[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[House]
[Pages 14445-14452]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes.
  Mr. GINGREY of Georgia. Madam Speaker, for the next hour, I am going 
to be joined by a number of my colleagues on the Republican side of the 
aisle, and most of them are members of the GOP Doctors Caucus, and we 
are going to spend time, Madam Speaker, talking about health care 
reform. Certainly that is the number one thing that's on our plate as 
we go through these next 6 weeks leading up to the August recess. And, 
of course, as the President has outlined his desire to have a health 
reform bill on his desk for signature sometime in mid October of this 
year, whether or not that can be done remains to be seen. There are a 
lot of thoughts out there as to how to approach this, but we feel that 
it's very important as physician Members. I think there is something 
like 339 years of clinical experience combined in this GOP Doctors 
Caucus. About 15 of us are health care professionals who have actually 
practiced in the field, if you will, most of us involved just in 
clinical medicine, what I like to refer to, Madam Speaker, as meat-and-
potatoes medicine. Not research at some high academic institutions but 
actually seeing patients every day in the office, in the operating 
room, in the delivery room. And so I think we have a perspective that 
we would like to share with Members on both sides of the aisle.
  Earlier in the evening, Madam Speaker, we heard from the 30-Something 
Group on the Democratic majority side. They were very articulate, very 
well spoken, but I think very wrong in some of the ideas that they have 
in regard to a government default plan, and we will talk about this 
during the hour.

                              {time}  2200

  I have been joined by a couple of my colleagues, Dr. John Freeman, 
the doctor from Louisiana; and Dr. Paul Broun from Georgia.
  I would like to yield time to my colleague from Louisiana at this 
point.
  Mr. FLEMING. I thank my friend and fellow physician and colleague, 
Dr. Gingrey.
  You made reference to the 30-Something Democrats, and I watched that 
debate, that discussion with great interest because, to be honest with 
you, with 32 years of medical practice and also owning businesses for 
nearly as long, when I hear this discussion about how a public plan can 
work, I really try to view that and try to understand that; but I 
always come out totally mystified with how this sort of thing could 
ever work.
  And to clarify the debate, basically Congress right now is looking at 
three different options. One is a total single payer nationalized 
health care system, Medicare for all. One would be a private system for 
all, which is what we, on the Republican side, back. And then the other 
is a public and private system that are competing with one another. So 
I really watch with great interest our colleagues on the other side--
none of whom are physicians, I might add--talk about how this could be 
a great deal, a great success, where you have a public system that's 
competing with a private system, somehow that's going to drive cost and 
prices down, and we're going to get a dividend from that.
  Well, what I would do is point out to my colleagues, let's look at 
Medicare today and Medicaid as well, both government-run systems. Both 
of them are running out of money rapidly, the budgets are exploding and 
expanding, and they are living off the fat of the private system. Today 
we know--in fact, a recent survey, a study came out showing that the 
average subscriber to private insurance spends an extra $1,000 a year 
to support the Medicare and Medicaid system. We also know that a lot of 
that support comes by way of the uninsured who are routed through the 
emergency room, who don't have any coverage; and if you think that the 
Medicare recipients pay for that, forget

[[Page 14446]]

it. That's not happening. Who is paying for that is the taxpayer and 
those who subscribe to private plans.
  So right now the systems that exist, Medicare and Medicaid, are, for 
the most part, supported not by premiums and not even fully by the 
taxpayers, but are supported by those who pay premiums into private 
plans. So if you expand Medicare to where everyone is eligible for a 
Medicare-type plan, who in their right mind is going to stay on private 
insurance when they know that they're going to have to pay increasing 
size premiums in order to get the same level of care that those on 
Medicare, who are largely supported by taxes, are going to get?
  What ends up happening is you lose that critical mass of those under 
private insurance, and so private insurance then becomes only an 
afterthought, a sliver of the economy. So what you're left with is a 
giant public system, a Medicare that's much bigger than what we have 
today. Incidentally, I will remind those that today, as it stands, 
Medicare will run out of money within 10 years, as it is. It's 
unsustainable as it is. Now if we grow it into a much bigger system, 
where are those cost savings going to come from?
  I will yield back in a moment, but I just want to bring out the fact 
that no one has ever been able to show that a government-run system, 
particularly a health care system, but any government-run system in 
which the economy is being controlled in some way has ever controlled 
cost. And even today we know that health care costs are going up twice 
the rate of inflation.
  Mr. GINGREY of Georgia. I want to apologize to the gentleman. I 
referred to him as Dr. John Freeman. Actually, it's Dr. John Fleming, a 
family practitioner from the great State of Louisiana. And it reminds 
me, the reason I did that, Madam Speaker, is because Dr. John Freeman 
was one of my classmates in medical school and also one of my co-
residents in my OB/GYN training back in Georgia. I think Dr. John 
Freeman practiced his entire career in Boone, North Carolina; and I 
hope Dr. John, wherever he is, is doing well, if he happens to be 
tuning into C-SPAN tonight.
  I wanted to say before yielding time to my colleague, Dr. Paul Broun, 
a fellow physician and family practitioner from the Athens and Augusta 
areas of Georgia, there was a letter sent from the National Coalition 
on Benefits within the last couple of days, addressed to the leadership 
of the House and Senate, House Speaker Nancy Pelosi, House Minority 
Leader John Boehner, Senate Majority Leader Harry Reid, and Senate 
Minority Leader Mitch McConnell, talking about the strong opposition to 
a public plan. I don't have time to stand here and read the names of 
all of these firms, but just to mention a few: Wal-Mart Stores, Xerox 
Corporation, Wellpoint Incorporated, Weyerhaeuser Company, National 
Restaurant Association, Bank of America, National Association of Health 
Underwriters, CIGNA Corporation, Chrysler LLC, Nike. I could go on and 
on. That's just maybe 5 percent of the number of companies that are a 
part of this National Coalition on Benefits that are so opposed to this 
idea of a public plan, which our colleagues, the 30-Something group, 
just an hour ago touted so strongly.
  At this point, I would like to yield to my good friend and colleague 
from Georgia, Dr. Paul Broun.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey, for yielding.
  I think the American people need to look at what President Obama said 
as a candidate and go back to what Dr. Fleming was talking about just a 
few moments ago about the options. Republicans are offering options 
because certainly we need to do something about health care financing. 
People are hurting. Health care expenses have gotten too high. 
Medicines are too high in the drugstore. Doctor bills are too high. 
Doctors are actually earning less money today. When I was practicing 
full time prior to coming to Congress, I was making in real dollars 
less money than I did 20 years ago and seeing as many or more patients. 
We see the whole health care system being strained tremendously. But 
candidate Obama talked about giving the American public options, a 
public versus private option. He said, if you like your current 
insurance, fine. Stay there. But as Dr. Fleming was talking about just 
a few minutes ago, what President Obama is actually offering us is a 
reduced-price health care financing system that's going to take away 
people's choices. It's going to take away their ability to choose their 
doctors. It's going to take away their ability to choose the hospital, 
what medicines that they have. It's going to delay them being able to 
get needed procedures, surgeries, delayed in getting x rays that are 
needed, ordered by their doctor. It's going to take the choices away 
from the patient, and it's going to put those choices in the hands of a 
Washington bureaucrat. I don't think the American people want that. I'm 
not sure that they understand yet what we're talking about tonight in 
our second opinion, that government-run health care is not going to 
give them the choices that they're used to today. They're not going to 
be able to stay in their private plans because they're going to be 
priced out of the market. They're going to have to go to that 
government-sponsored plan that is going to markedly narrow their 
choices.
  What it's going to do is it's going to kill people because, as we saw 
in the stimulus bill, there is a new program set up in the Federal 
Government to look at cost effectiveness and comparative effectiveness, 
comparing the effectiveness of health care decisions. Age is going to 
be one of the measures of how those decisions are going to be made.

                              {time}  2210

  We already see this happening in Canada. We already see it happening 
in all the socialized health care systems around the world. When people 
have celebrated a few birthdays and are getting what growing up down in 
Georgia folks talked about being ``long in the tooth,'' a little white 
haired, as I am turning to be, then what happens in those government-
run health care systems is they just deny the procedures, deny the 
tests, deny the care that the people need to stay alive, and people 
just die.
  Now, in Canada, a system that many tout, many on the other side in 
the Democratic Party tout the Canadian system and others, if you are a 
certain age and need a kidney transplant, you just don't get it. If you 
need bypass surgery, if you are a certain age, they will put you on the 
list, but you never get off the list. You just die. If you need 
medications, you are denied those. If you have cancer treatment that is 
needed, you just don't get those.
  We in this country, with the health care that we as physicians can 
give, we have made marked strides since I graduated from the Medical 
College of Georgia in how people survive various forms of cancers.
  I think Dr. Roe is probably going to talk about breast cancer, 
because he very eloquently talks about that frequently, but our breast 
cancer survival rates in this country are extremely good. In other 
countries, where they have socialized medicine, people die, and there 
is very poor long-term survivability of that disease. Heart disease, 
diabetes, you can go down the list of all these chronic diseases.
  In socialized health care systems, as this administration and the 
leadership in this House and the Senate across the way want to take us, 
it is going to take away people's choices. They are not going to be 
able to get the care that they desperately need to stay alive, and it 
is just the wrong thing to do.
  Dr. Gingrey, I just congratulate your efforts in trying to bring 
these things out to the American public, and I appreciate your being 
one of the cochairman of the Doctors Caucus and helping the American 
people to understand the direction that we are being led by this 
leadership, the liberal leadership in this House and the Senate, 
because it is not going to be in the best interests of the American 
public, and it is actually going to create a financial collapse, as Dr. 
Fleming was talking about, that is going to be exacerbated, and people 
are going to be exasperated

[[Page 14447]]

because of this rationing of care, taking away their choices, and some 
Federal Government bureaucrat in Washington, DC is going to make those 
health decisions for them. It is not going to be their doctor, it is 
not going to be their family and it is not going to be the patient, and 
it is the wrong thing to do.
  I thank you for yielding.
  Mr. GINGREY of Georgia. Reclaiming my time, I thank the gentleman.
  Before yielding to our colleague from Tennessee, Dr. Roe, a fellow 
OB-GYN physician, I just want to say to my colleagues on both sides of 
the aisle, Madam Speaker, that what we are about is trying to work in a 
cooperative way on both sides of the aisle and offer our expertise, to 
say to our colleagues, and there are some health care practitioners on 
the majority side as well, and we have reached out to them and made 
ourselves available, we want to be at the table.
  Unfortunately, Madam Speaker, we are not at the table. We haven't 
been enjoined, if you will. But we still hope, we still have hope that 
that can occur, because we do have some ideas, I think some very good 
ideas, in regard to bringing down the cost of health care, making it 
more accessible, making it more portable, making it available to 
everybody, and that would include people who are currently considered 
high risk, maybe even considered uninsurable, or if they can get 
insurance it is because they can afford to pay three or four times the 
normal standard rate, which many, many cannot.
  So we want to talk about some of those things tonight, and we will 
get back to that.
  At this point I yield to my colleague from Tennessee, Representative 
Roe.
  Mr. ROE of Tennessee. Thank you, Dr. Gingrey and also Madam Speaker. 
It is good to be here tonight to discuss a very important, and I 
believe, Dr. Gingrey and Madam Speaker, probably from a social 
standpoint, the most important issue that we will discuss, and probably 
this health care debate is the most important one since the mid-sixties 
when Medicare was voted on.
  Just to give you a little background, I am a native Tennessean, 
practiced medicine in Johnson City, Tennessee, in that region for 31 
years, and really saw a tremendous change in the health care delivery 
system from 1970 when I graduated from medical school until the 
current. I really marvel myself at the miracles that occurred.
  I recall when I was in medical school when St. Jude's Children's 
Hospital had just opened, it hadn't been there long, and the death rate 
among childhood cancers was 80-plus percent. Today, over 80 percent of 
those children survive and live and thrive.
  We are having a debate on what kind of system best fits America and 
its personality, and I will share with you some things we have learned 
in Tennessee about a public and a private system.
  What I hear when I am out talking to people is that, number one, they 
are worried about the cost of care. They are worried about the 
availability of it. And there is another whole discussion that we 
haven't had, which is accessibility.
  As we age, as the medical population and caregivers age, there is 
going to be a huge problem of accessibility in this country. We are 
already seeing it in our own communities, where in the next 7 years we 
will need 1 million more registered nurses in America. In the next 8 to 
10 years there will be more physicians retiring and dying than we are 
producing in this country.
  Well, you know, that is not sustainable. You cannot maintain the 
quality of care that we have grown to expect and the medical advances 
we have grown to expect without practitioners. That is an entirely 
different issue, not part of this debate, but indeed very much a part 
of this debate.
  In Tennessee, about 14 or 15 years ago we had Medicaid. We got a 
waiver to try a managed care system. Back in the eighties and nineties, 
managed care was going to be how we were going to control the ever-
escalating health care costs. So it was a wonderful idea to try to 
provide care to as many Tennesseans as we could at as low a cost as we 
could.
  What we did was we hastily put a plan together, as we are doing right 
here in this Congress right now. The most astounding thing I have ever 
heard in my life is in 60 days, or less than that, we are going to vote 
on a health care plan that affects every American citizen, 300 million 
of us. And your health care choices, as you know, are very personal 
choices. They are between you and your physician and your family.
  So the plan was a managed care plan, and it was a very rich plan. It 
provided a lot of care for not much money, and for some people no 
money. What happened was that people made very logical choices. About 
45 percent of the people who ended up on TennCare actually had private 
health insurance, but dropped it. Why did they drop their care? Well, 
you had a plan, this TennCare plan, which was cheaper, but provided 
more coverage, so therefore people made again a very conscious 
decision.
  The problem with the plan is, as with every public plan so far, is it 
does not pay the cost of the care. That cost has been shifted over to 
the private sector. So when you look at your health insurance costs 
going up each year, you are paying or supplementing, a tax really, on 
your private health insurance premiums caused by the increased usage of 
the public plan.
  In Tennessee, for instance, the TennCare plan covered about 60 
percent of the cost of actually providing the care. If everyone in 
Tennessee had the TennCare plan, most providers would lock the door, 
throw the key away and walk away because they couldn't pay their bills. 
Medicare, another plan that we have, pays about 90 percent of the cost, 
and our uninsured pay somewhere in between.
  Now, what I think will happen with this public plan is that once 
again, because politicians are involved in designing the plan, what 
will happen is more and more and more things will be promised about 
what will be covered in the plan, but when it comes to paying for it, 
and if we have time we can get in and discuss the Massachusetts plan a 
little bit, what will happen is you will have a Medicaid plan that 
doesn't pay the cost, you will have a Medicare plan that doesn't pay 
the cost, and you will have a public funded ``competitive'' plan that 
is subsidized by government but doesn't pay the full cost of the care, 
meaning more and more costs will be shifted on to the private payers.

                              {time}  2220

  Well, what will happen over time, I think, is that, again, 
individuals first, small businesses, 20, 30, 40, 50 in the business 
will say, We just can't afford this private continually escalating cost 
of private health insurance. And what will happen then is more will be 
shifted to the public plan, and over time you'll end up with a single-
payer system. And a lot would say, and I've heard it argued here on the 
House floor, Well, so what? What's wrong with that? We have a 
government-run, one-payer health care system. What's the problem with 
that? Everybody has coverage. Well, everybody has a health insurance 
card, but that doesn't necessarily mean you can get health care. Don't 
confuse a plastic card that says you have coverage with actually 
getting care.
  Well, what do I mean by that? Well, let me give you an example.
  When President Clinton had his heart attack, he went to the hospital, 
had a heart attack. He was operated on several days later, I think 3 or 
4 days, and probably the reason, in my opinion, he probably got a blood 
thinner that took a few days to get out of his system. And he was 
operated on and went home.
  Had he had that heart attack in Canada, they would have said, Mr. 
Clinton, you can go home and in 117 days, that's the average amount of 
time it takes to get a bypass operation in Canada, you can come back 
and get your bypass operation.
  Two weeks ago, I was in Morristown, Tennessee, talking to a physician 
there who is Canadian. His father began to have chest pain. I won't go 
through all the details about how long it took him to get a treadmill, 
how long it took him to see a cardiologist. Anyway, 11

[[Page 14448]]

months later, the man got--his left anterior descending coronary artery 
was 90 percent blocked, and he finally survived and got a bypass 
operation. I do not believe the American people are going to put up 
with that type of health care system. We are not.
  The other thing that I think that's been so astonishing to me, and I 
know Dr. Gingrey and Dr. Fleming, you have seen this, and Dr. Broun 
also, are the medical advances. When I graduated from medical school, 
we had one cephalosporin antibiotic, one. That's a type of antibiotic 
we use in infection. There probably are 50 today.
  There were about five antihypertensives, high blood pressure 
medicines, three of which caused severe side effects. I mean, it was 
almost better to have the high blood pressure than take this medicine. 
Today there are over 50, and the side effects have been reduced 
dramatically. People do so much better.
  So there are a lot of reasons, and we can go to it, and I'm going to 
yield back some time now, Dr. Gingrey and Dr. Fleming, for comments. 
And I have some other comments about a single-payer system. It's a good 
idea, as you pointed out a moment ago, to try to cover as many people 
as we can in this Nation as inexpensively as we can, and I agree with 
that.
  I yield back.
  Mr. GINGREY of Georgia. Well, I thank the gentleman. And before 
yielding back to Dr. Fleming, I wanted to say to my colleagues, Madam 
Speaker, that we are the party of a second opinion. And, of course, 
tonight we are talking about health care reform, but it could be an 
energy bill, a comprehensive, all-of-the-above approach to solving our 
energy problems and any other issue. But none really at this point in 
time is more important than solving this health care problem.
  And the bottom line is to, again, to lower the cost of health care, 
to make it accessible to everyone within their financial reach. And 
there are so many things that we can do short of, Madam Speaker, 
turning this over to the Federal Government to run what may be like 
they run Amtrak or the post office or, indeed, the Medicare program. 
And I don't think that that's what people really want and expect. We 
can do better than that. And there are a number of issues in particular 
that we could talk about in detail if we had more than just an hour, 
Madam Speaker.
  But clearly, this idea of electronic medical records, I think, is a 
way eventually to save money. I think the money that we put in the 
stimulus package, $19 billion to provide grants, I've got a piece of 
legislation that would help physicians purchase hardware and software 
and a maintenance program that's specialty specific, whether it was my 
specialty of OB/GYN or Dr. Fleming's specialty of family practice or a 
general surgery specialty program produced by a company in my district 
called Greenway where you have, as part of that electronic medical 
record program, you have algorithms set up of best practices that are 
developed not by a government bureaucrat, Madam Speaker, but by that 
very specialty group, those men and women, those leaders of that 
specialty society that want to do what is best and they want the best 
outcome at the lowest possible cost. They want to get paid a fair 
amount for their services, of course.
  And, in fact, with an electronic medical records system, they're more 
likely, Madam Speaker, especially under the Medicare program where you 
have something called evaluation and management code and intensity of 
care that you bring, doctors, I think, tend to undercode because, Madam 
Speaker, they're petrified that some inspector general is going to come 
along and demand to see 10 charts out of their 10,000 and nitpick and 
find some few, two out of 10,000 where they overcoded, and first thing 
you know they're not participating in the Medicare program and maybe 
even they're facing a jail sentence.
  So electronic medical records would--I don't know how much money, my 
colleagues, it would save, but I know that it would lead to a better 
practice of medicine based on best principles. We wouldn't need to have 
some comparative effectiveness institute, kind of like the Federal 
Reserve Board, telling doctors what they should do and not do, when 
it's time to operate, what medication to prescribe. We would have those 
best practices as part of an electronic medical records system. We 
could cut down on duplication of testing.
  People could be in Timbuktu, and with that little card smaller than 
our voting card, they, Madam Speaker, they could take that card, even 
in a country where they don't speak the language, or maybe they come to 
the emergency department comatose and can't speak any language, you 
reach in their pocket, pull out that card, swipe it, just like we would 
our voting card, and there's the entire record. We know what they're 
allergic to. We know what medications they're on. We know their past 
medical history, and we give them the best and most effective, cost 
effective, safest medical care.
  Mr. ROE of Tennessee. Would the gentleman yield?
  Mr. GINGREY of Georgia. I'll be glad to yield to the gentleman.
  Mr. ROE of Tennessee. Just a point right here. You were making an 
excellent point, Dr. Gingrey, about why you don't want the Federal 
Government to come between a patient and a doctor.
  A veteran can go to an emergency room, have an electronic medical 
record at the VA, can show up somewhere in an emergency room, let's 
say, in our area we have a VA Hospital in Johnson City, and let's say 
he lives in Mountain City, Tennessee. He shows up there and the doctor 
in the emergency room at Mountain City does not have access to his VA 
record, to his electronic record that they have at the VA. Now, I think 
we can do better than that, and that's going on right now.
  So that veteran who's up there with, maybe he's an elderly veteran, a 
World War II veteran with a very complicated medical history, that 
emergency room doctor is flying by the seat of his or her pants, and I 
think we can do better.
  And again, the health care decisions should be made between a patient 
and a doctor. And I don't want to let the private insurers off the hook 
here. You and I know this, and Dr. Fleming, also.
  I remember one of the last cases I did in practice before I retired 
to run for Congress, I spent almost as much time on the phone with a 
private insurer trying to get the case approved as I did actually doing 
a major surgical procedure. Now, that's the ridiculous item of the day 
when you do that, when you're not providing care to someone, you're 
arguing with a bureaucrat at the private health insurer.
  I yield back.
  Mr. GINGREY of Georgia. Reclaiming my time, those stories are just 
all too familiar, and it's a shame that that time is wasted when it can 
be better spent with the patient.
  I wanted to mention too, Madam Speaker, the issue of medical 
liability reform. Now, for a number of years--I've been here 7, this is 
my fourth term, and every year I have introduced medical liability or 
tort reform modeled after the system that was adopted back in the late 
seventies in California. The acronym for that bill is MICRA, but it has 
worked. It has stabilized the malpractice insurance premiums in that 
State. Yes, they've gone up somewhat because of inflation, but compared 
to other States that don't have that reform where there is a limitation 
on a claim, a judgment for pain and suffering, noneconomic, and where 
there is the elimination of this joint and several liability and there 
is collateral source disclosure--and I could go into some of the weeds 
of it.

                              {time}  2230

  But, obviously, we have not been able to pass that. When we 
Republicans had the majority in this House, we would pass it every 
year, Madam Speaker, in the House; but so many attorneys who are 
Members of the United States Senate would block that.
  Well, why can't we come together again in a bipartisan way and say, 
look, we can agree that part of the cost of medicine, cost of health 
insurance is the fact that medical practitioners order so many 
unnecessary--and in some cases, Madam Speaker, harmful--

[[Page 14449]]

tests, draw too much blood, get an MRI one day and a CAT scan the next 
day and a standard x ray the next day because they're trying to cover 
the possibility that someone would say, Why didn't you order this, or 
why didn't you order that?
  Lord knows we've gotten to the point now where everybody who shows up 
in the emergency department anywhere across these great 50 States with 
a headache is going to get a $1,200 CAT scan instead of a blood 
pressure check and an aspirin and a ``come back to my office in the 
morning.''
  So this is an area in which we could clearly come together in a 
bipartisan way and hash out. Well, if the California version of tort 
reform is not acceptable, how about a medical tribunal, a group of 
independent people looking at the claim and saying whether or not it 
has merit?
  There are so many things that we could do. And I've got a few more 
ideas, Madam Speaker, that I want to talk on, but I do want to refer 
back to Dr. Fleming and hear from him because I know he's got a lot of 
things he wants to share with us.
  I yield to Dr. Fleming.
  Mr. FLEMING. I wanted to tone down on the debate a little bit more.
  Again, we heard the 30-something Group Democrats talking about the 
debate earlier, and one said something very interesting. It really 
caught my ear. He said that the debate is basically Democrats want 
health care reform, Republicans do not want health care reform.
  Now, I have spoken on this floor, as you know, Dr. Gingrey and Dr. 
Roe as well, and I've heard you speak many times; many Members of our 
conference have spoken; I've spoken a number of times throughout the 
district. I've listened to everyone from Speaker Gingrich to many 
others. I have yet to hear one Republican say that he is against health 
care reform.
  So I want to remind my colleagues on the other side of the aisle that 
the only way we're ever going to solve our health care problems--which 
make up about 20 percent of our economy--we must have an honest debate. 
And framing the other side into a position that really doesn't exist is 
not going to get us there. In fact, I would say that we really agree, 
from what I can understand, on 90 percent of the discussion.
  We all agree that we should do away with pre-existing illness; we all 
agree that we should have portability; we all agree there should be a 
hundred percent access to care; we all agree that we should lower the 
cost of care. I can draw you a great list. There is really, when you 
get down to it, only one thing we disagree with, and that is we feel 
that a private system, private industry--even if it's paid for by the 
Federal Government--in many cases does a much better job in terms of 
quality of care and customer service and a much better job of 
controlling costs.
  This is proven time after time.
  Compare our economy with a socialistic economy and you see every time 
that we provide much better products and services and at a much better 
price than those countries do.
  So, really, the only disagreement is who is actually controlling the 
care. And, of course, I submit to you that a government-run system is a 
real problem. And I will tell you where I learned this.
  When I was in the Navy as a physician, I noticed in the first year 
that the commanding officer of the hospital sent out a call and said if 
there is--this is budget time of the year--and if there is anything 
that you think we could ever want in this hospital, wink wink--meaning, 
think of something; dream of things--put it on a list, because if we 
don't preserve that budget the way it is, then our budget will be cut 
next year. And that, my friend, is the way government works. If you 
don't force it into the budget, if you don't make sure and protect your 
territory, it won't be there next year. Somebody will cut into it. And 
that's really the way government works.
  And I will give you an example, a real-life example of how we will 
never be able to get rid of waste, fraud, and abuse from our health 
care system if it's run by the government.
  Think about this: we have to throw out a wide net, which is very 
expensive. We may capture a few offenders out there. Because it would 
have to be a criminal act, we would have to prove that they really did 
it on purpose; and then at the end of the day we would have to 
prosecute them with a lot of dollars; and then we may get one person, 
and we may get a few dollars. That's the way you get rid of fraud and 
abuse in a government system.
  In a private system, much different. You have a physician or some 
other provider in a health care organization that's privately run, and 
if his practices are not the best practice and he's not practicing in a 
cost-effective way, that shows up on a graph; and often, of course, you 
go to that provider and you reeducate, and you have him work with 
colleagues, and you get him back to the protocols. And if that doesn't 
work, then you fire him. Easy problem to solve. It doesn't require all 
of that--there is no crime involved. So you can work in the most 
effective way possible.
  Mr. GINGREY of Georgia. Reclaiming my time, I think that the 
gentleman has certainly hit the nail right on the head in regard to 
this, and we could go back to what we talked about earlier in regard to 
electronic medical records, which would be specialty specific--the 
information, of course, would be available for any provider who is 
seeing the patient.
  But in regards to best practices, as the gentleman was talking about, 
and these algorithms, I mean, doctors, let's face it, they're busy. 
They're operating; they're delivering babies. They don't have time, nor 
can they afford every 4 months going to a continuing medical education 
course. A lot of times they have to do that online. And it is hard to 
keep up.
  But with electronic medical records, this would help them keep up. It 
would absolutely help them order the right tests, give the best 
outcomes. And as Dr. Fleming pointed out, if they're in a single 
specialty group of eight surgeons and one in the group is not getting 
the information the others are getting, that information is available 
internally and externally. And you kind of police your own.
  I want to give--I think he just asked for 1 minute--my good friend, 
Dana Rohrabacher, is going to be on the floor in the next hour. He 
asked for a minute, and I yield to him.
  Mr. ROHRABACHER. As we are making fundamental decisions about things 
such as health care, which is so important to our country and important 
to each and every citizen, we should keep in mind the fundamental 
differences that you are bringing up tonight between a government-
controlled health care system and an individual-controlled health care 
system, where the individual basically controls a great deal of the 
resources that he or she depends upon for his or her health or the 
health of their family as compared to having those resources totally at 
the command of the government. And the one word that comes to mind is 
politicalization of what's happening and what could that possibly mean 
in health care.
  Let me give a little suggestion that if we have government-controlled 
health care, we're going to have illegal immigrants involved in the 
system. Our Democratic colleagues, as good-hearted as they are, cannot 
get themselves to say ``no'' to providing health care benefits to 
illegal immigrants. If we provide the type of operations that we want 
for our own people--heart operations and various things that are very 
expensive operations for health care--to be granted to illegal aliens, 
you can expect that it will, number one, bankrupt the system; but, 
number two, we will have illegal aliens coming here from every part of 
the world. And, in fact, one of the problems right now is that we 
already provide too much health care for illegal immigrants.

                              {time}  2240

  That issue alone should be a red bell for everyone out there saying, 
Do I really want the government to control health care and make the 
decision and give part of the money to an illegal immigrant?

[[Page 14450]]


  Mr. GINGREY of Georgia. Well, reclaiming my time, and I thank the 
gentleman for his contribution in regard to that.
  When you look at that number of 47 million who do not have health 
insurance, according to the Census Bureau, Madam Speaker, probably as 
many as 10 million of them are illegal immigrants. Now, they're not 
entitled, so to speak, to health insurance. That's not to say that you 
might not have a situation of extreme compassion if an illegal 
immigrant is admitted through one of our emergency departments and they 
are absolutely in the throws of a fatal illness, maybe it's a young, 
otherwise healthy person with congestive heart failure or congenital 
malformation that is resulting in an inability to sustain their blood 
pressure and they are on the verge of death, they would get the care in 
that hospital--in any hospital I think across the United States.
  Mr. ROHRABACHER. And no one argues with that.
  Mr. GINGREY of Georgia. Yes. Of course not. They would get that care 
to save a life, of course we would. But the gentleman brings up a good 
point. And I did want to point out the segue into that number of 47 
million.
  It is estimated that maybe 18 million of those 47 million are making 
more than $50,000 a year, and many of them just choose, of their own 
volition--maybe they're 10 feet tall and bullet proof, 20-somethings, 
30-somethings, have the Methuselah gene, they think, and don't spend 
much money on health care, and they just elect not to put the $200 a 
month payroll deduction or whatever it is. And maybe they have their 
own escrow account or their own health savings account. I think it's a 
bad decision, I think it's a bad bet, but a lot of people do that.
  And you can't really force them, I don't think, unfortunately, in 
this Democratic plan, Madam Speaker. What the President is talking 
about is to have a mandate on the employer. If they are above a certain 
number of employees and if they don't provide health insurance for 
their employees, then they have to pay a tax or pay a percentage of 
their payroll into this connector; and individuals are absolutely 
required to sign up for health insurance, or if not, they have to pay a 
tax. I mean, that is not the American system. We want to encourage 
young healthy people to get health insurance.
  And I want to make one point before I yield back to either one of my 
two colleagues. The insurance industry can help in a great way by 
looking at this. Let's say, take an example, a 22-year-old young man, 
newly married, newly employed, is not really convinced that paying for 
health insurance on a monthly basis is to his advantage, but he does it 
anyway. And he puts in whatever the cost is for a family premium and 
his portion of that payment month after month, year after year, with 
the same company maybe 15 or 20 years. During the course of that time, 
Madam Speaker, envision this, that individual develops high blood 
pressure, or maybe in addition to that high blood pressure develops 
type 2 diabetes--maybe the diabetes comes first, and then the high 
blood pressure--and then after that develops coronary artery disease. 
And then all of a sudden the company goes out of business and that 
individual is out of work, out of insurance, and desperately needs it. 
But because of these preexisting conditions, once COBRA runs out, how 
are they going to get health insurance? How are they going to afford--
struggling maybe to find a new job, but how are they going to be able 
to go out with no tax deductibility and purchase a health insurance 
plan that is three and four times the amount of a standard plan for 
everybody else?
  What I would say, Madam Speaker, to the Association of Health 
Insurance Plans, why don't you grant those individuals credible 
coverage, just like we did in Medicare part D, the prescription drug 
benefit? If you have a credible insurance plan that covers prescription 
drugs, say, on a supplemental plan, and then you lose that after 4 or 5 
years, then you shouldn't be penalized when you get into part D--and, 
indeed, the law says you won't be penalized. But why should the 
insurance company penalize these people who, in good faith, all those 
years have put that money, that premium--the insurance industry had it 
invested and had a good return on their investment--when these people 
all of a sudden are in a high-risk situation, I think they should get a 
community rating.
  I would be very curious to know how my colleagues feel about that, 
and I will yield to Dr. Fleming.
  Mr. FLEMING. I appreciate your yielding. I just wanted to take a 
moment to follow up on what you said and Mr. Rohrabacher.
  We have 47 million uninsured, 10 million of course are illegal 
aliens. And of course that is a solvable problem by only allowing legal 
aliens and requiring them to pay taxes and insurance like anyone else, 
and those who are here illegally should not be here. So that's not 
really a health care problem, at least primarily, that is an 
immigration problem.
  We also have, as you point out, at least half that 47 million who are 
insurable people, and very cost effectively, but they choose not to. 
That really hurts the risk pool, and we should do things to incentivize 
them.
  The real problem is the 10 or 15 million people who are either 
business owners or they work for small businesses and they can't get 
cost-effective insurance. And they're the ones that delay care, they're 
the ones that don't go to their primary doctor, they're the ones that 
end up going to the emergency room, getting care at a time when the 
outcomes are the worst and the cost is the highest.
  So when you think about it--and polls show that 75 percent of people 
are happy with what they have, whether it's Medicare or Medicaid, 
private insurance--it's that 25 percent that can't get affordable care. 
That's where the problem is, and that's where the focus needs to be. 
And if we do that, we get cost-effective coverage for them--and there 
are many ways of doing this, and we would have to get into ways to 
determine that--we would really have this problem under much better 
control. But if we, on the other hand, blow this thing out with a 
single-payer system, we are going to have exploding budgets as far as 
the eye can see, and I don't see any end to that. I thank you, and I 
yield back.
  Mr. GINGREY of Georgia. I thank the gentleman, and I yield to the 
gentleman from Tennessee.
  Mr. ROE of Tennessee. Just a couple of comments.
  Our colleague from California made great points. And I am going to 
ask the two of you who have been here for a while to discuss this 
Medicare part D discussion in just a moment. But he is correct. What 
happened was, when we created the TennCare plan in Tennessee, we are 
surrounded by eight States in the State of Tennessee, and we had a plan 
much richer than the surrounding States. So guess what happened? People 
came into the State. First of all, when we first put the plan out, all 
you had to have was a post office box. Well, there were a lot of post 
offices boxes that occurred, and a lot of people came into the State of 
Tennessee to get care.
  The way the Governor handled that--and remember that government-run 
plans--and I want people to understand, this is a very important 
point--in Tennessee, when it was about to break the State, our 
Governor, along with the legislature, made some very tough decisions. 
They cut the rolls. They limited the number of people that were on the 
TennCare plan. In a plan in England or in Canada or other single-payer 
systems, what happens is you ration care, you create waits. For 
example, in Canada--and this is the head of the Canadian Medical 
Association, not Phil Roe saying this--but he said you could get your 
dog's hip replaced in a week in Canada, but it takes 2 to 3 years for a 
person to get their hip replaced in Canada. And I think you made that 
point this morning during 1 minutes.
  Mr. GINGREY of Georgia. Reclaiming my time, we did talk about it this 
morning, and it was a Canadian testimony, was it not? And I yield back 
to you.
  Mr. ROE of Tennessee. It was. And I think the discussion, as I 
recall--and

[[Page 14451]]

Dr. Fleming is absolutely right, there are not that many disagreements, 
it's who is controlling these health care decisions; is it a bureaucrat 
or is it the patient and a doctor? And I think that is where the big 
discussion is.
  Now, as I recall, when the Medicare part D discussion came up, the 
problem was going to be--the argument I heard the other side make was 
that without this public option there wouldn't be enough competition, 
and therefore prices would go up. But was what happened in part D--and 
I'm not saying part D certainly is perfect, it's not--but what happened 
was, with a competitive market out there, that actually came in lower 
without the public option when you had the private option competing in 
the open market. And I believe the discussion among the Democrats was 
that without this public option, that wouldn't happen. Well, just the 
opposite happened.
  And again, we have seen what happened in Tennessee, I don't want to 
go over it again. But I can assure you that it will be a plan that 
promises more than it can deliver for the funds that are available, and 
there will be two options. And you know what those options are, and 
that's long waits--and I just don't think the American people are 
interested, I know I'm not interested in that.
  Mr. GINGREY of Georgia. Well, reclaiming my time, and I think you're 
absolutely right, that the only way to solve the cost overruns, which 
would no doubt occur--and I do believe, as our friend from California 
suggested, that if the government was running the whole show, and 
eventually if we approve this government default plan, that's just a 
giant step, and it's just a baby step toward a single-payer system. And 
when you get into that situation, I can almost assure you, Madam 
Speaker, that under current leadership, you would have any and all, 
come one come all, just like they did in Tennessee. And Dr. Roe was 
describing the TennCare program and the problems they ran into.

                              {time}  2250

  And then the only way you could pay for it, as he points out, would 
be to start cutting reimbursement to the providers, to the health care 
providers, to the physicians, to those primary care docs that we so 
desperately need to be focusing and to be running our medical homes and 
to make sure that people are taking their medication, that there's an 
emphasis on wellness and keeping people healthy, keeping them out of 
the doctor's office, keeping them out of the emergency room, out of the 
hospital, and toward the end of life hopefully out of the nursing homes 
and in their own homes. That's why I think it's a mistake to even go in 
that direction of government-run health care.
  I clearly feel, and I know my colleagues on the floor tonight agree 
with me, Madam Speaker, that the private marketplace works. And my two 
colleagues that are with me tonight weren't in the House back in 2003, 
but I know they were following the debate very carefully and very 
closely and maybe even felt that Medicare part D was something that we 
couldn't afford. Certainly it added cost, if you crunch the numbers 
statically, to the Medicare annual payments, Medicare part D did. But 
in the long run, in the long run, because of that program, if they can 
afford to take their medications for some of these diseases that I 
mentioned earlier, high blood pressure, high cholesterol, diabetes, and 
keep these things under control, then clearly what happens is you shift 
costs from part A, the hospital part of Medicare, and from part B, the 
doctor part, the surgeon part, the amputation part, the renal 
transplant part, and then also in part D keeping folks from having a 
massive stroke hopefully by controlling their blood pressure and you 
spend less on the skilled nursing home part. So I think that's a pretty 
good bargain and a pretty compassionate way of approaching things.
  But our Democrat colleagues, Madam Speaker, who were in the minority 
at the time, stood up here and they symbolically, some of them, tore up 
their AARP cards because that senior organization had the audacity to 
support a Republican bill. And then, of course, they said, well, why 
can't we have a government default plan and why can't the government 
come in and set the price and say, okay, this is the price, this is the 
monthly premium for part D, the prescription drug part, and these free 
market thieves will not be able to run up the price? And they even 
suggested, Madam Speaker, that we set that monthly premium at $42 a 
month. Fortunately, my colleagues, that amendment was defeated. And 
when the premiums first came in from the prescription drug plans, the 
private plans competing with one another for this business, they came 
in at an average of $24 a month. Now, 3 years later, that has gone up a 
little bit because of inflation, but it's nowhere near $42 a month.
  So if we don't learn from our history, we are going to repeat those 
same old mistakes. And it looks like the Democrats, with this idea of 
letting the government come in and run everything and saying that we 
can't trust the free market, I guess that's what they want to do with 
General Motors as well, and I'm very anxious to see how that one turns 
out.
  Mr. ROE of Tennessee. Will the gentleman yield?
  Mr. GINGREY of Georgia. I yield to the gentleman from Tennessee.
  Mr. ROE of Tennessee. Good points about the private versus the public 
sector. The private sector will always be more efficient and more 
responsive. And you have heard this story before, but when I began 
practice and when you did, Dr. Gingrey and Dr. Fleming also, when a 
patient came to me, and I took care of nothing but women, and when they 
came to me with breast cancer--which I unfortunately saw way too much 
of and our practice diagnosed about a case a week. It was that common 
or is that common.
  And we just had a relay this weekend. In 1977 or so, the 5-year 
survival rate was about 50 percent, maybe a little bit better, but 
about 50 percent. And the big argument came: Do you do a disfiguring 
operation of a radical mastectomy or a lumpectomy? Because the survival 
rates were the same. So what has happened over that time is that now a 
patient can come to you or me or any of our colleagues and we can tell 
them that because of early detection, because of education, because of 
mammography, you're going to have a 98 percent survival rate in new 
medications. That is a wonderful story to tell. And I know no matter 
how tough the times are for that patient, you can look at them and say, 
You're going to be okay.
  In the English system, they quit doing routine mammography. And why 
did they quit doing that? Screening mammograms aren't done anymore. 
Why? Well, because it costs more than the biopsies. Sometimes a test 
will tell us we have something when we don't have it. That's called a 
false positive. And the phone call that I love to make is to my 
patients to say, You do not have cancer. So this is one where they quit 
doing that because the cost of the biopsies was more than the 
screening. The best rates they had were 78 percent survivals, and those 
are going to go down if you use that technique.
  Mr. GINGREY of Georgia. If the gentleman will allow me, as we get 
very close to that bewitching hour of 11 o'clock, my southern drawl had 
better get a little faster than a drawl. But my mom, Helen Gingrey, who 
lives in Aiken, South Carolina, in a retirement community, a great 
community, Kalmia Landing, my mom had her 91st birthday on February 8 
of this year. Well, when she was 90, about 5 or 6 months ago, 6 or 8 
months ago, she had a knee replacement. And Mom had gotten to the 
point, Madam Speaker, where she could barely walk, in constant pain, on 
the verge of falling and breaking her hip at any moment. And now she is 
enjoying life and enjoying being with her friends, and maybe she's 
going to live another 10 or 15 years. I don't know. She seems to have 
the Methuselah gene. But do you think in Canada or the U.K. or one of 
these countries where they ration care that she would have had an 
opportunity to have that knee replacement? The answer we all know, 
Madam Speaker, is absolutely not.

[[Page 14452]]

  I would say in closing, the one thing I would like to see is the 
equal tax treatment of the health care benefit for individuals who have 
to go out and buy them in the market on their own. They don't get it 
from their employer. Why should they not get a tax advantage health 
care plan just like everybody else? And you know what, Madam Speaker? I 
have not heard the Democrats in the House, the Democrats in the Senate, 
or President Obama talk about that. And talk about fairness and wanting 
to be equitable, let's hear some more about that. We will talk about it 
in future Special Orders.
  I want to thank my colleagues Dr. Roe, Dr. Fleming, and my good 
friend from California, Representative Dana Rohrabacher, for being with 
me during this hour.

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