[Congressional Record Volume 156, Number 51 (Tuesday, April 13, 2010)]
[House]
[Pages H2488-H2495]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore (Ms. Pingree of Maine). Under the Speaker's 
announced policy of January 6, 2009, the gentleman from Georgia (Mr. 
Gingrey) is recognized for 60 minutes as the designee of the minority 
leader.
  Mr. GINGREY of Georgia. Madam Speaker, I thank my leadership for 
allowing me to speak to my colleagues over the next hour in regard to 
guess what? Health care reform, Madam Speaker. And I am going to be 
joined by several colleagues on the Republican side of the aisle who 
are physician Members, as I am, as you know, Madam Speaker, a physician 
Member.
  And we are all just returning to Washington after the 2-week Easter 
recess, a time that I think Members on both sides of the aisle 
hopefully enjoyed with their constituents. I know certainly that I did. 
Also a little bit of family time celebrating Easter and the Passover. 
And now we are, of course, back here in Washington inside the beltway, 
and the wars, as we say, begin again.
  But the time that I spent, these 2 weeks, in my district, the 11th of 
Georgia, northwest Georgia, in my nine counties that I represented, 
gave me, once again, an opportunity to meet with my constituents. We 
did that in a one-on-one format, and we did it in a town hall meeting 
format, several of those, and we did the tele-town hall meetings, I 
think a couple of those.
  But I can tell you, Madam Speaker, the people in my district, the 
11th of Georgia and the State of Georgia, are not happy. They are not 
happy with the Health Care Reform Act, the patient, whatever the 
acronym is for this bill. The people didn't want it. They made that 
very clear in every poll taken over the past year as we led up to the 
unfortunate passage of this massive takeover of one-sixth of our 
economy. Folks did not want that, and they still don't. And I think 
they're expressing that to Members on both sides of the aisle as they 
go home, and Members are going to be held accountable. I know, Madam 
Speaker, that Members on both sides of the aisle understood that when 
they either voted for or against this bill. And the American people are 
no happier today than they were 3 weeks ago.
  I would like, at this point, to yield to my colleague from Tennessee, 
Dr. Phil Roe, a fellow physician and also a fellow OB/GYN specialist. 
Dr. Roe, being from Tennessee and practicing a number of years and 
delivering a lot of babies there in that State, knows all too well what 
happened with TennCare and had said the whole time that he has been in 
this 111th Congress--this is his first term--that you had the perfect 
pilot program for this bill that the Democratic majority insisted on 
passing against the will of the American people right in his home State 
of Tennessee.
  And I would like to yield to him now, Madam Speaker. And maybe he can 
yield some light on what that experiment showed over an 8- or 10-year 
period in the Volunteer State.
  Mr. ROE of Tennessee. Dr. Gingrey, thank you, and it is good to be 
back.
  I, as you, enjoyed being with family, as I am sure most of our 
Members on both sides of the aisle did. And I also got the opportunity 
to view one of the greatest basketball games that has ever been, which 
is the Final Four in Indianapolis, and my hat's off to the Duke Blue 
Devils and to the Butler team that played such a great basketball game.

                              {time}  2110

  One of the reasons I had for running for Congress, I was very happy 
in a medical practice in Tennessee. I was mayor of our local community, 
the largest one, Johnson City, Tennessee, the largest community in our 
district. But I knew that this health care debate was going to occur, 
and I wanted to be part of that debate.
  Unfortunately, none of us on the Republican side were consulted, so 
we were only in the debate in a peripheral way. And the reason that I 
wanted to

[[Page H2489]]

be a part of the debate was to share some experiences that we had had 
in Tennessee over the past 17 years or so in our attempt to not only 
manage health care costs but to cover more of our people.
  Tennessee is not a wealthy State. We certainly have one of the lower 
per capita incomes in the country, and we have a lot of uninsured 
people. So there was a good reason to try to do something for this.
  We have several major medical centers in our State both in Memphis 
and Nashville, Knoxville, and the Tri-Cities area, where I live; and 
the idea was that we were going to have a plan in Tennessee that was 
going to have a competition, much like we heard in the public option, 
which this plan does not have, where various insurance companies would 
compete for your business, and when they would compete for your 
business, this would help drive costs down.
  Well, what we did was we actually provided a massive expansion of a 
Medicaid plan. TennCare is our exemption for Medicaid. What this 
current health care bill does is massively expand Medicaid.
  Now, remember, Medicare is a plan that has premiums which fund it. So 
there are premium dollars that a recipient gets now who has paid in 
just like you would for any other insurance plan, whereas Medicaid is 
not. It's an entitlement. So we massively expanded our entitlements. 
And how did we do that?
  We had about eight plans that would compete for your business. In 
1993, we had about a $2.6 billion program in our State. Ten budget 
years later, that has exploded to an $8 billion program; and in our 
State that was at that point taking up in 2004 about 35 percent of the 
State budget. Now, since that time, everyone realized that we couldn't 
continue on this pathway. Here we were in a plan that we would have 
been happy with 17 percent of our budget. It was 35 percent of our 
State budget.
  So what did the governor and the legislature do?
  And, by the way, our governor is Governor Phil Bredesen, who is a 
Democrat. He has dealt with this. He has a business background and also 
has been in the health care business himself.
  What we did initially was cut the rolls. We cut about 200,000 people 
from the rolls of TennCare. And when that didn't prove enough, this 
particular year during this recession, we have had to resort to some 
more drastic measures. It hasn't been completely worked out yet.
  But we also found out, Dr. Gingrey, that during this time--and I am 
going to, during this hour, predict what I believe will happen with 
this plan that we've just passed. I have seen it happen in Tennessee, 
and I believe it will happen again with this plan. What happened was 45 
percent of the people who ended up on TennCare had private health care 
insurance and dropped it and got on TennCare. Why did they do that? Why 
did they go on the government entitlement?
  Well, it was a perfectly logical reason why they did that. They did 
it because it was cheaper and it offered first-dollar coverage. It 
offered prescription drug coverage, unlimited doctor visits.
  And what did we get for spending this much money? We got the highest 
prescription drug use in America, number one in prescription drugs and 
47th in health outcomes. So if we had spent the money and had gotten 
better health outcomes and better usage of those dollars, I would have 
supported it in a heartbeat.
  The other thing that's not known and never discussed, you never hear 
it discussed on this House floor, are the pay-fors. And as you as a 
physician know this, and we're willing to do this especially in OBGYN 
because pregnancy is one of those things that you either are or you're 
not. So we accepted TennCare in our practice and always did because the 
patients needed the care and had to go somewhere.
  What happened was that at the point that it started, it paid the 
providers, that is, the hospitals and the doctors, about 60 percent of 
the cost of actually providing the care. So those other costs, that 
other 40 percent was shifted to private insurers.
  An example I will give you is, I don't know, 8 or 10, 12 years ago, 
our local hospital put an implantable defibrillator in. You know that's 
where if you have a heart irregularity and you have an arrest, this 
will restart your heart. The TennCare plan paid, I think, $800 to the 
hospital, and the device costs $40,000, just the piece itself, not the 
care to put it in, the doctors and so forth. So those costs were 
shifted.
  What I predict will happen with this plan when you massively expand 
the Medicaid entitlement and those costs are not paid, those costs are 
going to be shifted to private insurers, and over time those costs will 
be so expensive that the private insurers are going to say, look, we 
can't pay that, we're going to have to drop it, drop private health 
insurance. And you're going to hear the other side say, see, we told 
you so. We need to take over the whole plan. That is exactly what is 
going to happen. This particular plan right here is designed to fail, 
and it will fail financially.
  Now, will there be some good out of it? Sure, there will be. I mean, 
you can't spend a trillion dollars and not do some good. The question 
is, is this the right way to do it? And I believe that is the 
discussion that we have had this year.
  And as you well know, the bipartisan vote on this bill was ``no.'' 
There were 34 of our Democratic colleagues who elected to vote against 
this bill and all of the Republicans voted against this bill. And it's 
not that Republicans don't have ideas. I came here, you came here, Dr. 
Broun, who has joined us, came with numerous ideas. The problem was we 
never got to share those ideas with anyone.
  Mr. GINGREY of Georgia. I thank the gentleman from Tennessee, and I 
think he brought up some extremely good points. And, Madam Speaker, I 
agree completely with what he said in regard to this system, this 
health care reform act, being designed to fail. I think it was.
  I think that from the very beginning--Madam Speaker, I serve on the 
Energy and Commerce Committee; and, as you know, that is the committee 
that has so much jurisdiction over health care, all of Medicaid, which 
the gentleman from Tennessee was just speaking of, and part B of 
Medicare, the Children's Health Insurance Program. So it is one of 
three committees in the House that has jurisdiction over health care 
but probably the most important committee.
  The committee, Madam Speaker, as you and all of my colleagues know, 
has been chaired for many years in the past by the distinguished 
gentleman from Michigan, the Honorable John Dingell, a great Member, 
but a Member who for years and years, as his father also before him, 
was pushing and has continued to push for a single-payer national 
health insurance plan for this country, not unlike what exists in some 
Western European countries and other countries around the world, but 
certainly Canada and the U.K. are two very good examples of how 
national health insurance works.

  But I truly believe, Madam Speaker, and I am basing this not just on 
my belief but on comments that were made in the Energy and Commerce 
Committee, as this original bill that was called H.R. 3200 at the 
time--and this was before the August recess of last summer, and when 
that bill was marked up in committee and amendments were submitted, 
there were so many amendments, Madam Speaker, from your side of the 
aisle, the majority side, that would ask to make this a national health 
insurance plan, a single payer, as it's described. And in that bill, of 
course, was a robust--that's the way the progressive wing of the 
Democratic Caucus described it--a robust public option.
  Madam Speaker, just as the Democratic majority when President Clinton 
was the President of this country with the HillaryCare, they weren't 
able to get that bill passed. And this administration under President 
Obama and this Democratic majority realized that they could not 
initially get a single-payer plan through this Congress and past the 
American people, but they felt that they could get so close, one step 
away, by having this robust public option to compete with the private 
market and virtually squeeze the private market out of any hope of 
profitability such that eventually everybody would be in the public 
plan and eventually they would take that one additional

[[Page H2490]]

step in maybe the 112th or 113th Congress, if the Democratic majority 
continued and President Obama sought and got a second term, that they 
would get to that goal that so many Members on the Democratic side of 
the aisle who have been here for years and years and years, the 
ultimate goal of passing a single-payer national health insurance plan.

                              {time}  2120

  And so I think the gentleman from Tennessee is absolutely right in 
regard to what the overall plan was to accomplish, and that's a great 
fear that we continue to have.
  I want to yield back to the gentleman from Tennessee. I know we've 
been joined by my colleague from the State of Georgia, family 
practitioner Paul Broun, and I'll call on him in just a few minutes for 
his comments as well. I yield back to the gentleman from Tennessee at 
this point.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. And I think 
what we need to do, Dr. Gingrey and Dr. Broun, is, why is that a 
concern? You formed this very well. Why are we concerned about this?
  And as I said, I believe this is designed to fail because we saw what 
it did to our local private insurers in the State of Tennessee, where 
we had about $1,800 per year shifted in costs. So those costs, it's a 
hidden tax.
  What will happen is businesses now are struggling. And you know that 
the number one issue in this Nation right now should be jobs; number 
two, jobs; and, number three, jobs. Everywhere I went in the district 
this weekend people were fearful and worried about losing their jobs. 
They were underemployed or either not employed whatsoever.
  So we have a system, when this Medicaid expansion occurs, what will 
happen is private businesses will get, not in addition to all of the 
taxes that are in here we'll talk about later; but this is absolutely 
designed to fail. And we're worried about it for what reason?
  As physicians we're worried about rationing care.
  I attended a conference at East Tennessee State University College of 
Medicine while I was home, and we had a look at the Canadian health 
care system, we had a look at the English health care system, we had a 
look at the VA, and we had a look at our system. All have plusses, all 
have minuses, all have problems.
  One of the things that I listened and summarized in that is that our 
concern as a physician is that you will eventually, when you have this 
many dollars and you have more demand for services than you have 
dollars to pay for it, there is no other option but rationing care. 
It's happened in every system around the world, and it will happen 
here.
  And my prediction is by 2020 is when we're going to really hit, about 
10 years because this plan is phased in, if we don't repeal it and 
replace it, it's phased in over a period of years. And the reason I 
believe this is that's what I've seen in Tennessee.
  The other part of this plan that's so similar that we've tried also 
is in Massachusetts. We have no preexisting conditions, and the 
Republicans had a perfectly good way to solve that problem. It isn't 
even difficult if you do this. Preexisting conditions are only a 
problem for the small group market, small business market and an 
individual.
  And when I retired from my medical practice, I had a single insurance 
plan. If it had been tax deductible, it would have been 35 percent 
cheaper for me to own health insurance coverage; and high-risk pools, 
and let you go across State lines and form large groups. You can solve 
the preexisting conditions without mandates.
  In Massachusetts they have a mandate, and there's a tax for a fine if 
you don't purchase health insurance. And without subsidies, without 
Federal subsidies, that plan in Massachusetts would be in terrible 
problems, terrible shape.
  So what have we done? We have taken the Tennessee plan, which hasn't 
worked. And by the way, this year, Dr. Gingrey, we're going to limit 
patient visits to eight doctor visits per year in the State because 
that's all we can pay for. And all the TennCare plan will pay for your 
hospitalization is $10,000. I don't care what the bill is.
  So you've got both. We're already rationing care with that system. 
You've got the Massachusetts plan that's also doing exactly the same 
thing. And those two together.
  One other thing I want to mention before we get Dr. Broun in, 
actually two things----
  Mr. GINGREY of Georgia. If the gentleman will yield back to me, and I 
will yield back to you before, we, Madam Speaker, call on Dr. Broun.
  But you know, you mentioned about jobs. And certainly, I felt very 
strongly. I've said it from this dais on this House floor, I say it 
back in the district every opportunity I can, that the number one 
priority, the number one priority when President Obama was inaugurated 
last January, over a year ago now, was the creation of jobs.
  Now, you know, I heard our colleagues that were on the floor in the 
previous hour, Madam Speaker, Democratic Members from California, 
Wisconsin, Ohio and New York, touting the economic stimulus package, 
ARRA, the acronym, and how wonderful it was, and how----
  And the gentleman from California said, I think he, Madam Speaker, he 
said coming from California back to Washington today he picked up the 
Sacramento Bee and the newspaper, his newspaper said that the average 
tax refund for this year was going to be $2,400 a family. And the group 
of Members went on to explain, well, that was because of the economic 
stimulus package, and that these people were going to get this nice tax 
return.
  Madam Speaker, I would suggest that it's very likely that the average 
tax return out there in Sacramento, California, is because maybe during 
the last calendar year, that many of these people only got to work 6 or 
7 months, and then they joined the ranks of the unemployed. They had 
filled out a W-9 at the beginning of the year, and so much money was 
taken out of their pay check to pay their estimated Federal income tax, 
if they had been employed for a full year and, God help them, they 
weren't employed, they lost their jobs, they joined the ranks of the 16 
million, they became part of the 10 percent in this country of 
unemployed. And whoopty doo, they got a $2,400 tax return. Now, isn't 
that great?
  And, Madam Speaker, I heard these same colleagues talk about, I think 
it was the gentlewoman maybe from Ohio, talking about all the jobs that 
were saved. Well, it must have been a heck of a lot of them. I think 
she said 2.5 million, because 3.3 million were lost. Maybe they saved 5 
million. I don't know how you figure that.
  But I do know, Madam Speaker, that when that bill was passed, the 
pledge to the American people for borrowing $787 billion worth of 
additional, I guess, borrowed money from China that we will use to 
stimulate the economy, the pledge was that the unemployment rate, which 
was 7.6 percent at the time, was not going to go above 8 percent and we 
were going to save all these jobs.
  And no matter what the group said, and all the things that they tried 
to tout in regard to the economic stimulus package, I feel, Madam 
Speaker, and the American people feel it was a dismal failure. I 
guarantee you those 16 million that have been out of work for six or 
more months feel like it was a dismal failure.
  And so, you know, here again, somebody, one of the other Members 
said, hopefully the American people understand who's on your side. I 
think that was a quote from the gentleman from Wisconsin.
  Well, I would suggest the American people ought to think, well, who's 
your nanny? Who's creating the nanny state? Who's building your hammock 
that much bigger so that you depend on the Federal Government?

  So as we talk about our concerns about the health care reform act 
with the Federal Government taking over one-sixth of our economy, it's 
not just about health care. We're pretty passionate about it, Madam 
Speaker, because the three Members on the floor on the Republican side 
of the aisle tonight are members of the Doctors Caucus, the GOP House 
Doctors Caucus. We're physicians.
  In the aggregate, I bet you the three of us, Madam Speaker, have 
spent 75 or 80 years practicing medicine. So we're very passionate 
about that, the government taking over; not just the fact

[[Page H2491]]

that it's one-sixth of the economy, but coming between us and our 
patients, the doctor-patient relationship.
  But it's a much bigger issue than that, Madam Speaker. And the 
gentleman from Tennessee referred to it. I know the gentleman from 
Georgia, my colleague from the great district that he represents in 
Georgia, including the University of Georgia and Athens and my hometown 
of Augusta, they're going to talk about that.
  But we're concerned about much more than this egregious health care 
reform bill. We're concerned about the Federal Government taking over 
every aspect of our lives.
  And, Madam Speaker, I will just make this comment before yielding to 
Dr. Roe: the bigger the nanny gets, the smaller we get.

                              {time}  2130

  The bigger the Federal Government becomes, the smaller each 
individual becomes, and our rights are eroded inevitably.
  And I will yield back to the gentleman from Tennessee.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  I think the comment is a government large enough to give you anything 
you want is powerful enough to take away everything you have.
  Just briefly on jobs before I go on with health care, three counties 
at least in my district of 12 have unemployment rates of 16 percent. I 
left one yesterday, spending the day there before I came back last 
night. And 87 percent of the people in the First Congressional District 
of Tennessee don't think the stimulus package has done them any good, 
and the reason they don't think it's done them any good is it hasn't 
done them any good. Their own view of it is it hasn't helped them, and 
I think they're right.
  I know that we had a lot of discussions and a lot of jokes were made 
about death panels and so on. There is a provision--I would encourage 
my colleagues to read this bill, and I've already introduced 
legislation already. There is a panel. In this Senate bill--not in the 
House bill. The House did not pass this. But the Senate bill did in 
reconciliation. It's basically the Senate bill with a few tweaks is 
what got to the President for his signature.
  There is a panel in Medicare called an Independent Payment Advisory 
Board. And before--you know, in this particular plan, the way we fund 
this, we're cutting $500 billion out of the Medicare plan over the next 
10 years. And during the next 10 years, beginning next year, the baby 
boomers hit Medicare age. We're going to add 3 million baby boomers per 
year for the next 20 years. Actually, 78 million are estimated to be at 
Medicare age in the next 20 years. So in 10 years, about 35 million 
people will reach that age with 500 billion less dollars. And what we 
did as a Congress was we gave up our purse strings, our control of the 
purse strings on how Medicare dollars are spent for this Independent 
Payment Advisory Board.
  Well, let me tell you what happens. When you have 35 million more 
people chasing 500 billion less dollars, this panel will use something 
called comparative effectiveness research. And we know what that is. 
We've already seen just the beginnings of it when we talk about, Well, 
you really don't need to have your mammogram until age 50.
  Let me look the camera in the eye and tell people, Dr. Gingrey--and 
Dr. Broun knows this very well--I cannot tell you how many patients I 
have seen over the past years less than 40 years of age with no family 
history with breast cancer. And right now we begin screening mammograms 
at age 35, and almost every insurance company in the world pays for 
screening mammograms at age 35 and repeated at 40 and so on. If you 
have a family history, you get them more than that.
  That's what they're going to begin using, and that's what's done in 
England right now, because they can't afford to pay for the screening 
mammograms. And you and I both know that we can feel a lump in a breast 
when it gets about 2 centimeters. And for those of you who don't deal 
in metric, that is about three-fourths of an inch. You can palpate 
that. Once a lump gets that big, some of those have actually spread.
  So that's a panel that will decide whether you get a hip replacement, 
whether you have heart bypass surgery when you reach a certain age. We 
need to relook at that very seriously. And that's something that's not 
known to almost anyone, but I've already introduced legislation to 
repeal this.

  And, by the way, there was a letter with 50 Democrats on this that 
also agreed with this before this bill was passed, and I urge my 
colleagues on the other side of the aisle to help us to replace this 
current piece of legislation.
  I yield back.
  Mr. GINGREY of Georgia. The gentleman from Tennessee, Madam Speaker, 
talking about this preventative services task force that came out with 
this recommendation, their timing couldn't have been worse, I think, in 
regard to the Democratic majority wanting to get this health care 
reform bill passed. But this was several months ago, and they actually 
came before the Energy and Commerce Committee and testified and said, 
Well, you know, we're just an advisory committee. I mean, this doesn't 
have the force of law, this preventative services task force. It's just 
making recommendations of what preventive services are good for 
patients and, indeed, are cost effective.
  And, Madam Speaker, that's what Dr. Roe, the OB/GYN from Tri-Cities, 
Tennessee, is talking about. They came out and said that it was not 
necessary; in fact, indeed, it was a waste of money to do a mammogram 
screening for breast cancer in women during their forties. And then 
they went on to say it was really questionable whether it was cost 
effective or beneficial to do them in women over 65 and scared the 
bejesus out of all of our moms and grandmoms and sisters and, in some 
cases, daughters of this country.
  And the scary thing about this, Madam Speaker, is this will become, 
this preventative services task force that's an advisory group will 
become part of this massive bureaucracy of the new health care delivery 
system, and what they say will be law and will be gospel.
  Now, a physician who is advised by his specialty--so, say like mine 
and Dr. Roe, the American College of OB/GYN, we're both proud Fellows, 
and we get these best practices clinical bulletins on a monthly basis 
in regard to what is the best care. They continue to recommend that 
screening and the importance of that screening during the decade of the 
forties.
  So, Madam Speaker, we're in a situation now where the OB/GYN doctors 
decide, I don't care what ObamaCare says, I'm going to continue to do 
those self-breast exams and I am going to look for that 2-centimeter 
lump that the patient is unlikely to find herself, and I'm going to do 
that screening mammogram. And let's say the screening mammogram shows 
something, something a little suspicious. And then the doctor takes the 
next step, the next logical and recommended step by the ACOG, and 
orders a needle biopsy. And maybe, Madam Speaker, that needle biopsy, 
thank God, comes back benign and it comes back not to be a malignancy. 
It was suspicious but turned out not to be a malignancy.
  But lo and behold, that patient develops an abscess, an infection 
from that needle biopsy--which is certainly a risk, a very low risk 
that that could occur. That doctor would probably--he or she would be 
sued out of their practice for doing the right thing. But yet the 
provision of ObamaCare would allow this preventative services task 
force to make it appear that they had done the wrong thing and they 
would not be able to defend themselves.
  So these are just some of the things that I guess Madam Speaker was 
talking about, the Speaker--Madam Speaker, I know you are the Speaker 
pro tem, as it were, tonight. But Speaker Pelosi was quoted as saying, 
I don't know, just maybe a week or so before the bill passed, that we 
need to hurry up and pass this bill so people can find out what's in 
it. Well, people indeed, Madam Speaker, are finding out what's in it, 
and it's not pretty. It's not pretty.
  I think the gentleman from Tennessee wants to make one more point, 
and then I will quickly refer to Dr. Broun. And also Dr. Cassidy has 
joined us, and I look forward the yielding to him as well.
  Mr. ROE of Tennessee. I thank the gentleman for yielding.
  Just some real-world experience, not textbook and not in academia. 
I'm

[[Page H2492]]

talking about out in my office practicing. The last year I was in 
practice--and something strange happened over 31 years. My patients got 
older with me, and they started developing things. I saw 15 breast 
cancers myself the last year I was in my medical practice. I could feel 
one of them. The rest of them were picked up on. I could not palpate 
the mass. They were picked up on screening mammograms. Now, that's 
something that will be done--and you know if you find that disease that 
early--it's one of the great stories, Dr. Gingrey, that I like to tell.
  When I began practice--and all of us here are pretty close to the 
same vintage. When I began practice, 50 percent of the patients with 
breast cancer had a 50 percent 5-year survival rate.

                              {time}  2140

  Today, an early diagnosed breast cancer like that has a 95 percent 
survival rate. It's a wonderful story to tell. There is no reason for 
us to go backwards. I mean, it would be a tragedy of unbelievable 
proportions if we did that.
  Mr. GINGREY of Georgia. Thank you, Dr. Roe.
  I now yield to Dr. Paul Broun from Athens and Augusta.
  Mr. BROUN of Georgia. Thank you.
  I am asked frequently by my constituents, Dr. Broun, what does 
ObamaCare mean for me? And what I explain to my constituents that ask 
that is that, number one, if they have private health insurance today 
they can't keep it because it's going to change. In fact, I will 
respectfully disagree with my learned colleague from Tennessee really 
on the semantics of what Dr. Roe was saying when he said this bill was 
designed to fail.
  Well, actually, it's designed to fail for what it was promoted to be, 
and that's to provide free health care for people all over this 
country. Well, some people are going to get free health care, but the 
reality is it was designed so that we wouldn't stay in this current 
system. So it, according to the designers, it's going to be successful, 
because it's going to push everybody out of private insurance onto one 
single government policy.
  So it is designed to be successful in what this President and what 
the leadership here in Congress wanted it to do, and that's to go to 
what President Obama said during his dog-and-pony show at the Blair 
House just a few weeks ago. He said he wanted everybody in this country 
under one pool, one insurance plan administered by the Federal 
Government, which means every American citizen is going to have 
socialized medicine, everybody.
  That's what their plan is. That's what it was designed to do. So it 
won't fail in the respect of what they designed the plan to do, because 
it's going to be very successful. If it stays in place, everybody in 
this country is going to be under a socialized medicine system.
  The second thing we were told that it was going to lower the cost of 
health care. But American citizens need to know it's not going to lower 
the cost to anybody. In fact, private health insurance is going to go 
up.
  We are told by our Democrat colleagues that the doctor-patient 
relationship is going to be maintained. But that's hogwash. A Federal 
bureaucrat, as Dr. Roe was just talking about, about preventive care 
but really for all care, there is going to be a bureaucrat in 
Washington, D.C., that's going to be making decisions for every single 
patient, for every single doctor in this country.
  So the American citizens need to know that if you want to make health 
care decisions, and what I tell them, is if you want to make health 
care decisions with you and your doctor making those decisions, you are 
not going to be able to do that anymore, and there is going to be 
ration of care for everybody, whether you are currently under private 
insurance or whether you are under the government insurance program.
  If you have that card, if you are given free insurance, even under 
this plan, given that free health care insurance card or if you are on 
Medicare or Medicaid, you may have the card in your pocket, but there 
aren't going to be any doctors that are going to accept it because they 
can't from a financial perspective.
  Another thing the American people need to understand, that I keep 
telling my patients, is that, particularly in small rural communities, 
there won't be any hospitals and doctors there anymore because they 
can't afford to stay in business. They are just going to be some huge 
regional hospitals that eventually are going to be government hospitals 
like the VA.
  Now, there are some good VA hospitals. We have the luxury of having a 
great VA health care center in Augusta, Georgia, the Charlie Norwood VA 
Medical Center, which actually has two hospitals there. And the 
veterans are very fortunate, blessed, to have Rebecca Wiley in the VA 
system there in Augusta. But even there, there is ration of care and 
there are a lot of problems.
  It's going to get worse at the Charlie Norwood VA Medical Center for 
the veterans that are there, but it's going to get worse for everybody. 
So the quality of health care is going to go down for everybody in this 
country. The cost is going to go up.
  One other thing I tell my constituents, when they ask, Dr. Broun, 
what's this going to mean for me? If they are small businesses I am 
going to tell them that they are going to cut jobs because they are 
going to have to do so because of the financial burden that the extra 
taxes is going to put on them.
  That means that many millions, actually, of American citizens are 
going to lose their jobs because of this bill. They are going to lose 
their jobs, but strictly because of this bill.
  Another thing is we are going to have cost controls, or it's going to 
break this Nation financially, and it can cause an economic collapse to 
America.

  Mr. GINGREY of Georgia. On his point in regard to the loss of jobs, I 
want to ask my colleagues to refer to this poster that I have. Because 
in the first week after this bill passed, these companies like AT&T, 
Verizon, John Deere, Caterpillar, these are companies that are, of 
course, household names, everybody recognizes before I mention them, 
but there are some 3,500 companies, other companies, smaller, medium-
sized companies, some large as well as these four I mentioned, that are 
going to have to take charges against their future earnings. They are 
required, Madam Speaker, to do this by law, to file with the SEC, so 
the that the moms and pops across this country, retirees on fixed 
incomes who may have a few shares of AT&T, Verizon or John Deere and 
Caterpillar, in the interest of full disclosure, the companies are 
required to make those reports of charges against future earnings.
  And in the aggregate, Madam Speaker, these companies have taken $14 
billion worth of charges against future earnings because of a provision 
in the health reform act in regard to providing prescription benefits 
to their retirees, and that's exactly what my colleague from the 10th 
District of Georgia, Dr. Broun, is referring to when he says it is 
going to cost jobs. Because the only way these companies can continue 
to provide those benefits is to cut back on their employment base or 
simply say to the new hires, we are not going to be able to provide a 
prescription drug benefit to you in your retirement years. You just 
need to go sign up for Medicare Part D.
  So you have got everybody losing. The company is losing, the retiree 
is losing, and the Federal Government and John Q. Taxpayer is losing. 
Because more and more people are getting the benefit for Medicare Part 
D rather than from these companies who wanted to give it to them, but 
the provisions in this bill snatched that opportunity away from them.
  Mr. BROUN of Georgia. Well, thank you, Dr. Gingrey.
  In fact, there is a John Deere plant in Columbia County, Georgia, 
just north of Augusta. That's a great plant. It hires hundreds of my 
constituents and citizens in the State of Georgia, and people are going 
to be put out of work from John Deere in my district. And then people 
can look at your chart there, I hope that the camera will focus upon it 
and look at it just for a moment or two, and just see the amount of 
money that these companies are going to lose. Well, how can they lose 
that and continue in business? Well, the only way they could do so is 
by cutting jobs.

[[Page H2493]]

  The people who are going to be hurt most in this country are the poor 
people and senior citizens on limited incomes. The Medicare folks are 
going to be hurt because of loss of their doctors. The doctors are not 
going to be able to take their Medicare anymore. We already see 
doctors, primary care doctors like me who practice medicine are going 
to have to quit because they can't afford to continue to see Medicare 
or Medicaid patients anymore.
  In fact, I talked to a lot of my medical colleagues in the 10th 
Congressional District in northeast Georgia, and they are quitting 
seeing patients on government insurance. Why? Because they absolutely 
cannot afford to do so anymore because their reimbursement rate, what 
they are paid is less than what it costs them to give those services.
  I will give you one example out of my own practice. Medicaid, I used 
to be in an office. As the gentleman from Marietta knows, I did a full-
time house-call medical practice. I still practice medicine today. I 
still see patients, still do house calls, did that full time before 
coming here. But when I was in the office as a primary care doctor, I 
saw patients from cradle to grave; and some of my most favorite 
patients were the pediatric patients.
  We would give childhood immunizations. But Medicaid cut the 
reimbursement rate to us, in our office, below the level it cost us to 
buy the serum. And that didn't count the cost of the syringe or the 
nurse's time or the liability coverage and all the other things and my 
time, anything else. So we had to stop giving childhood immunizations 
in my office and had to send patients over to the health department.

                              {time}  2150

  And, actually, they could go to Kroger and get a flu shot cheaper 
than I could buy the flu shot serum and be reimbursed by Medicaid or 
Medicare at less than what the serum cost me just to buy it. I couldn't 
afford to do that. And that is the kind of thing that doctors all over 
the country are facing, this kind of a dilemma. They want to deliver 
those services, they want to take care of their patients, but they just 
cannot afford continuing to do so. And I think, coming back to the 
``designed to fail,'' what I think that our colleagues on the other 
side of the aisle and the administration have put in place is something 
so that it's going to fail, and they can establish a socialized 
medicine program.
  Before I yield back to Dr. Gingrey, I want to just say one more 
thing. Last August, I spent a few days up in Canada and I talked to 
patients just to find out about the Canadian health care system. I 
talked to one man who makes $50,000 a year. He told me that he spends 
60 percent, 60 percent of his income in Canadian federal and provincial 
taxes primarily to pay for the health care system; 60 percent of 
$50,000. That doesn't give him much to live off of. And that's exactly 
where we're headed in this country. So particularly lower-income, 
middle class folks and low-income people are going to be hit the 
hardest. And then the senior citizens who are on a limited income are 
really going to be hit hard because of the cuts in Medicare.
  Mr. GINGREY of Georgia. I thank the gentleman. And, Madam Speaker, I 
want to yield time now to another member of the House GOP Doctors 
Caucus, the gentleman from the Sixth District of Louisiana, Dr. Bill 
Cassidy.
  Mr. CASSIDY. Thank you, Dr. Gingrey. You know, I like the focus of 
this conversation. And if you will, I want to point out that oftentimes 
when we speak about losing a job, unless you've lost your job, you 
assume it's someone else that is losing their job. But I think it's 
important for the American people to understand that this has the 
potential to affect people at all strata.
  Let's start off with the tax on Medicare, the increased Medicare tax. 
This is going to be on the people who earn over $200,000 a year. Many 
of these folks don't consider themselves wealthy. If they're small 
business people, he or she is trying to make a payroll and expand a 
business, and this is going to hit them. And inevitably, when you tax, 
you are going to lose money that would otherwise be available to create 
jobs.
  One of our famous Chief Justices said that the power to tax is the 
power to destroy. When you increase taxes on these folks that are job 
creators, you destroy their ability to create jobs. Now, folks say, 
well, that doesn't relate to me because those are the folks who are 
small business people, and I'm not a small business person. Well, as it 
turns out, let's go to the other end of the spectrum. As it turns out, 
this plan levies a $2,000 penalty upon an employer whose employees will 
get a tax credit from the Federal Government. Now, the Congressional 
Budget Office--not the Republicans, not the Democrats, but the 
objective arm of Congress, the Congressional Budget Office--says that 
because of this there will be less hiring of lower-income people. When 
you are a small business person hiring entry-level wage earners and you 
are levied a tax of $2,000 per person, you're not going to hire. You're 
going to find a way to increase productivity where you don't have to 
hire those folks.
  I caught a fellow who owns a string of Taco Bells, and he has 20 
employees per place. He said, if I have to put a $2,000 tax on each of 
my employees--he has about 500 total--in a very price-sensitive market 
where someone makes a decision to buy or not to buy fast food depending 
on price, I'm going to have to lay people off. So now we have the small 
business person who is going to pay the increased tax. Therefore, it 
destroys the ability to create as many jobs, and now we have the tax, 
if you will, the employment tax on the person who is at the entry-level 
job.
  Let's go to a different person, someone who works for a large 
corporation. Well, again, in the effort to grab enough revenue to look 
like this is cost neutral, there is now a tax levied upon medical 
device makers. There was a great article in realclearmarkets.com where 
they kind of go through what you're posing here, that the health care 
bill that we just passed is going to be terrible for the job market. So 
in this bill there is levied a 2.9, I think, percent tax on medical 
devices. Well, it turns out you can ship those things to Ireland, 
according to this article, and you're still taxed. It isn't just those 
that are being marketed in the United States, but, rather, it's those 
that you would be selling overseas, incredibly competitive market where 
people in Ireland, China, the United States are all manufacturing these 
devices.
  Well, if you manufacture it here, there is a tax apparently even if 
you export. But if you manufacture it in another country, you are only 
taxed on those that you bring to the United States. So let's say your 
shop is in India and you're producing artificial hips and you send 100 
to the United States. Well, there is a little bit of tax in that 
hundred; but if you send 1,000 elsewhere in the world, there is no tax 
whatsoever. If you build those same artificial hips in the United 
States, you are taxed wherever they go. So if you're working in the 
manufacturing unit of that medical equipment maker, you lose your job. 
If you are the person designing it, they're going to offshore it to 
another country. If you're the owner, you may say, why am I doing my 
manufacturing here and taking a 3 percent hit on whatever I do? Why 
don't I set up my shop in another country and only pay the tax if I 
import it to the United States?

  Again, in a desperate desire for revenue to make this look neutral, 
we've taxed jobs. And going back to what Supreme Court Justice John 
Marshall said, the power to tax is the power to destroy. When you raise 
$500 billion of taxes in the economy, you are going to destroy jobs.
  I yield back.
  Mr. GINGREY of Georgia. The gentleman, Madam Speaker, is absolutely 
accurate in what he just presented to our colleagues.
  And there is another point in this bill that I think the Speaker, 
Speaker Pelosi, may have been referring to when she said we need to 
pass it so folks can find out what's in it. The law before this was 
passed in regard to what people could take in the way of a tax 
deduction for health care expenditures was limited to that amount above 
7.5 percent of their adjusted gross income. Well, you would have to be 
a low-income person to take advantage of that tax break, if you will. 
This existed for a number of years. And most people's adjusted gross 
income, if they're in the middle class or upper

[[Page H2494]]

middle class, their medical expenditures in 1 year, Madam Speaker, are 
not going to be more than 7.5 percent of their adjusted gross income 
unless they got into a catastrophic situation. So there is no advantage 
there except for our low-income taxpayers.
  That 7.5 percent of their adjusted gross income kicks in pretty 
quickly, and that's been heretofore an advantage to them. And yet in 
this bill that threshold has been raised to 10 percent, 10 percent of 
their adjusted gross income. This is just ripping the heart out of our 
low-income folks who are not on a safety net program. They have 
rejected the nanny state; they have gotten out of the hammock. They're 
working, they have pride in having a job and supporting their families, 
but we're making it that much harder on them, Madam Speaker. And this 
might be small potatoes to some people, but it's real to our low-income 
people who are working--the working poor, as we sometimes refer to 
them--and I wanted to make sure we pointed that out.
  At this point, my colleagues, I will start with Dr. Roe from 
Tennessee, and then we will go back to Dr. Broun from Georgia.
  Mr. ROE of Tennessee. I think what we were told--and you saw lots of 
manipulations during this particular, incredibly complex bill about the 
pay-fors and how this is going to be budget neutral. Well, let's just 
go over some history of these estimates by the government.
  Number one, when Medicare was established in 1965, it was a $3 
billion program. It was estimated by the government--there was no CBO 
then--but it was estimated by the government that in 25 years it would 
be a $15 billion program. The real number, $90 billion, and today, over 
$500 billion.

                              {time}  2200

  Some of the pay-fors are the CLASS Act. I think this would make 
Bernie Madoff grin from ear to ear, and he probably is right now. The 
CLASS Act, unless you exempt yourself out of it, it is a payroll 
deduction to pay for long-term health care services, maybe a nurse in 
your home or assisted living or that type thing. Probably not a bad 
idea. And over the next 10 years, this bucket of money will be about 
$70 billion.
  What this plan pays for is it is--have you heard this before? You are 
going to borrow the money out and spend it on health care, have a $70 
billion liability out here that you call an asset, and leave that 
liability for future generations. We are also doing that with about $54 
billion in Social Security. No money there. It is all spent. But my 
grandchild, who will be 17 in 10 years, will get the bill for that.
  The student loan program; it was touted as a savings. And let me just 
take a minute, because I don't have much time, to let people know why 
is the student loan program in the health care bill? I mean, you should 
ask that question.
  Well, the Federal Government took over the student loan program. 
There were two programs, of which 80 percent used the private sector. 
In the private sector, Dr. Gingrey, 80 percent of the loans were made 
for students. Eighty percent. I talked to the chancellor at Vanderbilt 
University in Nashville, Tennessee, a great university. He much 
preferred the private program, but it has been taken over by the 
Federal program.
  They are going to borrow the money at 2.8 percent, lend it to our 
students at 6.8, call this interest that they make a savings, spend 
that on health care. They are not doing that to lower the costs for 
students to make their education less expensive. In Tennessee, it is 
going to cost our students about $1,600 to $1,800 over the duration of 
the loan in more interest payments.
  Mr. GINGREY of Georgia. If the gentleman would yield back, Madam 
Speaker, and I know we are getting toward the end of our hour. And I 
really appreciate him bringing that out, because in the process of 
doing that, I think it is important for all of our colleagues to know 
that taking over, the government taking over, first it was a public 
option, and as Dr. Roe just pointed out, Madam Speaker, now it is a 
complete government takeover of the student loan industry, and I think 
it is instructive, as I said at the outset of the hour, of what the 
intention is in regard to the health care system.
  And, oh, by the way, in the process of the Federal Government taking 
away student loan lending from Sallie Mae and a lot of banks across 
this country, they destroyed about 70,000 jobs in the private market.
  I want to yield to the gentleman from Georgia for a couple of 
minutes, and then if he will yield back to me to conclude.
  Mr. BROUN of Georgia. Certainly, Dr. Gingrey. I appreciate it.
  Some of our colleagues keep saying we are just being sore losers. We 
have lost, that the bill is now law, and that we need to just move on. 
Well, that is what our colleagues who would very much like to see us 
have socialized medicine in America would like for us to do. But we 
cannot do that because this bill is going to be a killer. It is going 
to kill our economy. It is going to kill jobs. It is going to kill the 
quality of health care in this country. We are going to have rationing 
of care so that people who need services are not going to be able to 
get those services.
  It is going it kill unborn babies because the taxpayers are going to 
be paying now for greater abortion services. We are going to have, 
because of this bill, a greater expansion of abortion services, and the 
taxpayers are going to pay for it. Even a lot of pro-choice people in 
this country believe it is just fundamentally wrong for taxpayers to 
pay for elective abortions. So it is going to be a killer bill.
  But what we need to do, and we all heard during the time that many of 
the grass roots were here, they kept saying, ``Kill the bill.'' Well, 
we unfortunately weren't able to kill the bill, but what we can do is 
we can repeal it, and we can replace it with policy that makes sense 
for the American people.
  Mr. GINGREY of Georgia. If the gentleman would yield back me, and I 
just want to continue on that theme as we conclude. And I thank my 
colleagues from Louisiana and from Tennessee and from Georgia.
  But the gentleman from Georgia just said it so well. We are going to 
repeal this bill. That is the pledge. The Republican minority party 
now, but hopefully soon to be the majority party on November the 3rd of 
this year, our pledge is to repeal this bill and to replace it. And I 
think it is very important that the American people understand that 
that is part of the pledge.
  I read an article, Madam Speaker, today in the National Review by 
Jeff Anderson, this week's issue, and he described something he called 
a Republican small bill. And I will just quickly list about six things 
that would be in that replacement bill:
  Number one, medical malpractice reform;
  Number two, allowing people to buy health insurance across State 
lines;
  Number three, incentivize folks for healthy lifestyles in the 
workplace, working out, stopping smoking, losing weight, and giving 
them a break on their health insurance premiums or the deductible or 
their copay to incentivize these people over a 30-year career in a job 
so that when they get on Medicare they are healthier, and that we 
indeed save a tremendous amount of money as a result of that;
  Number four, equalize the tax treatment for individuals that are 
purchasing in the individual market or the small group market. Give 
them the same tax break that you give to employees and employers of 
large companies;
  Number five, increase Federal support, Federal support for State-run 
high-risk pools that we can do in every one of our 50 States so that 
folks with preexisting conditions wouldn't have to pay an arm and a 
leg, three or four times what the standard rates were;
  And, last but not least, get the uninsured out of the emergency room 
and into less expensive routine care and this expansion of community 
health centers. I agree with that part of the bill.
  But there are so many things that are wrong in this bill. It doesn't 
lower costs. You know, it doesn't. It fails in the number one goal of 
the President, to lower the cost of health care. This bill absolutely 
does not do it. The small Republican bill would do it, and it would not 
cost a trillion dollars to do it in the first 10 years and $2.5 
trillion to do it in the second 10 years. So that is what we say to the 
American people, give us a chance.
  Madam Speaker, we want the American people to give us a chance, give 
us

[[Page H2495]]

an opportunity to regain the majority. We will repeal this bill and we 
will replace it with something that really truly does bring down the 
costs and insure so many of those 10 to 15 million that today do not 
have health insurance because they can't afford it.
  I yield back.

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