[Congressional Record Volume 155, Number 161 (Monday, November 2, 2009)]
[House]
[Pages H12189-H12195]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Tennessee (Mr. Roe) is recognized 
for 60 minutes.
  Mr. ROE of Tennessee. Madam Speaker, we are here tonight to continue 
the discussion of health care.
  Before I get started, I am a freshman here in Congress, and I am 
going to tell you a little about myself and why I'm here to discuss 
this.
  I grew up in the rural south in a small, rural community. My father 
was a factory worker. I went to college, I went to medical school in 
Memphis, Tennessee, at the University of Tennessee--the real UT, I 
might add, for my Texas friends--and I spent 2 years in the military. I 
trained in an inner-city hospital, an urban hospital. I spent time in 
an infantry division in a medical battalion in Korea near the DMZ. I 
served in a military hospital, in a VA hospital. I practiced in Johnson 
City, Tennessee, an area in Appalachia in northeast Tennessee, and 
taught medical school with residents and interns. I really have had a 
varied experience, 31 years in private practice. My specialty was 
obstetrics and gynecology, where I delivered almost 5,000 babies. So I 
bring a rather unique experience to the House floor, and I am very 
privileged to be part of this debate.
  I think before, as a physician, what I would try to do in any case 
that I saw was try to identify the problem. In America, we are trying 
to identify a problem with health care. And certainly, I think we have 
heard it on both sides of the aisle that we do need health care reform. 
I think the main reasons for that are two: One is costs--health care 
costs are escalating beyond the average person's ability to pay for the 
care--and access to adequate care for all of our citizens.
  In this country, about 170 million of our citizens are covered by 
their job. Their health insurance is provided by their job. And this 
started where your employer provided health insurance after World War 
II as an incentive to get workers to come work for a particular 
company. And it has, of course, grown since that time, and I think it 
has been a good thing for most people. We have been able to provide a 
level of care in this country that has been unequaled anywhere in the 
world.
  What I have been able to see since 1970, when I graduated from 
medical school, were advances that I didn't even dream of. The one 
advance that we haven't seen come to fruition that I thought would is 
the cure for cancer. We haven't done that, but we have made tremendous 
strides in cancer and heart disease, diabetes, and so on.
  So we have a cost issue, and we have an access issue. We have 
approximately 47 million of our citizens in this country that are not 
covered currently by health insurance. Who are they? Well, the Census 
Bureau believes that approximately 10 million of these folks are 
illegally in the country. We also believe that probably 9 million or so 
have incomes above $75,000 a year and choose not to buy health 
insurance--their own choice. About 8 million people make between 
$50,000 and $75,000, and they may be families where this does stretch 
them, where they're a small business, and health insurance premiums--
again, the cost factor has gotten so expensive that these folks can't 
afford it. So we really are looking at about 20 million people in this 
country who are working poor who don't have access to care.
  How are we providing the care in this country now? Well, we're using 
private health insurance. Many people use their own employer, a small 
business, their health savings account. There are variations that 
people use to buy their health insurance.
  We have the government now which provides about 46 cents of every 
dollar spent on health care with Medicare and Medicaid and the VA. So 
we have government taxpayers approaching 50 percent of the care, and 
then we have the rest, the 15 percent, who don't have coverage at this 
time.
  So how do we go about keeping the cost down, quality high, and the 
access? We are joined here this evening--and I am going to stop, having 
framed the debate--with my good friend from Louisiana, Dr. John 
Fleming. And John, I am going to turn this over to you to sort of 
continue this thought that I put forward.
  Mr. FLEMING. I thank the gentleman, my colleague and good friend, Dr. 
Roe from the great State of Tennessee. I have visited there many times, 
the Smoky Mountains. Also, speaking of smoky, everything there is 
smoked, and it smells so delicious you want to eat bark off trees when 
you go through Tennessee. So it's a lovely State, and I always enjoy 
visiting it.
  Like you, I grew up in a very middle class, working middle class 
environment. I had to work my way through

[[Page H12190]]

college. My mother became disabled when I was five, and then my father 
died just as I graduated from high school. I suddenly had the burden of 
helping out with the family, but also working my way through college 
and then ultimately medical school, which, with the help of the U.S. 
Navy, I was able to do that. I served 6 honorable years--some of the 
best years of my life, and my wife--in the Navy practicing medicine in 
such duty stations as Guam; Charleston, South Carolina; Oceanside, 
California; Camp Pendleton Marine Base.
  It was, indeed, an honor to serve my country in that capacity as a 
physician. And then of course I've been in private practice since 1982, 
family medicine. I still see patients, I still provide care. I'm still 
dealing even day-to-day with some of the issues that all of us as 
physicians deal with.
  Like you, in your many years of practice, I have carried a burden 
about what a wonderful contrast we have here. We have tremendous 
quality of care and delivery of care and the best of care and the best 
of technology, but yet some people do have access problems. There is no 
question about it; that needs to be solved.
  I ran on a reform campaign, health care reform. I wanted reform, I 
came here to reform, but you know what I found when I got here is 
really anything but reform. What I'm seeing is a Congress that has 
taken a sudden left turn towards socialism to dismantle what is the 
best health care system in the world and remake it into the same image 
as Cuba, North Korea, Soviet Union, the U.K., Canada. Even some of the 
States like your own, Tennessee, who have experimented with socialized 
medicine and government takeover of medicine, have failed. I have 
actually asked, I have been to venues and asked, please, show me one 
example where government-run health care has ever been successful, and 
I have yet to find one single example of that.
  So, like you, I am very interested in health care reform that is true 
reform, that is common sense, that makes the cost go down--bend the 
cost curve down, that's the common theme today. And there are so many 
ways that I'm sure we will get into as we go forward that we can do 
that. And I thank the gentleman for recognizing me.
  Mr. ROE of Tennessee. We have also been joined this evening by our 
colleague from Wyoming, Cynthia Lummis. We appreciate you being here, 
and I would like to now yield time to you.
  Mrs. LUMMIS. Well, I thank the gentleman from Tennessee, who has 
tremendous experience with government-run health care in the State of 
Tennessee. And after he saw the 1,990-page bill that we received last 
week and saw how much government intervention is involved through that 
bill, how many unfunded mandates are being passed onto the States, how 
many government bureaucracies are created, how many times the word 
``shall'' appears in that bill, this is truly transformational.

  Some of the Members of our caucus have said that this is the most 
significant debate that they have ever been involved in. So for those 
of us who are freshmen and did come here to reduce the size of State 
government, or to reduce spending, or to, as the gentleman from 
Louisiana said, reform health care, we are seeing things that we hoped 
would not be a consequence, and that being more government 
intervention, more spending, more involvement in our lives.
  And so we are here to protect people from more government 
intervention and to protect the relationships that you have with your 
doctor, with your local community hospital, with your health care 
provider so you all can make decisions regarding your own lives and 
your own quality of treatment and the efforts that you will make to 
enjoy the type of health care and quality of life that you hope to have 
in your communities. And that is reflected in this recent survey of 
women. Sixty-four percent of American women would rather have private 
health insurance than a government-run health insurance plan. Sixty-six 
percent describe their health insurance as excellent or good. Seventy-
four percent describe their health care as excellent or good. Seventy-
five percent want few to no changes made in their own health care.
  We all know that there needs to be some reform. The cost is too high, 
and in some areas access is limited. And certainly with regard to 
Medicare, in rural areas hospitals and doctors are not reimbursed for 
the full cost of providing the services they provide. In my home State 
of Wyoming, in fact, the hospital in Casper, Wyoming, has said they are 
only reimbursed for about one-third of the actual cost of providing 
care to a Medicare patient.

                              {time}  2100

  Now, some doctors who are reimbursed at these very low levels have 
decided not to take Medicare patients anymore. So, when things like 
that happen, we really are denying access to care by having a 
government-run program.
  Not only that--and this is one of my greatest concerns--it's what we 
are giving up by taking on a government-run program. Let's compare 
ourselves to countries that have government-run programs. Let's look 
specifically at cancer.
  For men in the U.S., survival rates exceed 60 percent and also for 
women. In fact, two-thirds of women will survive. Spain, Italy, and the 
United Kingdom are all significantly below the United States in terms 
of survival rates. One of the reasons for that is, when diagnosis 
occurs in the United States, treatment follows much more quickly than 
in some of these countries. So, if you are rationing care, that is a 
consequence. You don't have the same survival rates that we do in the 
United States.
  Take, for example, my own sister-in-law. She was diagnosed with a 
very aggressive form of breast cancer on her annual mammogram. She had 
no symptoms. She had none of the usual markers or factors which would 
indicate she had a risk of an aggressive breast cancer. Yet she was 
diagnosed based on her annual mammogram. She was in surgery in the same 
month that she was diagnosed, and she then began a regimen of both 
radiation and chemotherapy. Shortly thereafter, it saved her life.
  So she falls into that category of two-thirds of American women who 
are surviving cancer. In fact, with breast cancer, it's a very 
significant number--the difference between survivability in the United 
States versus survivability in European countries--and that's because 
health care is rationed. This is a quote by the chief justice on the 
Canadian Supreme Court: access to a waiting list is not access to 
health care.
  In this bill, we have to have assurance that we're not going to be on 
a waiting list. Quite frankly, we don't have that at all. In fact, 
based on what I've read in this 1,990-page bill and based on what I've 
been told by my colleague, the gentleman from Tennessee who is leading 
this discussion tonight, in fact, we will have rationing. The cost will 
be tremendous, and the taxes that will be imposed on so many of us as a 
result will be exorbitant.
  So it sounds to me like health care reform, in the style of the bill 
that was introduced last week, includes higher taxes, penalties, less 
choice, more government, more costs to States, more costs to 
individuals, more costs to small business, and no guarantee of an 
improvement in access, in quality or in the ability to craft a plan of 
treatment between you and your physician or to seek a second or third 
opinion in the event you feel it's necessary for you, for your family, 
for your parents or for your children.
  This is not health care reform as was envisioned by my colleagues who 
are here tonight, the gentleman from Louisiana and the gentleman from 
Tennessee.
  Thank you kindly for allowing me to join you.
  I yield back.
  Mr. ROE of Tennessee. Thank you, the gentlewoman from Wyoming. 
Excellent comments.
  Health care decisions should always be made between patients, their 
families and their physicians, not the insurance companies and not the 
Federal Government. I believe that, and I have used that in my practice 
for many years. It's one of the reasons I was a very successful 
practitioner. I knew who I worked for--my patients--and I looked after 
their benefit.
  Now, one of the things I want you to think about in this bill--and 
this is the bill here. It's H.R. 3962. They've changed the number 
because H.R. 3200

[[Page H12191]]

has become so tainted now. It's two parts. As the gentlewoman pointed 
out, it's 1,990-pages long. I've only been through the first 1,000 or 
so pages, and it's going to take me a few more wakeful nights to go 
through it, but I will. In the Senate's Baucus plan, for instance, it's 
an alleged 1,500-page bill. It gets you to 91 percent coverage.
  You can do two things on one page and get to 91 percent coverage, 
which is to allow young people who have graduated from high school or 
from college and who are not yet covered by insurance plans at their 
work or who can't afford it to stay on their parents' plans until 
they're 26 years old. You can cover 7 million young people by doing 
that.
  Number two, you can sign up the people who are currently eligible for 
government programs, which would be SCHIP and Medicaid, and you would 
then be at 91 percent without all the other bureaucratic morass that 
this bill goes through.
  I want to make this point tonight: this bill right here is almost 
incomprehensible when you read it, because, when you do read it, you 
have to refer to the IRS code, to HHS, to Medicare, and so on. It's 
just almost incomprehensible. So I'm going to go over about four or 
five things which, I think, could be done very simply--and I want the 
gentleman from Louisiana to step in--which will allow those health care 
decisions to be made by families.
  Number one, one of the big arguments we hear today, or issues which 
we deal with, is preexisting conditions, and they're real. I've dealt 
with patients who've had breast cancer who then, as individuals, could 
not be insured. Well, in the group market, in large groups, that's not 
a problem because you just accept those increased risks and spread 
those risks among large groups of people.
  When I was mayor of the city of Johnson City, we had 1,500 people, 
plus their families, with plans--teachers and employees of the city--
and we were able to spread risk and to buy reinsurance for high-risk 
patients, but an individual has a real problem. I, as an individual, 
going in with a problem am not insurable.
  Well, how do you do that, how do you make that same group market 
available for an individual that you have for large businesses?
  Well, you eliminate State lines. You take the State lines out, and 
you allow association health plans to be formed, and then the 
individual market becomes a very large group market. Costs go down, and 
the preexisting condition problem goes away.
  Number two, I think that a person shouldn't be bankrupted if a person 
gets ill. I think, if you become ill through no fault of your own, you 
shouldn't go into bankruptcy. I think that's a fairly simple thing.
  What are you going to do for low-income people who can't afford these 
things? Well, you can have subsidies or tax credits so that people in 
this income bracket can also join health plans and can share their 
risks.
  I've never understood why the government treats our patients on 
Medicaid differently than they do from Medicare patients. They're not 
treated as well, I don't think, because of the payment differences, but 
they shouldn't be. They should be allowed to take those dollars as a 
credit that are spent on Medicaid, and they should be allowed to go 
into an association health plan and also spread those risks. So those 
are a few little things.
  Lastly--and I think it's barely mentioned in this 2,000-page bill--we 
talked at the beginning of this hour about costs and about how we 
control costs. You will never ever control the costs of health care 
unless you begin to do something with tort reform, or with malpractice 
reform, because, as a physician, if I don't order a test--if I have a 
patient come to the emergency room and if I don't get a CT scan and if 
something by chance happens to that patient, then I'm going to be 
liable for that problem. If I order the test and if there is nothing 
wrong, there is no penalty to me. So we have to change that. Let me 
just explain a couple of things that helped me understand this.

  We have a terrible tort system in this country. The reason it's 
terrible is we have no way to compensate injured people. When someone 
does have an injury due to malpractice, we have no way to compensate 
him.
  In 1975 in the State of Tennessee, we started a malpractice company 
called the State Volunteer Mutual Insurance Company. Since the 
inception of that company, over half the premium dollars have gone to 
attorneys. Now, these are defense attorneys and plaintiff attorneys, 
but less than 40 cents on the dollar have actually gone to injured 
people. All the thousands and hundreds of thousands of dollars I have 
paid in over these years have not gone to compensate injured people. So 
that's something which, I think, is not in this bill. Until you address 
that, you're never going to address the ever-escalating costs.
  What do you think about it, John?
  Mr. FLEMING. Well, I quite agree, with you, Dr. Roe.
  I would like at this moment--and I think it would be a fitting time 
for this--to quote an excerpt from The Wall Street Journal, today's 
edition, where there's an editorial, probably the best editorial I've 
ever read.
  For those of you who are watching tonight, I would strongly recommend 
that you read a copy of, again, today's Wall Street Journal editorial. 
I'm going to read just an excerpt. Here is what it says. Again, these 
are financial experts who are writing this. This is probably the widest 
read newspaper in the country, period, even more than USA Today, and 
they're certainly the most intelligent and best-trained financial 
people.
  It says: Speaker Pelosi has reportedly told fellow Democrats that she 
is prepared to lose seats in 2010 if that's what it takes to pass it.
  This is obviously suggesting that there are a lot of people out there 
who don't like this, and she's bound and determined to have this as her 
legacy.
  ObamaCare, as it says--I call it PelosiCare--and little wonder. The 
health bill she unwrapped last Thursday, which President Obama hailed 
as a critical milestone, may well be the worst piece of post-New Deal 
legislation ever introduced. In a rational political world, this 1,990-
page runaway train would have been derailed months ago.
  That's quite true. Not one single Republican at any point has 
supported this bill, and many Democrats have not supported it.
  With spending and debt already at record peacetime levels, the bill 
creates a new and probably unrepealable middle class entitlement that 
is designed to expand over time.
  Again, I emphasize ``unrepealable.'' Once this thing gets into law, 
like so many things, there is no way we can get rid of it. It will be 
with us forever.
  Taxes will need to rise precipitously. Even as ObamaCare so 
dramatically expands the government control of health care, eventually 
all medicine will be rationed via politics.
  So I think that's very critical. First of all, it's one party--and 
one party only--that wants to force this. Really, it's even less than 
that. Just the leadership of one party wants to force this takeover of 
one-sixth of the American economy forever and wants to put it under 
government control forever, controlling your life from day to day. For 
what gain? Dr. Roe just pointed out that we could easily cover the same 
number of additional people with much less cost and with much less 
effort.
  What it does is it leads to rationing. It leads to long lines. I 
think, certainly, what has been said about justice is true about health 
care: health care delayed is health care denied.
  Mr. ROE of Tennessee. Will the gentleman yield for a moment?
  Mr. FLEMING. Yes, I would be happy to.
  Mr. ROE of Tennessee. I just want to give a brief example.
  I was home this past week, and I spoke to one of my partners, Dr. 
Lewis. Dr. Lewis had a patient who had a fertility problem, which he 
helped her with. She was able to become pregnant, but miscarried. She 
lost her baby. Her husband worked for the State Department and was sent 
to England. Apparently, when the American employees are sent to 
England, they get private insurance. Well, she wanted to move on with 
her fertility evaluation, so she first had to go through the public 
system before she could access the private system in England. She went 
there and she didn't see the doctor. She saw a nurse.
  The nurse said, Well, you need to see the doctor for your fertility 
problem. That will be a year.

[[Page H12192]]

  She was going to have to wait a year to see the fertility doctor. 
Well, she had a visit planned back home in a few weeks; and while she 
was home, she called her doctor, Dr. Lewis, who got her into the office 
in 1 week. He got her back on her treatment, and she is now back in 
England. Hopefully, it will be successful.
  Those are the kinds of delays that you're going to see. This is just 
one example. I could spend the rest of the night giving these examples.
  Dr. Fleming, I want to get into the cost because that's something 
that isn't talked about in this CBO report. Now, the CBO report we got 
said this is going to be deficit-neutral. Well, I want to go back 
through history a little bit. Let's look at the history of Medicare, of 
Medicaid, of the TennCare, and of the Massachusetts plan. I'll just 
briefly and quickly go through them.
  In 1965, when Medicare was passed, it was passed as a plan that was 
going to be about a $3 billion to $4 billion plan. The CBO estimate was 
that, in 25 years, by 1990, this would be a $15 billion plan. Fast 
forward to 1990. This was a $90 billion plan. They missed it just a tad 
there. Today, it's over a $400 billion plan. It's about $428 billion.
  The Medicaid program has gone up 37 times since its inception.
  The Massachusetts plan had a noble goal, which was to try to cover as 
many of its citizens as possible. That's absolutely what we should try 
to do in an affordable way. In Massachusetts now, they're at around 97 
percent coverage.

                              {time}  2115

  Government spending on health care is up 70 percent since 2006. 
Between then and 2009, that's just 36 short months. In TennCare--and we 
will go into that a little bit more. The reason it's important to go 
into TennCare and what's happening in Massachusetts is because that's 
basically what the basis of a lot of this plan is that we are debating 
tonight.
  TennCare, which started in 1993 with a $2.6 billion Medicaid plan, by 
2004, just 10 years later, 11 years later, it was at 7.5 billion and 
would go to 8.5 billion in 11 years, which almost bankrupted our State. 
Today our State is in such dire financial--and this is with the 
stimulus money that came in--that we can no longer add any further 
children to the State Children's Health Insurance Plan.
  I got a letter from Governor Phil Bredesen, who is a Democrat, who is 
a health care expert, I might add, and has done a very fine job in 
Tennessee managing this along with the Republican legislature. They 
have worked together to try to control these costs. What the Governor 
said is that in the next 5 years this will add $735 million, which we 
do not have. If certain other stipulations are placed on this plan, it 
could be in the billions of dollars. We have seen every single 
government plan that's out there that didn't meet these cost 
expectations, and this one won't either.
  For our seniors, I know they get it, but I want you to listen, and 
you can do the math. This plan, according to CBO, is going to be 
financed by taking $400 to $500 billion out of an underfunded Medicare 
plan that's going broke by 2017. That's the last number that I saw. 
That it would be upside down, more money going out than coming in.
  We are going to take $400 to $500 billion out of that plan. We are 
then going to add between 3 and 3.5 million seniors, our baby boomers 
that are hitting Medicare age, beginning in 2011. That will be between 
30 and 35 million new recipients in the next 10 years.
  Then in 2 years, in 2011, we are going to cut provider pay by as much 
as 25 percent. We are going to now add 30 to 35 million more people. We 
are going to cut $400 to $500 billion and cut our providers. Let me 
tell what you that adds up to. They get it. I was home this weekend and 
spoke to many. Our seniors are genuinely worried.
  They know, number one, when you do that, you are going to cut access, 
because when you cut that much money out, you are going to have a very 
difficult time getting to your doctor. If you can't get to your 
provider, you are going to cut quality. Number three, to get there, you 
are finally going to increase your own costs because you are going to 
have to pay more for the care you are getting; without a doubt, you 
are.
  We have seen it in our State, as I said. We will go into it in more 
detail, but, Dr. Fleming, I would like to hear your comments about 
financing this.
  Mr. FLEMING. One thing that I think can be said about this bill 
that's pretty obvious, and that is by virtue of a lot that you have 
said tonight, Dr. Roe, is that everyone will see costs go up. There is 
individual mandates, so even individuals who don't sign up for 
insurance will pay 2.5 percent taxes, which they don't have to pay. 
That's middle class, even lower socioeconomic class taxation.
  There will be taxation on health savings accounts that does not exist 
today. Taxpayers will see their taxes increase. An employer will see 
their net tax go from 35 percent marginal rate today to 39 when the 
Bush tax cuts expire. Then another 5 percent above that, they will get 
to marginal rates of 45 percent, which most of those higher-income 
individuals in that range are small business owners, which means that 
they will have to reduce other benefits or reduce pay or reduce number 
of employees. That's all there flat is to it. There are only so many 
places you can cut.
  Mr. ROE of Tennessee. Have you had any of your constituent 
businesspeople come to you and say, if this plan passes as they 
understand it, they are out? Their business is closed? I have.
  Mr. FLEMING. I have. I have had a number of them say that. They have 
done the math. They cannot figure out where they are going to get the 
extra 5, 10, 15 percent. I mean, most businesses today operate on a 
margin of around 5 percent of gross income. Well, when you add overhead 
of another 15 percent, that means you are upside down by 10 percent. 
The bottom line is that everybody, not just the high-income people, 
everybody is going to be paying more in either taxes or premiums or 
both. Everybody is going to be getting less access to care. Yes, less 
access to care.
  Again, just quickly going back to Canada, remember in Canada, care is 
free for everybody. It's universal, 100 percent. Well, only one out of 
six people have a family doctor in Canada. They actually have a lottery 
system. Yes, it's 100 percent universal. Unfortunately, you can't get 
in the system. They close hospitals down.
  Even Cuba claims to have universal health care and medicine is free. 
The only problem is they've got no medicine. So what good is free when 
it isn't available? That is the direction that we are taking here if we 
go off this way.
  Just to kind of summarize my comments on this, that is that every 
health care model in the world looks at two possibilities, two options 
to save money. One is to bring it down to the unit between the doctor 
and the patient and give them both a stake in what the total cost is, 
not necessarily pay completely out of pocket but at least pay a portion 
of it, and that's where health savings accounts make savvy consumers 
out of patients. Either that, in which they have a stake in controlling 
costs, or you have a giant bureaucracy such as in Canada and the UK, in 
which case you have to have long lines and rationing. It's one way or 
the other.
  America, you are going to have to decide what you want. Today, we 
don't have the ideal thing. We need to improve the system we have. But 
if we go with the public option, which will lead to single payer, then 
we are going to go down the road of rationing and long lines. There is 
no doubt about that. And even Members of the other side of the aisle 
said that's where they want to be.
  Mr. ROE of Tennessee. I think one of the things I want to talk about 
now--and we have been joined here by Dr. Burgess, our good friend from 
Texas--I think, where is the money coming from to pay for this? I think 
at the end of the day, when a patient comes to me in my office and sees 
me, am I going to be able to deliver better care when we pass this in 
the House, if the House does pass this 2,000-page bill? The answer is 
no. Will access go down? I believe it will. Will costs go up? I believe 
they will.
  You mentioned about the individual mandate. So people understand what 
that is, you are a person working out there as a painter or you work in 
a small business or whatever and you don't have health insurance. You 
choose not to buy it if it's offered at

[[Page H12193]]

your group, or you just choose not to. You will pay 2.5 percent of your 
total income into this exchange as a penalty.
  Well, what's happened in Massachusetts? Let me sort of go over that 
for just a moment. They have a mandate. That experiment is being tried 
right now in the State of Massachusetts.
  The Harvard Pilgrim Health Care plan found from April of 2008 until 
March of 2009, 1 year, they found that 40 percent of their new 
enrollees kept their insurance for only 5 months. During that 5-month 
period of time, the average payment was $2,400 a month; whereas, the 
average person who just had part of their plan was $350 a month. People 
were waiting because you don't have any--in Massachusetts, you cannot 
be denied coverage, and you get a community rating, meaning that 
everyone pays the same rate. What people are doing is they are waiting 
until they get sick, at least in this Harvard Pilgrim plan. Then when 
they get well, they drop their insurance and pay the 2.5 percent 
penalty.

  The other is an 8 percent penalty on business, which is a payroll 
tax. Basically, a business will pay 8 percent of its payroll into this 
exchange or into the government. Well, if you are paying 10 or 12 
percent now, then what you are going to do is you are going to drop 
that if you can and get into the public option.
  Well, I started thinking about this the other night. It's the first 
time before, in my business, in my medical practice, I negotiated the 
health insurance policy every year as a separate cost than payroll. Now 
what's going to happen is your health care costs are tied directly to 
the payroll, meaning that if you give your employees a raise, you have 
also just raised your health care premiums. You put those linked 
together for the first time, and I think that's not good for the person 
out there working.
  I am going to yield now to my good friend, Dr. Burgess from Texas. 
Thank you for joining us, and we have been joined also this evening by 
Dr. Cassidy from Louisiana.
  Dr. Burgess.
  Mr. BURGESS. I thank the gentleman from Tennessee for yielding.
  I was watching the events of this Special Order hour as you all were 
discussing it earlier. I felt like I needed to come over and talk for 
just a minute about words we heard on the floor of this House the 
middle of September that this bill could be passed, and it would be 
entirely paid for, not one dime would be added to the deficit.
  The American people look at this, whatever the figure is, 890 
billion, 1.055 trillion, 1.4 trillion, whatever the number is, and they 
know a statement that it will not add one dime to the deficit is, on 
its face, preposterous. No one believes that. Yet if we are asking 
people to believe that statement, what else is hidden in this bill that 
we are not telling you, because again, clearly, the American people do 
not believe us on that.
  The gentleman talked about how we pay for it. Some significant cuts 
to the Medicare program in order to fund a new entitlement; a lot of 
people have difficulty with that.
  But what about the taxes? What about the promise that there will be 
no taxes on individuals in the middle class, no taxes on individuals 
who earn less than $250,000 a year? And yet, we are going put a tax on 
so-called Cadillac insurance premiums. We are going to put a tax on 
medical devices.
  I did a press event this morning at a library where I distributed 
copies of the bill for people who wanted to read the bill. A woman 
said, Well, then on my $1,000 insulin pump, am I going to have to pay a 
15 percent tax? I said, Well, at some point someone will. She said, 
Well, how will that be assessed? I said, My understanding is it will be 
like a sales tax or value added tax. She did some quick math and said, 
That's a lot of money to add to my already stressed budget trying to 
cover my medical expenses, because I do have diabetes.
  Ten percent of people earning under $50,000 a year, 10 percent of the 
taxes will be paid by people who earn under $50,000 a year. Ninety 
percent of the taxes are going to be paid by people who earn under 
$240,000 a year. Clearly, this is a tax on the middle class. That is 
how it's going to be paid for.
  I did have some people ask me, Well, if the benefits don't kick in 
for 4 years, is there perhaps not a way to, if this passes, if no one 
can stop this and the Speaker gets her way and this bill passes on 
Thursday or Friday or Saturday, what about, then, since the benefits 
don't kick in for a while, maybe we can dial it back over the next 
several years. My concern there is if we already start collecting the 
taxes for a benefit that is to occur in the future, it may be very, 
very difficult to indeed dial back the portion of this bill if we are 
going to--the sensible thing to do would be to hit the pause button, 
the reset button. Let's sit down and figure out really what the 
American people want us to do.
  We heard participatory democracy all the way through the month of 
August. I know. I was on a listening tour of sorts through my town 
halls in my district. Some people were quite vociferous about what they 
felt about this bill, both pro and con. But I felt that, after 
listening to her this summer, that we would come back here to Congress 
and perhaps sit down and try to rethink where we were. It was almost as 
if the Democratic leadership said that didn't happen, it didn't matter. 
It was some sort of national fugue state. This was all an illusion this 
August. People really weren't upset with the bill. They just wanted it 
so badly that you misinterpreted their passion because they want the 
government to control. They want the government to take over the health 
care system in this country.
  One of the other things, and I don't think we can underestimate this, 
is the effect that this bill will have on jobs and job creation. More 
people are concerned about jobs in this country than they are about 
health care right now by a factor of 4 to 1. We are going to go over 10 
percent, in all likelihood, on Friday when the jobs report comes up 
from the Department of Labor, will be the first double-digit 
unemployment in this country in decades.
  People are concerned about jobs; yet, at the same time, our small 
business people, the people that we, as politicians, say they are the 
backbone of the economy of America, they are the engine that drives 
economic growth, they are scared to death of what we are going to do to 
them in the coming months. They are scared of this health care bill. 
They are scared of an 8 percent payroll tax that may be levied upon 
them. They are scared of what we are going to do in cap-and-trade, and 
they are scared of what we are going to do in financial regulation, not 
to mention the fact that there are significant tax increases just 
around the corner when the tax laws of 2001 and 2003 expire.
  This is a debate that we must keep at a fever pitch all week. This is 
the opportunity. Now is the time to aggressively document and talk 
about what is in this bill. Doesn't really matter so much about what I 
think, what I would do if I was in charge. Right now, the task before 
us is to lay out to the American people what is in this bill, let them 
see for themselves whether they like it or not. Then, Madam Speaker, 
the American people need to tell us.
  Quite honestly they will have a chance on Thursday at noon, the west 
front of the Capitol, the people will have an opportunity to speak up 
about this bill.

                              {time}  2130

  Mr. ROE of Tennessee. Dr. Burgess, thank you for your comments. Also, 
just so people understand, it is not just an insulin pop. It is any 
medical device that we are talking about. It could be a wheelchair; it 
could be a prosthetic device, if you have a leg that is a prosthetic 
device; if you have stents in your heart or hip replacements. And who 
is going to pay that? The consumer is going to pay that, we know that, 
the person that is getting that device. What we don't want to see is 
this unbelievable amount of innovation that has occurred.
  Dr. Burgess, what comes to mind for me is the equipment we use for a 
laparoscopically assisted hysterectomy. When we first started, those 
took us 5 to 6 hours because we didn't have the equipment to do it 
with. Now it is a 1-hour procedure because of the new equipment that is 
there. Patients have benefited tremendously from this. Did it cost 
money to do this? Yes, it did. But I look at the advantages for the 
patient. I don't want to see that innovation brought to a halt, and I 
fear it will be.

[[Page H12194]]

  Mr. BURGESS. Well, if the gentleman will yield for a moment on that 
point, minimally invasive surgery has changed the face of operations 
like hysterectomy operations, like a cholecystectomy, removal of the 
gall bladder. I am sure you remember, I remember when I was in medical 
school and a resident, this large incision that would go underneath the 
person's rib cage. They would be in the hospital 7 days; not because 
their gall bladder surgery was that traumatic, it was the incision that 
was traumatic.
  Now it can be done laparoscopically through two or three 1-centimeter 
incisions. That patient is out of the hospital the next day, or 
sometimes even the same day if it is done in a surgery center, and that 
has vastly decreased the cost of hospitalization for that procedure and 
that has vastly decreased the cost of the time lost from work for 
people in recovery for operations like gall bladder removal and 
hysterectomy.
  I yield back.
  Mr. ROE of Tennessee. I thank the gentleman.
  We have been joined by Dr. Cassidy from Louisiana. I yield to Dr. 
Cassidy. We thank you for being here this evening.
  Mr. CASSIDY. You know, I agree with almost everything Congressman 
Burgess said, except for one thing, in that I do think it is important 
to discuss our Republican alternatives, because, frankly, part of the 
rationale, the steamroll we are on, is there is no other option. We 
have, as the President has said, the cost of doing nothing, the costs 
will double over the next 10 years, and that is an inflation rate of 
about 7 percent if it compounds.
  Well, as it turns out, since the cost according to the Congressional 
Budget Office of the reforms before us--the inflation rate is 8 percent 
per year--under the reform proposals before us, costs more than double 
in 10 years. At a minimum, reform should not be more costly than the 
status quo.
  That said, I think it is important for us to discuss alternatives. I 
think we can all agree on the goals. We need to control costs. I am 
with the President on this. If we cannot control costs, we cannot 
expand access to quality care.
  Now, as it turns out, we three are physicians. We know that if the 
patient is in the middle of the process, then costs are controlled. 
There is a report by McKinsey & Company and it talks about the three 
imperatives for health care reform, and they are to decrease the 
administrative costs--so much money goes to administration; to have 
transparency, so that when a patient goes in for her knee surgery, she 
knows before the surgery how much it will cost her, not find out a 
month later; and, lastly, incentivize healthy lifestyles. So in a 
patient-centered plan we should lower administrative costs, increase 
transparency, and incentivize healthy lifestyles.
  So I would like to compare it to the 2,000-page, $1 trillion, 20-
pound bill.
  Now, does it lower administrative costs? You almost have to laugh, 
because it creates 111 new bureaucracies, boards, commissions. You name 
it, it clearly expands administrative costs.
  Does it incentivize healthy lifestyles? I actually read that 
provision today, and it gives grants to small businesses that come up 
with innovative ways in which you can make employees healthier. But it 
is very vague and very gauzy. And I kept thinking of that small 
businesswoman who is really struggling to make ends meet, trying not to 
lay people off. What is the likelihood that she is going to take 2 
hours a day to write a grant application to submit to the Federal 
Government on the hope they will give her $150 per employee, which is 
the maximum allowed, in order for her to come up with a wellness 
program? That is something written by a Washington bureaucrat, not by 
someone who knows the travails of a small business person.
  Lastly, transparency. Frankly, I just find it unbelievable that a 
bill that creates 111 boards and commissions will be transparent.
  That said, what are the alternatives? I think we would all agree from 
our own experience, patient-centered care can work. For example, you 
have got great anecdotes about health savings accounts. Congressman 
Fleming, who just left, I love his story about a health savings 
account.
  For those who don't know what they are, with traditional insurance 
policies, a family of four, you put up $12,000 a year. If you use the 
insurance, you may get some of your money back, but at the end of the 
year it is gone, and you put up another $12,000 for the next year.
  With a health savings account, you sluice off some of that money and 
you put it into a banking account, and that banking account is yours 
and you can spend it on the things which you choose. But at the end of 
the year, if you haven't spent it, you keep it.
  With the traditional policy, you start over. With the health savings 
account, you conserve that money and it is there for you the next year. 
It rolls over, and it is that much less you have to put forward. It 
changes the psychology. We know that.
  But just to explain it, in a patient-centered account, a patient was 
telling me, he goes to a doctor. The doctor writes him a prescription, 
$159. He says, doctor, you have given this to me before. It is $159. 
Listen, I have got a health savings account. Can you write me something 
cheaper? He goes, oh, I am sorry. He writes him a $20 generic, so the 
system just saved $139.
  I actually think the power of millions of individuals making 
decisions at $139 a decision has more ability to control costs than 111 
boards and commissions in Washington, D.C., that are attempting to 
control health care in all the small towns across the United States.
  Mr. ROE of Tennessee. If the gentleman will yield for a moment, you 
are absolutely dead right on this. In my district, I visited four 
businesses, one is the City of Johnson City, Tennessee, where I was 
mayor. Another is Holston Munitions, or BAE Corporation.
  They have instituted a wellness program that in the last 5 years they 
have not had a premium increase. What they have done is they have 
basically incentivized behavior, for instance, smoking.
  If you smoke, and one of my good friends had a patient come to him 
the other day, and he said last spring, and this was in June, she said 
I have to quit smoking by the first of July. He thought, that is pretty 
good. I am glad to hear that. They've been trying to get you to quit 
for several years. But why are you going to quit? She says well, my 
insurance changes and they are going to penalize me if I smoke. It is 
going to cost me money.
  So, if you don't smoke, or you get your hemoglobin A1C, which is the 
way we monitor your sugar and diabetes, to get your hemoglobin A1C 
down, you lose weight, they will pay you for that. So you can earn the 
money back. And they have done that with their wellness program and 
been wildly successful.
  To tag-team into your health savings account, just me personally in 2 
years, and people will say that, well, you can't use that in Medicaid 
or you can't use that, I absolutely disagree with that. In our own 
medical practice, of the 294 people that get insurance through our 
practice, 84 percent use a health savings account. These are the folks 
that check you in at the front and draw the blood and the nurses that 
assist us and so forth. So it works very well for everybody. We all 
respond.
  Mr. CASSIDY. If the gentleman will yield for just a second, this bill 
specifically excludes small businesses from doing what you described as 
a wellness program. That effective program is specifically excluded. So 
the patient-centered program which was so successful in Johnson City is 
not allowed in that 2,000-page bill.
  Mr. BURGESS. If the gentleman would yield, you bring up a great point 
about tobacco. One of the problems with this bill is you are not 
allowed to rate on tobacco use. In fact, there will be only 2 ratings 
bands, based on age.
  Health savings accounts--I am a big believer. I have had a medical 
savings account since 1996. I skipped for a few years when I came up 
here, and we didn't have them available. Now I have it established 
again, and it is working very, very well. But the problem is, that will 
not be a qualified plan. It will not meet the minimum benefit standards 
under the new health care commissar that is going to be developed by 
this bill that we have before us. So the very thing that may lead to a 
reduction in costs, we are not going to be allowed to have.
  Now, since the gentleman disagreed with me, I do feel obligated to 
point

[[Page H12195]]

out that it is not that Republicans don't have alternatives or 
shouldn't have alternatives. I individually have 20 bills dealing with 
health care under my name and have cosponsored at least 30 additional 
bills. There are a plethora of bills out there with Republican names 
that do everything from fix the problems that doctors have with the 
sustainable growth rate formula in Medicare to liability reform. They 
are not part of this bill. They are not part of the discussion this 
week. What is the discussion this week is that monstrosity behind the 
gentleman.
  It is our obligation, it is our obligation to our patients and to our 
profession to kill this bill so we can then begin to talk about some of 
the alternatives that are rational, because it makes no sense to 
preclude a wellness program simply because it doesn't fit into some 
chairman's idea of what a health care bill should look like, some 
chairman who might have been here since 1974, by the way.
  That is the problem we have before us this week, is this bill. After 
we get rid of this bill, after we get past this bill, yes, we can begin 
to talk about those things to provide benefit to the American people, 
help to the American people who actually need it.
  You said it earlier in this hour. It is that 8 to 10 million people 
that have a preexisting condition. If we could make their problem go 
away, and we can, the Congressional Budget Office estimates between $8 
billion and $20 billion over 10 years. That is a far cry from $1 
trillion. We could make that problem go away with State reinsurance 
programs and State high-risk pools. We have that power within our 
hands. Some people may argue that constitutionally we don't have that 
power, but it would be a darn sight better than what we are talking 
about doing tonight.
  Mandates have no place in a free society. There was no mandate that 
required me to buy an iPod, yet everyone in the country has an iPod or 
iPhone today because it is a great product, and everyone wants one. 
That is what we should be looking at in our insurance policies, how to 
create products that people actually want, not making someone take a 
policy that the insurance company says I can make money selling. That 
is where we will go with mandates.
  Mr. ROE of Tennessee. Reclaiming my time, I would also say it takes 
away personal freedom to decide what is best for your family. For 
instance, in my family now we don't need fertility evaluations that 
maybe other families do need. They should be able to purchase those if 
they need to.
  I want the viewing public tonight to take a peak at H.R. 3962, which 
is a new name for H.R. 3200. I would encourage you to begin to read 
this. It will take some time. But the American people did read H.R. 
3200. They actually did. I had hundreds that came to me at town halls 
that printed it off the Internet and read it. It is probably just out 
on the Net.
  It is amazingly complex, and the devil is in the details. When you 
start reading the details, and I did begin the details today, that is 
where you begin to see what you lose in this.
  Mr. CASSIDY. If the gentleman would yield, I was a little late coming 
over here because we were having a telephone town hall. For the folks 
who are watching, that is where we from Washington have a phone call 
that goes out to thousands of people in our district, and we have a 
telephone town hall.
  There was a woman that got on and she just nailed it. You pointed 
out, we have a 2,000-page, $1 trillion bill that was introduced last 
Thursday that we are going to vote on this coming Friday that is going 
to remake 17 percent of our gross domestic product, drastically 
affecting the health care for us all.
  If it seems kinds of crazy that we would do that, this woman calls 
in, Rebecca, and I happen to know the family, I didn't realize it was 
from her family, and they are very bright people, very hardworking, 
good people.
  So here is kind of her quote. She went to the Kaiser Family 
Foundation site to determine what her costs would be under the bills 
before Congress, and she figured out that her family's costs would 
double.
  She says a small business is going to do a cost-benefit analysis, and 
they are just going to dump patients upon the public option because, 
why shouldn't they? Now, she says, I am quoting her, it seems like the 
people writing this are obtuse. They are not writing this for the 
middle class of the Nation. It is not centered on the patient. It feels 
rushed. It doesn't make sense; 2,000 pages, one week to digest it. It 
feels rushed.
  She finishes up by saying, for all the possible plans, our premiums 
will double. It is very expensive. You can't get ahead. The more 
productive a citizen you try to become, it is like you take one step 
forward and go two steps back.
  This is a bill which is two steps back.
  Mr. BURGESS. If the gentleman would yield on one point, it is hard to 
see if we make health care more expensive that we are going to make it 
more affordable.
  I yield back my time.
  Mr. ROE of Tennessee. I think, in summary, in closing up this 
evening, what we have got this week is a discussion, I think the single 
biggest social discussion we have had in this Nation in 50 years, since 
Medicare. The challenge is how do we make health care affordable, and 
how do we provide it for the citizens now who don't have it?
  I think, as Dr. Burgess stated just a moment ago, that right now, the 
bill before us, they are not our solutions. We keep hearing there are 
no Republican solutions. There absolutely are. They are not on the 
table. They are not being discussed. This bill right here, H.R. 3962, 
all 1,990 pages, that is what we are discussing this week, and, as Dr. 
Fleming said, we are probably going to vote on this week.
  So I think that this needs to be looked at as quickly as we can by 
the American people to try to peel this onion back, so to say, and look 
at what's there. I appreciate my colleagues being here tonight, and 
we'll be here throughout this week to further discuss this bill and 
what is in this bill.

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