement account to the 
usual 10 percent penalty for early distribution. Moreover, all 
individuals with retirement accounts would be eligible to take 
advantage of this opportunity.
  I believe this will help meet important public policy objectives of 
increasing access to health care coverage and overcoming a major 
barrier that small businesses face.
  HSAs, as they are known, are just one of the many simple new 
approaches that can make a huge difference in our health care system by 
providing positive incentives for those who use the system.
  Again, I would like to thank the gentleman from Georgia (Mr. Price) 
for undertaking this important discussion about health care and health 
care costs in our country; and I look forward to continuing our 
dialogue about innovative approaches to both save lives and save money.
  Mr. PRICE of Georgia. I thank my good friend from Nebraska for 
joining us today. I want to thank him for pointing out health savings 
accounts and also the incredible importance of this discussion to small 
business.
  When I go back to the district and I visit businesses all across the 
district, one of the things that they say, Whatever you do up there in 
Washington, please, please, make it so that we can afford to provide 
health insurance for our employees.
  So many of the things that we are doing right now as it relates to 
the model in which we are delivering health care make it more difficult 
for them to be able to provide that. So I thank the gentleman for his 
perspective and for joining us today.
  Mr. Speaker, I want to take a very, very short period of time and 
just close by saying that the model that we currently deliver health 
care under in this Nation is one that is not patient friendly; it is 
not efficient; and it does not spend anybody's money, be it tax money 
or personal money, wisely.
  We need a new model, a new model for health care. A transformation of 
our health care system is what is needed: more choices, more control by 
patients, higher quality and lower costs. What that does is make it so 
that we would have better care, more patients in power, and more 
responsibility and opportunity for patients to receive the kind of care 
that they so richly deserve.
  Again, I would like to say that I look forward to working with 
Members on both sides of the aisle who want to work positively and 
productively to bring about a system of health care in our Nation that 
allows patients, that allows patients to be the ones making decisions 
that give the highest quality of health care that they need and that 
they deserve.

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