[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[House]
[Pages 21896-21904]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Mr. Speaker, it's a treat to be able to join you, Members 
of Congress, and those listening in tonight on a topic that has 
absorbed the attentions of our country, the topic of health care.
  This week, the President delivered a major address to the House, to 
the Senate and to the public about his health care plans. It was really 
a big debate. There was a lot of discussion, actually some heated kinds 
of words, some concerns about facts, and what was opinion and what was 
fact. All of these things have probably been inescapably in the news 
for many of us to observe. The big debate on the facts calls forth that 
old quip that everybody is entitled to their opinions, but there's one 
set of facts.
  What we're going to try to take a look at this evening are some of 
these different controversial areas and how you straighten this thing 
out and why there is controversy and why there is debate over what the 
facts are, even though people have their own opinions.
  So when we take a look at this--I apologize. Being an engineer, I may 
tend to make things a little complicated here. This is a chart of the 
Democrats' health care plan. If it seems like it's a little 
complicated, it's because it is a little bit complicated; and something 
as complicated as this, obviously, is going to make it a little 
difficult for people to sort out.
  What exactly are the facts? That's what we're going to be working on.
  I'm hoping to be joined by some of my colleagues who are experts in 
certain areas here of the health care plan, but I think just to start 
with: sometimes a picture is worth 1,000 words. This is a fairly 
complicated proposal by the House Democrats in their bill. Essentially, 
it is going to try to take over 18 percent of the U.S. economy, which 
is the entire health care sector, and put it under government 
management. Now, it doesn't do that immediately, but that's its net 
effect over a period of time. So, if there are some debates over facts 
and questions, it may not be surprising.
  Now, perhaps, when you take a look at a big government takeover of 
something in any particular area of our government, one of the things 
that you worry about is that it may become expensive and that your 
quality may go

[[Page 21897]]

downhill. There have been complaints sometimes about the Federal 
Emergency Act and about the FEMA people. There were concerns about 
their performance during Katrina. There were concerns about the 
performance of the post office relative to how much it cost. There were 
concerns about the CIA, about the kinds of numbers they gave us on Iraq 
before Gulf War I and Gulf War II. They got it wrong both times.
  I do yield to my good friend from Minnesota (Mr. Kline).
  Mr. KLINE of Minnesota. I thank the gentleman for yielding, and I 
very much appreciate his leadership and his taking the time to do this.
  I wonder if the gentleman would mind putting up that first chart, 
because it strikes me that it's a pretty complicated chart, as the 
gentleman said. I found that, when I was back in my home State of 
Minnesota and when I was traveling around, talking to groups, I used 
that chart a number of times.
  I want to point out that it was, indeed, prepared by the Republican 
staff, but there is nothing on that chart that isn't in the bill. That 
is a best-effort depiction to describe what this bill does.
  Mr. AKIN. If the gentleman would yield, if you're talking about a 
1,000-plus-page bill and if you're trying to put it on one chart, it's 
going to look a little complicated.
  I yield.
  Mr. KLINE of Minnesota. Exactly. Exactly. It is over a 1,000-page 
bill, and it is complicated. The reason I asked the gentleman to put it 
back up is that I've been struck by a number of proponents, the 
supporters of this bill, including, frankly, the President of the 
United States, who've said, Well, the public option is just a little 
slice. It's not everything. It's a little slice of this reform.
  So, one time, I tried to look at that and ask, Well, where is that 
little slice? Can I take the public option out of this, off that chart? 
Can I find that little slice?
  It turns out that you cannot find that. It is interwoven. There is a 
Bureau of Health Information; there is a Health Choices Administration 
and a Health Choices Commissioner. You can't just go and remove one of 
those little squares and say, Well, that's the public option, and we're 
left with a simpler bill of reform without this government-run option. 
It's an integral, woven part of that whole 1,100-page package.
  Mr. AKIN. It's like, if you had a rug and you took out all the 
threads going one way, the whole thing wouldn't make any sense almost.
  Mr. KLINE of Minnesota. Well said.
  Let me make one more point before you move on. I think you made 
another very important point.
  You said this is the Democrats' health plan.
  Mr. AKIN. Yes.
  Mr. KLINE of Minnesota. That's really too bad. There is not a drop of 
Republican ink on the 1,100-page bill. That bill moved through three 
committees in this body, in this House, and Republicans tried 
repeatedly to make amendments but without success. The amendments 
failed largely on a party-line vote. So we have a Democrats' bill.
  Mr. AKIN. Gentleman, I can't help but interrupt you there for a 
minute because I've heard it said repeatedly, and particularly by the 
President, that the Republicans don't have any alternatives or options. 
The fact is there are dozens of Republican bills, and none of them were 
put into any of this.
  Mr. KLINE of Minnesota. I thank the gentleman. That's an excellent 
point.
  It seems to me that we should not be at a point where we are 
competing the Democrats' 1,100-page bill with, presumably, the 
Republicans' 800-page bill, 900-page bill or 1,000-page bill. What we 
should do to get a bipartisan solution is take that whole 1,100 pages 
and push it off. We should set aside the bills that have been 
introduced, and we should sit down and see where Republicans and 
Democrats could actually agree on something.
  A Republican proposal we've discussed many times is allowing young 
people to stay on their parents' insurance until they're 25 years old. 
If you just did that one thing, if we sat down, Republicans and 
Democrats, and said we're going to push all this aside and we're going 
to push a reset button and we're going to agree on this one thing, you 
would take 7 million of the uninsured and they'd be insured. There are 
many things we could agree on, but not dealing with that.

                              {time}  1915

  Mr. AKIN. What you are suggesting, Gentleman, it's almost too 
commonsense for us to do. One of the ways that when we do create good 
legislation, usually there is a good consensus, and the minority and 
majority parties work together, they put stuff together and say, Well, 
this is the stuff we can agree to, this is the stuff other people can 
agree to, but together let's take a piece of the problem and solve it.
  Instead, what this is is an attempt to take--what is it, one-fifth of 
our economy--and federalize it. And that's a pretty ambitious step, 
even if everybody agreed, this will be an ambitious step. And in this 
case, not one Republican agrees and agrees in the House or Senate, from 
what I know. Even if they did, this would be very ambitious to try to 
rewrite 18 percent of the U.S. economy and federalize the whole thing. 
That's a pretty ambitious thing to do.
  Mr. KLINE of Minnesota. Well, let me pick up on this point of a 
bipartisan effort.
  I serve also on the Armed Services Committee, as the gentleman knows. 
You will recall that earlier this year, the chairman of the Armed 
Services Committee, the distinguished gentleman from Missouri (Mr. 
Skelton) and the then-ranking Republican member, the gentleman from New 
York (Mr. McHugh) said we ought to see if we can do something about the 
defense acquisitions system.
  Everybody knows that it is a mess. Hundreds of dollars for hammers, 
huge cost overruns. We need to fix that system.
  And, if you will recall, the approach was to get some Republicans and 
some Democrats to sit down. And our friend from New Jersey, Rob 
Andrews, was chosen to represent the Democrats and our friend, Mike 
Conaway, from Texas was chosen. They sat down together and they wrote 
legislation.
  Mr. AKIN. Actually solved some problems.
  Mr. KLINE of Minnesota. It actually solved some problems. You will 
recall when they finished they had a pretty good bill, experts agreed 
it would help, and it passed that committee unanimously.
  Mr. AKIN. Ran right through.
  Mr. KLINE of Minnesota. And it should, because that's the way to 
solve the problem. You cannot take behind closed doors, one party, go 
write a bill, an 1,100-page bill, at a cost that, oh, it depends on 
what given moment you are looking at it, but it's somewhere well over a 
trillion dollars, and present it and say, frankly, as the President 
did, Well, I am open to suggestions.
  Well, the best suggestion I would offer to the President and to my 
colleagues, the majority party here is, let's set that aside and sit 
down and see if there is something we can't agree on here.
  And don't do as the lady did, a wonderful lady when I was back in 
Minnesota said, Congressman, is there some piece of this that if you 
took it out, it would be okay. And it's back to your wonderful example 
of pulling the strings on a rug. Pretty soon it doesn't function at 
all. You can't reach in there and take out one little piece and say, 
Well, yes, I could support that if we just took out the Health Choices 
Administration.
  If you take the Health Choices Administration out, it collapses. 
That's important.
  Mr. AKIN. Gentleman, I would like to get to some of these questions 
that have come up, questions the President has raised, other people 
have raised, and take a look at them a little bit more carefully now 
that we have a little bit of time to say, What is the story? What are 
the real facts? Because you are entitled to your own opinion, but not 
to your own facts.

[[Page 21898]]

  So one of the first things you are going to think about is in our 
environment, is this health care proposal expensive or is it too 
expensive? Somebody once quipped that if you think health care is 
expensive now, just wait till it's free.
  So how do we take a look to assess how expensive it would be? You 
know, the President started his speech last week by saying, Hey, I 
inherited a trillion-dollar debt.
  And immediately, as a member of the other party, I thought, well, you 
inherited a trillion-dollar debt, but you are not doing too shabby 
yourself. Because if you look at the Wall Street bailout, half of that 
was under his leadership, that's $350 billion. You have got another 
$787 billion for this supposedly stimulus bill.
  You have got SCHIP, and then you have got, what was it, the 
appropriations bill. And then the huge bill that was passed, the cap-
and-tax bill in this House, that all adds up to $3.6 trillion.
  So I think it's reasonable to ask the question is this thing where 
the government takes over 18 percent of the economy going to be 
expensive? And he said it's going to be so efficient that we are not 
going to have any debt, and it's going to be fantastic and will hardly 
cost anything because we will take the money out of Medicare.
  And so with a bill that's sort of plastic, I mean, you have got a 
1,000-page bill, and people want to change it all the time. No one 
really--hasn't been finalized, all we have is the 1,000-page draft. How 
much do you assess how much it's going to cost?
  Well, one way to do it is, here is Medicare and here is Social 
Security and Medicaid, the three biggest entitlements we have got, and 
they are growing out of control. So what we are claiming is that this 
socialized medicine bill is not going to do what these other socialized 
medicine things did or particularly Medicare and Social Security.
  Now the liberals agree to these numbers. They are saying Yes, these 
things are growing out of control, but this proposal is not supposed 
to.
  Mr. KLINE of Minnesota. Well, if the gentleman would yield one more 
time, I hate to interrupt, but you have got a depiction there of the 
unfunded liabilities, how much more we expect to spend on those 
programs than we expect to bring in.
  And that goes out for a number of years, I see out there, 2008, 2052 
and so forth. And we do need to look out there, we do need to recognize 
those unfunded liabilities. We do need to address that.
  But you don't need to look that far. Right now, with the latest 
projections that have come out of the White House, taking the projected 
deficit spending, how much more we are going to spend than we are going 
to take in over the next 10 years, increasing that from $7 trillion to 
$9 trillion. Trillion dollars. It used to be hard to say that. But now, 
we just talk about trillions.
  Mr. AKIN. It was billions, now trillions.
  Mr. KLINE of Minnesota. Trillions now. If you just take the next 10 
years, the current debt, which is a staggering number in itself, it is 
approaching $12 trillion right now. The Secretary of the Treasury is 
asking us to lift the cap, the statutory cap on the debt, and you add 
the $9 trillion of projected deficits--I ask the gentleman, what does 
the number $21 trillion of national debt in the next 10 years do?
  And that's without counting the cap-and-trade bill which passed so 
early in the House and shouldn't have passed at all. It doesn't count 
this health care bill, which already we know, the Congressional Budget 
Office projected that the bill that's in front of us, H.R. 3200, almost 
$240 billion of deficit spending, and it doesn't count for the out 
years where the deficit runs over $60 billion. Yes, it's a staggering 
amount of money.
  Mr. AKIN. So there is a good reason for people to be saying ``hold 
on'' in terms of these Big Government solutions. We are just absolutely 
not spending our kids, but our grandchildren, into debt with these 
things.
  And I guess the question is, when you go from George Washington to 
George Bush, and you are running at, whatever it is, $5 trillion, and 
then you are going to add another 8 just under the Obama 
administration, doesn't that suggest that perhaps we need to kind of 
get off the accelerator of spending government money?
  Mr. KLINE of Minnesota. Absolutely, it does. And speaking of 
grandchildren, my wife and I are planning to travel down and spend a 
little time here in a week or two with the grandchildren. I have four 
wonderful grandchildren. I always say best grandchildren, but then I 
run up against somebody like the gentleman who actually thinks his 
grandchildren are the best.
  We are going down to visit them. I am thinking I should just get down 
on my knees and thank them, because they are going to pay all these 
bills, and it's just not right.
  Those numbers and that chart, I would say to the gentleman, are 
terrifying. And as I mentioned, when you bring it down much, much 
closer, 2019 on that chart is way over there towards----
  Mr. AKIN. That's something we will live to see, and our grandchildren 
will just be growing up enough.
  I would just like to stop on that point because I notice that the 
gentleman is probably a little younger than I am, but not too far 
distant. And you don't get to be a colonel by just being a--you can be 
a chicken, but not just a spring chicken.
  As we grew up our parents, sometimes called the Greatest Generation, 
they had it in their heart that they wanted to hand a better future to 
their children and to America than what they had been blessed with. And 
it seemed like it was one of these, just sort of a national virtue that 
that generation had the desire to personally sacrifice so you and I 
could do things like go to college or graduate school or do things that 
they had not had a chance to do.
  And somehow or other, this breaks my heart that we, in our generation 
that had been blessed by a selfless set of parents in that great 
generation are, instead, wanting to leave our children and 
grandchildren in a much worse fix than we found ourselves. Something 
about that seems almost un-American and intolerable to me.
  Gentleman, would you want to comment on that?
  Mr. KLINE of Minnesota. Well, I take your point. I am, of course, 
very proud of my parents, part of that Greatest Generation. My father 
landed in Normandy, fought his way across Europe and part of that 
world.
  Mr. AKIN. Dad, my father, was with Patton.
  Mr. KLINE of Minnesota. Well, they may have been together. My father 
was, as I said, he landed on Normandy, fought in the Battle of the 
Bulge. But they came back, and they did make sacrifices. But it has 
been, as the gentleman suggested, the American way for all generations 
before us that the next generation has been in better shape, if you 
will, been left in better condition.
  And it's not that certainly you and I and people in this room don't 
want things to be worse for our grandchildren, but if we are not 
careful about how we build this public policy, things are going to be 
worse. And I would argue, we have not been careful, that we are running 
a deficit this year alone that was unthinkable 6 months ago, 
unthinkable.
  And that national debt I mentioned, unimaginable that we could 
possibly consider the mess our grandchildren are going to be in.
  Mr. AKIN. The experience of other countries with nationalizing their 
health care, has that been an inexpensive experience? My understanding 
is it's about broke the budget of people that have tried to do this 
thing.
  I do know that Massachusetts tried it and Tennessee tried it. And the 
experience that they had was, it was expensive. Massachusetts' health 
care costs have gone up like a skyrocket and Tennessee, the doctors 
just about left the State. The Democrat governor that tried it as a 
trial project was followed by another Democrat governor who called it 
an unmitigated disaster.
  The head of Canada just declared their socialized medical system a 
complete mess and a disaster also and very expensive.

[[Page 21899]]


  Mr. KLINE of Minnesota. Minnesota--our neighbor to the north is, 
indeed, Canada. And I am very proud to say that Minnesota is a 
destination State for health care. We have one of the most famous 
hospitals, clinics in the world, the Mayo Clinic, in Rochester, 
Minnesota. And the thing about Canada is, if they can't get care in 
Canada, if they get tired of waiting in line, which they do wait in 
lines, and they are denied care, they come see us in Minnesota.
  So it's expensive in Canada. The gentleman's point is, it is, indeed, 
expensive. But I am arguing, worse than that, it doesn't work for many, 
many of our Canadian neighbors. They cannot afford to wait in those 
lines.
  Mr. AKIN. I was told by some Canadians it's the best health care 
system in the world as long as you are healthy.
  Mr. KLINE of Minnesota. And then if you are not, you come to 
Minnesota. So I take the gentleman's point.
  Mr. AKIN. Well, thank you very much, the gentleman from Minnesota, 
Congressman Kline. I appreciate your staying extra on the floor and 
helping us with it, a close look, try to take a look at some of the 
questions.
  The first thing that the President raised was the fact that he had 
inherited debt. And he also said that his health care plan was going to 
get rid of debt and was going to save money and would work really well 
financially.
  And the question then becomes, well, if that's the case, how come 
Medicare and Medicaid seem to be costing so much? If the government 
can't run those without running a huge deficit, what makes you think we 
could go further?
  Well that's one question, how much it costs, a lot of discussion on 
that. Another question is the question of bureaucratic rationing. I 
think a lot of Americans that do have health insurance have been 
frustrated by the fact that insurance companies sometimes tell you that 
you can or you can't get treatment. And we don't want people rationing 
health care who are in the insurance business. We want that to be a 
doctor-patient kind of question.
  And so one of the big concerns about when the government takes 
something over, the government will tell you what you can and can't get 
for a treatment.
  And so because there was concern on this issue, one of the ways to 
probe and to test a bill is, when it's in committee for people to be 
able to make amendments to the bill. This particular amendment, here, 
was offered by Congressman Gingrey from Georgia, who was a medical 
doctor.
  And the thing that I like about it, it's a very simple and 
straightforward statement of policy, and it says this: Nothing in this 
section, this is being added to the Democrats' health care bill, 
Nothing in this section shall be construed to allow any Federal 
employee or political appointee to dictate how a medical provider 
practices medicine.
  In other words, what this language is saying is the doctor-patient 
relationship is sacred. We want the doctor and the patient to make the 
medical decisions, and that's what this particular sentence was trying 
to enshrine into law in the middle of this bill.
  And so this amendment was offered in a way to kind of determine, 
really, where are we going with this health care debate. And this 
amendment was defeated on an almost straight party-line vote. The 
Democrats, with the exception of only one Democrat, voted that this 
language should not be in the bill. The Republicans, 100 percent said, 
the doctor-patient relationship should be sacrosanct.

                              {time}  1930

  So this is a place where, through an amendment in committee, we know 
what the plan for this bill is, and that is that there will be 
federally paid employees or bureaucrats telling you what kind of 
medical treatment that you can get. And this of course is what happens 
in Canada and England and all, so it's not a big surprise. But this 
amendment makes it very clear the difference in policy between the 
Democrat plan, which is that bureaucrats are going to determine what's 
a reasonable procedure for you to get, and it's not going to be based 
on the doctor and the patient. As a Republican, I don't like insurance 
companies butting in there. Even more so, I don't like the Federal 
Government.
  I am joined by a good congressional friend of mine, Congressman 
Bishop, and I would yield to him and ask his advice on this point also.
  Mr. BISHOP of Utah. I appreciate the gentleman from Missouri for 
yielding.
  Actually, if you would maybe get that next one, the chart you have on 
the back there about abortion, because I think it relates to the same 
issue.
  We oftentimes have a great deal of debate and discussion over what is 
or what is not in the bill. That's probably because there is not one 
bill. There are several bills floating out. What is in some places are 
there and what is not in some places are there. But I think one of the 
things to remember, because this is basically the same issue, the 
language the gentleman from Missouri just gave on Medicare and what it 
does as far as the practicing of medicine is something that was 
supposed to be in the Medicare bill when that was first produced 40 
years ago. It doesn't quite work that way because when you start down a 
road, you often find out you end up in a different situation than when 
you started down that path.
  When I was still teaching school, I often showed my students about 
the construction of the Berlin Wall. I was so amazed at the Berlin Wall 
as to, in fact, why the United States did nothing to stop the 
construction of the Berlin Wall. They had a great interview of Dean 
Rusk, who was Secretary of State at that time, who said that if you 
know at the end of the day you're not going to go down that path, you 
don't take the first step down that path.
  Many of the issues like the issue of will this actually fund abortion 
or not, will this actually deal with illegal immigrants or not----
  Mr. AKIN. If I could interrupt a second, what you're talking about is 
precisely what I wanted to get to tonight because what we've got is a 
debate over what the facts are, and you're bringing up the question of 
abortion, which is one of the debates. Here is the direct quote from 
our President. It says: ``And one more misunderstanding I want to clear 
up--under our plan, no Federal dollars will be used to fund abortions 
and Federal conscience laws will remain in place.'' This is what the 
President says. And now you've made the point that in committee an 
amendment was offered; is that right, gentleman? I just wanted to lay 
that groundwork because this is his statement. This is what the 
President says. Now, what's actually going on in committee, please?
  Mr. BISHOP of Utah. Well, this, unfortunately, was in my committee as 
well in which amendments were made to try to put a limitation on the 
abortion funding, as you can see the language that is up there. And 
once again, that was defeated. What it tells us is that what is in the 
bill is not necessarily the same thing as what will happen 5 and 10 and 
20 years down the road, because oftentimes what we're doing is not 
necessarily starting a program now but we are opening up the door. I'm 
mixing metaphors here. You're opening up a door that's going to take us 
down a path, and the question is where will that path end. Not today 
but where will it end in the future? And that's why sometimes people 
can have a difference of opinion, on not necessarily what is in the 
bill but what this bill provides the opportunity to do in the future. 
That is not in the status quo.
  We have, in this bill, many kinds of provisions in there that may not 
necessarily start a program now, but it gives the opportunity. We may 
have a program that right now is voluntary and it's established, but it 
easily could become fully funded and then mandatory.
  Mr. AKIN. What you're saying is something that you and I, gentleman, 
take for granted. We live in this world day in and day out, God help 
us, and in the political world we realize that when a bill is passed, 
there are armies of people that write the rules and regulations that 
flesh out what the bill will be. So the question then becomes does

[[Page 21900]]

this bill make it clear that we won't be using Federal taxpayer money 
to provide free abortions to people.
  Now, to me, this is a different question because I have always been 
pro-life, but to me, it's a different question than the question of 
abortion. It's a question of the fact that I have constituents who are 
violently pro-life, violently pro-choice, and they disagree on that 
point. But the question is are we going to compel all citizens to use 
their taxpayer dollars to fund abortions. And that's something very 
upsetting to many people. So the question is does this bill do that.
  Well, the bill doesn't specifically say anything, does it? So one of 
the ways to determine whether or not that's a future intent, that 
that's a little thing you're going to put in later, is to offer an 
amendment to make it clear just so that nobody will get upset about 
this issue, make the bill so that people can be more comfortable that 
there won't be any of this Federal money used for abortions. So when 
this amendment is put up, what happens? It gets voted down by a great 
majority of Democrats, right? So that leads you to the conclusion, 
well, they want to leave the door open for Federal funding for 
abortions with this bill. You can come to no other conclusion.
  Mr. BISHOP of Utah. If I could make just one more statement to the 
gentleman from Missouri because I know we are joined here by one of the 
most creative thinkers I think we have here on the floor, the gentleman 
from Arizona. And I think if I could add a segue here in some 
particular way, I agree with you. This presents all the warning clouds 
out there if we insist that the only solution is a government-
controlled, government-mandated solution.
  And what I think I would like to do in the few moments that I have is 
to make it very clear that this is not the only plan that is out there. 
There are other bills. The gentleman from Arizona has a bill. The 
gentleman from California (Mr. Issa) has a bill. The gentleman from 
Georgia (Mr. Price) has a bill. The gentleman from Wisconsin (Mr. Ryan) 
has a bill.
  Mr. AKIN. And the gentleman from Texas will shoot you if you don't 
mention his bill.
  Mr. BISHOP of Utah. He has one. Mr. Gohmert has a bill. And all of 
them are based on a different premise, and the premise is that what 
government should be doing is not telling people what they do and 
telling people what their choices may be but to try to open up the 
system so that people have options so that they can choose what they 
wish. And I think that's one of the things that is a fundamental 
difference in what we are talking about. And if we really want a 
bipartisan bill, those bills must be brought to the floor and allowed 
to be debated and voted on so we have a discussion on the philosophy of 
how we're going to solve this problem and if we truly desire to empower 
people or truly desire to empower the government.
  I yield back.
  Mr. AKIN. Reclaiming my time, I appreciate your joining us.
  Congressman Bishop is just a regular powerhouse here in Congress.
  We are very thankful for your district's sending you up here. Your 
background in teaching and making ideas straightforward and clear and 
being precise, that scholarly discipline is dreadfully needed at this 
hour, particularly when we start talking about these very nebulous 
kinds of nail-JELL-O-to-the-wall health care bills.
  I am also joined by a gentleman that I respect greatly. He has been a 
leader here in Congress and an innovative thinker, Congressman Shadegg 
from Arizona. I appreciate yielding to you.
  Let me just say, as we're getting started, though, because you have 
just come on the floor, what I have tried to do is to say, look, 
earlier last week when we talked about health care, the President came 
on this floor, debated and discussed, talked about what he wanted to do 
with health care, there was quite a lot of concern about what really 
the facts were. The President made a number of assertions, and what I 
was trying to do was to go back and forth and say here's the assertion 
and here's what we know about what the facts are and try to lay that 
out to make it clear.
  The President said, first of all, that the bill isn't going to cost 
hardly anything. It's going to save money. It won't put us in debt or 
anything. And yet we don't have too much to be confident about other 
than his tremendous optimism.
  The next thing that he was saying is that--one of the things he said 
was there are no abortions in this bill, and yet when an amendment was 
offered to make it so that there couldn't be any, that was voted down 
on this great party-line vote.
  So that is what we are trying to do is to say let's try to get to the 
heart of what some of these questions were, the costs, the abortion, 
the immigration, some of these different issues.
  I yield to my good friend from Arizona.
  Mr. SHADEGG. I thank the gentleman for yielding.
  I watched the gentlemen engage in this hour earlier and felt I ought 
to come down and try to add to it, perhaps bring a different 
perspective, articulate some of our concerns in a new way. I want to 
thank my colleague from Missouri for his efforts. I want to thank my 
colleague from Utah for both his compliment and his hard work on the 
issues we confront.
  I really want to hit two parts. Most importantly, I want to hit the 
final point that the gentleman from Utah hit, which is what should be 
the process for passing legislation of this significance to the Nation. 
And I think the gentleman from Utah had it right. It needs to be an 
open process. It needs to be an opportunity where everyone can surface 
their ideas, and there needs to be a dialogue. And, quite frankly, that 
has not happened. It just has not happened.
  The gentleman led off in his discussion on this point by listing all 
of the different bills. Paul Ryan of Wisconsin has a bill. Tom Price of 
Georgia has a bill. I have a bill. There are many, many Republican 
bills out there. And, shockingly, the media doesn't tell the American 
people that there are any Republican ideas out there, and yet there 
are. And I think the gentleman from Utah said it well. There really is 
a great philosophical divide on a part of this issue, but it's really 
just a part of this issue. There are subsets on which there's 
agreement.
  When we talk about where the divide is, I think the gentleman from 
Utah said it well, that the divide is between the notion which the 
President is advancing that the only way to fix the problems we have in 
health care today, and Republicans agree there are deep problems in the 
delivery of health care services today, but the Democrats and the 
President say the way to fix that is massive government intervention in 
and, quite frankly, taking control of the entire health care system and 
the entire health insurance industry.
  Mr. AKIN. Reclaiming my time for just a minute, if Lyndon Johnson, 
who noticed there were people who were hungry in America, took the same 
approach, he would have had the government take over all the farms and 
the grocery stores, wouldn't he?
  Mr. SHADEGG. And the grocery stores. No question about it. All the 
farms, all the grocery stores, you name it.
  Mr. AKIN. We would have considered that a little bit radical, 
wouldn't we?
  Mr. SHADEGG. I would have been offended, and I don't think it would 
have solved the problem.
  I want to make the point that the Republicans are being portrayed as 
being allies of the health insurance industry in this fight. Bunk. The 
President in his remarks the other evening talked about special 
interests. Some of the biggest special interests in this Nation have 
thrown in behind the President and are pushing this bill. The big 
insurance companies, they have signed on in support of this bill. 
There's one piece of it they don't like. They don't like the public 
plan. But by gosh, they like the idea of an individual mandate, which 
is an issue I think we ought to be discussing. And the big drug 
companies, the big drug companies are in this hook, line, and sinker, 
so much so that they spent $100 million or maybe more

[[Page 21901]]

over the August break advertising their support for the President's 
plan.
  But let's go back to the basics here. The President and the Democrats 
say the solution is massive government intervention. Republicans say, 
well, now, wait a minute. What is driving costs and what will bring 
costs down? And the gentleman from Utah said it correctly. The reality 
is cost is being driven, I would argue and most Republicans argue, 
because you and I don't have patient choice. We can't make the kind of 
decisions like we could in any other market to drive costs down by 
buying a product that is less expensive and provides better service.
  Mr. AKIN. In fact, we don't even know what the costs are.
  Mr. SHADEGG. We don't because the costs are hidden. Now, why are the 
costs hidden? The costs are hidden because the current structure says, 
if you get your health insurance from your employer, it's tax free. If 
you buy it yourself, then it's taxed. So the insurance industry never 
runs an advertisement trying to get the gentleman from Utah or the 
gentleman from Missouri or the gentleman from Arizona to buy an 
insurance policy from them. They don't have to advertise for our 
business. They know our employer picks our plan and the plan picks our 
doctor, and they don't much care about us.
  Compare that with the auto insurance industry. In the auto insurance 
industry, you leave this room right now or anybody watching this at 
this moment flips from this channel to a commercial channel and within 
seconds they will see an add for GEICO or Allstate. I saw an ad for 
Allstate not 3 minutes before I walked over here. Or State Farm. Now, 
why?

                              {time}  1945

  Mr. AKIN. Because they are selling the auto insurance to the consumer 
in a free market. And people who have the most basic, fundamental 
understanding of what the job of government should be, which is 
justice, which means people are equal before the law. And yet how can 
it be equal before the law when one guy gets insurance with pretax 
dollars, and the other poor guy has to pay with dollars after he has 
been taxed.
  Mr. SHADEGG. One of the biggest outrages, and I think it is immoral, 
is that this government says that the least among us, those in this 
society just barely getting by, working for an employer who can't 
afford to give them insurance, we say it would be responsible for you 
to buy health insurance, and we are so concerned about your well-being 
that we are going to smack you down and make you buy it with aftertax 
dollars, making it at least one-third more expensive.
  That is immoral and it is a policy of this Congress, and I don't see 
the Democrats proposing to equalize that tax treatment.
  Mr. AKIN. I yield to the gentleman from Utah (Mr. Bishop).
  Mr. BISHOP of Utah. I just wanted to give a simple illustration of 
what the gentleman is talking about in today's medical market.
  If you still want to get a nose job, plastic surgery, the cost is 
decreasing every year. Because there is no middleman and no insurance, 
you go and negotiate with the doctor. Lasik surgery does the same 
thing.
  That is why I would like the gentleman to talk about what could 
happen. There is a large pool of people who have a difficult time 
getting insurance. They are the so-called uninsurable. But what would 
happen to that pool of individuals out there who can't get insurance 
right now if, indeed, you allowed them to buy insurance with pretax 
dollars, not post-tax dollars, you allowed them to go across State 
lines to look for insurance, and you allowed them pooling opportunities 
to do that. What would happen to that pool of uninsurables which might 
then be able to be handled by 50 different States with coming up with 
programs to meet the demographics of those States. And once again we 
try to do this thing of simply empowering people to meet their own 
needs and solve their own problems. What would be the result of that?
  Mr. AKIN. I yield to the gentleman from Arizona (Mr. Shadegg).
  Mr. SHADEGG. I think the gentleman knows well that I have been 
arguing for a freer market, a free market for health insurance for a 
long time. I have proposed allowing people to buy policies offered in 
other States and to make those policies available in the State where 
they live.
  The President stood before us and said it is clear we need health 
care reform, and it is clear we need a government plan because, and he 
cited, I believe it was Mississippi, he said 75 percent of the 
insurance plans sold in Mississippi are sold by just five companies. 
His answer is one new government plan.
  My answer is let's let dozens of private insurance plans come into 
Mississippi and bring about real competition.
  Let me point out that just today there was development on that issue. 
Senator Baucus released his plan. Senator Baucus, I don't think he is a 
true friend of free markets, but Senator Baucus in a nod to this idea 
that has been out there, he included in his bill the notion of allowing 
cross-state health insurance sales, increasing competition so that 
somebody who lived in Utah might have 30 plans to pick from rather than 
five. Or somebody who lived in Arizona might have 100 plans to pick 
from rather than eight.
  Mr. AKIN. Reclaiming my time for a minute, the gentleman raised an 
interesting point. And I think the President made a stronger case, he 
said there is one State where there is one insurance player in the 
market. So his solution is what, so we are going to give you one 
insurance plan for the whole United States. Now that is an interesting 
way of looking at the problem.
  What you are suggesting, gentlemen, is that you take your insurance 
and sell it across State lines and what you are trying to address what 
I believe is a problem, that in some markets an insurance company can 
kind of corner the market and run the prices up.
  And so what you are talking about is free market competition so you 
can buy an insurance policy across State lines.
  Mr. SHADEGG. I wrote a number of years ago a bill that is loosely 
described as allowing people to buy an insurance policy across State 
lines. It really doesn't do that, but it does increase competition and 
make more policies available in a similar way.
  The idea came to us because some people living in New Jersey were 
discovering from friends and family members who lived just down the 
street in Pennsylvania that the cost for health insurance for a family 
in Pennsylvania was a fraction of the cost of that same policy in New 
Jersey. Same four-member family, four times, five times, even eight 
times as expensive.
  Mr. AKIN. So you have to move to a different house.
  Mr. SHADEGG. You have to move to a different house, so people were 
shopping with their feet, literally defrauding the insurance industry, 
perhaps understandably so, by saying their address was their brother-
in-law's address over in Pennsylvania.
  What I did was I wrote a bill that said you have to meet a financial 
standard for financial solvency and for appeals, and then you meet the 
standards of one State in terms of what you provide in the policy, and 
you can file that policy in all 50 States. And by the way, if you sell 
it in Missouri, then you are subjecting yourself to regulation by the 
Missouri insurance commissioner to protect the people in Missouri, and 
the Missouri courts to protect the people in Missouri.
  If you sell that policy in Utah, you do the same. But you write one 
policy and sell it in 50 States.
  Mr. AKIN. So you are maintaining the principle of federalism, the 
State insurance commissioner still controls and regulates the insurance 
in their State, but you allow that competition to take place.
  I suspect, practically speaking, if it were passed, your bill would 
have its most dramatic effect right near the border areas of the States 
because there you have a network of providers that people could go to, 
and I would think that is where the bill would be most effective.
  I yield to Congressman Bishop.

[[Page 21902]]


  Mr. BISHOP of Utah. If I could just add one philosophical problem, 
and once again this is one of the reasons why I think this debate is 
becoming so partisan and bitter, is because it is philosophical. That 
has happened repeatedly in the history of this country.
  Progressive era, great growth in the size of government. In the 
twenties, there was retrenchment on the side of individuals.
  New Deal: Government. Eisenhower, Kennedy: Individuals.
  Great society: Big Government.
  Reagan: Individuals.
  We are now in that time where this administration wants to move us to 
again grow the size of government. It is a philosophical debate more 
than just taking the original chart you had and moving this agency here 
and trying to do kind of those practical things that lend themselves to 
bipartisanship. It is a structure on whether we try to help people make 
choices for themselves or have government come up with a government 
plan, government standard that comes in here.
  This is once again where I believe the Founding Fathers, who had the 
idea of federalism, play a significant role.
  My State has a plan recently instituted for those who are truly 
uninsurable, but it is dedicated and devoted to the demographics of my 
State. Once we do what you are talking about of giving people options 
so they can form their own pools, buy across State lines, buy their own 
products pretax, you will shrink the number down so it can be 
affordable.
  The advantage of federalism is simply this: you can have greater 
creativity and greater justice applying to circumstances. And more 
importantly if a State fails, a program fails, you don't screw up the 
entire Nation, which will happen. That is what we need to do if we 
really are going to find better solutions.
  So I appreciate that, and I appreciate once again bringing to the 
floor that the idea presented by the Speaker and the President is not 
the only idea out there. There are other ideas and other options that 
have a different purpose, and that purpose is to empower and ennoble 
the individual.
  Mr. AKIN. I appreciate the gentleman from Utah getting perhaps 
philosophically to the heart of this debate. Really, the question is 
are we going to go down the path. And if you take a look, there was a 
nation that we knew very well back just a few years ago, and the nation 
had this basic operating philosophy: the government will provide you 
with an education. The government will provide you with a job. The 
government will provide you with a house. The government will provide 
you with health care. And we see our own country. And that nation was 
called the Soviet Union which is now in the dust bin of history.
  Now we see our Nation providing housing, providing food, providing 
education, and now we are talking about health care. Now, this is a 
little different speed, though, because before when someone was hungry, 
the proposal was give them a food stamp, which I am not sure was very 
efficient, but it wasn't to federalize every grocery store and every 
farm in America.
  This proposal that we are talking about is different. This is saying 
that we are going to step right in and the government is going to take 
over one-fifth of the U.S. economy, and that is a pretty tall step to 
take.
  Mr. SHADEGG. If the gentleman will yield, first of all, it is a tall 
step given the track record of the Nation. The track record is that the 
government does not do these functions very well.
  We had a vote here to bail out the pension fund for postal workers 
just a few days ago because we are in trouble there. We had a lot of 
demonstrated history of the ineptitude of the government in solving 
problems having to do with the hurricane that destroyed much of the 
southern portion of the country. The government didn't do it well.
  Mr. AKIN. So you have postal service and FEMA. Keep going.
  Mr. SHADEGG. The next one is we just did Cash for Clunkers, and we 
flat failed at that miserably. So the track record of government doing 
these things isn't very good.
  Mr. AKIN. Let's stay on the subject just a little more. Somebody 
talked about the compassion of the IRS. Do you want the compassion of 
the IRS in the health care system, or the efficiency of the post 
office?
  Mr. SHADEGG. How about the efficiency of Cash for Clunkers?
  Mr. AKIN. Here is one that really frosts me, and nobody has made a 
big deal about this.
  In Gulf War I, the CIA came to us and said the Iraqis are 10 or 15 
years away from building a nuclear device. We get in there, and they 
are a year and a half away. So they got it completely wrong.
  Then we go to Gulf War II and they say they are a year and a half 
away from building one, and we get in there and they are not even close 
to it. They have completely missed it both ways. And then you want to 
trust your body to these guys?
  Then let's talk about the efficiency of the Energy Department. Do you 
know why the Department of Energy was created?
  Mr. SHADEGG. To ensure energy independence.
  Mr. AKIN. To reduce our dependence on foreign oil, to ensure energy 
independence. And ever since they have been created, which way has the 
graph been going?
  Mr. SHADEGG. The other way.
  Mr. AKIN. We are joined by the gentleman from Colorado (Mr. Lamborn).
  Mr. LAMBORN. Thank you for letting me join in and contribute to this 
discussion tonight.
  If I remember right, President Obama in this very Chamber said we 
have problems with Medicaid and Medicare, and we have waste and abuse 
and fraud. That all may be true, but I don't think the solution is 
let's start a new trillion-dollar government health care program 
because we have problems in Medicare and Medicaid. I mean, if we have 
problems in Medicare and Medicaid, I don't see that is any excuse to 
start a new trillion-dollar health care program. So I have real 
problems with that.
  Representative Akin, let me back up and tell you what I observed in 
my town hall meetings in Colorado on health care. Just a few weeks ago, 
I had some interesting meetings where hundreds of people showed up. 
People were turned away by the hundreds. It was a really good exercise 
in democracy. I enjoyed hearing from both sides. In fact, admittedly, I 
heard more from those against the program, but I would ask those for 
the program to come forward and say what they had to say because I 
wanted to hear both sides and I wanted the audience to hear both sides 
and those watching in the media to hear both sides.
  Mr. AKIN. You were courageous to do that because there were a lot of 
people who tried to have town hall meetings and their constituents were 
not very happy about what has gone on down here in the last 6 months. 
You had at least a sense that you wanted to hear both people's opinion, 
both sides.
  Mr. LAMBORN. That's right. There was give and take, high passions on 
both sides. It was a little unruly at times. But overall it was very 
positive. I hear that a few of our colleagues, unfortunately, were sort 
of AWOL. They evaded having some of these meetings. They only did 
telephone meetings, which is good in and of itself but doesn't go far 
enough compared to a personal meeting. So some of our colleagues around 
the country, Representative Akin, maybe went as far as they could have.
  Mr. AKIN. We did a town hall, a lot on health care, and it was very 
interesting.
  Mr. LAMBORN. What I am seeing with the passion of those who are 
concerned about what this is going to do is not just that health care 
is an intensely personal issue for their mother or grandmother, their 
loved ones, their child. It is an intensely personal issue, but it goes 
beyond that. I know you know this, but I will just remind you, it also 
has to do with the recent takeovers we have had in the government. We 
have been taking over financial institutions and we have been taking 
over auto companies.
  Mr. AKIN. We fired the president of General Motors. I still can't get 
my

[[Page 21903]]

brain around that. The President of the United States fired the 
president of General Motors. I never thought I would see that.
  Mr. LAMBORN. Me neither in my wildest dreams. So it calls into 
question is this just another takeover.
  Mr. AKIN. Today we are taking over college loans. We are going to 
basically chase the privates out of that business.
  Mr. LAMBORN. That's exactly right. That is the wrong thing. Those who 
say they trust the government and yet here we are taking over these 
things, these huge areas of industry, they have a right to be 
concerned.
  But the third thing, Representative Akin, is the huge spending that 
is involved. We get estimates anywhere from $1.2 trillion to $3.5 
trillion. I think President Obama said $900 billion, which is just 
under a trillion. We have huge amounts that are going to be spent on 
this program, so we have big spending, without a doubt. We have 
takeover by the government within the last 7 months happening in area 
after area of our industry and society.

                              {time}  2000

  You add to that the personal involvement that we all have in our 
health care. You put all those together, it's a very combustible, 
volatile mix. And people around our country have every right to be 
concerned.
  Mr. AKIN. Reclaiming my time, Congressman Lamborn. I just hit 62, and 
I have become even more and more painfully aware of the fact that I 
have to live inside this body. And I think Americans feel that way.
  When you start talking about, Well, I got some government that's 
going to take over all of this and there's going to be somebody 
determining what kind of health care you get, that gets people's 
attention. Maybe they like the idea. But they want to know how is this 
going to work.
  I yield time.
  Mr. LAMBORN. That's a great point. So I think you probably observed 
what I saw--and tell me if you did or didn't. But people around this 
country have every right to be concerned. It's the big spending, it's 
the fact that government's taking over all these sectors of our 
economy, plus it's health care--the most intensely personal things that 
we work on.
  So we have a proposal before us--actually, several proposals. So I 
don't know what the President really means when he talks about ``my'' 
plan, because there's four or five different proposals floating around.
  Mr. AKIN. Except there is something that has been proposed by the 
Speaker of the House. It's her committees. And we have a bill number on 
it, and there have been amendments made to it. It's been dealt with in 
committee. He apparently wants the Democrats to vote for that Pelosi 
plan.
  So I think, you know, at least a reasonable person is thinking that 
the President wants the Democrats to advance the plan, which is the 
1,000-page bill which is being offered by the Speaker and the 
committees that are under her authority. That's what we were talking 
about tonight, because the President makes these assertions, and yet 
when you take a look at what's in the Pelosi plan, you start to see 
this disconnect between the two.
  I think a lot of Americans have gotten that personally involved in 
this that they have copies of the plan. They're starting to read it, 
and saying, The President is saying this, the plan is saying this, the 
President is saying this, the plan is saying that, and that's what I 
was trying to get at tonight.
  Here's an example. There are those who claim that our reform effort 
will insure illegal immigrants. This, too, is false. The reforms I'm 
proposing would not apply to those who are here illegally. So this is 
what the President says.
  If you go to the bill, the bill says this bill is not for illegal 
immigrants. Okay, that squares with what the President says. But, then, 
when you look more closely, you find out that in the enforcement 
section it says, basically, anybody can sign up for the deal.
  So there's no enforcement to put any teeth at all in this, which then 
makes you think, Wait a minute. What's the smoke and mirrors?
  And so there's different ways to test this. One is to offer an 
amendment. So the Republicans offered this amendment. In order to 
utilize the public health insurance option, an individual must have his 
or her eligibility determined and proved under the income and 
eligibility verification system. This is fancy language of saying 
you've got to be a U.S. citizen. You have to be here legally. And this, 
of course, is voted down on a straight party line vote. There were 
Republicans--15 voted yes. A total of 15. Twenty-six Democrats voted 
``no.''
  Now this basically would say that not only are we going to say, No, 
illegal immigrants can't get this, but we're also going to say, Before 
you get it, you've got to prove your eligibility, and they said ``no.''
  Now that leaves some level of confusion, but it clearly leaves the 
point that the Democrats did not want this amendment in their bill. So 
this is that disconnect where the President says one thing. And yet, 
when you start to look at the facts, you go, Oh, my goodness. What 
other way can you look at this?
  One of the things we did, there's a Congressional Research Service. 
We asked them, When you take a look at this bill, will illegal 
immigrants be able to take advantage of the bill? Now this is a body 
that's not Republican, not Democrat. They're just a bunch of scholars.
  Here's the quote from the Congressional Research Service, August 25, 
2009, just a couple of weeks ago. Under House Resolution 3200--that is 
Nancy Pelosi's health care bill--a health insurance exchange would 
begin operation in 2013 and would offer private plans alongside of a 
public option. H.R. 3200 does not contain any restrictions on 
noncitizens whether legally or illegally present or in the United 
States temporarily or permanently participating in the exchange. So 
these people are saying the same things.
  When our constituents read the bill--bless their heart to wade 
through all of this stuff--they're saying, It says there's no illegal 
immigrants. But in fact there's an amendment we offer to make it clear. 
The amendment is turned down on a party line vote, and there are no 
teeth in it at all.
  So there's this disconnect. And I think that's creating a lot of 
stress out there.
  I yield to my friend.
  Mr. LAMBORN. You've raised a really good point, Representative Akin, 
and I think you're right on that. And it's unfortunate that the 
President didn't really understand the ins and outs of the bill or 
hopefully he wouldn't have said that. So I think maybe he wasn't as 
familiar with the ins and outs and details as what you're explaining 
right now.
  Let me back up and point out another problem that a lot of people in 
my district are having with this plan. Eighty-five percent of Americans 
do have health insurance, and by and large it's not a perfect system, 
but they're largely satisfied with the health care that they have.
  And so we have a relatively small number--not just 15 percent. It's 
actually smaller than that. Because of that 15 percent, some of these 
people can't afford insurance. They're just paying bills as they go. 
They're self-insuring. Also, there are those who are qualified for 
existing programs so they don't really need a new program for them. So 
it may be 5 percent or less of Americans that actually need health 
care.
  So why are we revamping one-sixth of our Nation's economy, the entire 
health care system, for a small percentage--5 percent or less--of our 
population? The people in my district can't understand that.
  Mr. AKIN. I just have to stop you there, gentleman. I think you put 
your finger on probably one of the biggest question marks going here. 
This is such a straightforward question, but I think it needs to be 
repeated.
  What we're saying is that 80 percent, at least, of Americans have 
some kind of health insurance. Most of them are reasonably pleased with 
the health insurance and the doctors they have and the delivery 
systems. So you've got 80 percent of the people that are okay with it, 
and yet you're going to basically take all of that and change it in

[[Page 21904]]

order to take care of what, 5 or 10, depending whether you count 
illegals or whatever.
  Mr. LAMBORN. Will the gentleman yield?
  Mr. AKIN. Yes.
  Mr. LAMBORN. What it boils down to, if the problem is really those 
who are uninsured who cannot afford it, we have a lot more targeted and 
focused ways of meeting that small percentage rather than revamping our 
entire health care system.
  Mr. AKIN. I think you have brought an exceptionally important point. 
Unfortunately, our hour has just flown by. I would just like to thank 
my good friend, Congressman Lamborn, for his expertise and great 
leadership you've shown here on the floor. I thank my other colleagues 
for taking part in trying to get through some of these details.

                          ____________________