[Congressional Record (Bound Edition), Volume 155 (2009), Part 14]
[House]
[Pages 19623-19629]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       30-SOMETHING WORKING GROUP

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Ohio (Mr. Ryan) is recognized for 
60 minutes as the designee of the majority leader.
  Mr. RYAN of Ohio. Mr. Speaker, we are here to discuss the health care 
reform proposal that is now being discussed in Washington, D.C., and 
really throughout the country.
  We are going to use tonight's hour of our 30-Something Working Group 
to

[[Page 19624]]

talk a little bit about what is in the bill--what is actually in the 
bill, not what is being said on talk radio or from some Internet site 
that is basing their comments and their critiques of this bill on 
really things that don't exist. And we want to do that.
  It is interesting that tonight the 30-Something Working Group will be 
articulating this, and then over the course of the rest of the week and 
into the fall, to discuss this critical piece of legislation for the 
American people because one of the previous speakers was talking a 
little bit, and it reminded me, as I heard some of the rhetoric, they 
were talking about health care savings plans and all of these accounts, 
a couple of things came to mind.
  The origination of this 30-Something Working Group was the creation 
of then-Minority Leader Pelosi to discuss Social Security 
privatization. That is how this whole thing originated 4 or 5 years ago 
with Congressman Meek, and then Congresswoman Wasserman Schultz and I, 
and then later on Chris Murphy from Connecticut. And we were discussing 
all of these issues, but one of the issues was Social Security 
privatization.
  So before we get into this bill, I think it is critical for us to 
remember that our friends on the other side who are now so critical of 
what we're trying to do here were in charge of the House, of the 
Senate, of the White House. They had President Bush, they controlled 
the Senate, they had this Chamber--Tom DeLay was running the show--and 
they didn't do anything for health care costs. So I think it's 
important that that's out there. And if they wanted to pass some kind 
of comprehensive health care reform, they should have done it because 
we are still dealing with the problems that they failed to solve when 
they were in. And this is a problem facing millions of Americans, 
millions of small businesses that we need to help address. So that's 
why, as we talk today, this needs to be in context.
  The Social Security privatization, I mention that because, let's 
imagine where our country would be today if our friends on the other 
side had their wish and privatized Social Security. Can you imagine 
where this country would be today if President Bush and Tom DeLay got 
their wish and privatized Social Security? I know in my district we're 
dealing with all kinds of pension issues--Delphi salary, Delphi hourly, 
UAW, steelworkers have all lost their jobs, their pensions in many 
cases are in jeopardy. Thank God for the PBGC to help cushion the blow. 
But can you imagine the cost to this country if the Republicans had 
been able to fully implement their economic agenda? They did the tax 
cuts, they did most of their economic agenda, but fortunately we were 
able to prevent privatized Social Security. So it's important for us to 
realize that as we begin to debunk some of these myths.
  I would just like to suggest, Mr. Speaker, as we go through this, and 
I have encouraged my constituents and would encourage all Members of 
Congress within an earshot to base their critiques on what's actually 
in the legislation. Don't we at least owe that to the American people? 
This is big. This is comprehensive. This is complex, multidimensional. 
Every chip you move moves another chip on the table. But we owe it to 
the American people to have an honest, mature discussion.
  The rhetoric that is being fed to the American people is outrageous. 
I want to start with one, and I will go through some others and we will 
talk about the bill a little bit. But one of the commercials about how 
much it will cost--and my friend from Texas mentioned it a few minutes 
ago, and I would love to talk about that and the CBO scoring. But one 
of the things that I'm hearing from people who listen to Fox News or 
listen to talk radio is this plan is going to cover illegal immigrants.
  How dare you drive up my health care costs. I have to lose my 
pension, but you're going to spend the American tax dollars covering 
illegal immigrants. It is clear, right here in section 246, ``No 
Federal payment for undocumented aliens.'' ``Nothing in this subtitle 
shall allow Federal payments for affordability credits on behalf of 
individuals who are not lawfully present in the United States.'' Black 
and white. Can we move on? Can we now move on and talk about how much 
health care is costing our country, that it may bankrupt our country? 
Section 246, ``No Federal payment for undocumented aliens.'' Right 
here. So now let's have an honest discussion about what's in this bill 
as we start to knock down some of these.
  First, the cost of doing nothing, which has happened over the last 13 
or 14 years. We haven't done anything since President Clinton tried to 
move health insurance reform in the early nineties. We know that if we 
do nothing, that there will be an $1,800 increase for a family of four 
every single year. That's what happens if we do nothing.
  There has been a 4 percent increase in property insurance and an 11 
percent increase in health insurance year in, year out; year in and 
year out. We can pull out boards and say it's going to cost you this 
and cost you that, but the biggest expense is the cost of doing 
nothing.
  Look at this system. It's atrocious. To even call it a health care 
system is ridiculous because it's not. Why would you possibly be okay 
with a system that doesn't try to prevent sickness? Why would you be 
okay with a system that waits--we don't want to prevent you from 
getting sick, but gosh, once you do, come right into the emergency 
room, we'll take care of you because we're a compassionate country. And 
we are a compassionate country, but let's be a smart country. Let's be 
a wise country. And true compassion would be not waiting until someone 
gets deathly sick and shows up at the emergency room. God gave us a 
brain, too, and he wants us to use that brain. And we are all in 
agreement here, as we use the gift that God has given us to use logic 
and process information, that if we take some of this money that we are 
spending in the system, and instead of waiting and being reactive and 
rescuing people, we spend a fraction of that money on the front end and 
we make sure that everyone has some preventative coverage.
  This is not a Democratic idea, it's common sense. Talk to the CEOs of 
hospitals. I've got one in my district. He is a Republican CEO. He 
says, Please, Tim, whatever you do, give me the opportunity to give 
this person a $20 prescription instead of having this person show up in 
my emergency room and costing me $100,000. This is not brain surgery 
that we're trying to perform here.
  And the fear tactics and the fear tactics and the fear tactics that 
are coming from Members of Congress, they're coming from talk radio, 
they're coming from Fox News about illegal immigrants are going to be 
covered under this plan. And as I read earlier in section 246, they're 
not. They're not. Section 246, ``No Federal payment for undocumented 
aliens.'' ``Nothing in this subtitle shall allow Federal payments for 
affordability credits on behalf of individuals who are not lawfully 
present in the United States.'' I'm going to say that to every single 
person I meet who brings it up because this debate has more to do with 
the well-being of all of our citizens than to try to be demagogued and 
try to alienate people.
  You look at our plan, and it covers 97 percent. Why doesn't it cover 
100 percent? Well, for the reason I just said. And it is already in law 
where illegal immigrants can't be covered under SCHIP, they can't be 
covered under Medicare, they can't be covered under Medicaid. And from 
the employer-based system that we already have, an employer is not 
allowed to hire an illegal immigrant, so how could you cover them under 
this plan, if you're under an employer-based system, when an employer 
is not allowed to hire an undocumented worker? So let's put this aside 
and let's have this discussion. The American people want us to have a 
mature discussion here. Small business owners want us to have a mature 
discussion.
  I got a call today in my office. I periodically pick up the phone and 
chat with my constituents who call, and the concern was about seniors 
on Medicare being hurt by this plan. It's important for our seniors to 
recognize--our friend

[[Page 19625]]

said, it's $9,200 a family. And I'm happy to pay my share because I 
remember when my grandparents were in their last months, weeks, years 
of their life, they had health care because of the Medicare program. So 
all of these folks who want to not have the government involved in 
health care, you know, tell your parents and your grandparents to give 
back their Medicare. Give it back. You don't want it. The government's 
involved in that. Give it back. No Medicare. Of course you're not going 
to say that. Of course you're not.
  And to have this discussion--honestly, we would say we could save 
money in Medicare. We should. Not on the backs of our seniors, but 
there are a lot of overpayments, in Medicare Advantage, for example, 
that we can squeeze out of the system. One of the costs to Medicare is 
the fact that there is no previous care for a lot of people. So if 
you're 60 or 61 or 59, you see the date coming where you're going to be 
Medicare eligible and you don't have health insurance coverage or you 
don't have a good plan or you have a preexisting condition in which you 
can't get health insurance, you have heart disease or you have cancer 
and it has not been in remission long enough--I had this woman come to 
a round table I had the other day. She had cancer. She got kicked off 
her plan, got cancer, and then could not get on any other health 
insurance plan because she had this preexisting condition. Her cancer 
wasn't gone for 10 years, so until it was gone for 10 years no one 
would pick her up. Tragic in the United States of America. But a lot of 
people do that. And so they wait. Instead of getting health insurance, 
they think, I'll be on Medicare in a few years, so I will just wait 
this out. And that leads to some chronic issues, chronic disease 
issues. That leads to, again, not preventing things from happening. 
Maybe cancer is spreading, maybe breast cancer, maybe cervical cancer 
because they failed to go and get preventative care. So they get into 
the Medicare program, and costs blow up because they've waited. So part 
of squeezing some of the fat out of Medicare is adding this element of 
prevention.

                              {time}  2030

  And this is what our grandparents told us growing up. An ounce of 
prevention is worth a pound of cure. Don't get yourself into trouble. 
You get in a fight, well, I was right, he was wrong. You should have 
not gotten in the fight, then you wouldn't have all these series of 
events that happened that you now have to deal with. Prevent yourself 
from getting in these situations.
  That's what we're trying to do with this legislation. It makes a 
great deal of sense. Another myth that has been forwarded by our 
friends on the other side is the cost that CBO gave a week or two ago 
in their analysis that the trillion dollars that we are saying needs to 
be spent in this plan is actually $2 trillion or $3 trillion. I don't 
know exactly what the exact number is from the Congressional Budget 
Office.
  Now, this is the point I want to make. The Congressional Budget 
Office is nonpartisan, so they deal a blow to the Democrats and then 
they deal a blow to the Republicans, but, you know, we have an 
opportunity--they're not partisan. They've slammed everybody. But what 
we want to say, and what needs to be highlighted is, in the CBO 
analysis of the health care plan, when they factor in the cost and they 
try to do the long-term costs and the long-term analysis, they do not 
factor in prevention.
  So as I mentioned with the CEO of the hospital the other day, you 
know, if you're not factoring in this person who shows up at the 
emergency room with late stage cancer, when you maybe could have given 
them access to an OB/GYN or a mammogram or regular prostate checks, I 
mean, these are the kind of things that will prevent that. So if you're 
just adding what if this person doesn't have health care and shows up 
in the emergency room and the long-term cost of that person, without 
factoring in the preventive side, that cost would balloon. But common 
sense will tell you that the prevention will lower the costs. And 
that's what CBO has not factored in.
  So this prevention can save the system a heck of a lot of money. Now, 
the CBO, one of the other myths is that the CBO, or our friends are 
saying, Well, this is going to dry up the employer health care plan or 
the employer-based system. And it's going to put--everyone's going to 
go into the public option and they're not going to stick with their 
employers. And so CBO did an analysis of this. So, as I said a couple 
of minutes ago, CBO blasted the Democrats. We have a response to that, 
saying that they failed to factor in the preventative aspects of our 
bill. And so the next myth is that our friends are saying that this is 
going to destroy the employer-based system. So I'd like to read an 
excerpt from the CBO letter analyzing this. Over the weekend they did 
this.
  It says there will be an increase in employer-sponsored insurance 
coverage. This is a quote, We estimate that about 12 million people who 
would not be enrolled in an employment-based plan under current law 
would be covered by one in 2016 largely because the mandate for 
individuals to be insured would increase workers' demand for insurance 
coverage through their employer.
  So they're saying that 12 million people who would not be enrolled 
now would be covered by one in 2016. So an increase of the employer-
based system in 2016 by 12 million, largely, because employers want to 
give their folks a benefit. And under this plan, they will be 
negotiating with millions of other people, as opposed to, in the 
instance of a small business, just being out there on their own with 
five, 10, 15, 20 people trying to piece this whole thing together. And 
we'll go through the cost of doing nothing for small businesses.
  It's incredible. So they see this as a real opportunity to leverage 
their business with others and therefore, increase the amount of people 
who will be covered under the employer plan.
  Third-party validator, Congressional Budget Office, not always in 
agreement with the Democrats, says that that's just false; Medicaid 
coverage does not crowd out private health insurance. CBO does not 
anticipate a substantial shift from private insurance to Medicaid. 
Specifically, we estimate that about 1 million people who would 
otherwise have employment-based insurance or individually purchased 
coverage would end up enrolling in Medicaid in 2016. So very small 
numbers.
  One of the things, too, there's been this Lewin Group's analysis 
about the public option and people going into the public option. CBO 
knocks that down. And it's good to know, I think, I'm trying to 
remember, I think it was United Health who, yep, the Lewin Group, who 
did this analysis saying everybody's going to leave employer and go to 
this public option. That study was funded by United Health Care and 
requested by the rightwing Heritage Foundation. It's been widely 
discredited for its flawed review of the House legislation. So it's 
important, again, that we base our analysis on what the facts are and 
what's actually in the bill.
  So the CBO refuted this Lewin group estimate, quote, For several 
reasons, we anticipate that our estimate of the number of enrollees in 
the public plan would be substantially smaller than the Lewin Group's, 
even if we assume that all employers would have that option.
  So CBO's projecting 10 to 11 million people would maybe go into the 
public option, a very, very small number. And it's important for us to 
remember that. So, again, another myth, that there's going to be a 
decrease in employer-based health care. Not true, CBO, nonpartisan, 
actually an increase of 12 million people by 2016.
  Also, stated by our friends on the right, that this is going to drive 
people to this public option. CBO, again, nonpartisan, saying that's 
just not true; that that just won't happen.
  One of the other things that I think's important to remember, again, 
doing nothing costs, will cost you or your family next year $1,800 for 
a family of four, a $1,800 increase. And that is not just next year and 
then it ends. As people know, it keeps going.
  And so there's a business in my district, I was talking to the 
gentleman who owns the business. He happens to

[[Page 19626]]

be on both sides of the insurance industry. He's a provider, but he 
also has 150 people who he employs. And over the course of the last 5 
years, he's had an increase, aggregate increase of, I think, 42 percent 
in his health care costs for his company. And then he's on the provider 
side, so he gets paid by insurance companies, and with a 42 percent 
increase on health care for his folks, but yet, he got no increase for 
the services that he was providing to the insurance company.
  So you see again that we need reform in the system where you can't 
just continue to increase costs, not pay your provider, and deny 
coverage. And that was really one of the messages that was hammered 
home in our townhall--it wasn't a townhall, it was a roundtable that we 
had this weekend in Niles, Ohio, at Vernon's Cafe, that a lot of people 
are very, very concerned about this preexisting, being denied for a 
preexisting condition. And with all the money that we have in this 
system, for us, as a country, to say, Oh, no, you have cancer. You're 
on your own. You're not eligible for Medicare yet. You're not poor 
enough to be on Medicaid yet. And you've got to go out and try to get 
COBRA coverage or something else is completely outrageous and needs to 
be dealt with in this country.
  And I feel like this is a moral issue for our country, for people to 
have to have that level of suffering that is unnecessary. There's 
enough suffering already with the cancer or with the issues that, the 
health issues that people are dealing with. We don't need to add to it. 
There should be a level of security within the system that we know 
everybody will get taken care of.
  One of the issues that we have to deal with and tried to be helpful 
with, is this issue of cost. Now, this is a chart of our expenditures 
up to 2006. As you can see, the United States is in red. France, 
Canada, Germany and the United Kingdom are in a shade of blue. And this 
line here is life expectancy. So you can see that we're all pretty much 
in the same realm of life expectancy, give or take a year and a half, 2 
years, which, if it's you, that's a very important distinction. But on 
the average, we're pretty much around the late seventies, early 
eighties.
  And the cost, as you can see, of health care for Americans goes 
through the roof. Goes through the roof. So you can see how much we are 
paying per individual in 2006. It's close to almost $7,000 a person, 
when France is spending a little over $4,000 a person. And we all have 
the same life expectancy. What's wrong with this picture here? So, to 
say that we're going to let this continue, that for a family of four, 
$1,800 increase next year, $1,800 increase in 2011, another 18, these 
are compounding on top of one another. Play it out. We bankrupt the 
country.
  You want to talk about small businesses being innovative, being able 
to compete against China, India, and all of these other countries, 
which is a whole other issue, but we've got to make these folks cost-
competitive. And small businesses? A 129 percent increase for health 
insurance since 2000. Want to just keep going down that road? We know 
how it ends. It don't end pretty. We can just keep going.
  And that's what many people on the other side of the aisle want to 
do, they want to say ``no.'' They want to nitpick and make things up to 
try to put the kibosh on this because they know, as has been stated in 
a memo from a top Republican consultant, that if they destroy health 
care they knock the legs out and they kneecap President Obama. This is 
a political issue for some people, and it shouldn't be, because the 
people that I met with at Vernon's Cafe want change.
  An independent small business person was sitting right next to me, 
Neil. He had to close his lawn and garden business because he couldn't 
withstand the health care bills that he was getting. And he was 
supportive of Barack Obama's plan because he couldn't sustain his 
business. 129 percent increase since 2000? You want to talk about a tax 
increase on a small business? You know what? We're going to do it again 
next year. We're going to put more on next year, another couple of 
thousand next year per employee, another couple of thousand the next 
year and the next year and the next year as your energy costs go up, as 
your health care costs go up, as manufacturing continues to decline in 
the United States because we don't make anything anymore. On and on and 
on and on.
  And you know what? This is about leadership, Mr. Speaker. This is 
about leadership. And sometimes some people just aren't going to like 
you. And sometimes people are going to try to use and score political 
points to try to prevent progress from happening. We need to do 
something, Mr. Speaker. We need to do it for the people who are out 
there suffering. We need to do it for the people whose costs keep going 
up. We need to do it for small businesses who recognize that this can 
put them right out of business in every single way.
  These small businesses, I tell you, have really gotten the shaft in 
this whole health care deal. They don't have much bargaining power. And 
I think part of the magic of this approach that we've been working on 
and will continue to work on over the course of the next days and weeks 
is to allow small businesses who now have to go out into the market and 
try to find something on their own, will now be playing with millions 
of other people, and that ability to use the buying power, the 
partnerships through this exchange that's being created, will reduce 
costs for them.

                              {time}  2045

  I mean that's common sense. If you're a small business and if you 
have 10 people and if you've got to go to a major insurance company and 
try to strike some kind of deal because you want to provide health 
insurance for your employees, then you're on your own.
  What we're saying is let's pool everybody together and give you an 
opportunity to go into these different plans, but if you like the plan 
you've got, you can keep that, too, and that will help drive down costs 
for these small businesses. It will finally put them on a level playing 
field.
  So there has been a 129 percent increase for small businesses since 
2000. Their premiums are 18 percent higher for a small business than 
they are for a big business. So they get it on that end, too. The 
percent of premiums that deal with administrative costs are higher for 
small businesses--25 percent as opposed to 10 percent. Yes, it does 
make sense. They're a small business. This is a bigger business. There 
are going to be more administrative costs. Yet, if we allow them to 
join together, to pool together, then they will begin to reduce some of 
those costs.
  This is a winner for small businesses that are already covering their 
employees, because they're not going to see that 8, 9, 10, 12--
sometimes higher--percent increase. What's great about this plan is 
that there are limits. We've talked a bit about preexisting conditions. 
So you get into the plan, and you may be sick, and you may have cancer 
or heart disease or a variety of other illnesses. What this plan does 
is it limits and caps for catastrophic coverage. So, if you're an 
individual, you can't pay more than $5,000 a year for catastrophic 
coverage. If you're a family, the number now is about $10,000 a year 
for catastrophic coverage. That's still a lot of money, but the bottom 
line is it's not going to bankrupt most people.
  When you look at what is happening today in the United States, half 
of our bankruptcies, Mr. Speaker--half--are caused by health care, by a 
health care crisis. Imagine this: In 2009, in the United States of 
America, you could have a health care crisis in your family, and you 
might have to file bankruptcy. Is that incredible? Are we okay with 
that as a country? I'm not, and I think there are millions of other 
people who aren't either. This is a problem that we need to solve, to 
share together and say, hey, wait a minute. What are the values we have 
in this country? Liberty and freedom. You know, there are a lot of 
different phrases and words we have, but what do we really believe? Our 
actions and our policies should be in line with those values that we 
have. What we're saying is that that is unacceptable.
  So our friends on the other side, who had control of the House, of 
the Senate

[[Page 19627]]

and of the White House, didn't do anything about it. You want to take 
the small piecemeal steps? You could have taken that one. In fact, you 
passed a bankruptcy bill that made it worse. They passed a bankruptcy 
bill that made it worse. Fifty percent of bankruptcies are health care-
related. Unacceptable.
  If our friends on the other side found it necessary and found it in 
line with their values to end denial for insurance coverage due to 
preexisting conditions, it could have happened. They had control of the 
House. They had control of the Senate. They had control of the White 
House, but it didn't happen. So now we've got some Johnny-come-latelies 
with a piecemeal plan here or there which doesn't solve the overall 
problem. We've got to bend the cost curve here. We've got to bend it. 
You don't do that with piecemeal actions. You do that with bold actions 
that will help bend the cost curve. Ultimately, that's what we're 
trying to do here.
  Also, there is the preventative side here. There are no copays for 
prevention, so there will be an incentive for us to be assured that 
people will go to the greatest extent possible to get preventative 
care.
  Let me add this: We can only do so much with the system. People, 
average Americans, need to do a better job of keeping themselves 
healthy, too. It's not all us. The government is not going to do that. 
The insurance industry is not going to do that. Yet, if we tilt the 
system towards prevention, if we tilt the system to create incentives 
for it with doctors--and there is a component in here that gives more 
say to the doctors and to the patients to keep that relationship sacred 
between those two to make sure that the doctors get rewarded and paid 
based on quality, not quantity--then there will be an incentive in the 
system to make sure that our docs are able and willing to provide the 
most quality care, not having to worry about a variety of other issues. 
They will deal with the patient. It will be patient-centered.
  Barack was at the Cleveland Clinic, which is just about an hour north 
of my district in Cleveland. He was at the Mayo Clinic. You hear what 
these top hospitals do. Every time you hear what they're doing 
successfully, it's patient-based, not insurance-based. You know, it's 
not ``Some doctor has got to call somebody at the head office and ask, 
`Is it okay for me to do this for the patient? Is it paid for? Is it 
not paid for?''' That's ridiculous. We're going to weed that out of the 
system and let the doctor make these decisions, not the insurance 
companies.
  This brings me to another point--again to our friends and to right-
wing talk radio, you know, which is at this point pure entertainment 
because I find very few facts issued out of the right-wing talk radio 
station as of late. It's the issue of rationing. People are saying, 
``Oh, my God. This big, you know, socialist system is going to be in 
place.'' It's not true at all. This is not Canada. This is a blend of 
what works here in America to make sure that we can bend that cost 
curve. This is going to be very uniquely American, which it should be. 
It maintains competition. It gives choice. You can keep what you've 
got, but you also have these other options which you may want to 
choose, including a public option, which should be there, I think, to 
keep people honest as a component of this whole system. You're able to 
shop around and to get what you want or to keep what you have and have 
choice and help contain costs.
  What our friends keep saying is the government is going to come in 
and ration health care. If you don't think health care is being 
rationed right now, you have not talked to anybody who has been 
breathing for the last decade. The insurance companies are rationing 
health care right now. As a nurse said, who was at our town hall 
meeting this week, The government couldn't possibly ration more than 
the insurance companies are. We deal with it all the time.
  A person will call his Congressman or Congresswoman, and say, Hey, 
can you help me? My God, this insurance company denied me. I thought it 
was in my policy. They wouldn't let the doctor do this or that. They're 
not going to reimburse. They're not going to pay for this.
  The insurance companies are rationing right now. They've been hiring 
people to knock people off the rolls. Their employment has gone up. 
Their coverage has gone down because of rationing by insurance 
companies.
  What we're saying is you can't do things like deny someone coverage 
for a preexisting condition. There will be a basic plan. Ninety-five 
percent of employer plans right now already meet the standard for the 
basic level, but there will be a basic plan on which people will be 
covered.
  Ultimately, as I've said before, this is going to save us a lot of 
money, and it's going to help bend that cost curve. Ultimately, by 
doing that, which we fail to, I think, sometimes incorporate into this 
discussion, when you insure and assure people that they will have 
coverage and that they will have preventative coverage and that their 
kids will have coverage, there will be a level of anxiety that 
obviously goes away, which is very helpful.
  This is going to increase the level of productivity in the United 
States because people will be healthier. There is a tremendous 
investment here to make sure that our docs and our nurses have the 
proper incentives for student loans to go to high-risk areas and 
practice and make some money so that their loans don't keep them from, 
maybe, wanting to be helpful in a community that they want to be 
helpful in. We need to make sure that we deal with the nursing 
shortage. It's all of these things. It will increase the level of 
productivity that we have because we're going to have more people who 
are healthy who are participating in this economy and who are 
contributing.
  There was a story a couple of weeks back--I think it was in the Wall 
Street Journal--in which there was a kid--not a kid. He was probably in 
his twenties or early thirties. He wanted to go out and start his own 
business--I think it was a computer technology business--but he 
couldn't because the job that he held had insurance. His wife was sick 
with cancer, I think, but he knew, if he left and tried to get 
insurance for his wife, that she wouldn't be able to qualify because 
she would have had a preexisting condition.
  How many stories are like that all across the country where you want 
to leave and want to start a small business and want to create value 
and grow your business but can't because someone in your family may be 
sick? So you don't because you have to stay put. How many times does 
that happen?
  We have, really, the gem of Youngstown, Ohio. In the Mahoney Valley, 
we have the business incubator, the Youngstown business incubator--a 
great place. Our district office is actually located on the third floor 
of the business incubator. Last week or 2 weeks ago, Entrepreneur 
Magazine said that Youngstown, Ohio, was one of the top 10 places in 
the country to start a business. It was really cool. They had the 
cover. It read, ``Top 10 Places to Start a Business.'' In parentheses 
underneath, it read, ``Youngstown, Ohio, anyone?''
  So here we are in Youngstown, trying to convert our economy over from 
manufacturing steel and, just down the road in Akron, rubber. 
Communities like ours have started this incubator where we have all of 
these business-to-business software companies that are incredible 
companies as is the level of talent that works in this incubator. There 
are, I think, 300 people who work for the company. The average wage is 
$58,000 a year. Companies from around the country now want to move 
there.
  You can begin to see why we need to do this, because you want these 
young, bright, intelligent, creative people to feel like they can take 
a risk, can take a chance, can start a business without having to worry 
about the burden of health care. This is going to unleash a generation 
full of young, smart, creative people to get out in the marketplace and 
to create wealth for us and to hire people.

                              {time}  2100

  And especially with the green revolution coming, we're not really 
sure what's going to happen. There are so

[[Page 19628]]

many nuances to green technology with solar panels and windmills and 
biodiesel plants and batteries, and we don't know.
  But wouldn't you want, wouldn't it be smart to say, Don't worry about 
health care. You're going to have to pay some. This is not going to be 
a free ride. There is going to be shared responsibility here. 
Everyone's got to do their fair share. No one's going to get on board 
for free. There is going to be a ticket price here and everybody is 
going to have to pay something.
  But wouldn't you want these young people to feel secure to be able to 
create the next generation wealth? I know we need it. I know when 
you're looking at places in the Midwest like Youngstown, we need these 
young people to feel unleashed and let their creative juices flow as 
they come out of engineering schools and they want to take a chance and 
be in an incubator and grow a company or start a company. That's what 
we need here. This is what America needs right now.
  And we're trying to compete, Mr. Speaker, in the United States of 
America with 1.3 billion people in China, 1.2 billion or 1.3 billion 
people in India, and we only have 300 million people.
  So we're spending all this money on health care, and we're not 
getting anything out of it. Let's spend this wisely. Half of the money 
to pay for it gets squeezed out of the current system; $500 billion of 
the trillion gets squeezed out of the current system. And that's young 
people and the Youngstown business incubator and incubators like it all 
over the country and young people like them all over the country. Let's 
fuel that fire. Let's throw some coal on it. Let's get it nice and hot. 
Let's let it burn. Because we don't have the same luxury that the 
Chinese have where if 300 million or 400 million people fall off the 
side of a cliff, they still have got a lot of people to contribute. We 
don't have that luxury.
  So what we need to do is take the wealth that we have, invest it 
strategically in this country. And one of the biggest burdens for 
people to be creative and to start new businesses or for small 
businesses to grow is the cost of health care.
  So our friends on the other side who say they're pro-business are 
going to allow an $1,800 tax go on the backs of a family of four next 
year through inaction.
  There are acts of commission and acts of omission. And there are 
taxes of commission and taxes of omission. And through inaction, there 
will be an $1,800 tax put on the backs of families next year and small 
businesses next year. How can you say you're for small business 
development when your inaction allowed health care costs to balloon 129 
percent since the year 2000? That is strangling small businesses.
  Let's let them compete and pool their resources and get into the 
exchange, bend the cost curve. Let's have a uniquely American health 
care system. I mean, not what we got now. This is ridiculous. We're 
going to keep this system that we got? It stinks. It's not working. 
We're not okay with keeping it like it is. We want it to change. We 
want something different. We want it to work for the people. We want it 
to represent our values. We want it to unleash the creativity that the 
American people have.
  The artists in this country in many ways are small business people. 
They take risks. They take chances. They go out in the public and they 
sell their products. They make it happen. That's an art form, and it 
takes a lot of courage. Let's help them. Let's not sit and turn our 
head, bury our head in the sand and hope problems go away. That's not 
what the people voted for. They didn't vote for us to stand by and 
watch. We're not on the sidelines. We're players in this game. We're 
supposed to do things. And inaction--and you can argue, Mr. Speaker, 
they can continue to argue inaction. Keep the government out. Don't do 
this, don't do that. That's bad. That's bad. No, no, no, no. That's all 
we've been getting here, and the American people don't want it.
  We've got to go out and explain this to the American people. We've 
got people running around--they're so afraid of this happening, the 
only argument they think they have, which isn't even true, that oh my 
God, this is going to cover undocumented illegal immigrants. That's 
your health care debate in 2009 in America. That's what you're telling 
your small business people? That's what you're telling this country? We 
can't do it because it's going to cover illegal immigrants, when in 
section 246 it says, No Federal payment for undocumented aliens? That's 
all you got? That's it?
  2009 in the United States of America in Congress and on right-wing 
talk radio, all you've got is this is going to cover illegal 
immigrants, when it's not even in the bill?
  Come on. American people deserve better than that. This is not what 
they signed up for.
  Running ads. We've got politicians running ads about how this is 
going to cover illegal immigrants. What are you talking about? Stop it. 
American people don't want to hear that. I mean, it's continuing--it's 
very consistent with what President Bush started off fear-mongering to 
the American people: if we can't beat them, we scare people. If we 
can't beat them on the merits, we try to scare people. And it's just--
it's not right.
  And so over the course of the next few days, weeks and months, we're 
going to go out and we're going to talk to the Americans. But we want 
to hear what they think this is, what they want, their concerns.
  But I can guarantee you one thing right now. I can guarantee you one 
thing right now, Mr. Speaker, that there is not any level of fear that 
can come out of right-wing talk radio, that can come out of FOX News, 
that can come out of the Republican conference, that can come out of 
the Republican Senate conference, that can come from Karl Rove and Newt 
Gingrich and everyone else. There's not a level of fear that they could 
manufacture that will meet or be able to compete with the level of fear 
the American people feel under the current health care system. They 
can't meet it, and we are going to try to the best of our ability to 
alleviate that fear for the American people.
  And our friends on the other side have not produced an alternative 
plan.
  Now, as we're wrapping up here--and I'm almost done--but the 
Republicans have not produced an alternative. They have not produced a 
plan. Because their sole goal is to destroy this one.
  And so, Mr. Speaker, I think it's important that we continue to ask 
the American people to look at the facts, look at what's in the bill. 
If you have questions, that's legitimate. This is a big deal. We should 
have a conversation about this, about what's actually in here. What's 
the subsidy level? What are the tax rates? Who's getting taxed in this 
whole deal and who is not? Who's going to get coverage, and what level 
of subsidy are they going to get? What's Medicaid going to look like? 
What's Medicare going to look like?
  This bill, through the savings that we have here, fills the doughnut 
hole in Medicare. It fills the doughnut hole through the savings that 
we squeezed out of the system here. We filled the doughnut hole for the 
Medicare prescription drug bill so that seniors won't drop off after a 
certain level and not get covered again until their bill goes up to 
$5,000 or so a year. That's what we're doing here.
  So, Mr. Speaker, it's important that we all ask the American people 
during the course of this discussion to remember that our friends on 
the other side who had their opportunity for health care reform, had 
their opportunity for energy reform, controlled the House, Senate, 
White House, didn't do anything. Now they're coming to us saying that 
we're doing it wrong.
  But it's important to remember that their top Republican strategists 
issued a memorandum to the Republicans in the House of Representatives 
that they have to be against health care because if they defeat health 
care, they defeat Barack Obama and they bring him down.
  Now, when you're listening to the debate on the issues, when you hear 
unsubstantiated rumors, Mr. Speaker, it's important that the American 
people hear that and see that within the context of this memo in which 
the Republicans have been instructed to march

[[Page 19629]]

down the line of destroying Barack Obama's health care plan, you can 
keep the plan you have. You will have more choice. This will bend the 
cost curve, be uniquely American, save us money that we can reinvest so 
that our small businesses can compete.
  Doing nothing will continue the cost curve on small business up 129 
percent since the year 2000. If we do nothing, a family of four will 
see an $1,800 increase in their health care bill next year, if that. 
And if we do nothing, people will still be denied by insurance 
companies who will say to them, We won't cover you because you have 
cancer. We won't cover you because you have heart disease. Those days 
need to be over.
  And let's muster up the courage to communicate to the American 
people, to have a mature, adult discussion about health care in 2009 in 
the United States of America.
  Since when did Americans get afraid to do big things? This is what we 
do. We've built transcontinental railroads, we built the interstate 
highway system, we make sure we lift millions of seniors out of poverty 
with the Medicare program. We do civil rights. We do big things in 
America. And this is the next great challenge for us.
  And we've got to meet this challenge. Not for the sake of me going 
home and saying, hey, we met this challenge or Speaker Pelosi saying it 
or anyone else, but because this is what the American people want. This 
is what they want us to do.
  So the next few days and weeks are going to be talking about this 
quality, affordable health care, health insurance reform, and we're 
going to do this. This is going to happen, and this is going to be 
another landmark achievement in the history of the United States.

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