[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 25816-25822]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank you, and I thank my 
leadership on the Republican side for allowing me to control the time 
during this Special Order hour this evening. And surprise, surprise, 
we're going to be talking about health care reform.
  Mr. Speaker and my colleagues, we all know that this is something 
that has been on the front burner for the entire 7, 8, 9 months of this 
111th Congress. It has certainly been a priority of the President; the 
President has said so on many occasions. In fact, President Obama 
indicated that reforming our health care system is the number one 
priority of his administration. First and foremost, it is the thing 
that he is willing to spend political capital, whatever it takes, to 
have comprehensive health care reform and to have it before the end of 
this first year of his first term.
  I certainly can see that the President, Mr. Speaker, has followed 
through on that pledge. I personally feel that he has made a mistake on 
that. I don't think that the American people believe that fixing our 
health care system to the extent that we literally would throw out 
everything that we've got and let the Federal Government essentially 
take over lock, stock and barrel our health care system--which accounts 
for something like 16 percent of our total economy--at a time when our 
economy is literally, figuratively in the tank. We're sitting here with 
a 10.5 percent unemployment rate across the country and 15 million 
people out of work. It has even affected my own family very, very 
personally, one of my four children. They say, Mr. Speaker, that when 
your neighbors lose their job it's a recession, but when you lose your 
job all of a sudden it's a depression. I know that feeling right now, 
and a lot of people across this country know that feeling.
  When we adjourned for the August recess, the District Work Period 
that's traditional in this Congress, all Members go back home, they may 
squeeze in a little family vacation, but you've got about a month, 
August, it has been traditional probably for 100 years that Congress 
has done that. And we got an earful, did we not, Mr. Speaker, during 
those 4 to 5 weeks of these town hall meetings that Members had all 
across the country? And by a factor of 10, the attendance had increased 
that much.
  On a typical town hall meeting in my 11th District of Georgia in the 
nine counties I represent--and we would always try to have our town 
hall meetings at a time that was most convenient to our constituents, 
that would be easy for them to get to, maybe at a senior center, and 
try not to schedule it during suppertime or during prime time TV 
evenings--you might get 50 people on a good night, maybe 75 people when 
they were really ginned up about something.
  Well, in my case, in the 11th of Georgia, we were getting 750 people, 
1,100, 1,500--in one instance 2,000 in some of the town hall meetings 
we had. And we were seeing the same thing all across the country, 
whether they were Republican districts or Democratic districts. Mr. 
Speaker, what these constituents were saying--many of them, of course, 
were seniors--they're most concerned about the economy, of course, 
because they're on a fixed income. My mom is one of those. God bless my 
mom, Helen Gannon Gingrey, originally from Manhattan, New York City, 
but lived in the South most of her life. She is 91 years old now on a 
fixed income, relies on Social Security and Medicare and Medicare part 
B and part D. She's a little disappointed she's not going to get a COLA 
this year. But these folks showed up at these town hall meetings 
telling us, We don't want to pay for some new government-run health 
care system from A to Z that's going to be paid for on our backs. And 
what they're referring to, of course, is mostly the cuts, the deep cuts 
that the bills in the House and the Senate propose to take out of the 
hide of the Medicare program.
  I'm going to be joined, Mr. Speaker, by a number of my Republican 
colleagues. In fact, tonight the participants in our hour are going to 
be for the most part the doctors on the Republican side. We have a 
caucus, a group that we call the GOP Doctors Caucus; there are about 15 
of us in that group. We have a number of M.D. physicians. We have a 
doctor of psychology, we have a doctor of optometry, we have a couple 
of dental doctors, and people that have spent before coming to 
Congress--and some of us now have been here 8, 10, 15 years even, but 
before coming here our day job, if you will, our profession was 
delivering health care. We were health care providers.

                              {time}  1745

  We keep our licenses active, I think most of us do, and we keep up 
with medical issues, realizing, of course, that Congress is not 
necessarily forever, particularly young ones who may want to go back 
and go back into the practice of medicine. Those doctors will be with 
me tonight.
  When I totaled up, I asked my colleagues, well, how long did you 
practice? Some of them are OB/GYN doctors, some of them are orthopedic 
surgeons. There is a gastroenterologist. There is a family practice, a 
couple of doctors do family practice, just all across the spectrum. In 
the aggregate, we probably have about 400 years of clinical experience. 
That says something about our age, Mr. Speaker.
  But as an example, I spent 31 years, from the day I graduated from 
medical school, practicing medicine either as a family doctor in a 
small town or while I was in training during my internship and my 
residency and then 26 years of being a part of an OB/GYN group and 
delivering over 5,000 babies in my hometown, which became my adopted 
hometown. My hometown is Augusta, Georgia, but Marietta, Georgia, in 
Cobb County is where I now live and practiced for 26 years.
  Mr. Speaker, we feel we have a lot to bring to the table. It's so 
disappointing we get to do these things at night--as I say, my 
colleagues will join me and I will yield to them when they arrive--
because this is our only opportunity. It's a shame we are in the 
minority. God forbid that it happens to the other side one of these 
days, and they will understand the feeling, but when you have got that 
knowledge of a particular profession, you would think, wouldn't you, 
that the Speaker of the House, the leadership, the minority

[[Page 25817]]

side, both Chambers, they would open their arms and say, for goodness 
sakes, come on in here. Come on here behind this green door where we 
are trying to work out how we are going to do this health reform bill 
and tell us a little bit how it was when you were seeing patients and 
practicing and what were the things that would upset people about 
insurance, health insurance companies and denial of coverage or not 
being able to get insurance because of preexisting conditions. Also, 
Doctor, what do you think is causing the 10 percent, 12 percent rate of 
inflation in the cost of health insurance premiums year after year 
after year? Why is that?
  Could it be this? I have heard some people say that maybe it's a 
medical malpractice issue and doctors ordering a lot of defensive 
unnecessary tests because they are afraid that if they are dragged into 
a court of law someone would say, well, you know, we have got, 
plaintiff's attorney, I have got this expert witness here from 
California. They will say, well, looking at the chart, I see where, 
Doc, you didn't order a fizzle phosphate level on this patient or some 
other esoteric test that nobody has ever heard of and say, ah, you 
know, you are guilty of malpractice. Doctors order everything, almost 
to the point of the patient coming to the hospital, have blood drawn 
one day and becomes anemic the next morning for all the testing that's 
done.
  Again, I bring up this point, Mr. Speaker, because we should be 
participating. We should be doing it on a bipartisan basis. If we 
would, if we had done it--and it's still not too late, my colleagues. 
It is still not too late. It's not soup yet. We have yet to vote on 
these bills that have come through committee on the House side or come 
through the committees on the Senate side. They haven't reached the 
floor of either Chamber. So there is plenty of time to amend, to start 
over. We don't need to rush it any more than we need to rush the 
decision to send the troops to Afghanistan.
  The President, Mr. Speaker, made it very clear, as did his advisers 
and this administration, well, you know, you can't, you shouldn't knee-
jerk now. I know what the General said. I know he said what his needs 
are, but we need to think about this. We need to get it right. It's 
better to get it right than to do it quickly.
  Well, I sure wish they would take the same attitude toward reforming 
one-sixth of our economy, and I think that we could do that. There is 
no rush.
  I will tell you where there is a rush though, Mr. Speaker. There is a 
rush in putting people back to work and stemming this tide of 
unemployment and all these jobs just disappearing and now 15 million 
people in this country out of work. That should be the President's 
number one priority.
  But, anyway, we are going to talk about these issues tonight, and 
there are a lot of thoughts that my colleagues have, as I see them 
begin to join me. I am going to try to go in order of those that walked 
on the floor.
  The first person that I am going to call on is our former majority 
whip, minority whip, someone who has been a part of the leadership with 
distinction on the Republican side of the aisle, and I am speaking of 
the gentleman from Missouri, Roy Blunt.
  I yield to Mr. Blunt.
  Mr. BLUNT. I thank my good friend from Georgia for yielding and 
appreciate the doctors letting me join them here for a few minutes.
  Most of our doctors in the House, Republican doctors in the House 
have been on the Health Care Solutions Group that we worked hard on all 
year to have alternatives, alternatives to government-run health care, 
alternatives to create access to health insurance, health coverage for 
people, even people with preexisting conditions.
  When I joined the doctors on the floor one day last week, there were 
15 bills stacked up in notebooks behind, on the dais, Mr. Speaker, that 
talked about the 15 things that Republicans would like to do. We don't 
think they have to be in a 1,500-page bill. In fact, the things we have 
talked about, like access for everyone, allowing people to stay on 
their parents' plan until they were older, then they have to leave the 
plan today, medical liability reform, more competition in the system, 
associated health plans, all of those things could happen individually.
  It would be great if all 11 bills that I personally cosponsored would 
pass and none of them conflict with the others. We think that's the way 
to move forward.
  But our doctors are consistently our best leaders on this issue, 
because they know all the problems that come up in health care, all the 
challenges that come up in health care, the importance of the doctor-
patient relationship and how important it is that you don't have 
someone come between the doctor and the patient.
  I know, Mr. Speaker, that I and others have been criticized for 
saying that in the Canadian system, if you want to have a procedure 
done, you have to get permission from the government. Often that has 
been interpreted to mean that we are saying you couldn't possibly have 
that procedure done. What we are saying is not that. What we are saying 
is that somebody besides your doctor decides whether you get that 
procedure done or not.
  A well-read Wall Street Journal article back in the spring talked 
about the 57-year-old Canadian that even wanted to pay for his own hip 
replacement procedure and wasn't allowed to do it. It doesn't mean that 
you couldn't get a hip replacement. It just means he couldn't get one. 
It just means some bureaucrat decided he couldn't get one.
  We are going to be talking in the next few days, because of the 
apparent nature of the closed door, behind closed doors negotiation, we 
are going to be talking again about this government-run health care 
plan. The government option would be government-run health care as a 
competitor. My belief, sincerely, is that the government would not 
compete fairly. It would drive the other competitors eventually out of 
business. Now, this new wrinkle, Doctors, to the government-run option 
is, well, the States could opt out.
  Now, I was never in the State legislature, but I worked in a capitol 
building that had lots of legislators in it. Many of my colleagues were 
in the legislature, and they know and I know, and the majority knows, 
that if the government-run option is cheaper--and it will be because 
they, like Medicare and Medicaid, don't have to pay the whole bill--if 
it's cheaper, no legislature is going to opt out and say people in this 
State are going to become the example of standing against government-
run health care. We are not going to have in this State that cheaper 
competitor until the other competitors go away. That's just not going 
to happen. This idea that somehow this is any kind of a compromise 
doesn't stand any scrutiny.
  And then the other big issue over the next few days will be this 
issue of why seniors and people who have been told their entire working 
career since 1965, and anybody who started work after 1965 has had 
Medicare, a Medicare deduction from their paycheck every single 
paycheck, now to be told we are going to cut Medicare benefits for half 
a trillion dollars to pay for this new government plan, if seniors 
figure this out in the next 10 days, this will not happen. If seniors 
understand how this bill would theoretically be paid, this would not 
happen.
  Whether it's the elimination, as is proposed, of Medicare Advantage 
for a whole lot of seniors, one out of four, or whether it's finding 
$300 billion in cuts in Medicare to pay a majority of the costs, that 
$500 billion in Medicare Advantage and cuts in Medicare to pay a 
majority of the cost, now everybody who will walk on this floor is 
surely for finding any legitimate savings in Medicare, but, my friends, 
if we are going to find savings in Medicare, we should use them to save 
Medicare.
  Everybody else that walks onto this floor knows that Medicare is 
supposedly in significant trouble beginning as early as 2017. Why do 
you take savings from a program already in big trouble and say we will 
use these savings to pay for some new program? It won't make sense to 
seniors or anybody who really, frankly, doesn't like the idea that they 
have paid into this

[[Page 25818]]

program out of every single paycheck they have ever had, and the 
Congress and United States is not going to allow that program to be 
solvent in order to start down another road of more health care.
  Mr. GINGREY of Georgia. I appreciate the gentleman's comments.
  I am sure the gentleman would agree with me that it's really 
disingenuous to take $500 billion out of the Medicare program over the 
next 10 years and then, at the same time, tell seniors that, oh, by the 
way, next year you are going to get to pay $110 a month for your 
Medicare part B--I think it's $98 a month, $98.50 now--and we are going 
to raise it to $110 a month at the same time that we are going to cut 
$500 billion out of the program.
  Mr. BLUNT. That's exactly right, you know, one out of every four 
seniors on Medicare Advantage, that would go away under any proposal 
out there right now. The administration apparently told the providers 
of those Medicare Advantage plans that they couldn't tell people that 
there was legislation that would eliminate the plan.
  Now, after a lot of appropriate outrage about that administration 
decision, that gag order to these plans, apparently now they are going 
to say, okay, you can tell them the truth. What a step forward that is. 
You can tell people in Medicare the truth about this. If people in 
Medicare find out the truth about that, and they figure out the truth 
about the other way to pay for this new government program and they 
start calling Members of the Congress of the United States, this will 
not go forward and we will be back to where my friend from Georgia said 
we should be, where we start over. We work together. We do the things 
that will fix what's broken in the system, but we also ensure that we 
keep what's working. More is working in health care than is broken.
  If we are not careful about this, we will eliminate what's really 
working and will actually encourage the things that are broken. None of 
us here on the floor at this minute want to do that, and hopefully none 
of our colleagues will either, and we can all work together in new 
ways.
  Again, I thank the doctors for the incredible credibility and 
knowledge base that they bring to this discussion. I know they are 
going to continue to be at the forefront of this debate between now and 
the end of the year, and, if possible, if it takes until next year. 
This is one-sixth of the economy. This is the most important thing to 
every family, people in your family being well. We ought to take the 
time that it needs to do this right.
  Mr. GINGREY of Georgia. I want to thank the gentleman from Missouri 
and thank the gentleman for his work in leading Leader Boehner's task 
force on health care reform on the Republican side.
  My doctor colleagues that are with me tonight were a part of that 
small group of about 15. We worked on coming up with meaningful reform 
issues in an incremental way over the last several months. I think we 
had a good plan that we submitted to the President, Mr. Speaker, and we 
are still waiting to hear back from him on that, unfortunately.
  Before I yield to my good friend from Louisiana, in fact, my two good 
friends from Louisiana--I am going to start with Dr. Cassidy, the 
gastroenterologist from Baton Rouge--I just want to say one thing. I 
have got this one poster. Dr. Murphy may have some other posters when 
he arrives, but we have a second opinion.

                              {time}  1800

  The GOP Doctors Caucus is the second opinion. The Republican 
minority, 178 of us, Mr. Speaker, we have a second opinion, and that 
second opinion is, no government-run health care.
  We listened to our constituents during the August recess, and that is 
what they told us loud and clear. Somebody might dig up some ABC-
Washington Post poll that says people want government-run health care. 
I would suggest, Mr. Speaker, to all of the Members on both sides of 
the aisle, go back and check with your constituents, like I did last 
night during a tele-town hall meeting, when all of the seniors were on 
the phone and said, Goodness gracious, Congressman, we don't need that.
  I will make this point, and then yield to Dr. Cassidy. There has been 
so much gnashing of teeth and wringing of hands and pulling of hair 
over the last several months, Mr. Speaker, trying to say how are we 
going to pay for this thing? It is going to cost a minimum of $1 
trillion. And then President Obama said, No, we are going to limit the 
expenditure to $900 billion, but we are going to pay for it all. I 
won't sign a bill that adds one dime to the deficit.
  So, you figure out, well, we are going to tax here, we are going to 
tax there. We are going to take $500 billion out of Medicare, as the 
gentleman from Missouri just talked about, Medicare Advantage. We are 
going to gut that program. And, hey, we have come up with $900 billion 
and we are going to do this government-run health care. What in the 
world, Mr. Speaker, have we accomplished?
  I want to use this analogy. It would be like a family 25 or 30 years 
ago scrimping and saving and cutting down on food and clothing and 
family vacation and college education for the children to save up 
enough money, and you finally save up enough money and you buy an 
Edsel.
  My colleagues, I hope you all remember the Edsel. I am not knocking 
Ford Motor Company, but I think most of you are old enough to remember 
the Edsel. You saved up enough money, yes, you have sacrificed, and you 
bought an Edsel.
  That is what it seems to me, Mr. Speaker, what the Speaker, Speaker 
Pelosi, and the leader, Leader Reid and the President and his advisers, 
many of them holdovers from the Clinton administration, that is what 
they are wanting us to do. They want us to buy an Edsel. I don't care 
whether it is paid for or not, it is a bad deal.
  With that, I yield to my friend from Louisiana, Dr. Bill Cassidy.
  Mr. CASSIDY. Thank you, Dr. Gingrey.
  I think Congressman Blunt made some great points. One of them is we 
want reform, but we want reform that works. Actually, I want to 
compliment President Obama, because of the three things we want in 
reform, one is to control costs so we can increase access to quality 
care. I think he has nailed it. My concern is the approach to achieving 
these will not work.
  I am also concerned that the Democratic proposals before us attempt 
to achieve that through gimmickry. They are using gimmicks to try and 
convince the American people that they are achieving the appropriate 
goal that President Obama has laid out, that it will not add to our 
deficit.
  I was struck today that on the Senate side they are saying that 
States can opt out of the public option. I am wondering, can you opt 
out of the taxes that will go into offsetting it? Can you opt out of 
the debt that the Congressional Budget Office says will accumulate? Can 
you opt out of losing the jobs that the increased taxes and the 
increased national debt will inevitably lead to? No. All you can opt 
out of is the benefit that is offered. You cannot opt out of the high 
cost that goes into providing this marginal benefit.
  I am also struck that there is this tax that they are creating for 
the American people, and on some similar criticism, it is truly 
bipartisan. The bill before the Senate Finance Committee that Mr. Reid 
says that we can opt out of is funded by about $350 billion in taxes. 
If I may quote Speaker Pelosi, she says that these savings, these 
taxes, if you will, come off the backs of the middle class.
  So I think we have a bipartisan criticism of the bill that is before 
the Senate right now. I think we would agree on the Republican side 
with Speaker Pelosi that the ``savings'' in those bills, that $350 
billion, comes off the backs of the middle class. Indeed according to 
the Joint Committee on Taxation, families earning less than $200,000 
pay 87 percent of these taxes.
  This is remarkable. During the presidential campaign it was stated 
that if you earn less than $250,000, your taxes will not go up. Yet, 
now, through these various accounting gimmicks, we are seeing indeed 87 
percent of these new

[[Page 25819]]

taxes will come off of those who earn less than $200,000.
  There are other gimmicks in this as well. It is pushing the cost of 
an expansion of Medicaid. And for those watching who don't worry 
about--I used to work in a hospital for the uninsured. For 20 years I 
have spent my life trying to bring health care to the people who don't 
have insurance. Medicaid is the safety net insurance program that is 
partly funded by the Federal Government and partly by the State 
government.
  Now, in this plan before both the House and the Senate, both plans, 
they are going to expand Medicaid. In the Senate plan, they are going 
to make the State taxpayers pay for this expansion. That is really 
great. It looks like we are saving money on the Federal level, but all 
we are doing is shoving that cost upon a taxpayer, it is just through 
the State income tax or property tax or sales tax, not through the 
Federal tax.
  That is a gimmick. If you want to say it is the taxpayer paying for 
it, absolutely she is paying for it. And so this expansion, this 
increased cost is going to lead to increased taxes, but it will be 
through the State tax code, not the Federal. There is the sleight of 
hand that is being passed off as fiscal responsibility.
  Now, on the other hand, we agree on the goals. We want to have 
quality health care, accessible to all at an affordable price. But we 
can see that this kind of bargain being offered by the Democratic 
proposals is really not controlling costs at all. It is merely shifting 
it onto State taxpayers or it is using taxes upon the middle class to 
fund.
  I like to say they are using new tax dollars in the old wineskin of 
an old health care delivery system. Just as we know that new wine in 
old wineskins will not work, so we know that these new taxes, these 
savings off the back of the middle class, as Speaker Pelosi says, will 
not work in the old wineskin of an old delivery system.
  Republicans, on the other hand, I think we truly want a 
transformation of how health care is delivered. The Republican proposal 
I have signed on to, and I think several of my colleagues have, H.R. 
3400, is wonderful in the sense that it empowers patients to make cost-
conscious decisions.
  If I might yield to my friend from Shreveport, he has got this great 
anecdote of how Health Savings Accounts in his business worked not only 
to hold down costs, but how by empowering his employees, also improved 
our health, if I may yield.
  Mr. GINGREY of Georgia. Dr. Cassidy, if you will yield back to me and 
I will yield to our good friend from Shreveport. That, of course, is 
our family practice doc who spent many years, and he will tell us about 
that, seeing lots of patients in south Louisiana, Dr. John Fleming.
  I do yield to Dr. Fleming at this time.
  Mr. FLEMING. I thank the gentleman. And thank you, Dr. Gingrey, for 
having this hour. You have shown tremendous leadership over the last 
few months and even before that, of course, but particularly the last 
few months in being willing to control time for us to have these 
discussions. Of course, Dr. Cassidy, my colleague from Louisiana, has 
been deeply involved in this issue, and we have all worked together, I 
think, as a great team, the GOP Doctors Caucus.
  I will get to that anecdote in just a moment. I think it is an 
important one. But let me stay with the subject just for a moment about 
the gimmickry, because I think that is essential to our discussion. I 
will develop it very carefully, but quickly, and also point out that 
this is an important part of the macroeconomics of health care that 
everyone must understand, and that is this: Currently Medicare and 
Medicaid, which are the current government-run health care systems, do 
not pay for the service that they are providing.
  Let me repeat that: These programs, Medicare and Medicaid, do not 
pay, at least completely, for all of the services that are provided, 
because the government requires and forces doctors, if you will, 
hospitals and other organizations, to provide care for less than the 
100 percent reimbursement. Physicians, nurses, hospitals, home health 
agencies and so forth actually have to settle for less.
  So, how is it that we can stay in business, we in the health care 
industry, and get by on less? The answer is that the private insurance 
market, a much bigger market, subsidizes to the tune of about $1,700 to 
$2,400 per year per family. If it were not for that subsidy, it would 
collapse. Yet and still, Medicare is scheduled to run out of money by 
2017.
  Now, how long is 2017? This is 2009. That is about 8 years that we 
are going to run completely out of money. Nobody in Washington is 
advancing any solutions to that.
  All right, where did the gimmickry begin? Remember that in the time 
period from about 1997 to 2003, Congress decided in its infinite wisdom 
that Medicare will be subject to a limitation on the budgetary 
increases from year-to-year. We call that the sustained growth rate, 
SGR for a lot of people. But because it was recognized even in the 
first year that such cuts would block access to health care by 
patients, it has never been enforced. So it has been a bookkeeping 
gimmickry that now has created an incremental difference of about $250 
billion, and growing. And even the other day the Senate attempted to 
resolve this.
  Mr. GINGREY of Georgia. If the gentleman will yield for one second, 
Mr. Speaker, for clarification, that limitation based on that formula, 
Dr. Fleming, applies to the doctors, doesn't it, all the health care 
providers? This is not applicable to the hospitals. They are reimbursed 
under a different system.
  Mr. FLEMING. That is correct. It is just physicians only. It is 
actually part B, which is mainly physicians. It simply says if you guys 
can't keep your billing and your costs and everything down in totality, 
we will just cut across-the-board. Well, that is an impractical 
solution. It is gimmickry. It would never work. Now we have a $250 
billion gap that is not being paid for. The Senate the other day tried 
to address that and failed to, because they knew it would be dumped on 
to the budget.
  Let's advance, fast forward to this bill today. Right now this plan 
for approximately $500 billion that will be cut from Medicare, $160 
billion or so of that would be a direct cut out of Medicare Advantage, 
which, as you know, is the more generous private system that is funded 
by Medicare dollars. If that happens, then those who are on Medicare 
Advantage, such as Humana Gold, will have to go back into the regular 
Medicare system and they will have to purchase Medigap insurance that 
they didn't have to purchase before. Again, seniors taking on the added 
burden.
  On top of that is another $300 billion to $350 billion coming 
directly out of Medicare on the basis of some future savings, some 
future efficiencies that no one has been able to figure out.
  So where are we today, Mr. Speaker? Basically $250 billion of doctor 
cuts, which have never been cut and will never be cut and are growing, 
that is going to end up in the budget at some point, another part of 
the deficit; another $350 billion which everybody in this room has 
known will never be paid for, but yet somehow it is being booked by the 
CBO as some savings. It is just continuous gimmickry. That is the only 
way this bill will ever be paid for, is gimmicks, which really means it 
is going to be taxpayers and premium holders.
  Then to go back and kind of summarize, my point here is that, as Dr. 
Cassidy points out, the only way that this is going to be an efficient 
health care system in terms of cost is the decisionmaking has to be in 
the exam room between the doctor and the patient, and one of the best 
methods to do that was a plan started in 2003 or so, Health Savings 
Accounts.

                              {time}  1815

  All this does is allow the employer--and government could do this, 
too, for Medicare and Medicaid--to put money in the bank that can be 
used at the discretion of the patient to buy medications or whatever, 
and it's his money or her money to use efficiently.

[[Page 25820]]

  Just an example of how it works, we implemented this with my own 
private health plan with my companies a few years ago, and instead of 
our rates going up an average of 15 percent per year, they're going up 
an average of 3 percent per year. I was giving this discussion to my 
employees one day, and one of my employees piped up and said, Well, 
look, if we go to this health savings account idea, that's going to 
mean that I'm going to have to pay out of my health savings account 
$100, $150 a month for inhalers.
  I said, Well, let me suggest to you this: Why don't you stop smoking? 
You will save money from the tobacco. You will be able to stop your 
inhalers, and then you'll just be banking all this extra money, which 
will end up removing any deductible you're going to have in the future. 
She came back to me 3 months later and said, I stopped smoking. I no 
longer have to use inhalers, and I've got extra money every week.
  I wanted to pull together some of these salient points that have to 
go with the gimmickry and how we're going in the wrong direction. 
Expanding government control is going to expand cost. Instead, we 
should be looking inwardly and bringing it down to the doctor-patient 
level where the decisions can really be made efficiently.
  With that, I will yield back.
  Mr. GINGREY of Georgia. Dr. Fleming, thank you for those comments. 
Before I yield one more time to Dr. Cassidy, just following through on 
this point that you are making, you may have mentioned one of the 
companies, Safeway and others who have testified up here--I don't know 
if they have been before the entire House or Senate, but certainly they 
have met with Members on our side of the aisle and explained some of 
the things that they're doing in regard to incentivize people to take 
care of themselves, to take better care of themselves, to realize there 
is a personal responsibility issue here. You pointed out in regard to 
smoking cessation, to not be using recreational drugs, to exercise on a 
regular basis. Certainly if you are overweight, particularly massively 
overweight, get on a good program. In fact, some of these companies, 
Dr. Fleming, I think they have programs in-house where it's free, and 
these employees are incentivized by a reduction in their monthly 
premiums for health insurance, their copay, their deductible.
  When we were marking up the bill, the health reform massive H.R. 
3200, a 1,200-page bill in the Energy and Commerce Committee of the 
House of Representatives, we had an amendment on the Republican side of 
the aisle to actually expand this program that Safeway and others had 
initiated to allow even more incentives. You know, for the life of me, 
Mr. Speaker, I do not understand even to this day--and it's been 6 
weeks ago July 30 that we passed the bill in the Energy and Commerce 
Committee--that amendment was voted down strictly on a party-line vote. 
Maybe one of these days they'll explain it to me. But to actually get 
healthier employees so there is less absenteeism, they have a longer 
work life, and to incentivize them with giving them monetary breaks in 
the cost of their health insurance, why in the world would we not want 
to do that?
  Mr. FLEMING. Would the gentleman yield for a moment?
  Mr. GINGREY of Georgia. Yes.
  Mr. FLEMING. That is a great point you make. What I would like to say 
is that something we have all observed as physicians is that while we 
all recognize collectively that, yeah, we should lose weight, we should 
exercise, and we shouldn't smoke, we, as human beings, tend to not 
address those issues until something comes up, until it affects us 
immediately in day-to-day life. The beauty of systems such as Safeway's 
is that they implement a financial impact, both positive and negative, 
that encourages healthy behavior before you ever get to a point where 
you go, You know what, I'm going to have to have heart stents or bypass 
surgery. Now I am going to make changes. Why not make the changes 5 
years in advance? Then you don't have to go through that. Look at all 
the money you save and the health that you have as a result of that.
  I yield back.
  Mr. GINGREY of Georgia. I thank the gentleman for yielding back. His 
final point was, give them the incentive when it really matters, not 
wait until it's too late.
  With that, I will yield back to the gentleman from Baton Rouge, Dr. 
Cassidy.
  Mr. CASSIDY. I am actually going to disagree with my colleague from 
Shreveport--and by the way, he is from north Louisiana, not south. The 
point being is that these gimmicks only pay for on paper. So the 
Congressional Budget Office, which makes an assessment, Does this 
achieve the goal of controlling cost? Because as President Obama points 
out, controlling cost is important. These gimmicks only control it on 
paper. Ultimately, this would be paid for not by gimmicks, but it will 
be paid for by taxpayers or by debt. Ultimately, that debt will come 
from taxpayers again. That's why I think Speaker Pelosi says of the 
savings--this is a public statement--The savings in the bills before 
the Senate side, the Democratic bills before the Senate, will come off 
the backs of the middle class, and these taxes will continue to be paid 
for by the middle class.
  I have learned in my practice--because, again, I have worked in a 
public hospital. I have worked in a government-run hospital where the 
nurses, doctors, med techs, therapists do their absolute best to bring 
health care to those who otherwise would not have it, a true safety net 
hospital. But when there is no money, the lines lengthen. When there is 
no money, something has to give. Now as it turns out, either we're 
going to raise taxes, we're going to borrow money, or their lines are 
going to grow; and our reform goals of controlling cost and, thereby, 
increasing access to quality care will not be achieved.
  On the other hand, let me just kind of amplify on your health savings 
account. The Kaiser Family Foundation has a study--I believe the Web 
site is kff.org--and they looked at a family of four with a health 
savings account and a wraparound catastrophic policy versus a family of 
four with a traditional insurance policy. They found that the cost of 
the patient-empowering health savings account with a wraparound 
catastrophic policy was 30 percent cheaper than the traditional 
insurance policy, that 27 percent of folks who had the health savings 
account with the wraparound catastrophic policy were previously 
uninsured, and that these folks who now have insurance access 
preventive services as frequently as a family with a traditional 
policy. We achieve the goals. By empowering patients, we, the folks 
buying those policies, lower their cost. By lowering their cost, folks 
who were previously uninsured now have access to insurance and, once 
having access to the insurance, are accessing the primary and 
preventive services as frequently as those who are paying 30 percent 
more for their insurance. The goals of insurance have got to be that.
  Now, again, I'll go back to the analogy I used earlier. We can either 
put the new financing, the new tax dollars in the old wineskin of a 
top-down, government-controlled, bureaucratic health care delivery 
system or we can use new wineskins, and I think the new wineskins that 
the Republican Party wants to use are patient-empowering. How do we 
empower patients to make a decision that's good not only for their 
health but also for their pocketbook? And by so doing, you lower cost. 
People previously uninsured can now afford it, and once they have their 
insurance, they're able to access those primary and preventive 
services. As practicing physicians, as a guy that's been working in a 
safety net hospital for some time, that seems the wineskin for us.
  Mr. GINGREY of Georgia. I appreciate the gentleman for being with us. 
Mr. Speaker, I can't quote the chapter and verse, but obviously the 
gentleman's been reading the Good Book. It's somewhere in the Old 
Testament. I know about those wineskins as well, and I really 
appreciate his analogy and his great insight on health care reform.
  We've been joined by another member of the GOP Doctors Caucus, and I 
will yield to him momentarily. But Mr.

[[Page 25821]]

Speaker, as we heard from our colleagues from Louisiana--north 
Louisiana. I'll get that straight one of these days. Shreveport is not 
New Orleans. But they brought out some excellent points. There was some 
commentary about health savings accounts. I think most of our 
colleagues surely understand that program now, and maybe many of them--
I bet many of them--I know that was the insurance plan that a lot of 
the doctors in Congress had when they were in practice, and Dr. Burgess 
may want to talk about that in just a minute when I yield to him. But a 
high deductible--in other words, you don't get first-dollar coverage on 
your health insurance. You have more out-of-pocket expense, but your 
monthly premium is much lower than your standard first-dollar coverage-
type policy. I mean, it might be less expensive by a factor of four, 
and you can fund it by putting in money. Your employer can do that. You 
can do it yourself. Family members can do it and get a tax break from 
doing that. But up to the limit of your deductible, every year you can 
fund these plans, and for the out-of-pocket expenses, whether it's an 
annual physical or Lord knows if somebody breaks their ankle playing 
soccer or something, you know, you pay for that out of this health 
savings account. If at the end of the year you haven't spent all that 
money, and you don't have to get into the catastrophic coverage, then 
that rolls over to the next year. And if you take good care of yourself 
and you exercise personal responsibility, which does include exercise, 
maybe at the end of 20 years, a young person has an account that has 
enjoyed the miracle of compounding, and they may have accumulated 
$125,000 in an account by the time they are 65 and they're eligible for 
Medicare.
  Mr. Speaker, these are great programs, and I, personally, would like 
to see them expanded. In fact, I would suggest that we could make some 
changes in the law in regard to COBRA, where if a person loses their 
job through no fault of their own, that they are able to continue to 
stay on the company group health plan, except they have to pay all of 
the premium, plus 2 percent administrative costs. They can do that for 
18 months while they're trying to get another job and get other 
coverage. Well, most people when they're out of a job, they can't 
afford that. They can't afford to pay those premiums. So why not let 
them, during that 18-month period, switch over to one of these health 
savings accounts that has a high deductible and a low monthly premium? 
This is an incremental thing that could be done and that Members on our 
side of the aisle have suggested. Just as we have a number of other 
incremental things, like equalizing the tax treatment, setting up 
State-administered high-risk pools, absolutely giving government 
subsidies to those who are low income but not low enough to be eligible 
for Medicaid or some other safety net program, let people buy insurance 
across State lines.
  I live in Georgia. Why can't I shop on the Internet for a policy 
that's offered in Florida, South Carolina or Alabama, my neighboring 
States, that fits my needs better and is more cost effective, less 
expensive, something that I can afford? We have done all of these 
things, made these suggestions. And yes, also on the Republican side, 
Mr. Speaker, we have a number of comprehensive bills. Some of my 
colleagues on the floor tonight have written and introduced 
comprehensive health care reform that would be cheaper than what the 
Democrats want to do with H.R. 3200, with the majority in the Senate, 
with what they want to do, the bill that Senator Reid, the majority 
leader, is about to put on the Senate floor. But I would say that 
probably my colleagues on this side of the aisle would tell you in all 
honesty, yeah, we have better bills and they're less expensive, but you 
know what, we don't even recommend that we pass those right now when 
the unemployment rate is over 10 percent and the economy is in the 
tank, people are suffering, and 15 million have lost their jobs. We 
might want to do it next year or the year after that. Eventually we'll 
do it--probably better in an incremental way--but it is not the number 
one priority of the Republican Party to totally reform our health care 
system, throw out the baby with the bath water, spend $1.5 trillion and 
have the economy get worse and more and more people lose their job. 
This is not the number one priority.
  With that, Mr. Speaker, I want to yield to my OB/GYN colleague and 
classmate, someone who I am proud to serve with on the Energy and 
Commerce Committee, Michael Burgess, an OB/GYN doctor from the Dallas-
Fort Worth area, a great Member.
  Mr. BURGESS. I thank the gentleman for yielding.
  I actually didn't intend to come over here talking about HSAs. But 
having initiated the discussion, I do want to just mention that the HSA 
is a way to save significantly on the premium. I currently have an HSA. 
It costs me about half of what a PPO insurance cost last year. Most 
importantly, in addition to an insurance card, I also have a debit 
card, and that debit card is something I can use to pay for expenses 
that occur throughout the year, and as Dr. Gingrey pointed out, the 
money in that account does roll over at the end of the year. It does 
not go away if it is not used at the end of the year.

                              {time}  1830

  You know, earlier today, we had many people come down to the floor of 
the House and speak on the issue of health care reform. One of the 
criticisms that was leveled at Republicans was that we were doing 
nothing but obstructing the process and that we had no ideas of our 
own. I did feel obligated to just touch on that point for a moment.
  Let's be honest. We do not have the numbers. We do not have the 
organization. There is no way that the Republicans in this body can 
obstruct anything that the Democrats wish to do. They have a 40-seat 
majority in the House. They have all kinds of ways of getting to 218, 
and really, because they are the majority party, it is up to them to do 
it. True, they don't have much Republican support, but tell me: If you 
have an excess of 40 votes and if you can't pass your own bill, it 
tells you that something may be wrong with the bill, that it's not 
something wrong with Republicans. Something is wrong with the bill the 
Democrats have crafted.
  More to the point, what makes a bill bipartisan? Is it because you 
can pick off a couple of Republicans at the final vote and can record a 
couple of Republican ``yeas'' in the final tally as the vote is passed? 
No. What makes a bill bipartisan is inviting the minority party in at 
the beginning and encouraging them to have their ideas as well as the 
ideas from the majority. That's exactly what didn't happen through this 
discussion.
  In November, I reached out to the transition team. I told them I 
didn't leave a 25-year medical practice to sit on the sidelines while 
we discussed health care. I was thanked very much for my interest. 
Never heard back. I reached out to the chairman of my committee, the 
Committee on Energy and Commerce. Again, I reiterated that I did not 
give up a career to sit on the sidelines. Again, no response from the 
committee.
  There was ample opportunity early in the year, as these bills were 
being crafted, to bring members of the minority party in and to get 
their ideas on paper, on record. Maybe there was room for some horse 
trading. Who knows? The problem is we never tried.
  Then 5 weeks ago on the floor of this House, when the President came 
and spoke to us--and this is the same President who said he would meet 
with Hugo Chavez and with Ahmadinejad without preconditions but who 
won't meet with congressional Republicans without preconditions. This 
is the same individual who, as a candidate in 2004, said there are not 
just blue States and red States. There is the United States. This 
individual was elevated in the eyes of the Nation as someone who could 
rise beyond partisanship. Yet we see a city today that is absolutely 
immobile because of partisanship.
  The fact of the matter is they've got the votes. They've got the 
votes on

[[Page 25822]]

their side in the House of Representatives and in the Senate. They have 
a 60-vote majority in the Senate. There is nothing they can't pass if 
they want to. Please do not attribute the lack of passage of this bill 
to Republican obstruction. Again, I'd like to take credit for it, but 
the fact is we don't have the numbers.
  The American people deserve a great deal of credit because, during 
the month of August, they spoke up and gave many Members pause, and 
caused them to reflect on where we were going with this bill. 
Unfortunately, today, it's almost as if August did not happen, because 
we're going full speed ahead with the direction they intended to go in 
the first place. Never mind what we heard or saw during the month of 
August.
  I know the time is tight. I'll yield back to the gentleman the 
balance of my time.
  Mr. GINGREY of Georgia. I thank the gentleman from Texas for yielding 
back, and I thank him for his comments.
  Mr. Speaker, I'm going to yield the remaining time that we have. I 
wish we had more. When you're having fun, it goes fast. We've been 
joined by my cochairman of the GOP Doctors Caucus, clinical 
psychologist Dr. Tim Murphy from Pennsylvania. He is my classmate and 
is president of our class. He is going to take the rest of the time. 
Dr. Murphy served with me--or I should say I served with him on the 
Energy and Commerce Committee, and I'm proud to yield time and the 
concluding remarks to Dr. Tim Murphy.
  Mr. TIM MURPHY of Pennsylvania. Thank you, Doctor. I appreciate that.
  You know, the big question becomes: Are we going to reduce the cost 
of health care or are we going to increase it?
  During the President's inaugural address, he said our health care is 
too costly. I could not agree more, and that has been our passion to 
reduce health care costs, and I still want to work with the President 
and with my friends on the other side of the aisle to make that work, 
but there are a couple of questions here.
  If you're on Medicare, if you're sick or if you have health insurance 
under the plans being proposed, you may pay more. Let's review that 
really quickly.
  First of all, with $500 billion cut from Medicare, there will be less 
to hospitals, less to skilled nursing facilities, $5 billion cut from 
inpatient rehab facilities, $56 billion cut from home health care, and 
fewer payments to doctors for drug programs, for part D and for 
Medicare Advantage, which has a lot of preventative services.
  Those are a lot of cuts. When you're taking away preventative 
services and when you're taking away money from the programs that we 
know save money, such as disease management--and that's important--
they're going to end up with higher costs.
  The second thing is, in taxing the sick, the proposal that's being 
kicked around the Senate now is increased taxes on all of these medical 
devices: heart monitors, heart valve rotators, pacemakers, artificial 
hearts--I hope you don't have a heart attack, because it will cost you 
more--defibrillators, hearing aids, hospital beds, nebulizers, 
artificial hips. There are a number of things. There are wheelchairs 
and ventilators. All will be taxed, including the insurance plans 
because it comes down to this:
  With the insurance taxes, you get taxed if you do have it and taxed 
if you don't. If the employers offer insurance, they may tax employers 
if they do offer it and tax them if they won't.
  Finally, there are issues with States. If States have an opt-out 
provision where they do not have to have as a provision in their State 
where they will have this health insurance plan run by the Federal 
Government, they may still pay the taxes, and that becomes taxation 
without hospitalization.
  Look, there's a lot we can do to fix this system. There's a lot we 
can do to reform Medicare. There are so many problems with the Medicare 
system, not just the fraud and abuse. I believe Congress will work on 
that, but it's just how things are run there, and we need a more 
effective and efficient system to make changes in how we operate with 
Medicare.
  Why does it take months to get a power wheelchair for someone? Why do 
you need such expensive procedures to get a crutch? Why do we have so 
many things that cost so much money? It's because they're done 
ineffectively and inefficiently.
  Let's change that. Let's make Medicare and Medicaid work better for 
people. If we're going to do anything so that the Federal Government 
can run it better, shouldn't we start off by making the government run 
it better? Let's cut the waste. Let's improve the quality. Let people 
cross State lines, as so many of my colleagues have said. In a survey 
in my district, 70 percent of people said that they wanted that.
  Let people join groups and have the purchasing power of the group. 
Let's make insurance permanent because millions of Americans are 
begging Congress to work together with both sides of the aisle to fix 
the problems. That's what we should be doing. Millions of Americans 
can't all be wrong. Let's not dismiss Americans as being frivolous with 
all of that.
  With that, Dr. Gingrey, I yield back to you for the remainder of our 
time here. Let's continue to work together as a Congress and as a 
Nation to fix this problem, not just to finance the problems.
  Mr. GINGREY of Georgia. Dr. Murphy, thank you so much.
  I failed to mention to my colleagues, Mr. Speaker, that Dr. Murphy is 
also an author, and has written a number of books on child psychology, 
and he knows of what he speaks.
  I think the theme tonight, Mr. Speaker, is to try to present Members 
who are knowledgeable on the subject matter. If we were talking about 
the law, if we were talking about national defense, there would be the 
people like Joe Sestak and Colonel John Kline on our side of the aisle. 
You'd listen to those folks. I hope that our colleagues will understand 
that we're trying to do this in a bipartisan way to help impart 
knowledge. Knowledge is power, and we hope and pray every day that God 
will give us all wisdom and that we'll make the right decisions and 
that we'll reform our health care in a way that doesn't destroy what 
really is the best health care system in the world.
  With that, Mr. Speaker, I thank you for the time. I yield back.

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