[Congressional Record Volume 156, Number 39 (Wednesday, March 17, 2010)]
[House]
[Pages H1567-H1574]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Thank you, Mr. Speaker. I'm just taking a moment here to 
arrange some charts and I will be right with you.
  Mr. Speaker, we once again are going to be on a subject that seems to 
be increasingly riveting the attention of Americans--and for good 
reason. What we are talking about here this evening is the proposition 
that the Congress will take over, over a period of time, one-sixth of 
the U.S. economy. That is the health care section of the economy.
  Obviously, this big a change, a remake of health care, which is not 
just changing a little portion here or there, but a complete remake of 
health care, is a question of significant proportion. It is a very 
costly proposition. It's one that involves a tremendous amount of 
change, and any change, of course, is controversial. This proposal, 
though, is more controversial than most and is resulting in a 
tremendous outpouring of phone calls. The switchboards are almost shut 
down here at the Capitol. But we, once again tonight, are going to be 
talking about it because there is talk we might even vote on the bill 
this week, and who knows what's going to happen.
  I'm joined in the Chamber by Dr. Fleming, a very fine physician but 
also a Member of Congress and someone who knows a considerable amount 
about the health care bill. Part of what the discussion has been lately 
has been a question of the procedure of how the bill would become law. 
That's, I think, where we should start, because that's where the news 
is right now and it's a big question.
  Dr. Fleming, I thought we might start there because a lot of people 
have heard about the bill, even some of the things in the bill, but the 
question is how this bill would become law.
  I'm going to start by just laying down the simple pattern that's in 
the U.S. Constitution. The way that a bill becomes law is that it's 
passed by the Senate. It's passed by the House. It's sent to the 
President, and he signs it. That's the plain, bare-bones facts of how 
it works. That's what the Constitution says. The Constitution gives the 
House and the Senate a lot of flexibility in how we design our rules, 
but ultimately the bill has to pass a straight-up vote in the Senate 
and a straight-up vote in the House and has to be signed by the 
President. If it doesn't do that, it doesn't meet the constitutional 
standard.
  Now, the process becomes a little more complicated as we go on 
because the Senate has a weird rule. In fact, the Senate does a lot of 
weird things, but it has a weird rule, at least to those of us who are 
Members of the House, and that is that before a bill can come up for a 
vote, it takes 60 votes to bring it up for a vote. So if you've got a 
bill and you say, Hey, we've got a hundred Senators; I've got 55 votes 
for the bill, you're in deep trouble, because you won't ever get the 60 
votes to get it up for just a straight-up vote even though you've got 
enough votes to pass it. In other words, the Senate has a little bit of 
a higher bar to protect to make sure there's at least 60 out of 100 
Senators that are willing to pass a particular piece of legislation or 
bring it up for a vote. So that makes things more complicated.

[[Page H1568]]

  The Senate took a House bill which we passed on health care. They 
gutted it. They took every single thing out of it and stuck their own 
language in it, a couple thousands pages of new ideas and text and all 
this, took it to the Senate floor and fought and fought and fought. 
Finally, on Christmas Eve, passed it by the 60 votes that were 
necessary, and so the bill was passed through the Senate.
  In order to do that, they put all kinds of special deals in there 
just to keep certain Senators to vote for it. There was what is called 
the second Louisiana purchase, a big benefit for Louisiana; the 
Cornhusker kickback; a special deal for people of Florida that they get 
to keep their Medicare Advantage money, but everybody else, the other 
49 States, have to lose $500 billion out of Medicare.
  And so there were all of these special deals in there, as well as a 
whole lot of other legislation; for instance, the fact that the 
government would be paying for abortions for people, which is a big 
problem for many Americans, and other provisions such as there would be 
health care for illegal immigrants and things like that, which are very 
controversial. So all of that is then passed on Christmas Eve and comes 
to the House.
  Now, in order for that bill to become law, two things have to happen. 
Either the House has to pass it just the way the Senate did, in which 
case they can send the bill straight to the President for his 
signature--so, if the House--and, of course, they have 80 votes less 
over on the Republican side. So we can all vote ``no,'' but Nancy 
Pelosi could lose a whole lot of votes because she has 80 votes more 
than the Republicans do. So what they need is a majority of Democrats 
to vote for the bill just the way the Senate passed it, could go 
straight to the President and the bill could become law. That's a way 
to do it.
  The problem is, it has all this junk in it that nobody wants to vote 
for. And so they're kind of stuck with making a decision: Are we going 
to just vote on it and send it to the President or are we going to try 
to amend it, which then requires it to go back to the Senate where it 
has to face a 60-vote rule to get these things cleaned up? And so 
that's the tension. So what's being proposed is something that is 
neither. It's something that is rather unusual and completely 
unprecedented, to a degree, and that is what they call deeming the bill 
passed; that is, it was never really voted on to be passed.
  In the past, we have done this deeming thing many times, but it's 
usually after a bill has gone back and forth and we're working out the 
details of an amendment. But this is thousands of pages of legislation 
that's never had a vote, and they're just going to say, Well, we've 
just decided it's all approved, without a vote. Now, that is really 
pushing the limits on what is constitutional. So that's the beginning 
of the process.
  So I wanted to invite my good friend Dr. Fleming to join me. Let's 
just talk about this process. Most people are really bored to death by 
this stuff, but when it involves one-sixth of the U.S. economy and 
everybody's health care, it's like, I guess we have to pay attention.
  Please join me.
  Mr. FLEMING. Well, I thank my friend from Missouri. You're absolutely 
right. But you know what's interesting? Everywhere I go, there are a 
lot of people around Capitol Hill today. I bump into people that I 
know, people who are just average, everyday people, and it's amazing 
how much they are keeping up with this even though it is getting 
boring. They know about this. This is not something that they're not 
tuned into, and that's for sure.

                              {time}  1800

  What's interesting, the way I have a mental picture about this, is 
that this bill way back months ago was being pushed like a locomotive 
up a hill. And as it got closer and closer to the top, more and more 
problems began to come out. It weighted it down. Finally as the bill, 
both in the Senate and now in the House, is getting close to the top, 
it's lost so much momentum because of the sleazy deals, the Louisiana 
purchase, the Cornhusker kickback, the carve-out for Medicare Advantage 
in Florida. These things are turning the American people off, and it's 
really taking a lot of momentum out of the process. And on top of that 
is the shenanigans, the fakery, if you will, the smoke and mirrors way 
of financing it which is, again, $500 billion taken out of Medicare, 
although no one will actually explain how we can do without $500 
billion from Medicare. Then that money is used to extend the life of 
Medicare, which is going to run out of money in 8 years. It's also used 
to subsidize the middle class entitlement of private insurance. So it's 
really the same money counted three times. One is taking it out of 
something we know good and well you can't do without collapsing the 
system. Two, extending the system. And then three, paying for other 
entitlements, and then adding the same amount again, another $500 
billion in taxes. The American people are not buying this.
  Mr. AKIN. Well, there are just so many things in this bill to talk 
about, and that's why you have such old and young, male and female--the 
public just doesn't like this bill. And the reason is because there's 
stuff for everybody to hate in this bill. I thought that this was an 
amazing quote Nancy Pelosi said. I just can't resist putting this up 
here. ``We have to pass the bill to find out what's in it.''
  Now what it seems like is going on now is, not only are we supposed 
to not read the bill, but we're supposed to not vote for the bill. So 
we want to pass a bill that we haven't read and haven't voted for. This 
seems to be really twisting the long arm of conscience a little bit to 
say, not only are you not supposed to read it, but now you can't vote 
for it, and we still want to pass it. And we wonder why the American 
public is just a teensy bit skeptical.
  I think some of the shenanigans are amazing. One of the ideas is, you 
have to get an assessment as to how much the bill's going to cost. The 
Government Accounting Office, who is supposed to be impartial, they 
take a look at a bill, and they go all through it and figure out what 
they think it's going to cost. Well, one of the tricks that they're 
playing is that they're going to collect taxes for a bill over a 10-
year period, but they're only going to count the bill being in effect 
for 6 years. Now that's kind of an amazing way to calculate what the 
bill's going to cost because the implication is that that's what it 
will be running along at. And the thing is is that every time the 
government's gotten into this taking over of the medical system, 
anytime we do a bill like Medicaid or Medicare, it always costs at 
least two times more than ever any accountant thought it was going to 
be, sometimes as much as 10 times more expensive than what some 
accounting office says. And yet we're going to start off with this, you 
know, smoke and mirrors deal where we're going to tax people 10 years 
but only run the bill six. And that's supposed to be how you figure out 
how it costs $1 trillion. I think that's what you're referring to.
  You're a doctor. Let me just ask you this question: What happens if 
you keep cutting the money to Medicare? What's going to happen to 
people?
  Mr. FLEMING. Well, I will remind the gentleman that currently 
physicians and hospitals are being paid 80 cents on the dollar, and the 
mystery that seems to be out there and very few people are addressing 
is--and you hear the other side talking about the rapid rise of private 
insurance costs. Well, one of the main reasons for that is to offset 
the shortfall in the Medicare payments to doctors and hospitals. So 
private insurance is having to make up the difference.
  Mr. AKIN. Let me stop you. Because you know this stuff cold, but 
there may be some people, some of our other Members here that just 
don't know this as well. So you've got Medicare, which is reimbursing 
doctors at 80 cents on the dollar, which means that somebody's got to 
make up the 20 cents. So we do a cost shift and shift that 20 cents 
into Medicare and dump that cost onto people who have private 
insurance, right?
  Mr. FLEMING. That is correct.
  Mr. AKIN. So we're really charging them some amount more, whatever 
their bill was. If it was $100, we're going to add a little extra to 
that to compensate for the Medicare thing. So now you're driving the 
cost up for the guy that's really doing what we think is responsible. 
And that is, going out and making sure he has insurance, and he buys 
insurance in the private market. But he's paying a premium for

[[Page H1569]]

that insurance because he's got to cover Medicare that's underfunded. 
So that's the first thing. Do I have that right?
  Mr. FLEMING. That is absolutely correct. And that is not considering 
Medicaid, which pays more like 30 cents on the dollar, which under this 
bill will increase by 30 percent. The number of people covered, that 
is.
  Mr. AKIN. So let's just say for instance that we wanted to cut more 
money out of Medicare. Let's say we're going to take $500 billion. But 
just theoretically, if you drop the money in Medicare so we're putting 
less money into it, what's the net effect of that going to be on the 
person that's counting on Medicare to pay for their medical care and to 
the usually older person that is counting on Medicare to cover their 
doctors' bills? What's going to happen then?
  Mr. FLEMING. It will cut access off to them for health care, and I 
can prove it.
  Mr. AKIN. Oh, wait. You are saying it will cut access for older 
people to Medicare?
  Mr. FLEMING. Yes.
  Mr. AKIN. Okay. Can you explain that?
  Mr. FLEMING. Well, if doctors and hospitals are under-reimbursed 
further--they're at their limit today. If the cuts go even further--and 
of course $500 billion is draconian by any stretch of the imagination; 
that's as much as the entire annual budget for Medicare. If you cut it 
that much, then doctors will have to opt out of Medicare altogether, 
and the senior citizens won't have doctors to go to.
  Mr. AKIN. Okay. So let me just see if I get this right. You're a 
medical doctor. You went all through med school. You've been practicing 
a number of years. You enjoy what you're doing. Old people come to you 
that need medical attention. You don't mind treating them. And before 
you were treating them at 80 percent of what the cost is. But let's say 
you drop down how much Medicare is paying. Well, at a certain point, 
you're just saying, I just can't afford to do this at this price, 
because ultimately, you've got to run an office. You've got to hire 
people. You've got to pay the rent on the building and all of those 
kinds of things. You've got a lot of insurance you're paying for, and 
you're trying to provide for your family. At a certain point, Medicare 
is reimbursing so little that you basically say, Hey, the old people 
I've been seeing before, I'm going to keep them on because I'm a nice 
guy. But I'm not going to take any new people. And so some old person 
that's sick wants to go find a doctor, perhaps they moved or something 
like that. And everybody says sorry, I'm not seeing any new Medicare 
patients. So while they've got Medicare, it doesn't mean they've got 
health care. So they don't get any health care.

  Mr. FLEMING. Absolutely.
  Mr. AKIN. So that's the problem with it.
  Mr. FLEMING. Absolutely. And again, it was only a month or so ago 
that the Mayo Clinic--I believe their branch in Arizona--announced that 
they were taking no further Medicare patients. And that's under the 
current pay system.
  Mr. AKIN. So this new bill is going to pull $500 billion out of 
Medicare?
  Mr. FLEMING. Yes.
  Mr. AKIN. So if you know nothing else about the bill, this is saying, 
Well, this is something to pay attention to. Now we haven't talked 
about some of the other nifty features. This is what gets me worried. 
This is what I don't like the most. And I don't like this bill. I want 
to be completely clear. I'm a conservative Republican. I do not trust 
Big Government to do a lot of stuff. And particularly, I don't want 
them meddling in our health care. So I'm not, I guess, objective, or I 
am objective, but it's just because we talk about how bad it is to have 
an insurance agent between you and your doctor. The last thing I want 
is a government bureaucrat or thousands of government bureaucrats 
between me and my doctor.
  This is a picture we've seen and used on the floor sometimes. But 
this is a very much simplified version of thousands of pages of 
legislation with shall, shall, shall, which means the government's 
going to do all of this stuff. And somehow as a consumer of health 
care, you're supposed to find your way all the way across, over to the 
doctor over there. This is like some sort of a maze that you've got to 
go through. So this is a very complicated government takeover of what 
is otherwise the private system of health provision in this country. So 
that, to me, is something that really causes me to say ``no'' on this 
bill because as Republicans, we don't like anything that gets between 
the doctor and the patient. And insurance companies, we don't like it 
when they get in there. But at least if you have a bad insurance 
company, you have a chance of changing your insurance company. What 
happens if you've got all these bureaucrats in there? You will never 
change it. And so this thing is really a very, very dangerous piece of 
legislation in my opinion. But I know you've given your whole life to 
taking care of patients. What's your impression of this whole deal?
  Mr. FLEMING. Well, I thank the gentleman. I've practiced medicine for 
over 30 years and still have a clinic and see patients from time to 
time. You know, insurance companies are a bee in my bonnet too. You 
hear the other side of the aisle talking about how insurance companies 
are the bad people. They're to blame for all of these problems. Well, I 
can tell you, insurance companies have been a headache for me, but 
insurance companies are not the problem here. They are not the problem. 
And if you don't like the bureaucracy of an insurance company, which 
you point out very adroitly, you're a customer, and you can always 
change who provides that service. When you get into this, not only is 
it 10 times worse than any insurance company and far more powerful, but 
you can't change. There is only one provider. Now you might say, Well, 
there will be a number of insurance companies within the exchange, but 
these insurance companies will essentially become utilities who will 
simply take the administrative cost for profit and basically do the 
work of the Federal Government.
  Mr. AKIN. So let's try and get up to 50,000 feet here and take a look 
at the sort of choices there are before Americans as to how we approach 
health care. It seems to me that in the beginning, you've got the sort 
of supply and demand situation. If everybody in America got absolutely 
the very, very best medical care that you could get, it would just 
bankrupt the country probably because the supply and demand law says 
that if you don't have to pay anything at all, people are just going to 
get the very most expensive thing they can do. So basically the whole 
country stops if you try to give everybody the very best thing 
possible.
  So the question then is how do you balance supply and demand? And we 
usually have a thing we call freedom, and we allow individuals to work 
hard, earn money, and then they spend their money to buy what they want 
to buy with it. They can choose whether they want health care, or a 
vacation, or food, or shoes, or a new car, and that's called freedom. 
So that's the free market, which allows people to decide how much money 
they can afford to pay on health care. So that's one way to balance 
that supply and demand.
  Another thing: The insurance companies then came along and said, 
Yeah, but we can get you some savings. We can reduce the amount of 
tests and do some other things and negotiate some special rates with a 
whole pool of doctors that we make a deal with so we get you a product 
that gives you pretty good health care, but it's a discount-priced 
product because we're doing some things to drop the cost down. So the 
insurance company then is one that is starting to take part in that 
management of the cost of health care. The free market, it's just a 
matter of you paying the barrelhead, and you go back and forth and 
figure out what the price is. That's the way we do most things. You 
have the insurance company which is kind of a hybrid.
  Then you can go to the socialistic model where the government does it 
all. But the government still can't make mathematics change. So the 
problem is that the governments in other countries that have tried it--
it's not like we're the only ones doing this. Canada and England do 
this kind of thing. And what they do is, in order to keep the cost 
down, they keep a big waiting line, so you have to wait a long time to 
get your health care. So it's basically a form of rationing. It's kind 
of a nice rationing because you're told,

[[Page H1570]]

Get in line. We're used to getting in line. You get in line, and that's 
how it is that they keep their costs down.
  The only trouble is, if you are like me, I had cancer. If I have to 
get in line, that means I have to wait. If I have to wait, it reduces 
my life expectancy. And that's one of the reasons why England has 
really high cancer rates, because of that. But let's just talk about 
places where this kind of idea has been tried before. Dr. Fleming, as I 
recall, they tried something like this in Tennessee, didn't they?
  Mr. FLEMING. Yeah, absolutely. Tennessee had something called 
TennCare. It I think is a similar model to what Massachusetts has today 
and somewhat similar to what we're looking at here. And what Tennessee 
found is the thing that's really a reality that we all need to 
understand. And that is that if somebody else is paying the bills, then 
you're going to have an explosion of cost. When I'm in town hall 
meetings, this is the way I like to put it. I say, I have a credit card 
here, and of course it's a virtual credit card. It has a $10,000 limit 
on it. I'm going to give you this credit card, and you can take it to 
Wal-Mart or Home Depot or anyplace you want, but only buy the things 
you need. Nothing that you want; only what you need.

                              {time}  1815

  And, you know, my question is, what do you need? And of course, the 
answer always comes back, well, I need a new shotgun because hunting 
season is coming up and I need some more camo, and I need, need, need. 
I need all kinds of things that I wouldn't pay out-of-pocket for 
myself; but if somebody else is paying for it, I'm willing to do it.
  So if you take that and apply it to this, and what I've witnessed 
over 30 years, when it comes to HMOs, capitated models, traditional 
insurance, no co-pays, high co-pays, what we find is that the more 
somebody else, a third party or insurance or government, is paying the 
bills, the more consumption occurs. And I'm talking about excessive 
consumption, far beyond anything that's actually needed.
  Mr. AKIN. So in other words, what's going on is if you tell people 
with this system they can have anything they want, you're going to have 
a tremendous level of demand, which is what we see in the other 
countries after this gets going, and then you have all the waiting 
lines because you can't do that all.
  Mr. FLEMING. And then if I could just add to that, addend that, is in 
theory, well, that's nice; you can have whatever you want whenever you 
want it. The problem is that taxpayers ultimately end up paying for 
this, and at some point you run out of taxpayers. You end up with 
budget limitations. And so every country that's tried this gets back to 
the same thing. And the only way to control cost, when you have a third 
payer, a government or whatever, paying the bills, is to set some rate-
limiting steps, and that's basically going to be waiting lines and, of 
course, rationing.
  And what I like to tell people is, look at Cuba. Cuba has universal 
health care. It's free. The problem is, it's not available. They have 
one colonoscope in the whole country. And you may need antibiotics, and 
it may be free; unfortunately, they don't have any antibiotics.
  Mr. AKIN. So it's really a nice promise. The trouble is there isn't 
any backup to the promise. It's just a piece of paper saying you've got 
free health care, but you got what you paid for. That isn't any health 
care at all.
  I see my good friend from Illinois, Congressman Manzullo, and 
somebody who really understands the Small Business Committee, 
understands small business in general and is a fierce, fierce defender 
of his section of Illinois, and a good friend of mine. And I'd like to 
yield some time to my good friend, Congressman Manzullo.
  Mr. MANZULLO. I thank the gentleman from Missouri. If the purpose of 
any health care bill is to bring down the cost of health care, that is, 
to break the curve, so instead of health care costs going up, they'll 
at least be stable, if not retreat, then it really defies logic as to 
why the Senate bill, which the House will take up and vote on in a very 
interesting manner, sort of a backdoor approach to approving what 
happened in the Senate, when that bill imposes an excise tax on medical 
equipment--
  Mr. AKIN. I call that the wheelchair tax. Now, I've thought of taxing 
a lot of stuff, but would you ever think of taxing a wheelchair? I 
mean, that's imaginative. It really is.
  Mr. MANZULLO. Well, it is. And then when my wife came down with 
cancer, and the neurosurgeon implanted into her spine this marvelous 
titanium brace, to think that that is a medical device and could be 
subject to a tax. Now--
  Mr. AKIN. So it's not just wheelchairs. We're going to tax other 
medical devices.
  Mr. MANZULLO. Well, yeah. I mean, the radiology machine that was used 
to kill the cancer cells around that particular level that was in her 
back that had the cancer. And, yet, by increasing the cost of 
lifesaving devices, has it ever occurred to people who are trying to 
ram through this bill that that will increase the cost of health care?
  Mr. AKIN. Now, let me just ask you a question. My friend, you come 
from the Midwest. You're a commonsense kind of guy. Now here's why this 
bill is having trouble getting votes, because it's like trying to grab 
yourself by the boot straps and lift yourself up and fly around this 
Chamber, because think about it a little bit.
  We've got the U.S. economy in serious economic problem because of 
three entitlement programs. They're the main things that are the budget 
busters: Medicare, Medicaid, and Social Security. So the government has 
stuck its nose into what was previously a free market with Medicare and 
Medicaid. And how well has the government managed those programs? It's 
about to bankrupt our country.
  So we've got Medicare and Medicaid about to bankrupt the country, and 
the government says, trust me to take it all over. I mean, there's 
something counterintuitive here somehow.
  Mr. MANZULLO. It is. And there's another aspect to tax on the medical 
devices. I was talking to a small businessman who runs a manufacturing 
facility, and he showed me the medical device that he makes. It's a 
marvelously crafted piece of aluminum that he did with a vertical mill, 
just unbelievably beautiful.
  And he said, I've been told by the people who order this device from 
me that if we have this tax on medical devices, even though this 
ostensibly would apply to imports, that they're just going to take it 
and go to China to have this made because they can come in cheaper than 
anything else, and that would really be the straw that breaks the 
camel's back.
  And so now here we are in the district I represent, with official 
unemployment in Rockford, Illinois, at 19.7 percent, add 7 percentage 
points to that, almost 27 percent unemployment, and now I'm looking a 
manufacturer in the eye who says, Not only will this bill impose this 
harsh mandate and force taxes upon me that I cannot afford, and 
increase the cost of health care insurance, but I could end up losing 
jobs because of people offshoring the manufacturing of these medical 
devices.
  And I wanted to share that with the gentleman from Missouri because 
it's just----
  Mr. AKIN. Let me see if I can just cut in and restate what you said, 
because I know that you have an expertise in small business.
  So you've got a small businessman who's showing a lot of creativity, 
the sort of innovative spirit that's in America, comes up with a 
medical device machined out of aluminum, which is a very specialized 
kind of device. And so what's going to happen is we're going to drop a 
tax on this thing, which makes it more expensive. And what you're 
saying is somebody overseas is going to say, I can make that device, 
and what's more, I don't have to pay the tax on it.
  Mr. MANZULLO. Well, they may have to pay the tax on the import, but 
no one knows. If we just throw the tax out and say, well, the tax may 
apply, even if the tax applies, I say to my good friend from Missouri, 
the supplier will look at that and say, or the people who order the 
equipment would say, what's going to be the next shoe to drop? How much 
more expensive is it going to be? And I've just had it with the 
increasing cost of American manufacturing, so I'm going to go offshore, 
and then that's that.

[[Page H1571]]

  Mr. AKIN. And you're already looking at, most people are looking in 
their district at a 10 percent unemployment rate. We're looking here at 
a bill that's going to cost trillions of dollars, 500 million jobs, a 
government takeover

  Mr. MANZULLO. Not 500 million jobs. Five million jobs.
  Mr. AKIN. I mean 5 million jobs. Excuse me. That would really be 
something. And a government, a major government takeover, and yet what 
do we have for the quality of results to expect in that we've seen it 
done in other countries and in the State of Tennessee and 
Massachusetts? I think Massachusetts health care costs are up 20 or 30 
percent over the average of other States. That's not a very good model.
  Tennessee, the Governor of that State, a Democrat Governor of 
Tennessee, said this thing is the mother of all unfunded mandates. The 
States are struggling with their budgets. And here you've got a guy 
who's a Democrat who's experienced with this thing and saying why are 
you going to impose this nationally, when it doesn't work on a State 
basis.
  Mr. MANZULLO. And in Illinois, which is already bankrupt. Illinois is 
the State where five of the past eight Governors have been indicted. 
It's a great State. They have a lot of ethical problems, you might say. 
The State's broken. Public employees have been laid off. A local 
school, the kids were out picketing because their AP classes may be 
eliminated because of a tremendous hit in the budget. And now Illinois 
would inherit a $400 million per year unfunded Federal mandate because 
of the increase in Medicaid recipients.
  Mr. AKIN. I notice that we're joined by another good friend of mine 
from the--
  Mr. MANZULLO. I thank the gentleman for letting me share.
  Mr. AKIN. Well, thank you. It's good to hear from Illinois. And I 
hope that you continue to join us in this discussion. We have my friend 
from Ohio, another State from the Midwest, a big manufacturing State, 
and a great young legislator, Congressman Jordan. I yield time.
  Mr. JORDAN of Ohio. I thank the gentleman for yielding and for his 
leadership on many issues here in the Congress and certainly on this 
issue of fighting and opposing this takeover of one-sixth of our 
economy, this health care bill. I appreciate my colleagues here from 
Louisiana and Illinois and their work as well.
  Look, when I think about this bill, I first start with the 
fundamental question, What part of ``no'' don't they get?
  They have tried to pass this thing. The majority has tried to pass 
this bill now for almost a year, and every single time--they tried to 
pass it in September and the American people said no. They tried to 
pass it in October and the American people said no. They said, oh, 
we're going to get it done before Thanksgiving, and the American people 
said no. Oh, well, wait a minute. We're going to get it done before 
Christmas, and the American people said no. Then they said, well, we're 
going to do it before the State of the Union, and the American people 
said no. And now, here, we're going to get it done before Easter, and 
we're going to keep all the Members here as long as it takes, twist as 
many arms, do what we can. What part of ``no'' don't they get?
  Mr. AKIN. You know what amazes me about that, gentleman, is I have 
heard various news outlets and various individuals, even people of 
political stripes saying that this bill is being held up by the 
Republicans. Now, somehow that just tickles my funny bone. You know, 
they've got 80 more people on this floor than we do, and if we all 
voted ``no'' and lit our hair on fire, there's no way we could slow 
this bill down. There's nothing we could do. The only thing slowing 
this bill down is there's a whole lot of Democrats that are going, ooh, 
is it ugly. So how in the world are they accusing us to be 
obstructionists or, you know--there's nothing we could do. I wish there 
were. But it's amazing.
  What you're saying, I just want to underline because what you're 
saying is it's the American people. The American people are the ones 
that are really driving what's going on here. And they're looking at 
this thing and they're saying, oh my goodness. What part of no don't 
you understand? Go ahead. I didn't mean to interrupt the gentleman.
  Mr. JORDAN of Ohio. I thank the gentleman. And you're exactly right. 
The reason the American people are speaking out loud and clear, the 
reason the American people, frankly, the reason the citizens of 
Massachusetts decided to send a Republican in Ted Kennedy's seat is 
because on a fundamental level, there's a lot of problems with this 
bill; but I want to just talk about three quick ones if I can. First 
and foremost--and this is what the majority party misses--it's a 
fundamental fact about Americans: Americans hate being told what to do. 
We're Americans. We actually think this thing called freedom and 
liberty is pretty important. And the idea that now here comes the big, 
not your local government, not your community, the big Federal 
Government's going to tell you and your family and you as a small 
business owner how health care is going to be delivered, and you're 
going to have bureaucrats getting between you and your doctor, they 
just fundamentally don't like that approach. And that's what the other 
party's missing. Americans don't like being told what to do.
  Americans don't like, secondly, and I think this is important, and I 
know Congressman Smith spoke earlier on the floor this evening, 
Americans don't like the idea that their tax dollars could be used to 
take the life of an unborn child. I mean, they fundamentally don't like 
that, and appropriately so. And so just two basic things they don't 
like.
  And then I would say third is Americans understand this thing is 
going to cost a lot. I mean, it's going to cost a lot.
  Now, they can, you know, here's the way CBO works. We've heard a lot 
of talk. More Americans know about the Congressional Budget Office then 
they ever knew about them based on this debate over the last year. The 
Congressional Budget Office, the data and the assumptions and the 
premises that are given to them, that's what they have to work on. 
They're good people over there and they do good work, but they have to 
take what information they're given from the majority party when they 
put together their analysis.
  And so people understand that this bill has 10 years of taxes and 
only 6 years of benefits in the next decade. They have all kinds of 
gimmicks, all kinds of things put into the CBO assumptions and premises 
when it's given to them to come up with this ``deficit neutral'' thing.
  There is not--now think about this: outside of this city, this bill 
is going to insure 30 million more Americans and be deficit neutral. 
Now, outside of Washington, D.C. there is not one person in America who 
believes that. Americans understand, on its face, that cannot be the 
case.
  Mr. AKIN. Let me just restate that. That is really an amazing 
premise, isn't it?
  This bill is going to insure 30 million more Americans and it's going 
to be budget neutral. Do you think people believe that?
  Mr. JORDAN of Ohio. There's no way. I mean, the claim is laughable on 
its face, and yet that's what we continue to hear out of the other 
side. And I think it's those kind of things that deep down Americans 
understand we need reform. They understand that there are some concerns 
and some real problems in our health care system.
  But they also fundamentally get that this bill, this package, with 
the dollars being used to take the life of unborn children, with the 
cost estimates that we know are really going to be there, they 
understand on a basic level that they don't want the Federal Government 
attempting to take over one-sixth of our economy and getting between 
them and their family and their doctor.
  And with that I would yield back to the gentleman.

                              {time}  1830

  Mr. AKIN. I sure appreciate the gentleman from Ohio joining us. I had 
a telephone town hall with my constituents last night, and I just asked 
them whether they thought it was a good idea for the government to be 
taking this over. And it was about 90 percent even said they just don't 
trust the government to do that. It's that freedom point. It's that 
idea of do we want a bureaucrat telling us what to do, what

[[Page H1572]]

doctor can treat us and all? And we are mandated to buy this?
  Of course the minor point of that is that's unconstitutional. The 
government can't force you to buy something. And so that's 
unconstitutional on the face of it. Just absolutely amazing.
  I just want to get back to my good friend, the doctor from Louisiana. 
Would you like to jump in? I did throw this chart up here about cancer 
rates in different countries. And so if you want to talk about that.
  Mr. FLEMING. Let me address that.
  We were talking a moment ago about the fact there are two ways to 
save money in health care. One is to have the patient become a savvy 
consumer and make choices for himself or herself in combination with 
his or her doctor.
  Mr. AKIN. That is called free enterprise, I guess.
  Mr. FLEMING. Free enterprise. That is right. Free choice. The other 
is to have total government control. And then you are going to have to 
have long lines and rationing.
  Now, in the countries that have the latter, that is the long lines 
and rationing, and these are well-developed countries like Canada to 
our north, the United Kingdom, the difference in death rates from 
common cancers, breast cancer and prostate cancer, are unbelievable. We 
are getting extremely high cure rates, well over 90 percent here in the 
United States.
  Let's take breast cancer. Breast cancer affects one in six women. Let 
me say parenthetically, the other side over there talks about women's 
rights and all the things we need to do for women, but yet this, if we 
follow this pathway, we're going to have a lot more women dying of 
things like breast cancer because here is why. You look at the U.K., 
the United Kingdom, they don't pay for mammograms. And also the better 
chemotherapeutic drugs that can cure the more difficult cases of breast 
cancer, they don't pay for them. Why? It costs too much. It doesn't fit 
into the budget.
  Mr. AKIN. So when the government doesn't have enough money to pay, 
they just say, well, we're not going to cover certain things because 
they're too expensive.
  Mr. FLEMING. Exactly.
  Mr. AKIN. So the government makes a decision as to whether or not you 
are going to get care or not, which is rationing.
  Mr. FLEMING. Unelected bureaucrats.
  Mr. AKIN. And so you have here in the U.K., these numbers here, this 
is women, but this isn't just breast cancer, but cancer in general for 
women, the survival rate at 52 percent or 53 percent, 66 in the U.S. So 
this difference is because of the fact they are just not covering some 
things.
  Mr. FLEMING. And if you multiply that times the number of women who 
get cancer, you are talking hundreds of thousands of women just in that 
range there.
  Mr. AKIN. So if you want to know why the telephones have been ringing 
off the hook, and there are a whole lot of people who don't like this 
bill, here is a whole block of people. Anybody who might get cancer, 
this is a pretty good reason not to like it. Is that correct, Doctor?
  Mr. FLEMING. That is absolutely right. Furthermore, just as way of an 
example, we actually had people from Canada and from the United 
Kingdom, both patients and doctors, who came to testify before us. And 
they told us really crazy things that we would never accept in the 
United States under our system. One is if someone gets cancer, 
oftentimes they are told, we're going to watch it. We're going to watch 
cancer. That's crazy. Why would you watch cancer? You've got to treat 
it. But in their country, in Canada, in some places it is 2\1/2\ years 
just to get an MRI scan. Then you get in the waiting line to actually 
get surgery or treatment.
  Mr. AKIN. So if you are in Canada and you have cancer, what you 
really don't want to do is you don't want to sign up at the hospital, 
you want to sign up at the airport for a flight that is going south to 
the United States so you can get taken care of.
  Mr. FLEMING. Yes. Absolutely.
  And just one last thing. The way they define emergency surgery in 
Canada is any surgery that doesn't at this moment save your life. What 
does that mean? Someone who needs bypass surgery, who has a 99 percent 
lesion in their artery, unless they are dying that moment, if they get 
bypass surgery, that is elective surgery. And we saw a recent example 
where a premier from Newfoundland literally came across the border to 
get his heart surgery because he chose the United States of America to 
get his care as opposed to his own homeland.
  We know people come from around the world. If they have the resources 
to get care here, they know where the best care in the world is. We've 
got problems, but these are solvable problems that we can use a scalpel 
to fix rather than taking a wrecking ball to the entire system and 
rebuilding it in a socialist view.
  Mr. AKIN. Right. I think the point was made once that if you've got a 
bad faucet in your kitchen you don't remodel a whole kitchen, you fix 
the faucet.
  Again, I would like to turn to my friend from Ohio, Congressman 
Jordan, and just see if he wanted to make a comment about that or a 
different point.
  Mr. JORDAN of Ohio. I appreciate the gentleman yielding and 
appreciate the comments from our colleague from Louisiana. I actually 
just want to go back and try to give some context for why I think the 
American people are so adamantly opposed to this legislation.
  I think it is important to remember what we have seen over the last 
year, things we never thought we would see in this great Nation. Who 
would have thought in the United States of America, the greatest Nation 
in history, we would see the President of the United States fire the 
CEO of General Motors? Who would have thought in the United States of 
America we would see the taxpayers of this country own General Motors? 
Who would have thought in this great country we would own AIG, the 
largest insurer? Who would have thought in the United States of America 
we would have a Federal Government pay czar telling private American 
citizens how much money they could make? Who would have imagined in 
this great country we would have the largest deficit in American 
history, $1.4 trillion? Who would have imagined in this country we 
would have a $12 trillion national debt? And now who would have 
imagined that this majority, this Democrat Congress, would continue to 
try to pass a piece of legislation that the American people have said 
time and time again they don't want?
  That is the context we find ourselves in. No wonder the people of 
this country have figured out this is a bad piece of legislation and 
they don't want it.
  I appreciate the gentleman for yielding. But I think it is sometimes 
important to step back and understand the framework we are operating 
in.
  Mr. AKIN. Boy, I really appreciate your putting that in perspective. 
Because we sort of rush through each day, each day is so busy, and we 
sometimes fail to just take a look and say, oh, my goodness, what is 
going on here? You know, first of all, a President of the United States 
firing the president of General Motors? And then surrounding himself 
with these people not approved by the Senate that he calls czars. 
That's weird. I don't know where that idea comes from. And then taking 
over AIG, a great big insurance company. And then you go through all of 
these other things, the bailout for Wall Street and this supposedly 
stimulus bill, which cost $700 billion and is not creating jobs, 10 
percent unemployment.

  We have just heard people critical of President Bush for spending too 
much money. You take his very worst year, which was '08 with the Pelosi 
Congress here, and it was $470 billion I think he overspent if I 
remember. You are the expert on numbers. And yet here we go in 2009, 
$1.4 trillion. That is a record since World War II. We keep setting 
these bad records and then here comes this piece of legislation.
  My constituents are going crazy. They are telling me, Todd, what can 
we do? What can we do? What do you want me to do? We had a great big 
meeting and thousands of them showed up to protest. The media covered 
it. But what can you do? I mean, they are shutting the phone boards 
down. Sometimes I don't know what to say, gentlemen.
  We are joined here by my good friend, Congresswoman Foxx. I think of 
her as somebody who is just one of those

[[Page H1573]]

Americans who has common sense, and she's tough. She's tougher than 
nails because she believes in commonsense American values, and she 
doesn't put up with a whole lot of baloney.
  I am just delighted to have you on the floor joining us tonight.
  Ms. FOXX. I thank you, Congressman Akin, and I thank you for leading 
this special order. I want to build on what you and Mr. Jordan have 
said. I had a town hall meeting in my district on Monday. The people in 
my district are commonsense people. And they are saying, we just want 
commonsense solutions. They want the truth. They want the simple truth 
about what this bill is going to do and what needs to be done.
  I find it just unbelievable that these folks who are in charge here, 
the Democrats who are in charge, have such a low opinion of the 
American people. I want to talk about that for just a minute because I 
think that is part of the problem that we have. There is an article 
today in the Washington Times, and it says, House Democrats Tuesday 
defended the idea of tying together the Senate health care overhaul 
bill and a companion bill of repairs that could spare Members from 
having to vote outright for the Senate's tax on high-cost insurance 
plans and other contentious provisions. Majority Leader Steny Hoyer 
said the public isn't going to be worried about how Congress passed a 
bill, but rather what's in the bill, and won't differentiate between 
the procedural paths. This is his quote: ``Do you think any American is 
going to make a distinction,'' he asked? ``I don't think any American, 
real American out there, is going to make a distinction between the 
two.''
  Well, the people I was dealing with on Monday are real Americans. I 
can tell him that. And they don't like the Slaughter provision. I want 
to add to that a comment that was made by Speaker Pelosi during a 
discussion with bloggers on Monday, saying she liked the idea of tying 
the bill to the rule. And her quote was, ``Because people don't have to 
vote on the Senate bill.''
  Now, the public understands that if these folks in charge are trying 
to keep their people from voting on something that there must be 
something wrong with it.
  Mr. AKIN. There is something that smells, doesn't it? This thing has 
been sitting around for about a half a year, and the more people find 
out about it, the more they hate it. A week or two ago, I just started 
making a list of all the people who would hate this bill, and there are 
just circles of Americans, one on top of the other.
  If you are an older person you don't want all that half a trillion 
dollars taken out of Medicare.
  If you are pro-life you think, well, I don't like abortion. Well, if 
you don't like abortion, how do you like the fact that your taxpayer 
dollar that you are forced to pay is paying for abortion? That to me is 
different than just--I mean one thing people talk about is choice. I 
don't call it choice, I call it killing children. But even if you 
accept the idea of choice, some people think abortion is okay, some 
people think it is not. But to take the people who think it is not and 
force them to pay to do abortions where they think it is killing a 
child even if other people don't, no wonder people don't like this 
thing.
  Or illegal immigrants getting medical care on the back of the 
taxpayer. I could see there are so many people that wouldn't like it.
  Ms. FOXX. Would my colleague yield?
  Mr. AKIN. I do yield.
  Ms. FOXX. I think another thing that they have a hard time 
understanding is how a Member of Congress could lambast the bill one 
minute and then say we need to vote on it the next. And I want to say 
Chairwoman Slaughter, the chairwoman of the Rules Committee, who is now 
doing everything she can to get this bill passed with the trick that 
she has come up with, the Slaughter sleight of hand I call it, she said 
last year, right after the Senate bill was passed, ``The Senate should 
go back to the drawing board.'' And she further said, ``The Senate bill 
will do almost nothing to reform health care, but will be a windfall 
for insurance companies.''
  So the public is really confused because one day these folks say one 
thing and then the next day they are doing everything they can to 
destroy our country and all that we stand for to get these bills 
passed. It's got to be terribly confusing.
  Mr. AKIN. Not only confusing, but in the telephone town hall I did, I 
sense an anger and a frustration in the public. First of all we are 
told that you don't have to read the bill, just vote on it because we 
haven't even put the bill together. You don't have to read it. Now we 
are being told, not only you don't have to read it, you don't have to 
vote on it. That seems like the silliest thing I ever heard. And yet 
that is what is being talked about, about bringing a bill to the floor, 
you just vote for a rule instead of actually voting on the bill. And it 
is questionable whether it is even constitutional.
  My good friend, Dr. Fleming.
  Mr. FLEMING. I think it bears noting that this bill defies common 
sense. We just talked about the fact that you take a half a trillion 
dollars out of Medicare, which is already struggling, and no one has 
ever explained in this year-long debate how in the world they are going 
to do that except to say fraud, waste, and abuse. But if we had the 
tools to do that better today, why aren't we already doing it? That is 
number one.

                              {time}  1845

  Mr. AKIN. Sort of like fraud, waste, and abuse is like a line item in 
the budget and you can just line it out and make it go away? All these 
years, if we had fraud, waste, and abuse, we try to get rid of it, but 
they say we're just going to line--it's really amazing. I didn't mean 
to interrupt.
  Mr. FLEMING. The other thing is the idea that suddenly you can cover 
30 million more Americans using the same resources. Nobody buys that.
  And finally, another way to say this is that there is going to be an 
increase of taxes on 25 percent more Americans; they are going to pay 
more taxes to cover 7 percent more Americans. The Americans are not 
buying that.
  Mr. AKIN. I think that's part of the reason why you see this 
tremendous opposition to this legislation.
  And, you know, one of the things we did, trying to get some kind of 
perspective on some of these main points, imposes half a trillion in 
Medicare cuts. The Republican alternative didn't do that, but the 
President's bill and the Senate bill does. It enacts a job-killing tax 
hike and government regulations costing hundreds of billions of 
dollars. The old Democrat bill and the President's new bill do that, 
and the Republican thing doesn't do it.
  I mean, we have a lot of reforms. I think you're a cosponsor/sponsor 
of a bunch of bills that reform things in health care, but it's not a 
complete government takeover of the system, and we're not talking about 
raiding Medicare and all of these other sad provisions.
  Now, one of the things that I think Americans are sensitive to is 
unemployment. I mean, there are a lot of people out there without a 
job. According to the government numbers, there are about 10 percent 
unemployed Americans. And that is not counting the people who have been 
out of a job more than a year, because they take them off. They just 
wipe them off the charts.
  So you have got a lot of unemployment, and now what you're going to 
do is you're going to enact these tax hikes on small businesses, which 
is no better way to get them to want to get rid of employees than to 
run their taxes up or their costs of having employees. So you're a 
small business owner, and all of a sudden it's going to cost you more 
to have an employee. You've just created a big economic incentive to 
get rid of some employees because now you've got to get rid of the 
taxes.
  You're also being encouraged not to invest in your own business to 
put the new wing on a building, to get the new machine tool or whatever 
is going to create new jobs. You're not going to do that when you're 
going to get hammered by this new tax increase.
  And I think Americans are sensitive, from what I found in my 
district. And I don't know about yours, but in Missouri, people don't 
like unemployment and they'd like to see us--they know government 
doesn't create jobs, but they'd like us to create an environment where 
small businesses can prosper. And this is the exact opposite to me. 
This doesn't make sense either,

[[Page H1574]]

that we're not thinking about the unemployment component.
  Mr. FLEMING. The statistics show that the number one issue for 
Americans today is jobs, without question. And that health care reform, 
while it is important to you and me and all of the Republicans and 
everyone in the House, for that matter, it's only, like, number five or 
even lower than that on the list. Americans see that the imperative 
right now is to get jobs back, and we're using a job-killing bill. How 
in the world are you going to get private insurance if you don't have a 
job to begin with?
  A recent poll by CNN--and certainly I don't think anybody could ever 
claim that CNN is a hard-right institution--says that 75 percent of 
Americans feel that we should either scrap this bill completely, throw 
it away and forget about it, or scrap it and start over again.
  So the American people, as you say, three to one, don't like this 
bill, and they don't want to see it or hear of it again.
  Mr. AKIN. I think a lot of Americans feel that there are things that 
need to be fixed in health care, and a lot of our colleagues that are 
Republicans think there are things that need to be fixed in health 
care, but we don't think you melt the whole system down.
  One of the things that I was asked in my town hall meeting--and I 
think maybe there are people that have this question in their minds, so 
maybe I'll ask myself this question and try to answer it. They said, 
Okay, you big-mouthed Republican--they didn't quite say that, but they 
said, You were in the majority for 6 years and you never fixed any of 
these and now you're bad mouthing them when the Democrats are doing it.
  Let me tell you about when I was a Republican for the 6 years that I 
was here when I was in the majority, and that was we passed a whole lot 
of bills in the House, a number of them, to fix health care that nobody 
has ever heard of or knows anything about. What happened to those 
bills? They passed the House. They went to the Senate, and there were 
Democrats in the Senate that basically filibustered it because we 
didn't have 60 Republican votes to push it through reconciliation so 
you could get it out to a vote on the floor. I know it's not 
reconciliation. Whatever they call it on the floor. The 60 votes in the 
Senate, we never had them.
  What sort of bills did we pass? Well, we passed a bunch of energy 
bills to deal with the high prices of gasoline that were killed by 
Democrats in the Senate. We passed a bill to deal with Freddie and 
Fannie that were being improperly managed financially that were going 
to cause a big crisis, and that was killed by the Democrats in the 
Senate. We passed associated health plans to allow small businesses to 
combine their employees together to get a better price on health 
insurance. That bill was killed. We passed it numerous times. It was 
never taken up. They never had the 60 votes in the Senate to deal with 
that.
  We did tort reform, which various States have passed. Dropped health 
care costs by 10 percent in some States. That went to the Senate, was 
killed by the Democrats in the Senate.
  So it wasn't that we didn't pass things or try to fix things as 
Republicans. We had a lot of reforms, but they were always killed 
because of the 60 votes in the Senate. So when people say, Hey, you 
guys were in the majority, how come you didn't do anything? We did 
things, but it was because of the way the Senate is set up, none of 
those things passed.
  And I think that's helpful for people to understand that because 
Republicans do have ideas, but they were more selective things that we 
knew were going to save money, going to give people better health care 
and solutions that we knew from other States that would work. So I 
think that's important to kind of get that out.
  Let's see. This thing here. Benefits trial lawyers by failing to 
enact meaningful lawsuit reform. Well, these bills do benefit trial 
attorneys. The weird thing about these bills is they are actually sort 
of antitort reform. It's not that they don't deal with those huge 
punitive damages which run the cost of health care up. In fact, the 
States that have tort reform, it makes it so they can't use their tort 
reform. So this thing is, from a tort reform point of view, is actually 
hostile to tort reform, and I'm sure you see some of that.
  Thank you, Madam Speaker, for allowing us to deal with this very, 
very important subject. I know the American public is interested.

                          ____________________