[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[House]
[Pages 24716-24722]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       COST OF HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Perriello). Under the Speaker's 
announced policy of January 6, 2009, the gentleman from Iowa (Mr. King) 
is recognized for the time remaining until midnight.
  Mr. KING of Iowa. Mr. Speaker, I appreciate being recognized to be 
able to address you here on the floor of the

[[Page 24717]]

House of Representatives and raise some of these issues that are so 
important and critical to the American people.
  As I have listened to the last hour, I can't help but bring myself to 
comment a little bit on that delivery, and I would speak to the last 50 
minutes or so of it specifically, that is, that we are a great Nation 
because we have understood the principles that motivate the American 
people to come forward and do the right thing and to take personal 
responsibility and be productive and to negotiate for a good value for 
their health insurance dollar and to manage their health in a way and 
set up a system so that they are rewarded for high responsibility and 
that there is a penalty there for a low level of responsibility.

                              {time}  2310

  Some of us, in fact a lot of us on this side of the aisle, have laid 
out data set after data set that shows what motivates the American 
people to do the right thing, and also provided the disincentives, 
described the disincentives when people don't do the right thing.
  It never ceases to amaze me how the other side of the aisle seems to 
want to focus on anecdotes, not facts, and we can reflect back upon the 
immigration subcommittee where we had hearing after hearing, witness 
after witness, anecdote after anecdote.
  Mr. Speaker, even in the perfect model of Utopia, there will always 
be an individual that slips through a crack, whether we can imagine 
what it was beforehand or not. We can always take that individual's 
story and use it and say, this illuminates the whole.
  The gentleman from Colorado has now delivered about 50 or 55 minutes 
of individual case after individual case, and I am sure every one of us 
in our district have dozens and hundreds of those kinds of cases. But 
as I have listened to this last hour, I have heard not one statistic, 
not one piece of data, nothing based on empirical information that one 
should be able to take and establish a national policy off of.
  Surely, as a nation, we are not the kind of people that listen to an 
anecdote and knee-jerk our way towards a national policy, believing 
somehow that if we can solve the problem of this individual, we can 
solve the problem of the whole. We do that with data, we do that with 
statistics, we do it with facts, and we do it with good, sound judgment 
that illuminates the facts that lie underneath those data points.
  But as I mentioned, in that immigration subcommittee, it went on for 
weeks of hearings, introducing study after study, data after data, and 
always calling for, where are your studies on the other side? Show me 
the data.
  Finally there was a report that was introduced into the Record. And 
as the Chair asked unanimous consent to introduce the report into the 
Record, I thought, finally, finally I am going to get my hands on a 
report. I am going to understand how they do an analysis and how they 
look at the data and how they come to a conclusion, because we come to 
opposite conclusions quite often. On the critical issues we always come 
to opposite conclusions. So I want to see the data.
  I got my hands on the data. This report that was introduced into the 
Record as a response to my call for ``show me your report, show me your 
study, show me your data,'' when I got my hands on it, it wasn't a 
report at all. It was simply a critique that was written of a report 
that I had introduced into the Record some weeks earlier. That was what 
substituted for facts.
  Now, here we have 50 to 55 minutes of individual anecdotes, sad as 
they may be. But there may well be other solutions, and there may be 
more people hurt off of this, rather than less people hurt, if we adopt 
the policy that is advocated by the President of the United States and 
by the gentleman from Colorado.
  So, Mr. Speaker, I do have some data, but I also first would like to 
lay a little backdrop of what we are talking about here, the health 
care reform debate.
  This is a little bit of the history of the health care reform debate. 
This is lifted out of the archives of the New York Times from back in 
1993-94. It is a replica of the chart that I had on my construction 
office wall for some years, by the way, and this is a chart that scared 
the living daylights out of me.
  When I saw the government that was created by HillaryCare, we called 
it then, this is what scared the Senate and the House of 
Representatives off of a national health care act, creating all these 
new government programs. Just a look at the chart. You didn't have to 
study it, although I did study it, to understand how big of an impact 
it would have on our economy.
  Now, this economy, maybe 14.5 percent of our GDP is spent on health 
care. It might be higher than that. But this black-and-white chart, Mr. 
Speaker, is relatively mild, although this black-and-white chart, 
HillaryCare, is a complete government takeover of our health care 
system.
  This, Mr. Speaker, is a gradual complete takeover of our health care 
system in the United States. This lays out all of these new agencies 
and departments, all of those in color. Those in white are existing. 
Those in color are created by H.R. 3200, the House's version of the 
bill. It is scary in and of itself.
  The focus I would bring on this, Mr. Speaker, is here to the private 
insurers. The President has said we need more competition, more 
competition for the 1,300 health insurance companies in the United 
States; more competition for the 100,000, and that is this box here, 
different varieties of policies one can purchase here in the United 
States.
  Why would we need more competition if we had 1,300 companies and 
100,000 policy varieties, unless you happened to just believe that the 
Federal Government should be running things? If that is the case, you 
would put them in the business to compete against them, and we would 
have in theory 1,301 health insurance companies and 100,000 and who 
knows how many policies.
  But truthfully, these two white boxes, the insurance companies that 
exist, the health insurance policies that exist, they would have to 
qualify. They would have a 5-year period of time, according to the 
bill, in order to qualify for the new qualified health benefits plans 
that would be established. And the rules that would be written for an 
insurance company to qualify and for their policies to qualify, it 
would be written right here in this box, in the health choices 
administration by the health choices commissioner, who would set the 
new rules for all of these policies and companies.
  And these policies and companies, all of them would not qualify. The 
companies wouldn't all qualify, the policies would not all qualify. If 
they did, there would be no reason to have the regulator write the new 
set of rules.
  So we do have an individual who has really driven this issue of how 
we set up competition between the health insurance companies, and that 
is to allow the American people to buy health insurance across State 
lines. I just have to thank and congratulate John Shadegg for being the 
driver of that idea and that issue for several years here in the House 
of Representatives.
  He is with us tonight, and I would be glad to yield to the leader of 
the Shadegg bill, I call it, to sell insurance across State lines and 
set up competition in that fashion, in the Federalist model of States 
competing against States from the private-sector perspective, the 
gentleman from Arizona, John Shadegg.
  Mr. SHADEGG. I thank the gentleman for yielding and I appreciate that 
compliment. It is kind of exciting to know that more and more people 
here in America are discussing the idea of selling or making available 
insurance across State lines, because that would be competition, real 
competition, and would drive down the cost of health insurance for all 
Americans.
  Indeed, we have a study that shows that literally millions of 
additional Americans could afford health insurance without the 
expenditure of a dime of public money if you allowed policies to be 
sold across State lines. Unfortunately, the current Congress doesn't 
seem to be interested in that idea, and we were not able to get it 
through

[[Page 24718]]

when the Republicans were in power. But maybe that idea's time is 
coming.
  I do note that the White House and the President have both talked 
about the lack of competition in the individual market. Indeed, in this 
very Chamber the President talked about how, I believe he said in 
Mississippi, 75 percent of the policies are sold by only five 
companies, and I think he said in Alabama, 95 percent of the health 
insurance policies, and I think that had to have been in the individual 
market, though the President didn't say it, are sold by just five 
companies. That kind of narrow competition does not bring down costs, 
and, as the gentleman indicated, allowing the sale of health insurance 
across State lines would do that.
  My bill actually doesn't allow the sale of health insurance across 
State lines. What it says is, you can file a policy in one State, have 
it qualify with the laws of that State, then file it and sell it in all 
49 other States. It means you could bring a policy to the market in all 
50 States for a fraction of what it costs today, but it also means that 
you could pick a State with a modest level of so-called mandates or 
benefit mandates, perhaps a State that didn't mandate for a hair 
prosthesis or a State that didn't mandate aroma therapy or a State that 
didn't mandate some other esoteric type of treatment. And, of course, 
every mandate adds to the cost of the policy.
  So I thank the gentleman for referring to that. I appreciate the 
charts he has put up in front of the people.
  I really want to get a dialogue going about the shocking, and I mean 
shocking things that have developed on health care just in the last 
four or five days.

                              {time}  2320

  And let me just mention those three or four items briefly, and then 
maybe we can get a dialogue going and talk back and forth about them.
  First, we had the CBO score of the Baucus bill. Wow. Our colleagues 
on the other side of the aisle, Democrats in the Senate were high-
fiving each other. Oh, my gosh. They had a score of only $829 billion. 
I wonder if the gentleman realizes that the CBO scored that bill 
counting 10 years of revenue from the taxes but only 7 years of 
expenditures? Under the Baucus bill, taxes start in 2010; expenditures 
for the program costs don't begin till 2013. So when CBO scored, it 
scored it for 10 years, beginning in 2010, ending in 2020. They counted 
10 years of revenues, 7 years of outlay. I went home to my wife and 
said, even the Shadegg family budget would look good, even the Shadegg 
family budget would look good if we could count 10 years of my salary 
and her salary or our income and only 7 years of our family outlays. 
That's scandal number one. They get better.
  Scandal number two, we discovered that Harry Reid, Harry Reid, 
majority leader of the United States Senate, found out that under this 
bill, because the cost of Medicaid is going to be increased 
dramatically, the size of the Medicaid program's going to be increased 
dramatically, that the burden paid by the individual States would go up 
quite significantly, including on Nevada. As it turns out, Harry Reid's 
up for reelection this year and he says, whoa, whoa, whoa. As your 
Senate leader, I can't be hurting the State of Nevada. So he got an 
exemption. Interestingly, not an exemption for all 50 States. No 
exemption, for example, for Iowa where the gentleman's from. No 
exemption for the State of Arizona where I'm from. He got an exemption 
for Nevada and three other States--Oregon, Rhode Island and Michigan--
under which the Federal Government will pay the State's share of 
Medicaid, if this bill passes, for the next 5 years. Just a little perk 
for a powerful United States Senator like Harry Reid.
  You know, it occurs to me, and I'll go through these other scandals 
very quickly, but what we're really getting here is we're not just 
getting single-payer care. We're getting full-on Russian gulag, Soviet-
style gulag health care, because under these plans it won't matter so 
much that you live in America. It will matter whether you live in the 
State that's represented by a powerful Senator or perhaps a powerful 
Congressman, because we just learned Harry Reid has just protected the 
people of Nevada and three other States from having to pay their share 
of the Medicaid expenses.
  But wait, as they say in the advertising world, there is more, 
because, as you know, the funding mechanism in the Baucus bill says 
we're going to impose a surcharge, a surcharge on very expensive gold-
plated health care plans. Got to tax those expensive health care plans. 
Well, Chuck Schumer, little Chuckie Schumer of New York, United States 
Senator, said, wait, that surcharge might apply to my constituents in 
New York. I can't have that.
  So Senator Schumer, in the give-and-take of politics in America, if 
we're going to have political health care, by gosh we're going to have 
really political health care. He said, no, no, no. We'll allow that 
surcharge, which is a 40 percent tax on policies that cost over 21,000. 
We'll allow that to be the law in Kentucky or in Arizona or in Iowa, 
where the gentleman's from, but no, no, no, not in New York. In New 
York, we won't let the surcharge kick in until the policy costs 
$24,000. And in Massachusetts, it won't kick in until the policy costs 
$25,000. So, if you're lucky enough to live in the State where you have 
a powerful Senator, like Chuck Schumer, you can get it so that your 
luxury tax won't kick in until your policy costs $24,000 or $25,000, 
unlike the poor sap who lives in Arizona or Iowa or Kentucky where the 
luxury tax kicks in at $21,000.
  Ladies and gentlemen of America, you want political health care? You 
want politicians in charge of health care? By gosh, you're going to get 
it, because that is politics American style. It is as corrupt as it can 
get, where politicians like Harry Reid, powerful, can protect their 
State, Chuck Schumer, powerful, can protect their constituents. But as 
they say in the marketing business, but wait, there is more, because 
our famous United States Senator from New Jersey, Senator Bob Menendez, 
that wasn't good enough for him.
  Bob Menendez represents a State where there's a lot of health care, a 
lot of health care drug companies that manufacture pharmaceuticals. 
Senator Menendez, they wanted his vote. He negotiated a deal. He got a 
$1 billion tax credit into this bill, into the Baucus bill, for 
investments in drug research and development. By all means, let's 
protect New Jersey because Bob Menendez's vote is needed. But wait. 
There is more, because in the political world of political health care, 
if we're going to politicize health care, if we're going to give the 
politicians control of our health care from border to border, coast to 
shining coast, or sea to shining sea, by gosh, that isn't enough.
  So Debbie Stabenow of Michigan and John Kerry of Massachusetts said, 
you know, this health care could be really expensive and we have lots 
of union workers in our States, in Michigan and in Massachusetts. 
Debbie Stabenow, John Kerry, they've got just a small little piece in 
the bill, you know, we're going to play a little politics with health 
care, why not play a little politics. They got--they make Bob Menendez 
look like a piker. They got 5 billion, count them, $5 billion into the 
bill to defray the cost of medical care for union workers.
  Now, if you happen to be a right-to-work State like Arizona where we 
don't have many union workers, well, that's just too bad. You don't get 
the benefit of that $5 billion. But if you're a union worker, Debbie 
Stabenow and John Kerry are making sure that those poor saps in Iowa 
that aren't union members and those poor saps in Arizona who aren't 
union members get to chip in an extra $5 billion for the union members 
in Michigan and Massachusetts.
  Not to be outdone, Mark Udall of Colorado, he comes in and says, 
well, this may be round one where we negotiate amongst the members of 
the committee that the bill's going through right now, but trust me, if 
Harry Reid has gotten a provision in there saying that Nevada doesn't 
have to pay the State share of Medicaid, by God, I, Mark Udall, am 
going to fight for the

[[Page 24719]]

same provision for my State of Colorado.
  So there you have it, ladies and gentlemen. Don't believe me. This, 
all of what I've just recited for you, comes from the Wall Street 
Journal, an article called States of Personal Privilege by Kimberly 
Strassel. It appeared in last Friday's Wall Street Journal. You can 
Google it. You can pick up the phone and call Kim Strassel. You can ask 
her about Soviet-style gulag health care in America, where powerful 
politicians protect their constituents. But if we're going to have 
socialized medicine, if we're going to have government-run--the Hillary 
Clinton was an overnight takeover of health care by the government. The 
current version, ObamaCare, is a gradual takeover.
  Trust me, the minute you take power away from the people and give it 
to Washington politicians, you get real sweet deals. Powerful Harry 
Reid protects Nevada. Powerful Chuck Schumer protects New York. 
Powerful Bob Menendez protects New Jersey. Powerful Debbie Stabenow and 
John Kerry protect Michigan and Massachusetts, and at least Mark Udall, 
kind of a pup in all of this, little bit young, not seasoned and 
powerful yet, he's going to try to protect the people of Colorado.
  Political health care, here we come. What you pay for health care in 
America once this bill is law won't depend so much on the bill as on 
whether or not you've got a powerful United States Senator or a poor 
sap United States Senator who can't pull the levers of power and get 
done what you want. And I guess I'm just interested in what the 
gentleman from Iowa thinks about these lovely little scandals that are 
going on.
  And oh, by the way, these are the politics they're playing while 
there's sunshine. Imagine when this bill gets kind of behind the smoke 
screen rooms and the President's new health care czar is implementing 
the policies that make that chart possible. And I'd be interested in 
the gentleman's reaction.

                              {time}  2330

  Mr. KING of Iowa. Reclaiming my time, I am astonished to a 
significant degree here at the depth of this, and I didn't catch that 
article coming into it over the weekend, so this unfolds as new news to 
me, at least in the composite. Some of the pieces I picked up.
  It is breathtaking in its scope when you add up the billions of 
dollars, the audacity. The President likes to use the term 
``audacity'': The Audacity of Hope. How about the audacity of political 
health care, the patronage that comes with this?
  Mr. SHADEGG. Hey, the audacity of power. Harry Reid can do it because 
he's Harry Reid. And if that's too bad for the people of 46 other 
States because they get to subsidize the people who live in Harry 
Reid's State, I guess Harry Reid's answer is, That's just too bad.
  Mr. KING of Iowa. I pull this back and I look at item number one, the 
CBO scoring the bill in 7 years of expenses in 10 years of revenue in 
order to get it to turn out so it doesn't violate the President's 
pledge; and I am wondering if these carve-outs that come for these 
powerful Senators like Harry Reid and others when they're carved out 
from their Medicaid costs so that the Federal Government will have to 
pick up the tab for the Medicaid increases that come with the bill, and 
I am wondering if those increases are scored against this bill. I am 
going to suspect they're not because we're only scoring on concepts.
  Mr. SHADEGG. I think maybe your suspicion is correct.
  But I can tell you this much: If you and I started a small business 
and we decided we'd do a stock offering and we presented a portfolio to 
our potential investors and said, Here's a picture of what our company 
is going to look at financially, and we included 10 years of projected 
revenue, but only 7 years of what we thought would be our expenses, you 
know where we'd go? We'd go to prison. We'd go to prison if we did 
that.
  But not Max Baucus. He can score 10 years of revenue against 7 years 
of expenditure, and they're all high-fiving each other. I said in my 
press release it makes the Enron accounting look reasonable and prudent 
when you score something like that.
  I've got to tell you, I don't know a business in America that 
wouldn't look pretty darn good if you scored--if you counted only 7 
years of expenditures against 10 years of income. But that's what Mr. 
Baucus did.
  And the American people--and only in Disneyland-on-the-Potomac, only 
here in this crazy city called Washington where what the government 
says is reality--notwithstanding its tea leaf reading--only here could 
you have a score that counted 10 years of revenue against 7 years of 
expenditures taken seriously. But by God, Max Baucus is being taken 
seriously in that club they call the United States Senate across the 
way.
  Mr. KING of Iowa. As I listen and I reflect back in those first years 
when I got to know who John Shadegg was--and I remember discussions 
here on the floor as I was watching on C-SPAN--and I believe one can go 
back and review the Congressional Record and be able to hear the 
criticism that you and others have made about Democrats declaring that 
a reduction in the anticipated increase was a cut.
  And so the reduction in the anticipated increase was called a cut by 
Democrats, and that was exposed--at least to thinking people in 
America--and now we have a CBO, the revered, nonpartisan CBO scoring an 
$829 billion bill and scoring that bill over a 10-year period of time 
by totaling up 7 years of expenses and 10 years of revenue. It's the 
same kind of sleight of hand, only this isn't just political sleight of 
hand; this is a nonpartisan Congressional Budget Office sleight of 
hand.
  And it has to be, I think, with the directions that come from the 
White House and Max Baucus. And as I understand it, there still is not 
a bill. We've only amended the concept to the point where we have the 
amended concepts that were voted on today coming out of the Finance 
Committee in the Senate.
  Mr. SHADEGG. You just made an interesting point.
  I tell you, I have been here over 14 years, and when they started 
talking about the Baucus bill moving forward and it was getting close 
to being adopted and they were offering amendments to it, naive me, I 
work in the House where we actually have legislative language, I called 
my health care staff one day--I was in Arizona and they were out here--
I called them from Arizona and I said, Hey, get me a copy of the Baucus 
bill. And they said, Well, um, uh, Congressman, um, uh, we can't get 
you the Baucus bill. We can only get you the chairman's mark. And here 
on the House side the chairman's mark is a copy of the bill.
  I said, Fine. Get me the chairman's mark. I want to see what the bill 
says.
  My staff said, Well, one little slight problem, Congressman. Over 
there in the Senate they do it different. The chairman's mark in the 
Senate, Mr. Baucus' chairman's mark is just a conceptual document. It's 
stunning.
  But, oh, by the way, we talk about scoring 10 years of revenue and 7 
years of expenses, the kind of Disneyland-on-the-Potomac world we live 
in says, for example, in that bill that we're going to save somewhere 
in the neighborhood of $400 billion from Medicare. Now, I heard the 
President stand in front of this room and say, By God, there will be no 
cuts to Medicare. But interestingly, they get I think about $170 
billion of those cuts by saying they're going to cut the money that is 
provided to doctors and hospitals and labs.
  Now, that's kind of interesting. We're going to cut how much money we 
give to doctors, hospitals, and labs under Medicare. As the gentleman 
from Iowa knows, we have been supposed to have done that every year 
since, I think, 1995 or 1996. We have never once actually done it. But 
in this bill, here in Disneyland-on-the-Potomac, they're counting as 
real savings--although we've never cut those reimbursements between 
1995 and today--somehow, tomorrow, when this bill is put into effect 
and tomorrow for the scoring of the bill as only $829 billion, we're 
actually going to put those cuts into effect. They've never happened in 
the past, but suddenly they're saying they will happen in the future.

[[Page 24720]]


  Mr. KING of Iowa. And when it comes to the Medicare as the proposal 
has been, as I understand the conceptual proposal in the Senate since 
there is no specific language to look at--and I've not looked at the 
line items that CBO is scoring, and there may not be any, actually--but 
the proposal here in the House was to cut Medicare about $500 billion 
over a period of 10 years. But there was going to be savings from 
waste, fraud, and abuse to the tune of some hundreds of billions of 
dollars.
  And it's almost as if we can't fix the waste, fraud, and abuse unless 
we first pass a proposal that will take us to a national takeover of 
our health care industry. One would think if you're going to be a 
responsible government, you wouldn't hold responsibility hostage to 
passing a bill that America doesn't want.
  Mr. SHADEGG. The gentleman isn't truly suggesting that we're not 
going to--having talked about cutting waste, fraud, and abuse for maybe 
the last 50-100 years--that we're not actually going to do it under 
this bill? Well, of course we are. Mr. Baucus says we are. The House 
Democrats say we are.
  Well, if they say we're going to cut waste, fraud, and abuse, by all 
means we'll cut waste, fraud, and abuse; and we'll produce all of those 
savings that they need to pay for this bill.
  Mr. KING of Iowa. Since we don't have any specific language and we 
don't have any specific approach. So cutting waste, fat, fraud, and 
abuse will happen even less effectively than it has in the past.
  And the Medicare component of this, too, the reimbursement rates 
across the country unbalanced are only being reimbursed at about 80 
percent of the cost of delivering those services.
  Mr. SHADEGG. So they shift those costs to private care, but under 
this bill--of course they're going to wipe out private care--where are 
they going to shift the costs then?
  Mr. KING of Iowa. It has to go to the taxpayers eventually; borrowed 
money is where it will end up. This bill--there's another component of 
this that is not going to be addressed.
  Now, they are scoring the waste, fraud, and abuse component part of 
this to get this up to meet the President's pledge. There is nothing in 
the bill, not one penny in the bill, of a reduction of the worst waste, 
fraud, and abuse, and that is lawsuit abuse that takes place across 
this country.
  The numbers that we have seen, the health insurance underwriters have 
put out a number--this is verbal, not in print--8\1/2\ percent of all 
of our health care costs are wrapped up in the costs of medical 
malpractice and defensive medicine, unnecessary tests, and also 
malpractice insurance premiums, 8\1/2\ percent. If you calculate 8\1/2\ 
percent across the cost of our health care, that comes to $203 billion 
a year, or CBO, if they were to score that revenue or expenses, I 
suppose--I don't know which--but let's say it's 10 years, that's $2 
trillion that--that's on the way outside that could be saved if we 
address lawsuit abuse and reform it as we did in this House. And it 
failed in the Senate because the trial lawyers are able to block 
anything that comes through the Senate or the House today.
  There is also a number that came out from Pricewaterhouse Coopers 
that 10 percent, slightly more than 10 percent actually, of the overall 
costs of health care were being wrapped up in medical malpractice 
premiums and the litigation that's associated with that and the 
defensive medicine.

                              {time}  2340

  So if we really wanted to fix some health care costs, we would go 
after tort reform.
  Mr. SHADEGG. I'm glad the gentleman brought that up. I view this as a 
Paul Revere moment. The reality is America needs to know this 
legislation, without one word of tort reform, this bill, this massive 
government takeover of health care, with the corruption I have just 
listed, Harry Reid protecting Nevada, Chuck Schumer protecting New 
York, Bob Menendez protecting New Jersey, Deborah Stabenow and John 
Kerry protecting Michigan and Massachusetts, with all that political 
corruption coming into the health care system, it will pass without a 
word, not a word of tort reform, unless the American people speak out.


                Announcement by the speaker pro tempore

  The SPEAKER pro tempore (Mr. Perriello). The Chair would remind 
Members to refrain from personal references to Members of the Senate.


                         Parliamentary Inquiry

  Mr. KING of Iowa. To the Speaker, a parliamentary inquiry. I believe 
that we had a rule change a few years ago that amended that language in 
the rules that allowed an individual to address Members of the Senate 
by their name. Could you verify that, Mr. Speaker?
  The SPEAKER pro tempore. Members are free to debate policies of 
Members of the other body but must refrain from personal references.
  The gentleman may proceed.
  Mr. KING of Iowa. Mr. Speaker, further parliamentary inquiry. I would 
just like to put into the Record I'm referring to the Feeney rule, and 
I think the Feeney rule should be upheld. And I know we can carry on 
this dialogue without referencing people specifically, but I believe 
the rules have been amended unless they have since been amended 
afterwards. Could you verify that?
  The SPEAKER pro tempore. Members may reference particular Senators, 
but may not engage in personalities toward them.
  The gentleman may proceed.
  Mr. KING of Iowa. Mr. Speaker, I yield to the gentleman from Arizona.
  Mr. SHADEGG. I certainly don't think anything has been personal. They 
have been just factual about policies pursued.
  I simply want to say that the gentleman is absolutely right about the 
desperate and crying need for tort reform in this legislation. The 
gentleman used various statistics about the cost of defensive medicine 
or lawsuit abuse. Now I will tell the gentleman that in my discussions 
with individuals in Arizona, I have been told that, indeed by insurance 
brokers, it's their belief that as much as 35 percent, as much as 35 
percent of all health care bills in America can be traced back to the 
tort system, that meaning the cost of malpractice insurance for 
doctors, a very, very high number, climbing higher every year, and the 
cost of defensive medicine.
  It is really important for people to understand what we mean when we 
talk about the cost of defensive medicine and what it really means for 
their health care. What it means is that your doctor is often 
compelled, indeed, probably every day, compelled to order tests or 
procedures or evaluations that he or she doesn't necessarily think you 
need, but if that doctor doesn't order them and gets second-guessed by 
a trial lawyer later, it could mean financial ruin for them.
  I had a medical doctor come in to visit me yesterday afternoon. Even 
though it was Columbus Day, I scheduled some office hours. I happened 
to meet with him at 5:30 last night. He practices in Scottsdale, 
Arizona. He said that time after time after time after time, he will 
get a chart where they have ordered that certain procedures be 
conducted, for example an expensive CAT scan, when he thought an x-ray 
would do, and he must order what he has been told to order and spend 
the money, or there's the risk that the lawyer will come along later 
and sue him.
  Interestingly, I often tell a story about growing up in Phoenix and 
being involved in a Boy Scout troop. One of the other young men in the 
Boy Scout troop, his father was a medical doctor. His father, the 
medical doctor, he explained to me years later, knew just about all of 
his patients personally. And if they called on a Tuesday night at 
quarter to 12 or on a Saturday afternoon at 2:30, he would take their 
call, because he knew those patients, and those patients came to him 
out of choice. They didn't come because their employer picked the plan, 
or some plan hired the doctor. They had an indemnity insurance plan, 
and they came to that doctor because they chose that doctor. But also 
if they called on a Tuesday night at quarter to 12 or a Saturday 
afternoon at 2:30 and said

[[Page 24721]]

they had a problem, that doctor, his father, would often call in a 
prescription to try to help them with their problem.
  What has happened to that aspect of health care in America today with 
the current tort system we have? It's gone. Your doctor won't even 
think about calling for a prescription for you based on a conversation 
over the phone because he or she, your doctor, knows if that turns out 
not to be the right answer, his or her socks will be sued off, to use a 
phrase, by some waiting trial lawyer.
  But is there a word of tort reform to limit that cost in this bill, 
where it's 8 percent or 10 percent or 35 percent? Not one word in this 
legislation. We're going to throw the entire baby out with the bath 
water, completely throw away the health care Americans have come to 
trust and rely on out the window and replace it with a new government-
run system because, after all, everybody knows the bureaucrats and the 
politicians in Washington have all the answers, and we're not going to 
put a word in there about tort reform.
  In my committee, in the Commerce Committee, we offered amendments to 
put in a little bit of tort reform, rejected. In the Education and 
Labor Committee where the bill was considered, there was an amendment 
offered to limit damages or to put in some tort reform, rejected. In 
the Ways and Means Committee, an amendment was offered, rejected.
  The current team is not about to allow tort reform to occur in this 
legislation. And so we will throw out the current health care system in 
America in the next few weeks. We will replace it with a whole new 
system, disrupt everybody's plan, and we won't even have gone after one 
of the biggest cost drivers, excessive lawsuits.
  Mr. KING of Iowa. Reclaiming my time, we will go up through these 
numbers. I want to agree with the gentleman with numbers as high as 35 
percent or even higher that go into the tort reform, the lawsuit abuse 
category. The lowest number I pick up is 5.5 percent of all medical 
costs, then the 8.5 percent from health insurance underwriters, then 
the 10 percent of PriceWaterhouseCoopers, and then there's an aggregate 
of providers out of Iowa that sat down and presented to me a 20 to 28 
percent calculation that they had that was the cost of the lawsuit 
abuse and defensive medicine.
  And then those numbers go on up, as the gentleman from Arizona said, 
35 percent. I talked to an orthopedic surgeon a week or two ago who 
told me that 95 percent of the tests that he runs, MRIs I believe he 
said, are unnecessary. And he knows they are unnecessary, but he has to 
order them on everyone, every injury, in order to protect himself from 
that single trial lawyer that will come in and file a lawsuit. Over the 
course of his practice, it was $1 million a year that was unnecessarily 
spent on tests in one single practice that he described as a small 
practice, that I see it as quite a respectably sized practice.
  But in throwing the baby out with the bath water, I'm going to see 
your doctor and raise you a nurse.
  This is very close to the family anecdote that took place just last 
weekend. A little child was sick, and his mother called in. We live in 
a rural area so we have hospitals in our county seats. She called the 
county seat hospital and said, here are the conditions of my child. 
Should I bring this child into the hospital or should I treat him with 
some aspirin and maybe watch his temperature? And the nurse that was on 
call said, I can't advise you because--she didn't go on much further 
than that, but we all know why. She couldn't advise the mother because 
of the potential for a lawsuit.
  Then the mother said to the nurse over the phone holding a sick 
child, who is the doctor that's on call? We don't always have doctors 
in great numbers, but we should know who the doctor is on call. And if 
that doctor is this baby's doctor, then the mother would have taken the 
baby in. The nurse was even prohibited from telling the mother who the 
doctor was that was on call at the hospital because I suppose of some 
imagined lawsuit abuse that is out there.
  This country has been so shut down by the abusive lawsuits. And we 
have lost our good judgment. We have the HIPAA Act now where we can't 
find out who is in the hospital so you can go visit them. You can go up 
to the visitors' center and ask and they can't tell you. And if a nurse 
can't tell a mother, bring the child in or not, what's its temperature, 
give the child an aspirin, call me back in 2 hours, tell me how you're 
doing, if a doctor can't even let his name go out that he's on call, 
you have to go to the hospital to find out where you walk into the 
confines of the hospital where apparently those confines then are more 
regulated, more controlled and more structured in order to prevent the 
lawsuit abuse.

                              {time}  2350

  This $200 billion, $203 billion a year, and that's at 8.5 percent. If 
you run this on up to Mr. Shadegg's number of 35 percent, I don't have 
that number, but $200 at a little over 10 percent, so you would be 
somewhere around--could be as high as $1 trillion a year on the outside 
of the cost of litigation in this country. And it's being paid by 
people across this country, and not one dollar is being addressed by 
the Democrats.
  I would just suggest that we have a lot of solutions. One of the 
solutions that Mr. Shadegg has introduced about selling insurance 
across State lines, some of the data that came out of similar policies 
with different mandates in it, a young man, 25 years old, could buy a 
policy in New Jersey for $6,000 a year. A similar policy in Kentucky 
would cost him $1,000 a year. Where would you put your money if you had 
the choice? I would buy the policy in Kentucky.
  I want to be able to preserve the catastrophic insurance component of 
this. I want to be able to expand health savings accounts. But my list 
of things we need to do to reconstruct this health care system 
recognizes that we have consumers. We need to maintain personal 
responsibility. We've talked about fixing the tort reform component of 
this which we did pass out of this House at a $250,000 cap on 
noneconomic damages modeled after California, modeled in Texas, I 
believe, modeled after that as well. They're doing well, especially in 
Texas.
  Buying insurance across State lines. Portability, so you own your 
policy and you can take it with you and you're not tied and strapped to 
your job.
  Full deductibility of health insurance premiums. How can it be that 
an employer, a large corporation, for example, can deduct 100 percent 
of the health insurance premiums even on the Cadillac policies--which I 
don't particularly object to--and ma and pa can't do that? If they're 
self-employed, if they're a sole proprietorship, if they're a 
partnership, if they don't have themselves set up on a wage and a 
benefit plan within a corporation, they can't fully deduct their health 
insurance premiums. If any entity can deduct a health insurance 
premium, every entity should be able to deduct a health insurance 
premium. And the numbers that I have seen on that is that it would 
increase our insured by about 1 million people a year.
  And we need to expand association health care plans, expand the 
health savings accounts. And we ran some numbers on that a couple of 
years ago. If a young couple had started with HSAs when we passed them 
here in 2003, maxed out at $5,150 for the couple a year, spent $2,000 a 
year out in normal health care costs, in accruing at 4 percent a year--
which will be logical by the time we get there; it may not be today--
they would arrive at retirement with about $950,000 in their health 
savings account, almost $1 million. Well, why wouldn't we let them buy 
a Medicare replacement policy and give them the rest of it tax free for 
their own retirement or to will to their children? We need to tie this 
together, health savings accounts with retirement accounts, and get 
people off the entitlement rolls.
  Transparency in our billings and electronic medical records.
  Mr. SHADEGG. If the gentleman would yield?
  Mr. KING of Iowa. I would yield.

[[Page 24722]]


  Mr. SHADEGG. I made the point earlier about this bill being the 
imposition of politics or special power and privileges imposed on 
health care in America. And I guess there was some question of whether 
or not it was appropriate to criticize the politicization of this 
legislation, the so-called Baucus bill. I held up the article from 
which I drew those examples, and I just want to read them so that 
everybody will understand it's not a personal attack by me. These are 
just, as they say, the facts, like Sergeant Joe Friday used to say on 
``Dragnet.''
  Kim Strassel points out, first of all, a central feature of the 
Baucus bill is the vast expansion of State Medicaid programs--I am 
quoting from the article. ``The provision has angered Governors, since 
the Federal Government will cover only part of the expansion and stick 
fiscally strapped States with an additional $37 billion in costs.''
  It then goes on to explain, that troubled Senate Majority Leader 
Harry Reid of Nevada, she says, ``who is worried about losing his seat 
next year, worked out a deal by which the Federal Government will pay 
all of''--and I am reading in quotes the article--``his home State's 
additional Medicaid expenses for the next 5 years. Under the majority 
leader's very special formula, only three other States--Oregon, Rhode 
Island and Michigan--qualify for this perk.'' So there is the first 
example of political health care, or of politically driven health care, 
special perks and privileges for four States.
  It then goes on to say, ``Mr. Baucus's legislation would tax high-
value insurance plans--a 40-percent tax on plans that cost more than 
$21,000 a year.'' The article proceeds, ``Senator Chuck Schumer didn't 
want a lot of angry overtaxed New Yorkers on his hands,'' and I am 
quoting, ``so he and other similarly situated Democrats carved out a 
deal''--not my word, the article's word--``a deal by which the 
threshold for this tax will be higher in their States. If you live in 
Kentucky,'' says the article, ``you get taxed at $21,000. If you live 
in Massachusetts, you don't get taxed until $25,000.'' There again, 
another special little perk, politicians protecting their own inserted 
into the bill--not my words, but the article.
  ``And Senator Bob Menendez, of the Garden State, seems concerned that 
his home-State employers are going to struggle to both pay their 
Federal liabilities and to continue to grow and innovate. Thus, Mr. 
Menendez's quiet deal for $1 billion tax credits for companies 
investing in R&D.''
  And last, she talks about Michigan Senator Debbie Stabenow and 
Massachusetts Senator John Kerry including ``$5 billion in the bill for 
a reinsurance program to defray the medical costs of union members.'' 
All of those are the comments I made about the special political deals 
inserted in this bill. Don't believe me? Just Google the Wall Street 
Journal and Kim Strassel.
  I want to thank the gentleman, by the way. I also mentioned that the 
Senator from Colorado said, ``If Colorado has a fair claim on being 
treated the same way Nevada has been, of course we're going to ask for 
that kind of treatment.''
  So there you go, politics and health care in America. Health care 
won't be driven by care or by medical evidence. It will be driven by 
the most powerful Senator on the block.
  Mr. KING of Iowa. I thank the gentleman from Arizona.
  And talking about the politicization of health care for perks and 
privileges, the part that's left out is the patronage. Patronage goes 
with perks and privileges. And when you see that happen in government, 
then it slows down the operations and it shifts the balance. And we're 
wondering, why isn't government logical? It's because perks, privileges 
and patronage take government off kilter. That's why we're a free 
enterprise system. That's why we have been a free enterprise system. 
And that's why this Nation has been strong and powerful and successful 
and our economy has eclipsed that of the world is because we left the 
standards of Adam Smith in place for dozens and dozens of years, for 
generations and generations.
  In this last year, we have given up to nationalization perhaps as 
much as one-third of our private sector. We are looking at 14.5 percent 
of our GDP being potentially nationalized in the sequence, all to 
reduce this.
  This is, by the way, 100 percent of the population of the United 
States of America. And here in the blue, that represents 84 percent in 
the blue of all. This is 100 percent, the circle. These are the 
uninsured, those Americans without affordable options right here, this 
little orange, less than 4 percent, about 12.1 million people. This is 
47 million all together. And if you look at the color code on the 
chart, we have illegal immigrants there in the yellow. We have those 
that are yellow in the 5-year bar, no welfare for 5 years by law. 
That's another 5 or so million people. You have those that are earning 
more than $75,000 a year, Americans without affordable options. They 
can find a way to insure themselves. And then you've got those that are 
eligible for government programs, primarily Medicaid, that's 9.7 
million. And then you have those eligible for employer offers that 
don't opt in or opt out of their employer's plan, that's about 6 
million. And then we have the Americans without affordable options. So 
all of these folks here, there's another answer for that; less than 4 
percent to change 100 percent of the entire insurance and health care 
delivery system.
  I thank the gentleman from Arizona and the Speaker, and I yield back 
the balance of my time.

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