[Congressional Record Volume 156, Number 6 (Wednesday, January 20, 2010)]
[House]
[Pages H248-H255]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Good afternoon. Once again, we find ourselves here on the 
floor of the U.S. Congress and the subject before us, in spite of 
various events that have been of great interest to people yesterday--
I'm thinking of the election of Massachusetts--still remains the 
question of health care.

[[Page H249]]

  There is discussion with the new political realignments that it may 
be that the House will take up and just pass the bill that was passed 
by the Senate. That is one possibility, which then of course would 
require the bill not to have to go back to the Senate.
  And so we come back to this question of health care in America, 
something that has a lot of people's attention. It's not the top 
priority I think for many people. I think many people are worried about 
unemployment, they're worried about the economy, they're worried about 
excessive government spending, they're worried about terrorism and 
national security. But underneath those, perhaps, there is still some 
concern about health care, but particularly a fear that in an attempt 
to try to solve a problem we may make a bad situation worse. Indeed, 
when government does too much, we have found that we sometimes get some 
very bad side effects--inferior quality, inefficient allocation of 
goods, bureaucratic rationing, and of course excessive expenses.
  Now, if health care is expensive now, just wait until it's free, some 
have said. We were promised by our President, Here's what you need to 
know: First, I will not sign a plan that adds one dime to our deficits 
either now or in the future. Sounds pretty definitive. It sounds like 
he says, hey, I understand about the deficit, I understand about the 
debt, I understand about excessive spending, and I am not going to add 
one dime to our deficit.
  Well, the bill that's being proposed does not add a dime, so I guess 
technically this statement is correct. It adds, rather, either one or 
several trillion dollars. That may be a whole lot worse than the dime. 
So this particular statement, along with some others that we've heard, 
is not really precise in terms of what has been proposed, particularly 
the Senate and the House versions that we have seen.
  In order to try to put a package together, there have been some 
compromises made, as tends to happen when you're writing large and 
complex pieces of legislation. This protects insurance companies in 
kind of an odd way. The legislation that is being considered in the 
Senate preserves the legal immunity of large insurance companies in the 
event of negligence or any other wrongful action even if their action 
results in injury or death of a patient.
  Now, this is the language that's in the bill. What does that really 
mean? What it means is something that I think most Americans consider 
to be very undesirable, and that is, you walk in and you feel sick and 
you go see your doctor. You trust your doctor, you've known your doctor 
for some period of time, and so you have the doctor take a look. He 
runs some tests and he says, well, now, Congressman Akin, this is the 
news: You've got this, this, and this, and I recommend we do this. And 
you check with him, ask a bunch of questions and say good, that seems 
like a good course of action.
  Now, here's where the train comes off the tracks. Your insurance 
company says, but we don't really think that's necessary, we're not 
that concerned about you, Congressman Akin. And your doctor, well, you 
know, he's probably being pretty cautious, but he's also being pretty 
expensive. And so we're going to say you really don't need to go to the 
hospital for this, we're going to recommend you just stay home for a 
while and take some aspirin and see what develops. Now, that's what we 
call something or somebody getting in the way of the doctor-patient 
relationship.
  In this country, we have gotten spoiled. We have enjoyed contact with 
our doctors. We have enjoyed the process of getting to know the doctors 
and trusting them and soliciting their opinion. At times, we get 
multiple opinions from different doctors just to make sure. But we 
don't want some insurance company coming between the patient and the 
doctor; that's pretty bad when that happens. What's worse is when the 
government comes between you and your doctor. That's what a full-born 
socialized medicine bill will do.
  This bill here says that these insurance companies can basically 
second-guess the doctors, and if things go wrong, guess what? They have 
no liability. Is that what we want in health care reform? I don't think 
so. Doctors can be sued if they make a bad diagnosis, but not insurance 
companies, even when they get in between the patient and the doctor. Is 
that something we want in a health care bill? I don't think so. And 
that's one of the reasons why a lot of Americans don't want this 
massive government takeover to pass, because it has these little 
loopholes like this in it. I don't think many of you would have known 
that that was in the bill, and yet it is.
  There are also some other problems. We have a bill, when you start to 
get thousands of pages of legislation, there is a lot of room for 
mistakes and an awful lot of creation of bureaucracy. I don't know what 
the latest version of this is because a lot of this is negotiated 
behind closed doors, but we're talking about close to a 2,000-page bill 
passed with I don't know how many hours of public review--72 hours 
would be nice, I'm not so sure we'll have that. We have not had that on 
other major pieces of legislation.
  This particular bill creates 118 new boards--that sounds like some 
bureaucracy, doesn't it--commissions and programs full of new mandates. 
One of the things in legislation that people who are legislators pay 
attention to is how many ``you musts'' and ``you shalls'' and ``you've 
got to's'' there are in a bill. This one contains the word ``shall'' 
3,425 times. Obviously somebody has very strong opinions about what 
other Americans ought to do, and they're going to mandate it. And so 
you have here quite a large bill, many, many pages, 3,425 ``shalls,'' 
118 new boards.
  We tried to draw a picture of what that would look like. Now, you 
know they say a picture is worth a thousand words. I don't know if this 
picture is worth 1,000 or 2,000 pages, but this is an attempt at 
drawing a picture of what we've got. And the more you look at it, the 
more you look at all these colored boxes, which are some of the new 
agencies and all, it starts to look more and more like some sort of a 
maze. And you kind of wonder whether what's going on is, the consumers 
or people who are sick are somehow trying to get across this maze to 
find their doctor. It's almost like something you would be given at a 
restaurant with a Crayon, and you're supposed to plot the path, if 
you're a patient, to somehow get over to see the doctor. But this is 
the kind of complexity that is being created by what has been proposed 
over the last 7 or 8 months by the Democrats.
  The reason this is so complicated is because of the overall strategic 
approach that health care started, and that was the idea that we're 
going to take what we have and pretty much pitch it, and we're going to 
redesign the whole thing and put the government in charge of it. 
So we're not going to go in and fix this or that that's broken; we're 
going to basically scrap it and start over.

  Consequently, the result is a very complicated piece of legislation 
for the government to try to take over what is essentially close to 
one-fifth of the U.S. economy.
  So that's one of the things that people are concerned with and one of 
the reasons why, not so much based on political party, but just based 
on good old American commonsense, there is a concern for the complexity 
and of course the cost associated with that complexity.
  We don't like mandates a whole lot. Americans tend to be a little bit 
freewheeling, and they're not too much into following all the dots and 
tittles and all the little nuances of laws and rules. Americans like to 
have some freedom, a little bit of elbow room, a little flexibility. So 
when we're talking about the mandate, we're saying, here, there's 
mandates in this bill. All those ``shalls'' come into things that 
restrict your freedom. One of the mandates is that employers must offer 
a qualified health care plan to full- and part-time employees.
  So we're saying to companies, we don't care what you think is good 
for your employees, and we don't really care what your employees think 
is good for them; what we're going to do is tell you how it's got to 
be. And so we are going to write what your health care plan has to look 
like, and then, Mr. Employer, you have to offer what we're writing up 
for you to your employees.

[[Page H250]]

                              {time}  1715

  That is an interesting approach. We think of it in terms of the idea 
of a top-down, Big Government solution because the government is going 
to tell you what you need. Whether you think you know what you need 
doesn't make any difference. It's going to be a top-down status 
mandate, and you will pay for 65 to 72 percent of the cost of the plan.
  So we're going to tell you what kind of plan you're going to offer. 
By the way, you're going to pay for it, and if you don't pay for it, 
we're going to penalize you, and we're going to hit you with a tax of 
up to 8 percent of your payroll costs. So whoever you are, even fairly 
small businesses, you know, in terms of what the cutoff is in this, 
you're going to get hit with 8 percent of your payroll taxes. In fact, 
if you have 100 employees, if 99 of them want this qualified plan and 
one does not, the way the bill is written is that you're going to end 
up paying this 8 percent because everybody has to agree to what the 
government has mandated.
  So there are some mandates in here which, from a small business point 
of view, are considered fairly onerous. It's another thing which makes 
the bill offensive and not popular.
  Now, one of the concerns is, when the government takes something 
over, it tends to cost money. The President said it's not going to cost 
a dime. I suppose that's true. It's supposed to cost over $1 trillion, 
but there are a lot of hidden costs. You see, you bury the costs of 
some things that you don't want to show. Trying to keep it under $1 
trillion was a tough thing to do; $1 trillion is a fair amount of 
money. Even for the U.S. Federal Government, $1 trillion is a lot of 
money.
  We spent about $1.4 trillion last year. That was about what our level 
of debt was, $1.4 trillion. The highest debt that we'd had before that 
was under President Bush in 2008. During the Pelosi Congress here in 
2008, we had just south of $500 billion in deficit spending that year. 
So, if deficit spending of 400 and--whatever it is--50 or 60 billion 
was a lot, $1.4 trillion in deficit spending was a considerable amount. 
So our deficit in '09 tripled from '08, and it was a $1 trillion-plus, 
$1.5 trillion.
  Well, here is $1 trillion for this little plan. This is not small if 
you're worried about Federal spending. The estimate here is it's going 
to raise taxes $729 billion. If we got away with that few in tax 
increases, we might be doing well. It increases the long-term cost of 
medical care by $289 billion. Again, I think those are conservative 
estimates. It creates shortages, higher costs, more regulations, more 
patients, and a fixed supply of medical professionals.
  This is part of the CMS Report. CMS is a group of staffers who are 
not connected with a political party. They take a look at legislation, 
and they try to come up with what the costs are and how it's going to 
work. Of course, there's a lot of argument about what they count and 
about what they don't count; but things like creating shortages and 
also considerable amounts of unemployment are expected to come from 
this because, if you mandate that businesses spend a lot of money, what 
happens is it means their employees are going to cost more. If their 
employees are going to cost more, there's an incentive for them to get 
rid of some employees and to run the employees they have for longer 
hours. That reduces their costs, which of course increases 
unemployment.
  So this bill will affect unemployment, which is another reason people 
are not very pleased with it and are disappointed in the bill. There is 
an inefficiency and an expense here which is quite considerable.
  There is another mandate. This is one on individuals. It says that 
individuals must buy acceptable health insurance coverage. Now, guess 
who defines what health insurance coverage is acceptable if you're an 
individual citizen of the United States?
  Is it the individual citizen? Is it the 22-year-old who says, I can't 
afford health insurance right now, and I'm very healthy and I'm making 
the decision not to get health insurance? Is he the one who decides 
what acceptable health insurance coverage is?
  Of course, the answer is ``no.'' The answer is that the Federal 
Government knows what you need better than you do, so the Federal 
Government is going to mandate that you have this coverage, and they're 
going to tell you what kind of coverage it is, and you've got to buy 
it.
  Now, this raises kind of an interesting legal point, which is, if the 
government mandates that you have something or that you buy something, 
is that not really, essentially, a tax increase? When you mandate that 
somebody has to buy a particular product, is that something that the 
Federal Government should be doing in this particular area? Is it even 
constitutional? When it is a mandate, is it not just essentially a tax 
increase? Or pay an additional 2.5 of your income in taxes. So now 
you're going to have a choice. You can either buy the insurance that we 
know is best for you--Big Brother government--or you can pay a fine or 
face criminal penalties, including jail time and severe fines if you 
don't get in line with what we know is best for you.
  Who is ``we''? Oh, we just saw a picture of the ``we,'' didn't we? 
Here is the ``we.'' We know what's best for you. All of this matrix of 
bureaucracy, this matrix run by the Federal Government, really knows 
what's good for you, and so we're going to tell you what it is that you 
have to buy. You've got to buy the insurance we tell you you've got to 
buy. Otherwise, you'll face criminal penalties, including jail time.
  How do you think that goes over with a lot of freedom-loving 
Americans? Well, not very good.
  I think some of the election results that we've seen in the last 
number of months reflect the fact that people are not that comfortable 
with Washington, D.C.--Big Government--playing God in everybody's 
lives. That's one of the concerns and why this is not particularly 
popular.
  I notice that we have joining us this evening a doctor, somebody who 
has spent years in the health care profession and who has really been 
in the middle of it as to providing that doctor-patient relationship. 
He knows the subject far better than this poor, old engineer does, and 
I would like to yield some time to my good friend who has just joined 
me on this health care topic. I was just running through some of the 
reasons why people aren't that excited about this Big Government 
takeover of health care and why you're seeing a lot of people voting, 
saying, I'm not sure we're on the right track with this.
  I yield to the gentleman from Tennessee.
  Mr. ROE of Tennessee. I thank you for yielding.
  As Congressman Akin has said, I've spent the last 31 years, until a 
year ago, practicing medicine in Johnson City, Tennessee, and really in 
a rural area in Appalachia. I've also practiced medicine in Memphis, in 
the inner-city, while I was in training and in school.
  We have to back up, I think, and look at what the problem was, what 
problem are we trying to solve.
  In this country, I just saw a poll recently that showed among likely 
voters that approximately 90, 91 percent of the folks had some form of 
health insurance. What we're getting confused with is there are people 
out there who don't have access to care. There is no question about 
that, and we need to address that problem.
  What we've been hearing in this particular H.R. 3962, aka H.R. 3200 
that we began to deal with, is that this is the only solution, which is 
this very complex health care bill, which I've read--I've read all 
2,000 pages of it--and you have very adequately stated some of the 
problems. What are we trying to fix?
  Well, we have 40-plus million people in America who do not have--not 
access to care, because a law was passed in 1986 called EMTALA, and 
that afforded every American, whether you're legal or not--you could be 
an illegal citizen in this country--or whether you could pay or not. If 
you go to a hospital with an emergency room, you have to be cared for. 
We have no choice. When I was on call in the emergency room--and 
believe me--I'm the one who had to get up at 3 a.m. in the morning and 
go see these patients and care for them. So the care was there. It's 
just not the most efficient way to provide the care. There is no 
question about that.
  We have a system in this country now where costs are out of control, 
and I think that's what this bill doesn't do. It doesn't address the 
fear that most of

[[Page H251]]

us have and that I know I had as a doctor and that I have as a consumer 
of health care, which is the ever-rising cost of the care.
  We can do several things. Let me just point out, in the 2,600- or 
2,700-page Senate bill, I can cover 20 million people on one page. This 
is just to show you how simple you can make it. Number one, if you have 
signed up the people currently who are eligible for the State 
Children's Health Insurance plan and they've just not signed up for a 
current plan that's already there in Medicaid, you would cover 10 to 12 
million people.
  There's one thing in this bill that I do like a lot, and that's to 
allow adult children, when they graduate from high school or college 
who don't have health insurance, to stay on their parents' plans, their 
parents' health care plans. You could cover 7 million young people. You 
could cover almost 20 million people in this country. I don't think 
either side, the Democrats or the Republicans, would mind doing that. 
You've covered two-thirds of what the Senate bill is going to do by 
doing that one thing, and you can do that on one page.
  Mr. AKIN. Could I just reclaim my time for just a minute, Dr. Roe?
  The way you're approaching this seems to be a little bit more sane in 
some ways in that you're saying, look, we're going to define our 
problem precisely, and we're going to tailor a solution to try to 
improve what we've got in order to try to make the system work.
  Now, you're not proposing--I thought it was 2,000 pages. You're 
saying it's coming up close to 3,000 now. You're not proposing a 3,000-
page or 2,000-page solution. You're talking about one simple thing, and 
you can take half of the people who don't have health insurance, and 
you can get them insurance.
  Mr. ROE of Tennessee. Yes.
  Mr. AKIN. You can do that on one page.
  Mr. ROE of Tennessee. On one page.
  Mr. AKIN. Now, I think the American public prefers simple and to just 
fix what's broken instead of scrapping everything and starting over, 
but I yield to my good friend from Tennessee.
  Mr. ROE of Tennessee. Another issue that we deal with all the time--
and as a physician, I would deal with this--are patients who would 
develop, let's say, breast cancer and lose their jobs. Then they would 
lose their insurance coverage. Now they have chronic conditions, and 
they don't have insurance coverage. How do you help those patients? How 
do you help those folks?
  Well, this is a very simple problem. Preexisting conditions are a 
problem but not in the large group market. In other words, if you've 
worked for a large corporation or let's say--like we get our insurance 
here through the Federal Employees Health Benefit Plan, the so-called 
FEHBP. You've got 9 million people who get their insurance through 
that. If one person has a chronic condition like breast cancer or 
diabetes, it really doesn't affect our rates because you spread those 
risks over millions of people. If you would simply get rid of State 
lines and if you would allow small groups to become big groups, you 
then solve the preexisting condition problem.
  The second thing you can do is to subsidize----
  Mr. AKIN. I don't mean to interrupt you, and I don't want to be rude, 
but I just want you to develop that point a little bit more.
  In other words, am I understanding, Doctor, that what you're saying 
is you could buy insurance across State lines? Is that the point you're 
making?
  Mr. ROE of Tennessee. Reclaiming my time, absolutely.
  Look, you can buy any other kind of insurance in the world but health 
insurance across a State line. Why in the world should it make any 
difference? If I'm living near the State line--and we're surrounded by 
multiple States in Tennessee--I should be able to buy that insurance 
across a State line.
  For instance, let's take Realtors. Almost every Realtor's business is 
a small business. They have six, eight, ten. Twenty would be a lot in 
our area. Let them all group together across this Nation, and then 
you'll have 500,000 or 1 million Realtors who could spread their risks, 
and you wouldn't have any government involvement. You wouldn't have any 
subsidies involved. You wouldn't have any complications. You'd simply 
let the free market system work.
  Mr. AKIN. Doctor, reclaiming my time again, what you're saying is 
you're combining a couple of ideas, but you're saying it fast. I want 
to make sure people can understand it.
  The first thing you're saying is you can buy insurance across State 
lines. Particularly if you live in a place like, for instance, Kansas 
City, Missouri--and there's a Kansas City, Kansas, right across the 
river--you could be buying insurance out of two markets instead of one 
or even possibly from someplace like all the way up in Massachusetts. 
So that's one idea.
  As to your other idea, though, it sounds like what you're saying is 
you're allowing the individuals, let's say, who work for some small 
employer to pool together to create large pools, which then gives you 
the statistical smoothing so that you could apply for insurance, one, 
because you have a whole lot of buyers. You're a significant player, so 
you can buy at a discount price. Second of all, if somebody does get 
ill, you can smooth that load over a big enough base that it doesn't 
affect it. Am I understanding you correctly?
  I yield.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. You're 
absolutely right, because what you allow it to do is you allow a small 
business to become a large business.
  Like I said, the problem with preexisting conditions is, if you have 
a small shop of 5, 10, 20 employees, which many businesses have--and 70 
percent of our employees in this country work for small businesses. If 
you have one very expensive condition that hits, it breaks them. They 
can't afford insurance. That's why it's not affordable.
  Some other things we could easily do are preventative care, and you 
could do that where you have different incentives to keep yourself 
well.

                              {time}  1730

  As a physician, I can tell you all day long how to stay well, but it 
is up to you as a patient to carry that out. I can give you all the 
great ideas in the world, but if you don't carry them out, then it 
doesn't do any good.
  Mr. AKIN. It is about that third helping of french fries, I 
understand.
  Mr. ROE of Tennessee. That is correct. So you want to have the 
incentives built into our health care system.
  For instance, a health savings account. I have one, a health savings 
account. Let me explain this to our audience today, the people who are 
watching this.
  Before, when you pay a premium in, if you don't use it, who keeps the 
money? The insurance company does. In my case right here, with a health 
savings account, you put in X dollars. In our office, it is $3,000. It 
can be $5,000 that your employer puts in that account for you. You pay 
everything first dollar, so I am highly motivated to take care of 
myself, because at the end of the year, if I don't spend that money, I 
get to keep that money, not the insurance company. And you can roll 
that money over and use it the following year and the following year.
  In our group, we have 350 employees in our medical group at home, and 
for those who get insurance, over 80 percent of them choose a health 
savings account. They manage their own care, so they are motivated not 
to smoke and to exercise and to lose weight because they save their own 
money. You can use that money later in your life if you accumulate many 
thousands of dollars for long-term care or whatever you want. You are 
the insurance company.
  Mr. AKIN. Doctor, again, I would like to cut in for a minute here. 
You are talking about a medical savings account. What you are saying 
makes a whole lot of sense.
  In other words, what you do is you put your money aside, and you have 
some tax benefits from setting it aside, into not something for your 
retirement but something to help cover your medical needs. Then, as 
medical expenses come up during the year, you can pay for those out of 
this pre-tax money which is in your medical savings account.
  If you stay healthy and you have a good lifestyle and you didn't have 
that third helping of french fries, then you may not spend as much 
money as you put in there and you would be allowed to keep it year in 
and year out, and it

[[Page H252]]

could continue to earn interest to cover in case of a medical problem.
  Is that right so far?
  Mr. ROE of Tennessee. That is correct. And if something were to 
happen catastrophically, let's say you have an accident or a heart 
attack and you spend more than that predetermined amount, you buy 
catastrophic coverage that covers every bit of it.
  For instance, in my particular case, anything over $5,000 is paid for 
100 percent. And you had the $5,000 to begin with, it was your money, 
so you got to keep it. I think that is a very simple thing that we are 
currently doing and we should be encouraging people to do, not 
discouraging.
  Mr. AKIN. Now, my understanding is we put that into law, but there 
were a lot of limitations on it, and I don't think that is generally 
available for most people in the public. Is it, Doctor?
  Mr. ROE of Tennessee. It is not, and it should be.
  Mr. AKIN. Is that a problem that the marketplace hasn't caught up to 
what the law says? Or, are there roadblocks that make it so that people 
can't do that?
  Mr. ROE of Tennessee. I think probably we haven't educated our public 
as much as we should have. I was surprised in my own practice about how 
many chose to do that once they understood it.
  When you are faced with paying $3,000, that is kind of scary to do 
that when you normally have a small copay or deductible. But once you 
understand how it works, that you get to keep the money, not the 
insurance company--and while we are on insurance companies, I have got 
a problem.
  I know one of the things that I did in practice that really 
frustrated me to no end was to have insurance companies deny needed 
care for patients, and I think certainly they are culpable. I know I 
have spent as much time on the phone sometimes getting a case approved 
for a patient to get needed care as I did actually doing the procedure 
I was trying to get approved. That is very frustrating. So the 
insurance company is culpable out there, and we do need some reform.
  Mr. AKIN. Doctor, we just talked about that. One of the first slides 
I brought up was starting, when you want to talk about health 
insurance, one thing that you want is you want to have that doctor-
patient relationship kept--I don't know if you would call it sacred, 
but you want that to be a primary kind of consideration. And if an 
insurance company parks itself between the patient and the doctor, we 
don't like that idea very well.
  Mr. ROE of Tennessee. No, we don't.
  Mr. AKIN. And with this bill that is being proposed, the insurance 
company can second-guess the doctor, and if there is a bad result, they 
can't be sued. That is one more strike why people don't like this bill. 
But that is a great point.
  We have been joined by another colleague of mine, Congressman 
Thompson. G.T. is here, just a stalwart, free-enterprise guy, and 
somebody with a whole lot of common sense. I would like to yield some 
time, if you would like to comment.
  We are trying to take an overview of what is happening now, after the 
election yesterday, and where we are in this whole thing of health care 
and are we still under this model of Big Brother is going to take it 
all over.
  Mr. THOMPSON of Pennsylvania. I thank my good friend from Missouri 
and my good friend from Tennessee for this Special Order tonight that 
you are doing.
  Yesterday was a landmark day. I think it established a pretty 
confident trend of what the American people like and what they dislike. 
And what they dislike I think is properly captured and framed in that 
chart that you have on the tripod, the bureaucracy of a government-run, 
government takeover of health care.
  We need to be approaching health care and we need to be approaching 
everything we do in this Chamber, I believe, from a principled 
leadership perspective, of leading with principles. And I have to tell 
you, and I suppose my colleagues on the other side of the aisle would 
agree with that. It is just their principles are completely 180 degrees 
from our principles. I have to imagine, what are the principles behind 
that health care nightmare that is outlined there? I liken it to a 
train going down a mountain with no brakes--it never ends well.
  What they are trying to shove through is just to get anything, get 
something. I can imagine how the behind-closed-door discussions are 
going, which happened again today even after the people in 
Massachusetts spoke.
  Mr. AKIN. All the complaints.
  Mr. THOMPSON of Pennsylvania. It has to be something like this: ``We 
don't care what it is, let's just pass something, whatever it might 
be.'' The goal is just to get something through to be able to say they 
did something. Well, that is wrong. That is not the approach we do. The 
American people need and deserve better than that. They want 
principles.
  The health care principles I believe in and the Republican Party and 
some of my Democratic colleagues, I think we can work together. There 
are four principles I have always held dear as a health care 
professional for almost 30 years, and that is--and my belief is that we 
have a health care system that is pretty good. In fact, I would rate it 
one of the best in the world, not that it couldn't be improved upon. 
And the principles that we dedicate ourselves to are decreasing costs, 
increasing access, improving quality, and preserving that relationship 
that Dr. Roe talked about, the decisionmaking relationship between the 
physician and the patient, not allowing a bureaucrat to insert 
themselves into that relationship. And this certainly, I think, is 
regressive, regressive in terms of all four of those principles.
  My colleague from Tennessee talked about the impact on the 
relationship of decisionmaking between the patient and the physician, 
where the bureaucracy, a bureaucrat is inserted between that 
relationship. But when you look at all of it, when you look at cost, 
the cost of the Senate bill, which I believe--I don't know, but that is 
what will be shoved at the American people and will be shoved at this 
Chamber to work on. The Congressional Budget Office showed those costs 
going up significantly. I believe the individual costs were at least, 
on the average, $300 per year, $2,100 per family. I thought the idea 
behind that is to lower costs for everyone, yet we know what is out 
there.
  My colleagues have talked about allowing the purchase of health 
insurance across State lines. That is greater competition. That is a 
good thing. That brings costs down.
  Certainly the whole issue of tort reform; $29 billion a year that is 
spent in this Nation on tort reform premiums, $29 billion. And we talk 
about waste and fraud, waste within health care spending. I think that 
is the biggest waste there is. Those dollars could be going into 
directly caring for patients. You add on top of that the cost of the 
practice of defensive medicine, and I understand why that occurs.
  A physician comes out of medical school with a quarter million 
dollars of loans, if they are a specialist, maybe half a million 
dollars in loans. And at the risk of even a frivolous lawsuit they can 
lose a practice, lose their family's home. They order extra tests that 
may not be necessary to treat the illness at hand but does substantiate 
they followed a standard of practice, a standard of care.
  Mr. ROE of Tennessee. If the gentleman will yield, let me just 
mention a couple of things that my friend from Pennsylvania is talking 
about.
  In 1975, all the malpractice companies left the State of Tennessee. 
We had nothing. So the physicians there brought together and formed 
what is called the State Volunteer Mutual Insurance Company. It was a 
mutual company that anything that wasn't paid out in premiums came back 
to us. Since the inception of that company in 1975, over half the 
premium dollars have gone to attorneys. Less than 40 cents on the 
dollar went to the injured parties, the injured patients, and about 10 
cents to run the company.
  We have a system that is broken terribly when you can't even 
compensate injured people. That is the system we have in America now, 
and that is wrong, because there are events that do occur that need to 
be compensated. We don't have a system that can even do that.
  Mr. AKIN. Reclaiming my time, gentlemen, what you have been outlining 
here today is, I think, what the American public is eager for. They are 
eager for people to define specifically what a problem is, and to 
outline a solution

[[Page H253]]

that makes common sense, that isn't going to be that expensive. In 
fact, the solution should save money. They are going to increase the 
amount of freedom that consumers have and choices, and improve the 
quality of health care. That is a way to approach health care. That is 
to say, we are not going to totally destroy it all; we are going to fix 
the parts of it that are broken.
  That is usually the way we approach most legislative questions. And 
yet, now, for to whatever it is, eight months, we have been running 
down this track trying to reproduce in America what has never worked in 
foreign countries very well.
  I think you could say there are a lot of things we could fix in 
America. But, on the other hand, if you are the guy that lives in Dubai 
and you are worth a couple hundred million dollars and you get sick, 
guess where you want to be treated. You want to come to the good old 
USA.
  So why do we want to scrap something that has many aspects? In fact, 
I would say if you take a look at the American health care system, if 
you look at what is being provided in care, we are doing pretty darned 
well. If you are taking a look at how are we paying for that, we have 
got some problems.
  So our problems tend to be more in the pay for side than in the 
quality of the care that is coming out. And each of you gentlemen have 
demonstrated, I think very articulately, tonight the fact that there 
are some certain specific things that could be fixed, yet we seem to be 
just on this--you called it a train wreck--just trying to replace the 
whole thing with a Big Government solution.
  And I think it is ironic, almost amusing, and a month or two ago 
would have been unbelievable, to say that this whole thing may well 
have been derailed by Massachusetts voting for a Republican for the 
U.S. Senate. If you said that 2 months ago, people would think you 
needed to be locked up in a little white straitjacket. They would say 
there is no chance that something like that could happen.
  Yet people are starting to pay attention to what is being proposed 
here, and this, along with a whole series of other incidents and 
mismanagement, has created a political anomaly. I mean, there wasn't 
one Republican Congressman in the State of Massachusetts, and yet the 
State, looking at this kind of thing, along with the tremendous 
spending that this represents, said, Time out. We are not solving our 
problems.
  I appreciate your time.
  Mr. ROE of Tennessee. I would say, when you look at this--I am just a 
country doctor from east Tennessee, but if you look at the health care 
problem in America, it is this: One is we have had escalating costs. 
There is no question of the costs. And we have got people who don't 
have health insurance coverage. Those are the two problems. How do you 
solve those problems?
  Let me explain to you why having more government will never work and 
will end up costing more money. And my good friend from Pennsylvania, 
Congressman Thompson, has hit the nail right on the head.
  When you take $500 billion--and I have dealt with Medicare patients 
for my entire medical practice. When you take $500 billion out of a 
plan that is already underfunded, that goes upside down in premiums by 
2017--and beginning next year the baby boomers hit 3 million to 3.5 
million new recipients every year. You take a half trillion dollars out 
and you add 30 to 35 million people, three things happen: One, you have 
decreased access; two, because you are not going to get in to see the 
doctor, number two, you are going to have decreased quality; and three, 
and seniors get this, their costs are going to go up to get the care 
that they need.
  Mr. AKIN. Doctor, you are so eloquent and you said it so smoothly, 
but I just think we need to underline what you said.
  What you are saying is you are going to take $500 billion out of 
Medicare. Now, is this a Republican that is going to raid Medicare?
  Mr. ROE of Tennessee. No, sir.
  Mr. AKIN. We have always been accused of raiding Medicare, but we are 
not the ones doing this, right?
  Mr. ROE of Tennessee. That is correct. Unless you are in Florida, of 
course.
  Mr. AKIN. So we are going to take $500 billion out of Medicare. And 
what do you think is going to happen? If you take $500 billion out of 
Medicare, it is going to be harder to provide services for people.
  But you are not just doing that alone. You are adding more people and 
taking money out.

                              {time}  1745

  So now you're sort of compounding the problem. And so the result is 
you're going to get poorer quality care and you're going to have to pay 
more money on the side, I suppose. Is that right, Doctor?
  Mr. ROE of Tennessee. That's correct. What you're going to do is, 
you're going to create waits. There's no other way around it. And 
that's my biggest fear as a physician, is that at the bottom line, the 
end of the day, when you budget so much money for health care and you 
have more demand for services than you have money to pay for it, you 
create waits. It happens in England France, and Germany, unless you are 
wealthy and can buy your way around the system, which is what happens. 
But I'm talking about for the bulk of the American people.
  Over 90 percent of the people who have insurance in this country like 
it. And they like what they have. They understand we pass all of this 
right here. When a patient comes to me, am I going to be able to 
provide better care for that patient? The answer is, No, I can't. And 
let's look at some numbers.
  Mr. AKIN. One other point, Doctor. You said you're just a country 
doctor from Tennessee. But if I remember right, there were two States 
that did the experiment of essentially government-run health care. One 
was the great State of Massachusetts, which has now become my fond 
friend.
  Mr. ROE of Tennessee. Mine, too.
  Mr. AKIN. And the second one is Tennessee. So you've had personal 
firsthand of the State government deciding they're going to take over 
health care. Is that correct?
  Mr. ROE of Tennessee. We had the 17-year experiment called TennCare. 
And to back up to the beginning of Medicare, in 1965 that great program 
that was passed started as a $3 billion program. The congressional 
estimates were at that time that by 1990, 25 years later, it would be a 
$15 billion program. The actual number, a $90 billion program. It's 
gone from $90 billion in 1990 to over a $400 billion program. And we're 
going to cut this much money out. As our population ages, there's going 
to be more spending involved. Now that's one plan.
  In Tennessee, we started with a managed care plan in 1993 to control 
costs, because costs were going up and there wasn't enough access for 
our citizens. It was a $2.6 billion program in 1993. In 10 budget years 
it was an $8 billion program. It took up almost every new dollar that 
the State of Tennessee brought. And let me go on and fast forward to 
this Senate bill for a moment, because this is very important for 
States.
  This bill calls for a massive expansion, the Senate bill, a massive 
expansion of Medicaid. In the State of Tennessee we're looking at 
three-quarters of a billion dollars of unfunded--unfunded--liability. 
That's what Nebraska got off the hook for. What you're asking us to do 
in Tennessee is we, this year, Mr. Speaker, this year we have 50 less 
highway patrolmen in the State of Tennessee than we had in 1978. And we 
have 2 million more people. That's the kind of shape that the States 
are getting in. And we're getting now another unfunded mandate through 
this health care bill that I don't know where the money is going to 
come from.
  We have no capital projects for our colleges this year in the State 
of Tennessee. We're not building a new dormitory, a new library, or 
anything. And yet we're going to get crammed down this massive 
expansion of government with an unfunded mandate. That's why people are 
angry.
  Mr. AKIN. Doctor, you just made another point. What I'm hearing you 
say is that the estimate that the CBO has put together of this little 
treasure here of a trillion dollars, that part of the deal is it's a 
little more than a trillion, because we're going to do something that's 
going to make the States pay a chunk of change, too. So we have what's 
called an unfunded mandate that's going to descend on the States.

[[Page H254]]

The trouble is the States don't have the option we do of just busting 
the budget, because a lot of them have balanced budget amendments. And 
that's going to be tough.
  I'd like to go back over to Congressman Thompson from Pennsylvania. 
Would you like to join us here?
  Mr. THOMPSON of Pennsylvania. Absolutely. I believe, actually, it was 
the Tennessee Governor, a Democrat, who coined the term that this 
Senate bill and the Medicaid, the shoving of the increased Medicaid 
rolls and shifting that over to the State was, ``the mother of all 
unfunded mandates.''
  Mr. ROE of Tennessee. That's what he said.
  Mr. THOMPSON of Pennsylvania. Sounds like a very smart man.
  Mr. ROE of Tennessee. He is a very good Governor.
  Mr. AKIN. That's a Democrat Governor.
  Mr. THOMPSON of Pennsylvania. That is correct.
  Mr. AKIN. He says it's the mother of all unfunded mandates. That says 
that trillion may be a pretty conservative number.
  Mr. THOMPSON of Pennsylvania. When we look at the State of 
Pennsylvania, the conservative estimates are that the Senate bill 
provision with the huge expansion of the Medicaid rolls, which is truly 
just shifting it to the States without funding, $2.4 billion to the 
State of Pennsylvania. Pennsylvania went 6 months--at least 6 months 
without a budget this past year, the State government, because they 
couldn't make it balance. They're required to, but they just couldn't 
get it done. The economics, the revenue, and the expenses just did not 
match up.
  I think that there are so many problems with the proposals that our 
Democratic colleagues have been proposing. And I suspect what we will 
see as a bill comes out of the closed, dark room to the House floor, 
that it will be very flawed. But let me just say there are solutions. 
There are solutions that have been defined. There are solutions that 
have been introduced going back to July of this year, 7 months ago, and 
there are solutions that have received even some support but are 
largely Republic solutions.
  The Putting Patients First Act, which addresses the issue of tort 
reform and takes that $329 billion-minimum of waste, and that would 
allow the cost of everybody's health care to come down. The Putting 
Patients First Act, which allows the bidding of health insurance across 
State lines, which allows the formation of association health plans to 
give small businesses the opportunity to join together to have a larger 
voice and more negotiation power. It also addresses key issues, and 
does it in a good market approach of addressing preexisting conditions.
  They allow the States to create high-risk pools. Just because you're 
born with a preexisting condition or during the course of your lifetime 
you experience or develop a disease or disability, say breast cancer or 
prostate cancer, that should not mean that you shouldn't be able to 
afford to purchase--I'm not saying anybody give you--but be able to 
afford to purchase reasonably priced health insurance.
  The Republican solution does that. And it doesn't do it with massive 
taxing. Does it with no taxing, does it with no cuts to Medicare, does 
it with no shifting of tremendous health care cost to the State. It is 
a win-win and brings down the cost of health care for everybody.
  Mr. AKIN. So we've got some solutions. I was just thinking about the 
voters in all the different States that are frustrated. They may be 
listening to us even here on the floor of the Congress, and they're 
thinking, Do they guys get it or not? Why are they talking about these 
huge Big Government solutions and spending the money that we don't 
have. I'm not sure some of them aren't ready to declare independence 
again.

  I was just thinking, if you're going to write a declaration of 
independence relative to health care, one of the things you say is, 
it's not going to add a whole lot of money to the big national debt. 
That's one thing you've got to pay attention to. It's not going to 
impose mandates on States or employers or individuals. And it's not 
going to use taxpayer dollars to fund abortions or illegal immigrants.
  I think those are all things that have been debated and discussed and 
people are upset about. It's going to be negotiated, I think, in a free 
and open format instead of behind closed doors. We're going to reserve 
that doctor-patient relationship. And we're going to allow freedom, 
which has worked so well in America for a couple of hundred years, to 
reign. To actually have some freedom to let people make choices and 
trust them to make their own choices and then do some of these 
commonsense solutions that you're talking about to not try to reproduce 
the failed systems of the Soviet Union or the failed systems of 
European medicine or Canadian medicine, which are very inefficient and 
expensive, but rather build on the model of freedom and people's free 
choices and people making distinctions between what sort of health care 
they do or don't want and, particularly, allowing doctors to practice 
medicine without feeling threatened from lawyers or insurance companies 
or Big Brother looking over their shoulder.
  If you go to med school and spend a quarter of a million bucks on 
education, I think I'd rather have your opinion as to what you ought to 
do to me. I don't mean to rant here, but it seems like we need some 
sort of statement or declaration or something about some basic 
principles that Americans believe in.
  I yield to you, Doctor Roe.
  Mr. ROE of Tennessee. I think one of the problems that you've seen 
with this plan is the complexity of it. I think the bottom line, what 
you saw in Massachusetts yesterday is that the people there do 
appreciate their own personal freedom. They want their freedom to 
choose. Also, Massachusetts was being asked, since they've already been 
mandated to pay for their own policy, which I might add has added 
tremendous cost, and I will also tell you that half of the primary care 
doctors in that State are not accepting patients.
  This is one of the things that isn't understood about a lot of the 
government-run plans: They don't pay the cost of the care. We haven't 
discussed that much here, but in our own State, Medicaid pays less than 
60 percent of the cost to the providers; the hospitals and the doctors. 
Medicare pays somewhere between 80 and 90 percent of the costs. The 
rest of those costs are shifted to private health insurers, meaning 
that people out in private businesses are actually getting taxed again.
  What Congressman Thompson was talking about, another thing that's 
left out of this particular plan that's really unfair is that you're 
not even putting in the so-called ``doctor fix.'' Let me explain that 
to the viewing public out there. In 1997, there was a bill passed here 
called ``The Sustainable Growth Rate: How Medicare Pays the 
Physicians.'' And what happened was, is there was supposed to be cuts 
every year. This year, there was supposed to be a 21 percent cut to 
physicians, which if that happens, nobody is going to able to see a 
Medicare patient. And that's not even here. It's over a $200 billion 
pricetag that's not even listed in this current trillion-dollar 
pricetag.
  Mr. THOMPSON of Pennsylvania. Will the gentleman yield for a 
question?
  Mr. ROE of Tennessee. Yes.
  Mr. THOMPSON of Pennsylvania. So the statistic you talked about, 
Medicare payments, which it has been my experience in Pennsylvania, for 
every dollar of cost, reimbursement of 80 to 90 cents. So for every 
dollar of cost, the physicians are already losing significant moneys. 
That 21 percent cut that you talked about, that's on top of that.
  Mr. ROE of Tennessee. That's correct. That's on top of the 80 to 90 
percent. So for patients and what they're concerned with now, I believe 
what's happened, and just to simplify in my own terms, is what happened 
in Massachusetts, where people saw they were already paying very high 
taxes, they were already paying for coverage, and then they were going 
to have to pay for States like Nebraska, who were opted out of this 
deal.
  Congressmen, I was very proud to be sworn in to the U.S. Congress on 
the 6th of January, 2009. I woke up on the 23rd----
  Mr. AKIN. You didn't know what you were in for, did you? It's been a 
whale of a ride, brother.
  Mr. ROE of Tennessee. It has been a whale of a ride. I woke up on the 
23rd

[[Page H255]]

of December and told my wife that I was actually embarrassed to be in 
this House because of the deals that were cut. And who ultimately paid 
for them are the patients and taxpayers. And that's wrong. It really 
embarrassed me when you saw this deal in Louisiana and the different 
deal in Florida.
  Mr. AKIN. We've just got about a minute or two. We're going to be 
followed up by another good friend of mine. We may stay on this topic a 
little bit. I thought it might be appropriate tonight in the last 
minute or two to make a tribute to Massachusetts. Now who would have 
thought Congressman Akin would be making a tribute to Massachusetts? 
But if you recall our history, Massachusetts used to be the cradle of 
freedom and innovation in terms of government. It was Massachusetts in 
1620 that saw the Pilgrims come. They put together the idea of the 
first concept of a Republic. A group of free people, under God, 
selecting their own leadership to preserve their God-given rights. 
That's a powerful idea that came from Massachusetts. A hundred-fifty 
years later you had the Massachusetts provincial Congress saying, 
Resistance to tyranny is your Christian duty.
  For the last 50 or 100 years it seems like Massachusetts has been 
sending us the King's people, always wanting more taxes, more 
government, more government spending, bigger government, and yesterday 
the people of Massachusetts reverted back to that great heritage of 
patriotism and freedom and said, We're finally tired of Big Government. 
It's time we start to look at solving our problems without thinking 
every solution means more taxes and more Washington, D.C., control.
  I thank you, gentlemen, that your States have stood for freedom and 
your constituents have elected you to join us here to stand up for just 
plain, old basic American principles. I think we're going to get the 
job done. I think that what happened yesterday was about, from a 
political point of view, quite a stroke of lightning. I think it should 
get people's attention. I think the public has spoken. And it's time 
for us to move on with the ideas that you, Doctor Roe, have been making 
very clear here. It's not like these things are too complicated. And 
G.T., same thing. You're from Pennsylvania, representing the people 
with common sense. These things are not complicated. Define the 
problem, craft a limited solution that fixes it instead of trying to 
scrap everything and go to the Big-Government-fixes-all kind of model. 
I think it's really something that the people of Massachusetts kind of 
came back to their heritage and to their roots in standing up for the 
country, as they did so many years ago.

                              {time}  1800

  When I was a little kid, I lived in Concord and Lexington--actually 
in Concord, and I saw the place where the Minutemen had stood against 
the biggest military power in the world. There is a statue that says: 
``By the rude bridge that arched the flood, their flag to April's 
breeze unfurled, here once the embattled farmers stood, and fired the 
shot heard round the world.'' They stood for freedom, and they stood 
for the basic principles that America has always stood on. And I am 
sure glad they joined us yesterday in making a statement and a 
statement that's going to affect this chart right here. Hopefully this 
chart goes in the dust bin before it ever becomes law. Last word, GT?
  Mr. THOMPSON of Pennsylvania. Well, I just couldn't agree more. I 
think yesterday was a statement that the American people--what they 
want and what they expect from our leadership is that we do our best to 
provide safety, prosperity and liberty, the freedoms within this 
country. And that's the type of public policy that they've been getting 
since last January. That has worked against all three of those.
  Mr. AKIN. Dr. Roe.
  Mr. ROE of Tennessee. Health care should not be a partisan issue. In 
30-plus years, I never saw a Republican or Democrat heart attack. I 
never operated on a Republican or Democrat cancer, just a people 
problem. We need to get together in this body and not have a partisan 
solution. There needs to be a bipartisan solution that is simple and 
addresses problems that we have laid out here today so that patients, 
their families and doctors can make health care decisions.
  Mr. AKIN. And that's certainly what you've been talking about 
tonight, both of you gentlemen. I understand that my good friend 
Congressman King is going to be here in just a jiff. He is going to be 
continuing along the same lines, talking about freedom, talking about 
the principles that made this country and how those principles can be 
applied to solving these very practical problems with health care.
  I will check to see how we are doing on time. Oh, we actually have 2 
minutes. So I don't want to cheat anybody. Are there any last comments? 
Anything that we haven't covered that you want to catch, Dr. Roe or GT?
  Here is one. We didn't talk about all of the cool features of this 
policy; but this wheelchair tax, it was kind of stuck in my craw. The 
idea that you are going to tax a wheelchair, the mental picture of that 
just doesn't seem to be what we want to do. So we're looking for places 
to dig for money to pay for this Big Government system. So what are we 
going to do? We're going to pose a 2.5 percent excise tax on medical 
devices, which includes wheelchairs, to try to raise some money.
  Mr. THOMPSON of Pennsylvania. If the gentleman will yield, my 
background is rehabilitation services. I have seen where these types of 
medical devices--and it is not just wheelchairs. That is an 
understatement. It is insulin. It is crutches. It is canes. It is 
prosthetic limbs. I mean, there are just so many different things that 
this applies to. And this 2.5 percent excise tax, that is going to get 
passed right along to the consumers.
  Most of the consumers who utilize these types of medical devices are 
older adults. They're individuals on very fixed incomes. Those who are 
surviving on maybe $800 to $1,200 a month of Social Security, and the 
very things that maximizes their independence, maximizes their quality 
of life, we're going to tax that? That's a quality-of-life tax, 
actually, because the people who use those medical devices, they are 
medically necessary. They're not luxuries. Those are devices that make 
their lives possible, that allow them to be able to live in the 
communities, to be able to live in their own homes, to not live in an 
institution. That's a quality-of-life tax.
  Mr. AKIN. So if it moves, tax it. If it doesn't move, tax it anyway. 
It might be dead.
  Thank you very much, Mr. Speaker, and thank you, gentlemen, for 
joining me.

                          ____________________