[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 25291-25298]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  REPUBLICAN ALTERNATIVES TO OBAMACARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Georgia (Mr. Broun) is recognized 
for 60 minutes.
  Mr. BROUN of Georgia. Mr. Speaker, it is a pleasure to come and talk 
about health care tonight. I expect other physicians to come and 
discuss this extremely important issue to the American people.
  We keep hearing over and over again from our Democratic colleagues 
that Republicans have no alternatives. Well, we have got a bunch of 
binders here. Each one of those contains a Republican alternative to 
ObamaCare that the Democrats are proposing.
  As the staff brings these forward, every single folder is a 
Republican plan. Every single folder is a different Republican plan. 
Every single folder offers suggestions and solutions to the cost of 
health care for all Americans.
  Almost every one of those folders, if not every one of them, we could 
get bipartisan agreement on, if any of these bills would ever see the 
light of the day. Let me repeat that. I believe that we could get 
bipartisan agreement on most, if not all, of these Republican bills 
that will affect health care costs for every single American and will 
offer some solutions to Americans' concern about the rising cost of 
health care.
  It's untenable that health care costs are rising like they are today. 
It's unsustainable the way health care costs are rising like they are 
today. But we ask why. Well, there are many reasons why.
  I have practiced medicine in Georgia for almost four decades now. I 
am a general practitioner, a family doctor. I have seen in my medical 
practice the marked amount of government intrusion and how it runs up 
the cost of health care.
  I will give you a good example, Mr. Speaker. When I was practicing in 
rural south Georgia, I had a small automated lab with quality control 
to make sure that the results I got from my lab were accurate, because 
I wanted to give good quality care to my patients.
  Well, Congress passed a bill called CLIA, the Clinical Laboratory 
Improvement Act, which outlawed mine as well as every doctor's lab in 
the country. Prior to CLIA, if a patient came in to see me with a 
fever, red sore

[[Page 25292]]

throat, white patches on the throat, coughing, runny nose, headaches, 
aching all over, I would do a CBC, or a complete blood count, to see if 
they had a bacterial infection which needs an antibiotic treatment, or 
a viral infection, which is not helped by antibiotics. The patient 
doesn't need to expend the money on those antibiotics and doesn't need 
the exposure with the possible side effects and the consequences of 
being on the antibiotics.
  I could do that test, CBC, in 5 minutes. It cost 12 bucks. CLIA shut 
my lab down. I had to send patients over to the hospital across the 
way. It took 2 to 3 hours and cost $75 for one test. The test goes from 
5 minutes, 12 bucks, to 2 to 3 hours, $75, for one test.
  Now, the American people, if they look at the math there and just 
extend it over the course of everything that comes into play in the 
health care financing in this country, would see that the health care 
insurance costs went up for everybody because of that one government 
intrusion into my office and my ability to give the kind of quality 
care that I am trained to do and that I want to do.
  Another example, Congress not long ago passed HIPAA, the Health 
Insurance Affordability and Accessibility Act. The HIPAA bill has cost 
the health care industry billions and billions of dollars, billions of 
dollars. That's passed on down through the insurance companies and 
through pricing to the consumers.
  It has to be, because people have to make a living. It has cost the 
health care industry billions of dollars and has not paid for the first 
aspirin to treat the headaches that it has created. It's government 
intrusion into health care. That's what's caused a marked rise in the 
cost of care.
  Mr. Speaker, let me tell you something else where this bill that is 
being written in darkness or in secrecy now by the Speaker, we don't 
even have the bill that we are going to see here on floor, if we ever 
see one, because it's being written in secrecy.
  Democrats nor Republicans can see the proceedings. We can't put any 
of our ideas into the writing of that bill. It's being hidden from all 
of us. It's being hidden from the public view, and that is not right.
  We have been promised transparency by this Speaker, but we have had 
everything but transparency and fairness. Both of those things were 
promised, but we are not getting them.
  The bill that Speaker Pelosi is going to present at some time, 
whenever she takes a notion to do so and gets it finished, that she is 
writing in secret currently, is going to have a tremendous amount of 
more intrusion into people's lives. Experts tell us that it's going to 
cost millions of people their jobs.
  In fact, in my home district of Georgia, I have talked to small 
businessmen and women that tell me if the mandates that we already know 
in H.R. 3200 are put in place or the mandates that the Senate bills--
that are already being written in secrecy also on their side--but the 
mandates that we know that they want to include in those bills will 
cost millions of people their work and put people out of work. Why? 
Because they are mandates on small business that small business is 
going to have to either not hire people or they are going to have to 
let people go.
  In fact, I have talked to small businessmen and women, and they tell 
me that with the 8 percent mandate that's in the House bill that's 
going to fall upon them if they don't supply health insurance for their 
employees, it's going to put that business out of business. Millions of 
people in this country are going to lose their job with ObamaCare. The 
American people need to understand that, Mr. Speaker.
  Not only that, it's going to be extremely expensive. We don't know 
what the ultimate cost is because we haven't seen the bill. Nobody can 
see it except for the few handpicked minions of the Speaker and the 
majority leader of the Senate. We don't know how much it's going to 
cost, $1 trillion, $2 trillion, $3 trillion.
  We know this, Mr. Speaker: When Medicare was brought into being, the 
cost estimates of Medicare missed the mark terribly. Medicare has cost 
many, many times over what it was projected to cost by the 
Congressional Budget Office. I think that's exactly what we are going 
to see with us today.
  Congress, Mr. Speaker, is spending money that it doesn't have. We 
hear people over and over again say, well, government will provide free 
health care for me. There is nothing that's free, Mr. Speaker, and 
health care is not going to be free. Who is going to pay for it?
  Mr. Speaker, our children and our grandchildren are going to pay for 
it. It's going to cost them their livelihood. It's going to cost them 
their standard of life, their standard of living, because they are 
going to live at a lower standard than we do today because of this 
outrageous spending that this Congress and this President have been 
doing since January.

                              {time}  1645

  It's got to stop, Mr. Speaker. The American people need to understand 
exactly what ObamaCare is going to mean to them. It's going to cost 
jobs. It's going to cost our children's future. And seniors need to 
know that it's going to cost them tremendously.
  In the nonstimulus bill, and I call it a nonstimulus bill because 
where are the jobs? The President promised us that if we passed his 
stimulus package, we would not reach an 8 percent unemployment. Well, 
it's approaching 10 percent. In my district in Georgia, in many 
counties, it's nearing 14 percent. In many communities around this 
country, it's even higher than that. I have already said that ObamaCare 
is going to put more people out of work. We are going to have more 
joblessness throughout this Nation.
  We cannot continue to spend. You cannot spend yourself into 
prosperity. It's impossible. And that's exactly what we seem to be 
doing. In fact, the President came to the Republican Conference when he 
wanted us to vote on his stimulus package, and he said he wanted 
bipartisanship, which is laudable. But then he went on to say he wanted 
bipartisanship but we needed it and must vote for his bill. He didn't 
want any input from us.
  He's said that his door is open for Republican ideas on health care, 
but he won't listen to us. We've tried and tried, but he doesn't 
listen, because with the President, with the Speaker and the majority 
leader, it's their way or no way.
  In the nonstimulus bill, there was funding for what is called 
comparative effectiveness research. And in medicine, as a doctor, what 
we'll do is look at comparative effectiveness of different treatment 
programs. We will decide, for instance, for prostate cancer if surgery 
alone is more effective than radiation therapy alone or chemotherapy 
alone. And we will compare the effectiveness of those treatment 
modalities, those treatment options, or maybe surgery plus radiation, 
surgery plus chemotherapy, surgery plus all three. This is what we do 
in health care. This is what we do in medicine today. We compare the 
effectiveness of treatments: one medicine for high cholesterol versus 
another medicine for high cholesterol; one medicine for diabetes versus 
another; one medicine for high blood pressure versus another. We do 
this comparative effectiveness. But that's not what the Democrats put 
into the stimulus bill with their comparative effectiveness research. 
And in the new bureaucracy created by ObamaCare here in the House, 
there is a comparative effectiveness panel that is going to make 
decisions about seniors and what they can get in the way of treatments, 
medicines, surgeries, everything. And it's going to be age related. So 
they are going to use an age-related cost comparative effectiveness of 
looking at spending dollars, not treatment outcomes, not whether one 
treatment saves lives over another, but how to best spend the limited 
dollars that the Federal Government has.
  We don't have unlimited dollars, Mr. Speaker, and we cannot continue 
to print dollars like we're doing today. It's got to stop. We've got to 
stop printing money. We've got to stop borrowing from our children's 
future. We've got to stop this outrageous spending, Mr. Speaker, and 
we've got to give people choices.

[[Page 25293]]

  Republicans have offered many bills. Over 40 Republican bills, 
alternatives to ObamaCare, to H.R. 3200, have been introduced in the 
U.S. House of Representatives. Each folder contains a separate bill. 
Republicans are offering folks in this country options, options to 
lowering the cost of health care, options to make sure that patients 
have the ability to choose their own doctor, and that in that doctor-
patient relationship, that's how health care decisions are made, not by 
some bureaucrat that H.R. 3200, ObamaCare, is going to put between the 
patient and their doctor.
  In fact, just today, I introduced my own bill. It's in this stack, 
one of them. Mine is a little over 100 pages. By the way, I have read 
my own bill. I doubt Nancy Pelosi ever read her own bill. But I read my 
own bill. We call it the OPTION Act. The OPTION Act stands for 
``Offering Patients True and Individualized Options Now Act.'' My bill 
will make the purchase of health care more affordable to more people 
because it drastically expands the individual markets available for all 
of us and gives us many options.
  Right now, most people in this country only have one option, and 
that's the insurance that their employer provides to them. About 85 
percent of America has that one option. Medicare and Medicaid patients 
only have those two government options, one each. Also my bill 
increases pooling options. What my bill will do is it will allow what 
we call associations to be formed, if they are not already there, to 
offer health insurance to their members. For instance, I'm a Rotarian. 
Rotary International could have one or more health insurance plans that 
they offer to all Rotarians and Rotarian families around the country. 
I'm also an alumnus of the University of Georgia. We can have a UGA 
health care option that people could buy into. I'm a hunter. I'm a 
fisherman. We could have a hunters' option and a fisherman's option. We 
could have a bricklayers' option and a carpet layers' option. This will 
increase the options and thus increase the marketplace for all 
Americans. And the more options you put on the marketplace, the lower 
the cost is going to be. Plus, it will help to drive down some of these 
outrageous salaries that the insurance companies are offering their 
executives.
  Mine will lower the overreaching cost of health care for everyone 
through the tax system, because what my bill will do is give 100 
percent tax deductibility--let me repeat that--100 percent tax 
deductibility for everybody for every health care expense. And this is 
above a standard deduction. So it will allow an income tax deduction on 
all health care premium costs for everybody. It will allow individuals 
to make tax deductions to any health care expense, including their 
expenses that are funded through a health savings account.
  My bill markedly expands the health savings account and gives people 
the ownership of that where they can turn their health savings account 
into their estate so that their beneficiaries, their family, will 
receive the benefits. In fact, it even creates a Medicare health 
savings account and allows Medicare patients to buy health insurance, 
private health insurance, on top of the health savings account. It 
gives them ownership. It will be funded through Medicare. But it will 
be such that they will own that, and that will go into their estates, 
too, if they don't spend all the funds.
  The AARP can, for instance, sell them supplemental insurance on top 
of their Medicare health savings accounts, and all the insurance 
companies will be able to continue to do business. But it creates a 
marked amount of market forces in the health care field.
  My bill will also repeal and reform the barriers that currently exist 
for physicians to donate their services to people who don't have health 
insurance or can't afford to pay for their health care. And many others 
things are in my bill, H.R. 3889, the patient OPTION Act.
  Republicans offered many alternatives. The American people, Mr. 
Speaker, need to know that what they hear from our Democratic 
colleagues, that Republicans don't have a plan, is absolutely false. 
It's trying to mislead the American people. And the American people 
should call them on that and say shame on you for making these 
outrageous statements because they know it's not factual.
  We have many plans. I have been joined tonight by several other 
physician colleagues here in Congress. We are offering many 
alternatives. Another family doctor is a freshman who has been very 
vocal in this from Shreveport, Louisiana, Dr. John Fleming.
  I welcome you, Dr. Fleming, to this discussion tonight. I know you 
have a lot to say, and I will yield to you.
  Mr. FLEMING. I thank the gentleman, Dr. Broun from Georgia, whom I 
consider a mentor of mine, a family physician who has preceded me into 
Congress. And it's important that we physicians speak out on this 
important issue. We've come to a point now where the Democrat version 
of this, or versions I shall say, are about to be put together and put 
to a vote. And I think that we have an idea about what's going to come 
out on the other side of this, whether it's a hybrid or some sort of 
combination or one or the other, the Baucus bill, which mainly 
emphasizes increased premiums, taxes on health plans, on medical 
devices, if you will; and then on the House side, a plan with a so-
called robust public option which we know to be a very robust takeover 
by the government of health care which will lead to a number of taxes.
  Every one of them finance this program basically in two ways: one, 
raising taxes or a cost on premiums or both; and the other is gutting 
Medicare to the tune of a half trillion dollars. On top of that, it 
gets a running start by taking in revenue for about 3 years before 
actually spending it on anything to, again, cook the books and make 
things look better. And then on top of that is an impending decline in 
reimbursements to physicians of 21 percent in their Medicare 
reimbursements, which, again, adds another $250 billion of cost on 
this, which can be hidden. They're trying to hide it, but it's not 
successful.
  Mr. BROUN of Georgia. I want to reclaim my time just 1 second because 
there's an extremely important point, Dr. Fleming, you just made, and I 
think the American people need to understand that. So I would like for 
you, if you would please, to repeat the statement that you just said, 
and then I want to ask you a question about that statement, if you 
would. Please repeat that statement.
  Mr. FLEMING. That at the end of the day, this thing is going to be 
financed by a combination of increased premium costs--significantly 
increased premium costs--or taxes or both, and gutting Medicare to the 
tune of a half trillion dollars, and on top of that, another $250 
billion of impending cuts to the tune of, at this point, of 21 percent, 
if not greater, to physician reimbursement, which if it ever goes into 
effect will basically collapse the Medicare market and accessibility of 
care to physicians.
  Mr. BROUN of Georgia. The physician reimbursement rate is the point I 
wanted you to really focus upon, Dr. Fleming. I know you've talked to a 
lot of doctors in Louisiana, just like I've talked to a lot of our 
physician colleagues from Georgia, and really from all over the 
country. The doctors' reimbursement rate is what doctors are paid. That 
is now below what it costs them to deliver the care. I think most 
physicians would agree with that, wouldn't you?
  Mr. FLEMING. Absolutely. It's only a fraction of the real cost.
  Mr. BROUN of Georgia. Then if doctors are cut more, that's through 
Medicare and Medicaid today, if doctors' payments are cut even more, 
what's going to happen to a senior's doctor who is out there trying to 
take care of folks now and being underpaid by Medicare? What do you 
think is going to happen? What is the doctor's response going to be? 
What does it have to be?
  Mr. FLEMING. Again, to look at the fundamentals of economics, today 
doctors are paid on average 80 percent of the cost of the care they 
provide. The rest is made up on private insurance. And if you cut that 
further, then physicians will find not only can they not

[[Page 25294]]

break even on providing care to Medicaid recipients, they are going to 
lose money. And they can't afford to do that. They can't make payroll. 
They can't pay their light bill, their rent and so forth if they can't 
make enough money from their patients.
  So the bottom line here is the basic dishonesty of this bill. It says 
that a half trillion dollars will be cut out of Medicare and it's going 
to come out of fraud, waste and abuse. After 40 years, no one has been 
able to figure out how to do that. No one advances a methodology for 
doing that today. And so if you add already the fact that physicians 
are paid less than their costs, an impending cut of 21 percent of their 
reimbursement and perhaps more in future years, and then another half 
trillion dollars, which is going to go against them and hospitals, what 
we're basically doing is telling seniors, Forget it; we're taking your 
health care, and we're giving it to other people.

                              {time}  1700

  Mr. BROUN of Georgia. That is right, and that is what the Cost 
Effectiveness Panel is going to tell seniors is you just can't get that 
surgery, you just can't get that test you need. But doctors are going 
to quit seeing Medicare patients is what is going to happen. I have 
talked to a lot of physicians. So seniors particularly are going to 
lose, because they are not going to get the medical services that they 
need to keep them healthy and keep them living, plus they are going to 
lose their doctor that they have trust in today.
  In fact, in some communities, some patients have difficulty finding a 
doctor who will take Medicare, and a lot of communities, even in my own 
community, patients are having a hard time finding a doctor that will 
take Medicaid, or PeachCare, which is the Georgia SCHIP, State Child 
Health Insurance Program payment.
  Doctors are going to be forced to abandon their acceptance of these 
patients. They want to see these patients, but they are not going to be 
able to do so because of the economic squeeze upon the doctors. Right 
now doctors are being paid less than what it costs them to actually 
give the service.
  Mr. FLEMING. If the gentleman would yield, I would like to extend 
that another step. Remember that I said earlier the only way doctors 
are making it now is that private insurance is making up the 
difference, it is making up the gap, on average $1,800 per family per 
year that is insured.
  Mr. BROUN of Georgia. That is not fair either to the private side.
  Mr. FLEMING. No. Absolutely. What this bill will do is not only gut 
Medicare and reduce the reimbursements to physicians already, but it is 
going to deliberately push people from private insurance, because this 
so-called competition is going to be an artificial market, which is 
really a low-ball, and it is going to force employers to push their 
employees onto this. So you will see Medicare enlarging. And when I say 
that, I don't necessarily mean in a generic way.
  Just today, the Democratic Party released a trial balloon, saying, 
well, instead of calling it a public option, let's call it Medicare for 
everyone. Every physician will be paid at the Medicare rates for all 
these new patients.
  So what you have in the end, just to summarize, is a growing Medicare 
pool or universe and a shrinking private insurance, which will drive 
insurance costs up steeply, and you will be left with basically a 
collapsed private insurance market.
  Mr. BROUN of Georgia. That is the reason we know that millions of 
people are going to lose their private health insurance, because they 
are going to be forced off of it and forced into this so-called public 
option, this government, bureaucrat-run, socialized health care system. 
And we already see we have several government, bureaucrat-run health 
care systems, Medicare being probably the most notable one, which is 
already rationing care.
  It tells me as a doctor and you as a doctor when we can put a patient 
in the hospital or not and how long they can stay there or not, whether 
they can get a medication or other types of treatments or not. And they 
want to put everybody in that kind of system? I think not. That is not 
what is in the best interests of the American people. The American 
people need to understand this.
  We have also been joined by another good friend of mine, also from 
Louisiana. We are blessed in the Republican Conference with three 
excellent physicians from the State of Louisiana. Dr. Bill Cassidy is a 
gastroenterologist, and he has been working in a public hospital for 
years and taking care of patients that have had problems with health 
insurance.
  Dr. Bill Cassidy is one of the sages of the freshman class and an 
excellent physician from Louisiana. We are blessed to have him here 
tonight, and we are blessed to have you, Dr. Cassidy, in the Congress 
to help us discuss the issues about health care finance reform.
  This whole discussion is not about health care reform. We have got 
the best health care system in the world. Some of the Democrats will 
refute that statement, but, factually, people come from all over the 
world for our health care because it is the best in the world.
  Dr. Cassidy, thank you for joining us tonight. I will be glad to 
yield to you for a while.
  Mr. CASSIDY. Thank you, Dr. Broun. I am pleased to be here.
  Let me start off by saying I actually totally agree with our Democrat 
colleagues on the goals of health care reform. We have to control 
costs. By doing so, you can create access to high quality care.
  As you mentioned, I have been working in a hospital for the uninsured 
for 20-something years, a public hospital in Louisiana, part of our 
safety net system, so it occurs to me that I know firsthand the need to 
control costs. In our budget, there is a fixed budget, if you will. If 
we exceed that, then we don't have the ability to provide more access. 
We do have to form those long lines. And I kind of applaud the 
President because he recognizes the need to control costs.
  For example, he has more than once said that the price of failure is 
that costs will double over the next 10 years. In fact, I think the 
President has said that without his reforms or the reforms he agrees 
with, that we know that the costs will double over the next 10 years 
and they will be out of control. I think he recognizes that cost 
control is one of the three legs of the stool. Again, we must control 
costs in order to ensure access to high quality care.
  But we on the Republican side, I think, have continually pointed out 
that his programs will lead to higher costs, not lower costs, and that 
is of concern to me, who has worked in a public hospital, that knows 
that once costs are out control, then you inevitably have a decrease in 
access.
  I was struck today that there is an independent article that just 
came across the Associated Press that under the proposed overhauls, the 
U.S. health care tab would grow. That is the headline. And this is an 
analysis by the Health and Human Services Department looking at the 
impact of H.R. 3200 upon overall health care costs.
  Mr. BROUN of Georgia. Tell me it is not so. It is going to go up? The 
health care costs are going to go up?
  Mr. CASSIDY. You know, in one sense, in one sense it is almost 
humorous, and in another sense, it is almost tragic. Because what we 
have been saying all along is that under these proposals, costs 
actually go up, and we know in our practice when that cost goes up, 
inevitably there is some sort of squeeze-down on people's access to 
high quality care.
  By this, which is an independent government economist, this is the 
Medicare Office of the Actuary, it says that the report found that 
health care would account for 21.3 percent of the U.S. economy in 2019 
under these reforms, slightly more than an estimated share of 20.8 
percent of the economy if no bill passes.
  Additionally, it says that with the exception of the proposed 
reductions in Medicare, the legislation would not have a significant 
impact upon future health care gross costs. It adds, it is doubtful 
that the proposed Medicare cuts will stay in.

[[Page 25295]]

  What we are seeing is that when the President says that reform must 
be done or costs will double, indeed, under their reform plan, costs 
more than double.
  Another report by the Congressional Budget Office suggests that under 
the reform plans before us, including the Senate Finance Committee, 
that the rate of inflation will be 8 percent per year. That is 
compounded. That more than doubles costs. At a minimum, reform should 
not be more expensive than the status quo if cost is the issue.
  So, Dr. Broun, I want to return, I think you are right on when you 
spoke earlier about your bill, and, of course, I am a cosponsor of H.R. 
3400, which includes things such as Health Savings Accounts, that 
actually can bend the cost curve.
  I was speaking to a woman back home who does small group insurance. I 
called her up and I said, If you have a family of four with an HSA and 
a wraparound catastrophic policy versus a family of four with the 
traditional insurance policy, what is the rate of inflation?
  She said, Well, with the Health Savings Account and the wraparound 
catastrophic, about 6 percent per year. Now, that actually begins to 
bend the cost curve down. She said, though, for the traditional 
insurance policy, it is more along the lines of 9 to 11 percent per 
year.
  So I think what we in this delegation, this conference, have found is 
that if we empower patients, if we do what a Health Savings Account 
does, which is take a portion of that health insurance premium, puts it 
into an account, and if the patient has money left over at the end of 
the year, it belongs to the patient, she can roll it over into the 
account the subsequent year, as opposed to a program which empowers 
government, which is a top-down, central planning Medicaid-Medicare 
type of program, which, as good as they are, nonetheless have inflation 
rates which are higher than the inflation rates for even traditional 
insurance policies. If we go with the patient-empowered process, we 
control costs. If we go with the same paradigm as this report states, 
we actually increase costs, the kind of government paradigm.
  If I can defer to my colleague from Shreveport, Dr. Fleming actually 
has a very nice story about how they brought Health Savings Accounts 
into their small group and indeed lowered costs.
  Mr. FLEMING. I appreciate your yielding for a moment.
  Absolutely true. Apart from being a family physician for over 30 
years, I have owned small nonmedical businesses for a number of years, 
over 20 years, and we ran into this same escalation problem, 9, 10, 12, 
15 percent, really, per year. Finally we said, What can we do to 
resolve this? And the Health Savings Account had been enacted again by 
the Republicans just shortly before that, and I studied it.
  I used my background as a physician in the economics of medicine and 
I said, You know what? This, in effect, connects the patient, in this 
case me and my employees, back to the real cost of care. It should have 
a remarkable impact bending the cost curve down. We didn't use that 
term then because it hadn't been used. But to make a long story short, 
we implemented it. We are about 7 years down the road now, and our net 
increase in inflation cost has been less than 3 percent per year.
  Mr. BROUN of Georgia. That is outstanding.
  Let's go back to something we said with both of you, Dr. Fleming as 
well as Dr. Cassidy. H.R. 3200, the Pelosi-ObamaCare bill, is going to 
raise overall costs of health care in this country. It is not going to 
lower the cost; it is going to raise the cost. Not only do we have this 
administration estimate that it is going to increase the cost, but even 
CBO said it is going to increase the cost. CBO said it is not going to 
cover everybody.
  Mr. CASSIDY. CBO, if I may, the Congressional Budget Office, because 
I find sometimes we get used to these terms, but the independent arm of 
Congress that evaluates the fiscal matters, if you will, whether or not 
something costs more or less or is just right, the Congressional Budget 
Office says the rate of growth will be 8 percent per year under the 
plans before us from the House Democratic leadership and the Senate 
Finance Committee, and that more than doubles costs in 10 years.
  Mr. BROUN of Georgia. Absolutely. So it is going to cost more money 
for everybody, and it is going to cost jobs. Millions of people are 
going to be put out of work by the ObamaCare bill. And we have got all 
these bills. Every folder has a different bill that the Republicans 
have introduced, many, many alternatives, that will lower the cost, let 
me repeat that, lower the cost for everybody and get more people on 
insurance.
  We have also been joined tonight by another good friend, a freshman 
from Tennessee who has been very eloquent in telling us about the 
Tennessee experiment that is exactly the same experiment, the same 
program that Nancy Pelosi and Barack Obama and Harry Reid are trying to 
force upon the American public called TennCare. It didn't work in 
Tennessee and it is not going to work here. In fact, one of the 
definitions of insanity is doing the same thing over and over again and 
expecting different results.
  We have already done it, haven't we, Dr. Roe?
  Mr. ROE of Tennessee. Well, Dr. Broun, we have. Let me say I was here 
this morning early, and I came to this Congress, I practiced medicine, 
OB-GYN, delivered almost 5,000 babies, and I came to this Congress with 
a nonpartisan background as the mayor of Johnson City, Tennessee. That 
was my political background. So I came here to try to help be part of 
this great health care debate.
  How I started my time off was I brought every think tank that I could 
find--Brookings Institute, which is a left-leaning think tank, Heritage 
Foundation, Cato, AEI--into my office and sat down and listened to them 
and said, What is the problem? How do we define the problem of our 
country right now as far as health care is concerned?
  One of them was escalating costs. How do we deal with that? How do we 
deal with the uninsured and how do we deal with preexisting conditions?
  I think the thing that troubles most of us out there, and me as an 
individual, quite frankly, is if you lose your job, you lose your 
health care. That is something that everyone in this country fears, and 
certainly in a bad job market. So I thought about that at great length 
and brought some basic principles which we have, and I stood on the 
House floor this morning and heard three different individuals say that 
there were no other plans out there.

                              {time}  1715

  That is absolutely false.
  Mr. BROUN of Georgia. Let me interrupt you and just say that we hear 
that over and over again. We hear claims from the Democrats that the 
Republicans don't have a plan. Look at all these bills. Every folder 
has a Republican bill in it. I have my own there. Many other Members, 
all these are Republican plans, Republican bills to help rein in the 
costs and give people more options.
  Mr. ROE of Tennessee. Well, Dr. Broun, if you'll yield back.
  Mr. BROUN of Georgia. Yes, sir.
  Mr. ROE of Tennessee. And I heard my good friends, Dr. Fleming from 
Louisiana and Dr. Cassidy, both mention this. But I looked at it, and I 
thought How can we make insurance portable? How do you affect 
preexisting conditions? If you have a large group market, you don't 
have a problem with preexisting conditions.
  For instance, in our city, where I was mayor, it didn't matter. How 
did we handle a preexisting condition? We took everyone in. Everyone 
paid the same rate, and we bought catastrophic coverage in case someone 
had a leukemia or a cancer or a severe heart problem and covered that 
issue.
  We also used prevention and wellness. And I can tell you there are 
four organizations in my community, in my area, that have had minimal 
health care increases in the last 4 to 5 years. How do they do that? 
Well, they change the incentives from consumption to wellness. And 
let's say you

[[Page 25296]]

 came in and you were hypertensive and you had diabetes and you smoked 
and you were overweight. Well, we would penalize you financially for 
that. These organizations--and there are businesses there that have 
been able to hold their costs down--but if you changed and modified 
your behavior, we rewarded you for that and you would actually earn 
money by changing your behavior.
  And guess what that's done? That's empowered the patient to be in 
charge of their own health care. And we hear all the time about 
insurance companies. And I can tell you right now, I'm not sitting here 
defending an insurance company. And you and I--I'm a surgeon, and I've 
spent as much time on the phone trying to get an insurance company to 
approve care than I actually do in the cases. But in our own practice 
we have about close to 300 people who get their care from our group, 70 
providers, 300 or so employees.
  What we did, and what I've done, is use this as a health savings 
account card. And what Dr. Cassidy was talking about, so people 
understand how this empowers the individual, is this: so much money, 
whether it's $2,000 or $3,000 and you go buy first dollar. You're going 
to shop. I do. If I go get a scan, I want the best price. At the end of 
that year, if I don't spend that money, it goes into an account, as 
Doctor Fleming said. Now, how many people in our group chose to use 
this? Eighty-four percent, instead of traditional accounts, they used a 
health savings account.
  Mr. FLEMING. Will the gentleman yield on that?
  Mr. ROE of Tennessee. Yes.
  Mr. FLEMING. On the subject of health savings account--and you heard 
me say our experience was less than 3 percent increase in costs per 
year. And you point out that it's the employer's dollars that are going 
into that account, not the employees. It's pre-tax or nontaxed, really; 
and it's used at the employee's discretion.
  Just a quick example: had a lady who, when we first implemented this, 
she said, Well, I'm a little concerned because this means that I'll 
have to pay out of pocket, meaning out of the health savings account 
for my medications for my respiratory problems. And I said, Well, what 
is it that you take and how much does it cost? And she says, Well, I 
use several inhalers. It costs me $100, $150 a month for medication. 
And I suggested, Well, why don't you stop smoking and you'll save money 
on the tobacco, and you can stop your inhalers, probably. And sure 
enough, she did: came back 3 months later and thanked me. She felt 
better. She had a lot more money in her pocket, and it all had to do 
with the health savings account.
  Mr. BROUN of Georgia. Reclaiming my time, as a family doctor, it's 
always been a problem for me to get patients to comply with these 
wellness suggestions that I make that Dr. Roe is taking about. I talked 
to a hospital administrator in my district Monday, and he told me that 
their health insurance plan for their employees has a $2,500 
deductible. But what they put in place was, if a patient smoked, they 
would pay a $2,500 deductible. If they have high blood pressure, they 
pay a $2,500 deductible. Diabetes, if they didn't lose weight and 
control their sugar, they had a $2,500 deductible for everybody.
  But if you don't smoke, they'd give you a $500 credit. If you 
controlled your blood pressure, they'd give you another $500 credit. If 
you controlled your blood sugar, another $500 credit. If you lose 
weight, another one. And people could actually, by doing these things 
that we all suggest to our patients to make them healthier, and make 
them less liable to expend health care dollars, people could actually 
get credits so they had no deductible. And if an employee didn't have 
those problems, then they didn't have the deductible because they were 
already under control, their blood pressure was controlled, their sugar 
was controlled, et cetera.
  So going back to what Dr. Roe said, it was an excellent way of 
getting their employees to help take care of themselves and lower the 
cost for them as a company, plus it lowered the cost for all of their 
employees too. We've also been joined by my good friend, Roy Blunt from 
Missouri; and we welcome you, Mr. Blunt, anytime for, not only this 
Doctors Caucus Special Order, but you've got--you're very sage on these 
issues and I yield to you, sir.
  Mr. BLUNT. Well, I thank the gentleman for yielding. It's good to be 
here on the floor with so many of our Republican doctors. When you're 
in a debate on health care, and you can say, Doctor, Doctor, Doctor, 
Doctor, you'd probably better be in a discussion on health care. And I 
want to say that our Republican doctors have really been doing a great 
job leading on this issue. Many of them were on the health care 
solutions group that I led and, you know, we haven't produced an 1,100-
page bill or a 1,500-page bill. But there's lots of legislation out 
there that Republicans are for that would change health care in the 
right way and a lot of it that you as individuals are supporting as 
well.
  And one thing I've heard, Dr. Broun, all over the summer, throughout 
the summer and now into these early months of the fall, is why do we 
have bills that nobody can read, that nobody can understand and 
certainly, in health care? I suppose if you're on the other side of 
this issue and you're trying to come up with a health care plan that 
costs $1 trillion, maybe it all has to work together. You have to have 
the taxes, you have to have the mandatory insurance for every American, 
you have to penalize small businesses that don't create insurance for 
their employees, maybe it all does have to come together.
  Certainly in our plan, you can take the bills that we're individually 
involved in and collectively involved in, for medical liability reform, 
nothing else has to pass for that medical liability reform bill to save 
$54 billion. Nothing has to pass for our associated health association 
health plans bill to be out there and suddenly allow lots of people to 
have access to health care that they don't have right now. Nothing else 
that I'm for has to pass for fair tax treatment so that if you get your 
insurance on your own, you have the exact same tax treatment that the 
biggest company in America has if they give insurance to people.
  So we've got lots of bills out there. There are Republican solutions. 
The biggest misleading thing said in this debate, which has lots of 
misleading elements to it, is you can either do what the administration 
wants to do, or you can do nothing. There are lots of choices between 
what the administration wants to do and nothing. They reform health 
care without devastating taxpayers. And that's what we're doing. And, 
again, nobody has been better on talking about the doctor/patient 
relationship and what you do to be sure that doesn't become the 
bureaucrat/patient relationship than our doctors, and I'm glad to be 
here on the floor with you and look forward to being part of this 
discussion for a few minutes.
  Mr. BROUN of Georgia. Mr. Blunt, I want to point out here we have all 
these folders here on the desk. Each one contains a Republican bill to 
help reform the health care financing. Every single one of these, these 
are all Republican bills that have been introduced in this House of 
Representatives. Not one will see the light of day if Nancy Pelosi 
wants to bury them as she has thus far. Every single one of these is a 
plan that I think we could get a lot of Democrats, if they would ever 
have the ability to look at them and consider them.
  But it's unfortunate that this leadership is saying it's either the 
Obama way or no way. And then they come and literally lie about us not 
having a bill. Just this morning during Special Orders, Democrats came 
in and said we don't have a bill. Here they are. The American people 
need to understand that.
  Mr. BLUNT. If the gentleman would yield, we have plenty of 
alternatives, and I'm absolutely confident that if you ask the American 
people would you rather have one 1,500-page bill--I actually heard 
today that the Senate bill, the Baucus bill, is over 1,500 pages. Would 
you rather have one 1,500-page

[[Page 25297]]

bill, or would you rather have 15 bills that were all less than 100 
pages that you could debate one at a time, that you could change the 
system in a way that people understand exactly what you're doing, and 
that you don't devastate future generations with a health care plan 
that just simply can't be paid for when we have reforms that would 
create a lower cost of health care generally, lower cost of taxpayer-
provided health care specifically, and not add to the Federal deficit.
  And I know the answer to that, doctors. I know the answer to that and 
you do too. You all were at the town hall meetings. You've been on 
telephone town halls. And people are tired of bills where the answer, 
where the problem is hidden somewhere in the bill and nobody can find 
it. And believe me, if there's a 1,500-page bill, if this Congress 
stays true to form, there will be a 1,500-page substitute put on the 
table the day we're asked to vote on it, and nobody will have possibly 
had time to read it.
  The bills right behind you are not only the Republican solutions to 
this problem, but they're also the way the American people would like 
to see this problem solved, and we're working hard to do that. We'd 
just like to have an opportunity to present these bills. We'd like to 
have an opportunity to have a hearing on these bills. We'd love to have 
an opportunity for these bills to be debated on the House floor. So far 
nobody's given us that opportunity at any level.
  Mr. BROUN of Georgia. Thank you, Mr. Blunt. I appreciate it and 
appreciate your chairing the task force to look at the health care from 
the Republican Conference side. We've also been joined by my dear 
friend and colleague, one of my mentors actually, Dr. Phil Gingrey, OB-
GYN from Georgia. He grew up in Augusta, Georgia, that I represent. He 
was slightly ahead of me in medical school at the Medical College of 
Georgia, and we're just very honored to have you, Dr. Gingrey. I yield 
to you, sir.
  Mr. GINGREY of Georgia. Mr. Speaker, I appreciate my colleague, Dr. 
Broun, for yielding and for controlling the time and my colleagues Dr. 
Roe and Dr. Fleming. And plus we just heard, Mr. Speaker, from Roy 
Blunt, former majority whip, long-term member of our leadership. And 
talking about wouldn't it be better to have fifteen 100-page bills that 
we could look at and study and understand and take up in a very 
deliberative manner rather than one 1,500-page bill, or in the case of 
the House bill, H.R. 3200, I think, Mr. Speaker, we're talking about 
maybe 1,200 pages.
  But, again, you hear this over and over again, whether it's the 
Sunday morning talk shows or inside the beltway up here, people accuse 
even President Obama suggesting that we weren't bringing him any good 
ideas, any meaningful ideas or, you know, the party of ``no.'' Well, 
Dr. Broun and I and others have spoken about we'll accept that 
accusation if you spell it correctly, K-N-O-W.
  And those bills behind him, behind my colleague from Athens, attest 
to that fact. And probably my colleagues have already mentioned this. 
But just in our GOP Doctors Caucus, there are about 12 of us, and I was 
just looking at a list of bills on health care that have been 
introduced. Probably most of them are in those binders behind Dr. 
Broun.

                              {time}  1730

  But Dr. Boozman from Arkansas has three different bills, Dr. Boustany 
from Louisiana--cardiothoracic surgeon--two bills; Dr. Michael Burgess, 
our colleague from Texas, OB-GYN, has six different bills, including a 
paid-for doctor fix elimination of that SGR. Dr. Broun has a great bill 
himself, H.R. 227; Dr. Cassidy has a bill; Dr. Fleming has H.R. 615; 
Dr. John Linder; Tim Murphy, our colleague from Pennsylvania, has two 
bills; Dr. Ron Paul from Texas has six different bills; Mike Simpson 
from Idaho has a bill.
  Let me just say real quickly, Mr. Speaker, because I know our time is 
running short, but you talk about a simple bill, an easy to understand, 
easy-read bill, my bill, H.R. 3700, here it is, Mr. Speaker. Here it is 
right here. This is easy. If you drop this bill, it just kind of floats 
down. But it is so important because H.R. 3700, Ten Prescriptions for 
Healthy America--I can run through them quickly and not take up too 
much of my colleagues' remaining time.
  Number one, no government-run health plan. I hope my Democratic 
colleagues on the majority side haven't forgotten what people were 
telling them in August despite this recent poll they came out with. I 
think they need to think about that. People don't want a government-run 
health care plan. They certainly don't want cuts in senior care, that's 
$500 billion out of a Medicare system and literally gutting Medicare 
Advantage.
  No new deficit spending. And the President said, Hey, not a dime will 
we add to the deficit. No new taxes. No ration of care, particularly 
for our seniors. They don't want to get thrown under the bus just so we 
can spend $1.5 trillion covering an additional 15 million people. 
That's what, 4 percent of the population--many of whom are young and 
healthy and really don't want that coverage. No taxpayer coverage for 
illegal immigrants.
  So I could go on and on with these 10, but I know we're running short 
of time. But it's great to have an opportunity, Mr. Speaker, to let the 
Democratic majority and their leadership, let the President know we're 
here, we're ready. You say your door's open, we're knocking on it. 
We're ready to come in and present some of these ideas.
  I yield back to my friend from Athens.
  Mr. BROUN of Georgia. I want to go back to Dr. Roe for a minute 
because we've got about 5 more minutes.
  In Tennessee, you all put in a government-run health care program, 
just exactly the same kind of thing that Nancy Pelosi's offering us 
here in H.R. 3200, or whatever she's writing. We know those things.
  Bottom line, very quickly in 30 seconds, did it work, or did it fail, 
and what was the outcome?
  Mr. ROE of Tennessee. Dr. Broun, what happened was exactly as you 
point out. In 1993, we were spending $2.6 billion. We had a lot in the 
State of Tennessee on our Medicaid plan. We changed to a plan called 
TennCare. By the year 2004, it was a $7.5 to $8.5 billion plan. It 
tripled the cost. Forty-five percent of the people who got on the plan 
had private health insurance and dropped it--exactly what's going to 
happen in the public option. And how did the governor, a Democratic 
governor, rein in costs? He cut the rolls. He rationed care in that 
way. And that is exactly what will happen in a public option that we're 
talking about. We'll go into it in more detail.
  Let me take 30 seconds and tell you if we could agree on this and 
pass a meaningful health care bill, this is all you have to do. 
Eliminate State lines so you can form association health plans; give 
tax credits for low-income people to buy affordable health care; have a 
tax deduction for individuals. Last year I was an individual when I ran 
for Congress, and I couldn't deduct my health care premiums. It made 
them 30 percent higher.
  Number four, let young people who don't have a job when they get out 
of high school or college, let them stay on their parents' health care 
until they're 25, 26 years old. It costs the government a big fat zero. 
You can cover 7 million young people doing that.
  Tort reform and SGR fix. Those are not terribly expensive things to 
do. I think we can all agree on them. And I believe we can get a 
meaningful health care plan that doesn't blow up a system that's 
working for 80 or 85 percent of the people right now.
  Mr. BROUN of Georgia. Thank you, Dr. Roe.
  TennCare failed?
  Mr. ROE of Tennessee. Yes.
  Mr. BROUN of Georgia. ObamaCare is going to fail. It's going to wreck 
our economy, it's going to put people out of work, and seniors are 
going to be hurt the most by ObamaCare.
  We've got just a minute left.
  I would like to go back to Dr. Fleming.
  Mr. FLEMING. I just have 15 seconds of a thumbnail little summary I'd 
like to mention.

[[Page 25298]]

  If ObamaCare passes, there will be increased taxes for the middle 
class--which the President promised wouldn't happen--and significantly 
increased private premiums. It will decrease services to senior 
citizens. It will explode the budget. And the bottom line is we will 
pay more for less
  Mr. BROUN of Georgia. You're exactly right, Dr. Fleming. We'll pay 
more for less, we'll get poor quality care. It's going to destroy the 
quality of health care in this country.
  CBO says it's not going to cover everybody, and we hear our 
Democratic colleagues say they want to cover everybody, but it's not 
going to. And it's going to hurt everybody. And it's really going to 
hurt the middle class.
  When the President came and spoke to the joint session of Congress a 
couple of weeks ago, only one person told the truth, and that was Joe 
Wilson. Joe Wilson is the only person who told the truth.
  The ObamaCare bill is going to give free health insurance to illegal 
aliens, it's going to pay for abortions, it's going to do a lot of 
things that people don't like. But the bottom line is people are going 
to be out of work that are working today. It's going to hurt our 
economy. It's going to hurt the elderly, because they're going to have 
their health care services cut, and they're not going to be able to get 
their services from the doctor or from the hospital that they need and 
deserve because of ObamaCare. And the American people need to 
understand these things. Millions of people are going to lose a job and 
be out on the street, and it's going to hurt our economy.
  So the American people need to understand these things and rise up 
and say ``no'' to ObamaCare. Let us have a bipartisan debate on all of 
these Republican plans so that we can find commonsense market-based 
solutions for health care.

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