[Congressional Record Volume 155, Number 157 (Tuesday, October 27, 2009)]
[House]
[Pages H11849-H11855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. 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. Mr. Speaker, it is a privilege to address you on 
the floor of the House. I have the chance to do so, perhaps, with some 
people that have expertise in the subject matter that I heard just go 
through my ears a little bit ago, and that would be where do we save 
money when it comes to this cost of health care in America?
  I listened to the gentleman from Iowa (Mr. Braley) talk about 17 to 
28 billion in added costs of preventive medicine. Preventive medicine. 
When I first heard that, I actually misunderstood his point. I thought 
surely he was talking about defensive medicine, but, I am sorry, it 
wasn't the case. It was preventive medicine.
  This amorphous target of how you save money on health care by 
watching your diet and being physically fit and getting regular 
checkups, yes, that's important. But his discussion of $17 to $28 
million multiplied across 10 years, actually, when you look at it, it 
pales in comparison to the overall costs that are included in the 
lawsuit abuse in the health care in America.
  I will submit these numbers, that the lowest number that I find is 
that the costs of medical malpractice, Mr. Speaker, and the liability 
insurance and the defensive medicine that definitely takes place so 
that doctors can protect themselves from lawsuit abuse adds up to a 
number of something like, a lowest number is 5\1/2\ percent of the 
overall health care costs. The health insurance underwriters put that 
at 8\1/2\ percent of the overall costs. That's $203 billion a year, and 
this is still a low number. If we take Mr. Braley's analysis and 
multiply it times 10 for the 10-year life of this bill, that comes in 
to over $2 trillion, the costs of the defensive medicine that's taking 
place and the funding that goes into the pockets of the trial lawyers.
  I talked to an orthopedic surgeon who had told me that 95 percent of 
the tests that he runs are unnecessary, that his diagnosis actually 
will apply. It will be there, but he has to protect himself for that 5 
percent that he may need to be right. But the 95 percent are there, 
money that's wasted, he said completely wasted, in order to protect him 
from lawsuits that come from trial lawyers.
  It's interesting that a trial lawyer would come to the floor of the 
House of Representatives and talk about the value of preventive 
medicine but not the cost of defensive medicine. That's a subject that 
I will never hear defended on this side of the aisle. If anybody over 
there would like to ask me to yield, I would be happy to take this up 
how many trial lawyers might be in that large caucus that has a 79-vote 
advantage over Republicans and still wants to blame Republicans for 
their socialized medicine bill not being passed in the House of 
Representatives.
  Those are the circumstances and the facts, Mr. Speaker. Actually, I 
believe it's a 78-vote advantage, and it lets the Speaker be able to 
have 39 votes to take a walk and still have 218 votes to pass a 
socialized medicine bill.
  Now, you would think that if you had roughly 80 people swirling 
around over there that are extra over the number of Republicans, you 
might be able to turn your sights on the people in their own caucus, 
Mr. Speaker, and resolve this issue, instead of coming back here to the 
floor as the gentleman did, Mr. Murphy, and point his finger at 
Republicans and accuse Republicans of not having solutions.
  Oh, yes, we have solutions, Mr. Speaker. We have many solutions. In 
fact, I have in my hand here the health care solutions, not just from 
the Republicans, just from, oh, a little more than half of us, the 
conservative Republicans that are members of the Republican Study 
Committee. This report was produced by the Republican Study Committee, 
and the chairman, of course, is Tom Price of Georgia, a medical doctor 
himself and a lead thinker and a real national voice on health care, 
along with many of the doctors that we have in our caucus.
  I looked down through the list of legislation that has been offered 
by Members on the Republican side of the aisle, and I see my name 
there, yes, but I also see names such as Mr. Issa of California, Mr. 
Fortenberry of Nebraska, Mr. Stearns of Florida, Mr. Latta of Ohio, Mr. 
Royce of California, Mr. Scalise of Louisiana, Dr. Gingrey of Georgia, 
Marsha Blackburn of Tennessee, Kenny Marchant of Texas. It goes on and 
on, the mountain of legislation that has been introduced by 
Republicans.
  It's quite interesting that another gentleman from Georgia this 
morning, Mr. David Scott, made the allegation that Republicans had no 
solutions. Well, Mr. Price followed him over to the side of the floor 
and offered to give him this stack of Republican solutions. He smiled 
nicely, but he refused to take it. Now, we don't always get a nice 
smile from the other side, but they refused to accept this whole stack 
of ideas. This is just a list of ideas. This isn't bills. These are a 
list of ideas. These are pieces of legislation that Republicans have 
seen fit to put into language for law and introduce into the 
Congressional Record and seek to get it passed into committee and try 
to offer these health care solutions as amendments to the overall 
markup of H.R. 3200, the bill that is the House version of this 
national takeover of our health care, or at least the framework to do 
so, Mr. Speaker.

                              {time}  1945

  So, it is something the American people need to see through. I can 
express frustration. I can speak from facts and I can speak from a 
level of experience being engaged in this debate. The American people, 
Mr. Speaker, need to focus on what is true and what isn't; what is 
honest and what is just; and what is, I don't want to describe it as 
dishonest, I will describe it as political hyperbole designed to reach 
a conclusion that I don't believe is in the best interests of the 
American people.
  So I come to the floor this night to raise this issue and to 
enlighten I believe yourself, Mr. Speaker, and in the process the 
American people. And I will start out again, take us to this Medicare 
issue that was brought up by the other side.
  Now, their argument is that there are billions of dollars to be saved 
in Medicare. And so they only want to cut Medicare by half a trillion 
dollars, $500 billion in cuts to Medicare, and they will argue that 
Republicans want to raise the fees on payroll in order to fund Medicare 
if we are not willing to slash Medicare to our seniors by half a 
trillion dollars.
  I recall watching a spokesman for the AARP on television one day 
arguing that, well, that half a trillion dollars in cuts to Medicare 
really isn't that much money. It is a small percentage of the overall 
layouts. Half a trillion dollars. What could they possibly be getting 
that would offset a half a trillion dollar cut directly to their 
members?
  Here are some of the places that these cuts come from: $133 billion, 
and now the most recent number that came out within the last few days 
is actually $162 billion, cut from Medicare Advantage. A lot of those 
people are in my State, Iowa. Of course, they are senior citizens, and 
they want to have some extra options and they are willing to invest in 
Medicare Advantage. But since this is the only component of the 
Medicare program that actually has the private sector engaged in it, 
which keeps the costs down, the Democrats want to scrap Medicare 
Advantage.
  They seem to despise free enterprise and despise economic 
competition. So this $133 billion apparently has grown to a minus $162 
billion right out of the pockets of our seniors, taking away their 
Medicare Advantage, killing the rest of it after they have already 
landed a severe blow on this year.

[[Page H11850]]

  Here is a minus $128.8 billion from our hospitals. I don't have any 
hospitals that tell me they are being overpaid in Medicare, and I don't 
expect if I did have they would tell me that. But I can tell you the 
national number for Medicare reimbursement rates is only 80 percent of 
the cost of delivering that service--80 percent of the cost.
  Now, some of these doctors and nurses and health care practitioners 
are actually in business for a profit, Mr. Speaker, and I don't 
begrudge them that profit. I hope there is competition, and the more 
profit they make, the more competition it is likely to attract. Some of 
these hospitals are for-profit hospitals; they all are not. So we can't 
begrudge them that profit. That is what has driven the United States of 
America.
  In fact, over in my desk at 1131 Longworth there is a stack of flash 
cards in there that are produced by USCIS, the United States 
Citizenship Immigration Service. They are laminated glossy cards with a 
red background and pictures on them, and they are there so, let me say, 
naturalizing Americans that seek to pass the naturalization test to 
become American citizens can study on these flash cards the things they 
need to know.
  For example, Who was the father of our country? George Washington. It 
has the question on the front side, George Washington on the back side. 
Who saved the Union in the Civil War? Front question. Back side, Abe 
Lincoln.
  Question, What is the economic system of the United States of 
America? Flip the card over, answer: Free enterprise capitalism, Mr. 
Speaker. I mean, that is like the simplest no-brainer question for the 
economy of the United States that we require of anyone that wants to 
naturalize to become an American citizen in this country; they have to 
know it is a free enterprise system.
  Yet we have people in this Congress that are constantly assaulting 
the free enterprise system. We have seen the nationalization of one-
third of our private sector just in the last one year, one-third, 
according to The Wall Street Journal. And this health care industry, 
one-sixth of our overall economy, perhaps another 18 percent. If you 
add those together, we are very close to if not exceeding over half of 
our economy being nationalized, meaning a Federal Government takeover 
of management and running the show and calling the shots and freedom 
disappearing, all of that within, what, a year or a year and a couple 
of months, Mr. Speaker?
  It is appalling to think that we have had an all-out frontal assault 
on free enterprise while at the same time we are testing our immigrants 
who want to become Americans to make sure they understand that this 
Nation is for free enterprise, that that is the basis of our economy. 
It is appalling. It is ironic.
  It is disingenuous to take this attack against the free enterprise 
system in America and go against Medicare Advantage, the only free 
enterprise component of Medicare, to knock all of that out, which is 
what they propose to do in H.R. 3200, and go after our hospitals and 
ding them for $128.8 billion, when many of the hospitals and many of 
the hospitals that I represent are taking a high percentage of Medicare 
patients, and every time they take a patient, they know that they are 
losing money, and it has to be picked up somewhere else or they can't 
keep their doors open. So it requires cost shifting, and that is where 
we get the medical costs that seem out of line.
  Then you can go on down through the line. Cutting home health care by 
$56 billion. Cutting Medicare Commission, $22.2 billion. Cutting 
Medicare Improvement Fund by $22.3 billion. Part D, $19.8 billion. We 
will be down to aspirins in no time. Skilled nursing facilities, $14.6 
billion. Cut part B schedules, except for physician services, $23.1 
billion. You go on down, CMS, innovation center, hospices, accountable 
health care organizations; $800 million out of the power wheelchairs 
component of that. That must be McCaskill out of Missouri. And 
comparative effectiveness, $300 million. The list goes on. Medigap $100 
million.
  This stack here takes us up there in the neighborhood of $500 billion 
cut out of Medicare. And what do we hear from the other side? ``Well, 
we are always going after waste, fraud and abuse.'' ``There will be 
always be abuse,'' I heard a gentleman say, ``so we are going after the 
waste and the fraud.''
  Are we? If they know where the waste and the fraud is, rather than 
pointing to categories, tell me. Tell me, Mr. Speaker, what is it that 
is going on in Medicare in my State, in my hospitals and the clinics in 
my district, that is waste, fraud or abuse, when they are receiving on 
the national average 80 percent of the cost of delivering that service. 
I don't have anybody in my district that is making money off of 
Medicare. But Iowa is the lowest reimbursement State in the Union, and 
that is the biggest reason why.
  So we have the lowest reimbursement rates in the entire United States 
of America. We rewrote that bill in 2003, and Iowa got a little better 
off. They climbed a little bit up out of that 50th in the Nation for 
reimbursement rates for Medicare. They closed the gap a little, but we 
never got up to 49th.

  Who was number one in the Nation at the time in reimbursement rates 
for their citizens? Louisiana. Who got the most per capita out of the 
entire 2003 Medicare rewrite legislation and the prescription-drug 
component of that? Louisiana.
  We look across this country, and Democrat after Democrat says ``there 
is waste, fraud and abuse in my Medicare.'' Well, maybe it is in yours. 
It is not in mine. But you want to cut mine, not yours. You will defend 
those reimbursements to your districts. You won't let us adjust those 
rates. You have a little package over there which I support, and I have 
worked with some of the people on that side of the aisle, and I 
appreciate the effort they put in. They deserve more of the credit than 
I can certainly take on this, although I did write some language into 
the 2003 bill that allowed for consideration for cost and quality.
  But this is supposedly a component of a negotiation that we will get, 
and that number is something like $8 billion that would be rolled back 
in to help compensate cost and quality. But it is pretty vague. You 
can't get your fingers on it. The language isn't there. We don't really 
know whether it is cost and quality or whether it is demography and 
geography. I mean, that is the question now. If it is going to be 
demography and geography, that is what Democrats usually want to do.
  So I suspect that they want to change the rates so that people that 
live in their chosen areas that meet their demographics will get a 
higher reimbursement rate. And I can only conclude that that means that 
they will target minorities and inner cities. And I think that every 
American should be considered as one of God's children, regardless of 
what their ethnicity or national origin is and regardless of where they 
live.
  So, if you take that off the table, and I sure would like to because 
it pits Americans against Americans and causes some people to focus on 
skin color instead of the content of our character, but if we could 
take that off the table, it is still geography, and they will define 
the demography that gives them the advantage. They will still take away 
our Medicare Advantage and decrease and gain themselves an advantage to 
their constituents, without regard to justice and equity.
  Now, justice and equity would look at this and conclude that the 
States with the lowest reimbursement rate should be in a position to 
get the greatest bump up. But even if that is not the case, what if it 
would be the States and the locales and the metropolitan service areas 
that had the best cost and quality ratios in America? Who ranks number 
one in cost and quality? And shouldn't we reward the people that 
produce the best product for the best value?
  Now, my State will rank in the top five in every broad health care 
results analysis that comes out. Every objective, broad health care 
results analysis that comes out, I will be in the top five. Sometimes 
we are number one in some categories, and sometimes it moves across the 
spectrum. But they will be in the top five in quality because of the 
result that they get, because a lot of people that are there put their 
hearts and their heads and their souls into this and their backs and 
their hands and all their know-how and resources, and they get a good 
result.
  So that is the quality. But they are rewarded with the lowest 
reimbursement rate in Medicare in the Nation.

[[Page H11851]]

So they get a low cost, because they aren't being paid for the service 
that they are providing. They produce a high quality anyway. And I am 
saying that we need to recognize the best cost and quality combination 
in America and reward those.
  If you want to go out and find a half a trillion dollars in savings 
in Medicare, don't come to my State. Don't come to my district. We are 
producing the best combination of cost and quality in America. Go to 
those places then where Medicare reimbursement rates are high and 
results are low and advise them that they are going to have to get 
their standards up, but you are going to reduce their reimbursement 
rate, if that is your determination, to take half a trillion dollars 
out of this. That is my suggestion.
  This is the chart. This is the reality. To cut Medicare and argue 
that there is waste, fraud and abuse everywhere, slash it across-the-
board and starve the people that are doing the best good for the least 
amount of dollars is unjust, and there is no equity there for anybody 
involved, not the providers, not the practitioners, not the patients, 
not the senior citizens in this district that I represent, which I 
believe is the most senior congressional district in America.
  The Fifth District of Iowa and Iowa itself has the highest percentage 
of the population over the age of 85. And then of 99 counties in Iowa, 
32 of them are in my district, and in that 32 county district, we have 
10 of the 12 most senior counties in Iowa. So, 10 of the 12 most senior 
counties in Iowa in the most senior State in the Nation results in, I 
believe, the most senior congressional district in America. And we are 
looking at a half-trillion dollar cut across this country because some 
people have to figure out a way to pay for this $1 trillion to $2 
trillion bill.
  Now, this takes us to this conclusion that was drawn by President 
Obama while in debate with Hillary Clinton in the presidential primary 
process last year, in 2008. And I think it was a given that going into 
this presidential contest on the Democrat side, Hillary Clinton clearly 
owned the field as far as knowing her health care issues. And here is a 
point as to why I say that, Mr. Speaker.
  She produced this for America, working in conjunction with her 
husband, Bill Clinton, who, by the way, came to this floor and spoke 
from this well on September 22, 1993, to plead with and entreat a joint 
session of Congress, House and Senate Members and the galleries full, 
to adopt his concepts and write into law a national health care act 
that would completely take over at that time one-seventh of the U.S. 
economy. And Hillary Clinton was instrumental in that.

                              {time}  2000

  She held the meetings and put together a bill. Some were closed-door 
meetings. That sounds a bit familiar these days. I remember my 
frustration at the door being closed with Hillary Clinton and a big 
table full of people who were sliding papers around, arguing and 
hammering out the destiny of America. I have always had an aversion 
about turning people loose to go make decisions for Americans or Iowans 
behind closed doors.
  I recall a policy that needed to be handled when I was in the Iowa 
Senate. They appointed six Democrats and six Republicans; the 12 
apostles, I called them. They put themselves in a room and closed the 
door. They all swore an oath that they wouldn't talk about the product 
they were working on until they all agreed to come to a conclusion and 
sign off on this document, and then that's what they did. One of my 
close friends was in that room and would not utter a word of what was 
going on, what was being negotiated inside that room, and of course I 
didn't pry very hard because I respected his integrity.
  But you know what happens, Mr. Speaker, when they meet behind closed 
doors, when they meet in secret, when they appoint themselves as the 
people that are the--how shall I say--the sole repository of wisdom 
inside the room when they close the door. They come out. And once they 
reach a consensus inside the room, they produce a document or a 
philosophy, and they all sign off, either in ink or verbally, and they 
go out and stand together behind the microphones. Then they say, We 
have produced the best product possible. We've had the right brains in 
the room, and I am really optimistic about what we've done. This is the 
right thing for America or Iowa or whatever group it is that they're 
seeking to impose this policy on. And invariably they will say, Don't 
amend this because if you do, this perfectly balanced specimen that we 
have would be knocked out of balance, and it won't be able to function 
properly.
  It actually reminds me of former Secretary of the Treasury Paulson 
when last year, on September 19, he came to the Hill and asked this 
Congress to write him a check for $700 billion. His response to us and 
his presentation to us was, I've been looking at this for 13 months. 
You've only been looking at it for 24 hours. I have thought of 
everything. Whatever you think of will knock it out of balance. Don't 
try to amend this. You will destroy the overall product. This is a 
perfectly balanced vehicle.
  Well, it doesn't take much to perfectly balance a vehicle when it 
happens to be not a blank check but a check for $700 billion, signed by 
the American taxpayers and borrowed from the Chinese to be paid with 
interest and principal by grandchildren yet to be born. Those were 
about all the details that were in there, and I had to write some in 
myself as I speak about it; not in the language itself. That's what 
came out with the $700 billion TARP piece.
  By the way, the Wall Street Journal came out today with some regret 
that they supported that $700 billion. Now they would like to see the 
plug pulled and the money paid back to the American taxpayer and no 
more doled out in the fashion that it was. That's an inside-the-closed-
doors rush to judgment. And right now we've got behind-the-closed-doors 
negotiations taking place in the House of Representatives, in the 
United States Senate; people frantically negotiating at different 
stages with doors closed. Maybe three Senators over on the Senate side 
right down that hall, Mr. Speaker. A few more House Members maybe.
  I've talked about some of these things that are ironic, but here is 
the irony: As President Obama was campaigning--and I will have to 
circle back to the Hillary issue in a moment. But as President Obama 
was campaigning, he said that he would open up unconditional 
negotiations with Iran. That meant to a lot of us, Mr. Speaker, that we 
envisioned Barack Obama sitting down across the table with Ahmadinejad 
or the Mullahs and maybe asking them if they would just be nice people 
and shut down their nuclear weapons operations.
  Now aside from how that makes the United States look and how it 
rewards people for threatening Israel and the United States, aside from 
that, Mr. Speaker, it seems ironic to me that the President is meeting 
with people like Harry Reid, Nancy Pelosi, a handful of Democrats, and 
they're crafting legislation behind closed doors, yet he's not willing 
to sit down with people like Mitch McConnell, John Boehner and Eric 
Cantor. What is it about that, Mr. Speaker, that the President of the 
United States would announce that he's willing to do unconditional 
bilateral negotiations with Iran, Ahmadinejad, because he is the boss 
there. If you will remember, he won an election, an election supported 
by the White House--or the result, at least, supported by the White 
House. To sit down with Ahmadinejad potentially or the Mullahs but not 
the leaders in the Republican Party or the leaders on the health care 
issue--and we have many on our side--is a real irony. I was about to 
make the case that during the campaign, Hillary Clinton made the 
argument that her version of health care--now it wasn't exactly this. 
She had some alterations because 14 years have gone by, and we know 
that the shape of this body isn't the same that it will be after 14 
years of wear and tear. But this is the 14-year-old, now 15-year-old 
flow chart of HillaryCare.
  I believe that her background in this is what drove President Obama 
into taking positions on health care that now he is seeking to sustain 
in the same way that he's seeking to sustain his Executive Order that 
closes Gitmo, Guantanamo Bay, on January 22 of next year. The 
difficulty of accomplishing such a thing looms now over the Justice 
Department in an imposing dark cloud, a hasty Executive Order, a

[[Page H11852]]

policy in health care that was hammered out in the face of, I'll say, 
persistent, skillful debate on the part of Hillary Clinton. But this is 
her plan. This is from the New York Times back in '93-'94, shortly 
before Senator Phil Gramm stood down that hallway on the floor of the 
United States Senate and said, This plan passes ``over my cold, dead 
political body.'' A lot of people thought that Phil Gramm was wrong, 
that this health care bill couldn't be killed. Phil Gramm wasn't the 
only one lined up to kill it, Mr. Speaker. There were many of us that 
did, but he was a man that was in the lead. He was one of the generals 
fighting this war to fold this scary flow chart and end the effort to 
take over what was at that time one-seventh of our economy. He inspired 
people in the House, people in the Senate and people all across America 
with his belief and conviction that this could be killed.
  So this scary flow chart, this thing that I've said a number of times 
scared the living daylights out of me when it showed up in the paper, 
and I ended up with a laminated chart. And I do think it's someplace in 
my archives. But I hung it on the wall in my construction office in 
that '93-'94 era, and it stayed there all the way through the nineties. 
When I got to wondering about government and how I was going to keep a 
construction business operating in the middle of the tax increases and 
the changes in regulation and the burden that I had of government, I 
would look at that chart, and I would see that it had been buried by 
the leadership of Phil Gramm and others and by the American people, it 
gave me great heart that the common sense at the core and the heart, 
soul and conviction of the American people prevailed over this scary 
flow chart, which is a complete takeover of the health care system, and 
almost every one of these boxes would have become and our future would 
have been these proposed organizations, proposed agencies.

  Now we have a new flow chart, not the 1993-94 version. Fifteen years 
later, we have the 2009 version. Mr. Speaker, if you observe this, the 
white boxes are existing entities out there. Here is the private sector 
entity, private insurers. Here are the traditional health insurance 
plans that they produce. You can go on around and see what exists along 
here. The Office of Civil Rights is there. The Office of Minority 
Health is there. But there are at least 31 new agencies and now, on a 
more careful inspection, it grows this up to more than 50 new agencies 
created by H.R. 3200.
  This is a scary proposition. HillaryCare, scary in black and white, 
was scary enough to scare some of us into public life. It didn't scare 
me out of the private sector because this was killed. It was killed by 
the American people; but it helped motivate me to come into public 
life. I wonder if that had not been proposed to the American people 
whether I would be standing here opposing this or even in the United 
States Congress today. This takeover now of one-sixth of the American 
economy is a scary proposition. This takeover of a good share of our 
freedom, the freedom to buy the health insurance policy of our choice, 
the freedom to move to another State if we don't like the 
accommodations and the regulations that we have, the freedom to go 
without health insurance if we chose choose to do so, the freedom to 
take our risk and then be able to accept the profits that come from 
that, and pay the price if we take the risk.
  Here are the few premises that President Obama has hung his hat on as 
a means of counteracting the very active and informed health care 
approach in the primary that Hillary Clinton mounted. He was forced to 
take a position on health care, so here are the two conclusions that he 
drew. One is, we spend too much money on health care. We have to fix 
that. The other one was, we have too many uninsured. We have to fix 
that. So somehow they've morphed along and have gotten away from the 
idea that, you know, there are rights and there are responsibilities. 
It seems to be that the point that they would like to make is a point 
that you're more likely to hear of in Western Europe than you are in 
the United States of America, and that is an argument that people have 
a right to a health insurance policy. The policy. I mean, everybody has 
access to health care. It may not be the best. They may go into a 
public health clinic. I know some awfully good practitioners there that 
have committed themselves to working in that environment, and I see 
high-quality care when I walk into those in my district. So maybe they 
go into a public health clinic. Maybe they walk into the emergency 
room, and it does run up some costs. But everybody has access to health 
care in America. Whether they have a dime, whether they have $1 billion 
or whether they're in the hole and they have a negative net worth, they 
have access to health care. That is not the issue.
  So they make a new issue which is too many uninsured. I will go to 
that chart in a moment. But I want to make the other point and it's 
easier to make, and that is President Obama's premise that we spend too 
much money on health care in America. You can argue that, and you can 
debate it. We're at around 14.5 percent on up to maybe more than 16 
percent of our GDP is spent on health care in America. They'll point to 
numbers that show that about 9.5 percent of the GDP of the other 
industrialized world is spent on health care, some above, some below 
that number. Well, you know, this is all in the eye of the beholder. 
Those that are receiving this health care that need it, the lifesaving 
procedures, they will tell you that it is worth the price. But I won't 
belabor that because we get into anecdotes to no end. I will just say 
this, if President Obama is right--and I am not conceding that point. 
But if he is right, for the sake of conjecture, I would make this 
point. His solution for spending too much money on health care is, 
spend more. Spend $1 trillion to $2 trillion more on health care, and 
then somehow it magically fixes the problem of spending too much.
  You heard the words from one of the gentlemen that spoke in the 
previous hour. It's counterintuitive. It's kind of hard to rationalize. 
Well, it is. It's not just counterintuitive. Mr. Speaker, it's 
completely illogical to make a point and take a drive for the 
presidency and seek to impose upon the American people through the 
leverage and the majorities in the Congress, the Pelosi majority here, 
the Harry Reid majority down that hallway, a $1 trillion to $2 trillion 
health care plan. Because we spend too much money, now we'll spend $1 
trillion to $2 trillion more.
  And now one of the President's moving targets--I feel like a cat 
chasing a ball of string here--but one of the President's moving 
targets now is, Well, it's got to be under $1 trillion, in the $900 
billion range. So write me a bill that does that because we can't take 
the political hit of something that's over $1 trillion. So they brought 
the doctors fix to the floor of the Senate the other day, and the 
doctors fix was $247 billion to try to fix the adjustment rates for our 
doctors that are underpaid in some of these cases. It failed on the 
floor of the Senate, and 13 Democrats voted with Republicans. How can 
this be? That was a way to take that $247 billion out of this 
government health care bill so that the bill didn't go over $1 
trillion. If they would have passed that, the doctors fix wouldn't be a 
part of it, they wouldn't have to put it in there, and they could keep 
it all under the $1 trillion category. We're really here with AARP 
making a public statement that $500 billion is a very small percentage 
of the overall outlays, and they can take a hit and have their 
reimbursements reduced in the category I showed in this chart earlier, 
by $500 billion, and still their hearts are cold.
  How can they do that? I have a chart here that shows me a little bit 
about why AARP might do that. A couple of points here. One of them is 
that there is a section in H.R. 3200 that would exempt Medigap policies 
from new limits on preexisting condition restrictions.

                              {time}  2015

  Well, AARP's Medigap insurance, which they sell and which they 
collect a good deal of premiums on--and it's the lion's share of the 
profits that AARP makes--continues to deny Medigap claims to 
individuals with serious health conditions. There is a preexisting 
condition clause written into Medigap policies, and H.R. 3200 would 
preserve the preexisting condition component for AARP. So I presume 
that is one of the reasons AARP can watch $500 billion be cut out of 
Medicare as long as they preserve their preexisting condition component 
of their

[[Page H11853]]

Medigap insurance, which is so they can stay in that business.
  There are several others on the list, but that's the easiest one to 
understand.
  The President wants to solve a problem with spending too much money 
by spending more--$1 trillion to $2 trillion more. The Democrats in the 
Senate, Harry Reid, sought to blur that and sought to exempt the 
doctors fix so that they could keep their, I'll call it, socialized 
medicine bill down below $1 trillion. The $247 billion piece of 
legislation that dealt with the doctors fix independently was shot down 
in the Senate, and it could not receive a majority vote.
  So let me get that other part of the President's position 
illustrated, Mr. Speaker.
  This is the other position of the President's. The first, remember, 
is that we spend too much money. Therefore, we'll spend more. It's not 
logical because it's not logical. Here is the other one. We have 47 
million uninsured in America--too many uninsured. Thus, we must insure 
them all because people on this side of the aisle believe that having 
your own health insurance policy is somehow intuitively withdrawn from 
the Constitution as a right that comes down from God, that flows 
through the Declaration of Independence, that shows up somewhere in the 
Constitution and maybe in the Bill of Rights, and that now they can 
divine that and hand that over to everybody in America, legal and 
illegal, no matter who you are.
  I know that there are a good number of Democrats who have actually 
endorsed legislation that says that every human being in America--every 
person in America, would be the language--has a right to one's own 
health care, to receive it for free and that health care practitioners 
will be salaried employees who are working for the government. That 
would be a 1981 bill that I happened to read the other day, introduced 
by Ron Dellums and John Conyers. John Conyers is still here, and he's 
still pushing the same kind of issues.
  This is the 47 million, Mr. Speaker, the 47 million who are 
uninsured. Now, that's the highest number that anybody defends. We 
could take this on down to, maybe, 39 million, but here is how you do 
the math:
  These two categories right here are illegal aliens and immigrants. 
Add those both together, and it comes to 10.2 million. They're not part 
of the 47 million. They're not part of the people who, I think, we 
ought to impose upon taxpayers to fund their insurance.
  I want to take illegal aliens and immigrants out of this equation of 
those who would be handed gift-wrapped health insurance policies. I 
want to subtract from that list the Americans who have the means to 
provide their own insurance. Those Americans making over $75,000 a year 
can find ways to write checks for their health insurance premiums. They 
don't. Nine million of them who are making over $75,000 a year don't.
  Here, this is 9.7 million who are those eligible for a government 
program but who are not enrolled--mostly Medicaid. They don't bother to 
sign up. Why would they sign up for another program if we hand them 
silver-plattered health insurance policies? All they have to do is walk 
in and sign up, but they don't--9.7 million.
  Here are those who are eligible for employer-sponsored insurance but 
who are not enrolled--6 million. Hmm. They told their employers ``I 
don't want it'' or they don't bother to sign up.
  Now, all of these people who I've described are the people who, I 
don't believe, the American people want to hand silver-plattered, gift-
wrapped health insurance policies. For the ones who are left, we do 
have some compassion. Those are the Americans without affordable 
options. That's 12.1 million people. They are the Americans without 
affordable options.
  Right before I yield to the gentleman from Texas, I want to show you 
what it looks like when you look at all of America. This is 47 million. 
This is 47 million in America's population. Here we are. Eighty-four 
percent are with health insurance. This is 306 million Americans in 
this circle.
  These folks in these categories here are the ones who I say I don't 
want to insure and that the Americans don't want to insure--illegals 
and those with the money and those who are already qualified, et 
cetera.
  Yet, as to this red sliver here, this tiny, little piece of the pie, 
that's 12.1 million people. That's less than 4 percent of the overall 
U.S. population--Americans without affordable options. Now, it would be 
nice to help these people. I'm open to doing some of those things, and 
we've got some proposals here on the RSC's list to do that.
  Yet the real bottom line is that Democrats and the President, behind 
closed doors, are putting together a policy that they want to ram down 
our throats which will maybe reduce this 4 percent number down to 2, 
but the price would be to transform completely 100 percent of the 
health insurance industry in America and to start down the path of a 
complete transformation of 100 percent of the health care delivery 
system in America. It's the best health insurance system in the world. 
It's the best health care delivery system in the world.
  We have a whole list of fixes, some of which we've passed out of this 
House but which were blocked by the trial lawyers and the Senate in the 
last few years. It's the Republicans who preserve your free enterprise; 
it's the Republicans who preserve our freedom, Mr. Speaker, and it's 
the Republicans who will reduce these costs in our health care and who 
will reduce this number of 4 percent slightly, not by a big amount, 
maybe by a percent or so or two. That's about half. All of this is 
coming out of the lists here of the Republican Study Committee and of 
the list of the 10 things that I carry around in my pocket which are 
the solutions that I propose.
  So, Mr. Speaker, I recognize that the most tenacious, resilient and, 
perhaps, entertaining Member of the United States Congress, who is from 
East Texas, is here tonight. Whenever I see Congressman Louie Gohmert 
on the floor, I want to hear what's on Louie's mind.
  I'd be so happy to yield as much time as he may consume to the 
gentleman from East Texas, Mr. Louie Gohmert, the judge.
  Mr. GOHMERT. Thank you, and I appreciate the gentleman, my dear 
friend from Iowa, for yielding.
  It is interesting when we talk about people who do not have coverage. 
As my friend from Iowa knows, earlier today, there were a great many 1-
minute speeches given by Republicans and numerous 1-minute speeches 
given by Democrats.
  A Democrat, whom I happen to like a great deal--he has always been 
most gracious to me--gave a 1-minute in which he pointed out that he 
had a friend who had called a doctor's office, seeking help with a 
medical problem.
  The doctor's office asked the question, Do you have health insurance? 
He responded that he did not.

  They said, Well, we will see you, but you'll need to bring $250 to 
pay for the visit and treatment, to which he responded, as I recall, 
Look, I'm not from this country. I don't have $250.
  The doctor's office responded, Well, then you'll need to go to the 
emergency room.
  So this individual is going to get health care, is going to have it 
provided. Obviously, somehow this person got into this country, and we 
don't know if he was legally here or illegally here. My friend across 
the aisle, my Democratic friend, said that's why we've got to have this 
universal health care bill. That's why we've got to pass this so that 
people like his friend could have health insurance and could be covered 
and would not have to go to the ER to get, apparently, his free care.
  Well, that, I think, really points out a distinct difference between 
the approaches of the two parties. That is why, even though the 
Democrats have about 40 votes more than they need to pass any bill they 
want to, they still haven't got the votes they need, because our 
Democratic friends have indicated they can't support the bill that has 
been presented to them. Yet they take the opportunity to blame 
Republicans. We're not on board.
  When you have someone come into this country--and let's give him the 
benefit of the doubt--who's here legally, he comes into this country 
and immediately demands free health care? I mean, that's incredible 
that somebody would have that kind of demand.
  I know that, in China just recently, someone from the United States 
was

[[Page H11854]]

over there, and required a test. He was required to pay the money up 
front before he could get his testing. That goes on. China, for 
example, and Europe have been chastising the United States for 
squandering money--imagine that.
  Here you have the Democratic position that somebody from another 
country who is visiting here, who is not a citizen, who is maybe here 
legally or illegally should be able to call up and demand that any 
doctor in the country he wants to see should be forced to see him even 
though he can't pay for it. It is amazing to me because, you know, I 
thought the Civil War was fought and won to show, among other things, 
that the Constitution did not allow people to become or to be made 
slaves. That's what would happen to the health care profession if you 
were to allow that kind of thing. By golly, the heavy-handed government 
is going to demand that you, Doctor--you who went through so many years 
of training and education and through all those sleepless nights while 
working as an intern and as a resident--will be required to provide 
free health care to someone who just comes into this country.
  I was recently with a group that went over to the Middle East. We 
flew on a commercial airline--that is a long flight--and one of our 
congressional friends said that the lady next to him seemed well-to-do 
and that she had commented during the long flight that her husband 
worked with Hamas. Well, we recognize Hamas as being a terrorist 
organization, and here she's very cavalier about it. Well, he works for 
Hamas. During the course of the trip, she also volunteered that her 
son-in-law is with Hamas. Eventually, she said they were about to have 
their second grandchild, and with this grandchild, they were going to 
do as was done with the first: This daughter who was pregnant was going 
to fly over to the United States right before the baby was due, at the 
end of August, and have the baby. She pointed out that their family 
liked the option of having American citizens in their family. That's 
why they call them ``anchor babies.'' That would allow them--her 
husband with Hamas and her son-in-law with Hamas--to come into the 
United States as an excuse because they're raising an American citizen. 
So they get visas. They come over here. They have babies. As she 
pointed out to a fellow Member of Congress, not knowing who he was: Do 
you know what the best thing about it is? She'll fly home with her new 
grandbaby, and she won't have to pay a dime.
  That's what's going on, and that's what our friend across the aisle 
was pointing out earlier today that he thinks should go on, that people 
should be able to come into this country and demand free health care 
from whomever. Most of the people I know on our side of the aisle take 
the position that this country is such a blessing and that, through 
this country, we've been the most philanthropic country in the history 
of the world. We've been able to help people around the world in times 
of crisis, and we're willing to do so in times of crisis; but if we 
take on the health care expense of the whole world as much as we're 
doing with pharmaceutical costs--and we seem to be subsidizing the 
pharmaceutical costs. If we do that with all of the health care costs 
for anybody who wants to just come in and get free health care--anybody 
who wants to at any time anybody wants to--we will bankrupt this 
Nation. This blessing that we've been handed will not be around to be 
passed on to our descendants.
  You know, we've heard over and over--and I get so tired of hearing it 
because it's so untrue--that Republicans have no solutions. This is a 
bill that I've filed. It's a health care solution that, I think, trumps 
anything that I've heard any of the Democrats point out since we now 
know from Secretary Sebelius that the President, even though he keeps 
talking about ``my bill'' and ``my plan'' actually doesn't have any 
bill. He's talking about a set of principles. That was quite a 
revelation.
  Anyway, in my bill, section 301 reads that, notwithstanding any other 
provision of law, a consular officer defined in section 101(a) of the 
Immigration and Nationality Act, 8 U.S.C. 1101(a), may not issue or 
renew an immigrant visa to an alien unless the alien presents evidence, 
which may be in the form of an attestation, by a sponsoring employer or 
individual in the United States in whose household the alien intends to 
reside who will be responsible for providing the requisite coverage, 
that the alien and the alien's spouse and children who are accompanying 
or following to join the alien will be covered by a high-deductible 
health care plan as defined in section 223 and will be an account 
beneficiary of a health savings account under such section after the 
alien's admission to the United States as an immigrant for the duration 
of the alien's residence in the United States or be subject to removal.
  In other words, the long and short of this is, under my bill, we 
welcome immigrants coming into this country. We welcome them. It has 
made this country strong. Yet, since it's a matter of national security 
that we not let non-American citizens bankrupt this country, then in 
the future, if they allow my bill to come to the floor for a vote, 
anyone wanting to come in will have to prove that they will be covered, 
that their health insurance needs will be covered. They'll be met 
before they get visas. If their health insurance expires before their 
visas do, they will be subject to removal from the country. That would 
help provide some sanity.

                              {time}  2030

  And I know my dear friend from Iowa was with me when we journeyed to 
the United Kingdom, over to England, to talk about immigration over 
there, and we had one conversation with some people with the British 
Government. And it was a bipartisan trip. There were people from both 
parties who were there. But a lady, she may have been on their type of 
Social Security, but she pointed out that before you can receive Social 
Security in the United Kingdom, they require, as I understood, that you 
be there paying into their system for at least 5 years before you could 
get a dime. And one of our friends from the other party was outraged: 
But that's discrimination based on national origin. You shouldn't be 
forcing them to pay in before they can receive. That doesn't seem fair. 
And she very calmly, and with that beautiful English accent, pointed 
out that, Well, in this country we happen to think it's fair that 
before you receive benefits from everyone else in the country, you help 
pay into the benefits pool.
  Mr. KING of Iowa. Reclaiming my time, I thank the gentleman from 
Texas.
  I recall that conversation. And just to give a balanced view of this, 
the lady was with the British Embassy and had a Ph.D. in Africa studies 
and a delightful intellect.
  And I remember in part of that discussion and debate that I engaged 
with her, she made the statement that she believed that there was more 
freedom in China than there is in the United States.
  ``Why would you come to that conclusion?'' was my question. And her 
answer was, ``Well, because they have access to health care, free 
health care, in China.''
  I don't know that it is free in China, but that's the difference in a 
British viewpoint and an American viewpoint. We know what our rights 
are. We established those rights in the matter of wresting our freedom 
out of the British Crown. They're still under the Crown, so theirs have 
evolved in a different way. But we received a lot of the underlying 
principles of freedom. And they are delineated in our Constitution and 
in our Bill of Rights, and the foundation for them is in the 
Declaration, the rights that come from God.
  So we see rights differently in America than anyplace else in the 
world, and it's awfully hard to talk about freedom with people who 
speak English that have a different definition of the word ``freedom.'' 
So if there is more freedom in China because they don't have to earn 
their own health insurance policy, I'd say there is less freedom in 
China because they don't have to. We get to struggle here. We get to 
try. The people that excel and take personal responsibility need to 
have an opportunity.
  Jimmy Carter would be the person I would quote on this. I don't know 
if he ever lived by it, but Jimmy Carter once said, and I think it was 
when he was in Iowa campaigning for the Presidency and establishing the 
first-in-the-Nation caucus. He said, I believe the people that work 
should live better than those

[[Page H11855]]

that don't. That's Jimmy Carter. And I don't know that he lived by it, 
but I believe those words made a lot of sense. That's why I remembered 
them.
  I yield to the gentleman from Texas.
  Mr. GOHMERT. I appreciate the gentleman's yielding.
  And I note interesting headlines in the news this evening. For 
example, one article says, the headline, ``Reid Targets Government 
Takeover of Health Insurance.'' Another says, ``Snowe,'' talking, I'm 
sure, about Senator Snowe, ``Rejects Reid Public Option Plan.'' Another 
says, ``Democratic Senator Lincoln, Public Option a Nonstarter.'' 
Another headline, ``Lieberman Backs GOP Filibuster of the Public 
Option.'' Another Gallup poll: ``Conservatives Outnumber Moderates.''
  So these can't be too good of news. This article from Monday says 
that in an appearance at a Florida senior center during the day, 
Speaker Nancy Pelosi suggested a new name for the same approach to ease 
the opposition, talking about the public option. She suggested, ``the 
consumer option.'' Representative Debbie Wasserman Schultz, a friend 
from across the aisle, Democrat from Florida, appearing at Pelosi's 
side, used the term ``competitive option.''
  The article says, ``Critics say that by any name, the approach 
amounts to a government takeover of the insurance industry,'' with 
which I would tend to agree. This article quotes Senator Olympia Snowe 
of Maine, the only Republican to vote with Democrats on health care so 
far this year, issued a statement saying she was ``deeply 
disappointed'' in the approach the Democratic leader had chosen.
  But, anyway, it can't be too good of news for ramming this bill down 
America's throat and forcing us to take care of people who come into 
this country and immediately demand free health care.
  We just have a difference of opinion across the aisle as to how that 
should be handled, but I also do know that we have friends across the 
aisle that simply do not believe that that will restore our country's 
ability to avoid bankruptcy by ensuring and providing health care to 
the world.
  Mr. KING of Iowa. I thank the gentleman.
  Reclaiming my time, I know that we are very near the end of this. 
But, Madam Speaker, the point that I would like to leave you with 
tonight is this: There was a time just 3 years ago when the American 
people rose up. They rejected a policy that was being driven through 
the House and the Senate, a bipartisan policy driven by the President 
and Democrats and Republicans that was called ``comprehensive 
immigration reform.'' I called it ``comprehensive amnesty.'' They rose 
up. They jammed the telephone lines, and they killed that bill.
  This bill, this bad bill, affects more Americans. It does not have 
bipartisan support. It has only Democrat support, and they're behind 
closed doors. The American people can rise up, Madam Speaker, and they 
can jam the telephone lines and they can stall the United States Senate 
and they can do so in the House of Representatives as well. They can 
convey this message to kill this bad bill so we can start all over with 
some real solutions, real solutions, among them the list that I have: 
tort reform, buy insurance across State lines, portability, full 
deductibility, association health care plans, health savings accounts, 
transparency in billing, electronic medical records, preserve 
catastrophic insurance, extend COBRA. That's just the top 10 on my 
list.
  And here's what I'd reject. I would say that if we are going to be 
able to opt out, as Harry Reid said yesterday, well, I'm going to opt 
out of this: I'll opt out of abortions. I'll opt out of funding illegal 
aliens. I'll opt out of the lawsuit abuses that are costing us billions 
every year. I'll opt out of the tax increases and the Medicaid cuts.
  Madam Speaker, I want to kill this bill, and I appreciate your 
indulgence.

                          ____________________