Congressional Record, Volume 156 Issue 2 (Tuesday, January 12, 2010)

[Congressional Record Volume 156, Number 2 (Tuesday, January 12, 2010)]
[House]
[Pages H22-H30]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE BILL

The SPEAKER pro tempore (Mr. Quigley). Under the Speaker's announced
policy of January 6, 2009, the gentleman from Texas (Mr. Burgess) is
recognized for 60 minutes.
Mr. BURGESS. Mr. Speaker, I would like to continue much as we have
done over this past hour, talking about this same issue, the health
care bill that is now before the House and Senate, even though none of
us have seen the finished product, and what has happened on the issue
of transparency over these past several weeks since the House adjourned
in the middle of December.
I am going to talk a little bit more about the resolution of inquiry
because I believe that is an important tool that is available to the
minority Members of the House. And I think it is a tool that we need to
use, a tool that we need to exercise in order to get the American
people the information that they are going to need to make up their
minds about this bill.
If time permits, we will talk a little bit about some of the
structural issues, some of the procedural issues that still are yet to
occur if this bill indeed passes and is signed into law: What are the
ramifications thereof? When will things happen? What will occur at the
level of the Federal agency at the Department of Health and Human
Services?
But I thought, first, it might be useful just to do a brief recap of
where we have been this past year.
As most of us know, it has been not quite a year since the
inauguration took place here in January of 2009, a historic day. A
record number of people came and stood to watch the inauguration and to
hear the speeches that occurred that day.
We had a very spirited campaign during the fall. We had the
appearance, for the first time, of some rather stark economic news that
hit the headlines and perhaps dictated some of the course of the
campaign, and certainly

[[Page H23]]

dictated some of the course of the very early legislative process in
this body.
I will tell you, as someone who watched the campaign of 2008 for
President, as someone who watched that very closely and was very
interested in the health care policy aspects of that campaign, I was,
frankly, surprised. When the campaign came to a conclusion and the
votes were counted and the President won, I was surprised that there
was not a bill that was almost ready to come to either the Senate
Finance Committee or one of the committees of jurisdiction on the House
side.
I rather expected that to be the Senate Finance Committee, because in
October of 2008, Senator Baucus, the chairman of the Senate Finance
Committee, convened several stakeholders over in the Library of
Congress in the Members' briefing room there, had a day-long session,
and took testimony and began, for all the world, to look like he was
crafting a health care bill; produced a white paper shortly thereafter
that, for all the world, looked like it was going to be a health care
bill.
So after the election, I thought that we would see, relatively
quickly, the introduction of at least some draft language as to what
this health care bill was going to--what form it was going to take now
that the election was over.
We all remember the election. Senator McCain had his ideas on health
care. We might come back to those in just a moment, because some of
that, we are back to the future now with some of those same tax issues
that are now being raised by the Democrats as a means to pay for the
Democratic health care bill. They are talking about using some of the
same procedures that Senator McCain was talking about during the fall
of 2008. So that is a little bit of irony, when they spent so much
money blasting the Presidential candidate on the Republican side over
his approach to health care.

But we heard President Obama's approach. He said there was going to
be a mandate to cover children. He said there was not going to be an
employer mandate nor would there be an individual mandate, but that
anyone who didn't have insurance would be able to have insurance just
as good as a Member of Congress under a program like the Federal
Employee Health Benefits Program.
So those were the issues that were discussed and the platform that
the President produced during the campaign. Then we had the election. I
again was surprised that no bill came forward. I thought perhaps that
Christmas of 2008 we might see from perhaps one of the Senators or from
someone on the House side, again, at least a draft or an outline or
some structure of what this bill was ultimately going to resemble.
Then everyone came back to town for the swearing in in early January
of 2009. We stayed around for the inauguration. Three weeks later, the
inauguration occurred. And I thought, well, very quickly now we will
see some structure on the health care bill.
Now, arguably, there was a great deal of difficulty with the economy.
The stock market was in free-fall in those days shortly after the
inauguration, and there was a sense of urgency to do something about
the economy.
I think the wrong decisions were made in February. But, in all
honesty, I think the wrong decisions were made in September and October
of 2008, when President Bush put forward the economic stabilization
plan and Secretary Paulson, then-Secretary of the Treasury, put forward
the economic stabilization plan that they proposed in late September of
2008. I thought those ideas were wrong. I thought the stimulus bill was
wrong in February.
In fact, when you look back over this year and you look at the
expenditure of political capital on that stimulus bill, had the health
care bill been ready to go, had there been anything more than just
rhetoric during the campaign, and had there actually been legislative
language laid down or at least legislative principles developed from
which legislative language could be developed; if we had taken that
health care bill up in February, because of the enormous popularity
that the President enjoyed in those early days after the inauguration,
I think that the President could have pretty much gotten whatever he
wanted during those early days. But the decision was made, for whatever
reason, not to do that, but to go forward with the stimulus; and that
is the legislation that came out of February.
We also had a bit of a disconnect with the nomination for the Cabinet
Secretary position for Health and Human Services and the name
originally put forward. In fact, that individual had cleared through
the Senate committees that were necessary to confirm that individual.
But then, for problems that no one could have foreseen, that individual
withdrew his name from consideration, and we went for several months
without an agency head at Health and Human Services. And I think you
can see during that interval that the agency did suffer from not having
anyone at the helm at that point of that organization, because,
obviously, Secretary Leavitt left upon the completion of the Bush
Presidency, and there was no name at that point even to be confirmed by
the Senate. So it was problematic that there was not a Cabinet
Secretary named for Health and Human Services. And I think, in
fairness, that did cause some of the delay on the health care front.
We had, of course, as will always happen during the course of our
legislative year here, we had things that happened around the world,
things that happened in this country. We had a novel flu, H1N1, that
came on the scene that took a lot of attention and time and discussion.
We still had problems with the economy. No bill was produced during all
this time.
Now, when the Senate Health, Education, Labor, and Pensions Committee
met in June for the first time, they began to hear and began to mark up
a bill in the Senate committee. And that was really the first glimpse
that the American people had of what this new administration and what
this new Congress was going to do as far as health care policy, and it
was startling. It was a startling revelation because the cost and
coverage numbers that came out of the Congressional Budget Office were
some of those first passes through the Health, Education, Labor, and
Pensions Committee in the other body, some of the cost and coverage
numbers were quite startling.
The cost was quite high, the coverage numbers were quite low, still
leaving many people in this country uninsured; and there was quite a
scramble to try to adjust things, try to pull the costs down and try to
bring the coverage numbers up. In fact, we saw that evolve over the
next several months, not just in June, as the Senate Health, Education,
Labor, and Pensions Committee dealt with the bill, but on into the
summer when the three committees in the House who have jurisdiction
over the bill, as they dealt with the bill, and then finally the Senate
Finance Committee for the last part of the bill. We saw quite a bit of
maneuvering and some magic numbers occurred.

We have got to keep the cost under $1 trillion. I think $900 billion
is where everyone generally agrees they want to keep that number. And
if you exclude people who are in the country without the benefit of a
Social Security number, we have got to insure in excess of 90 percent,
perhaps 93 or 94 percent. Bearing in mind that 85 percent are insured
today, we want to get that number up to 90, 92, 93 percent for that
cost of nearly $1 trillion over 10 years.
So there was a lot of maneuvering around cost and coverage. Cost and
coverage really hadn't been a discussion during the campaign of 2008.
Cost and coverage really wasn't a discussion around the time of the
inauguration. But cost and coverage really stole the show during the
summertime.
Now, that was complicated because we had just gone through a
terribly, terribly difficult budgetary process in the House and in the
Senate, and the deficit numbers were higher than anyone ever thought
possible, that anyone thought that they would ever see in their
lifetime. So we were already dealing with a budget that was literally
bursting at the seams, and then we found a $1 trillion price tag on
this bill that came out of the Senate.
And then, for reasons that I just simply cannot explain, the
leadership of the House of Representatives decided in June, while all
this drama was unfolding with the Senate, Well, we will just do the
cap-and-trade bill. We will just do this energy bill and raise taxes on
energy, and maybe that will help us offset some of the cost of this
health care bill. It was the darnedest thing I had ever seen.

[[Page H24]]

We had marked up a bill in committee. It seemed pretty terrible to my
observation during the committee process, but nevertheless we marked up
a bill that was voted out of committee, and then it just lay there for
about a month. It was like no one wanted to touch it. People were
stepping around it. No one wanted to actually address this cap-and-
trade bill.
Then, suddenly, it was brought to life, brought back from the dead,
literally, and passed within less than a week's time here on the House
floor. And we passed it late in the day right before we left for the
4th of July recess. After the news shows and the news cycle was over
for that weekend, we passed that cap-and-trade bill.
I remember walking out of this House. It was a scant number of votes.
There really were not a lot of the excess votes that the Speaker had
for that cap-and-trade bill. And I remember walking out of here, and
this was not a good feeling of what the House just did.
I have got to tell you, when I got home to my district on Saturday
morning, just 12 hours later, the people in my district were up in arms
about what the House had done. Even though I had voted against the cap-
and-trade bill, there was a lot of anxiety and, in fact, anger in my
district because I hadn't stopped this legislative travesty from coming
forward. And what in the world did Congress think it was doing with
passing this type of energy tax when the country was faced with this
severe a recession?
We just had a summer before where gasoline prices had gone through
the roof. We perhaps got a little bit of relief there, but it was only
because the economy had faltered, but at least energy prices were down.
And, now, you are going to raise taxes on energy to put us right back
where we were the year before? I don't think so.
So a lot of Members came back here from that July recess
significantly set back by what their constituents had told them during
the recess over the July 4th weekend.
You can just imagine, Mr. Speaker, walking in your 4th of July
parade. You are somewhere behind the American Legion, in front of the
Cub Scouts. And as you are walking down Main Street in one of the
cities in your district, people are yelling at you from the side about
this bill that you passed. And nobody read the bill. That had been over
the news. And people were yelling: Next time, read the bill, and even
adding adjectives to those exhortations.
So many Members of Congress came back a little bit shaken by what
they had encountered in their districts because of some of the actions
that Congress had taken.
People thought nobody would notice about us passing a cap-and-trade
bill late on a Friday afternoon or late on a Friday night right before
a holiday break, but the American people were engaged. The American
people were paying attention. And as a consequence, as we worked our
way through July, remember, the big scheme or the big plan was that we
were going to take this bill up in the three House committees, my
committee of Energy and Commerce, the Committee on Ways and Means,
Committee on Education and Labor.
Those three committees were going to take up identical bills, work
through them, pass them out of their committees, and then we were going
to bring the health care bill to the House floor, vote on it right
before the August recess, was the plan, and then we would all go home
for the August recess having passed this massive health care bill.

{time} 2115

Well, it didn't work out like that. Now, the time for the markup in
committees was significantly condensed. Although, no, we're not
supposed to talk about process too much, I will tell you this is the
type of legislation that really, yeah, it's going to take months. My
understanding is--I was not here in 1990 when the Clean Air Act was
passed, but it was my understanding it was a months-long markup process
in Energy and Commerce. That's the way it should be.
This is complicated legislation. It's going to affect a lot of
aspects and a lot of people's lives. There really was not a reason to
rush this through unless you didn't want anybody to know what you were
doing. And that's the impression that the American people got from this
Congress, that we were trying to do it fast so we could sneak something
through before anyone really realized what had happened to them, just
as we did with cap-and-trade. But because we did it with cap-and-trade,
the American people said, Aha, not so fast, and you saw Members begin
to waver. And they wavered just enough so that the bill did not pass
out of all three committees until we were right up against the August
recess.
The bill passed out of my Committee of Energy and Commerce, which was
the final of the three committees to mark the bill up. I think we got
more time than any of the other committees. Some just had a single day,
a 24-hour period, to mark up this complex and complicated legislation.
We had at least had several days, though there were several of those
days that we didn't actually work while the Democratic leadership tried
to fine-tune the bill and take some of the rough spots out of it. But
we did have at least a period of time in our committee to read the
bill, become familiar with it, and then it passed.
One of the myths that I should dispel is that the Republicans were
not involved in the process. Republicans have been involved in the
process from day one. Number one, I was involved in the campaign in
2008. I talked to the transition team right after the election and
said, Health care is going to be important this year. I know something
about that. I would like to be consulted as you write this legislation.
I went to my chairman with the same comments. I didn't give up a 25-
year medical career to sit on the sidelines while Congress deals with a
bill that affects most of my friends back home who are physicians. No.
I wanted to be involved in that process, but we never were.
We were never asked. We were never consulted. We were vilified along
the way that we had no ideas and that we would not offer ideas. I had
50 amendments--50 amendments that I offered in committee, in the Energy
and Commerce Committee. Now, some of them were great amendments, some
of them were relatively modest amendments, but every one designed to
improve what I thought was a bad bill. Now, it was still likely to be a
bad bill at the end of the process, I was likely to vote against it,
but at least it would be a better bad bill as it came out of committee
than it would have been had there been no input.
Now, in fairness, the committee did ultimately accept several of my
amendments, and several of my amendments were put in the House bill as
we passed it out of committee July 31. Unfortunately, those all left
the bill some time after that when the bill went to the Speaker's
office to be rewritten. But I appreciate the fact that the committee
was able to or was willing to accept at least a few Republican ideas.
Then the bill goes to the Speaker's office. A great deal of mystery
surrounding it. Where is the health care bill? No one knows. No one
knows what's going to happen to it. Are we going to get it the first of
October, are we going to get it the middle of October? Remember, the
President came right here to the House of Representatives and spoke to
a joint session. It had the Senate and the House, both sides. You may
remember there was some excitement that night because of some debate
that occurred on the floor during the President's speech. But the
President said, I welcome ideas from both sides. I want Republicans to
offer ideas. But when we offered ideas, the sound of crickets chirping.
The President said during July that, You know what, I'll invite any
Republican Member to come down to the White House and go through this
bill line by line so they will understand what I'm trying to do. I
said, Great, Mr. President. Fired a letter off. Made a call down to the
White House. That was around the time of the famous beer summit that
you might remember. I said, I don't drink beer, but I'll bring Diet
Coke if that will help pass the time. But I would appreciate the
opportunity of going through this bill line by line. Again, never heard
a word. Did see something quoted indirectly in one of the newspapers on
the Hill that the White House really was not interested in speaking
with me on that subject.

[[Page H25]]

The President then offered during that speech in the middle of
September, the President said, I will sit down with anyone. It's
interesting. The President will sit down with Ahmadinejad and Hugo
Chavez without preconditions, but he's not sure about congressional
Republicans. But that night at least he said, I'll sit down and meet
and talk with congressional Republicans about this bill. Again, great
many ideas to offer, Mr. President. I even produced a summary of the 50
amendments that I'd introduced in committee, many of the health care
bills that I'd introduced during the course of this year, and said,
Let's talk about some of these ideas down at the White House. Again, no
answer back for that.
In October, kept trying to get information out of my committee
chairman--the Subcommittee on Ways and Means--Mr. Stark, my
subcommittee chairman, Mr. Pallone. When can we see a bill? We're going
to get this bill and we're going to take some time to read it and
understand it. When can we see this bill?
Well, you'll have plenty of time. Don't worry about that. It will be
coming along at some point. Maybe it's too complicated to read before
we vote on it.
That bill left our committee July 31, in excess of a thousand pages.
We went home to our August town halls during the summer and people
didn't like a thousand-page bill changing their health care. They said,
Members of Congress won't read it. You won't accept the insurance for
yourself, so we don't want it either. A thousand-page bill upset
people. That was actually a revelation for me during the summer. I
thought the Republicans ought to have their own bill to counteract the
Democratic bill, but, in fact, what people were telling me is, We'd
like to see you do something specifically with preexisting conditions.
I'd like to see some specifics on increasing competition by being able
to buy across State lines. We'd like to see something specific about
holding down health care costs by offering some sensible liability
reform, which we don't see in this bill. These were the things that the
American people wanted us to see. Perhaps you might even argue that
seven small bills might have been better than one large bill.

What happened next was after that bill left our committee at a
thousand-plus pages, it went over to the Speaker's office, and then in
secret, with the White House participating, no Republicans, and I
submit no back-bench Democrats were involved in that process either,
the bill comes out at the end of October, the first of November, and
it's 2,000 pages. Well, if a thousand-page bill upset people some, a
2,000-page bill really upset them. As a consequence, we heard from our
constituents. In my office, the phones were ringing off the hook day
and night, calls almost uniformly against whatever was going to happen
next in the House with the passage of this bill. As people learned more
about the bill, they got more and more uncomfortable about it.
What occurred next was we passed this bill on the floor of the House
late on a Saturday night after we'd been kept up here all week and all
weekend to pass this bill. It passed by a slim, slim number of votes.
In fact, just a few votes changing one way or the other and the bill
would not have passed.
It was interesting that the Cable News Network, CNN, produced a poll
the morning that we voted on the bill. And I don't remember the precise
numbers, but it was approximately 26 percent of the American people
liked the bill the way it was and wanted us to pass it just the way it
was. A larger number, perhaps 35 percent, wanted major changes in the
bill before it was passed. A similar number, about 25 percent, felt
that Congress shouldn't even be doing this, that we were overstepping
our authority by even working on health care. And then a smaller number
was simply disinterested.
So you had 26 percent of the American people thought we were doing
the right thing that day when we passed that bill. So it's no great
surprise that after that bill passed that, again, many Members have
heard from their constituents and, again, there's a great deal of angst
and anxiety out there in the country over what has happened. But,
undaunted, they picked it up in the Senate and let's go forward. Let's
get this bill done. And you heard it discussed in the last hour.
I've told people now for several weeks what we're doing up here has
really nothing to do with health care. When's the last time you heard
anyone talk about a vaccination rate, or when's the last time you heard
anyone talk about something to reduce hospital-acquired infections? No,
we're not talking about that. We're talking about how many Medicaid
dollars do we need to give away in Louisiana in order to secure a
Senate vote. It's an arithmetic equation. The first one to 60 wins.
And, as it turns out, the Senate majority leader and the Senate
Democrats have 60 votes, and they were able to collar in every one of
those and pass the bill right before they left on Christmas Eve. So
Santa Claus may have put coal in the stocking of many Americans who
were expecting something worthwhile to come out of the House and Senate
this year, but he left the Senate floor on Christmas Eve and now is our
first blush back in the Chambers to deal with the aftermath.

Now what has caused all the flap since then is normal process is the
House passes a bill, Senate passes a bill. There's going to be
differences. The House is a different structure than the Senate. The
House has a 2-year term. There are more of us in the House. We tend to
be a little more rough-and-tumble than the gentlemanly arena over in
the Senate, but that's the way the Founders designed it. So there's
always likely to be some differences between the House and the Senate
bill. That's not a problem.
The House and the Senate have a way of reconciling that. They get the
two together and let's call a conference committee. Conferees are
appointed by the Democrats in the House, the Republicans in the House,
the Democrats in the Senate, Republicans in the Senate. The conference
committee meets and works out the differences. It might pass on a
party-line vote. Of course, there are more Democrats on the conference
committee than Republicans but, hey, they won the election, and that's
what elections are all about.
But the conference committee is not going to happen because--it's not
going to happen because this debate now has become an internal debate
on the Democratic Party. We will continue to be blamed on the
Republican side for obstructing this bill, but please understand there
is nothing that we can do. We lack the numbers to stop this bill--
supermajority in the House, a 60-vote majority in the Senate. All the
Republicans can stay together and the bill still passes because we just
simply do not have the numbers.
The arguments that are going on right now are arguments entirely
within the Democratic conference. And it is a conference committee, if
you will, of the Democratic conference where they're trying to work out
the difference the Democrats have with Democrats over the bill, and
ignore the Republicans--blame them, to be sure, because they're useful
to blame as being obstructionists, but realistically no Republican is
obstructing or slowing down this bill. We can't. We would like to, but
we can't.
Now, actually, there is perhaps something that might happen. We
talked a little bit earlier about sometimes events that happen, change
things here in the Chambers, events that happen out of the country.
There is going to be a special Senate election in one of the States in
the next week's time. In fact, a week from today there's going to be an
election from the Senate. If that Senate seat were to change from
Democrat to Republican, that would shift the balance from 60 Democrats
to 59 Democrats. I'm sorry, 58 Democrats and two Independents that vote
with the Democrats for a functional 60-vote majority in the Senate. But
they could lose one of their votes. What happens then? Can we rush this
bill through before that new Senator can be sworn in to stop things? I
don't know. It will be interesting to see what the plans are, what
people try to do. But that could be a game changer that no one would
have anticipated a month ago as we left out of these Chambers, that a
Senate seat that has historically been in Democratic hands for years
and years and years could possibly change.
But such is the angst of the American people over what they've seen
us

[[Page H26]]

do. And because we've done so much of it, so much of it in secret in
the Speaker's suite of offices, again, with the heavy hand of the White
House applied at all times; the Majority leader's office over in the
Senate, with the heavy hand of the White House applied at all times,
why shouldn't--okay, fine, lock the Republicans out.

{time} 2130

We lost the election. Maybe we deserved to be locked out, but don't
lock the American people out. Which kind of brings us back to the issue
of C-SPAN and Brian Lamb's letter to the President. We have all heard.
We saw on the news shows a couple days ago. We saw the multiple clips
that were up on various Web sites of the President during the campaign
saying over and over, I want this process to be open. I want the ideas
to be brought in. I just ask that we do this out in the open, around a
big table. Bring the C-SPAN cameras in so all can see. If your Member
of Congress would rather stand with the special interests than stand
with the American people, I want you to see that.
Mr. President, I think you got it right. I want to see that. That's
the reason I filed the resolution of inquiry. Because if a Member of
Congress is going to stand with a special interest--and not all special
interests are Republican special interests, bear in mind. Some of them
may be a union special interest on the Democratic side. We heard
another discussion tonight by the AARP. Who knows where the special
interests are? The American people know, and the American people need
to be able to watch that and make those decisions for themselves. This
is a big deal.
The first President Bush, during the campaign for President, famously
said that the Democrats are going to come to me with tears in their
eyes and say, Raise our taxes. And he said that I'll turn to them and
say, read my lips, no new taxes. And then he walked back from that
pledge, and it cost him. It cost him in the next election. It cost a
lot of credibility on the Republican side for a President to walk back
on that pledge. So if you have a President who said that this is going
to be such an open and aboveboard process that I'll put the cameras in
the room, you'll be able to see which Members of Congress are aligning
with the American people and which Members of Congress are aligning
with the special interests, who's taking up for the insurance
companies, who's taking up for the drug companies, who's taking up for
the unions, who's taking up for this special interest group or that
special interest group? You will be able to see that on C-SPAN, and the
President has now walked back from that pledge. In fact, his press
secretary wouldn't even openly acknowledge that they were walking back
from that pledge.
Well, let's stop and think for a minute. What is the symbolism of C-
SPAN to the American people? People are watching tonight on C-SPAN. C-
SPAN is like a window into Congress. It's impartial. It doesn't have an
editorial objective. It doesn't come with an agenda. Sometimes it can
be frighteningly boring, but at the same time, it is what the American
people have identified as their way to keep an eye on Congress. My
predecessor, the former House Majority Leader Dick Armey, when he was
deciding to run for Congress that first time back in 1983 or 1984, said
that he watched the proceedings on C-SPAN, and it troubled him, and he
thought he could do better.
You know what? The same thing applies to me. I watched C-SPAN from
labor and delivery on the little television that the hospital provided.
And I would see things happen, like the House vote on an increased
expansion of the debt limit, and I would get frustrated and upset. C-
SPAN has been a way to invite the American people back into the
people's House, and that has been an important aspect of what has
happened with C-SPAN. But think back for just a minute. Why did C-SPAN
happen? It wasn't just something that got created on the eighth day
because they were running out of things to do. C-SPAN happened because
of Watergate. C-SPAN happened because the Watergate hearings that were
held were covered by 24-hour continuous, live television coverage.
Television executives said, Nobody is going to watch that stuff.
That's so boring, no one's going to watch that. It's like watching your
grass grow, watching your grass die in wintertime. But people watched,
and they were fascinated by the process. As a consequence, the C-SPAN
cameras then came on, and they have not been turned off from Watergate
until this day. And the American people get that. C-SPAN is synonymous
with good government and good governance.
So if you're not proud enough of your work to put it up there on C-
SPAN, what have you got to hide? Why have we developed the major House
legislation completely in secret? Why have we developed the major
Senate legislation--which now, by the way, is up to 2,700 pages. Why
have we developed that completely in secret? I say the White House was
involved. We all know that people from the White House were here in the
Capitol building the days that those bills were worked on. But since we
couldn't watch it on C-SPAN, we don't know who from the White House was
sitting in, what they were saying, whether they were simply standing
there with their arms folded, or were they participating? Were they
part of the give-and-take, Hey, if do you this, we'll do this. We'll
try to help you with this. We'll try to protect you here.
We don't know because none of that, none of that has been available
to the American people. But the American people do get this. C-SPAN is
good government. C-SPAN is good governance. C-SPAN is sunshine on the
process. Sure, there's a value in opacity. Anyone can tell you that.
But if you're able to kind of get, you know, some of the guys together
in secret and kind of work things out amongst yourselves, and then you
come to the House floor and say, Well, here's what we think the
American people want. No, it's what these guys decide by themselves
behind closed doors. Nobody wants that. Republicans lost the majority
because the then minority leader Nancy Pelosi said that the Republicans
were crafting bills in secret with the special interest groups, writing
the legislation.
Well, guess what, folks: Nothing's changed. It's just different
special interest groups today than perhaps there were 5, 6 or 7 years
ago. The way to ensure that this process is fair and above board is to
keep the cameras on, not to include the Republicans in the room. I
think we should be in the room, by the way. But that's not necessarily
the key to the transparency. The key is to let the American people in
the room if they choose to do so. If they're uninterested, if there are
other things going on, if there are football playoffs, Final Four,
beauty pageants, and the American people are not interested and don't
want to watch the goings-on on C-SPAN, so be it. They had the
opportunity. They chose to do other things. No one to blame but
themselves if they don't like the final product.

But at least they had the option of turning on that channel and
watching the proceedings. Our committee hearings, our committee markup
was covered on C-SPAN hour after hour after hour, and many of us would
sit there and write in little Twitter messages about what was going on
now in the committee process. And the three people who are interested
in what I send out on a Twitter feed were grateful to get that little
bit of information, that little kernel of information. Then they go
turn on C-SPAN and say, Yeah, sure enough they're talking about
community organizers in health clinics now.
Well, the American people ought to have that option, and the fact
that they don't, the fact that we will not give it to them then raises
the question in their minds, What do we have to hide? You've got a big
bill, now 2,700 pages. We don't think you're reading it. We don't think
you'll take the insurance that it produces for yourself, for your
families. Why should we be satisfied about what you're doing to--we
heard it quoted earlier--one-sixth of the American economy? Why should
we be satisfied that you're going to change the health care arrangement
that 85 percent of the country says they are either satisfied or very
satisfied with? Why are we going to change that arrangement simply to
bestow additional political power on a select group of Members of
Congress and Senators?
Because remember, this bill has nothing to do with health care any
longer. If you don't believe me, watch--

[[Page H27]]

oh, you can't watch, that's right. But remember what happened over on
the Senate side. This wasn't about how do we improve outcomes. This
was, how do we get the outcome we want, which is to pass this bill?
There is something wrong with the process when you say, We can't let
you read it. We can't wait. We've got to do it in a hurry. And oh, by
the way, the benefits that are going to come to you off of this bill
actually start in 2014. Your taxes will start next week.
The American people get that. That's a problem. It's a 2,700-page
bill--or at least the one that they passed on the Senate floor was.
Goodness knows what it will look like. Whatever happens to it, it's
going to be a big bill. There is going to be a lot of legislative
language. Well, what happens to legislative language after the bill
becomes law? The President signs it down at the White House, a big
signing ceremony. People from all over gathered around him, a great day
is had by all, a wonderful photo op. What happens then to this signed
piece of legislation, this public law that has now been created through
this very flawed process?
Well, it goes over to the Federal agency, the Department of Health
and Human Services. And there the rules and regulations are written
that will dictate what happens in health care to everyone in the
country. Those rules will be written, and they'll be written in secret
as well. To be sure, there will be a notice of proposed rulemaking.
There will be thousands and thousands and thousands of pages generated
in the Federal Register of this notice of proposed rulemaking and the
rules and regulations that come out of this 2,700 page bill. I would
submit that those rules and regulations will probably number in the
tens of thousands of pages once it gets through the goings-on over at
Health and Human Services.
But here is something that's kind of strange about all of that. One
of the big arbiters of those decisions is an individual who is in
charge of a part of the agency of Health and Human Services, the
Centers for Medicare and Medicaid Services. CMS we call it. CMS has an
administrator. The administrator at CMS is going to be the one in
charge of writing a lot of those rules and regulations.

Well, now, who is the administrator at the Centers for Medicare and
Medicaid Services? Let's stop and think for a minute. Well, there isn't
one because a year into this administration, no name has been put
forward to the Senate for confirmation for the administrator of the
Centers for Medicare & Medicaid Services. And yet we're in a rush to
get this bill passed. We've got to get this thing done. Time's a
wasting. People are hurting. We're going to pass this legislation. It's
going to go over there to an empty auditorium until that position is
filled. It's not the Senate that is blocking a Presidential nomination.
Don't fall for that. There has been no name put forward in a year's
time.
Now, do you think there's going to be a fight over that nomination
over in the Senate? Yeah. I'll bet there is because that individual is
going to hold a tremendous amount of power with a 2,700-page bill that
affects every jot and tittle of how medicine is practiced in this
country. Yeah. There is going to be a pretty big fight over in the
Senate, and there should be because it is going to be a very, very
powerful position.
So we certainly don't want to rush someone through like we've seen
with some of the other Federal agency heads in this past year and have
someone in that job who doesn't fit the bill. We want someone who is
competent. We want somebody maybe who has run an integrated delivery
system at some point along the line. We want someone who has some
experience in dealing with not just the creation of health care policy
but the actual delivery side, putting the meat on the bones, if I can
use that analogy, someone who has actually worked in the trenches in
health care.
I think that would be an enormously important first step. But again,
we don't even know who that individual is at this point. Since the
acting administrator left at the end of the Bush administration, it has
basically been filled by agency personnel who are career bureaucrats,
and their ability to deal with a 2,700-page bill is anyone's guess. I'm
not being critical of the Department of Health and Human Services.
That's just the way it is. Right now you've got people who are acting
in that capacity, but they are not direct Presidential appointees.
So there is not that accountability. There has not been advice and
consent from the Senate, as is required under the Constitution for a
Presidential appointment. This is not a czar, after all. This is an
actual administrator of one of the agencies within the Department of
Health and Human Services. So there are a lot of moving parts yet to
happen.
Now we've seen this bill have more than its share of near-death
experiences. Maybe it would be the best thing if one of those near-
death experiences actually stuck and forced us to go back and craft
something that would actually be useful for the American people. Now
I'm not talking about delaying. Remember, it's 2014 before any of these
good and great and wonderful programs are going to come to a town near
you. There is no urgency about implementing any of the great things
that have been talked about in conjunction with this bill. They are
going to languish by the wayside.
So since we have that gift of time, why not try to get it right?
Because I will tell you this: I've heard people say, Well, let them
pass their bill, and then perhaps the Republicans can fix it and repeal
the parts they don't like. No, it doesn't work like that. It doesn't
work like that. Once you start collecting taxes from people for a yet-
to-be received benefit at some point in the future, it becomes very,
very difficult to roll that back.
We have a lot of discussion in this House of Representatives about
what are the right things to do with Medicare in the future. And
goodness knows that any one of us might do things a little bit
differently in setting up the Medicare system if we could roll the
clock back to 1965 and start over, but we can't. We have what we have
with that program. And it becomes--as you've heard over and over again
on the floor of this House--it becomes very, very difficult then to
take big chunks of it away. We are going to take $500 billion out of
Medicare. That's going to hurt some people.

{time} 2145

It is not going to be without pain for some people to do that. There
are going to be constituencies that are benefited, and some that are
upset. Such is the nature of doing those types of things. Well, you can
just imagine if you have the whole health care bill and now you are
trying to do that kind of major surgery on that bill after the fact, it
is going to be very, very painful, indeed.
So I would submit that as many near-death experiences that this bill
has had and as many times as it has been resuscitated literally off the
floor of the House and brought back to life, perhaps we would all be
better off if one of these times this bill did not survive, and we went
back and tried to do the right thing. Again, I enumerated those a
moment ago.
What I heard repetitively in the town halls I did this summer and
this fall: we are scared of what you are doing. We don't think that you
are competent to do the things you have said you are going to do, but
we would like to see something done about people who, through no fault
of their own, lose employer-sponsored insurance, have had a tough
medical diagnosis and now find that they are frozen out of the
insurance market, they are on the outside looking in, and it becomes
very difficult for them to get back into a condition of insurance.
We would like to see some of the protections that are out there for
the ERISA-administered plans, we would like to see those out in the
individual market. And we would like to see more flexibility for COBRA
plans, for people who lose their job and then lose their employer-
sponsored insurance; and, oh, under COBRA, you can keep it for 18
months but you have to pay not just your premium but the two-thirds
that the employer was kicking in during the time of your employment.
And guess what, you have just lost your job so that is a very difficult
payment to maintain. I know, I saw patients with this when I was in
practice.
But we could do things to allow more flexibility within the COBRA
plan so that it didn't have to be an identical insurance plan that
person carried under COBRA. It could be a plan that

[[Page H28]]

had perhaps a benefits package that was more in keeping with what that
person could afford at that time. But we don't know; we have never had
that discussion. We have never had a hearing or a discussion on that.
We have never had an opportunity to have a give and take between the
right and the left over what that might look like.
Preexisting conditions, we talk about things like risk pools and
reinsurance. Maybe there is a way to do that. The CBO scored one
proposal that cost $25 billion over 10 years. Well, that is expensive;
but it is a whole lot less than $1 trillion. If that is the main
problem the American people want to see fixed, why not work on that.
Perhaps there is some place we can get that $25 billion without adding
to the deficit. Maybe that would be a legitimate use for some of the
moneys in the Medicare slush fund, but we don't know because we never
tried. We never had the hearing, and we never seriously addressed how
do we do anything other than take it all over, which is what we have
done with this bill.
Liability, the Congressional Budget Office has said there is $50
billion of savings over 10 years or more. Some people say that is a
drop in the bucket with health care costs. Maybe so, but it is a start.
And it is a pretty big drop, and it is one that we can ill afford to
just ignore. Why don't we have those discussions, and why don't we have
those hearings. Why don't we do the right thing for the American people
and not just continue to protect a special interest group who may have
a significant interest in keeping the liability laws the way that they
are.
We have had some big changes down in Texas, and it has improved
things for people. It has brought more practicing physicians into the
State. It gets a lot of criticism because prices and costs have not
come down, but that does take time. A journey of a thousand miles
starts with the first step, and you have got to take that first step,
which is liability reform, before you are ever going to get any of
those other benefits. But, indeed, costs have come down. The cost of
insurance has come down. The number of doctors available for delivering
the care has increased, and we all know the laws of supply and demand:
if you increase the number of doctors in a community, costs will
diminish. People will have more open appointment slots, and they are
anxious to fill them. If there is excess capacity to fill in their
clinics, they are going to want to fill those appointment slots. So
perhaps they are willing to take someone who will pay over time, or
perhaps they will offer a discount to get more people in. That's the
way things work.
Instead, we have this massive government overlay that is going to
control every aspect of your doctor's and patient's life, and it has
never been tested. We have a system that 85 percent of the American
people are satisfied or very satisfied, and we are going to change it
all with something no one has ever seen in this country. God help us if
they don't like it. Well, we know that they don't like it because they
have told us they don't like it. A CNN poll, CNN which generally tends
to be very favorable to programs proposed by this President, generally
tends to be very favorable to Big Government solutions to social
problems, 26 percent of the people polled by CNN said, hey Congress, we
like what you are doing, go get them. The other 75 percent said slow
down and do things differently or you shouldn't even be working on it
at all, or we don't know what you are doing and we don't care. But only
26 percent endorsed the activities of this House of Representatives.
And that is consistent with the numbers that you see even tonight that
are reported by the various reporting agencies, Web sites and cable
news services who report around 55 to 58 percent of the American people
don't like what they see us doing with health care.
That brings me back to the resolution of inquiry which was filed on
December 17. A resolution of inquiry is a tool that the minority has or
in fact a Member on the majority has in order to ask for information
that they believe is being withheld from them that they need in order
to make an informed legislative resolution. It is H. Res. 983,
introduced on December 17 just as we left town for the Christmas break.
It requires 14 legislative days to mature at which time it must be
either voted on in committee or discharged from the committee to the
House floor where it becomes then what is called a privileged
resolution to ask that that information be delivered.

Now, I know we don't have the numbers to pass anything on the
Republican side. I know a resolution of inquiry introduced in the
Committee on Energy and Commerce, if the chairman wants to simply quash
it, he has the votes to do that. He will ask his side to vote with him
on voting ``no'' on the resolution of inquiry, and that's where it
stays.
But I was encouraged by a newspaper article that appeared on the day
that the resolution was filed. It appeared in one of the newspapers up
here in Washington called The Hill, and in it Chairman Waxman was
quoted as saying, and remember this resolution of inquiry was
requesting documents from the White House that were produced in
meetings last May and June when the White House invited six parties to
participate in talks down at the White House.
They came up with $2 trillion in savings over 10 years that they were
going to then use to pay for this health care bill. Those were
representatives of the pharmaceutical industry, the American Medical
Association, the American Hospital Association, an association of
American insurance plans, the medical device manufacturers, and the
Service Employees International Union. So you had a rather disparate
group of individuals representing doctors, insurers, hospitals, medical
device manufacturers, pharmaceutical manufacturers, and union
representatives who each brought something to the table to say we can
give you this much in savings if you will help us with whatever if
there is a problem. We don't know what was offered up by the groups
that were meeting at the White House, and we don't know what was
offered back by the people in attendance at the White House.
Chairman Waxman was quoted as saying: If there are such documents,
Burgess should get them, but I don't know if there are such documents.
I think some of these things that he wants are not written down, and
different people have different ideas of what was agreed.
Well, fair enough. Maybe there wasn't anything written down. It is a
little hard for me to believe that a $2 trillion agreement would be
reached on nothing more than a handshake. But if indeed that is the way
it went down, then someone should at least tell me.
I sent a letter to the White House September 30 talking about this
very issue and asking for specifics as they came out of those meetings
and as yet have gotten no answer from the White House. If the answer
is, we have no documents, that there never were any documents produced,
we did all of this $2 trillion of savings simply on a wink and a nod
and a handshake, fine, just tell me that.
But at the present time, you are left with situations as developed in
the Senate Finance Committee when a tax was suggested on some of the
hospital charges and the hospital association said, wait, that wasn't
part of our deal. Well, if that wasn't part of the deal, what was the
deal? Can you give us some of the details on what was agreed to? Again,
as legislators trying to write this legislation so it won't conflict
with anything that has been agreed to by the White House, it seems it
would make good common sense that they would want to share that with
us. I frankly don't understand why that information has not been
forthcoming.
Now this resolution was introduced on December 17. Sometime likely
toward the end of the first week of February or at the beginning of the
second week in February, it will have to come to a vote in the
committee. We will see what they do with it. Again, the chairman may
say, look, nice try, but we are not interested in pursuing that right
now and vote it down; or it may come to the floor as a privileged
resolution.

But at least over that period of time we have the opportunity to talk
about this. We have the opportunity to talk about these secret deals
that were struck down at the White House, and then it ties in very much
with the story that everything is going to be up and out in the open on
C-SPAN, but we don't want to let the C-SPAN cameras

[[Page H29]]

in the room while we craft this final legislative product that is going
to deal with health care and how health care is administered in this
country for the next two or three generations. That is pretty
important, but we are not going to get to see any part of what is going
on.
The American people understand that C-SPAN is sunshine. C-SPAN
represents good government. C-SPAN was the foil that the American
people had against the excesses of a Presidential administration that
overstepped its bounds and brought us the spectacle of Watergate and
the crumbling of a Presidency. C-SPAN is the preventive medicine that
keeps that from happening again in the future.
The first President Bush went back on a pledge he made in the
campaign. He made it one time, and he was dealt with very severely by
the American people and did not win a second term as President. And
many people feel that going back on that pledge of no new taxes, and it
wasn't so much the fact that he raised taxes, it was that he raised
taxes after he told us he wouldn't. Now we have a President who said it
will be out in the open, trust me. You will be able to see it. If your
Member of Congress is standing with the insurance companies instead of
you, you will know that. Well, guess what, now you don't.
I will tell you since there are no Republicans in the room, there are
no Republicans standing with the special interests as this health care
bill is being written because we are not allowed in the room and we are
not allowed to be part of the process. But we don't know what Democrats
are defending the insurance companies or the unions. We don't know what
Democrats are defending the pharmaceutical manufacturers. And we don't
know what Democrats are defending the doctors, if indeed any actually
are. We don't know because we are shut out of the process. Not just us
as Republicans, but us as the American people. And that is what is so
inflammatory about what has happened this past week here in Washington,
D.C.

{time} 2200

So a lot has occurred since the House and the Senate went out just
before Christmas. We are now back in town. We are told we have an
artificial time frame of doing this before the State of the Union
address, though it appears that the State of the Union address is a
little bit fluid because we don't want to schedule it on top of the
season's start of a new television series, so some give-and-take about
when that actual address is to be scheduled. I thought it was the end
of January. It's now sometime in February.
We do have a big Senate election, and people would do wise to tune
into that and be aware of what is happening in a part of this country
where a Senate seat that has been safely in Democratic hands for two or
three generations may in fact change hands a week from tonight. How
long will it take to get that new Senator sworn in? How long will it
take to get that new Senator to town so they will be able to vote on
this very important health care legislation? Will it take longer if
that is no longer a reliable ``yes'' vote but becomes a problematic
``no'' vote? Will there be an attempt to run out the clock or stretch
out the clock so that we don't seat that new Senator? I think the
American people need to pay attention to that because all of those
things are an integral part of this process that we call ``health care
reform'' that is now playing out in its final chapter here on the floor
of the House and the Senate.
Mr. Speaker, you've been very generous with the time, and I'm going
to yield back the balance of my time.

September 30, 2009.
President Barack Obama,
The White House,
Washington, DC.
Dear Mr. President, I write you once again on the topic of
health care reform. As you know, Democrat leaders in the
House of Representatives are currently working to merge the
three committee bills. Meanwhile, the two Senate bills are
waiting to be merged pending completion of the Senate Finance
Committee's mark-up of the Baucus plan.
I have closely followed the health care debate for months,
making note of actions by all parties involved, including the
House, Senate, White House, advocate groups, and the health
care industry. These reforms have wide-reaching implications,
and you have stressed the importance of conducting business
in public so that the American people are aware and involved
in the process.
In fact, during a Democratic Presidential primary debate on
January 31, 2008, you said: ``That's what I will do in
bringing all parties together, not negotiating behind closed
doors, but bringing all parties together, and broadcasting
those negotiations on C-SPAN so that the American people can
see what the choices are, because part of what we have to do
is enlist the American people in this process.''
It has now been over four months since the White House
announced numerous deals with major stakeholders in the
health care debate to save upwards of $2 trillion in the
health care system. Little to no details regarding the
negotiations have been released, and recent actions and press
reports have reminded me of the importance of openness and
transparency throughout the legislative process.
Roll Call reports today that negotiators working in the
House to merge the three committee bills plan to trim the
cost of the legislation by roughly $200 billion. I wonder
what programs or services are being cut, who will be
affected, and how these cuts are being decided.
In the Senate Finance Committee's mark-up, Senator Bill
Nelson (D-Fla) introduced an amendment regarding drug prices
in Medicare and Medicaid. During the debate on the amendment,
Senator Tom Carper (D-Del), while arguing against the
amendment, said ``Whether you like PhRMA or not, we have a
deal,'' referring to the deal PhRMA cut with the White House
earlier this year.
In addition, within the Senate Finance Committee plan is a
commission to slow the growth of Medicare spending, most
likely through changes to reimbursement policy. However,
hospitals would be exempt from this commission because,
according to CongressDaily, ``they already negotiated a cost
cutting agreement'' with the White House.
Despite your promise to make all health care reform
negotiations in public, we still have very few details on
what exactly was agreed to during these highly publicized
negotiations. In fact, even the stakeholders involved have,
at times, seemed at odds with what was actually agreed to.
But the one thing we all know is that, through press
statements, many deals were made. Unfortunately, even where
brief descriptions of policy goals are available, details on
achieving these goals are absent, a point made by the
Congressional Budget Office (CBO).
I am compelled to ask--how could Congress have done its'
due diligence in creating the policy before us without
crucial details surrounding these deals? Were the votes we
have seen in the Senate Finance Committee as of late a direct
result of these backroom negotiations? Will CBO be able to
actually score any of these deals to apply those cost savings
to legislation? Were these negotiations in the best interests
of patients?
Having little to no information, I cannot judge. However,
this begs even more questions. Is Congress enacting the best
policy reforms for Americans, or are certain changes being
made or not made because of the negotiations orchestrated by
the White House? Will smaller stakeholders suffer more from
our policy choices because of what larger groups may have
negotiated behind closed doors?
Mr. President, I do not write this letter to chide you for
engaging in what I consider the most pressing debate before
Congress. I applaud you for your leadership in compelling
Congress to act. In order to fully understand the policy
choices before us, though, we need to know what took place
earlier this year during these meetings at the White House.
You have made it very clear that you value transparency and
have sought to make your Administration stand out in this
regard. As a member of the House Energy and Commerce
Committee's subcommittee on Oversight and Investigations, so
do I. The last thing I would want to see is a formal
investigation of these meetings.
Thus, I formally request full disclosure by the White House
in the following areas regarding all meetings with health
care stakeholders occurring earlier this year on the topic of
securing an agreement on health reform legislation, efforts
to pay for any such legislation, and undertakings to bend the
out year cost curve:
1. A list of all agreements entered into, in writing or in
principle, between any and all individuals associated with
the White House and any and all individuals, groups,
associations, companies or entities who are stakeholders in
health care reform, as well as the nature, sum and substance
of the agreements; and,
2. The name of any and all individuals associated with the
White' House who participated in the decision-making process
during these negotiations, and the names, dates and titles of
meetings they participated in regarding negotiations with the
aforementioned entities in question one; and,
3. The names of any and all individuals, groups,
associations, companies or entities who requested a meeting
with the White House regarding health care reform who were
denied a meeting.
In our efforts to improve access to health care services,
the American people expect us to act in their best interests,
rather than protecting business interests of those who are
interested in currying favor in Washington, DC. If these
health related stakeholders have made concessions to
Washington politicians without asking anything in exchange
for the patients they serve, Congress and, most importantly,
the American

[[Page H30]]

public deserve to know. Conversely, if they sought out
protections for industry-specific policies, we need to know
that as well.
We must learn what these negotiations mean for the millions
of concerned Americans. How they will be better served,
including having affordable health coverage and access to the
providers they need? These negotiations may have produced
consensus on policy changes that are proper and needed, but
Congress will never know for sure that we are acting in our
constituents' best interests until all the facts are known.
I look forward to the opportunity to speak with you at your
earliest convenience on this matter. Should your staff have
any questions about this request please contact me or my
Legislative Director J.P. Paluskiewicz at my Washington, D.C.
office at 202-225-7772.
Sincerely,
Michael C. Burgess, M.D.,
Member of Congress.

____________________