[Congressional Record Volume 156, Number 29 (Wednesday, March 3, 2010)]
[House]
[Pages H1088-H1095]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE TAKEOVER
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. Mr. Speaker, it is a pleasure to be able to join you, my
colleagues, and those gathered in various places around the buildings
here near the Capitol.
I have had the opportunity, having served in government as a
legislator for a number of years, to serve both in the majority, in the
minority, but also in the wilderness. This last year and a half has
been different; I have served in the wilderness because we have
actually come up to the edge of the abyss with a piece of legislation
that promises to be so threatening and so destructive to our country
that should we decide to swallow this poison pill and pass this piece
of legislation, America will never be the same.
I have seen, in the majority and in the minority, pieces of
legislation which are harmful and that may be poor solutions to some
particular problem or solutions to a problem that doesn't exist or
excuses just to have more taxes and more government control, but we
have never quite seen a threat like the threat that confronts America
today, and we, you and I, my friends, who love the red, white, and
blue, are looking off the edge.
I don't know if you have ever stood on the edge of the rim of the
Grand Canyon and looked thousands of feet downward, or if you have ever
been on the top of some high skyscraper or bridge and looked off into
empty space, but that is where we stand tonight. That is where we stand
this week or next week in America. We are standing looking into the
abyss, into a piece of legislation which is quite possibly going to be
passed. And if it is passed, it will leave our Nation very, very weak,
much weaker and unlike anything that we have seen before.
It threatens to do two major things: to destroy the quality of health
care in America, and to destroy the fiscal integrity of our very
country. I am talking, of course, about an old topic, a topic that has
been debated now for more than half a year here in Congress. It has
absorbed the attention of the Nation, and it is an interesting topic
because the more that it has been around, it seems the more the public
is aware of it, and the more they see of it, the more they don't like
it. In fact, as you start to take the covers off the legislation on
health care, it becomes a very ugly picture, and the American public is
wise. In fact, the statistical information suggests that at least 20
percent more Americans believe that we would be better not passing this
piece of legislation and a great majority think we should just scrap it
and start over again by systematically defining a problem and fixing it
rather than having government take over all of health care.
{time} 1915
Now, the process, the way that the legislature works historically has
been so boring that none of the American public pay any attention to
it, but that has changed since we have been in the days of looking into
the abyss, the abyss of the destruction of health care and the
destruction of our economy. And people are becoming conscious of how it
is that bills are passed and how they become law.
What would be required to have this health care bill passed would be
a process that people call reconciliation. What that means essentially
is that the bill would end-run or bypass a safety process in the U.S.
Senate. The U.S. Senate has a very conservative way of operating, and
that is that you can have a bill that you have 51 Senators who would
vote for it--so it would pass if you had a chance to vote on it--but
they put this extra caveat, that you have to have 60 Senators agree to
bring it up for a vote. So in a sense, everything in the Senate
requires a 60 percent approval before it goes to a final vote.
Now, there is an exception to that, and that is because of the
necessity of dealing with the budget and spending and taxing and some
of those issues, that on certain financial kinds of transactions,
because of the fact that we can't afford a gridlock, we allow a 50-vote
majority to be able to move something along, and that's called
reconciliation. But it is not a process that is typically used for a
completely new bill on a very broad subject, which is not just
specifically a financial kind of thing.
We have this quote from our President on this subject of
reconciliation, he says, ``Reconciliation is, therefore, the wrong
place for policy changes.''
[[Page H1089]]
Now, wait a minute now, this is the President saying ``reconciliation
is, therefore, the wrong place for policy changes. Isn't the health
care bill a policy change? I guess it is. It's a whale of a big policy
change.
In short, the reconciliation process appears to have lost its proper
meaning. A vehicle designed for deficit reduction and fiscal
responsibility has been hijacked to facilitate reckless deficits and
unsustainable debt. Well, I wish the President would pay attention to
his own words. This is what he said, Reconciliation is not a place for
policy changes, and yet the health care bill is a massive policy
change. It will take over about one-sixth of the U.S. economy. The
government will step in and effectively run one-sixth of the U.S.
economy with all kinds of rules and regulations and bureaucracies. I
guess that's a policy change, Mr. President.
In short, the reconciliation process appears to have lost its proper
meaning. Indeed, it does. A vehicle designed for deficit reduction and
fiscal responsibility, that's what the reconciliation process was
supposed to be about, and in fact it's going to be hijacked. It's been
hijacked to facilitate what? To facilitate jamming down the throats of
the American public a bill that America clearly does not want us to do.
They want to take the reconciliation process as a mechanism to jump
with all of America into the abyss.
So I think it's interesting that after the votes, particularly the
vote in Massachusetts where the Democrats do not have 60 votes in the
Senate, they don't have one Republican that would support this bill,
not one, for people who have served in the legislature, that is a huge
warning sign. When you see a total party line vote on something, that
means there's some problems.
Usually in the legislative process, if it's been done properly, a lot
of people have a chance for input, people have a chance to improve and
say this part seems to be a little radical, let's go back this way.
Usually what you have is more of a mix of people. When you see
something being jammed in a process that is not designed--that is,
reconciliation--for this massive policy change, and you see not one
Republican voting for it, that should be a warning sign for people
everywhere, and it is a misuse of reconciliation.
And so while the public is saying in poll after poll, survey after
survey, phone call after phone call from our districts, stop this
train, do not jump into the abyss, do not allow the Federal Government
to take over one-sixth of the economy, and yet, what do we see? We see
a tremendous determination to jam this bill through, whether the
procedure fits or not. But it's my way or the highway, and we're going
to do it because we know what's best for you.
This is a very high-handed approach, and it is something that does
not--never does and never will--produce a good consensus in America. It
will be something that will divide America, create a tremendous amount
of tension and pressure, end up with lousy health care, and a Federal
budget that is even more out of control.
Now, if you take a look down here, we have another quote from the
Speaker of the House, Nancy Pelosi, and it says, ``This will take
courage.'' In other words, for the Democrats to vote for this bill, it
will take courage. What does that mean, it will take courage? Well, if
it takes courage, it means somebody is going to be mad, somebody is not
going to like it. And so you have to be courageous and stand up to
somebody who doesn't want you to vote for this bill. Who do you think
the ``somebody'' is? Is it the Republicans? The Republicans don't like
it, but we have 80 votes less than the Democrats, so we can't say much
of anything about it other than explaining why we don't like it. But
our votes don't make the difference.
Nancy Pelosi has a whole lot of extra votes. She could have 20 or 30
people vote no and still pass this bill. So why does this take courage?
Well, it takes courage because somebody doesn't want it, somebody very
much doesn't want it, and they're going to be mad if it's jammed down
the throats of the American people. Who is the somebody going to be?
You got it, the American public.
People are not going to like this bill. So if you vote for it, the
point she's making is you're risking your seat because people are going
to be mad. It's interesting when the leader is saying it's going to
take courage. That says somebody doesn't like it.
Now, are there some reasons why people don't like the bill? Well,
first of all, this is a rough flowchart trying to describe what happens
when the government takes over one-sixth of the U.S. economy.
Obviously, there's a whole lot of things being done by private
institutions which will be replaced with government institutions, and
they've got to figure out how to replace it all. So no wonder it takes
almost 3,000 pages of bill to try to put some sort of a scheme together
for the government to be running the health care business.
Now, on the surface of the whole situation with this bill, this is
not an easy sell. As you know, this bill has been around for more than
half a year--I guess it's three-quarters of a year. People don't like
it very well. The President thinks it's a beautiful bill, but the more
that people see it, the less they like it; they think it's an ugly
bill.
Well, let's just think about the logic of this, stand way back away
from all the details of health care. We've got Medicare and Medicaid,
both of those have to do with medicine. They are both very large
Federal entitlements, Medicare, Medicaid. In fact, the great challenge
to the American budget are three entitlements. People say earmarks is
what it's all about. Earmarks are 1 percent. Earmarks are not the thing
that's really a threat to the budget. The thing that's a threat to the
budget are three entitlements: Social Security, Medicare, and Medicaid.
Two of those have to do with health care--Medicare and Medicaid. And
what's the problem with Medicare and Medicaid? Well, they're
financially broken, and if they continue as they are right now without
changing those laws, they will bankrupt our country.
So we've got Medicare and Medicaid, government programs that are
currently bankrupting our country. And so what are we trying to sell
the American public? Oh, hey, we've got the government running Medicare
and Medicaid, they're bankrupting our country, so let's take over all
of health care with the government. There is something intuitively
counterintuitive about that, isn't there? Why would you want the
government to take over something that it's already messing up, that
not working financially, that is in the process of bankrupting our
country. If you can't do it in a smaller area of Medicare and Medicaid,
why do you want to expand it to everybody?
So this is kind of a hard sell for the President, and that's why it's
taking a lot of courage and why this bill is not moving any too fast
and why the public doesn't like it. But there are many, many other
reasons. You can see the complexity here, and as you can imagine, when
you start to look at the details, you find that it is full of a lot of
little devils. One of the things that you find--and I think one of the
little devils that is perhaps most noxious to a lot of American
people--are the special deals. You see, when you have a piece of
legislation that's going to take a lot of courage, you have to put some
sugar in it to make people vote for it. And the sugar, of course, comes
in the special deal form.
So what you find in the legislation--to the best of our knowledge,
because the idea about transparency and openness we have not seen, and
so we don't actually see exactly what's in this bill in its final form,
but you see what it was like in the House, we saw what it was like in
the Senate. But we find that it has some of these special little
things, that is, that it's going to take $500 billion out of Medicare,
but is it taking $500 billion out of Medicare all the way across the
country? No. In fact, in the State of Florida, it's not going to take
any money out of Medicare Advantage at all. So it won't be coming out
in Florida, but in the other States, they do take it out. Well, that
was a special deal for somebody in Florida.
Then we've got special deals for--I think it was called Louisiana
Purchase II for Louisiana; special deals for Massachusetts that
Medicare gets these special reimbursements there; going to build a
hospital, as I recall, in New Jersey, but not in other places. So you
have special deals. That's one of the things that makes this look ugly
to the
[[Page H1090]]
voters because you're not treating every State the same; you're making
some States pay more and other ones don't, and you're making some
special adjustments for various people.
You find there are special adjustments for people who work in a labor
union, but somebody who works the same kind of job in a company that's
not in a union doesn't get the same break as if you are in a union. So
again, this is one of those special deals. The American people in
general see that and say that isn't fair, that isn't right, that isn't
good legislation, that's special deals. We don't like special deals
because they don't treat people equally before the law.
Now, when you take a look at the complexity of this chart, what it
suggests is that this is going to be expensive. Not only is it going to
be expensive, if you've got a problem and you fall through the crack
somewhere, you may never get over to getting any health care at all
because it has got so much redtape and bureaucracy. And so the whole
idea of this kind of a system working well and providing good quality
service is a little bit hard to understand. And when you take a look at
the failings of Medicare and Medicaid in terms of the projected way
that they're going to take our country into bankruptcy, do you really
want to expand all of health care into these categories? So there is a
fiscal sanity kind of component.
One of the ways to take a look at the bill and to ask some questions
and to get a sense of what's going on as to why this bill is unpopular
as people study it and see more and more of it, these are some
comparisons of what the health care proposal does. This is the old
Democrat bill, this is the President's new online bill, and this would
be the Republican alternative, or alternatives. So we have three
different bills in comparison here, and a comparison based on a number
of different criteria. I think it may be helpful to take a look at some
of those.
First of all, it says here that it imposes half a trillion in
Medicare cuts. We talked about that just a minute ago. This bill is
going to cut Medicare. You always heard the Democrats saying the
Republicans are going to take your Medicare away. That didn't turn out
to be true, we have not done that, but this bill does. This bill is
going to cut $500 billion out of Medicare, and the answer to this of
course is yes, the old Democrat bill did that. That's the yes. The
President's new bill is going to do the same thing. So it's going to
impose a half a trillion in Medicare cuts. The Republican alternative
does not.
{time} 1930
So this is one of those situations where people are a little
uncomfortable. Medicare is having trouble financially, and doctors are
not being reimbursed very much in Medicare, so they're starting to not
accept new patients because they're not being reimbursed enough to make
it worth their while to take patients. If that's a problem in Medicare,
why are we going to pull half a trillion dollars out of it? That's one
of the ways you can look at these bills. So there is a difference. The
Republicans are not proposing that, but both the President's new online
bill and the Democrats' bill do that.
Then it also enacts job-killing tax hikes and government regulations,
costing hundreds of billions of dollars. It's a $1 trillion bill, which
is a conservative estimate. This bill is going to cost a lot more than
$1 trillion. How do you pay for it? Guess what. By tax increases--
right?--and with cuts to Medicare. So the tax increases here are going
to come from where? Well, a lot of them come from small businesses.
When you tax small businesses a whole lot for their employees, guess
what's going to happen? They're not going to be able to hire as many
employees, so this bill then has the effect of causing unemployment.
So, in our particular climate, with unemployment near 10 percent in
America and with not a lot of sense of hope that that employment is
going to turn around in a hurry because of very badly shaped policies
by the Federal Government, particularly policies which hammer small
business owners, to have this bill which is going to tax heavily small
business owners and which is going to put tremendous new government
regulations on them which will cost billions of dollars is not
something, from an unemployment point of view, that is a very good
idea.
This is going to be done by the old Democrat bill and the President's
new proposal. The Republican alternative, it won't surprise you, is not
enthused about tax increases, and we don't know that that's the best
way to be dealing with some of our problems in medicine.
I am joined by a very good friend of mine, Congressman Bishop. I
would very much appreciate his perspective as to what we are talking
about.
I've just been saying--and I don't think I am overdramatizing this--
that, to a degree, it's my sense that America is standing on the edge
of an abyss, like looking over the Grand Canyon or something, and that,
if we step off the edge and misuse this reconciliation process, we are
going to damage our country in a way unlike anything that we have seen
before.
Please join me.
Mr. BISHOP of Utah. I appreciate being able to join the gentleman
from Missouri here, and I appreciate his efforts so far in explaining
the differences in these particular bills.
I want to echo that I agree with you that we are in a precarious
situation. There are those who would tell us that the most important
thing we could do right now is to pass something. A lot of bad pieces
of legislation and policy changes have happened when we have simply
passed something that was there. Our goal on this particular issue
should be to pass the right type of reform, not just something. Until
we get the right type of reform, we should never actually quit looking
to form a way that is best in providing options and choices to the
American people.
I am assuming, when you started, that you talked about some of the
four supposed, alleged, Republican proposals that were added today. You
know, when I first saw that, I thought somebody was pulling my leg. It
was a joke. I find it ludicrous and somewhat insulting to the American
people that there are actually those who believe, if you take a $1
trillion program which transfers power from the American people to
bureaucrats in Washington, by adding more spending for a few studies
and for a few small, little tweaks here and there, that that's actually
better and that that's going to buy people's support.
I think one of the things, maybe, we have done too long in both
Houses of this Chamber, perhaps with both parties, is we've spoken too
long about it. We've been giving speech after speech as if that's going
to convince Americans to go along with this program. What we should do
now is listen to the reasons Americans have complaints about the core
program that is before us.
I appreciate what you're doing up there. You're going through some of
the core problems in this particular bill--that a few little add-ons,
which cost even more money, are not going to sell this core problem
issue.
If I could say just one more thing--go ahead.
Mr. AKIN. It sounds like what you're saying is that you can chrome-
plate a pig, but it's still a pig when you're done. Go ahead. Yes.
Mr. BISHOP of Utah. I've actually been trying to think of a lot of
metaphors here, and I don't think any of them really work terribly
well.
Except I do remember one time when my oldest kid was about 3 or 4. He
had been given a candy bar and was supposed to participate in a
program, and he didn't want to go up and join the other kids in the
program. So I took his candy bar away. I said, If you go up there and
perform, I'll give you a candy bar. Of course, he was dumb enough to
accept that, and he waddled right up there and did the program, and I
gave him his candy bar back.
I hope that people don't think, just by giving me my candy bar back,
I'm going to buy this program, because the program hasn't changed. It
is still fundamentally flawed.
A reporter just asked me, Don't you think these bills should have an
up-down vote? Well, here in the House, everything is an up-down vote.
Also, the bills that have been introduced by Representative Shadegg
and by Representative Price have a different approach to solving the
problem and to reforming our system, which is based on giving power to
the people so that people can make choices. Representative Akin, I
think they deserve
[[Page H1091]]
an up-down vote in this body as well. Instead, they have been
prohibited from even being discussed in committee or on the floor.
Mr. AKIN. So, in other words, what's happening is you have other
approaches to solving some of the problems of health care, not trying
to have the government take it all over but, rather, to fix various
component parts. We have a Rules Committee. If you want to offer a
suggestion, for instance, they prohibit you from offering it as an
amendment to get an up-or-down vote on it; is that correct?
Mr. BISHOP of Utah. Yes. I would simply suggest to the leaders of our
Congress and to the President, instead of saying, If you have ideas,
give them to me, and I'll make a choice on whether they're good or not,
put the ideas on the floor.
Mr. AKIN. Well, that's the way the process has worked. Yes. Go ahead.
Right.
Mr. BISHOP of Utah. Put those ideas on the floor, and let all of
those ideas be fully debated in front of the American people. Give an
up-down vote on every idea that's out there. Just perhaps, just
perhaps, we will find that there is a needed reform to our health care
system that actually meets the needs of the American people, that does
not cost them out of existence, that does not cut jobs, and that does
not move power away from the people back here to Washington. It allows
people and their doctors to chart their own futures.
I have said it a couple of times when I've talked to you on the floor
here on this issue: the State of Utah launched last year a reform of
the health care system based on Utah's unique demographics. We have the
youngest State in the Nation. Our median age is younger. We also have
probably more small businesses which don't provide insurance than in
most States. We need something specifically for our need, and we have
launched a program that is well designed with fundamentals. It still
needs to be tweaked, and it still needs to be worked on, but it is
based on our needs and on our demographics. If either the Senate or the
House bill, these one-size-fits-all programs, were to pass in any form,
it would totally destroy what the State is trying to accomplish.
We are not the only ones with brilliance here. We are not the only
ones who care about people. We should be partnering with States to come
up with new and creative ideas to meet the individual needs of our
people in their individual areas, and we flat out are not allowing that
to take place.
Mr. AKIN. We are basically muzzling a lot of the representative
process.
As you said, there have been different analogies. You talked about
your son with a candy bar. Another one was the idea of a kitchen that
has a broken sink. When you hire a plumber to fix the broken sink, you
don't remodel the entire kitchen. Of course, that's the model that the
Democrats have been using. It's the concept of, Ha, the sink is broken.
Therefore, we can remodel the whole kitchen. They have the idea of
remodeling the kitchen, and they've been wanting to do that for a very
long time. The broken sink is now the excuse to remodel the whole
kitchen.
I think the point of the matter is that the American people would be
more comfortable and the legislative process would work better if we
were to say, ``Let's define a specific problem in the health care
system.'' Instead of having the government take it all over, let's try
to solve that one individual problem. I guess it depends on how you
explain it or say it.
If I were to ask, Gentleman, would you like the government to buy you
a house, you might be tempted to say, Well, that sounds pretty good.
Yet, if I were to ask, Would you like to live in government housing,
you might think, I'm not so sure I want that. That may be a little bit
of an analogy to explain what we've got here.
The idea is to say, ``Hey, don't you want free health care?'' But the
other way of looking at it is, Do you really want the government making
health care decisions, or would you prefer that your doctor makes those
decisions? So it depends how you say it, but the American public has
gotten wise to this, and that's why you've got at least 20 percent more
in the number of Americans who don't want this program.
Mr. BISHOP of Utah. Well, I think the gentleman has also brought the
other chart down here, which you probably used earlier, which is how
the system would be structured. Now, when the first bill was presented
by our good friends on the other side, that was the structure. I hate
to say this. Over all the times we've just discussed it, that typical
Washington approach of convoluted, complex patterns and about people
making decisions hasn't changed at all. As we have come through and
have supposedly come up with this new idea that has a few tweaks from
the Republican side, there has been no compromise on the basic problem,
which is that structure.
Mr. AKIN. You know, I kind of like this chart because I think that
some entrepreneur could make money with this chart. If you were to just
shrink it down a little smaller and add some additional lines, you
could start over here. These are the consumers. These are the people
who are sick. The medical professionals are over there. You could sell
it to restaurants as a placemat and give people crayons, and customers
could try and draw and see if they could get through the maze to get
over to the health care professionals, because that's a little bit how
this looks.
Now, maybe that sounds like a silly thing to say; but, gentleman,
you're in the business in your office--among other parts of the work
that we do as Congressmen, we get phone calls from our constituents.
Our constituents want us to help them solve problems that they're
having with the Federal Government. I'm thinking, if this system gets
put in, I'm going to have I don't know how many thousands of people
every day on my phone, saying, ``I need this kind of medical care, and
I can't get through this system''. They're going to ask me to help them
do it. I'm going to say, ``Fat chance. This is a mess.''
Mr. BISHOP of Utah. I think you're absolutely right, and I think
that's one of the reasons a lot of people have changed their opinions.
A lot of people have grave concerns about this type of a program, a
one-size-fits-all, Washington-based program.
I've also had some other people calling me, a lot of people with
grave concerns and with a great deal of anger over everything that's
going on. There are some who have simply asked, ``Why can't you just
sit down and compromise? Why can't you work things out?'' I think I
join with you in saying I am more than happy to sit down and work with
anybody who will work with me.
The bottom line is we have not been allowed to work together, which
is why I was saying earlier to let those other ideas, the other bills,
have an up-down vote as well. Bring them to the floor and allow a true
debate on all ideas. Don't siphon the ideas down to what is allowable
by the leaders of Congress. Allow us to actually work together. As I
think you intimated, there are some things, certain provisions, on
which both Republicans and Democrats do agree. Let them stand by
themselves and see what we can actually accomplish without taking an
idea on which we basically all agree and then adding 10 or 15 bad ideas
on which we fundamentally disagree and saying, Okay, it's take it or
leave it.
Mr. AKIN. Well, you know, I hate to admit how many years I've served
in the legislative body. I started by saying I've served in the
majority, in the minority and now in the wilderness.
As to most legislation I've seen that works pretty well, surprisingly
enough, people are sold on it. There is a process of a bunch of people
coming together, defining a problem, working on a solution. Frequently
when they start, the bills are pretty rough, are pretty hard to
understand, and have a lot of questions and problems in them; but as
more and more people have a chance to work on them, to roll their
sleeves up and have input in them, the bills get refined.
In the business world, if you want to mess something up, you send it
to a committee. In the political world, when committees work on
legislation, they tend to refine the product. After a period of time,
what happens is you have certain ideas that some people just can't
tolerate, and you tend to throw the radical stuff out. What you can
agree to comes together. When that happens and particularly when it
[[Page H1092]]
happens across party lines, you don't have major fundamental reform,
but you change, and you fix things in ways that solve people's
problems.
What happened this year is we had 80 less seats than the Democrats,
so they thought, We don't need the Republicans. The dickens with the
Republicans. We've got such a majority that we can do whatever we want.
As they've marched off to totally change all of health care, now
they've gotten kind of in a jam because they're realizing the public is
not agreeing with it, and they don't have one Republican vote. That's
very, very unusual politically that there is not at least one
Republican who would vote for a bill.
That says that this has been such a partisan kind of approach, and
that's why there is cause to scrap it. It's not that people are going
to go back to ground zero in health care, but they're saying this
approach right here is just too much.
Mr. BISHOP of Utah. I would be very hesitant to try and ascribe any
motives as to why things happened the way they did.
What we do know is, historically, when major changes of policy have
taken place, even when they have been hotly debated, even sometimes
when cloture has been approached over in the Senate, the final product
has had a lot of majority and minority votes coming together.
{time} 1945
It was not this divisive of an issue that was trying to be pushed
through in, once again, a very partisan and divisive way.
I think you are right. What Republicans are saying is there are other
ideas that still have to be out there, and what is more important for
us is to do the system and do the reform the right way the first time.
It is very difficult once something is established to go back and fix
it. It is best to do it right the first time, and we are not doing that
here.
Mr. AKIN. You are right. The thing about legislation, because it
affects so many people, it is so expensive and what you sometimes
create can never be taken back, it is absolutely crucial that we get
this thing right the first time. We would be far better off--I guess it
is maybe a little bit like choosing a wife. You want to be sure you
choose the right one the first time. It is less expensive that way.
This is something you want to get it right the first time, and if
there is doubt, if there are questions, then it says it is probably
better to slow up and take a good look at what you are doing.
Now, there are some things about the bill that are being proposed
here that are just completely anathema to many, many Americans. I think
if you have to say, well, what would some of those things be, I
mentioned the special deals. People don't like that.
But if you get to the heart of what is going on in health care, it is
that relationship between you when you are sick and your doctor. We
call it the doctor-patient relationship. I think that is fundamental to
our understanding of what good health care has to start with, and that
is that you have got qualified, professional doctors who work with
somebody who is ill. The family and the doctor come together and they
put together a solution as to what is going to happen and what the
doctors can do to help you with your health.
Now, one of the things that gets people very upset, and with good
reason, is when somebody butts in to that doctor-patient relationship.
One of the examples that we have seen too frequently is that we have
allowed insurance companies sometimes to jump into that doctor-patient
relationship, and they say, oh, we are not jumping into the doctor-
patient relationship; it is just that we are deciding what we will fund
and what we won't fund. In other words, the doctor says you need to do
X, Y, and Z, and the insurance company says, oh, you don't need to do
that. So we don't like it when somebody who is not a medical
professional starts to superintend over our health care and we don't
have any control of it.
What is even worse is that when the doctor makes a medical mistake,
he is going to get sued, but when the insurance company says you don't
need to do that and then you up and die and your relatives say, hey,
the insurance companies just cost a life, well, it turns out they don't
have any medical liability. That is not a good situation.
But it is not the worst situation. Something worse could happen. It
is this. This is what is worse. Instead of an insurance company, which,
if you want to, if you have to, you can change your insurance company,
this is going to put a government bureaucrat between you and your
doctor, and that is something that I don't know a single Republican
that likes that idea.
We don't think we want government bureaucrats getting between you and
your doctor. And how is that going to happen? Well, because the
bureaucrats have got their calculators, and as they calculate, they
say, how old are you? What are the statistical chances of this? Whoops,
you don't get this care.
So the bureaucrats say, we are not going to allow you to get this
kind of health care. And the doctor says, no, I understand the
statistics, but in this case this particular medical treatment is
necessary. And the bureaucrat says, no, you can't get it. That is one
of the reasons why in the United Kingdom health care death rates are
much higher than they are in America, because of the fact that the
bureaucrats say, no, you can't get any care.
Mr. BISHOP of Utah. If I could get the gentleman to yield for just
one second.
Mr. AKIN. I do yield to my good friend from Utah.
Mr. BISHOP of Utah. I think it is well to reemphasize that fact that
not everyone will get what they want in this particular program. I was
told that once again today, the President, in his remarks, said, if you
like your plan, you keep your plan; if you like your doctor, you can
keep your doctor.
Now, if that line sounds familiar, it is because it was a staple in
the rhetoric for all of last year, with a couple of problems. I have
been told that media outlets like the Associated Press and ABC News
debunked that claim, showing that that cacophony of programs and lines
going through, that that simply was not the case. And the White House
then said, well, we are not taking that line literally, and eventually
it was removed.
It is coming back now, but it still is not accurate. The problem is,
if you like what you have, you may not end up keeping what you like.
You may end up being told what to do, which is the problem every time
when you try and transfer power from individuals back to Washington to
tell us what is best for us. We sometimes may not agree. And that is
the sad part.
That is the fundamental problem that a few tweaks around the edges
can't solve. But that is a significant problem. And I think the
gentleman from Missouri hit the nail on the head when he said this is
one of those fundamental issues, which is why this program should not
be forced through, but you should back up and start again with
something that doesn't have that premise of Washington being empowered
to tell us how we will live our lives.
There are 8,000 State legislators out there, all of whom are bright,
all of whom can come up with programs for their States. Allow the
States to be the laboratory of democracy that Louis Brandeis used to
talk about. We can do better. We can do better. This is not good enough
for us to force through, just so we can say we did something. There is
a better approach to it.
I yield back.
Mr. AKIN. I couldn't agree with you more, and I do think that is a
fundamental question. And when people talk about compromise, I would
picture people on the outside of Congress saying, why can't those
people just get together, solve a problem, bury their partisan hatchets
and just serve the American public?
Part of the reason why you don't see that is because there are really
fundamental differences of opinion on what you do with health care, and
one of the very, very big ones is that question: Is it going to be
between you and your doctor or is it going to be between you and the
Federal Government and some doctor that they choose? And that is a
very, very big difference in opinions on health care, and this system
forces the Federal Government between you and your doctor, and it is
why it doesn't have any support, among other reasons, from Republicans.
There are a couple of other things here we probably ought to talk
about,
[[Page H1093]]
because when we talk about health care being too expensive, one of the
things that really increases the cost of health care has been
attorneys, particularly trial attorneys who are going to sue doctors
for having done the wrong thing.
Now, there are times when doctors do the wrong thing. There are times
when doctors do the wrong thing. They need to fix it and need to pay
for some of the damages that their actions caused. But this is more
than that. These are these punitive lawsuits with millions of dollar
claims. And what does that do? It adds a tremendous cost to the cost of
health care. So, one of the ideas, if you want to reduce the cost of
health care, is that you want to have what is called tort reform.
We were promised in Baltimore by the President that certainly he
believed in tort reform. But as we take a look at the legislation that
we have got, one of the things that you find is that the supposed tort
reform in this bill, the old Democrat bill, and I believe the
President's new bill, although I am not sure this is in there, is the
fact that the States that have enacted tort reform, such as my own
State of Missouri, the States that have enacted tort reform, they
cannot keep that tort reform in place when this medical bill goes in.
So it gets rid of tort reform instead of making tort reform.
Now, I said that costs a whole lot of money if you don't have tort
reform, or tort reform is a good idea to reduce the cost of health
care. In the State of Missouri, it has dropped the cost of health care
significantly, I am talking in excess of 10 or so percent, States that
have decent tort reform. It reduces the cost of medicine. So, that is a
reform that Republicans wanted to do, and it is not included in the
bill, which is the tort reform.
I do yield.
Mr. BISHOP of Utah. If I could maybe add to that, because I think you
have hit on one of the things I think is essential if we are really
going to reform the health care system, because we do have two
problems. One is people being covered by insurance, but the second one
is the overall cost of the system. If you don't address both of those
problems, you haven't really done a good health reform.
Mr. AKIN. The cost of the system, and what is the other?
Mr. BISHOP of Utah. Coverage of individuals, being covered and having
the costs overall. Because even if you have insurance, it still is very
expensive, and the costs keep going up. So we have to deal with both of
them.
A key element, a crucial element that everyone within the medical
community will tell you, is if we don't do cost reform dealing with
tort issues, if we don't deal with the massive amount of litigation
that forces doctors to do more and more procedures just so they are
covered just in case someone decides to sue them, we will never
actually get a handle on the costs of health care that keep going up.
Once again, the President has said in past speeches he is willing to
look at that. But in one of the four proposals he seemed to add as a
sweetener to this deal, it was not to actually have malpractice
resolutions, but simply to study alternative malpractice resolutions.
Now, that ain't it. A study, we have been doing that for a long time.
We know what the problem is.
Mr. AKIN. It seems to me the study has already occurred. Various
States have done it, tried it, and it saved a lot of money. What more
do we need to study on it?
Mr. BISHOP of Utah. So adding that as something to improve the system
doesn't improve the system at all. It is nothing. What we need to do is
actually implement those. And you are right. Once again, even my home
State, the legislature once again is addressing on a State issue that
concept of tort reform and litigation limitations. It is essential, and
we need to do that.
That is one of the issues on which I think both parties could easily
come together and make a resolution, if we were allowed to discuss real
litigation reform. But, once again, that is not on the table. That is
not discussable on the floor, if ``discussable'' is a word, which it
probably isn't.
Mr. AKIN. Well, but it is something that needs to be dealt with. If
we just kind of run through that, I think people can understand. You
are a doctor. You have somebody who is ill, and you think, well, I am
pretty sure this is what is wrong with them, but it could be five other
things, so I am going to run all these tests, some of them are very
expensive tests, just in case, no matter what, so if anything goes
wrong, anybody gets me in a courtroom, I can say I did absolutely
everything that anybody could do, and a whole lot more besides.
Well, of course, that costs a whole lot more money, and they are
doing it strictly to cover their tails because they don't want to be
sued and have millions and millions of dollars thrown against them and
run their cost of insurance up.
Now, if their insurance goes up and up and up, guess how they have to
pay for that insurance? By charging the patients more money. So that is
how this tort reform can save in various States. We don't have to study
it. It saved a whole lot of money in a great number of States.
So those are some things that I think are important. I talked a
little bit about reconciliation, the misuse of that process. I had a
good quotation here from a prominent Senator. A prominent Senator was
looking at reconciliation. That is the process the Democrats are
talking about doing. And this prominent Senator, you have got it, it is
the President, says, ``Reconciliation is, therefore, the wrong place
for policy changes.''
I think the government taking over one-sixth of the U.S. economy
would probably qualify as a policy change.
He says, in short, the reconciliation process appears to have lost
its proper meaning, a vehicle designed for deficit reduction and fiscal
responsibility. This doesn't seem like deficit reduction and fiscal
responsibility. It seems like it is a policy change.
We have to agree with the President that this is not the place for
reconciliation. And yet, guess what? In spite of the fact that
Massachusetts has even voted on this, we are going to jam this bill
through, whether you want it or not, using this process, the misuse of
this process called reconciliation, which most people have never heard
of before, but it is by hook and by crook and not by a legitimate
method.
Here it benefits trial attorneys, by failing to enact meaningful
lawsuit reform. That is that tort reform. The old Democrat bill does
not put it in; the new one does not. The Republican believes, yes, we
should have tort reform.
Here is another one. Protects backroom deals with Washington special
interests. There have been a lot of special deals in these particular
bills. I think the one that I find most offensive was an agreement made
with insurance companies that said if an insurance company makes a
decision that overrides the doctor-patient relationship--that is, they
say, yeah, we recognize the doctor-patient relationship; we are just
not going to pay for it--if they do that and something goes wrong, the
insurance company cannot be sued. So the doctor gets sued for
everything. But if the insurance company that is not a medical
authority makes a decision, the decision turns out to be bad, yes, the
doctor said your wife should go to the hospital but we said we are not
going to cover it, she doesn't really need to go to the hospital, and
then she gets really, really sick because she should have been in the
hospital, guess what happens? The insurance company has no liability
whatsoever. So that is one of the backroom deals that is particularly
upsetting.
The other one we talked about puts the government bureaucrats in
charge of personal health care decisions. The Democrat bills are doing
that. That is why Republicans--this isn't a matter of, hey, can't you
just be a little open minded? No, I can't be open minded. I don't want
the government involved in health care decisions with my body.
{time} 2000
The Republican proposals don't do that. We're joined--I don't know
whether he wants to join us yet or not--by a good friend of mine from
Texas. No, he's not quite ready. Will you talk to us in a few minutes?
We'd like to have you as part of our discussion. But you're going to do
another hour.
Here's one. This is: Breaks President Obama's pledge to not raise
taxes on those who make less than $250,000. I recall in the campaign he
said, I'm not going to tax anybody who makes less than $250,000. And I
thought, Man, am I
[[Page H1094]]
glad about that, because I don't make $250,000. I'm going to skate free
for 5 years. No taxes. It's not going to be a big deal.
Well, the trouble was the House passed a bill not so long ago that
was going to get you. If you flipped the light switch, you were going
to get taxed. That doesn't have anything to do with $250,000. This bill
is going to tax a whole lot of people making less than $250,000. Yes,
it does. And the old Democrat bill, the President's new bill, yes, it
is taxing people under $250,000 very heavily. In fact, it mandates that
you have to buy a government product, which is unconstitutional. The
Republican bill doesn't do that.
My good friend from Utah.
Mr. BISHOP of Utah. If I could add just one element to that concept
of $250,000, because I agree with you, if $250,000 was a salaried
employee, that's pretty good money. The only problem is, in all of
these equations it applies to the business world as well, in which
almost every small businessman is grossing at least $250,000. I know in
my district--once again, I said Utah has more small businesses on
average than most States do. And in my district, almost 98 percent of
those, according to the IRS, will have a bottom line that's above
$250,000. So it means the taxes that are imposed are also imposed to
the business community. It's one of the reasons why the State of Utah,
when they looked at a reform for health care in the State of Utah,
tried to come up with a policy that would give a consistent number to
small business so they knew how to plan for what the health care cost
would be and can come up with a defined contribution level they could
give their employees, who could then go to the exchange and buy
something that fits into what they need. But that consistency is
extremely important.
It's very difficult for small business to provide health care for
their employees when they don't know what the escalating and
skyrocketing, almost roller coaster costs, will be to them. They cannot
plan for that so they basically don't do it at all. And if indeed we
add a tax to them at this stage of the game, that means we are making
it even harder for the business community to recover, to provide jobs,
to grow our economy, and to get people working again. That's why when
we say this thing hurts job performance, that's why it hurts job
performance. It can be devastating to job creation.
Mr. AKIN. I really appreciate your highlighting this question of
unemployment because I really think that a whole lot of Americans would
think we were more effective and that they would have more respect for
Congress if we were dealing with the fact that we've got a 10-plus
percent unemployment rate out there. And in fact that number is
probably conservative because of the fact that if you haven't had a job
in a year, you're no longer part of the statistic. So as people get
more and more discouraged, don't get a job, they fall off those
numbers, and we still have a 10 percent unemployment rate.
So I think a lot of the public would say, Hey, why don't you guys pay
attention to unemployment. Well, here's a way to pay attention to
unemployment. We've got a bill here that, on the face of it, economists
have rated it's going to cost 5 million jobs. Why in the world would
this proposal cost 5 million jobs? Well, you just hit it. But do it
again, gentleman, so people can make that connection.
You have got to understand, this is going to increase unemployment in
America. Is that what the public wants, more unemployment? I don't
think so. But please run through that again. You're a small businessman
and this bill passes, and what does that mean?
Mr. BISHOP of Utah. That means there will be an extended cost of
doing business associated with this particular plan. Even though when
we say anyone making over $250,000 will not be taxed, it will be taxed.
Once again, if that was simply a salaried employee--a salaried
employee--that sounds pretty good. But that covers almost all the
businesses we have who are small in this country, and large as well.
Once again, it does go to the point we tried to make a little bit
earlier. The Shadegg bill, the Price bill, the other Republicans' bills
that should have been allowed to be debated, they don't have any of
those provisions. So that negative anti-job aspect that is definitely a
part of this bill if it's pushed through does not necessarily have to
be there if you simply allowed the other ideas to be debated, discussed
openly here on the floor.
Mr. AKIN. Right. So we don't have to create unemployment and deal
with health care. It's just that this approach is going to create
unemployment. Now let's take a look at how that works. There's a number
of ways that unemployment is going to be driven. The first is you're
going to tax the guy that owns the business. When you tax somebody that
owns a business, it means he's got to give money to Washington, D.C.
That means he can't take that same money and put it back in his
business to add a wing to the business, to buy a new machine tool to
create a new process to create more jobs, because instead of taking the
money to build the small business, you're taking it to give to the
government to run health care. So when you take money away from the
owner of a small business, you're going to kill the job creation
process.
What else does it do? Well, it creates a lot of redtape for business
owners. And when you create redtape, that also makes it so that it's
harder for them to be efficient and competitive. And so that tends to
hurt job creation. You also, because this bill has been sitting around
and been hanging, scaring everybody to death for three quarters of a
year, it creates a sense of tension and a restlessness, so that
business owners are saying, I don't know what the business climate is
going to look like in 6 months. I don't dare take a risk because I see
threats on the horizon to the financial stability of my company.
Mr. BISHOP of Utah. The gentleman from Missouri also has those last
two points on your chart, which reemphasizes the very statements that
you were just making.
Mr. AKIN. It forces individuals to purchase government-approved
health insurance. Let's talk about that for a minute. Yeah, the old
Democrat plan forced you, it forces everybody in America to buy
something. And the President's new version forces you to buy something.
The Republican does not force you to. And aside from the fact that
Americans don't like to be told that you have to buy something, there's
a small detail: It's not constitutional. When can the government tell
you that you have to go out and buy a gun or you have to go buy a
watermelon or something? That's not constitutional for the government
to tell you you have to buy something. Yet, that's what's going on
here.
Mr. BISHOP of Utah. At times we have talked in the past about this
concept of constitutionality in two ways. One, that it violates the
concepts of federalism. But the second one deals with specifically the
commerce clause. I think that's been brought to our attention before.
That even in court cases, and maybe somebody will correct me here when
it's his turn, in court cases there are usually two principles that are
involved on whether the commerce clause is justifiably used. One: Does
it have an impact on interstate commerce? I think everybody admits this
would have an impact on interstate commerce. But the second is: Is
there a willing participant in this program? This is why this is
different, because for the first time you are threatening to fine
people, throw them in jail, for not doing anything. For doing nothing.
I don't know how many negatives I put in those sentences. But for
someone just living their life who does not want to participate, they
will now be fined for doing that. The government has never done that.
And that is what I think exacerbates and expands the commerce clause
beyond recognition and beyond fairness to individuals at the same time.
Mr. AKIN. Well, I think we have had a chance to take a look tonight
at what I started out by saying that we are standing as Americans on
the edge of an abyss. I recall standing on the rim of the Grand Canyon
and seeing a thousand feet of open space in front of me. And in a
sense, that's where we stand today, with America perhaps politically
poised to push forward using a misuse of a process to force this
government takeover of health care down the throats of many, many
Americans who do not want to see this take place.
[[Page H1095]]
This is a very serious moment in American history. I can recall
historically there's been other very, very serious moments in American
history. The Pilgrims standing on the frozen shore of Plymouth with the
dream of creating a new kind of civilization; our President-to-be,
President George Washington, on his knees at Valley Forge, praying for
his little army. And even old skeptic Ben Franklin at the
Constitutional Convention asking for prayer each day.
In all of these cases, Americans discovered that in their hour of
need they turned to God for his help and his guidance. I believe as we
stand on the abyss tonight, for those Americans who are wont to turn to
God for answers, that this is a time to be doing that. To ask for his
help supernaturally so that we don't make this fatal step pushing our
Nation into socialized medicine, creating a precedent for our citizens
to be continually handcuffed to a government health care in a system
which no politician that's freely elected could ever reverse because
the public would say, You're going to take my government health care
away. I won't elect you. That's been the experience of other countries.
It completely changes the nature of the freedom and the nature of the
quality of health care in America if we'd fall off this abyss. And it's
time for some prayers.
God bless you all. Thank you. And good night.
____________________