[Congressional Record Volume 155, Number 106 (Wednesday, July 15, 2009)]
[House]
[Pages H8176-H8183]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Ellsworth). Under the Speaker's 
announced policy of January 6, 2009, the gentleman from Iowa (Mr. King) 
is recognized for 60 minutes.
  Mr. KING of Iowa. Thank you, Mr. Speaker. I appreciate the privilege 
of being recognized here on the floor of the House. And I would be 
happy if I could borrow the poster from Mr. Ryan with all of the 
question marks on it, because I have the one with the Democrats' 
answers on it. And I think what he has done is perhaps looked at these 
question marks and created, I'm not sure who actually comes up with 
these things, and decided that he would produce government solutions 
for all the question marks that could be produced on the poster that he 
has delivered here earlier in this hour.
  And so I have here something that looks to me like the basis of it, 
which is HillaryCare, and I believe if I go back to my office in Iowa 
and I dig through my archives from my construction company that was 
seeking to thrive during the Clinton administration, I have in there 
the very poster that was laminated that showed the entire flow chart of 
HillaryCare which was presented to the American people and rejected by 
the American people. It has got to be, once I compared the two to the 
template, for what we have here that is produced off of this bill.
  There really aren't question marks with what Republicans want to. We 
have more ideas than we can agree upon. I will concede that much. We 
have sought to improve health care, but we fought Democrats every step 
of the way. Now it is clear that when you look at the differences 
between the proposals that we have and what it is that they are poised 
to vote for, here is what will happen. You will hear all kinds of 
platitudes about how we can't stimulate the economy and grow our way 
out of this situation that we are in unless magically the solution that 
arrives is ``let's go to socialized medicine and that is going to fix 
our economic woes.'' Somehow when I hear that said, I can't connect it, 
Mr. Speaker.
  I'm listening to the dialogue that comes out, and with such great 
self-confidence it flows. Let me see. I wrote it down. I was listening 
to Mr. Murphy from Connecticut, and he said, let me see, I see no way 
to get this economy back on track unless we fix health care. Fixing 
health care means nationalizing health care. It means turning into 
socialized medicine. And what goes on, if we look at the flow chart 
here, is the Health Choices Administration, HCA, just a moment, I will 
get this back where I can read it too, Mr. Speaker, the Health Choices 
Administration, HCA sets up a commissioner. There is a health insurance 
exchange that would presumably broker health insurance through this 
exchange. It's kind of like where you might trade on the Board of Trade 
for a commodity like corn oil or beans or gold. And they want to trade 
traditional health insurance plans that would be in there and then a 
public health plan matched up against it. Now that is the center piece 
of this proposal.
  And what it really says is that they want to establish a government 
health insurance program that would compete directly with the private 
health insurance programs that are out there. And we have hundreds and 
hundreds of those insurance programs that are out there, and if I 
remember correctly, the number that I have seen was 1,300 different 
companies competing in health insurance and the health insurance 
business. That is a lot of competition. It is not a little competition; 
it is a lot of competition.
  If you believe competition brings out the best in us and the markets 
that are driven because of the competition and the demand that is 
there, then you have to know that there are a lot of different models 
that have been tried, and there may be some good models that weren't 
marketed very well, and there may be some bad models that were marketed 
well, and there may be some other alternatives out there.
  But this I can guarantee you, Mr. Speaker, if there is a better idea 
in how to insure health care in the United States of America, it will 
not come from government. Government doesn't provide solutions. The 
creativity is not there. And this proposal that comes from the 
Democrats that was just unleashed on America yesterday has within it a 
series of presumptions on how they are going to save money on health 
care.
  One, if we listen to the gentlemen that made their presentations here 
within the last hour, they would tell you they are going to squeeze the 
profit out, that there are people that are actually making money by 
providing us the very best health care in the world, and we surely 
couldn't have that. We couldn't have people that are making money doing 
this.
  I don't know where people get incentive. We have good hearts. We are 
altruistic people. But it is nice to have a little profit so that you 
can justify going to work. Otherwise you might just stay home and raise 
the kids and work in the garden, go fishing, golfing, mow the grass, 
whatever you do. If you squeeze the profit out, people are going to 
quit going to work. And that is what they suggest is going to happen. 
Squeeze the profit out, take it out of whatever might be there for the 
insurance companies, take whatever might be in the profit for the 
health care providers, our doctors and our nurses and our 
administrators and all the people

[[Page H8177]]

that work so well in the health care industry--and by the way, let's 
acknowledge the volunteers, the EMTs that are out there on a daily and 
nightly basis. They deliver more regularly than the mail does, rain or 
snow or sleet or hail. Nothing stops them from going out to save 
people's lives and increase the quality of our life.

  But into all of this mix, they propose that we upset the very, the 
largest and the best health care system in the world. To what purpose? 
Fix the economy? Mr. Murphy would have you think that because he says 
that he can't imagine getting our economy back on track unless we fix 
health care.
  Here it is: ``I see no way to get this economy back on track unless 
we fix health care.'' This is something that was amazing to me, Mr. 
Speaker. I listened to, at the time, it was Senator Obama, Candidate 
Obama, arguing to the American people that they should elect him 
President because he is going to fix all of these things that aren't 
functioning with government and that the economy will work better if we 
just simply nationalize our health care plan.
  Now, I will concede this point: this Nation spends too high of a 
percentage of its GDP on health care. It is too high if you compare it 
to other countries in the world. But it is not too high when you are 
someone who needs that care, when you have cancer in the family, when 
you need some emergency heart surgery. We are not a country that waits 
in line for health care. But the countries that are mentioned here do 
wait in line. Canadians wait in line for health care. The Europeans 
wait in line for health care. Those in the United Kingdom wait in line 
for health care.
  One of the gentlemen, I believe it was Mr. Ryan from Ohio, said that 
people delay getting health care services until they qualify for 
Medicare, then the cancer spreads and presumably it is a bigger 
problem. ``The cancer spreads because people wait until they qualify 
for Medicare'' was what the statement was.
  But it is a fact that if one is diagnosed with cancer in the United 
Kingdom, your life expectancy is, on average, 18 years less than if you 
are diagnosed with cancer in the United States.
  Now I wonder how the gentleman that gave the presentation the last 
hour would reconcile that, and I will use that, that dirty little 
secret, about how much better our care is for cancer patients here in 
the United States and how much longer our life expectancy is than it is 
in a place like the United Kingdom. Presumably they have a similar 
health care plan to those in the European Union. And their answer will 
be, the life expectancy of Canadians and Europeans is 1 or 2 or 3 years 
longer than the life expectancy of those in the United States.
  Well, that is typical liberal logic, Mr. Speaker. They would look at 
one statistic, and if that statistic could support the argument they 
want to make, they don't look underneath that to ask the question, why 
would the life expectancy of a Canadian be longer than the life 
expectancy of an American by 1 year, I think that data was. I didn't 
get to see the chart.
  The first thing you need to do when you hear some data like that is 
ask some other questions like why? How could it be if one is diagnosed 
with cancer and lives to 18 years longer in the United States than if 
you are under the socialized medicine program of the United Kingdom, 
then how can you then equate that the life expectancy of someone in the 
United Kingdom is going to be longer than that of the United States 
because they have access to health care when that health care 
supposedly cures their cancer, but they are dying 18 years sooner?

                              {time}  2030

  Could it be, Mr. Speaker, that there are other factors involved that 
reduce the life expectancy here in the United States? How many of us 
die violently in accidents, for example, compared to those in Canada? 
How many of us die of addictions like abusing illegal drugs or from 
alcoholism? What are the ratios of that? How many die of suicide? I 
wouldn't think that is a situation that's going to be solved by a 
socialized medicine program, except I'm just willing to bet there's 
something in the flowchart here to expand the mental health that I 
might have overlooked in this nasty-looking, modern-day, technicolor, 
expanded and exploded version of the former Hillary Care.
  It is here somewhere, I'm confident, how they would address the 
mental health situation. And that is an issue, and it is an issue we 
can certainly talk about how to address. But when you carve all of 
these things out of the statistics, I'd be willing to take the stand at 
the life expectancy of Americans who take care of themselves similar to 
the ways that Canadians take care of themselves is equal to or better 
than that of Canadians or Europeans.
  And otherwise, what is the variable? If they're dying 18 years sooner 
from cancer in Europe than they do in the United States, then would 
there be some other illness that counterbalances that? Maybe it's 
diabetes here in the United States because we may tend to be a little 
heavier, and I believe we do tend to have diabetes more often. Put 
those factors into place, but don't just throw a blanket number out 
here and tell us that you have to upset the best health care system in 
the world because you've got one data point that you can point to 
without looking underneath that data point to draw a legitimate 
conclusion from that data.
  This is a typical approach.
  Let's see. If I go on, the dirty little secret from Mr. Murphy. There 
is a secret limit to what insurance will spend on you. You know, I 
don't know that that exists, and it implies that exists in every health 
insurance policy in the United States. I expect it exists in some of 
them. I'm confident it doesn't exist in all of them. But here is the 
real little dirty secret that is in this bill and this broad, exploded, 
technicolor floor chart that's built off of the foundation of the 
former Hillary Care plan that came out in about 1993.
  Part of the secret is this. They intend to tax the middle class 
workers in America and some of the working poor in America--in fact, 
probably all of the working poor in America--to fund this outrageously 
high-priced socialized medicine plan. And how will that work, Mr. 
Speaker? And here's how it will work.
  There will be a surcharge, according to this bill, that will be 
imposed upon the payroll of employees. Now, the employer is asked to 
pay the tax, 8 percent that would be put upon the payroll. It would be 
calculated off of the wages of the employer's workers in order to fund 
the health insurance plan for those employees if the employer doesn't 
provide the health insurance for them.
  Now, to make it simple, they want to tax the employer who doesn't 
provide health insurance for the employees. Now, that may sound good to 
people who don't have health insurance. It may sound good to someone 
who a little begrudges their boss and maybe the lack of generosity on 
the part of their boss, but here's what happens. And I will just draw 
this comparison so we can think of it in relative terms.
  The Social Security that we pay, the payroll tax that we pay, all of 
us on our payroll, up to whatever the cap is, is considered by 
economists to be--even though it's 50-50, and I've many times sat down 
and done the math formula making out payroll for my own employees. I 
would multiply .0765. That's half of the payroll tax, and that came out 
of the employee's side. And then that same .0765, which adds up to 15.3 
percent, employer's half came out of my side. I would look at that and 
I would say, that 7.65 percent out of the employer is something I'm 
actually paying to the employee. It's the cost of hiring that employee. 
It's a fixed cost that comes with it.
  So regardless of whether I take it out of his check or my check, it's 
all money that I would be paying that employee if it weren't going to 
the government. It is a tax on his earned wages, his or her earned 
wages. And so I've always viewed it that way, as the payroll tax being 
a tax on the earned wages of the employee and the limiting factor on 
how much I can afford to pay the employee.
  Let's say you can afford to hire someone who will return for you $30 
an hour, and if you pay them in total cost of their wages, their 
overtime wages, the payroll tax, the benefits plan that you have, 
whether it be health insurance, retirement plan, whatever else it may 
be, all of those costs--including the lost time that's in transition, 
the lost time in production in coffee breaks

[[Page H8178]]

and all of those things that have to be added in, the inefficiencies 
are added in. Let's say all of that adds up and it costs you $20 an 
hour to have this employee hired and you can make $30 an hour off of 
having that employee. Now, there's a little margin there to work with. 
And of course you have other factors involved to take that profit to 
apply to, such as the overall overhead of the company, and the list 
goes on.
  But let's say it costs you $20 an hour to have this employee working 
for you and he's making $30 an hour, and you can make that work and 
have a little margin for profit and apply some of that overall margin 
to your overhead, your own administrative costs, and along comes the 
government and says, Well, I'm going to tax you $10 an hour for this 
employee.
  Now they've taken entirely all of the cushion that was there and the 
necessary profit that you have to have to fund other parts of the 
company from that and the profit that you have to have to build enough 
capital so you can offer somebody else a job, and government takes it 
all away. Now, what's an employer to do? I will tell you exactly. He 
has to lay off the employees that cost him more money than they are 
making. You can't sustain yourself that way. You can bridge these gaps 
over time and things go up and down, but over time, this will all be 
reduced down to can you afford to have the employee or can't you.
  And one of the ways that you adjust that affordability is if the 
Federal Government adds $10 on to the cost of keeping the employee. You 
have to look at that in terms of, then, if that eats up all that you 
have to work with, then you have to look at lowering the employee's 
wages, or more often it happens, you simply don't offer the raises at 
the same time you might have otherwise. This comes off the backs of the 
worker.
  Democrats want to tax the working poor and the working middle class 
and the middle and upper class Americans to pay for a health care plan 
that I believe is completely misguided, that doesn't fix what it's 
designed to fix and surely will not fix this economy.
  We have to know that their approach to the economy is so far off that 
more of the same is not going to solve the problem. These are a bunch 
of Keynesian economists here that are in charge of the country today in 
the White House, in the House of Representatives, and in the Senate, 
and they believe, like FDR believed, that if you could just borrow 
enough money and pour it into this economy and replace jobs in the 
private sector with government jobs in the public sector, that somehow 
you could stimulate this economy and get the engine or this economic 
engine running again.

  Mr. Speaker, I can find no empirical data out there that consistently 
supports the idea that we can borrow money from our children's and 
grandchildren's future, and actually borrow it directly from the 
Chinese and the Saudis, while we're at it, and dump that money into 
this economy and stimulate the economy so that it grows.
  Back to the 1930s, I thought--and I believe there's been a definitive 
experiment that's taken place with Keynesian economics, this borrow 
money and dump it in in government jobs and grow government to 
compensate for a shrinking that has taken place in the private sector.
  And if we go back to Henry Morgenthau, who was the Treasurer for FDR 
back in the 1930s, he objected and he said, What have we to show for 
this? We borrowed money. We spent money like nobody has spent it 
before, and we haven't created any jobs. We have nothing to show for 
all of the money that we have spent. And he was the believer, he was 
the mouthpiece for FDR's Keynesian approach to the New Deal. The New 
Deal that I was taught was a good deal when I went to school--and, of 
course, I went back and actually studied the data and came to an 
informed conclusion rather than just simply a cursory statement that 
reinforced FDR's New Deal program.
  The father of this, of course, was John Maynard Keynes, the father of 
Keynesian economics. And he--throughout those years, he was very 
influential in the 1920s and 1930s and less so in the 1940s, although 
America was distracted from economics during that period of time. But 
Keynes said that he could solve all of the unemployment in America. All 
we needed to do was go find an abandoned coal mine and go out there and 
drill a lot of holes down in that abandoned coal mine and fill those 
holes full of American cash, greenbacks, the dollar, drop cash down 
into those holes, fill them up again, and then fill the old coal mine 
up full of garbage--this is his story--and turn the entrepreneurs of 
America loose to go dig up of the money. It would create all these jobs 
in digging through the garbage, digging down through the holes, finding 
the money, keep everybody busy, and the entrepreneurs would find that 
money eventually--and probably all of it somehow--and it would keep 
everybody busy and they would all have a job and they would all have 
money.
  And I know that it was a facetious model. I know that he drew that 
description as, let's just say, a facetious model that would illustrate 
how ridiculous it can be. I think he began to realize this later on in 
his career how ridiculous it can be to put government in to make work 
and to put government into the business of intervening between the 
private sector. That's what's going on here in America.
  But the dirty little secret, to use the phrase used by Mr. Murphy 
from Connecticut, is not that there is a limit on what an insurance 
company will provide and that they will shut off their health care. 
What the dirty secret is, Democrats have committed to taxing the 
working people in America to fund their trillion-and-a-half or more 
health insurance plan that is designed to crowd out the private sector 
insurance companies in America, the hundreds and hundreds of them that 
are providing such a good job and such a highly professional service. 
And it comes down to the health insurance exchange and those qualified 
health benefits plans that exist today competing against a proposed and 
newly created public health plan that would crowd out our private 
health insurance here in America as we know it.
  We have a model we can look at to learn from this. Otto von Bismarck 
established a national health care plan in Germany before the turn of--
into the 20th century. My guess is 1898, but I suspect it was actually 
before that. I know that it's the oldest national health care plan in 
the world. And then it didn't cost very much because medicine hadn't 
developed very far. But they do have private health insurance in 
Germany, but what it is, it's 10 percent of the market. And the 
national plan, the required plan has crowded out all of the private 
health insurance in Germany except for about 10 percent. And the people 
that have that 10 percent are those who are self-employed, that run 
businesses, that have found a way within their business to go out into 
the marketplace and buy some health insurance that provides them 
perhaps a little better care than they get out of the government plan.
  So that's what we can expect to happen with the insurance companies 
here in the United States should the Democrats in this Congress, in the 
House and in the Senate, and in the White House get their way, Mr. 
Speaker. We will see these proud, important, independent health 
insurance underwriters, their companies, these people that are doing 
this business, this service on Main Street in many small towns in 
America and across this country, we will see them shrink down, drop off 
one by one, companies dropping off one by one. Some will go in one fell 
swoop. But they're looking at almost the death knell of their industry 
if this socialized medicine plan gets passed by this Congress.
  And yes, they will try to find a little niche in the market, but it 
isn't going to happen in the end. Some will find their way, but they 
will be narrowed down like they were narrowed down in Germany.
  And we won't have the people that are answering the phone at 7 
o'clock at night going over to someone's house to sit down and talk 
through their health insurance plan with them, helping to nurture them 
and helping inform them as to the situation. It will be a government 
bureaucrat that punches the clock, and there will be a lineup outside 
the door. We know how this works in government agencies. There will be 
a lineup outside the door.
  And that bureaucrat will take the appointments at the appointed time, 
usually. And when it's time for the coffee

[[Page H8179]]

break in the middle of the conference, they will get up and go off into 
the break room. They will have their little coffee break and it will 
last all of 15 minutes, and when it's time for the lunch hour at noon, 
the ``closed'' sign goes on, the bureaucrat walks out the door and goes 
off down to the bistro or wherever to have lunch with his other 
bureaucrats. He or she shows back up again at 1 minute to 1 o'clock and 
opens up the door again and starts through this process.

                              {time}  2045

  And the American people will not be able to compete. They will not be 
able to go someplace where they're treated like a real human being 
customer. They will be treated by a government bureaucrat.
  Don't we have 300 million Americans who have experience with 
bureaucrats? Don't we know what that does to the attitude? Bureaucrats 
have an attitude. It's the nature of it all. It's because they have a 
monopoly. People that have a monopoly have an attitude, and whether 
they're in the private sector or whether they're in the public sector, 
if it cashes out the same for being nice as opposed to being not so 
nice, to being the same for providing happy, friendly service, compared 
to providing that grumpy, reluctant service, we know the result. People 
like that often gravitate towards the government.
  We'll create this great big massive technicolor flowchart of 
interrelated government agencies. And by the way, the ones in color are 
the new ones. The ones in white are existing. Medicaid, SCHIP, 
Medicare, they're existing. Go on down the line, through the private 
insurers, they're existing. Traditional health insurance plans, they're 
existing, but they get shoved into the qualified health benefits plan, 
but they have to write a plan that actually qualifies, too, which takes 
some of these people out.
  These are existing government. Here are the departments: Treasury, 
Health and Human Services, Veterans Administration, Defense Department, 
Labor Department, here's Congress, the President. Institute of Medicine 
exists. There's the National Health Service Corp., they're there. 
States, all these programs.
  And the ones in white are existing. The ones in color are created 
new. All of those that are in color, that's thousands and thousands and 
thousands, Mr. Speaker, of new bureaucrats, new bureaucrats who will be 
handed this monopoly, and they will be in the business of not only 
taking customers in and writing their insurance plans in the pace that 
they see fit, because they're government after all--what government 
office stays open after 5 o'clock on any working day? What government 
office would ever think of coming in on a national holiday? What 
government office would take a look at how they're going to retool 
their service so they could compete with higher competition, so they 
could expand because they could compete better? They won't do that 
because they're handed a monopoly, and if they can't compete, then they 
will be subsidized more by the taxpayers in America.
  And we will be trained as a people to line up outside the door, 
patiently wait our time, take what we can get, not be able to shop 
around because these qualified health benefits plans that come from our 
traditional health insurance providers will be squeezed out. And by the 
way, that squeeze-out that will come will not be an accident; that's 
the result of people who really didn't think through what they were 
doing to the American people. It will be the willful, premeditated 
result of the people who happen to have the gavels in this Congress now 
and the power in the White House now who believe in socialized 
medicine.
  They want to adopt a policy that's a socialized medicine policy, and 
they want to kill the private sector because they don't believe in it. 
They believe that government provides better than individual 
competition, free markets and people provide, and that's the great 
divide in our two approaches here, not a chart with question marks on 
it. Those must be things that were confusing to Mr. Ryan, the chart 
with all of these new bureaucracies on them.
  And I would say, Mr. Speaker, that it's a chilling thought to think 
that my children and my grandchildren and their children and every 
generation beyond them might be receiving their health care standing in 
line in front of a government agent who hangs the closed sign the 
minute the clock ticks past the appointed hour, regardless of how long 
the line is.
  We're a people that will be conditioned to a lot of things, but 
standing in line is not one of the things that Americans do well. We 
have to do that when we get on an airplane now to go through the 
security at TSA. And I look at that and I watch that, the security 
line, and sometimes I wonder how do they ever get Americans to stand in 
line like that. We don't do that. We'll stand in line to get into a 
ball game. We will stand in line to get into a concert. We'll stand in 
line to vote. And now we will stand in line to get on an airplane. And 
if this broad exploded Technicolor Hillarycare expanded plan gets 
passed by this Congress, you know it will be signed by the President. 
He wants a bill to sign, and I don't think it matters what's in it. 
Americans will be standing in line for their health care, not just in 
the offices to get signed up to be part of the public health plan but 
lined up in emergency rooms, clinics, hospitals, all across this 
country or in a queue that doesn't show up so much, not one that you 
can see that's clearly tangible until you look at the long lists that 
will be there because it's an inevitable result that socialized 
medicine produces rationing of care. It's been a fact wherever it's 
been tried. It's a fact today wherever it exists, and it will become a 
fact in the United States of America should this program that was 
unleashed on us yesterday be made law.
  Here's another place where they think they're going to save. They're 
going to save money by rationing care, getting you in a long line. 
Places like Canada, United Kingdom and Europe, people die when they're 
in line. There are plenty of examples of that.
  I listened to the gentlelady talk about some anomalies that justified 
to her socialized medicine. Well, they would describe those who die in 
line in Canada or the United Kingdom or Europe as being just simply 
anomalies, that somehow the system let them fall through the cracks. 
The families that lose their members don't think that it is just the 
system that fell through the cracks. It's a real life, a real loved 
one.
  Someone whose health care is rationed by formulas that are created by 
bureaucrats, the bureaucrats that will close their door at the 
appointed time, could be the health choices administration 
commissioner; could be coming from the bureau of health information; it 
could be the ``national priorities for performance improvements''.
  When I see national priorities, we know that some of the national 
priorities will be they want to spend less money on certain types of 
care. That will mean that people will die because they weren't a high 
enough national priority. They've already got it here in the 
bureaucracy. National priorities for performance improvements, it says. 
Well, here's how they want to improve their performance, and by the 
way, I endorse some of these things as being good ideas. I just don't 
think that government can run it and make it work.
  They want to expand the information technology in their health care. 
I agree with that. I think we ought to have interconnected health--the 
health records so that if someone gets sick from my district who 
happens to be in Speaker Pelosi's district in San Francisco, they can 
put their health care card into an Internet-connected security database 
and find out what prescription drugs a person might be on, find out 
what they've been treated for and be able to save lives accordingly and 
provide efficiencies accordingly. And I think it could reduce the 
numbers of those people that are going around and shopping for 
prescriptions if we had a central database. And I believe that is being 
developed within the health care industry and not fast enough to suit 
any of us, I don't think, including the people that are developing it.

  But info tech is a good thing, and it can be used in a lot of good 
ways, and you don't have to have socialized medicine to have 
information technology.
  Second item that they would save money with would be comparative 
research. Good, we're doing a lot of comparative research. They're 
earmarking

[[Page H8180]]

comparative research. We're earmarking comparative research although 
you don't see it much because this place has been--this floor, there's 
not really legitimate debate on this floor because this House has been 
shut down by the Speaker and the Rules Committee. I have to inject that 
in. Special Order and 1 minutes is about the only place where you've 
got an opportunity to have these kind of discussions, Mr. Speaker.
  Comparative research is good. The other countries can do a little 
more research and that would be great. But what happens is we do the 
research in this country. All of the progress--I put it this way--much 
of the progress that has been produced by the pharmaceutical companies 
and the innovations that have come on to the health care markets within 
the last generation have dramatically transformed the way we provide 
health care in this country. The research and the development is 
predominantly paid for by American users of pharmaceuticals, and the 
beneficiaries of that research are the people in the countries like 
Canada, United Kingdom and Europe where they do negotiate for a cheaper 
rate and where here in the United States we're paying too much of that. 
We can fix that without socialized medicine, and I'd like to see them 
pay a greater share of the costs of the research and development that 
goes into making these wonder drugs that we have today that do extend 
people's lives.
  And I would add that those people in those countries that have a 
longer life expectancy are probably using American research and 
development pharmaceuticals. They might be made in a foreign country, 
but a lot of them are produced by the R&D here in the United States, 
and they're the beneficiaries of it as well.
  Third thing they would do to save money on health care is more 
prevention and wellness. Mr. Speaker, you don't need to socialize the 
health care system in United States of America in order to have more 
prevention and wellness. That's something that is emerging. It's 
emerging in our culture. It's emerging with some of the health 
insurance providers we have in this country who are packaging up 
proposals in different ways to provide incentives for the insured to 
live a healthier lifestyle, to get regular checkups, to go across the 
scales and watch their weight and, let's say, avoid some of the vices 
that shorten our life expectancy, and letting that be reflected in the 
premiums that are being paid.
  But I can guarantee you, Mr. Speaker, that this public health plan of 
the health insurance exchange is not going to have those incentive 
nuances in there. It's the private sector that's going to produce those 
things, and we need to encourage them to do that.
  So they have borrowed some ideas from the private sector, but the 
idea that they've borrowed that is the centerpiece of this is the idea 
of expanding Medicare to reaching across the generations and reflecting 
the model of socialized medicine that exists in Canada, the United 
Kingdom, Europe. We could keep going further east I think, Mr. Speaker, 
and might end up with something that's a little closer to what they're 
talking about.
  So we're a country that has thrived on free enterprise. We need to 
continue to thrive on free enterprise, and the idea of socialized 
medicine is an idea that's abhorrent to Americans. The idea of standing 
in line waiting for a bureaucrat to approve your health insurance 
premium is also abhorrent to Americans.
  I went over and visited Russia earlier this year, and as I traveled 
around Moscow, Mr. Speaker, I saw something there that was kind of a 
phenomenon that exists in Russia that I'm afraid might exist in the 
United States if they pass this socialized medicine. And that is, that 
if you watch the Russians walk around Moscow--I didn't go much beyond 
Moscow--so they walk around out there with their shoulders hunched, 
looking down at the sidewalk. And I see people on the streets of 
Washington, D.C., do that all the time, but they're looking out for all 
the cracks and bumps and holes that we have. It's a matter of survival 
here. Where I come from we look people in the eye when we walk down the 
sidewalk. We bid them good day, good morning, good afternoon, nice to 
see you. We're friends and neighbors working together.
  And it doesn't happen in that country. They look down and their 
shoulders are hunched, and they wander around, and if you sit and watch 
them, they will wander around. You can follow one of those fur coats 
and a hat, and it will lead you to a line, and they go get in line. 
They stand there. And then the line moves slowly. And I stood in line 
for nearly 2 hours, even as a Member of Congress, to walk into their 
legislature, the Duma, and they knew we were coming. And I see the 
other Russians standing in line a lot longer than I was. It looks to me 
like they go find a line and stand in it, and then they get to the 
front of the line and find out why they're there, do whatever it is, 
buy their toothpaste or whatever, and then go find another line and 
stand in it.
  It looks like the Russians, to me, are conditioned to go to from line 
to line, standing in line. It reminds me of that story of where you see 
someone will go out in the street--it's a comedy routine from back in I 
think the 1950s or 1960s--and stand on the street in New York City and 
look up into the sky and just stare into the sky. And someone else 
would come along and look, and someone else would come along and look. 
And after a while, there's a whole crowd of people looking up into the 
sky, and the original person that was looking at nothing, steps back, 
smiles. Well, he's drawn a crowd by doing that.
  Just standing in line in Russia draws a line behind you. It doesn't 
really--I mean, without regard to what's in front of that--and I know 
they have to talk to each other and figure out if they're wasting their 
time. Human nature is human nature.
  We're going to create line standers in America, people who capitulate 
to the system, submit themselves to the system. And I will argue that 
the health care system we have in the United States, some of the 
problems we have is because we have too much government and we submit 
too much to the system, and the individuals who are receiving the 
health care don't have enough vested interest in, not enough skin in 
the game, to be able to use their incentives that should be there to do 
a better job of evaluating the costs.
  So what should we do? And I will provide some answers here, Mr. 
Speaker, on what we should do for health care.
  First and foremost, take a look at our health savings accounts. We 
did that. We put that in place as Republicans, as a Republican majority 
in the House and in the Senate, and it was signed by President Bush. 
And who comes out against health savings accounts today? Well, they 
don't comport very well with socialized medicine, Mr. Speaker. So 
that's something that's probably going to go.

                              {time}  2100

  Probably not going to be in this flow chart here that--I don't see 
the health savings account. Now I've not read the whole bill, and I 
don't know that I'm going to put myself through that.
  But we passed health savings accounts. And it stands today this way: 
if you are a young couple at age 20--I do this because round numbers, I 
can figure--at age 20, and you put in the $5,150 for a couple into a 
health savings account, tax-free, first year. And then that groove 
being indexed to inflation grows each year since then. And we're in 
about year 6, I think we are. Maybe year 5.
  You put that money, the maximum amount in the health savings account 
every year and spend $2,000 out for reasonable health care costs and 
grow this account at around 4 percent, and when I did the math on this, 
that made sense. Today, it doesn't quite make sense. It will again.
  Grow that at about 4 percent. If that couple would work and put the 
maximum into their health savings account every year from age 20 to age 
65, they arrive at Medicare eligibility with about $950,000 in their 
health savings account. Now that's a pretty good deal.
  But I can tell you what the Democrats in this Congress want to do 
with that if they get their hands on that money. They want to tax the 
$950,000 in the health savings account. They'll tax it then, before you 
can take it out, because you won't really need much of it, if any of 
it, anymore. Or, they will take it out of you in inheritance tax when 
you die.

[[Page H8181]]

  You are not going to be able to avoid Democrats increasing taxes on 
you. And that's one of those dirty little secrets, is your health 
savings account will be taxed, by the ideas of Democrats, either when 
you die or when you try to take the money out when you retire.
  Here's what I propose: let's increase that amount. Let's increase 
that amount to the point where that couple can arrive at age 65 with 
enough money to buy paid-up Medicare replacement insurance policies, 
policies that they own. Or maybe a transition policy that they have 
owned throughout their working lives that's theirs, that is 
transportable, that can go with them, a policy that they own, and let 
them transition into a lifetime health insurance plan and be able to 
use their health savings account to purchase that full up.
  That's one thing we should be able to do to give people back some 
freedom. And I can tell you what it costs today if you wanted to buy a 
Medicare replacement policy at age 65. The liability--the present value 
of that liability of Medicare replacement at age 65 is around $72,000 
this year. That's about where we are.
  So it gives you an idea if that $950,000 were in a 65-year-old 
couple's health savings account today, they could write a check for 
$144,000 and buy a paid-up Medicare policy and take the difference--
let's just call that $800,000--and I would want them to have that tax-
free and go off and retire, travel the world, will it to their 
children, buy a new convertible, whatever they want to do, and give 
them their freedom because they've earned it by being responsible.
  But the problem that we have is the Democrat plan takes away the 
responsibility of the insured, of the individuals in this country, and 
puts it on somebody else. It puts it on the employer that says 
regardless whether your employee wants to sit down and market his way 
through a health insurance plan--his or her--regardless of that, if 
they don't have health insurance provided by you, then we're going to 
tax you 8 percent on that payroll. And I said earlier that comes out of 
the worker. That's wages he is not going to get. The employer has to 
crank it out of the worker because he is paying all the market can 
stand on the wages that are there. So, we tax small business, we're 
going to tax workers.
  There was the issue raised of preexisting conditions. We can do some 
things with preexisting conditions without adopting socialized 
medicine.
  But here's a point that was made by the gentleman from Arizona 
yesterday, John Shadegg, who is a leader on this health care policy 
that we have. He said, If you like your health insurance, and over 70 
percent of Americans like the health insurance that they have, if you 
like it, then get ready to lose it, because you will lose it under this 
Democrat plan.
  In this flow chart is the trap that you will be sucked in from here, 
over here to the public health care plan. And when President Obama 
says, If you like your health insurance, if you like the plan that you 
have, don't worry, you get to keep it.
  Well, Mr. Speaker, you get to keep it for the first minute that 
President Obama signs such a bill, and probably the first hour, day, 
month, maybe even a year. But maybe not. Maybe not. Because most of the 
health insurance in this company is provided through people's jobs 
through their employer who brokers it. And there are long, deep reasons 
for that that I won't go into tonight.
  But the President can't say you get to keep your health insurance 
plan because he doesn't make that call. If the government model, this 
public health plan here, if that model is financially advantageous for 
the employer, if the policies that the employer are paying for cost the 
company more than the policy that's offered by the public insurance 
plan, an employer will almost always then drop the private-payer health 
insurance plans, these that are in this circle, which would become the 
qualified health benefits plans, drop them and adopt the public health 
plan.
  Now how is President Obama going to tell some company they can't do 
that? And if you don't quite follow this yet, Mr. Speaker, I will put 
it this way.
  Walmart announced last weekend that they are supporting an employer-
mandated health insurance plan. They announced that policy over the 
weekend and I thought, Why would Walmart do that?
  I have the press release here. Let's see. I'm going to say this. They 
would do that because it looks like it would help their bottom line. 
Here's what they said. The company says it supports the employer 
mandate because all businesses should share the burden of fixing the 
health care system. Well, I don't know what the basis is for that 
statement except that there must be some advantage to this.
  So are we to believe that a huge company, a company that I applaud 
for the business model that they've creatively put together, but are we 
to believe that a huge company like Walmart that is everywhere would 
propose and support--an employer-mandated health care system is the 
language that they used--would Walmart support that and then not adopt 
the public health plan, because they already have the traditional self-
insurance plans provided to 52 percent of their employees? Would they 
then move into a qualified health benefit plan for all of their 
employees because of the mandate that they have endorsed, or would they 
opt into the public health plan option?
  Would Walmart still support the President's proposal, which is 
basically what has been presented here in this Congress? Would they 
still support it if they had to guarantee they were going to keep the 
qualified benefits plan? Would they still support it if there was in 
the bill that they couldn't drop the private provider and could not opt 
into the public plan, into the government plan, into the socialized 
medicine plan?

  I think not. I think they want the best option of the two. They will 
fight to preserve that. So will a lot of companies. But I think this is 
about something that puts pressure on some of their competition that 
doesn't provide as much health insurance for their employees as Walmart 
does for theirs. Less responsible employers, some might call that.
  But there still remain a lot of uninsured in that group. Some are on 
Medicaid. That's true for a lot of companies that are more entry-level 
wages.
  I don't take so much issue with that. I just point out that the idea 
is this: the employees of Walmart won't get to decide that they get to 
keep the private plan that they have today, the traditional health 
insurance plan in this white box that will transition into a qualified 
health benefit plan, most likely, if it does qualify, unless a 
bureaucrat says it doesn't. They'll write some new rules for that. 
Those employees won't make that decision. Walmart will make that 
decision.
  So when the President says, If you like the plan you have, don't 
worry, you get to keep it, in truth, you should worry. John Shadegg is 
right: if you like your plan, get ready to lose it, because you will 
lose it. The public plan will crowd out the private plan and everybody 
will fall under the same category, and we will have health care that is 
rationed in America. We will have lines, and we will have bureaucrats 
with their nose in the air making life and death decisions on the 
health care that will be provided to the American people. It is 
inevitable. It's resulted in that every time that it's been found.
  Now, I draw another comparison. The Canadians are forbidden by law to 
jump ahead in the line. Now if they didn't have a line, you wouldn't 
have to have a law that forbids you from jumping ahead in the line and 
accessing health care.
  So when you need a hip replacement--and I have seen the data on this. 
I actually have to guess, but I believe what I saw for a hip 
replacement number was 171 days of waiting. Something in that category 
is pretty close, anyway. I don't know how long you wait in the United 
States. Not at all, if you're in a hurry. Somebody will get you in. 
They'll find a way to schedule it. We have that kind of service here in 
this country.
  I talked to an individual in my district a year and a half or so ago 
who had immigrated to the United States from Germany. And he had had 
hip surgery over there under their socialized medicine plan, a German; 
but he didn't get his surgery in Germany. He had to go to Italy to get 
his hip surgery.
  The European Union has queues--longer lines in some places, shorter

[[Page H8182]]

lines in another place is--certain times that you get into a line and 
move closer to the front of the line. I suppose you try to get yourself 
in as many lines as you can.
  But this individual happened to be--I ran into him when he was out 
picking up some things for home improvement, as I was, and he told me 
the story about how long he had to wait in line and what he had to do 
to go from Germany to Italy, get in that line and then get his hip 
replacement, hip surgery.
  Here in the United States you're not going to have a measurable line. 
You might be able to get in one if you're not in a hurry and get it 
scheduled for convenience. But if you want that surgery, you're going 
to get that quickly.
  Now, Canadians have an innovative thing. One is it's against the law 
to jump ahead in line. Those are not enforced equally across the 
provinces in Canada. So some people with more money, some people with 
more influence get ahead in the line.
  Mr. Speaker, if you have ever had the experience of standing in 
line--and one of the easy ways to think of this is in the airport. If 
you're standing in line waiting to try to make a flight and you see one 
or two or three flight crews arrive late and they go get in line in 
front of you and they start going through the security--now they're 
actually pretty efficient at it and I know I want to get them on the 
planes and get these planes going. The lines would be longer if the 
crews don't show up.
  But I stood in that line and had to back up. And the result is this: 
when someone gets in line in front of you, you have to back up. The 
line gets longer. Have you ever stepped in a line and watched the line 
get longer? You know that it isn't paying your time very well to stand 
in that line.
  Well, the lines get longer in places in Canada and in Europe because 
you have people who have money and influence and power that get 
preferential treatment over those who don't have the money, influence 
and power.
  So, in Canada it's resulted in this: some of the employers who offer 
a good employment package pay the wages and the benefits to their 
employees, the employees who have full access to the Canadian 
socialized medicine plan. But also as part of the package, let's just 
say, for example, if they need heart surgery and you're working in 
Toronto--just say you're wearing a suit and tie, working in a company 
in Toronto who puts together a good health care package, a good 
employment package. Here will be the wages, the vacation time, the 
retirement benefits. They don't get to say the health care plan for 
Canadian, but they do get to say, You can opt out and go to the United 
States.
  And in their employment package will be an insurance plan that will 
put them on a plane in Toronto and fly them to Houston for heart 
surgery so that they can cut ahead of the line. They don't have to 
wait.
  Now, what kind of a country has a health care plan that we would want 
to emulate that would have employment packages that fly people all the 
way across the continent to give them heart surgery quickly because the 
line is too long in Canada?
  And it's worse than this, Mr. Speaker. There are companies that have 
sprouted up in Canada that turnkey these things. Sometimes within the 
health insurance plan that's part of the employment, that says, We will 
opt you out of the country to get you fast health care services to the 
United States. And sometimes it's someone in Canada who can't wait in 
line to get the service.
  And so there are companies there like tour companies, travel 
agencies, travel/health care agencies that put together the package. So 
let's just say that you are in Quebec and you want to go to, let's say, 
the Mayo Clinic in Rochester, Minnesota, to get a hip replacement, and 
the hip replacement line you're in in Canada is long.
  Well, the travel/health care agency in Canada that's sprouted up 
because of entrepreneurs, you can go contact them and they will set it 
up. They will say, Here, let me see. You arrive at the airport here in 
Quebec at this time and this is your flight number and here's your 
ticket. And you can fly down to the Mayo Clinic and here's the hotel 
that you can go check into. You'll arrive at this time. Transportation 
to the hotel is a shuttle bus from the airport to the hotel that you'll 
be staying at.

                              {time}  2115

  Here is your examination from the doctor and the surgeons, and 
they'll do that examination, and later on in the day, or overnight, 
they'll start the surgery, give you the hip replacement. Here's the 
package on the rehabilitation therapy. Here is your trip back and your 
plane ticket back to Quebec. Turnkey. I don't know how long it takes, 
I'm guessing three to four days turnaround, give you a little therapy, 
send you back home again. All of that, you write one check to the 
travel/health care agency that's sprouted up to meet a demand that 
exists because of the lines and the rationing that necessarily result 
in government-run plans and always have.
  And, Mr. Speaker, I'll go back to 1948 and 1949. I had a World War II 
vet hand me a stack of Collier's magazines. And he fought in Europe, 
the Second World War. He'd saved these Collier's magazines all of those 
years, from 1948 and 1949. Now, 1948 was the year that the United 
Kingdom established their national health care plan, their socialized 
medicine.
  And in the magazine, each issue of the magazine had a story about the 
health care that was unfolding in Canada. And you can just range 
through some of them. I can remember pictures of people lined up 
outside doctors' offices, nurses that were frazzled, doctors who were 
speaking into the record quoted saying, I have to see so many more 
patients now in order to provide enough income because I'm being paid 
so much less per patient, I have to spend less time with the patient, 
and I have to run them through and see too many patients an hour. I'm 
missing diagnoses. I'm not able to treat these patients the way I 
should be. The relationship between us is so fast that there is no 
doctor/patient relationship.
  People are leaving the health care industry because the stress was 
turned up and the margins were turned down. And we have a good lot of 
highly talented people in this country that stepped forward to go into 
the health care industry, good doctors and nurses and other providers. 
And they're highly educated. It takes a long time to train a doctor, 
roughly a decade to turn one out that can start to take charge and 
teach others. That takes time and money. They need to be paid what it's 
worth to attract them into the profession and to be able to be on call 
in the middle of the night and on weekends and all the things that they 
do. And that isn't going to happen in a country that rations health 
care and squeezes down the prices, Mr. Speaker.
  So, I would just suggest that we should think long and hard before we 
leap into this abyss. As I listened to the gentleman from Connecticut 
(Mr. Murphy), I would suggest that he should know this, if anyone does, 
and that is, when you turn government loose to do something that the 
private sector should be doing, Murphy's Law always applies. Murphy's 
Law, of course, is what can go wrong will go wrong.
  The incentives will not be in place to provide the quality of care, 
the timely service. And we don't have rationing of health care in the 
United States today. We don't have lines that exist in a measurable 
way. We don't have long lists on paper of people that are waiting their 
turn to get their service.
  We have the best health care system in the world, and it's getting 
better, and we can do more with competition. We can do more with 
addressing the medical malpractice litigation that we have in this 
country that they don't have to a measurable extent in the other 
countries. We can do better with health savings accounts. We can do 
better with bringing in competition. We can allow people to expand 
their health savings accounts, and we can allow them to have enough 
money in that they can bargain down a higher co-payment and a higher 
deductible in order to get a lower premium.
  And you roll all of this together. If you give people freedom, if you 
give them responsibility, if you believe in the free market system and 
you let the markets do what they will without interference, without the 
intervention of some fraudulent medical malpractice suits that are 
driving up these premiums and causing doctors to do tests that are 
unnecessary, except to protect them from litigation, we can bring this

[[Page H8183]]

health care down, and we can see the quality of it go up, and we can 
also be an inspiration for the rest of the world.
  And creating socialized medicine is not a solution for an economic 
problem. That will make the problem worse, not better. And we are, on 
one side of us, we are Adam Smith free-marketeers on the Republican 
side of the aisle. These are the Keynesian economists on the Democrat 
side of the aisle, those who want to grow government, nationalize eight 
huge entities in America; that all happened on the watch of President 
Obama, the nationalization of eight huge entities.
  And with that in mind, nationalization, there is no exit strategy 
there. There will be no exit from socialized medicine, and cap-and-tax 
will crush this economy as well. We must draw a line. This is it. This 
is the Rubicon. I'm not going across into the irrevocable policy. And 
those that do, I believe, will regret it the rest of their life.
  With that, Mr. Speaker, I thank you for your indulgence, and I would 
yield back the balance of my time.

                          ____________________