[Congressional Record Volume 153, Number 118 (Monday, July 23, 2007)]
[House]
[Pages H8284-H8290]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE OFFICIAL TRUTH SQUAD
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 18, 2007, the gentleman from Georgia (Mr. Price) is recognized
for 60 minutes as the designee of the minority leader.
Mr. PRICE of Georgia. Madam Speaker, I want to thank my leadership on
the Republican side of the aisle for allowing me to address the House
this evening. It is always an honor to come before the House of
Representatives and to discuss issues of importance to this Chamber, to
this Capitol and to the Nation.
This is a truncated version of the Official Truth Squad because of
the hour of the evening. The Official Truth Squad is a group of
individuals who come to the floor of the House and try to shed a little
light, try to shed a little truth, if you will, on the deliberations
going on here in our Nation's Capital and hopefully bring a perspective
that will allow Members of the House and this Chamber and men and women
across our Nation to be able to gain a little greater perspective on
exactly what is going on here in Washington as we struggle with the
challenges that we have facing the issues that we have in our Nation
that demand so much of our attention and demand, frankly, a greater
level of cooperation than is frequently seen here in Washington.
It is one of the things that I strive, along with my colleagues, try
to bring about, and that is a greater sense of urgency to solve the
challenges that we have, and to address honestly and openly and
truthfully the issues we have before us.
We have one special quote that I like to quote that I think kind of
puts it all into perspective, especially when you are talking about
issues that are so complex in Washington. It comes from Senator Daniel
Patrick Moynihan. He used to say everybody is entitled to their own
opinion, but they are not entitled to their own facts.
So often here in Washington, people want their opinions to be facts.
It is one of the items or issues that the Official Truth Squad attempts
to address, and that is trying to talk about facts, trying to bring
facts to the table as it relates to any particular issue.
Tonight we are going to talk about at least one issue that is in
great need of facts. Madam Speaker, we are in appropriation season.
During this period of time, the House works on its multiple
appropriations bills and tries to determine exactly how we as a Nation
ought to set priorities from an appropriations or a spending
standpoint, what level of spending ought to go into the various
programs of the Federal Government. And so often, and we just heard it
this evening, many people come to the floor and they say, if we just
had more money, if we just had more money for this program or that
program, that would solve the problem.
And so often it is not money that is needed for programs, especially
out across our Nation, because what is needed most often is to free up
the wonderful enthusiasm of the American people and the wonderful
ingenuity of the American people. What happens is along with the money
that comes from Washington comes rules and regulations and strings and
stipulations, and makes it that those individuals who are trying as
hard as they can to make ends meet and improve their communities and
make certain that they are providing for their families, so often what
Washington does is ties their hands behind their back and makes it so
they are not able to realize the kinds of dreams that they would
otherwise be able to realize.
We cite often the Golden Rule. You know what that is. Most folks know
what that is, but the Golden Rule of Washington is not what most people
across this Nation know. The Golden Rule across this Nation is to do
unto others as you would have them do unto you. But the Golden Rule
here in Washington is he who has the gold makes the rules. That is
especially true during appropriation season because we put all kinds of
strings attached to the money that the Federal Government spends.
We often forget, as I am fond of reminding my friends here in the
House, of whose money it is, because it is not government's money, it
is the people's money. It is hard-earned American taxpayer money.
We have had individuals come even to this well and say, ``Keep your
hands off my money.'' My money. It is phenomenal when you hear that,
when I go home to the Sixth Congressional District in Georgia, and my
constituents ask incredibly insightful questions about that kind of
mindset that exists here in Washington. ``How can politicians believe
it is their money?'' This is so important as we are in this
appropriation season and as we determine exactly how to spend that
hard-earned taxpayer money, and we ought to do it more responsibly, I
would suggest, Madam Speaker.
I want to talk tonight about an issue that is near and dear to my
heart, and to the heart and well-being of every single American, and
that is the issue of health care. Before I came to this body, I was a
practicing physician. I was an orthopedic surgeon and practiced for
over 20 years in the Atlanta area.
One of the things that drove me into politics or had me stand up and
volunteer to get into politics was the recognition and the appreciation
that year after year after year would go by as I tried the best I could
to care for my patients and worked with my colleagues to provide the
best and highest quality of health care we could provide, and year
after year, and month after month, and day after day each of us
appreciated that there were more individuals in our State capital and
in this Capital right here who were making decisions about health care
that affected very directly what I could do for and with my patients
than anybody I ever met in medical school and anybody I met in
residency and training as I was training to become an orthopedic
surgeon. That was true for every specialty that I talked to, every
single colleague.
If you talk to your doctor, Madam Speaker, or if the Members of
Congress would speak to their physicians and to their neighbors, they
would appreciate readily that there are so many rules and regulations
that are coming from Washington and from State capitals around this
Nation that tie the hands, that make it more difficult, not easier,
more difficult for physicians and other health care providers to be
able to take care of patients. And that's wrong. That is wrong because
what it means is we have a lesser quality of health care system than we
would otherwise have if the government weren't involved in the way that
it is.
And there are all sorts of programs that you can talk about that
would lend truth and credibility to that statement, but I want to talk
about one specifically this evening that is going to get a lot of
discussion, Madam Speaker, here over the next week or two and maybe
number of months as we move forward in Washington, and that is the
program known as SCHIP, or the State Children's Health Insurance
Program.
That is a program that was begun 10 years ago. It was part of the
Balanced Budget Act of 1997. It was a program that had wonderful goals.
The goals were, specifically, there was a recognition that low-income
individuals who weren't eligible for Medicaid, they made too much money
to be eligible for Medicaid, but they didn't make enough money to be
able to afford health insurance for their families, those individuals
ought to be able to have some sort of assistance provided by States and
the Federal Government in a complex formula that would allow those
families to be able to have health insurance for their children. So
hence the name State Children's Health Insurance Program. And it was a
laudable goal, without any doubt. And it was passed by a significant
majority, and the goal was to increase the enrollment of children who
were below 200 percent of the poverty level. That is what was selected
as the limit at the time.
Over the last 10 years what happened, however, is a distortion, a
significant
[[Page H8285]]
distortion, of the program so that it covered not just children up to
200 percent of the poverty level, but in some States covered up to 350
percent of the poverty level, and it covered not just children. The
State Health Insurance Program covered hundreds of thousands of adults.
So like other government programs, it grew.
Government programs in the area of health don't just grow, as I
started this conversation talking about, they insert themselves in
terms of rules and regulations into the process and make it extremely
difficult for those who are charged with the administration of the
program, charged with caring for patients in this instance, to be able
to care appropriately for them.
So what we saw between 1998 when the State Children's Health
Insurance Program was instituted and became effective, at that time
there were about 28 percent of the children of this Nation on some sort
of government-run health care. In 2005, that number had grown to 45
percent. It is a little more than that right now, but about 45 percent.
The proposal that will be on the floor of the House or certainly in
Committee of the House is to move it so that in a relatively short
period of time, another 5 years, we will have 70 to 75 percent of
children on government-run health care.
We will talk a little bit more about the consequences of that and why
many of us believe that is the wrong direction to head, because most of
us, most people, most Americans, I believe, are not interested in
having a Washington-controlled, bureaucratic medical model be the one
that is making those kinds of personal health care decisions for
themselves and their families, and especially for their children.
That is what we are going to talk a little bit about tonight. I am so
pleased to be joined by one of my good friends and colleagues, the
gentleman from New Jersey (Mr. Garrett), who has great insights into
both fiscal responsibility issues and issues where government tends to
intervene in ways that most of us would desire that it not. I am happy
to have the gentleman join us this evening, and I yield to the
gentleman.
Mr. GARRETT of New Jersey. I thank the gentleman from Georgia for
coming to the floor this late hour, although on the west coast it is
just early evening, and so we welcome all those who partake in these
forums that we have that are educational to not only the American
public, but also to our colleagues who may be in their chambers
learning a little about SCHIP as we go along.
I was listening to your opening comments, and you were right on point
on this one, as you are always right. I have great respect for your
ability to have a strong grasp of the situation on a whole slew of
topics. I sort of focus on certain areas like the U.N., which is one of
my pet peeves, or financial services, or education and No Child Left
Behind. But I know whether on the floor or at home, I can watch and be
assured that you are covering thoroughly a topic of importance to the
American people. And SCHIP is one of those topics.
You were just beginning to address the issue of the number of
children that will be on SCHIP and the direction that the government is
going in this area. Your chart makes the point abundantly clear.
Red is usually a warning sign to people. When the red flashers go off
or the red lights flash, you know something is amiss, and I guess you
chose the appropriate coloration of your charts that something is
amiss.
We see back in 1998, less than a decade ago, a little over a quarter
of the kids in this country were under a government-run plan, and now
we are looking to see almost three-quarters of the children in this
country under a government-run plan.
{time} 2300
That is fine. That would be fine if you thought that the U.S.
government, if Washington is in the best position to take care of and
administer the health of our children.
But you know, you don't have to listen to The Official Truth Squad
here on the floor each week to know that things are oftentimes amiss
when it comes to the efficiency and the accountability of the Federal
Government.
Heck, just look a couple of years ago when the whole issue of Katrina
was coming on, there was railing from both sides of the aisle,
rightfully so, when we realized that the Federal Government couldn't
get into an area where it had an obligation to, and that is, to help
out people in a tragic situation, whether it's home settings or others
or in a health situation.
Likewise, I think I recall there was railing again against the
Federal Government when, again, in an area that the Federal Government
does have a distinct responsibility, and that is taking care of our
veterans and our men and women who are in the military or returning
back from the military to the facility just down the road a piece from
here, and there was a question as to the conditions of those medical
facilities and whether we're giving those brave men and women all the
facilities and care and comfort and proper medical care that they
deserve.
Yet, when we know that all those problems exist, there are some,
especially from the other side of the aisle in this House and certainly
on the other side of the aisle in the Senate, who would say that the
solution to the health dilemma in this country is not by turning it
back to a patient-doctor relationship, but instead of turning it to a
Federal Government/doctor-patient relationship. So we are going in the
wrong direction with regard to that.
I'd like to come back to that in a moment or two, but at this point I
yield back to gentleman if he would like to speak.
Mr. PRICE of Georgia. I appreciate your comments in pointing out a
number of different areas where the government has been intimately
involved in health care issues specifically and ones where most
individuals across this Nation I believe, Madam Speaker, have questions
about the advisability of governmental involvement and the
effectiveness of governmental involvement.
We're pleased to be joined by another good friend, the gentleman from
Wisconsin, who has been chair and now is ranking member of the Budget
Committee, an individual who has great perspective on both fiscal
responsibility and the issue of health care as a member of the Ways and
Means Committee. We are pleased to have Mr. Ryan join us this evening
and I'm happy to yield to him.
Mr. RYAN of Wisconsin. I thank the gentleman for yielding, and I
thank the gentleman for his leadership on health care issue, not only
the fact that you're practicing physician, but also your leadership
here in Congress, and the gentleman from New Jersey as well.
I just listened to this conversation you're having in my office, and
I wanted to come down and just add maybe a few facts. I missed part of
your debate as I walked over here.
But we're looking at all these various SCHIP bills to renew this
program, and we looked at what the other body is doing over in the
Senate. They propose a new $35 billion expansion of the program, but
what we find in their legislation is that, not only do they provide a
$35 billion expansion, they provide another $35 billion expansion after
that in 5 years. Then to contort their budgets to make it all work,
they actually say that we will cut off 4.5 million children off of
SCHIP insurance to make their numbers work, meaning they have a budget
gimmick.
The budget gimmick is, they're going to put as much money into this
program as possible, but to fit in their contorted budget window, they
will just assume that in about 9 years everybody's knocked off of
health insurance.
Both you and I know that that's not going to happen, but what we have
over here in this body is an even larger SCHIP expansion, a $50 billion
SCHIP expansion which translates into $100 billion SCHIP expansion if
their full 10-year ambitions are realized.
And what does that mean? What they're talking about is having all
families at 400 percent of poverty, a family of four earning $80,000,
being on government health care. What they're talking about is the
largest expansion of Washington-controlled bureaucratic health care we
have seen in decades, and this expansion of Washington-controlled
bureaucratic health care is not the recipe for America.
[[Page H8286]]
All of us know from the fact that we represent Americans that the
cost to health care and the cost of health insurance is an enormous
crisis in America today. Finding good quality, affordable health care
is a big problem.
And so what the majority is doing is, rather than attacking the root
cause of health care inflation, rather than looking at what is
producing these high costs, they're simply saying we will just pay for
more of that from the government. They simply want to take more control
in Washington and go down the same path, the same path where, today, we
spend two-and-a-half times per person on health care of any other
industrialized world; yet, today, we have 46 million people who have no
health insurance.
We have a system today where all the fiscal experts in Washington and
across America from the left and the right are telling us health care's
unsustainable, the entitlements in this country are bankrupting
America, that our children and grandchildren simply won't be able to
pay for the government of tomorrow because of the cost of health care
today and the trajectory it's on.
We believe in a different philosophy, a different alternative. We
believe we can have affordable, accessible health care that is patient-
centered, that is patient-driven and patient-controlled health care.
And so that is why we have a very different vision of this
Washington-controlled bureaucratic health care, where the patient and
his or her doctor are making the decisions in health care, where we
actually go at the root cause of health care inflation and attack those
causes so that people get affordable health care at a good price and
good quality, and that the patients are the ones who are the drivers of
the system.
Today, under the third party payment system we have today, either an
HMO bureaucrat or a government bureaucrat's making the decisions, and
we as consumers really don't care what things cost because someone else
is paying the bills. We can't shop around based on quality and price
because we don't know what quality and price is or we're told who and
where we've got to go to by our closed network. That's a system that's
unsustainable. That's a system that we have today, but this is the
system that the majority wants to not only expand, but they want to
turn more of it over to Washington, more of it over to government
bureaucrats making our health care decisions which will cost us even
more money, $50 billion to be specific, in this bill that's going
through the Ways and Means Committee and Commerce Committee this week.
But the key here is that we have 16 percent of the GDP, 16 percent of
the economic output of this country is dedicated to just health care.
The Democrats want that to grow and grow and grow. What's ironic about
this is the other 84 percent of health care doesn't work like the 16
percent of GDP that health care consumes, because the other 84 percent
of our economy operates on the basic free market premise of
competition, competition on price, competition on quality. If you don't
do a good job, you don't get more business. If you're not price
competitive, people aren't going to buy your product.
Unfortunately, that is not how health care works today, and those are
the reforms that we want to inject into health care so that people can
get affordable, accessible health insurance coverage, health care that
is very high quality and that doesn't grow at 6, 10, 20, 18 percent of
price increases every single year.
So we have two different philosophies, two different visions of where
we want to go to with health care. We very much believe in putting the
patient at the center of the equation, giving the patient and their
physician control over the health care system so health care providers,
rather than oligopolistic pricing, rather than just raising prices on
everybody, will compete again for our business on price and quality.
What the majority wants to do is continue this system, where
providers continue to raise prices over and over and over, third
parties make the decision whether it's a bureaucrat at an insurance
company or a bureaucrat in Washington, and they simply want to raise
more taxes to pay for more of this.
In this particular bill, they want to cut Medicare patients. They
want to raise taxes on low-income individuals in order to pay for this
unprecedented expansion of Washington-controlled bureaucratic health
care. To me, that's not the right way to go. It's not the right
priorities, and what it will do will be to get more difficult for small
businesses, individuals, families and even large businesses to be able
to afford health insurance.
That's not the path to take. That's the way that's going to bankrupt
this country. That's going to raise our taxes and that's going to take
health care decisions away from individuals and families.
That's the approach that we want to go, and I just am pleased to see
that my colleague from Georgia and New Jersey have joined in this
debate on the floor because it's a very important debate. I would argue
that the cost and affordability and accessibility of health care is the
largest domestic crisis facing America today, and it's high time we do
something about this.
I just want to thank the gentleman for including me in this debate.
Mr. PRICE of Georgia. I thank the gentleman for his comments and
really succinct presentation of the issue of health care and the
philosophical difference between the two parties, philosophical
difference between the majority party and our party at this point.
The majority party believes that Washington-controlled bureaucratic
medicine, bureaucratic health care is exactly what the country needs,
and we don't believe that. We believe firmly in patient-centered health
care and patient-centered decisions as it relates to health care.
So I thank you very much, and you point out as clearly as anybody
could ever do the philosophy on that side of the aisle, once again,
that is, if we just give it more money, give it more money, it will
somehow miraculously improve.
You know as well as anybody as the ranking member on the Budget
Committee that when the estimates are a certain amount, it's never that
amount. So if $50 billion is the estimate for the first 5 years and
$100 billion for the 10-year period of time, it will never remain at
that level. When folks across America hear that kind of comment, they
just better say I better hold on to my wallet.
I'm pleased to yield to you once again if you have any other
comments.
Mr. RYAN of Wisconsin. All I would say is I think most Americans
realize, if you're spending someone else's money, you are not going to
be judicious with that money like you are with your own, and that is
what we do here in government.
And in health care, by asking Washington to spend our taxpayer
dollars, they are not spending it like it's their own money. Think of
what's happening in health care. In health care, they're spending
someone else's money, our money, and they're spending it in a very
irrational way, and it's giving us high health care costs. That is the
basis of this third party payment system.
And so by simply saying we're going to raise taxes to spend more
money in Washington on health care in a system that takes control of
health care out of the hands of the patient, him- or herself, is just
wrong.
I can't think of a more intimate and personal decision you experience
in your life than making a decision over your own health care. Yet,
they want more bureaucrats to make that decision than individuals. They
want Washington to control this system. They want HMO bureaucrats to
control this system and not the patient and their doctor.
That is the real core of the issue here, who you trust. Do you trust
Washington with your money to make personal decisions for you or do you
trust individuals to make them for themselves?
I would argue, and I think the evidence is clear, that when
individuals make the decisions for themselves, when they're spending
their own money, when they're talking to their doctor and making
decisions on their own treatments, with affordable insurance, that the
system's going to be far better, people are going to be much more
satisfied, and we're going to save a lot more money and we'll have
healthier outcomes.
[[Page H8287]]
So it's a real difference in philosophy, and where we see competition
working, prices go down and quality goes up, even in health care.
I will just give one final conclusion. I used to have really bad
eyes. I had 8.5 in this eye and 8.0 in this eye, which means you have
really bad eyes, about 2800 vision. In the year 2000 after years and
years of wearing contacts, I decided I'm going to get this LASIK
surgery, and that LASIK surgery cost me $2,000 an eye for a total of
$4,000 out-of-pocket discretionary spending in elective surgery. They
used this Excimer Laser at the time, and it went very well. I can see
your charts extremely well. I can even see the detail on your tie.
You're standing about 20 feet away me, and the LASIK worked well.
Well, what is LASIK procedure now in the year 2007 where it was in
the year 2000? It costs $800 an eye at the same place, and they've
revolutionized this procedure, revolutionized this Excimer Laser they
use four times over. So the procedure is much better in quality, it's
much better in recovery, and it costs $800 an eye instead of $2,000 an
eye. $1,600 instead of $4,000 seven years ago. Better quality, lower
price, because of competition.
So, even in health care, with complicated things like eye surgery,
you can see where competition is allowed to work, is allowed to
flourish, that good results can occur, and that is the way out of this.
That is the way forward, and that is the lesson that we need to learn
as we go through this, instead of raising taxes on Americans and having
more Washington-controlled bureaucratic health care, which has given us
this double digit inflation on health care.
And with that, I'd be happy to just yield back to the gentleman, and
I thank him for including me this time debate.
Mr. PRICE of Georgia. Thank you ever so much for your comments and,
once again, succinctly pointing out the rationale for why it doesn't
make sense for Washington to be controlling health care.
And sometimes I get the question as a physician, what does it mean
specifically? What kind of issues would the government insert
themselves into? If I think back on personal experience that I have,
there are a number of issues where Washington and governments insert
themselves into health care. The reason that it sometimes isn't easy to
see is because patients don't often see it.
{time} 2315
I worked for a period of time in a veterans hospital in Atlanta, and
every quarter there were a certain number of joint replacements that
were allowed to be done at the hospital. When we got to the end of that
number, even though it wasn't the end of the quarter, there were more
patients that needed joint replacements, we couldn't do them. We
weren't able to do them because the resources weren't there to be able
to fund them.
Now, the patients that didn't get their joint replacement in May or
June because they were rescheduled to July didn't know that the reason
they didn't get their joint replacement in May or June wasn't because
there wasn't anybody to do it, or there weren't any prostheses to
implant, or the nurses weren't there, or the operating rooms weren't
functioning, no. They didn't know that the reason they weren't getting
it is because the Federal Government wouldn't pay for it. That was the
reason.
So, the government inserts itself in so many ways into the practice
of medicine. Medicaid programs are a classic example. Medicaid programs
across this Nation, which are government-run health care for lower-
income individuals, the vast majority of States have formularies for
drug prescription plans in Medicaid, which means that the government is
deciding which drugs are available for folks at the lower end of the
economic spectrum. That's wrong. That's simply wrong.
Now, there is a way to solve that without the heavy hammer of the
government, because when the heavy hammer of the government comes in,
what happens is that they just put more restrictions on, or they make a
change, and for 2 months it's the right change to make.
But government isn't nimble, it isn't flexible, it can't change
easily. Even if it made the right decision at one point in relatively
short order, it would be the wrong decision, because science moves on,
medicine moves on, health care moves on. There is no way the government
can catch up, which is why the importance of having patient-centered
decisions, patients and their families making decisions in concert with
the consultation with the physician, is so incredibly important.
I yield to my good friend from New Jersey (Mr. Garrett).
Mr. GARRETT of New Jersey. The last point you make as far as the area
of intrusiveness of the Federal Government and how they are sometimes
basically out of step with what is appropriate between the normal
doctor-patient relationship, maybe that's because the Federal
Government and all governments in general always lag behind the private
sector, whatever field you might consider, as far as innovation and
moving ahead and new areas.
I mean, think about it. You can go to the store tonight and buy any
item that you possibly want, whip out your credit card and slip it
through a machine. Within seconds that transaction is created, and they
know your credit rating and whether you have money in that bank account
to pay for that item. It's all done just in the blink of an eye.
Go to your local town hall or go to the IRS or go to anybody else
like that and see whether they are up to date with that technology, and
you will find out they are not. Those are okay, because that's not a
life-and-death situation. But you, as a physician, know that when it
comes to a life-and-death situation, or we all know, that we want our
children and our spouses to be able to have the most up-to-date, the
most innovative, the most advanced technology available to them.
I think that is going to be found on the marketplace of ideas that is
in the general marketplace, as opposed to the convoluted, Byzantine
system that we call this, the Federal Government.
Mr. Ryan just stated that what the Federal Government is attempting
to do here, with the expansion of this program, as we come to the floor
tonight, we mark approximately the sixth month of control of the
Federal Government under Democrat leadership. As we mark this sixth
month, we have seen the largest expansion in taxes, the largest tax
increase in U.S. history. I guess, as we discussed here on the floor
tonight about the Democrat plan for the expansion of the SCHIP program,
we see the largest expansion intrusion into the family and personal
life by the health system, by the expansion of the SCHIP system.
The point I just wanted to make, though, is take a look at how the
system has worked so far with respect to the system, the distribution
of money to the States. If you go back to I guess it was 1968 or 1969,
the first couple of years under the Nixon administration, and he came
up with a program of distributing money to the States that was called
revenue sharing. That was a new idea at the time, and after a time we
realized it didn't really work exactly the way Nixon intended it to do.
In fact, he tried to do it in certain areas like education and was
never able to get it into legislation. Yet the same sort of idea here,
in the original version and the version that will be coming out in the
Senate as well.
In a similar situation that we can all relate to, say you have four
kids in your family, and you are going to give them all $40 to spend
each week. So you give each one of your children $10 each. So here,
Child One, Two, Three, Four, presumably you have better names than that
for them, here is $10 each. You each get to spend it on anything you
want during the course of this week. But, mind you, when the weekend
comes, if you don't spend it, if one of the other ones here happens to
go over their budget, and you didn't spend it all, what we are going to
do is redistribute those funds to the other child there.
What do you think that your kids are going to do? I would imagine
that each one of them is probably going to go out as soon as they
possibly can, spend that full $10, and maybe even spend $11 just hoping
that there will be some money left over from their siblings there to
spend it.
Well, children, not to make the comparison here to the States, but
the States here are a lot like children in
[[Page H8288]]
this situation. This system was set up with $40 billion initially
spread out to all the States. It was done, you might say, as fair as
the Federal Government goes, as far as how many children may be in the
program versus how many children are under other programs. But what
happened immediately after that, when they told the States, now, look,
if you don't spend your money, we are going to take your leftover money
and send it to the other States? Well, initially, in the first couple
of years, a number of States did not spend all their money. In 2001,
only 12 States exhausted their entire allotment. However, once they saw
how that all came down, in 2006, 40 States used all available funds. In
that same period of time, unused State funds dropped from $2 billion to
only $170 million.
So, finally, in this past appropriations, we had to step in, because
there was too few States not spending all their money, too many States
spending it. So we had to come up with spending of an additional $393
million that was recently appropriated to address the 2007 shortfall.
That just goes to show you one of the inherent problems in the system
and the way it has been administrated in the past and, I believe, will
continue under this system as well.
Mr. PRICE of Georgia. I thank the gentleman for pointing out the
shortfall of Federal Government rules, because they can't ever catch
up.
My State, Georgia, was one of those States that spent too much. It
spent too much, we would argue, in Georgia, because we were too
efficient at signing up children in the program.
Because the formula wasn't flexible, wasn't nimble enough, couldn't
accommodate for a State that overperformed, if you will, then it wasn't
able to be able to get the match that it was promised. Whether or not
that should have happened in the first place is a different question.
But the fundamental challenge that we see in all of this is that the
Federal Government can't respond, and it can't respond in so many
different ways.
But what we see with this chart here that my colleagues know very,
very well, and that is that there are all sorts of children out there
right now across our Nation that are covered by private insurance. What
happens when the Federal Government and the States get involved and
they say, let's put this carrot in front of you; let's entice you to
come and join government-run health care? What happens?
The fact of the matter is that there is a crowd-out phenomenon, that
individual families who currently have private insurance, either they
or their employer looks at the program and they say, well, we could
save that money by having you enroll your children in government-run
health care.
Mr. RYAN of Wisconsin. So what the gentleman is saying is because you
have so many families and children with private health insurance, with
this new expansion, taxpayers will be replacing that private health
insurance and paying for families who already have health insurance?
Mr. PRICE of Georgia. That's exactly right. That's what we saw with
the previous program. It happens every time when you have a government
program that potentially can supplant the private program.
In 1998, 28 percent of the children in our Nation were covered by
some sort of government-run health insurance. In 2005, 45 percent. This
is a combination of SCHIP and Medicaid.
Now, the problem is that when you look at the number of children that
are covered by private health insurance in our Nation, up to 200
percent, 50 percent of them are already covered by private health
insurance. If you go up to 300 percent, which is what the Senate
proposes, 70 percent of the children in America whose families have
incomes less than 300 percent have some form of private health
insurance.
Mr. RYAN of Wisconsin. At 400 percent?
Mr. PRICE of Georgia. At 400 percent it's nearly 90 percent.
Mr. RYAN of Wisconsin. So in the bill that's coming to the House
which takes SCHIP to have government, Washington-controlled,
bureaucratic health care, for all children at 400 percent poverty,
those families, 89 percent of those family already have health
insurance. We are talking about having the government step in, raising
taxes on taxpayers, and having the government take over the provision
of health care for a group of families, 89 percent of whom right now
have private health insurance?
Mr. PRICE of Georgia. That's exactly right. That is the crux of the
matter. If everything else were equal in the system, if it were to
allow for the same kind of ability for patients and families and
doctors to make decisions, that might be one thing. But as we have
talked about, and as everybody across this Nation knows, that's not the
case.
When you have government get involved in the provision of health
care, government is going to make decisions about where you can be
treated, who can treat you and what kind of treatment you can have.
That's where the personal health care decisions go away from the
individual. I don't believe, and I know you don't believe, that that's
what the American people want. It's up to you.
Mr. RYAN of Wisconsin. So just to expand on this point a little bit
further, we have here a situation where 89 percent of the children in
these families are already covered by private health insurance that
their parents had purchased, that their parents and employers probably
had provided them. So what we are proposing here in this bill is that
we raise taxes on the American taxpayers, and that we pay for
government-controlled health care to replace that health insurance that
they already have.
Mr. PRICE of Georgia. Yes.
Mr. RYAN of Wisconsin. So we are going to pay for a system that we
already have coverage of so that we can raise taxes and have the
government control their health care system. That is a system, that is
a sense of priorities that just doesn't square with the American people
that I know. That is not what people in Wisconsin sent me to Congress
to do.
I don't believe the American people, if they really know the truth
and the facts surrounding this issue, want to see their taxes raised so
that Washington controls the health care for all of these families, for
all of these children, especially when they already have health care
provided to them.
I think people understand that if we truly have uninsured poor
children, that they ought to get health insurance. I think there is no
disagreement here about making sure that uninsured low-income children
receive health insurance.
But talking about providing government-controlled health care to
families that already have health insurance and raising taxes to do
that, that just doesn't jive with the priorities of the American people
and the American taxpayer, in my opinion.
Mr. PRICE of Georgia. No, it doesn't make any sense at all. It lays
bare the true motive and the true philosophy, which, on the other side
of the aisle, at least the true leadership who are pushing this
legislation, their belief is that government knows better how to spend
people's money than the people themselves. This stretches all the way
into the area of health care, which, as you mentioned, are very
personal, personal, health care decisions.
Mr. GARRETT of New Jersey. I know that the gentleman from Wisconsin
would be able to elaborate on this in much more detail, but in the best
case scenario, would that the Federal Government be awash with cash
right now, and would that we had no mandatory spending problem going on
in the Federal Government right now, maybe some people would want to
sit down right now and say, how can we spend our extra dollars around
the country?
But as the gentleman can elaborate in much detail, and we have seen
in the Budget Committee for the first months of this year, testimony
after testimony after testimony, expert after expert after expert from
all spectrums of authority, we are now in that situation where we find
ourselves with the Federal Government and mandatory spending going out
of control. There are legitimate groups within that that the American
public would agree with, or those that we should be targeting, to make
sure that they do.
The aged, the poor, the infirm, who desperately need medical care and
are not able to cover it by themselves and are not fortunate enough to
be able to work any longer, and who are not working now and covered by
an employer plan, and did not unfortunately
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work for a company that provides for a company-sponsored plan after
their termination at work, those are the people that the American
public would ask that's where our focus would be.
But do we find ourselves in our situation right now where we can say
that we have all the other mandatory spending under control that we can
address this now?
Mr. RYAN of Wisconsin. All three entitlement programs that are in
place today, Medicare, Medicaid Social Security, all go bankrupt in
about 10 years. It's because we are doubling the amount of retirees in
this country at a time where we were only increasing those taxpayers
into the program by 17 percent.
So we are seeing a 100 percent increase of the consumers of those
three entitlements, while only experiencing a 17 percent increase of
the taxpayers in these entitlements. That's why these three programs
are going bankrupt. That's why these three programs will consume 100
percent of our budget by about 2030. By about the year 2040, when my
kids are my age, they will have to pay twice the level of taxes we pay
today just to keep today's Federal Government going at that time.
{time} 2330
We have run this Federal Government remarkably constant at about 18
percent of GDP. We have had to tax the U.S. economy at about 18 percent
of the output of the economy just to run the Federal Government for
about the last 40 years. And what we are on the trajectory today
because of the aging of America and way the entitlement programs are
designed and the baby boomers retiring, my children will have to pay 40
percent of GDP just to keep today's Federal Government going when they
are at my age group. You can't have a strong growing economy, a high
standard of living.
So what we are in the middle of doing here, we are deciding whether
or not we are going to sever that American legacy to our children and
grandchildren. And the American legacy that I was taught by my parents
was that you leave the country better off for the next generation than
when you received it. You leave a standard of living better off for
your children and grandchildren than that which you received from your
parents. We are at risk of severing that legacy for our children and
grandchildren if we are going to confound them to a system to where
they will literally have to pay twice the amount of taxes to just the
Federal Government than we do today.
At a time when we are in tough competition and globalization with
China and India, it is impossible to pretend that we are going to be
able to enjoy this kind of standard of living if we are requiring our
kids and our grandkids to pay double the amount of taxes they pay today
to Washington when they are in our age bracket. It will just be
fundamentally irresponsible if this is the future we would confine them
to, yet that is exactly the trajectory we are on today.
Mr. PRICE of Georgia. You are absolutely right. And to give some
credibility to that from a pie chart standpoint, these are the
mandatory spending programs, and all of what you said happens unless we
act. Unless we act as a Congress, all of these things happen.
In 1995, those three programs were this yellow portion, about percent
48.7 percent of Federal spending. In 2005, about 53.4 percent. In
relatively short order, 2017, 62.2 percent. And, as you mentioned, in
2030 the yellow portion of that will be the entire pie.
Mr. RYAN of Wisconsin. And if the gentleman will yield, so the blue
portion, which is what we call discretionary, that is national defense,
the Department of Education, the Department of Commerce, the Department
of Energy, Transportation, roads, bridges, the Pentagon, all of those
things are the blue portion. There won't be any money left for those,
Will there?
Mr. PRICE of Georgia. You are absolutely right. And that is why you
mentioned the significant increase in taxes that would be required, and
that is if we don't do anything. That is why it is so imperative that
we act, which is why it was so astounding to me that this new majority
that came in with this ``new direction'' that they were going to take
us on for our Nation. You know what happened when they had the
opportunity to bring about some entitlement reform.
What happened with the bill that they passed this year in their
budget was no entitlement reform, in spite of the fact that we worked
as diligently as we could back in 1997 with the Balanced Budget Act,
about $130 billion of entitlement reform, and fought like the dickens,
as you remember, in 2005 with the Deficit Reduction Act to get about
$40 billion in entitlement reform.
But this new majority comes in with the previous chart that we saw,
increases in Social Security spending, increases in Medicare spending,
increases in Medicaid spending, the prospect of another $100 billion
entitlement with the SCHIP program if they have their way, and no
reform. Can you imagine what that is going to do to our economy?
Mr. GARRETT of New Jersey. If the gentleman would yield, And lest
anyone following this get confused when we talk about the tax
increases, the gentleman from Wisconsin set it out and you followed up
with quite some detail, as far as the tax increase necessary in order
to pay for those entitlement expansions over time. That would be in
addition to what we have already seen has occurred during this first 6
months in office.
In other words, we have already seen the largest tax increase in U.S.
history. And the current tax increase means that 115 million taxpayers
are going to see a $1,716 increase in their tax bill in just a couple
years; 84 million women would see their taxes go up by $1,970; 42
million families with children, which is what we are down here talking
on the floor about right now, those children, trying to be sure they
have health insurance. Those 42 million families with children will see
an increase of over $2,000 in their taxes already this year because of
what the Democrats have done. And what you are speaking of is going to
be in addition to and on top of that.
In trying to just throw some numbers to the percentages that you were
throwing out there before as far as this expansion of children that
will come under this program now, those children who may be just living
across the street from us who their dads or moms work for a company
right now that provides them insurance, all of a sudden those companies
don't provide it anymore because now the government, we are going to
pay for it.
Or those children who have parents who have retiree benefits and are
getting insurance for them now, they will no longer have to get it from
their retirement pension programs; the government, meaning taxpayers,
will pay for it.
The CBO just came out with some numbers on this, and real numbers
means that for the first, just the expansion of the program as far as
additional dollars means 600,000 new children who used to yesterday
have coverage under the private sector will now look to the taxpayer to
pay for it; and another 600,000 children yesterday who had insurance,
whether through pensions or their parents' employers, will now look to
the Federal taxpayers. So 1.2 million children. Now, that is under the
House version. That number, I haven't gotten a CBO estimate yet, would
be even greater under the Senate version as far as children expanded
into this program who are already covered.
Mr. PRICE of Georgia. I appreciate your pointing out the issue of
taxes, because there has also been work that has laid out the tax
increase for the average citizen in every State across this Nation. And
in Georgia, that average increase is $2,700 average tax increase when
those tax increases go into effect if they are not changed. They were
included in this budget that included no entitlement reform. In
Wisconsin, the average number was $2,964. And New Jersey is a big
winner, average increase $3,779.
Mr. GARRETT of New Jersey. We are number one in a number of things,
in the number of taxes that we pay and the number of taxes that the
Democrats are going to make us pay in the future as well.
Mr. PRICE of Georgia. I want to thank you all for joining us tonight.
I do want to close on a positive note, and that is that there is an
alternative. And the alternative, as we talk about, is patient-centered
health care. And patient-centered health care, as you know, puts the
opportunity and the
[[Page H8290]]
right and the privilege and the responsibility for decisionmaking among
patients and their doctors, among families and their doctors. And the
way to do that is to structure a tax system that allows individuals,
incentivizes individuals to purchase health insurance, through whether
it is tax deductions or tax credits, or advanceable refundable tax
credits, through high-risk pools, through risk pools that allow people
to pool together, making certain that individuals have the same kind of
tax treatment for the purchase of health insurance as employers do now,
as businesses do now, all sorts of wonderful ways to bring about the
opportunity for folks to purchase health insurance.
So it is not whether or not you have the current system or whether
you march down the road to more Washington-controlled bureaucratic
medicine. There is another way. And I know my good friend from
Wisconsin has worked on this extensively on Ways and Means, and I would
be pleased to hear your comments.
Mr. RYAN of Wisconsin. I just think that we have a different vision,
and that vision is that we believe we can provide a system that gives
us universal access to affordable health insurance for all Americans,
where they and their physicians are the nucleus of the medical system.
What the majority is offering is a bankrupting entitlement system,
massive tax increases unprecedented, in addition to the largest tax
increase in American history that they have already passed here on the
floor this year, and more Washington-controlled bureaucratic health
care, where bureaucrats, either HMO bureaucrats or government
bureaucrats make the decisions in health care rather than patients and
their physicians. We can come up with a system that is patient
centered, where every American has access to affordable health
insurance, where we have universal access to affordable health
insurance throughout America. Or that person who has a risky health
care profile, may be overweight and has diabetes, has a history of
cancer in the family, we can come up with a system where that person,
too, can get affordable health insurance and get access to it without
having the government run the entire system, without have to go through
a government or an HMO bureaucrat to make decisions on how you get your
care. You ought to be able to go to your doctor and come up with a good
treatment plan that works for you, and that is where the decisions
ought to be made.
And more important to that, all the health care providers, the
hospitals, the physicians, all those who are in charge of providing
care in the health care system will compete against each other for the
consumers and the patients' business. That is the vision we see, where
everybody has access to affordable health care and it is a patient-
centered system, not a government-driven, government-run,
bureaucratically controlled system. And I just thank the gentleman from
Georgia and the gentleman from New Jersey for taking this time to
address this incredibly important issue.
Mr. PRICE of Georgia. I appreciate the gentleman's comments from
Wisconsin. And this is what we believe, patient-centered health care,
and we going to work on putting some limbs and leaves on the tree of
this over the next number of weeks and number of months, and make
certain that the American people understand, Madam Speaker, that there
is an alternative and it is a positive alternative. Because we live in
a wondrous and a grand Nation, and a Nation where when individuals are
allowed to encourage their own visions and their own dreams and their
own entrepreneurship and their own work, that they can decide what is
best for themselves, not government.
Nobody across this Nation I believe is truly interested in having
Washington-controlled bureaucratic medicine, yet that is the road that
we are about to march down if this new majority has their way. Our
alternative is patient-centered, patient-centered health care and
allows individuals to make decisions with their families and with their
physicians and with their health care providers.
I look forward to working with colleagues on both sides of the aisle
to make certain that as we move forward on this issue, that we move
forward in a way that ensures that those decisions, those very personal
decisions are able to be made in a very personal way without the
government limiting care, without the government determining where you
can be seen and who can see you and what kind of treatment you would
receive.
Madam Speaker, on that positive note and looking forward to patient-
centered health care across this Nation, I want to once again thank the
leadership for allowing us to spend this time on the floor.
I yield back the balance of my time.
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