[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[House]
[Pages 24804-24812]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Mr. Speaker, this evening we're going to be continuing on a 
familiar theme for many, probably the single issue that rivets the 
attention of Americans perhaps more than any single debate and 
discussion and, that is the change to American health care. This is 
not, of course, a small debate. It is a debate that involves a question

[[Page 24805]]

of, to a large degree, whether the government is going to take over 18 
percent of our economy. That's not a small section of our economy, 18 
percent, nor is it a small question.
  Not only economically is it a big question, every one of us has to 
live inside our own bodies. So it is a very personal question. We have 
to live inside our bodies, and we're dependent on health care, and we 
hope that we can continue to enjoy the high quality of health care that 
we have had in America.
  But people recognize that there are problems with American health 
care. Those problems largely are not so much in the delivery of the 
health care but rather in how the health care is being paid for. So 
there are stresses in the system as to who's going to pick up the tab 
on it.
  We've seen a lot of examples of different departments of the Federal 
Government. It does amaze me just in a commonsense point of view why 
people would really want to trust their own personal health care with 
any department in the Federal Government when I think of the profound 
inefficiencies within many departments of government.
  We don't think of the post office as being a model of efficiency, the 
IRS as being any particular model of compassion or precision. If you 
think about the Energy Department, the Energy Department was founded on 
the idea that we had to make sure that America never had to rely on 
foreign sources of energy. Since that time, the Energy Department has 
grown in employees, and we have also grown on our dependence on foreign 
oil.
  Then you've got, of course, the Education Department. That is a model 
of something that I wouldn't put my trust in. In fact, there was a 
study done on the Education Department some years ago that concluded 
that if a foreign nation had done to America what the Education 
Department had done, it would be viewed as an act of war.
  Yet there are people in spite of this--and we've seen the Federal 
emergency management in response to Katrina and other departments of 
the Federal Government. In spite of that, people want to turn over 18 
percent of our economy to the government.
  Well, when the government does too much, there are some things that 
we tend to see as becoming problematic. One of them is that you get 
some inefficiencies. You could get excessive expenses, degraded 
quality, or bureaucratic rationing.

                              {time}  1700

  Is this something we need to worry about when we are talking about 
health care? Somebody quipped that if you think health care is too 
expensive now, just wait until it's free. We will take a look.
  Here is what was proposed in the House plan, right here. It's a 1,000 
page bill, but you can summarize it in this nifty flowchart. All of the 
colored boxes are new parts, new moving pieces.
  You could see that it certainly doesn't meet the test of simplicity, 
that's for sure. People who have looked at this and studied it long 
enough say, I want to be the health care czar. He's the guy who makes 
all the decisions and determines who gets care and who doesn't.
  Tonight, we are going to be talking on the subject of health care. A 
lot of new information is breaking, new estimates from the Senate as to 
how much their plan is going to cost and how much is going to be taken 
out of Medicare on that plan.
  I am joined by some good friends of mine here, and I am thinking my 
friend GT is here. I am just going to recognize and yield to you, my 
friend, a Congressman who has not been here that many years and yet who 
has already earned a reputation far in disproportion to the amount of 
time he has served, and long on the common sense department, which I 
think we need a whole lot more of that common sense.
  Mr. THOMPSON of Pennsylvania. Well, I thank my good friend and, 
actually, 10 months, just about 10 months is what I have been here. The 
world I came from, actually, was the health care world. I mean, I had 
spent 28 years working in health care services as a therapist, health 
care manager in rural hospitals, licensed nursing home administrator.
  I came here knowing with a commitment that we could do better with 
the health care system we had, that we can improve all four principles 
of health care: access, affordability, quality, and choice.
  Mr. AKIN. Slow down just a minute now. The four basic principles of 
health care, do that again.
  Mr. THOMPSON of Pennsylvania. Access, affordability, quality, and 
choice.
  By choice, I mean strengthening that vital decisionmaking 
relationship between the physician and the patient, and not having the 
government or a bureaucrat being wedged between those two.
  Mr. AKIN. Doctor-patient, yes.
  Mr. THOMPSON of Pennsylvania. Doctor-patient relationship, yes. I 
happen to think we have a pretty good system. Not that we couldn't 
improve on it. I came with ideas on how to do that. Unfortunately, the 
ideas I brought with my almost 30 years of experience have been largely 
ignored by the majority side, by the Democratic Party.
  I find that the proposals put out there, specifically House 
Resolution 3200, in many ways I can find where that proposal, that the 
Democratic health care proposal, would make all four of those 
principles worse.
  Mr. AKIN. That doesn't sound like a very good idea. Just probing a 
little bit, though, you made a comment. You said that you came here 
with 20-plus years of health care experience. You came here with ideas 
that could improve the system, and we have been accused for months, 
both by the President and others, as saying the Republicans don't have 
any ideas, yet you had quite a few ideas.
  Mr. THOMPSON of Pennsylvania. Absolutely. I am proud that, as 
Republicans, we have over 30 bills that we have introduced that would 
specifically address the different issues and the concerns that I came 
with, and many others, the visions of my colleagues, that I think would 
be good to address the health--
  Mr. AKIN. Let me ask you this. Did any of your proposals--because we 
have been accused of this as well, did any of your proposals raid money 
out of Medicare?
  Mr. THOMPSON of Pennsylvania. Absolutely not.
  Mr. AKIN. Yet the Democrat proposal we were talking about 2 weeks ago 
was raiding $500 billion out of Medicare. Now, that has been scored in 
the Senate. It's about 400-and-something billion being taken out of 
Medicare to try and pay for this thing. That wasn't something you were 
proposing?
  Mr. THOMPSON of Pennsylvania. No. Especially when you are looking at 
proposals to raid Medicare specifically, the hospice services, people 
that are preparing their lives to die with dignity, to die in their own 
homes and places surrounded by their family and can be comforted in a 
way that provides that dignity to those final days. And to cut Medicare 
in that area is just wrong.
  I think that what I find most interesting about that proposal to cut 
Medicare to fund this new large government-run program, sweeping 
government-run program, is that it's, in my experience, as I look at 
the issues surrounding--and this is some of the things I came with--the 
issues surrounding a wide commercial health insurance is so expensive, 
and it is in many places.
  The average health insurance pays, nationwide, 140 percent of cost to 
hospitals and to physicians. The reason for that is--there are many 
reasons, and we will talk about them this evening, like tort reform, 
but the other reason is Medicare. It's medical assistance.
  Medicare pays, on the average, 90 percent of the costs. For every 
dollar of costs a hospital has or a physician has, Medicare pays 90 
cents. For every dollar of cost that a hospital or a physician has, 
medical assistance pays, varies State by State, but 40 to 60 cents. 
Within our health care system, because the government set up these 
entitlements and soon found that it couldn't sustain them, couldn't 
afford them and

[[Page 24806]]

begins to systematically underpay them, we look to commercial insurance 
to make up the difference.
  It's interesting that Medicare is the reason, I think, one of the 
primary reasons why commercial insurance is as expensive as it is, yet 
the proposal is to make more Medicare cuts.
  Mr. AKIN. Here, this is a chart of these three big entitlements. 
People talk sometimes about earmarks and other stuff about Federal 
spending. But the real story about the Federal budget being broken is 
really within these three big entitlements. All of them, you can see, 
are growing out of control over time: Medicare, Medicaid, Social 
Security.
  Now, as these things grow, what you are saying is, in spite of the 
fact it's costing a ton, there is still not enough money in those 
programs to really pay for what the medical costs are. We are now 
taking money out of the private sector or from other sources to help 
subsidize these things that don't work.
  Now, you are a commonsense guy. It seems to me that if we have 
Medicare and Medicaid that are financially broken, the solution to say, 
well, we are going have the government take over all of that and a lot 
more, that almost defies common sense.
  You know, we are joined by a gentleman whose sagacity and also years 
of service on the floor are about legendary. Congressman Souder, I 
would appreciate you joining. I think of these as kind of a dinner 
conversation. Let's just talk about what we have got going on. This is 
something that Americans care about all across our country, and I think 
we need to have enough time to talk about it, take a look at it, and to 
say just say rationally what's the right thing for us to be doing.
  Mr. SOUDER. Right, and you have taken the lead here on the floor. 
Trying to make sure we present this, I have got a couple of specific 
points, but one, which you are doing through this, is at a minimum, the 
public needs to know what's in the bill, and the thought that something 
may come here without 72 hours to read it, which is not a long time, is 
just abhorrent.
  Mr. AKIN. This is not really a particularly subtle point, yet the 
American public understands this. They would like us to read the bill. 
It's really hard to read the bill when the bill we are debating and 
voting on is still being collated up here, like the cap-and-tax bill 
that we had with 300 amendments passed at 3 o'clock in the morning.
  Your point is well taken. First of all, it would be a good idea to 
see what the bill is before we vote on it. It seems like a 
straightforward point.
  Mr. SOUDER. The other body passed a Senate Finance bill, which has 
correctly been called a conceptual bill, that we heard the budget 
estimates of that bill. But as they said in the notes, in their report, 
you can't hold us accountable for these estimates because the bill 
doesn't specify how they are going to achieve certain savings, doesn't 
specify how certain things are going to be paid for, doesn't specify 
exactly what they are covering. It doesn't give enough specifics.
  Even when you are taking over this big a sector of the economy, 1,000 
pages is like a sneeze at this problem. There has to be not only 72 
hours to read it, but we need to actually see a real bill, not a 
conceptual bill.
  Now, there are a couple of things. Our friend from Pennsylvania 
alluded to this one. We have had this huge controversy about the so-
called death counselors that are clearly in the bill to do counseling 
in the last 5 years of life and if your condition deteriorates. Many of 
us are strong supporters of hospice care. I think a lot of people 
thought this was for hospice care, but they are getting cut 18 percent. 
I just read a letter from someone in my district that says we don't 
know how our hospice care can survive with these cuts. What is the 
point of these counselors if you are wiping out the hospice care?
  No wonder some people are a tad paranoid. I don't know what it means. 
How can we know what it means? What we know is it looks like they are 
rationing because they are cutting off services to Medicare.
  Mr. AKIN. This is death care?
  Mr. SOUDER. Well, it says they will present all the alternatives. But 
I assume that the real intent around that was to promote hospice care. 
But if they are cutting hospice care, and the hospice centers don't 
know what they are doing and you are rationing certain life supports, 
and if they are talking about how much is spent in the last years of 
life, this is really disturbing stuff.
  That's why we have to read the bill. We have to know precisely what's 
in it. What do you mean when you put that kind of stuff in?
  Where that section was on our House bill referred back to the Social 
Security act. It didn't even fit. The counseling part didn't even fit. 
Nothing else in there was counseling. It was things like liver and all 
this kind of stuff. It was incredibly sloppily written. It will be 
forever litigated.
  It seems to set up a pattern where you are going to be counseled and 
given a different alternative from hospice to euthanasia. You are going 
to be told you are going to get things reduced, or at least they should 
disclose that. But if there is no hospice that can survive, 
particularly in the smaller markets--which brings up another critical 
point. The cardiologists were here on the Hill just a couple of weeks 
ago.
  Mr. AKIN. As you talk, what comes to my mind, as I am hearing you 
talk, is basically a form of rationing that's really diabolical, a sort 
of rationing that says, well, you can take a bottle of aspirin or what. 
I am getting to be an old codger at 62, but if I were older, I would be 
even more paranoid, I think, from what I am hearing you say was in the 
bill.
  Mr. SOUDER. The challenge here is that people are confused. You hear 
the President or others say it's not in the bill, then you hear the 
Republicans make an allegation.
  Here is the thing. It doesn't specify, A, if we could read the bill, 
but what we see doesn't specify. What it does say is there will be 
counseling. In another section it says there's going to be savings, 
which implies rationing, and in another section--or implementing and 
procedures, a cut for hospice care.
  In another part of it it says, the first part says 5 years. Nobody 
knows exactly what that means, every 5, once in 5, not explained. Then 
later it says if you have a condition change. When you put those 
together, you come to a logical conclusion.
  But then the other side goes, well, it's not in the bill. Well, not 
precisely, but it's in there in five different places, and there is no 
other way to resolve it. There has to be some kind of unit that has to 
put this together to make these kinds of decisions.
  In this waste and abuse, one of the questions is what does waste and 
abuse mean.
  The cardiologists were in the other week, and the oncologists the 
week before that, because they were concerned because they have started 
to implement some of these procedures. What we hear is that, well, if 
there is waste and abuse, why aren't we checking it right now.
  Well, they are defining waste and abuse as underutilization of 
equipment. What does underutilization of a heart machine mean? What 
does underutilization of a heart center mean? What does nonefficient 
usage of oncology machines mean?
  In Indiana, what it means is everybody goes to Indianapolis. You are 
going to close your heart centers in Fort Wayne because you have a 
utilization of 44 percent, not the 80 they are mandating. It means 
South Bend, Evansville, northwest. In Missouri, maybe you get Kansas 
City and St. Louis.
  We had a number of Russian health care administrators in my district 
as well as people from the Duma a number of years ago. We took them to 
some of our hospital systems. They said we have seen most of this stuff 
in Moscow. What's unusual even in the United States is that even in 
towns of 15,000 you have hospitals like we have in our big cities.
  When we hear about lines in Canada and England, it's partly because, 
to be efficient, they have people drive 200 miles to a heart center, 
and they get to

[[Page 24807]]

pay the mileage. They get to pay for the motel. They get to go back for 
repeat visits and the cost to them. That's not savings of waste and 
abuse; that's transferring the fees to individuals.
  What we have right now is a dispersed health care system that brings 
it closer to home with what we call RediMeds in our area. You have 
blended regional hospitals feeding up to bigger hospitals. They seem to 
think that these savings are going to become like they were trying to 
do in the veterans hospital system in Indiana and make everybody go to 
the biggest city in the State.
  Mr. AKIN. What strikes me, gentleman, and your points are very, very, 
well taken, currently full of waste and abuse. It's almost like you 
have a line item on a budget that says waste and abuse and so many 
million dollars. I mean, if you had that, you take that line item off 
the budget. Well, what exactly does waste and abuse mean?
  We were just talking to cardiologists today that came in. They 
explained the kinds of equipment they have in their office. From a 
practical point of view, if you are a cardiologist, it's like what used 
to be a stethoscope. A doctor hung it around his neck. He might not 
have used it all the time, but he needed it on a fairly regular basis.
  Their stethoscopes now are far more sophisticated, but they use them 
all the time. Not all time, but they have to have them immediately 
available to do their job. As you say, that allows them to provide 
service reasonably close where people live, and it allows them to do it 
right in the office. Particularly, it provides the fact you don't have 
to wait weeks and weeks to get some particular checkup.
  That is the weak underbelly of the socialized medical systems in 
England and Canada, because you take a look at things like cancer, you 
don't want to wait weeks and weeks. If you have got melanoma, you want 
to get it and you want to get it now. If you have got heart disease, 
you want to get it now.

                              {time}  1715

  I just went through this with my father. He got a new heart doctor. 
His old heart doctor wasn't paying too much attention. His new heart 
doctor took a look at him, took a look at his meds and said you need to 
get a chemical stress test. When he got that, he said you need to get 
an angioplasty thing. So they go in and look around with that. They 
said when you get that, you need to get a heart bypass, which turned 
out was a seven-way heart bypass. When he got done with that, 4 days 
later he is home. Total period of time, less than 3 weeks from the time 
he went in to see the doctor until he had a seven-way heart bypass and 
was home from the hospital.
  That is the American medical system, because it can react quickly and 
rapidly to something that if you let it go is going to be life 
threatening. That is what you are talking about.
  So this waste and abuse, we have seen where some of this supposed 
waste and abuse is coming from; $500 billion out of Medicare. I know 
Republicans have been accused for years of being people who want to cut 
Medicare. Here we have got the Obama plan, we are going to get the 
money out of Medicare.
  In fact, you made the point, gentleman, that we hear these 
conflicting claims and people say, Well, what's the truth?
  Here's what you need to know: ``First, I'll not sign a plan that adds 
one dime to our deficits, either now or in the future.'' This is our 
President. He says he is not going to add a dime to our deficits. 
Guaranteed, first thing. Well, let's take a look at the track record 
since the beginning of the year.
  Deficits. We are talking trillions of dollars worth of deficits here. 
Here is the Wall Street bailout, the second half of that. Economic 
stimulus. If you don't vote for this, you might have over 8 percent 
unemployment. So all these liberals voted for this thing, $787 billion, 
mostly in handouts and welfare types of things; and now we have got, 
whatever it is, 9 percent unemployment.
  Mr. SOUDER. Maybe he meant that he wasn't going to add one dime, that 
he was going to add a couple of trillion.
  Mr. AKIN. Maybe that's what he meant, it wasn't a dime, it would be 
trillions of dollars. But this doesn't give us any record to be 
comfortable with. This assertion doesn't square with what our history 
is.
  Now, there have been a number of other assertions. This is what makes 
people confused.
  First, if you are among the hundreds of millions of Americans who 
already have health insurance through your job, Medicare or Medicaid or 
the VA, nothing in this plan will require you or your employer to 
change the coverage or the doctor you have. The President is saying 
this. You get to keep what you have got. If you like what you've got, 
you can keep it.
  Yet here you have an MIT health economist, with or without reform, 
that won't be true. His point is that the government is not going to 
force you to give up what you have, but that is not to say that other 
circumstances won't make that happen. Essentially, what happens is the 
government gets into the insurance business, the other privates all 
close down, and you only have one choice: you have got to go to the 
government.
  So one thing you are hearing, you can keep what you have. In fact, 
here is a guy from outside that doesn't have a dog in the fight, he 
says that is not how it's going to work.
  Here, this is a section, the doctor-patient relationship. If there is 
anything important in medicine, it is the doctor-patient relationship. 
This is an amendment that was offered by Dr. Gingrey from Georgia, one 
of our friends and colleagues. Here is his amendment:
  ``Nothing in this section shall be construed to allow any Federal 
employee or political appointee,'' that is bureaucrat or whatever, ``to 
dictate how a medical provider practices medicine.''
  In other words, we are going to enshrine the doctor-patient 
relationship. We are going to make it clear that when a doctor and 
patient decide on a particular procedure, we are going to proceed. 
Nobody is going to get in the way. Not only do we not want the 
insurance company getting in the way; we don't want any bureaucrats.
  So he puts this amendment up and it goes to a vote in committee. Most 
people don't know this amendment went to a vote in committee and here 
is the result: 23 Republicans say, yeah, we want to leave that doctor-
patient relationship sacred. And where were the Democrats? Thirty-two 
of them voted against this, only one voting for it. So what confidence 
does that give you that we're not going to get a rationed health care 
system? And yet we're saying whatever you have, you can keep it. We've 
had these claims and counterclaims, and I think it's important for us 
to let the American public shed some light on this. This is what people 
are saying.
  I've got some other charts, but I want to go to my good friend from 
Pennsylvania. I yield.
  Mr. THOMPSON of Pennsylvania. I appreciate that, and I thank my good 
friend.
  I want to come back to the waste and abuse claim, that in addition to 
obviously significant taxes, that there's all these savings under waste 
and abuse. It's being presented and proposed by the Democratic Party 
like this is something new that we're looking at.
  I have to tell you that I was working in health care in 1983 when 
diagnostic-related groups and the first prospective payment system came 
into health care. Soon after that, we began to hear about and work on 
eliminating fraud and abuse. Professionally and ethically, that's a 
responsibility that health care professionals have to do. The fact is 
that is something that has been ongoing. So now this claim that we're 
going to find these massive amounts of money as a result of waste and 
abuse that we can use and save and help to fund this government-run 
health care program is just false, absolutely false.
  Now I do think there's waste in health care, and I can point to 
annually $26 billion. We can take $26 billion annually, and we can find 
that like this if we had the courage of my colleagues on that side of 
the aisle to address medical malpractice.
  Mr. AKIN. Gentleman, you've got all of our curiosity up. How can we 
get $26

[[Page 24808]]

billion? You say there is a line item of $26 billion that you could 
work on.
  Mr. THOMPSON of Pennsylvania. There are line items in physician 
budgets, in hospital budgets; and we could eliminate that cost to 
health care today by passing medical malpractice tort reform.
  Mr. AKIN. Oh, tort reform.
  Mr. THOMPSON of Pennsylvania. Tort reform. Premiums annually in this 
country are paid in the amount of $26 billion. The average award under 
malpractice is $4.1 million in this country. And so there's a line item 
that actually is in health care budgets and all the providers across 
this Nation that we could take that money--and we've got great 
proposals. The Republicans have H.R. 3400 that's out there that would 
address tort reform, that would do it in a way that would limit 
punitive damages. It would set up panels to be able to deal with those 
situations using judges that have health care experience.
  So we have bills out there that if we could get our colleagues' 
support tomorrow or today, we could actually eliminate what I consider 
$26 billion of waste from health care.
  Mr. AKIN. I think my friend from Indiana had a comment on that. I 
yield.
  Mr. SOUDER. I beg to differ just slightly. While that's the amount 
that people pay, what I hear from doctors in my district--and we have 
MedPro, which is one of the biggest insurers of doctors--that that's 
just part of the cost of defensive medicine. After the doctors are told 
to keep your insurance down, make sure they get an MRI if they're 
questioning at all rather than extra x rays so they can't sue you, make 
sure you do this extra test, that doesn't count all the things that 
they do to try to avoid their rates from going up. We don't know what 
the cap is.
  The problem with the studies that claim you don't save as much from 
tort reform by those who are proponents of it literally do not take 
into account what doctors are saying in their daily practice of things 
that they wouldn't do at the margins if they didn't think there was a 
potential of being sued that would drive up the rates.
  Mr. THOMPSON of Pennsylvania. Will the gentleman yield for one quick 
point?
  Mr. AKIN. Yes.
  Mr. THOMPSON of Pennsylvania. There was a recent study done just in 
Pennsylvania that showed that 93 percent of physicians in Pennsylvania 
practice some form of defensive medicine. Ninety-three percent, for 
that very reason. You invest $200,000 to a half a million dollars in a 
medical education career and then because of these lawsuits and because 
of medical malpractice and the lack of tort reform, you're at risk of 
losing not just your practice but your family's home. I understand why 
defensive medicine occurs. We've got the solution. H.R. 3400 would 
address that.
  Mr. AKIN. We've been talking about how do you deal with some of the 
different questions in health care. What has just been illustrated here 
is the fact that Republicans do have a number of ideas. One of those is 
tort reform. You're not talking about the fact that if a doctor makes a 
mistake that the patient shouldn't be made whole; but what you're 
talking about is this wild, punitive damage kind of thing which just 
introduces such a wild card for the insurance companies that they run 
the cost of insurance up and then the doctors practice all this 
defensive medicine, which my friend from Indiana is pointing out as 
well; and any doctor you talk to will explain that that's just 
standard. We don't necessarily like it, but politically the Democrat 
Party doesn't want to allow dealing with that tort reform.
  Now, the President did make a comment about it, and it is kind of the 
elephant in the room, but it's a big cost to health care that could be 
dealt with.
  We're joined also by my good friend from Louisiana, Congressman 
Scalise. Please join us.
  Mr. SCALISE. I want to thank my friend from Missouri for hosting this 
and for helping to continue this debate to really get the facts out 
about some of the dangers of the proposal being brought by President 
Obama, Speaker Pelosi and others to really have a government takeover 
of health care. I agree with most Americans in this country who 
recognize that there are problems in the system but also recognize that 
with those problems we still have some of the best medical care in the 
world and we surely don't want to see the government come in and take 
over health care and destroy the things that work all in the name of 
fixing the very specific things that are broke.
  If you talk about medical liability reform, doctors will tell you 
that many of the tests, maybe a third of all of the tests and 
procedures that are run on people, are just purely in defense of trying 
to avoid a frivolous lawsuit. Experts will tell you you could save 
about a hundred billion dollars--billion with a B--a year in medical 
savings just by doing something to eliminate the frivolous lawsuits and 
address medical liability reform which, as my friend from Pennsylvania 
points out, we do in the bill that I'm a cosponsor, many of us are 
cosponsors of, H.R. 3400.
  Not only that, for Americans who have to go through these tests and 
procedures that they know they don't have to go through and they 
wonder, why do I have to go through these CAT scans and these other 
tests that my doctor really doesn't think I need but because he's 
afraid of a lawsuit, I've got to spend the extra time and the extra 
money.
  Outside groups have now come and just earlier this week, 
Pricewaterhouse said that the bill being brought by President Obama and 
others in Congress would add another $1,700 a year to the average 
American family's health insurance cost.
  Mr. AKIN. Wait a minute now. You got my attention. The average 
American family, the proposal that's being offered is it's going to add 
$1,700 more a year for the cost of their medical insurance?
  Mr. SCALISE. That's exactly what the Pricewaterhouse study says.
  Mr. AKIN. Isn't that the new study on the Democrat Senate plan? Isn't 
that where that was done?
  Mr. SCALISE. Right. Because as we're getting more information on this 
bill that just passed out of the Senate, they still won't put the 
legislative text out there, and I think we should have at least 72 
hours where the bill is available online so that not only Members of 
Congress but all Americans can read it, but also as they're starting to 
research and look at all of these taxes.
  The Democrat bill in the Senate has $400 billion in new taxes that 
would be passed on to American families. The House bill has $800 
billion in new taxes. All of that will raise the cost of health care.
  Mr. AKIN. Let's talk about cost. You've got $400 billion in new 
taxes, and you're going to take another 400 or $500 billion out of 
Medicare. So right off the bat when you say, Here's this new piece of 
legislation, what do I get for it, well, first of all, $400 billion in 
taxes, 400 or $500 billion out of Medicare. That's something, just as 
we started talking. It raises this kind of commonsense question: You've 
got over a hundred million Americans that have insurance and doctors 
and health care that they like pretty well, and they don't really want 
to change; they're content with what they've got, and in order to try 
to fix what problem, you've got somewhere between 10 and 20 or 10 and 
30 million who don't have health care, maybe could afford it but don't. 
And so in order to do the 10 or 20, you're going to basically take 
apart the system for a hundred, which also raises kind of a commonsense 
question, too. I just don't quite see that.
  There are a lot of claims going on. Here's one:
  ``There are also those who claim that our reform effort will insure 
illegal immigrants. This is false. The reforms I'm proposing would not 
apply to those who are here illegally.'' This is the President. This is 
his claim. But let's take a look and see, well, what does the fine 
print say.
  This is the Congressional Research Service. This is a nonpartisan 
group. They've studied the bill that the President was talking about. 
They say:
  Health insurance exchange would begin operation in 2013 and would 
offer

[[Page 24809]]

private plans alongside public option. H.R. 3200--that's Speaker 
Pelosi's bill--does not contain any restriction on noncitizens. It does 
not contain any restrictions on noncitizens, whether legally or 
illegally present or in the United States temporarily or permanently 
participating in this exchange.
  Mr. SOUDER. Will the gentleman yield?
  Mr. AKIN. Yes, I do yield.
  Mr. SOUDER. Can you imagine the outrage in America if liquor stores 
posted on their door, No IDs checked here? If you went to a gas station 
where we assume that tobacco cannot be sold to minors but you had a 
sign that said no IDs checked here, would you believe that the liquor 
store or the place selling the tobacco isn't going to sell to minors? 
On what basis? In effect, what we're telling them in this bill, no IDs 
checked here, so how do you know?
  Mr. AKIN. Isn't that amazing? This is why Americans to some degree 
are upset. They're upset about the points you made. They would like us 
to have 72 hours to at least look at a bill and read it.

                              {time}  1730

  And then, they're not too fond of the idea they're going to get 
cracked for $400 billion or $500 billion taken out of Medicare. 
Certainly senior citizens aren't too fond of that. Some people don't 
like the idea of having to pay for illegal immigrants' health care 
services. This is very clear from the Congressional Research Service 
that what the President said just flat isn't true.
  And if that were not enough for you, here's an amendment by one of 
our colleagues, Congressman Heller. This is another one of these 
amendments that takes place in committees where people don't see it so 
much. This is going to clarify this statement that the President made. 
In order to utilize the public health insurance option, an individual 
must have had his or her eligibility determined and approved under the 
Income Eligibility Verification System, IEVS, and the Systematic Alien 
Verification for Entitlement, SAVE programs under section 1137 of the 
Social Security Act.
  So, in other words, what we're saying is, we're going to make sure, 
we're going to card you at the liquor store. When you buy those 
cigarettes, we're going to card you. That's what this amendment says. 
You notice it says ``failed'' down here at the bottom. It failed why? 
Well, because here's the Republicans. They all voted for it. Here's the 
Democrats. They all voted against it. There are more Democrats so this 
amendment is history.
  So the President says, we're not going to have any illegal 
immigrants, but, in fact, the Congressional Research Service and this 
amendment and the vote on this amendment bears testimony that that just 
isn't true.
  Mr. THOMPSON of Pennsylvania. Will the gentleman yield?
  Mr. AKIN. I do yield to my good friend from Pennsylvania.
  Mr. THOMPSON of Pennsylvania. I'm not sure which committee this is 
representative of, but I serve on the Education and Labor Committee. 
And in that approximate period of time of around July 16th, the next to 
the last week in July, we were also presented with H.R. 3200, and we 
were presented with it and went into within 48 hours of when we were 
given the first copy, which was 500 pages of the bill, and then that 
was on a Wednesday. The very next day, on Thursday, we started bill 
markup, which is an important event around this place. It's where we 
make substantive changes to bills. And at that point, the bill had 
grown, with a manager's amendment, to over 1,000 pages. And we started 
a marathon markup that started at 10 a.m. on a Thursday and was driven 
by the leadership of the Democratic party until 5 a.m. on Friday, 20 
hours. I can't tell you the--
  Mr. AKIN. Till 5 'o clock in the morning?
  Mr. THOMPSON of Pennsylvania. 5 'o clock in the morning. I can't tell 
you--you can imagine what the quality of work was after about 11 p.m. 
But some time during those wee hours of the early morning, probably 
between 1 and 3 a.m. I specifically remember that amendment coming up 
and being debated, and debated passionately, that we have a 
responsibility to the American citizens to be able to be good stewards 
of the resources that are here that we have as a country, and that we 
have the responsibility of overseeing. And I remember that amendment, 
and specifically how it was defeated, along a party line, with all the 
Republicans voting for that amendment and the Democrats opposing it.
  Mr. AKIN. This is the illegal immigrants getting access to the money 
of Americans that are paying money for health care.
  Mr. THOMPSON of Pennsylvania. That is correct.
  Mr. AKIN. I do yield to my friend from Indiana.
  Mr. SOUDER. Also as a member of the Labor Committee, my friend from 
Pennsylvania and myself and probably three others, I thought, were 
actually very articulate in arguing some of these amendments at 3 in 
the morning. Our audience wasn't very big. You know, when people say, 
oh, what happened, why didn't you guys--I mean, the only place we can 
offer amendments usually is committee. We don't get to offer them here 
on the floor.
  Mr. AKIN. Just for some people that might not be familiar with the 
way the House works, when this bill, this medical bill, whatever it is 
that the Democrats come up with, it comes to the floor, they're not 
going to let us offer any of the amendments that are going to be in any 
way embarrassing or debate them or discuss them. It's going to be a 
take-it-or-leave-it. The train is leaving; either get on or stand on 
the platform with your hat in your hand.
  Mr. SOUDER. Putting aside that that may be why they don't bother to 
let us read the bill, because we can't amend it anyway, that you would 
think that there would at least be some public responsibility to give 
us 72-hour notice. In committee, we didn't get 72 hours. As my friend 
from Pennsylvania, Mr. Thompson, has pointed out, it was just, I mean, 
we got it basically when we sat down, the final bill. Then we're 
debating it in the middle of the night, which the other party said was 
shameful when the Republicans held a vote because of the debate which 
was actually on the floor. We don't do debates in the middle of the 
night anymore because we don't do debates, we don't offer amendments.
  But in the amendments in committee, the amendments on pro life, the 
amendments on trying to check ID, the amendments on a lot of these 
controversial provisions, nobody got to see the very eloquent debate. I 
thought we were pretty eloquent at 3 in the morning. You know, I took a 
little offense. I thought we were fairly good but nobody will witness 
it.
  Mr. AKIN. Well, let's just review a few of those amendments. The 
first thing is, you don't want illegal immigrants to be tapping into 
the money for the health care. Another one was saying we weren't going 
to use health care to pay for abortions. So that was one that, I mean, 
a lot of Americans are thinking, I don't really want my--whether you're 
for or against abortions, I'm not sure I want my money being used to 
give people free abortions. And then there was a question about the 
doctor-patient relationship. Are we going to ration health care with 
bureaucrats, some calculator, some computer that says, well, at your 
age and at this and such, you don't get any?
  And so you've got an amendment that says that you're going to have a 
doctor-patient relationship that is going to be sacred, and that you're 
going to allow the doctor and patient to make medical decisions. All 
those amendments offered in committee go down on a straight party-line 
vote.
  Mr. SOUDER. Another one for a second that you referred to earlier. 
That, you know, people can say things. We can stand up and say whatever 
we want. But when you vote it's your action. And in the action--
  Mr. AKIN. A vote isn't an opinion. It's a hard and historic fact, 
yes.
  Mr. SOUDER. Keep your own insurance, keep insurance the way it is? 
No. It was defeated. We had one that said catastrophic plus an HSA. 
That means that you could get flexibility to get

[[Page 24810]]

catastrophic coverage that could be provided by the firm; they give you 
money so you get an HSA, and then if you want pregnancy coverage you 
could cover pregnancy. If you were older--like, we're probably not 
going to have any more babies; it would be a big shock if we did, since 
I am 59, about to turn 60, and my wife's similar. Much younger of 
course, but similar. I'm going to get killed when I get home. The 
bottom line is that we may not want pregnancy coverage, so why can't we 
get a health policy that's customized? Defeated.
  You know, this idea that the Senate bill in their talking points 
today says they're going to allow you to keep your own insurance. And 
then further down it says all these new things will be added. 
Mandatory. By the way, that wouldn't be your insurance. If your 
insurance doesn't have it, that's not your insurance. Your company 
would have to either raise the prices or drop your policy. If they're 
dictating, that's not your own insurance.
  Mr. AKIN. And that's one of the talking points as we talked to one of 
the Senators this morning about the new--because we're getting 
information about what the Senate is doing, and that was one of their 
things--it reduces health choices. I think the whole point of the 
policy is Americans don't all necessarily want the same policy. You 
know, if you've got a medical savings account, which is something that 
we have supported, so you can put money aside to cover different 
things, and you've got a lot of money in that medical savings account, 
the insurance you may want would be what we used to call a major 
medical policy. It covers the great big things, but the smaller stuff, 
you can say, hey, I can afford to take a thousand or $2,000 hit because 
I've got enough money in my medical savings account that I don't need 
to pay for a policy that covers everything.
  Somebody else who's just starting, and maybe they're a little bit 
worried about they just can't take anything, they're going to want a 
policy that covers a lower deductible. And depending--as you made 
eloquently clear, one size doesn't fit all. It's not the, You can have 
any car you want as long as it's black. We've got choices in America. 
And what this Democrat Senate plan, and it is Democrat, does--there's 
only, huge news, one Republican, just one, that ventured to vote for 
this thing; everybody else is against it--it reduces health choices. 
That's not the way you save money, and it's not the way you provide 
good health care. Very good points, gentleman. I yield to my friend 
from Pennsylvania.
  Mr. THOMPSON of Pennsylvania. Well, what you're talking about is 
actually an amendment that I offered in the Education and Labor 
Committee to bar the exchange, the health insurance exchange, which 
essentially allows this new health insurance commissioner to dictate 
the terms for your private insurance policies. Exactly what my good 
friend from Indiana was talking about. Specifically, what would be 
required, as opposed to a consumer in a free market, where I choose 
what's best for me and my family, a government bureaucrat would dictate 
if my insurance policy qualifies or not within this exchange. And 
again, that's an amendment we offered up to eliminate the exchange from 
H.R. 3200 within the Education and Labor Committee. And that was 
defeated along party lines.
  Mr. AKIN. Another party-line vote. Just amazing, isn't it? Well, you 
know, if you take a look at what the Senate is talking about doing, you 
can understand why there's this amazing gap, because the public opinion 
polls are showing that people are not very comfortable with what we're 
talking about jumping into, and for the sake of whatever it is, 10 or 
20 million people, destroying the health care of 100 million.
  And this, these are some of the costs: It raises premiums, and it 
reduces the health choices which we've been talking about. Those health 
choices are very important. It delays or denies care. This thing here, 
delaying and denying care, as a cancer survivor, I understand the 
importance of this because if you don't get it and get it quick, you're 
a goner. And so this idea of rationing and postponing and having to 
wait in queues, which is endemic in England and Canada, that's 
something that we don't--that's a high cost.
  We've got some other costs here. We've been joined by my good friend 
from Iowa, Congressman King, and I imagine you might have a few 
thoughts on these subjects as well.
  Mr. KING of Iowa. Well, I thank the gentleman from Missouri for 
holding this special order. And as I hear the word Iowa, I look across 
that list and I see $500 billion in Medicare cuts. And we know that 
nationwide, Medicare reimbursement rates, the services provided under 
Medicare, are only compensated under the schedule we have today at 
about 80 percent of the cost of delivering that care.
  And if you look around the country where you have concentrations of 
seniors, we know that's where the Medicare dollars go. And my district 
of Iowa, as a State, has the highest percentage of its population 
that's over the age of 85. And we're in the top six or seven over the 
age of 65. So we actually do pretty good on the longevity side. And in 
99 counties in Iowa, 10 of the 12 most senior counties in Iowa are in 
my district, so I may well represent the most senior congressional 
district in America.
  And I'm standing here looking at this data that's been out here now 
for probably 2 months, a half a trillion dollars in Medicare cuts, 
Medicare cuts. And the administration takes the position that they're 
going to find waste, fraud, and abuse. But it's odd that if they know 
where the waste, fraud and abuse is, why do you have to bargain to get 
a socialized medicine program in order go after the waste, fraud and 
abuse? If you find waste, fraud and abuse in government, don't keep it 
secret, Mr. President. Tell me where it is. We'll find it here in 
Congress.
  And that's one of my concerns is that you can't bargain that. If it's 
good policy, eliminating waste, fraud, and abuse is always good policy. 
You don't hold it out and say, I've got a secret. It's in the 
envelope--karnak predicts that if you pass my national health care 
plan, I can find you billions of dollars worth of savings. But taking 
it out of our senior citizens' pockets. And it's so interesting to me 
that I remember my junior Senator, Tom Harkin, had a political campaign 
that resolved around a statement that he made, he referenced $6 
billion, and he said, Well that's just pencil dust. And so his opponent 
walked around with a man-sized pencil the whole campaign showing $6 
billion is not pencil dust.
  But I recall the spokesperson for the AARP sitting on a national 
cable news program, referring to the half a trillion dollars in 
Medicare cuts, now it does sound like more when it's $500 billion in 
Medicare cuts, referring to it as a small percentage of the overall 
outlays. Half a trillion dollars, a small percentage of the overall 
outlays. That's one of the pieces of the bullets that you have there.
  Mr. AKIN. I'd just like to cut in a little bit on you, gentleman. 
When you've raised this point that Medicare pays for whatever it is, 80 
or 90 percent of the actual cost of a procedure. So what that's saying 
is, whenever a doctor treats a Medicare patient, what's really 
happening is there's more cost than actually is being paid by Medicare. 
So what that means is at a certain point, if you were to reduce what 
Medicare is paying, there's going to come a point where a doctor says, 
enough already. I just can't afford to cover any more Medicare patients 
because, guess what, I'm going to have to cover some other patients, 
and I'm going to have to charge them 120 percent to make up for the 80 
percent over here because we're cost shifting.
  So, in other words, what's happening is somebody is having to pay 
more. So now what we're going do is take $500 billion out of this. And 
what's that mean? Somebody else is going to have to pay more.
  Mr. THOMPSON of Pennsylvania. I think that you are just going down a 
line, a road that is so important in this debate. It really comes back 
to where we started talking about rationing. And the ultimate form of 
rationing, to me, is where you have to close hospitals, especially in a 
congressional district like mine, and probably a number of my 
colleagues here are very

[[Page 24811]]

rural; to get to another hospital when one closes is a commute that 
makes a difference between life and death. Hospitals, rural hospitals, 
and I'm sure underserved urban hospitals in particular, they have a 
banner year when they make a margin of 1 to 3 percent--1 to 3 percent.
  Mr. AKIN. That's not a lot of fat.
  Mr. THOMPSON of Pennsylvania. No. Because out of that 1 to 3 percent, 
hopefully they're able to give some type of cost-of-living adjustments 
to keep the best and the brightest in terms of physicians and 
therapists and nurses and health care professionals.

                              {time}  1745

  They also need to be investing in new lifesaving technology that is 
being developed all the time. And so we see these Medicare cuts in 
particular.
  I also put out there the public option, because the public option 
will pay by statute, what I saw in the Education and Labor Committee, 
pays Medicare rates 80 to 90 cents on the dollar of costs, essentially 
what you will do is bankrupt hospitals and physicians. And I project 
that that will hit first in rural America and underserved urban areas.
  That's rationing. When you close facilities, when physicians no 
longer are in practice because they can't balance their books, that is 
the purest form of rationing services.
  Mr. AKIN. Rationing is something we need to give some thought to.
  My good friend from Indiana.
  Mr. SOUDER. There's one point I wanted to make sure I got in here 
tonight, because part of my district is stunned today. The Senate 
Finance bill yesterday is proposing a tax that ranges from 10 to 30 
percent on the medical device industry. Now, when we talk about 
Medicare, what we're really talking about is they cover not quite 
variable costs, but cover no mixed costs, and no fixed costs for 
hospitals or for reimbursement of other things. Private pay pays for 
the rest of it. And what this bill is in danger of is squeezing or 
taxing out private pay.
  Now what I hear often is why can't we just all go to the Medicare 
system? The Medicare system, people who are alive today wouldn't be 
alive if it were based on Medicare reimbursements because the 
pharmaceuticals wouldn't have been made. The hip replacements that they 
have, the shoulder replacements, the knees wouldn't have been invented, 
because the key is R&D. Lilly in Indianapolis, at one point, 60 percent 
of their profits were from Prozac. Every other drug that was invented 
was funded with R&D from that. But if they attach an R&D fixed amount 
to a particular drug, there will be no excess profits with which to 
experiment.
  The orthopedics industry, according to OrthoKnow, an article by John 
Engelhardt that was just released shows that the tax on the orthopedic, 
a little town of Warsaw, 15,000 people in that county, is one-third of 
the orthopedics industry in the world in my district. Three of the five 
biggest, they own the biggest companies in Europe, they are looking if 
this tax goes through and how they move out. This is one when we move 
up the ladder, we say we're not going to just flip hamburgers, we're 
going to go up, we're not going to do commodities, we're going to go 
higher, and then we get up to the higher areas, and we tax them.
  Here is Zimmer, the biggest, based in Warsaw. Their R&D budget was 
$194 million. The tax under the Senate bill is 94.7. Stryker--
  Mr. AKIN. Wait. Wait. Wait. You're going too fast for me. This is 
absolutely incredible. What you're saying is one of the most brilliant 
parts of American health care has been the innovation, has been all the 
new drugs, the new devices, the new procedures. As I mentioned, I'm 62 
now. I have gotten to be an old geezer, and my left hip has been giving 
me trouble. You see me limping around, and I'm going to be looking at a 
hip replacement. Those weren't available 25, 30 years ago.
  Mr. SOUDER. Commodities. The head and founder of Biomet, Dane Miller, 
talks about in here, they didn't think titanium was going to work. He 
had somebody serendipitously put into his arm titanium. He walked 
around with it for 12 years and proved it worked. And they said, wow, 
this doesn't disintegrate. They used to use basic pieces of wood as 
your hip. Now we customize it. We try to make it so that when soldiers 
get hurt on the battlefield and they are 18 years old, they're not 
going to die in 5 years. Is this going to be flexible enough? How is 
the skin and bone going to go around it? Michael Porter points out, 
innovation comes when you have a cluster and there's competition. You 
destroy that, you take away the R&D. Medicare doesn't pay for that. 
Private pay pays for that.
  Furthermore, Zimmer is proposed to be taxed half. Stryker is proposed 
to be taxed half. Smith & Nephew is proposed to be taxed half of their 
R&D budget. Biomet, $82.2 million in research; $60.9 million is their 
tax. Because they were doing readjustments last year, they didn't even 
make any money.
  Now, how do you think we are going to have a single innovation in 
orthopedics if you tax half of the R&D? And furthermore, they don't 
call it a ``tax,'' they call it a ``fee,'' so it is not even tax 
deductible.
  Mr. AKIN. So what I'm hearing you say, gentleman, then, is this. 
Let's just assume if you're a company, for every dollar you put into 
R&D, you get the same benefit out. You're saying you're going to slash 
the R&D budget of some of the big innovators in medicine; you're going 
to slash it by half because you're going to tax them?
  Mr. SOUDER. The little ones get hit harder.
  Mr. AKIN. Now England and Canada have had this socialized medicine 
for years. Are they known for the innovation that those countries have 
added to health care?
  Mr. SOUDER. They come here.
  Mr. AKIN. They come here?
  Mr. SOUDER. When they need a new hip, the inventions are coming out 
of Warsaw, Indiana. The parts groups that work at some little companies 
like OrthoPediatrics, they're working on specialized hips for kids who 
are 4 years old and 6 years old. Are they going to go to Wal-Mart and 
pick one up off the shelf? Let's get real here.
  Innovation requires competition. It requires investment. The way you 
keep a cluster, according to Michael Porter in ``The Competitive 
Advantage of Nations,'' when you have a cluster, you need competition. 
There has to be innovation every week, how can I get better? And that's 
driven by profit and by competition.
  R&D in England is one of the highest in the world, yet they don't 
produce new products because the government is most of the R&D. It's 
not driven for what the consumer wants where the consumer basically 
rewards the market. And we are going to tax these little ones totally 
out and the big ones half, and we simply aren't going to get the 
products. So we don't have the option of going to Canada and England to 
get it.
  Mr. AKIN. So what you're saying, gentleman, is you're going to kill 
R&D. You're going to kill the development. There are all kinds of 
people that have cancer that is ticking away slowly. They want some 
innovation. They are hoping some new drugs or some new procedures are 
going to come along. We're going to kill that. We're going to get rid 
of that, and we're going to go to a system that has never worked 
historically.
  Here is a chart. This kind of got my attention, because as I 
mentioned, I was diagnosed with cancer, but take a look at the cancer 
survivor rates when you go to the U.K. compared to the U.S., and what 
you see is that big waiting time and that lack of innovation. You don't 
live as long when you are over in the U.K. In fact, I was told that 
when you add up all the cancer times, U.K.'s is a 50 percent survival 
rate if you're diagnosed with cancer. In the States, it's supposedly 
considerably higher. So why do we want to destroy a system that is 
producing this level of innovation?
  What you are talking about is free enterprise. And free enterprise 
needs, first of all, to have people have enough money to be able to 
invest; and second of all, have that competition and that

[[Page 24812]]

hub of technology that you're starting to drive and one guy is 
thinking, Hey, I see what they did. That was a cool device. But I think 
I could up it one. I could do it even better. And that American process 
is what has allowed us to enjoy the best health care in the world. If 
you're a rich sheikh from Bahrain and you're sick, guess where you're 
going to go? The good old U.S.A.
  My good friend from Iowa.
  Mr. KING of Iowa. I thank the gentleman from Missouri, and I look at 
this data that is there. You didn't read the text below that, the 
success story here in America in proportion, but U.S. companies have 
developed half of all new major medicines introduced worldwide over the 
past 20 years. It happens to also be true that in the United States 
slightly more than half of the research dollars in the entire world are 
invested here. Those things are not coincidences. Those things come 
together. It's almost directly proportional to the research dollars. 
I'd like to think we are a little better than that. I'd like to think 
that we have innovative skills and there's something within our culture 
and our mindset that lets us push even a little harder than that. But 
what we're hearing from the gentleman from Indiana is that this policy 
punishes the very most successful among us in this country, and it's 
likely to drive them overseas.
  I had a long conversation with a representative from one of the large 
well-known medical industries in the country, and they've developed a 
technology, and I'm not going to define it any more than that it would 
be transformative from a cure standpoint. And they are looking at 
deploying that in other countries where they can actually get it 
deployed more quickly. If that happens, if they can introduce new cures 
in other countries, the research dollars will follow too, and they will 
set up shop in those countries. It won't be just customers; it will be 
our businesses that go, just as we heard from the gentleman from 
Indiana.
  Mr. AKIN. The thing that concerns me is that it's possible for us 
jumping in haste to some kind of a solution like this because of all 
the political hubba-hubba that's going on, to jump into something which 
is going to permanently damage American health care. It's going to 
irreparably move us in a direction where it's going to be almost 
politically impossible to recover from. It's a little bit like when you 
get on the gunwale of a canoe, you put enough weight on it, and you're 
going to dump it over.
  We have a very good health care system, but can it take this kind of 
a hit? $400 billion in new taxes. Guess who is going to pay those? Do 
you think those are rich guys that are going to pay those? That's going 
to be every plain old working person in this country that is going to 
be part of that $400 billion. $500 billion out of Medicare. Guess who's 
going to pay that? That's going to be the seniors. And the delays and 
denied care. Who's going to pay that? That's people with heart 
problems, people with cancer problems. People will be waiting in line. 
People will have some bureaucrat controlling their health care.
  One of the things that really scares me about this, and maybe I'm 
thinking of it a little too personally, but we are Congressmen, and one 
of the things that we do in our office is we try to help our 
constituents that have a problem with the Federal Government. And so if 
somebody needs to get a passport, we go hurry up and try and help them 
get their passport quicker. If somebody has a problem with a permit or 
something, WE go call the bureaucrats up and say, Can you help out? 
What form have we not done? How can we help this? And we try to help 
our constituents out. Now, I'm picturing I'm on the phone and we've got 
this kind of system, and I'm getting the phone call that says, You've 
got some government bureaucrat that just told my dad he can't get a 
heart bypass. What am I supposed to do?
  I yield.
  Mr. SOUDER. The chancellor of one of my universities, yesterday, when 
I was at Turnstone, this fellow that works with kids who have physical 
disabilities and gets them recreational activities, he said, My dad is 
a veteran and my mom is now in the hospital, and we tried to check with 
the Federal Government to get the eligibility benefits. We kept getting 
taped messages saying the person is there on Thursdays for 2 hours.
  That's what you'll get with government health care.
  Mr. AKIN. Thursdays on 2 hours. So get in line. That's incredible.
  We are about at the end of our hour. I would very much like to thank 
my good friends representing a host of different States, people with a 
great deal of common sense, and particularly Pennsylvania, with 25-plus 
years of being in the medical business. You see this thing, it's like a 
train wreck that you're seeing in slow motion.
  What we're trying to say is Americans, pay attention. We cannot 
afford to go this deal about taking 18 percent of our economy and 
giving it to the Federal Government to run. It doesn't make sense. It's 
going to be expensive. It's going to destroy health care. And in every 
other regard, this is just a bad deal for everybody.
  Thank you so much for joining me, gentlemen.

                          ____________________