[Congressional Record Volume 156, Number 80 (Tuesday, May 25, 2010)]
[House]
[Pages H3795-H3802]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           THE DOCTORS CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Georgia (Mr. Broun) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. BROUN of Georgia. Madam Speaker, tonight the Doctors Caucus, 
people who are physicians, and those of us who are involved in health 
care on the Republican side, are going to be talking a little bit 
tonight about ObamaCare. We've talked about ObamaCare a lot over the 
last several months, and it's now law. We hear over and over again 
about how ObamaCare is beginning to filter out, and how it's going to 
affect the American people.
  Our President has said, Madam Speaker, that when the American people 
know what's in the bill, they're going to like it. Well, to the 
contrary. As the American people get to know what's in the bill, they 
dislike it more and more, as they rightfully should, because ObamaCare 
is going to be extremely expensive for everyone.

                              {time}  1900

  It's going to be very onerous to almost everyone, except for the 
Federal bureaucrats who are going to be hired to put ObamaCare into 
place and who are going to be enforcing it. And in fact, we are even 
going to have to hire, I think it is 16,500 new IRS agents to enforce 
it. That's right, Madam Speaker, 16,500 new IRS agents just to enforce 
ObamaCare on small businessmen and women around this country. The more 
the American people discover about ObamaCare, the less they like it.
  We just heard, I think it was last week, where the Congressional 
Budget Office said, Oops, we made a mistake. We made a mistake. We were 
$115 billion too little on our estimate, which puts it way over a 
trillion dollars. Our Democratic colleagues, their leadership--
actually, it's not even all the

[[Page H3796]]

Democrats, because there are many of them who are very reasonable over 
there on that side. But the leadership of the Democratic Caucus wanted 
to get ObamaCare and the President wanted to get ObamaCare passed, and 
forced the CBO through the parameters that they gave them to try to get 
the numbers below $1 trillion. Well, they are north of $1 trillion.
  Frankly, if you look at Medicare, when CBO projected the cost of 
Medicare, CBO missed it, missed it terribly. And in fact, I think 
that's what's going to happen here too. I think ObamaCare is going to 
be $3 trillion, $5 trillion, maybe $10 trillion. And it's money that 
our children and our grandchildren are going to have to pay because we 
don't have the money.
  In fact, we just had a lecture about hypocrisy by one of our 
colleagues just a moment ago, talking about saying one thing and 
believing another. Frankly, we are continuing to fight to stop this 
outrageous spending. As Republicans here, we are fighting against 
ObamaCare. Every single Republican voted against it. Even several 
Democrats, many Democrats, voted against it. The only bipartisan vote 
was a vote of ``no'' against ObamaCare, because it's going to be 
terrible. Unfortunately, it passed the House by five votes. Five votes. 
That's certainly not a mandate from the House.
  The American people, as they study the bill, they are beginning more 
and more to see how bad it is. The feelings against ObamaCare have been 
described by one Democratic pollster as hardening against it. We need 
to repeal and replace ObamaCare. It's the only rational, reasonable 
thing to do. It's the only economically feasible thing to do.
  We see colleagues on the other side talk about budget deficits. They 
don't care about budget deficits. They don't care about the huge debt 
that's created. In fact, just last week I was down here on the floor 
and heard several of our Democratic colleagues blame this economic woe 
that we have and this huge Federal debt and deficit on George Bush. Can 
you imagine? On George Bush. We have created more debt in the last 
year-and-a-half than George Bush did in 8 years. But my Democratic 
colleagues continue to blame George Bush.
  I blame George Bush for bringing us the first tranche of the TARP 
bill. I voted against it. Many Republicans voted against it. I thought 
it was a mistake. Then the President came back, our current President, 
President Obama, came back and he wanted another $350-plus billion to 
bail out Wall Street even more. Now they are talking about a Financial 
Services bill to regulate Wall Street that they, the Democrat 
leadership in this House and the President, want to bail them out and 
then regulate them on the other hand.
  And if the American people will look at who Wall Street gives money 
to, it's the Democrats. They give the Democrats and the Democratic 
Party a whole lot more money than they give Republicans. The best 
friends of big business and the best friends of Wall Street are our 
Democratic colleagues.
  So we are here tonight to talk about spending and failed promises. I 
am joined in this discussion tonight with two very good friends, two 
great Members of the House, both freshmen. Both are physicians. We have 
got Dr. Phil Roe, who is an OB/GYN from Johnson City, Tennessee, and we 
have got my fellow family doctor, Dr. John Fleming, from Shreveport, 
Louisiana, that have joined us tonight. I understand that Dr. Phil 
Gingrey may join us. He is in a markup. And so is Dr. Burgess. They are 
both in markups in Energy and Commerce.
  But now we've got three stellar Members of this U.S. House of 
Representatives, three stellar members of the Republican Caucus, three 
stellar members of the Doctors Caucus who have been leaders here. I 
want to thank the people of Tennessee and Louisiana for sending these 
two gentlemen here and being part of our conference and being part of 
this Congress, fighting for the interests of their constituents. I want 
to thank the people of Louisiana, Madam Speaker, and thank the people 
of Tennessee for sending Dr. Phil Roe and Dr. John Fleming here.
  So to kick this off, I will go to Dr. Phil Roe to put in his input 
about failed promises and the huge spending that ObamaCare, as well as 
the Democrats not only with ObamaCare, but with their stimulus bill. 
Dr. Roe, we are fixing to have another bill that our Democratic 
colleagues are calling a jobs bill. If they liked the first nonstimulus 
bill--actually, it stimulated big government. It has been an abject 
failure. But they want to give us another bill. They call it the 
extenders bill here in Congress, but the American people are going to 
hear it described as a jobs bill. And that is just absolutely 
incorrect. Thanks for joining us.
  Mr. ROE of Tennessee. Thank you, Dr. Broun.
  I bring with me tonight a blank sheet of paper. On this blank sheet 
of paper is where we ought to go back with health care and start over. 
That's what the people in my district and in the State of Tennessee 
have overwhelmingly told me. I was at a convention in Gatlinburg this 
weekend. They understand it. They get it. And who gets it the most are 
our senior citizens.
  When I came here, I came as a 31-year practice physician, private 
practice. I also taught in medical school some, and run a small 
business, and also was mayor of a city, the largest city in our 
district. So I have been used to balancing budgets, not raising taxes. 
And I do believe in smaller, more efficient government. And by far and 
away after seeing this, I call it the Twilight Zone here inside 395. No 
one understands in the State of Tennessee or in the cities where I go 
to, in Kingsport, and Bristol, and Newport, and Gatlinburg, and 
Sevierville, and all the cities in my district, Rogersville, they have 
to balance a budget. The county mayors have to balance a budget, the 
city mayors, the local city commissioners.

  One of the things that I have paid very close attention to since I 
have been here is I have tried to not vote, and to the best of my 
knowledge have not voted for any unfunded mandate for local or State 
government. I have had enough of that when I had the Clean Water Act 
and ozone and everything else as a mayor I had to deal with, with no 
money to deal with it.
  Mr. BROUN of Georgia. Dr. Roe, let me interrupt you briefly and 
reclaim my time here.
  The American people understand what you are having to say about 
balancing budgets because they have to do that every day in their own 
home and businesses. My State of Georgia has to balance its budget, our 
State government does. Many States around this country have to balance 
their budgets. You had to balance the budget of the city when you were 
mayor of Johnson City.
  We don't even have a budget. First time in history since the last 
budget act was passed that we're not going to even attempt, not even 
attempt to have a budget. So how can they constrain their spending? I 
guess they don't want to have any constraints or anything to try to 
hold them accountable.
  So the American people I think, Dr. Roe, need to know that we are not 
going to have a budget. They don't have a budget. We're not going to 
have a budget in this Congress. John Spratt, who is the chairman of the 
Budget Committee, said, ``If you can't budget, you can't govern.'' The 
majority leader on this side said that putting forth a budget is 
critical for governing. They're not governing. They're not budgeting. I 
just wanted to kick that in just so that our listeners tonight could 
understand they don't have a budget so they're not working under the 
constraints of a balanced budget.
  I have introduced a balanced budget amendment to the Constitution. 
There are three actually on our side that have been introduced. They 
are all slightly different. But all of them call for a balanced budget. 
But we on the Republican side want to balance our budget.
  Mr. ROE of Tennessee. I think until we do that, you are going to see, 
and you see this fiscal irresponsibility around the world. You've seen 
the Greece meltdown, and you've seen Spain is in trouble. Italy is in 
trouble. The EU is having problems even being held together now because 
of the spending and social programs that are going to have to be paid 
for. We're going down the same path. And I just asked myself today, how 
long can you continue to run enormous, 43 percent this year of our 
budget is deficit spending, how long can you continue to run

[[Page H3797]]

almost half the dollars you spend are borrowed dollars until you can't 
do that any more and then a true crisis hits?
  But what I was going to bring up was I came here with high ideals and 
high thoughts about health care. I had spent my career doing that, and 
I said, you know, I think I can go to Washington and have something to 
offer in the debate. What really disappointed me is we have 10 doctors 
on the Republican side in the Doctors Caucus, and not one of us in a 
meaningful way was consulted about this health care bill. When I tell 
people that, they can't believe it.
  Mr. BROUN of Georgia. What? Not one doctor on our side? Not one?
  Mr. ROE of Tennessee. It's the most astonishing thing I have ever 
heard of, Dr. Broun, in my life is you would have the expertise here. 
And I know people think this is all politics and games and so forth. I 
came here very sincerely wanting to be part of this debate and offer 
30-plus years of experience about what worked and what didn't work. And 
the thing that this bill has that the Senate has, about half of it is 
what we had already tried in our State that failed miserably. And I 
wanted to explain what went wrong so that we wouldn't magnify this 
debate 50 times across America.
  When I came here, I recognized the problems were ever-rising costs, 
number one. Number two, we had a lot of uninsured people that needed 
health care services in this country. You've dealt with them. Dr. 
Fleming has dealt with them. I've dealt with that problem. And 
preexisting conditions. And so we had a way, very easily, to deal with 
those without a massive 2,500-plus page bill that almost nobody read. 
And that's very frustrating to me to see no physicians involved, no 
malpractice reform in this bill, which has to be in there. No doctor 
fix.
  And so the folks understand what we are talking about, our physicians 
that accept Medicare, many of them now, hundreds have left in Texas--I 
was reading an article the other day--won't take Medicare any more. And 
why? Because for years now we've been putting off a proposed cut. And 
this year, next week, there is going to be a 21 percent cut in your 
doctor's pay for Medicare.
  The problem is when you do that, that's going to do three things. 
That's going to decrease your access to your doctor, it's going to 
decrease the quality of care because you can't get to your doctor, and 
number three, it's going to increase the cost to patients when they can 
least afford it. We on our side have been tasked, the Physicians Caucus 
has been tasked with a true doctor fix. Not this stuff tomorrow that's 
going to be done and voted on where 2013, I believe it is, 3 years from 
now, there's a 35 percent cut. So the doctors get a reprieve for 36 
months, a car payment basically, a 36-month reprieve and you're facing 
the same thing again instead of a true fix for this very, very real 
problem.
  So we had those three things. It didn't take a trillion dollars--and 
Dr. Broun and Dr. Fleming, you can't spend a trillion dollars without 
helping some people. When people ask me, Is there anything in this bill 
you like? I said, well, you can't spend a trillion dollars and not help 
some people. That's not the issue. The issue is, could you have done 
the same thing and done it better with a lot less money?

  I think more importantly than this, is that ultimately this right 
here, I can write the prescription, no pun intended, I can write the 
prescription right now of what's going to happen in this country. You 
set up a scenario where the private sector will fall apart, and I think 
in a very few years. I don't think it will take long. And then the 
politicians right here on this House floor are going to step up once 
again and say, Oh, see, we told you this wasn't going to work. And 
here's the government, we'll take the whole thing over. When that 
happens, my friends, rationing of care is going to occur. And there's 
no doubt in my mind that will occur.
  You brought up a minute ago, Dr. Broun, about the costs and the 
government estimates of Medicare. I know those numbers. In 1965, 
Medicare cost $3 billion. The estimate 25 years later was it was going 
to be $15 billion. The actual number in 1990 was $90 billion. They 
missed it by a factor of six. That's how much they missed it by. In 
TennCare, in Tennessee we brought forth this managed care plan, 
uninsured, costs going up, the same argument I just made, and guess 
what? In 10 budget years we tripled our costs--just in 10 years.

                              {time}  1915

  So from 2010 to 2020, if we triple, it will be exactly as you just 
pointed out, it will be a $3 trillion program, not a $1 trillion 
program, and that will probably be on the low side.
  I think the other thing about this particular plan--and we'll get 
into it in more detail here in a moment. But what folks don't 
understand between the difference of Medicare and Medicaid, Medicare 
you've actually paid a premium in for that. You paid 2.9 percent of 
your salary, either as employee or employer, both shares are. So 
there's a premium. It may not be the right number to actually fund it 
properly, but you are paying into that.
  Medicaid's a flat-out entitlement. It just comes right out of a 
general fund from taxpayers to pay for it, and we're going to expand 
that by some 20 million people. We've seen the problem in Tennessee 
when you do that, when you don't put the patient in control on health 
care expenses. They'll explode like they did in Tennessee.
  I yield back.
  Mr. BROUN of Georgia. Thank you, Dr. Roe. I appreciate it.
  And you are exactly right. In the State of Georgia, they've just 
finished their session, a 40-day session. The general assembly just 
finished about 2 weeks ago. It took 40 legislative days, all the way to 
May to finish 40 legislative days, and it is because of the economic 
downturn and the lack of revenue. And we have a balanced budget 
requirement in our State constitution. So Georgia has to balance its 
budget, just like people have to balance their budgets, just as we 
should be balancing our budget here in the Federal Government.
  And in doing so, people who are paid by the State--teachers, 
policemen, State highway patrol, as an example. Just talked to Jimmy 
Williamson, the police chief at University of Georgia, as a person who 
is employed by the State. All of these folks are being furloughed. 
They're being furloughed on a day-by-day basis. So they have to lose a 
day of work, maybe a day a month, a day periodically. They're not 
counted in these unemployment statistics. They're not counted in how 
the Department of Labor gives us all of those numbers on a monthly 
basis. So our administration and the leadership up here don't count 
those furlough days, but they're unpaid furlough days. It's hurting 
their salary. It's hurting families.
  And it's because of this gross mismanagement of the Federal spending, 
this gross, outrageous spending that the Federal Government's doing 
that is going to put our children and our grandchildren in an economic 
squeeze where their standard of living is not going to be as high as 
ours. And ObamaCare is going to put a lot of people in a position, as 
you were just saying, where they can't find a doctor.
  In fact, during another previous Doctors Caucus period of time of 
discussing things during Special Orders, I said that people may have a 
free health care card, Medicaid card or whatever card it is, but it 
will be as worthless as a Confederate dollar was after the War Between 
the States. And the reason for that, you just brought up, Dr. Roe, is 
that doctors are not going to be able to accept Medicaid and Medicare 
because of the rationing of care, the marked reduction of their 
payments from the Federal Government and doctors who are trying to take 
care of poor people. And the elderly today are struggling because the 
Federal Government pays providers--whether it's a hospital, a doctor, 
or a physical therapist--less money today than it costs them to provide 
that service.
  I'll give you an example, just a number of years ago in my own 
practice when I was in an office. I've done house calls since 2002. So 
I'd go see my patients at home, and work was no longer office space. 
But when I was office space, Medicaid reimbursed us for the shots, 
immunizations for our kids, childhood immunizations, at less money than 
it cost to buy the serum. And then that doesn't count the cost of our 
nurses' time and the liability costs and the medical records costs and 
the syringe and the alcohol pad and these

[[Page H3798]]

other things. Government was reimbursing us at a lower level. So I had 
to send all of my pediatric patients for their childhood immunizations 
over to the health department, and they were getting them from a 
government entity because I could not provide those services.
  But that comes back to another thing that you said, Dr. Roe, where 
just before ObamaCare was passed, our President said he wanted 
everybody in this country in one health care pool. What does that mean 
to the American people? What that means is that his desire is for us to 
have total socialized medicine where everybody in this country is in 
the same pool. Everybody's health care is controlled by the Federal 
Government. So there are panels here in Washington, D.C., that are 
going to ration care, as Dr. Roe was just mentioning. It's going to 
tell us who can go in the hospital, who can get a treatment, what 
medications we can get. There's going to be a tremendous rationing of 
care.
  Before that happens, I think, Dr. Roe, you're exactly right in that 
this unfunded mandate that's being forced on the States by the 
expansion of Medicaid rolls is going to hurt my State of Georgia that 
much more. They're struggling now to balance their budget. The teachers 
are being released from their duties and are not going to be rehired 
for next school year because the State of Georgia doesn't have the 
money to pay for Medicaid today. And it's going to be expanded. And 
we're going to fire all of the teachers? I hope not. We need to be 
paying our teachers more. We need to be doing more for our teachers.
  But we're in a bind. And the Federal Government, under this 
leadership of this administration and the leadership of the House and 
the Senate, are making matters worse and worse.
  Dr. Roe.
  Mr. ROE of Tennessee. It is not going to matter about health care if 
we don't get our budget in order, if we don't get our deficits in 
order. And these budget deficits that you see out into the next 6 to 8 
years that they predicted is without health care. And if it adds on top 
of that, I don't see how we can afford it, how we can go forward as a 
nation. And I am truly concerned about that for the people who are 
retired on fixed incomes, for young entrepreneurs.

  Look at what a business would do right now. Let's say a business 
looks up, and this ObamaCare plan, they can pay a fine that's $2,000 
per employee and they can put them on the exchange--which is not even 
calculated into these numbers, this $1 trillion.
  There's a business in Tennessee--I won't say where--that's using--the 
government will again decide what's adequate health insurance coverage. 
Not you, not you as an individual. You won't go out as a family. The 
government will decide if your plan is adequate. And if it is not 
adequate, then you'll have to buy an adequate plan.
  Well, this particular company's plan wouldn't be considered adequate 
right now. It would cost them $40 million to comply with this. Or they 
could drop the folks in their business into the exchange, pay the 
$2,000 fine and have a net $40 million savings.
  So what are they going to do? They're going to drop those people into 
a plan. They will not pay the cost of the care. And it's going to 
amplify much faster. And that's why I said a moment ago that you're 
going to have people step up real soon and say, See, we told you that 
the private sector failed.
  No. Businesses are making a perfectly logical business decision.
  Mr. BROUN of Georgia. Dr. Roe, just tonight I went to a meeting just 
before we came down for this last series of votes. In fact, I came from 
that meeting here to the floor of the House. And I was talking to a 
leader of a large transportation organization, and he told me that 
they've studied ObamaCare and they've decided that they're going to do 
exactly what you said. They're going to push all of their employees 
into the public exchange, which--they're just going to pay the $2,000. 
Just tonight I talked to a guy, just an hour and a half ago, who said 
that hundreds of their employees are going to be pushed into the public 
exchange.
  This goes back to fulfill Barack Obama's promise of wanting to try to 
develop one pool for everybody. But he has failed in his promises 
because we were assured that their new law would be the answer to 
health care financing problems. Au, contraire. I am not good at 
speaking French. My wife, Niki, all the time chastises me for my not 
being able to speak these things and not even--she's from Indiana, so 
she doesn't even think I speak English.
  But we see over and over again where these failed promises and this 
increased debt and all of the things that are going on are costing 
hundreds of jobs and are going to force people into government health 
insurance programs.
  So the spending has to stop. This outrageous spending has to stop 
here. And unfortunately, we have failed promises by the Federal 
Government.
  Dr. Roe is unfortunately having to leave, and I thank Dr. Roe for 
spending some time with us and with the American people this evening. 
Thank you, Dr. Roe.
  I want to go to our next doctor who's here with us tonight, a good 
friend, great Member of Congress, Dr. John Fleming. Family doctor from 
the northwest corner of Louisiana. One of my favorite States. I love to 
go down there and go duck hunting. And they're struggling by the 
Federal Government's failure to deal with this outrageous economic as 
well as environmental disaster that's going on down there. In fact, 
failing--our Federal Government and this administration is failing to 
take care of what they're charged to do under Federal law.
  In fact, Steve Scalise, our good friend from New Orleans, came to the 
floor yesterday and was talking about that. He was even chastised by 
one of our dear Democratic colleagues. But the Federal Government has a 
responsibility under Federal law on these major oil spills to get 
engaged in trying to deal with that. They failed to do so.
  But thankfully, your district is up in the northwest corner. I know 
your patients miss you like my patients miss me. I am still practicing 
medicine, but, Dr. Fleming, thanks for joining us tonight.
  And I yield to you, sir.
  Mr. FLEMING. I thank the gentleman, Dr. Broun from Georgia.
  And I still see patients as well when I get a chance, but it's not 
nearly as often as I'd like. We, being both family physicians, I think 
we have a special bond. I want to thank the gentleman for his 
leadership, and certainly he's been a mentor for me, and also a special 
kind of family practice heart that only we family physicians 
understand, not just for your patients, but for the work that you do 
here, and not least of which is for this Republic that I know you love 
so much. And that, I greatly respect.
  What I wanted to extend a little bit from our discussion that we're 
already into is the fact that, you know, we've had a number of these 
GOP Doctors Caucus Special Orders during the health care debate, and 
tonight we know the bill is passed. There's nothing we can say tonight 
that's going to keep it from being passed. The votes have all been 
counted and it is in law; although, it's not been fully implemented.

  Mr. BROUN of Georgia. Let me interrupt you a minute, Dr. Fleming, and 
reclaim my time, but I want to ask you a question.
  Have you heard any of our Democratic colleagues say we need to move 
on, it's now law and we need to accept it, and we just need to go 
forward and it's the law of the land and, thus, we're being sore 
losers? We're just being nothing but soreheads because we're talking 
about health care still.
  But it's critical the American people understand that it's not put in 
place completely, and the most onerous parts of ObamaCare are yet to 
come, and it's a few years out. So we can repeal ObamaCare. We can 
replace it with something that makes sense. I've already introduced one 
repeal and replace bill. I had introduced a bill, H.R. 3889, prior to 
ObamaCare passing, which was my own comprehensive health care reform 
bill. Comprehensive. It dealt with Medicare, helped reform Medicare so 
that people could continue to get Medicare and could continue getting 
their money back that they invested in the Federal Government through 
Medicare through their FICA taxes and their payroll deductions and 
stuff like that. And I reintroduced it as repeal ObamaCare and replace 
it with my H.R. 3889.

[[Page H3799]]

  Just this week I'm going to introduce another one that puts in place 
repealing ObamaCare and puts in place four things:
  Number one, across-State-line purchases for individuals and 
businesses.
  Number two, where anybody in this country can join an association 
just for a meager amount of money, 5, 10 bucks, $25, have multiple 
insurance products that they can buy and own themselves, have huge 
pools with these associations.

                              {time}  1930

  The third thing is to encourage the State to set up a high-risk pool.
  The fourth thing is to have tax fairness for everybody in this 
country so that everybody can deduct every health care cost that they 
have, including purchasing insurance. Makes sense.
  I have had many of my Democratic colleagues--when I challenged them 
before ObamaCare passed--I challenged Democrat after Democrat 
individually to introduce those four things in a bill, that I would 
give them the legislative language. I would give them the bill, have a 
blank. They would just write their name in the blank.
  And then it would be a Democratic bill. They could claim that as 
being ObamaCare, as far as I was concerned, because it's not about my 
name being on anything. I am just concerned about policy. I had 
Democrat after Democrat say, Paul, I would love to do it. It makes 
sense.
  Many of our Democratic colleagues said, Paul, that makes sense to do 
this and to work on this incrementally. Many Democrats wanted to work 
on this incrementally. But their leadership wouldn't let them, Dr. 
Fleming. They were forced to swallow ObamaCare just like the American 
public is being forced to swallow ObamaCare.
  And those four things would radically change the health care 
financing, would solve a lot of problems, not all of them, but would 
solve a lot of the problems we have. It would help cover a lot of 
people who can't afford health insurance today, would cover a lot of 
people who can't get health insurance because of preexisting 
conditions.
  We have very few people. In fact, ObamaCare is not going to cover 
everybody in this country either until we get everybody in the same 
pool that the President wants us to go in. But these are all failed 
promises and high spending that we are getting from our leadership. I 
just wanted to throw that in, Dr. Fleming.
  Mr. FLEMING. I thank the gentleman.
  What I would like to do is take a moment to look through the retro 
spectroscope, where we are today now that the bill has passed, look at 
the rhetoric that occurred during the debate--
  Mr. BROUN of Georgia. Now, Dr. Fleming, you better explain about 
retro spectroscope because a lot of people haven't heard about that. 
They have heard of a colonoscope or sigmoidoscope, but you are not 
talking about the same thing.
  Mr. FLEMING. Right. Well it's a quasi-medical term which is 
equivalent to armchair quarterbacking or postmortem in which we look 
back and we go, How do things look now, looking back, as opposed to the 
way they looked then? You know, what we were saying during the debate 
is this: This bill is by no means really paid for, that there is smoke 
and mirrors about the financing, that it will definitely cost tax for 
the middle class, although the President said otherwise.
  The President said premiums would go down for insurance. We said they 
would go up. The President said people would get more care and better 
care, and we said, no, the care would be diluted, there would be less 
access to care.
  Mr. BROUN of Georgia. Let me interrupt you again a half second, if 
you don't mind, Dr. Fleming, because I have got some news for the 
American people.
  The Congressional Budget Office, even missing all the numbers, as Dr. 
Roe and I were just talking about, the Congressional Budget Office has 
stated that the law will raise the individual market premiums by an 
average of $2,100 per family, raise them. They are going to go up above 
what would have been if we did nothing. Now, I don't want to do 
nothing.
  I know that you don't want to do nothing. You made that very clear in 
many hours here on the floor, talking. But the cost is going to go up 
by $2,100 per family on the average across this country. That's another 
failed promise by Speaker Pelosi and Barack Obama.
  Mr. FLEMING. So there were a number of promises made and, you know, 
each time we tried to rebut these, we were told that we were using 
scare tactics, that we are scaring old people and that, really, it was 
unconscionable to do that.
  So what has happened since the bill was passed? Well, first of all, 
the bill had about 52 percent of Americans who were against it, against 
38 percent who were for it. Today, 63 percent of Americans want repeal, 
so that means that more people now want to get rid of this bill than 
actually were against it before. That means that some people who were 
for it now want to repeal it.
  And what was the first thing we heard after it passed? Almost within 
24 hours, AT&T a write-down of $1 billion, that is a loss of $1 billion 
for the year; Verizon, $970 million; John Deere, $150 million; 
Caterpillar, $100 million.
  We had communication just the other day, a small business owner who 
thought he was going to be okay under ObamaCare because he had 24 
employees, and he said, you know, the threshold is 25 employees, so you 
get special tax credits and you get support under this program because 
you are a small business owner that has fewer employees.
  Mr. BROUN of Georgia. Say that again, please, so people can 
understand, because we just saw a report. I don't know if you saw the 
report, because we haven't talked about it.
  There was a report just recently where businesses that were going to 
hire new employees, that are right on the cusp, have decided not to 
hire those new employees. So it's killing jobs, right?
  Mr. FLEMING. Yes, what's happening is the employers, now that they 
are getting the language of the bill--remember that Speaker Pelosi said 
if we want to find out what's in it, we have got to pass it first, 
okay? Well, now it's passed. So, now, business owners are putting the 
pencil to it.
  Here is what they are finding. This is a gentleman who said, you 
know, I have got 24 employees. So I should be under the threshold, and 
I should actually get some subsidies and tax credits.
  But what he found out was that the way it's calculated, he would have 
to draw down his 24 employees to 10, and he would have to cut wages 
down to $25,000 a year, fine print. The gentleman's name is Zach 
Hoffman.
  He is going to have to go from 24 employees making an ample of 
$35,000 a year down to 10 years making $25,000, $35,000 versus $25,000 
a year in order to make that happen. But that's not all. Remember, what 
I am telling you is not me telling you this. I am just passing on the 
bad news. Don't shoot the messenger here, okay.
  What I am telling you is what people are finding out. The President's 
chief actuary, this is from, this is in the President's administration, 
soon after the bill was passed, said, You know what, we made a 
miscalculation on this. That's from CMS, that this is going to cost 
$311 billion more than what was anticipated and that it will consume 21 
percent of gross domestic product instead of the 16 percent that we 
predicted. This was within days of it passing.
  And then also the CBO, the Congressional Budget Office, which we know 
played along with the smoke and mirrors and the sleight-of-hand 
financing of this says, oh, my goodness, there's $115 billion that we 
haven't accounted for. So instead of this thing being revenue neutral 
or maybe a little bit on the plus side, no, it is going to go in the 
red just like we were saying all along.
  Mr. BROUN of Georgia. That's another plus side, Dr. Fleming. We were 
told that the cost curve would go down. Now that may be a nebulous term 
to most people in the country, some of that congressional speak 
language we talk about up here. We have heard over and over again from 
our Democratic colleagues, particularly in leadership, that the cost 
curve would go down.
  In other words, that the spending, the total level of spending, the 
total level of spending in this country on health care would go down 
with ObamaCare.

[[Page H3800]]

  Mr. FLEMING. Right.
  Mr. BROUN of Georgia. But what you are just saying is great 
information, so that the American people can understand and hopefully 
our Democratic colleagues will understand, the cost curve goes up, 
higher than if we did nothing. In fact, this new estimate does not 
include any cost for the 52 new programs, 52 new programs that are in 
the bill that the CBO could not even measure and give us a figure for 
the cost because each program was authorized for such sums, blank 
check, such sums, funding level.
  So our leadership, Ms. Pelosi and company, have given us 52 new 
programs that are funded at such sums that they need and is not even 
scored or accounted in this new estimate of $150 million that the CBO 
missed because they couldn't even score that.
  Mr. FLEMING. But it goes further than that. There's going to be $120 
billion in taxes that were not anticipated. That's on top of the $600 
billion that were already----
  Mr. BROUN of Georgia. Tax increases.
  Mr. FLEMING. Additional tax from the actuary who is saying it's going 
to be more taxes. Job cuts: 90 percent of medical device makers say 
that they will eliminate jobs. That's 9 out of 10 companies that make 
anything from tongue blades to pacemakers, what have you, as a result 
of the taxation, heavy taxation, excise taxation of medical devices.
  Mr. BROUN of Georgia. Doc, let me interject something there.
  Mr. FLEMING. Yes.
  Mr. BROUN of Georgia. One of our constituents in northeast Georgia in 
my 10th Congressional District just wrote us a note saying that he is a 
small businessman, and he said that his small business was going to 
survive this economic downturn. But the way it was going to survive was 
he was going to let all of his employees go, and he and his family were 
going to run the small business. That's the only way you can stay in 
business.
  It is ObamaCare that is running his employees, even of a small 
business, very small business, where they are having to let employees 
go because of ObamaCare, right now today.
  Mr. FLEMING. Yes. So you have costs going up and you have jobs going 
down. We know that there's supposed to be 32 million more Americans 
covered under this than otherwise. Half of those are to be estimated to 
be going into Medicaid. And doctors across the country are dropping 
Medicaid.
  Where are these people going to end up? They are going to end up in 
emergency rooms, not in the doctors's offices like was anticipated.
  But let me get to something that I think is real important because 
you remember that we brought up the idea that there would be committees 
that may make a decision about what kind of treatment you may or may 
not get? Now, we know that they exist in Canada and in the United 
Kingdom, but we started talking about these. I know that Sarah Palin, 
Governor Palin, made mention of this and the left blew apart. They 
said, my goodness, you are talking about death boards. Shame on you for 
scaring the American people.

  Okay, well, let me tell you what's really happening, and this is 
being reported now. The President has nominated Dr. Donald Berwick to 
run the Centers for Medicare and Medicaid Services, that's CMS, and his 
job is to oversee CMS. He is also supposed to oversee the $2.5 billion 
comparative effectiveness research.
  Mr. BROUN of Georgia. Those are big words. What's that mean?
  Mr. FLEMING. Well, what it basically means is that there's going to 
be a bunch of unelected bureaucrats, perhaps not even doctors, who are 
going to be tasked with looking at research, hopefully there's going to 
be research or they are going to do research, to decide what treatments 
and what diagnostic tests are worth paying for and which ones are not.
  Mr. BROUN of Georgia. Dr. Fleming, you and I talked about creative 
effectiveness research and comparative effectiveness of different 
treatments. For instance, as an example, my trout fishing buddy at 
home, a retired full bird colonel, Randy Dudley, served a stellar 
service in the United States Air Force, retired.
  Randy Dudley has just undergone a series of treatments for his 
prostate cancer. He has been very open about it and that's the reason 
that I can bring that forward here tonight because HIPAA otherwise 
wouldn't let me do so.
  But Colonel Dudley looked at surgery, looked at high-dose radiation 
therapy, low-dose radiation therapy, chemotherapy, or a combination of 
those, as he chose his treatment. We, as physicians, do comparative 
effectiveness evaluation or research to look and see whether the 
surgery for him is better or which of those treatments are a 
combination of treatments or better.
  But this comparative effectiveness research that was started with a 
nonstimulus bill back a little over a year ago--that's when Nancy 
Pelosi and company funded the comparative effectiveness research--what 
the American people need to understand, Dr. Fleming, is something you 
and I understand very firmly; it's not about what's the best treatment, 
but it's how to spend dollars.
  Mr. FLEMING. Right.
  Mr. BROUN of Georgia. They are going to use age as the means of 
trying to determine how to spend dollars. That means that one of my 
patients who is 75 that has diabetes versus another one of my patients 
that's 35 with diabetes, they are going to decide whether they are 
going to spend $100 on my 75-year-old diabetic patient or $100 on my 
35-year-old diabetic patient.
  Dr. Roe was talking about seniors are very upset because we know 
where that decision is going to be, and that Federal bureaucrat who is 
not a doctor, that panel that is not going to be run by physicians, is 
going to be deciding the comparative effectiveness of spending dollars 
on an age-related basis with less dollars being divided by more people, 
which means rationing of care. And this panel is going to deny, deny, 
treatment to that 75-year-old.

                              {time}  1945

  And the reason Governor Palin was talking about death panels is 
because they're going to just say, So sorry, you can't get that 
treatment because comparative effectiveness says spending $100 on you, 
a 75-year-old patient who has diabetes, is not as effective as spending 
$100 on a 35-year-old, and our senior citizens are going to be denied 
treatment. And what's going to happen? They're going to get gangrene in 
their legs, and they're going to die from that. They're going to get 
pneumonia, and they're going to die from that. This panel is not going 
to put them to death, but it's going to deny treatment, particularly 
the more expensive treatment.
  Mr. FLEMING. If the gentleman would yield.
  Mr. BROUN of Georgia. Yes, sir.
  Mr. FLEMING. Let me focus on Dr. Berwick, specifically, because this 
is important.
  Mr. BROUN of Georgia. Thank you.
  Mr. FLEMING. Dr. Berwick, this is a quote from him.
  Mr. BROUN of Georgia. Now this is the head of CMS, who is going to be 
heading up the comparative effectiveness rationing panel. I call it a 
rationing panel.
  Mr. FLEMING. Right. This is his quote. He considers the British 
health system ``a global treasure.'' In fact, it's my understanding--I 
don't have it in my data right here--it's my understanding that he 
helped design it. And it's designed very simply just to be--a little 
more technical than what you were describing--is that what they do is 
they take the population and they assign a value, a numerical value 
based on quality-adjusted life years. And so just as you say, let's say 
that the government can afford 1,000 hip replacements this year because 
of the budget and you've got someone who's 75 with diabetes and let's 
say somebody 35 who's fully healthy----
  Mr. BROUN of Georgia. A football player.
  Mr. FLEMING. A football player, okay. Now, according to the quality-
adjusted life years, the 35-year-old has not only more years left to 
live, but he has more productive years, that is, he's going to work for 
the state more years. In fact, the 75-year-old probably is not going to 
work any more years. And so they have to draw the line someplace: Which 
thousand is going to get the hip replacement this year? And guess which 
one it's going to be? It's going to be the 35-year-old. That is the way 
the comparative effectiveness system works.

[[Page H3801]]

  That's the way they do it in England today. And anybody who's 
skeptical or doubts that that's where we're headed, they just need to 
read about Dr. Berwick and all the other information that's coming out 
on this. And again, there is much reported by The Wall Street Journal. 
It says, The decision is not whether or not we will ration care--
according to The Wall Street Journal--the decision is whether we will 
ration with our eyes open. And right now, we are doing it blindly.
  It goes on and on to describe the fact that if the quality 
effectiveness research board is not, in essence, a death panel, then I 
don't know what really is because, just in the case with the gentleman 
with the prostate cancer, that's a decision between him and his doctor 
whether he gets chemotherapy, whether or not he can get surgery. Or 
maybe he decides, he and his doctor, that the cancer has advanced too 
far and he's just going to go home, take pain medication, and not fight 
it. Some people decide that, but that is their decision. But this is 
going to make it the government's decision to do that.
  If you doubt that that happens, again, go and talk to people from the 
United Kingdom and from Canada. It happens all the time. It's 
acceptable in those countries and in those cultures that if the 
government says you don't get treatment or you get only palliative 
treatment when there is a cure, then that is strictly the way it is. 
And as far as I know, there is no right to petition; there is no court 
or anything that you can go to.
  So what we really have, just to summarize my comments here, is we had 
a number of promises by the President. He said the cost curve would go 
down, as you say; he said the middle class would not pay increased 
taxes; he said the premiums would go down; and he said a number of 
other things that I can't even think of today. He scoffed at the idea 
of death panels and any kind of board or bureaucrat that would dictate 
what your care would be like, whether the bureaucracy or government 
would come between you and your physician.
  And he said that businesses would be happy, that this would be a boon 
for businesses. Well, today, where are we? None of those things have 
proven to be true. Now that the bill is in law, we have businesses not 
hiring people because we have an unemployment rate of 9.9 and holding 
because businesses know that if they hire people, they're going to have 
to pay a lot of money for their health care coming forward. And we also 
know that what we feared the most is actually in play, and that is that 
we will have a board, a comparative effectiveness board, just like that 
in the United Kingdom.
  Mr. BROUN of Georgia. You're right, Dr. Fleming. Let me reclaim my 
time.
  Just today, the consulting firm of Towers Watson just released a 
study of large employers across the country, what their response is to 
ObamaCare. And it's not at all surprising, really, to us because we've 
been talking about it. You and I and many of our Doctors Caucus members 
have been here on the floor talking about these things, you're just 
talking about it now, as we did for months and months before ObamaCare 
was put in place. But let me give you the data, some things that Towers 
Watson found that just released today.
  The overwhelming majority, 90 percent of employers, believe that 
health care reform will increase their organization's health care 
costs. They're right. I don't know why it's not 100 percent, because 
it's going to; but 90 percent of employers believe their health care 
costs will go up, and they will. Sixty-eight percent plan to re-examine 
their health benefit strategy for active employees this year.
  Now, I'll tell you something, just Sunday, I think it was in the 
Sunday Athens Banner-Herald, there was an article where the University 
of Georgia is very seriously considering not giving any new hire that 
the University of Georgia puts on their payroll retirement benefits 
once they retire, or health care retirement benefits because of the 
cost, because of ObamaCare, and because of the strain on the budget 
that University of Georgia is suffering from right now. So I know 
University of Georgia, there are a lot of people in Athens, Georgia, 
who want to go to work for the University of Georgia. It's a great 
place to work, it's a great school to go to. I'm a graduate of the 
University of Georgia. But 68 percent are going to re-examine their 
health benefit strategy. That, I'm sure, is going to please our 
President because he wants everybody to go off of private insurance; he 
said that himself. He didn't say it in those words; he said he wants 
everybody to be in the government pool, one pool.

  Eighty-eight percent plan to pass increased costs from the law onto 
their employees through high premiums. So those people who are working 
today, those middle class people that Barack Obama said it wouldn't 
affect them, we heard over and over--still hear--95 percent of 
Americans are not going to see an increase in taxes. That's just 
totally erroneous; it's nothing but falsehood. Eighty-eight percent 
plan to pass on the increased cost to their employees through high 
premiums.
  And let me give a couple more examples, and then I will yield back. 
Seventy-four percent plan to pass the law's higher costs onto their 
employees by changing the plan options, by restricting eligibility, 
which means more people won't be eligible to get insurance through 
their employer, or by increasing their deductibles or copays. More than 
one in 10 firms plan to pass on these higher costs of ObamaCare by 
reducing employment. Twelve percent say that they're going to do that, 
12 percent, or by reducing employee contributions to their retirement 
plans, like their 401(k)s, 11 percent.
  Forty-three percent believe that their plans will be subject to the 
Cadillac tax on high-cost plans. Of course, our leadership here in the 
House and our President want to get rid of Cadillac plans unless 
they're for who? The unions. In fact, they've given the unions a pass 
on the Cadillac plans because they want to do everything that they can 
do to support the unions.
  Of those firms offering coverage, 43 percent said they are likely to 
eliminate or reduce retiree medical programs as a result of the law's 
enactment. That's what I just mentioned with the University of Georgia 
is a good example that is considering right now, very seriously--and I 
expect it probably will happen. Almost half of the companies in this 
country are going to reduce or eliminate their retirees' health care 
plans for their retirees.
  I yield back to Dr. Fleming.
  Mr. FLEMING. If you would yield for just a comment about employers.
  I'm a small business owner, and you, as a medical physician and one 
who has to run a business, in essence, for health care, I think a lot 
of people out there may feel safe in the fact that, you know, my 
employer has always taken care of us, they've always stepped up and 
done the right thing. But what people have to understand is that if an 
employer is paying these high premiums and their competitor is not 
paying those high premiums or reduces the number of employees, then 
your employer is no longer competitive in the marketplace, and he 
either has to do the same thing or he goes out of business.
  So it's not like you can take comfort in the fact that, well, my 
employer always does the right thing, he always steps up and he always 
buys us insurance. This is a whole new paradigm because he's going to 
be competing; and if his costs are higher, then he's going to go out of 
business or match what the other one does.
  I yield back.
  Mr. BROUN of Georgia. Thank you, Dr. Fleming.
  We have just a couple of minutes left, and maybe I will get back to 
you in a second.
  But I want to tell Madam Speaker and the American people that 
Republicans have been charged by our Democrat colleagues--and I've 
heard many a Democratic colleague come stand down here in the well or 
stand back there at the Speaker's desk and say that the Republican 
Party is the party of ``no.'' We are the party of ``k-n-o-w.'' So I'll 
admit that we are the party of ``know'' because we know how--k-n-o-w--
we know how to reduce the cost of health care for everybody in this 
country. We know how to solve the problems of insuring those people who 
are uninsurable today because of preexisting conditions. We know how to 
maintain that doctor-patient relationship; it's how health care 
decisions are made. ObamaCare doesn't do that.
  That's another failed promise, another myth that our President and

[[Page H3802]]

Nancy Pelosi and company have given to the American people. President 
Obama said over and over again, If you like your insurance, you can 
keep it. And Dr. Fleming was just talking about, no, you can't. That's 
another myth; that's another failed promise. But the Republicans are 
the party of ``k-n-o-w,'' know, because we know how to do those things. 
We know how to create jobs. We've been asking over and over again, 
Where are the jobs?

  The American people are hurting. We see the statistics, 9.9 percent, 
but that's not correct. It's much higher than that. As an example, one 
of my county commission chairmen just told me that 1 year ago the 
unemployment in their county was 14.3 percent. Now it's down to, 
according to the statistics, 10.7. I said to him, That is fantastic. 
Where did the jobs come from? He said, Paul, there aren't any jobs; 
people have just gotten discouraged and fallen off the rolls. And I 
think that's why we see it below 10 percent today.
  We also mentioned earlier where teachers and policemen and other 
people are being furloughed and not being paid for those furlough days. 
There are millions of people who are unemployed. And people who are 
unemployed and getting jobs, the few that are out there, are being 
employed at a lower level than they are really qualified. So the 
unemployment, the underemployment, those that are off the rolls, it's 
much, much higher than 10 percent. I think it's above 20 percent, maybe 
even 25 percent; I don't have the data because we can't get those data. 
But the Republicans do have alternatives. And we're going to try our 
best to repeal ObamaCare and replace it with things that make sense, 
that will build jobs, build a stronger economy.
  We're just going to see, in the next few days here on the floor of 
the House, a bill that they're going to call a ``jobs'' bill, and 
that's not correct. They are naming anything a ``jobs'' bill these 
days, but jobs are being killed by this outrageous spending.
  The health care quality in this country is going to go down. The 
American people deserve better. We are going to try to repeal and 
replace ObamaCare and put in place something that makes sense 
economically and is good for the American people.
  I yield back.

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