[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[House]
[Pages 24333-24340]
[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. Madam Speaker, thank you for this opportunity to once again 
take a look at some of the very significant questions that face our 
country this evening in this 1-hour. We're going to be taking a look at 
the subject of health care in America, something that has absorbed the 
attention of citizens and political leaders now for a number of months. 
Something that is, of course, important to every single one of us.
  We each have to live inside the bodies that we have, and how health 
care is run in this country is not only very important from a financial 
and economic and policy point of view; it's very personal because it's 
our bodies, after all.
  So what we're going to take a look at this evening once again is the 
question as to what are the reforms that should be made in American 
health care.
  Now, sometimes people when we deal with this want to say that 
everything is wrong; we need to just burn the entire barn down and 
start completely over. But of course people from foreign countries that 
have millions and millions of dollars come to America all the time as 
their choice for the best health care that they can buy anywhere in 
this planet.
  So, certainly, there are many good aspects to our health system even 
though it may need some reforms in some areas.
  What is being proposed here is not minor. In fact, that's one of the 
problems with the fact that legislation has not moved in months on the 
health care subject and that's because what was being attempted is to 
do a great, great deal. What's being attempted is the government, 
essentially over time, is going to take over 18 percent of the entire 
U.S. economy, that is, the government is going to run the health care 
system.
  Now, this is a rather bold proposal. When Lyndon Johnson discovered 
hunger as an issue, he didn't propose that the government was going to 
take over all of the grocery stories and farms and all of the trucking 
in between, but rather that he would propose food stamps. This, 
instead, is the idea the government is going to take over everything in 
medicine over a period of time.
  So the question is, is this a good thing. Does it really meet the 
problems, and what are the potential dangers of it.
  When the government does too much, we have seen a pattern in the past 
of things that happen. We have examples of England and Canada where the 
government is running their health care systems but also examples in 
our own country of government getting involved in things that it's not 
very well positioned to do. And we see some inefficient allocation of 
resources, excessive expenses, degraded quality, and bureaucratic 
rationing. All of these are part of what can happen if the government 
does too much.
  In fact, it led someone to quip, If you think health care is too 
expensive now, just wait until it's free.
  One of the things that happens when the government does too much is 
they tend to make things very complicated. This is a chart that we have 
that tries on one chart to summarize a 1,000-plus-page bill. All of 
these different groups--the heart, of course, is not really a czar, but 
it might as well be a czar. It's either a commi-czar--we're very, very 
fond of czars lately. And commi-czars are I guess a sort of a form of a 
czar, but it's telling everybody what they're going to do in health 
care.
  But this is an organization chart, and I've often thought we can 
almost turn this into a maze. And we can put the patients here and the 
doctors over there, and we can see and give people a crayon and do it 
as a doily, and they could see if they could get their patient over to 
the doctor. I am not sure whether it's possible to do that or not, but 
it would make a good maze.
  This is a good chart that we have trying to depict what happens when 
the government takes over 18 percent of our economy.
  Another aspect of that is an objection that the President has tried 
to respond to.
  He says, Here's what you need to know. First, I will not sign a plan 
that adds one dime to our deficits either now or in the future. Period. 
Boy, that's reassuring to have the President tell us that he's not 
going to sign a plan that adds one dime to our deficit either now or in 
the future. That's reassuring, if it were true.
  Well, this is what we've got going so far this year. We've got the 
Wall Street bailout, that's $350 billion; economic stimulus--I don't 
think it's really stimulus--but whatever it was, it was mostly just 
increasing government programs, $787 billion; SCHIP at $6.6 billion. 
Then there's the appropriations bills at $410 billion; and IMF bailout. 
And then you've got some taxes, also.
  So when you put it all together, we're talking about a total of $3.6 
trillion. I don't have a lot of confidence with this level of spending 
that this idea about one dime, he's not going to add one dime to the 
deficit when we've got $3.6 trillion that we've already done this year. 
Somehow this is not reassuring, this promise that he made.
  Most of this plan can be paid for by finding savings within the 
existing health care system, a system that is currently full of waste 
and abuse. Of course, our health care system--I don't know of anything 
in our budgets that say waste and abuse. So you can just delete a line 
that says waste and abuse all through it.
  But he says this will be paid for by savings within the existing 
health care system. Well, what is he talking about?
  Of course, what he's talking about is taking $500 billion out of 
Medicare. I don't know if that makes the older people in my district 
very happy to know that we're going to take all of this money out of 
Medicare to try to pay for the thing. In fact, what's the track records 
of these great big socialized programs? You've got Social Security, 
Medicare, and Medicaid; and if you take a look at the projected trend 
in these things, by the time you get up here to about 18 or 20 percent, 
you just can't raise taxes enough to pay for them.
  What this chart is saying is when you see the growth of Medicare, 
Medicaid, and Social Security, they will eventually absorb the entire 
Federal budget.
  So we've got Medicare and Medicaid, government-run socialized-type 
programs, and they're out of control economically.
  And so the President says, Well, don't worry, but this one is not 
even a dime. I don't know that that really helps a lot.
  I am joined by several good friends of mine, one I just found out is 
a Ph.D., and I didn't realize that we had a Ph.D. joining us.
  But I would yield the floor to the good doctor.

[[Page 24334]]


  Ms. FOXX. Well, I want to thank my colleague from Missouri. It's not 
important what credentials we have. I think it's important how we feel 
about serving the people that we serve, and so--if I have any accolades 
for myself, it's that I want to be known as a Member of Congress who 
cared for her constituents and worked hard to serve them. But thank you 
for your recognition.
  I just heard tonight on the news about a study that evidently came 
out last week that somehow or another I missed it. And it fits into 
what you're talking about there. I am not sure if you've heard about 
it.
  There's a GAO report that came out, I think September 29, and there 
was an article about it in USA Today: ``Millions in fraud and drug 
abuse clogs Medicaid.''
  Now, I know the President has said that he expects to fund a lot of 
the health care bill, the government takeover of health care with 
weeding out waste, fraud, and abuse; but that's never happened in any 
kind of government plan, as you say. We don't have a line item in the 
budget that says we're going to reclaim X amount of money from waste, 
fraud, and abuse and plug that into the system. Perhaps we should do 
that.

                              {time}  1930

  But if we have waste, fraud and abuse now, wouldn't it make sense for 
us to just go ahead and go after that?
  Let me tell you about that. It is a staggering study with staggering 
results. An audit of the government program Medicaid in five large 
States found 65,000 instances of beneficiaries improperly obtaining 
potentially addictive drugs at a cost of about $65 million during 2006 
and 2007, including thousands of prescriptions written for dead 
patients or by people posing as doctors.
  You know, we could save millions of dollars and we should be doing 
that whether there is any health care plan out there or not.
  Mr. AKIN. Congresswoman Foxx, how is it that dead people could be 
eating all of those narcotic drugs? That is kind of an interesting 
equation, isn't it?
  Ms. FOXX. Well, I think what is happening is you have people who are 
addicted to drugs, and they figure out ways to get prescriptions 
written. What they did, the GAO looked--well, the program for low 
income and disabled Americans, run jointly by States and the Federal 
Government, underwrote, get this figure, more than $23 billion in drug 
costs last year.
  Mr. AKIN. $23 billion in drug costs?
  Ms. FOXX. For drugs alone in the Medicaid program.
  Mr. AKIN. Drugs in the Medicaid program.
  Now, just sort of seeing where you are going, if you allow me, what 
this makes me think is that the government is running this program now. 
If the government is so efficient in running this program, what 
confidence does that give us that the government should take care of 
your personal and my personal health? Is that the direction you are 
going in?
  Ms. FOXX. Exactly. Here is a program that has been around since 1965, 
I believe I am right, and yet we have millions, potentially billions of 
dollars of fraud, and the government hasn't been able to figure out a 
way to collect that money or to stop it from happening. That is my 
concern. And it deals only with a rather small segment of our 
population. Here the government wants to run health care for everybody 
in this country. Imagine the kind of fraud that we are going to have, 
because there is no incentive when you have a government-run program to 
knock out fraud, waste, and abuse.
  People in the private sector, people either are punished or rewarded, 
depending on what direction they go in. That doesn't happen with a 
government-run program. This is just the tip of the iceberg.
  Mr. AKIN. If that happens in a short period of time, what happens 
when the program gets older and older and gets more encrusted with 
bureaucracy?
  We are joined here by Congressman Bishop who has shared with us some 
very good insights in the past.
  Mr. BISHOP of Utah. I thank the gentleman from Missouri very much.
  The gentlelady from North Carolina may be by her degree and education 
a good doctor. I at least directed and starred in the play a couple of 
times, if that helps. That is as close to ``The Good Doctor'' as I can 
get. And the way I did Neil Simon's play is not a pretty sight.
  Mr. Akin, I just want to add a couple of elements to this. I had a 
constituent who came into my office today talking about how the Senate 
intends to pay for this new health care plan to try to reduce it: by 
adding a fee on medical devices to try and raise $4 billion.
  Now I hate to say this, we all know that companies don't pay taxes. 
They pass on the fees. And I find this somewhat incredible that we are 
in a situation here, to pay for the Senate health care plan, we are 
going to add to the cost of those who will be using the Senate health 
care plan and somehow say that is not an additional cost to anybody.
  I find it difficult to figure out how this system has evolved into 
the way it is, but it seems very clear that we do not have a handle on 
what this will cost. We now are stretching and scratching and clinging 
for any kind of straw to try and give some reason to say this can work, 
when in reality we don't have a system involved that makes it work.
  Part of the reason it doesn't work is I think we have missed the 
focus of the problem and the issue. The issue is not insurance. The 
issue is the cost of health care. What we should be looking at, which 
is not allowed to be debated on this floor or in the Senate committees, 
is how to bring down cost of health care as opposed to how to make sure 
everyone has some kind of health care coverage.
  If you have insurance, the cost is still too much. We should be 
looking at a different approach than what we are doing, because we are 
playing game after game after game on this issue.
  Mr. AKIN. It strikes me, not dealing with tort reform, you can talk 
to any physician, that builds a lot of cost into medicine. Although the 
President made sort of a passing reference to it, there is no genuine 
interest in dealing with tort reform, which is something that 
Republicans do support.
  We are blessed with a couple of doctors here tonight. Dr. Price is 
also joining us. Let's talk a little bit about the cost of all of these 
things.
  Mr. PRICE of Georgia. Mr. Akin, I appreciate your leadership on this 
and always bringing truth to these issues on the floor of the House.
  As you mentioned, before I came to Congress, I practiced medicine. I 
was an orthopedic surgeon and took care of patients for over 20 years. 
One of the things that I recognize and certainly my patients recognize 
is that when the government gets involved in the practice of medicine, 
which is what they do when they stick their fingers in the pot, it 
confounds things.
  You had a chart up earlier on the machinations, the diagram of the 
plan. There it is. This chart is astounding to me. I have shared this 
with my town halls back home, any number of them, and what I ask folks 
to look for on that chart is not whether they can figure out all of the 
lines and boxes and squares and triangles, but I ask them to 
concentrate on the colors on the chart, because every single 
configuration on the chart is a new bureaucrat or new bureaucratic 
program.
  When they recognize that they say, Oh, my goodness, that is not what 
I want for my health care, because they know that already in place, 
either through the government or through the insurance companies, the 
bureaucrats make it incredibly difficult to get the kind of care that 
they desire.
  The good news is we don't have to move in that direction, and I know 
that we are going to talk about that some tonight, the solutions. There 
are positive solutions that put patients in charge. I appreciate you 
bringing that chart because it points out the increase in bureaucracy 
which will increase cost and decrease the quality of care, just that 
diagram right there.
  Mr. AKIN. Just thinking for a minute, you've grown up in the medical 
profession. I actually came out of engineering. I used to work for IBM

[[Page 24335]]

and some businesses, but I have also been a legislator for some number 
of years. One thing that we all experience as legislators, we have our 
constituents call us up and they have a problem and they want us to 
help them fix it.
  Now I am picturing to myself, on top of everything else we have got, 
now we have people calling us and saying, you know, my dad needs a hip 
replacement and he went to the government bureaucrat and the bureaucrat 
told him he is too old and he can't get his hip replacement. Also, my 
mother needs a heart bypass. And, Congressman, won't you go to bat with 
this bureaucracy and get them to give medical care to my relatives? And 
we are supposed to take a look at this mess and say somehow we are 
going to get past all of the rationing for health care and bureaucracy 
and are supposed to get people the medical care that they need. It is 
asking too much of people's Congressman. Anybody who sets this system 
up is just creating a complete disaster.
  Mr. PRICE of Georgia. I appreciate that point because we do. We get 
calls from our constituents all the time to help people work through 
the morass of government bureaucracy in whatever arena. I get calls 
about the passport office or the post office or the IRS when they have 
a challenge with them. We may talk about that in a moment. If you think 
about just the calls that you get on Medicare and Medicaid and the VA 
health system itself, and some of our colleagues on the Indian Health 
Services, it is astounding the challenges people have just to get 
through, the ability to be able to be seen by a doctor and get the kind 
of care that they want.
  What this administration apparently wants and the Speaker wants is to 
turn all of us over to a bureaucracy that would increase certainly the 
number of folks calling our offices and trying to work through that 
bureaucracy because they will never figure it out because that is not 
the role of government to help them figure that out.
  Mr. AKIN. The thing that scares me to death is my first experience as 
a State legislator was trying to get a left-turn signal put into a 
traffic light. Now, there was a lane marked in the pavement. They had a 
left arrow, but they didn't have a light that had a left arrow. That 
took me about 4 years and probably over 150 phone calls to the highway 
department to get them to put that little lens in there with a light 
that says left turn.
  I am thinking, if I have trouble with that, how in the world are we 
going to make something like this work. This is just bizarre. Then I 
start to think who in the world would have the faith to want to put 
this system together. Let's take a look at how well our current 
different departments are doing.
  You have the post office department known for its efficiency.
  Then you have an energy department. It was created with the purpose 
of making sure that we weren't dependent on foreign oil. Oh, that is 
helpful to know that.
  Then you have the people who took care of Hurricane Katrina and our 
emergency management services there.
  Then you have the education department. They set some records, too, 
because a study was done of the U.S. Education Department and the 
conclusion was, if a foreign power had done to America what the 
Department of Education had done, it would be considered an act of war.
  Then you have the CIA. Now, there is an interesting operation. In 
Gulf War I they tell us, well, Iraq is probably 10 years away from 
making a bomb. We get in there, they are 1 year away. Gulf War II they 
say they are 1 year away from making a bomb. We get in there and they 
are not doing it at all.
  So we have all of these agencies with a great track record, and now 
we are saying, yeah, so let's turn our health over to the Federal 
Government. I mean, this takes a lot more faith.
  I would yield to my good friend, Congresswoman Foxx.
  Ms. FOXX. Well, I think all of these issues that you and Dr. Price, 
and he is a real doctor, he is an orthopedic surgeon and we are really 
glad he is around, but all of these things that you have brought up are 
extraordinarily important. But we might need to bring up another one 
that is very important, and that is that the American people have 
become awakened as a result of this issue of health care. I think it is 
the best thing that has happened to our country perhaps since the 
founding. People are saying we want to know what is going on and we are 
voicing our concern. They want to read the bills, and they are incensed 
that the bills are not being put online and out there for them to read 
and for us to read.
  Mr. AKIN. Reclaiming my time, there may be some people here that have 
forgotten, but we took a vote saying that at least you should have a 
couple of days, especially on a thousand-page bill.
  We have heard all kinds of promises about transparency from Speaker 
Pelosi, and yet the bottom line is it is not transparent at all. We do 
not have a chance to read bills. The spectacular one was the 300 pages 
of amendments passed at 3 in the morning and brought out here, and we 
are debating and voting on a bill on the floor and there wasn't even a 
copy of the thing here in the Chamber. It is almost laughable it was so 
silly. And the American public was going, we don't have to be very 
sophisticated, but we would at least like you to read the bills.
  Ms. FOXX. Obviously the majority party hasn't learned any lessons 
because right now they have no bill in the Senate. They have been 
dealing with concepts.
  Mr. PRICE of Georgia. Wait a minute. Are you telling me that the 
Senate is about to vote on a health care bill and they don't even have 
a bill?
  Ms. FOXX. That's exactly right. They have no bill, and they are about 
to vote on it. They have even asked the CBO to score it, and the CBO 
has scored against an outline of what the Senate says it is dealing 
with.
  Mr. PRICE of Georgia. So the Congressional Budget Office is trying to 
figure out how much this is going to cost, and they don't even have the 
text of the bill before them to figure it out; is that correct?
  Ms. FOXX. That's exactly right. The American people should be up in 
arms.
  Mr. AKIN. Jumping in here, I didn't realize that the economists who 
can score outlines are so smart.

                              {time}  1945

  I don't even know how I'd start scoring an outline of a bill when you 
don't have anything that says--that's really an amazing--I wonder if 
the American public is going to be impressed with the fact that we're 
scoring an outline of a bill?
  Ms. FOXX. Well, I think the attitude of the people in the Senate is, 
we're smarter than the American public. We know better than the 
American public. That's really been the attitude of this entire 
Congress, and this administration, and that is, the American public 
doesn't need to read these bills. And, in fact, some Senators have said 
they're not smart enough to read them and understand them. I think even 
some House Members have said that. They don't expect them to read them 
and understand them.
  But what we need is the transparency that the American people were 
promised. In the elections in '06 and '08, they were promised by the 
people in charge of this Congress, and by the administration, that we 
wouldn't have these kinds of shenanigans anymore, that the bills would 
be out there, they'd be out there for 72 hours, even 5 days before 
they'd be voted on. I believe the President promised 5 days after a 
bill was passed--he wouldn't sign it until 5 days had passed. That's 
not happened on any significant legislation, maybe no legislation 
that's passed in this entire House. We have a real need to hold people 
accountable in this body.
  Mr. AKIN. Just reclaiming my time for a minute. You know, what has 
really encouraged me in the last 3 or 4 months is the American public 
is really engaged. They're starting to pay attention, and they're 
starting to make comparisons between claims and what the bill actually 
says, if they can get copies of it. Here's one. This is kind of an 
interesting deal. Again our President says, There are also those who 
claim that our reform effort will insure illegal immigrants. This too 
is false.

[[Page 24336]]

The reforms I'm proposing would not apply to those who are here 
illegally.
  So I mean, this is what's being said by the President, and yet the 
public is starting to say, wait just a minute.
  Ms. FOXX. Would the gentleman yield for just a moment?
  Mr. AKIN. I do yield, lady.
  Ms. FOXX. I see you have a wonderful chart here, and I want to say, 
isn't it true that the Republicans have put up on the Internet a 
section-by-section breakdown of H.R. 3200, so the public doesn't have 
to wonder are we telling the truth, is the President telling the truth? 
Are the Democrats telling the truth? They can go to the Internet or, in 
my case, I made these available to the libraries in my district. They 
can go read for themselves. Isn't that true?
  Mr. AKIN. That is correct. People are starting to cross-check 
Congress, and they know the bills better than some of the Congressmen 
that are proposing them. And that's exactly what's happened. One of the 
things, and I don't know if it's quite as easy to catch on the 
Internet, lady, would be also these amendments. This is the Heller 
amendment, which was on that very subject of illegal immigrants. What 
this says: In order to utilize the public health insurance option, an 
individual must have his or her eligibility determined and approved 
under the income and eligibility verification system. In other words, 
what this is saying is, before you come and can get this socialized 
medicine and everything and tap into that you, first of all, have to 
prove that you're a citizen.
  So this amendment was offered in committee and the amendment failed, 
which doesn't give us a whole lot of room for confidence that we're 
really serious about cracking down on illegals who are illegally taking 
money out of the health care system.
  Mr. PRICE of Georgia. Will the gentleman yield?
  Mr. AKIN. I do yield.
  Mr. PRICE of Georgia. Now, this is, again, a very interesting point. 
So the President is saying that none of the monies in this health care 
bill will go to cover medical treatment on a non-emergency basis for 
folks that are here illegally. That's what the President says, right?
  Mr. AKIN. That's what he said.
  Mr. PRICE of Georgia. And then we have an amendment proposed by Mr. 
Heller from Nevada in committee that outlines the process that you'd go 
through to be able to make certain that that wasn't the case, and the 
amendment failed. And as I see on your chart there, the vote was taken 
on July 16. Fifteen Republicans voted in favor of it; 26 Democrats 
voted no. So 26-15, it failed because the Democrats apparently don't 
believe that you need to have any process in place to determine whether 
somebody's here legally. That's the only conclusion I can draw.
  Mr. AKIN. That's correct. The bill has something in it that says 
well, illegals shouldn't access it, but there isn't any protection 
whatsoever in terms of the mechanics of the bill. So anybody who wants 
to can just walk right in and help themselves. And this amendment, I 
don't know if this amendment is available to the American public, but I 
think this pretty much says, you know, there's a huge difference 
between the two parties, first of all, and second of all, that this 
amendment really calls into question what the President is promising. 
And there's a whole series of other promises that we can talk about as 
well.
  Mr. PRICE of Georgia. If the gentleman will yield, there is a spot 
where folks can go to look at the amendments that were offered in 
committee. In fact, I think there were 57 or 58 of them that failed 
virtually along party lines. It's at the Republican Study Committee Web 
site if folks were interested in doing that, colleagues were interested 
in going to the Republican Study Committee Web site and looking up, and 
there's a document there that has all of the amendments that were 
offered on the Republican side of the aisle in the three committees of 
jurisdiction, and the vote that was taken, and in fact what it shows 
time after time after time, as the gentleman from Missouri so well 
knows, is that the statements that are made by the President and by 
Members of the folks in charge here, the Democrat party in charge, so 
oftentimes are at odds with the policy that they're putting in place.
  So they know what they want to tell their constituents, but in fact 
the policy that they put in place doesn't match what they're saying. 
And that's why I believe the American people have been so incredibly 
outraged over the past couple of months, because they don't see 
Congress doing what they say they're going to do or what they want them 
to do.
  Mr. AKIN. You know, gentleman, that's exactly right. And the thing 
that I find perhaps encouraging at least, maybe it's a bright side to a 
dark cloud, and that is that the public is becoming aware of what's 
going on, and the mainstream media is putting this out. The President 
is putting this stuff out. And yet, you take a look at the polling 
information and the public is starting to pick up on this. And they're 
realizing that what the media tells them and what the President tells 
them just isn't true, just isn't true.
  And as they start to read it, they start citing sections of the bill. 
And here's another one. This is perhaps--and I know we have a couple of 
doctors joining me on the floor here. If there's anything that as a 
patient is a big deal to me, if you want to boil health care down to 
one thing, I want the doctor and the patient to be making the 
decisions. As a Republican, I don't like it when insurance companies 
stick their big nose into that relationship. The only thing I could 
think of that's worse than that is some government bureaucrat sticking 
their big nose in that relationship.
  So here's another promise that the President has been saying, and 
this one too isn't true. First, if you're among the hundreds of 
millions of Americans who already have health insurance through your 
job, Medicare, Medicaid or VA, nothing in this plan will require you or 
your employer to change the coverage or the doctor you have. That's 
wonderful if it were true. But the trouble is, it ain't necessarily so, 
one more time.
  Here's the first. There's a Congressional Research Service. This is 
an unbiased--it's very professional people that we use, count on them. 
Hear what they say, okay: Under this bill, this is Pelosi's bill, under 
H.R. 3200, a health insurance exchange would begin operation in 2013, 
would offer a private plan alongside a public option. And it goes on to 
say, it does not contain any restrictions on noncitizens. Well, this is 
the one about legal or illegal immigrants.
  But here's another amendment that's along the same lines. This is Dr. 
Gingrey. Nothing in this section shall be construed to allow any 
Federal employee or political appointee, that means bureaucrat, to 
dictate how a medical provider practices medicine. This is the heart of 
what we believe in as Republicans, the doctor-patient relationship. 
This is an amendment offered. It says no bureaucrat's going to get in 
the way of your health care.
  Mr. PRICE of Georgia. Does the gentleman yield?
  Mr. AKIN. I do yield.
  Mr. PRICE of Georgia. This is a remarkably important amendment that 
was offered in committee because, as a physician, my patients would 
literally bristle at the knowledge that somebody was affecting what I 
could do for and with them. But this amendment, which was offered in 
committee, this is not conjecture. This actually happened. Was offered 
in committee. And it said that nothing in the bill would allow any 
Federal employee or political appointee, these are nonmedical people, 
to dictate, that's the language, to dictate how a medical provider 
practices medicine. And the vote, as I see there, was 23 Republican and 
one Democrat supported it, so that was 24. And 32 Democrats voted no, 
which tells me, the only conclusion I can reach from that is that the 
Democrats want Federal employees and bureaucrats to dictate to doctors 
how to practice medicine. That's the only conclusion I can draw.
  Mr. AKIN. You know, the thing that's scary to me about that is, the 
way the Federal Government's going to

[[Page 24337]]

go about that, they're going to start taking a look at your age and how 
much it costs and everything, and I'm getting to be kind of old. I 
mean, I just hit 62, and I'm not too encouraged by the idea of some 
bureaucrat saying, look you old geezer Akin, you can't have that hip 
replacement that you need. I've been talking to you, Doctor, about 
getting some help with that because I've been limping around. We have 
Dr. Burgess here, and I would just really appreciate it, as a medical 
doctor, if you could shed some light on the situation.
  Mr. BURGESS. I thank the gentleman for yielding. I thank him for 
putting this hour together this evening. I think it's terribly 
important. Rumor mill out there is that we will have this bill next 
week or the week after on the floor of the House. People do need to be 
paying attention to this. I am on one of the committees of 
jurisdiction, on the committee of Energy and Commerce. We had this bill 
in our committee for a couple of weeks in July. I thought that it would 
pass along party lines and the Democrats would vote this favorably out 
of committee. I thought we would have it on the House floor in the 
month of July, and I thought that the Democratic leadership would force 
this bill through passage again on a party line vote in July.
  It didn't happen that way. I think it's because they pushed the cap-
and-trade bill through at the end of June. Many Members went home and 
were startled by the reactions of their constituents and said, hey, 
maybe we'd better study about this a little bit before we just go ahead 
and pass it. As a consequence, we didn't pass the bill on the floor of 
the House, passed it out of the three committees, and then we hit 
August. And what happened in August was, the same sort of anxiety that 
we encountered in July after cap-and-trade came back big-time in the 
month of August. And little sleepy town halls that I would normally do 
in August that might command the attention of a dozen people, maybe 50 
people if there's something big going on, 2,000 people would show up. 
They wanted to look--
  Mr. AKIN. 2,000 people?
  Mr. BURGESS. On a hot Saturday morning in Denton, Texas, we had to 
call an audible and change it from inside to a parking lot location 
and, with no thought to my personal safety, I took my jacket off and my 
tie off, grabbed the microphone, stood under the hot sun and answered 
questions for an hour, 2 hours, about this bill that we had just 
passed.
  Now, I will admit that I had a little bit of an advantage being on 
the committee. I could hold a copy of the bill up, because I had a copy 
of the bill, and say that I can truthfully say I'm one of the Members 
of Congress who's voted no on this bill because we had it in committee, 
and that I will likely vote no every time it comes back again. And that 
seemed to be a reasonable approach for the people in my district.
  But I've got to tell you, I was astounded, I was stunned, coming back 
in September, after all this angst and anxiety we encountered during 
the month of August, and it was like it never happened. It was like the 
Democratic leadership assumed that the country was in some sort of 
fugue state in August and they weren't really serious about the 
opposition to this bill because we came back to committee in September. 
We had a few more amendments that they said we could consider after the 
fact and we did. Many of us brought up the fact that boy, August was a 
game-changer, and really the American people want us to be more serious 
about and more thoughtful about our approach to this bill.
  And the chairman of the committee said, no. We're not paying any 
attention to August. August didn't happen. It was a mirage, it was a 
heat-induced hallucination. It wasn't the American people speaking, it 
was made up.
  Mr. PRICE of Georgia. Will the gentleman yield?
  Mr. BURGESS. I'll be happy to yield on that point.
  Mr. PRICE of Georgia. I appreciate you bringing that up because I was 
so astounded as well by this incredible outpouring by the American 
people of their concern and fear about what their government was about 
to do to them. And then the President seemed to just dismiss it, didn't 
even recognize that it had happened, and the Members of Congress, 
including the Speaker of the House and others, seemed to be saying, 
don't pay any attention to that man behind the curtain. You know, it 
was like they didn't even acknowledge that, in fact, the American 
people were concerned, which is--I appreciate you saying that because 
it's one of the things that has further angered my constituents and the 
folks that I talk to across this land, who say, is anybody listening 
there? Is anybody paying attention?
  Mr. BURGESS. Reclaiming my time, if the gentleman will continue to 
yield, the fact is the American people do not trust us to do something 
this big. They look at this 1,000-page bill, they recognize that it 
will go to a Federal agency, the interpretation of those thousand pages 
will lead to 10,000 or 20,000 or 30,000 pages in the Federal Register, 
years of rulemaking, and years of rules that will be rained down upon a 
free society because of the actions taken on the floor of this House 
within the next couple of weeks.
  Mr. AKIN. Well, you know, gentlemen, a number of you have raised the 
point that there's a whole lot of Americans that are not very thrilled 
with this approach of government takeover of health care. But let's 
just think about it for a minute: Why it is that you had that reaction, 
2,000 people come out of nowhere, and they're all hotter than hornets 
about how this is lousy stuff, we don't want some bureaucrat rationing 
our health care.
  Let's talk about who might be against this bill. First of all, if 
you're an older guy like I am, you're going to be worried, because 
statistically you're at the point where they're saying it's not worth 
it for the government to pay for you to get your health care.

                              {time}  2000

  So if you're an older person, all they're going to give you is 
aspirin and some pain pills or something. And so if you're an older 
person--you're not going to like this--if you're an older person, 
you're probably also on Medicare. And you want $500 billion taken out 
of Medicare? I just don't think that's going to be very popular with 
some of our older voters.
  But let's say that you're a different person. Let's say that you have 
a small business. This bill is going to tax your small business a whole 
lot. You're saying, I'm already struggling. I'm barely making ends 
meet. We've got a lot of unemployment in America. If I had some money, 
I'd be able to add some new machines, get my small business going, and 
we could help the unemployment. But now you're going to tax me to death 
on a bunch of this socialized medicine. So the small businessman is not 
going to like it, the guy who is pro-life is not going to like this.
  I yield.
  Mr. BURGESS. I thank the gentleman for yielding, because that's a 
very good point. I had several roundtables with small business in my 
district over the summer. An 8 percent payroll tax will be the largest 
single tax ever levied upon small businesses in this country. Think 
about that for a minute. We just hit, what, 9.6, 9.7 national 
unemployment.
  Mr. AKIN. We've got unemployment that's just running away. The 
statistic almost everybody knows is that I think it's pretty close to 
79 percent of the jobs in America are with companies with 500 or fewer 
employees. So small business employs almost 80 percent of Americans. 
And what are we going to do? We're going to slam them with an 8 percent 
tax on top of things right now with unemployment already at 8 or 9 
percent.
  Mr. BURGESS. If the gentleman will further yield, all last month I 
heard from small business people either at home or who came up to 
Washington to see me. I heard from a lady who has a saddle 
manufacturing plant in Fort Worth; I heard from cardiologists; I heard 
from air-conditioner compressor remanufacturers in my district. I heard 
from literally butchers, bakers, and candlestick makers, all concerned, 
yeah, the economy may be doing a little bit better in north Texas. 
Yeah,

[[Page 24338]]

maybe those aren't wild leaves; maybe those are in fact green shoots.
  I said, Well, are you looking to expand business or add any jobs? No, 
I am not, because I don't know what you're doing to me in health care. 
I'm scared to death about what you're going to do with this energy 
bill. I haven't a clue what you might do with this financial service 
reregulation you're going to do, and it is too uncertain.
  When I look across the horizon, all I see is the abyss. I cannot 
possibly add a job in this environment that Congress is doing. Forget 
the economy; forget the worldwide situation. It is what Congress is 
doing; the uncertainty that Congress has now injected into the small 
business climate, small business environment.
  They are holding back on adding jobs in a climate where, otherwise, 
maybe if I could find a banker to loan me some money to do something, I 
might do it, but not if I'm going to face an 8 percent payroll tax, not 
if I'm going to have to pay more for my energy or, by the way, pay some 
sort of premium in a carbon offset somewhere at some point in the 
future. And, oh yeah, who knows what this financial regulation is going 
to do to me if I'm a financial planner.
  All kinds of businesses in my district, the multiplier effect of 
perhaps those one or two jobs in every small business spread out across 
my district, spread out across my State, spread out across the country; 
and is it any wonder that our unemployment rate is 9.7 percent?
  Mr. AKIN. The sad thing is that, to a large degree, we're doing it to 
ourselves with this kind of overkill legislation. This almost looks 
like somebody has got a solution looking for a problem to justify it.
  I notice that we're joined by my good friend, Congressman 
Fortenberry. I'd like to yield some time to you so you can be part of 
our discussion.
  I have to say that Congressman Fortenberry is highly respected. He is 
one of these level-headed kind of decent guys. Everybody likes him.
  You've got to have some people in your district talking to you about 
this. What are you hearing, Congressman?
  Mr. FORTENBERRY. Well, first of all, thank you for your comments, and 
it's a pleasure to join you this evening. I didn't have the benefit of 
the conversation in its fullness before joining you just a moment ago, 
but I would like to try to make a contribution to what you're saying, 
if you can yield a few minutes to me.
  Mr. AKIN. I yield. We're basically enjoying having a conversation 
here. A little bit like going to dinner with your Congressman, except 
the food, you have to provide that for yourself.
  Proceed, please
  Mr. FORTENBERRY. Thank you. I think, if I could reframe this for just 
a moment, I think there's a central question we should all be asking 
ourselves on both sides of the aisle, and including the administration: 
How do we actually strengthen health care in America? How do we answer 
a fundamental question as to reducing cost, improving health care for 
all Americans, and protecting vulnerable people?
  If you start to frame how we move forward on appropriate public 
policies that improve health care, reduce cost, and protect our 
vulnerable people, you begin to get actually underneath the reasons 
that we're in a circumstance now where you have a large section of 
America that is pretty happy with its health care, but generally 
unhappy with the rising cost. You have another section of America that 
has real problems with gaps of insurance coverage either because of 
preexisting conditions or loss of job and an inability to afford a 
product individually. That's a real problem.
  Then you have certain vulnerable populations who, frankly, end up in 
the emergency room a lot of times; whereas, if there were alternative 
methods of care, primarily for primary care, that would reduce that 
cost as well. So how do you begin to answer those questions, I think.
  One is--and I think there has been a certain bipartisan focus on 
this--and that's this positive in this overall debate--but it's the 
whole issue of health and wellness.
  Our total health care bill in this country is about $2.2 trillion. 
About 75 percent of that is actually due to the onset of chronic 
disease. A major portion of that could actually be prevented or better 
managed with significant cost reductions.
  For instance, some estimates suggest that 80 percent of 
cardiovascular disease could actually be prevented or better managed. 
Can you imagine the hundreds of billions of dollars that we could be 
saving if we had a cultural shift in the paradigm of health that looked 
at incentivizing both prevention and wellness? I will give you a few 
examples.
  In Nebraska, we have a rehabilitation hospital called Madonna Rehab 
Hospital, and we actually held a committee hearing, a public hearing in 
the field back home on putting the health back in health care. It was a 
subcommittee of the Agriculture Committee, which we held back in 
August.
  Madonna Rehabilitation Hospital's principal testified they have a 1.7 
percent increase in their annual health care bill over the last 5 
years. Incredibly low.
  Mr. AKIN. Only 1.7, gentleman? That's not very much increase. Most 
people's insurance jumps 20 percent a year.
  Mr. FORTENBERRY. Exactly right. They have a very aggressive, 
progressive health and wellness program where you're actually 
incentivized to watch your health, to take measures to actually engage 
in preventative care. The largest employer in Nebraska actually has a 
50 percent lower increase--it's still increasing--in their own health 
care cost because they aggressively incentivize prevention as well.
  A manufacturing entity in my hometown of Lincoln has a $5,000 per 
employee cost for their health insurance versus $8,000 dollars in the 
industry average because, again, a strong focus on health and wellness.
  Right now--and, Doc, you might want to add something--we tend to pay 
the medical establishment, the systems, to fix or cut or prescribe. And 
if we incentivize wellness for persons who are in insurance plans to 
actually have incentives to watch their own cost, perhaps through 
expansion of health savings accounts and other entities that allow for 
the creative opportunity for families and individuals to better control 
their own health care as well as companies paying directly for 
prevention, and then incentivizing the medical establishment to be paid 
or to be reimbursed basically for that type of care, you'll begin to 
get to one of the major cost drivers that has left us in this 
situation. Hundreds of billions of dollars could potentially be saved.
  Mr. AKIN. Gentleman, I really appreciate your approach of trying to 
solve problems. We have focused for some of our discussion this evening 
on the things that are wrong with basically having the government take 
the whole thing over and socialize it. But we have also been criticized 
by the President and others that the Republicans don't have any kind of 
solutions to health care, which you just showed was a tremendous amount 
of innovative and very kind of strategic thinking in terms of how do 
you approach this. I think maybe it would be worthwhile. Doctor, I ask 
you to join us, please.
  Let's just kind of tick off some things that--just think about our 
Republican colleagues and friends. I'm going to just toss out a few 
things that I would figure get at least 90 percent, probably 95 percent 
from our colleagues.
  One of them is that the big companies and employees of big companies 
get to pay for health care with pretax dollars, but the small business 
guy and the individual has to pay with after-tax dollars. I think most 
of us would say justice means that people are treated equally before 
the law, and that if we're going to allow people to buy their medical 
insurance with pretax dollars, that should be made available to 
everybody.
  Don't you think that we'd get a 95 percent on that, probably?
  Mr. FORTENBERRY. If I could speak, Doctor, real quick.
  Mr. BURGESS. I think on our side of the aisle, no question, you'd get 
95 percent. I can't speak for the whole House.

[[Page 24339]]


  Mr. AKIN. I'm not speaking for the whole House because they want the 
government to take things over, apparently. That's just one idea. I 
toss out another one.
  Mr. FORTENBERRY. You've made a very good point that there is an 
unequal tax treatment based upon your defined status in the Tax Code. 
And if you're an individual left out there on your own versus a 
multistate corporation, you have a different incentive, basically, 
based on the Tax Code structure. I agree with you, it's unfair.
  Mr. BURGESS. Further, a multistate corporation actually has the 
ability to deliver their health care product over State lines. 
Individuals in the individual market are prohibited from buying 
insurance across State lines.
  Mr. AKIN. Which therefore, Doctor, suggests?
  Mr. BURGESS. It would suggest when the President stands up before us 
and says there's a place in Alabama where there's only one insurance 
company--sure, insurance companies tend to form natural monopolies. But 
if you remove the barriers rather than adding another company for 
competition, which is a government-run option, why not remove the 
barriers and open it up to the 1,200 or 1,300 companies that might like 
to compete for that business in Alabama.
  Mr. AKIN. Fleshing that idea out a little bit, in the case of 
Missouri, where I'm from, you've got Kansas City; half of it's in 
Missouri and half of it's in Kansas. So if somebody in Missouri kind of 
goes over the line into Kansas and finds out, Hey, I can get a couple 
hundred bucks less a month on the same health policy, why can't I buy 
that policy from an insurance company in Kansas?
  So what you're saying is, Yeah, that's okay. Allow people to shop for 
insurance across lines, which then reduces the monopoly problem in the 
insurance industry. That's something that don't you think most 
Republicans would support that idea?
  Mr. BURGESS. The real tragedy in this debate is we've never really 
explored those types of ideas. Maybe it doesn't need to be throughout 
the entire United States. Maybe there could be regions. Maybe there can 
be reciprocity between States that make that agreement. But we've never 
even explored that.
  One of the things that really concerns a lot of people when they look 
at this bill is you get 10 years of taxes and 6 years of benefits. 
Remember, none of these good things that are going to come people's way 
and lift the burden of health care off their shoulders, none of them 
happen until after the next Presidential election.
  Part of that is to keep the score low on the Congressional Budget 
Office; part of that is because, again, it's going to take a long time 
to set up those programs. We don't even have an administrator at the 
Centers for Medicare and Medicaid Services right now. And that's the 
individual who's going to be charged with setting up many of these 
programs.
  So, in the meantime, we do need to do something to cover those 
individuals with preexisting conditions, those individuals who get a 
tough medical diagnosis, their insurance is rescinded from them. 
Nothing is more offensive to Americans than to think that someone has 
played by the rules, written that check every month, they get a tough 
diagnosis and the insurance company finds a reason to drop them.
  If there's been outright fraud in purchasing the policy, maybe so. 
But in so many of those cases it is really iffy why those policies are 
dropped. We could fix that.
  Mr. AKIN. Which, again, gets to another Republican proposal for 
portability. I mean, you know something isn't right with the way 
insurance is written when somebody does all the right things. They run 
for a number of years, they buy insurance, and all of a sudden their 
kid gets sick with juvenile diabetes or something very expensive. Then 
they changes jobs or something and now they're uninsurable. They fall 
through the cracks.
  That's not the way the system should work. That would be a very 
admirable thing if the House were to just focus on fixing that problem. 
That would be very good work. No, we have to scrap everything. We've 
got a hundred million Americans with insurance policies and doctors and 
doctor-patient relationships, a hundred million of them, and we're 
going to scrap the whole thing and have the government take it over. 
That's irrational.

                              {time}  2015

  Mr. BURGESS. But even the President himself said here the other night 
when he addressed the joint session of Congress, because these programs 
won't be up and running quickly, maybe we should take the John McCain 
idea of the high-risk pools, the reinsurance and get people some 
immediate help now.
  I would submit to you that if we would work a little harder on that, 
it may not be necessary to go the full strength of the government 
program. Why do we have to fix a program that is arguably working well 
for 60, 70, 80 percent of the population? Why do we have to change it 
for everyone to capture those 8 to 10 million people who get caught in 
that cycle of having a preexisting condition?
  I yield to my friend from Nebraska.
  Mr. FORTENBERRY. This is well stated, doctor, that the injustice of a 
person who has wrongly had their insurance rescinded has to be 
addressed by this body, another clear point of bipartisan agreement. 
Persons who have preexisting conditions through no fault of their own 
and are caught in a cycle of not being able to find insurance for the 
type of problem that they're dealing with is another point of real 
unfairness that I think you could find appropriate solutions for in a 
bipartisan way and fix.
  It leads to my second point that we really ought to focus on creative 
new risk pools for insurance affordability and innovation as well as 
increased access for people out there.
  I got a letter from Affiliated Foods in Norfolk, Nebraska, the other 
day. They are a cooperative. Now in Texas, Missouri and Nebraska we are 
used to the concept of cooperatives. That's where we leverage our 
buying power to get agriculture inputs a lot less expensively and sell 
our grain a lot of times. This is a cooperative grocer who basically 
uses their group buying power to provide the products for mom-and-pop 
grocery stores throughout rural Nebraska and other States. They used to 
be able to buy their insurance through that cooperative, but because of 
the change of the law a few years ago, they can no longer do so. So it 
leaves the small business entrepreneur out in the rural community who 
is struggling to make it, to have to go out on the very expensive 
individual or small business market instead of using the group buying 
power.
  Now this is a legitimate business. It is a group of people who have 
bought into a business plan and have ownership in it. They are 
stakeholders. They're going to be appropriately capitalized. There's no 
reason that they shouldn't be allowed to use that entity as a creative 
form of association to leverage group buying power to provide more 
affordable insurance for themselves.
  Mr. AKIN. So what you're talking about now, just to kind of summarize 
what we have talked about, what you're talking about is what people 
call in this business associated health plans, the idea that people can 
create these pools and buy, on a discount rate, their health care. 
That's a pretty straightforward idea. That's something that Republicans 
have voted for dozens of times. So we have got associated health plans. 
We're saying people should have their tax treatment and when they buy 
health insurance should be the same. We're going to deal with the issue 
of portability so that when you own a policy you get to keep it and the 
insurance company can't just dump you.
  The other thing we haven't, of course, talked about is tort reform 
which we have good support for that. That drives health care costs 
tremendously. And yet we are unwilling to really be serious about it. 
All of these ideas Republicans are supportive of. So the charge that 
we're not willing to deal with this debate is not true.

[[Page 24340]]

  Go ahead, my friend.
  Mr. FORTENBERRY. There's another option out there that we should 
actually have a creative policy discussion about in a bipartisan way 
which the good doctor just mentioned as well, high-risk pools is 
another option you have to insure or have the government basically 
subsidizing a market that does not exist for people who are priced out 
of because of preexisting conditions or other affordability problems, 
normal market rates through their business, through their individual 
policy. You could look at the expansion of those opportunities. We have 
a fairly good one in Nebraska. It's argued that it's a bit expensive 
for folks, but that's another way that the government, again, could use 
public dollars to ensure that people are adequately covered and pay 
normal rates or provide a reinsurance mechanism, and then as the doctor 
was saying, you will have gone a long way toward resolving the real 
difficult problems that exist for about 10 million Americans in 
providing affordable, good coverage. You'd probably have a bipartisan 
winner on your hands.
  If I could add one more point, there are certain other options, maybe 
this is a little more controversial, but I think it's worth exploring, 
in terms of basic public health expansions like community health 
centers, where you actually help persons who are in more vulnerable 
situations avoid ending up in the emergency room for primary care 
treatment.
  A combination of this, a focus on health and wellness incentives, new 
insurance risk pools for affordable innovative options and protecting 
those who are, because of preexisting conditions or other problems, 
priced out of those markets with perhaps other types of high-risk pool 
entities combined with other public health initiatives like that, you 
would have answered the question I posed initially: How do we improve 
the health of all America, reduce costs, particularly for families and 
small businesses, and protect vulnerable persons? We could all applaud 
and have a big bipartisan agreement and have accomplished, I think, 
what the people have sent us here to do.
  Mr. AKIN. Except instead what we've had is apparently our Speaker has 
pulled together various people, ignored the recommendations that we had 
and decided, well, we just know what's best, that is the government is 
going to run it all, we want this public option, and we're charging 
down this aisle.
  Basically people are wondering, well, why is this health care thing 
stalled? Well, the reason it's stalled is you don't just take over 18 
percent of the economy, take $500 billion out of Medicare, basically 
allow a program which is going to allow public funding for abortion and 
illegal immigrants getting access to this money and all that stuff 
without people having something to say about it.
  Mr. BURGESS. And if I may, the taxes and fees that are added on top 
of medical devices and insurance policies in order to pay for these 
programs are going to drift down to the middle class. There is no way 
to avoid taxing the middle class or putting a fee schedule on the 
middle class with the structure that has been proposed by the Senate 
Finance Committee.
  With the gentleman's indulgence, I would just make a point that if 
people are interested in this debate, healthcaucus.org has documented 
the debate that has gone on since January and February of this year. I 
would just further like to point out, we do hear the complaint that 
Republicans have not been involved or engaged in this process. I met 
with the transition team in November and offered my assistance. I was 
never called back. I met with the chairman of my Committee on Energy 
and Commerce in January and never received a call back. I submitted 50 
amendments to our bill in committee and had several of them accepted 
toward the end.
  Republicans do have ideas. They are reasonable ideas. They deserved a 
fair hearing and a fair airing in committee. Unfortunately we were 
denied that opportunity, because as the gentleman correctly points out, 
as the deputy President has said, ``Never let a good crisis go to 
waste.'' They were determined to use this economic crisis to expand the 
reach and grasp of the Federal Government in health care.
  Here is the reality: If the President had really wanted to do this, 
they could have done it in February when the Presidential approval 
rating was near 80 percent. No one would have been able to stop him. It 
could have been signed into law before the month was over.
  Mr. AKIN. I would like to thank my good friend, Congressman Burgess 
and also Congressman Fortenberry. Thank you very much.

                          ____________________