[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 26096-26102]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Welcome to this debate that's been going on now for a good 
number of months, a debate that has caught the attention of Americans 
everywhere, Members of Congress, Members of the Senate, the question 
about health care. It's something that's big, it's as big as 18 percent 
of the entire U.S. economy.
  We have seen in the last number of weeks the involvement of the 
government in new and expanded ways in this economy, not just the 18 
percent, but we have seen czars setting the salaries of people in the 
insurance and banking industry, firing the president of General Motors. 
So we've seen quite a trend of the government getting involved in the 
private sector. But this involvement in the area of health care is 
certainly the biggest of all; this is 18 percent of the entire American 
economy.
  I had the pleasure of being able to sit here and listen to quite a 
number of the Democrats talking about health care. It was like coming 
from a different planet. I thought it was interesting that they talked 
about pet phrases and slogans and things. I guess there have been quite 
a lot of different words bantering about and different phrases and 
things, and I think it's important for us to be very precise with our 
use of words. Otherwise we fall into very serious mistakes.
  One of the things that has been talked about is will there be a 
public option? That's kind of an interesting choice of words, a public 
option. What that really means, in political talk, is not a public 
option, but a government solution. A government solution.
  So when you talk about a public option, really the public doesn't 
have anything to say about who's going to get treated or what price 
it's going to cost or how it's going to work. The public has no say in 
that; the government is the one who does that.
  And in terms of options, you can talk about how bad health insurance 
companies are--and certainly they do some things that we don't like--
but there is one thing about health insurance companies: If you don't 
like one, you at least have some option to try and find something else. 
If the option is the U.S. Government, your only option is to go to 
another country.

                              {time}  1600

  So there's not much option and not much that is public about the 
public option. Another phrase that sounds just wonderful is ``every 
American has a right to health care.'' Hmm, that's an interesting 
phrase. Let's think about that a little bit.
  There was once a country that doesn't exist right now that had the 
idea that everybody had a right to certain basic things. For instance, 
if it gets really cold outside, you should have a right to housing, 
because if you don't have a warm place to live, you'll freeze to death. 
So they said that everybody should have a right to housing. If you 
don't have food to eat, you'll starve to death. So everybody should 
have a right to food. They said that everybody should have a right to 
education, that you should be able to read. So in each of these cases, 
the government was going to provide housing and food and education. The 
government said that you also needed to have a right to have a job. So 
the government was going to provide the job. And the government, of 
course, said that you had to have a right to health care, so the 
government was going to provide your health care.
  This idea that because it's essential for your survival to have 
housing or food or education or a job or health care, to say, then, or 
to assume that, therefore, it's a right is to make the same assumption 
that was made by the Union of Soviet Socialist Republics. We used to 
call them commies when I was younger. How well did their system work? 
It didn't work very well. Lots of people got lousy health care, starved 
to death, froze to death and were persecuted and killed by their 
government because they had an assumption that you had a right to all 
these different things.
  But I think that when our Founders started America, they talked about 
a right to something else, a right to life, a right to liberty, a right 
to pursue happiness. What's the difference between those things? Well, 
the right to life, liberty, and the pursuit of happiness is something 
that is granted by God to each and every individual citizen. Nobody 
else gives you that. Only God himself.
  When you talk about a right to food, does that mean that the farmer 
has to be your slave and give you food, which is the product of the 
sweat of his brow? I don't think so. We call that stealing. So we need 
to be a little careful when we talk about rights a little bit too 
quickly. Because when you assume you have a right, then it's the 
government's job to enforce it, and pretty soon you end up with public 
option or essentially one choice, and that is the government running 
everything.
  So let's take a look at when the government does too much. What 
happens when the government does too much? Well, one of the things we 
can see by other departments of the Federal Government is that we have 
some sense of rationing, inefficient allocation of services, degraded 
quality, and excessive expense. These are things that are not uncommon 
in government departments.
  You can think about the postal department. The postal department is 
not known for its efficiency. There are a lot of private operations 
that are more efficient than the postal department. It was necessary 
when America first got going. But the government can do too much. That 
is the point of many of us on this side.
  It's not that we want to have people not have health care, but it's 
also a reality on our side, as a Republican, that there are things 
called the law of supply and demand. And as much as we might like to 
repeal those basic laws, like the law of gravity, the laws of physics, 
the laws of economics and supply and demand, we can't do that. We 
cannot have the government guarantee everybody to get absolute first-
class health care at absolutely no cost. It just doesn't work 
mathematically. You can't do it.
  So the promise is that you're going to get Cadillac-quality health 
care at no cost, and don't worry because the government's going to take 
care of it. That's a great proposition. And if you believe that, 
there's probably some swampland in New Jersey that you could buy.

[[Page 26097]]

  What happens when the government does too much? Well, we've taken a 
look at the Democratic health plan and tried to put 1,000 pages--
because it's got to be complicated to take over 18 percent of the 
economy. So we came up with this chart. Every colored box here is a new 
agency or something created. Now, if you think of yourself as a 
consumer and you've got the doctors on the other side, you've got to 
somehow get through this maze to get your health care.
  Obviously, the first thing that you note about this chart is--and as 
you can imagine, a 1,000-page bill, if it's as limited as that--I'm 
sure it's longer than 1,000 pages--is not going to be simple. Another 
thing that you know about it is that the more the government takes 
over, it's going to be kind of difficult if you don't like the quality 
of your care to change. What is your option? Where can you go?
  Now, one of the things, when Americans start thinking about whether 
or not they really want to go this distance, whether they really want 
to fundamentally change all of American health care--you know, the 
proposition that I heard here in the last hour was pretty much the 
concept that, hey, American health care is broken, so burn the whole 
thing down and rebuild it entirely, have the government run it, is 
essentially where it's going. They're not doing that in one step. They 
are having the government option, which then takes over everything, and 
every other insurance plan has to be like the government one. And 
pretty soon, guess what? Just like student loans started out 15, 20 
years ago, the government was just one player, now they're 80 percent 
and they've absorbed almost everything.
  So what's going to happen in this kind of a complex scenario? Well, 
how do you answer that kind of question? What you have to do is you 
take a look historically at who else has tried it. One of the people 
that have tried it has been the Europeans, Eastern and Western Europe.
  I have a letter here that was sent to me personally by a lady. She 
doesn't want me to give her name out because she is involved with some 
government things and that would be some very sensitive information. 
She has family that has lived in Western and Eastern Europe and looked 
for health care. She said, in the different governments where she has 
been involved with government-regulated health care, which is most of 
the European countries, she says, The first thing I note about the 
system of health care is that people who want really good health care 
travel to the United States if they can. If you're a well-to-do sheikh 
from Bahrain, and you have got a serious health care problem, guess 
what happens? You take your millions of bucks and you hike over to the 
USA to get your health care.
  I was just hearing people saying that our health care is just 
terrible in this country, but an awful lot of people vote with their 
feet, coming to America to try to get their health care. This is a 
person who has a family that has had surgeries, transplants, various 
tests, medical maintenance checkups and facilities in these countries 
where medicine has long been regulated by the government. This is what 
was said. My first introduction to this was hearing a national friend 
express her joy to others by this statement. ``God has been so good to 
my mother. She got in a hospital where the staff mops the floors and 
changes the sheets.'' For an American used to even community health 
clinics that surpass some of the westernized specialty clinics that she 
saw when she went to Europe, she said this was a very, very shocking 
first impression that she got.
  Later, as she talks about elderly people, she says, Later, as I 
became a regular visitor in middle class hospitals, I saw firsthand how 
very fortunate we are in America. The hospitals and the clinics, to 
speak of, care for the elderly is almost too sad to describe. But I can 
tell you that, whereas, once I was incensed by a low-budget nursing 
home my aunt was placed in, now that I have ministered to elderly 
people lying on narrow beds in the back corner of dingy two-room 
apartments because nursing homes or assisted-living programs are beyond 
the hope of the people who supposedly have free access to their 
nation's health care plan, I think of my aunt, and I'm grateful she had 
a comparably luxurious environment.
  There are other stories, too. Here is one for women. No woman enjoys 
her annual gynecological annual checkup. I would ask American women to 
imagine a scene where, in one of the best clinics, you sit in a stark, 
icy cold room, naked from the waist up as folks walk in and out until 
you learn to bring your own cover-up while awaiting a mammogram.
  Imagine that one of the best clinics in your city cannot give you 
more sophisticated testing for a suspicious spot, and after seeking a 
clinic in a neighboring country, you end up in another stark clinic 
where attitudes and expectations are demeaning to a woman's dignity. 
Eventually, you're sent where for reliable testing? To America.
  Those are examples of Europe, Western and Eastern Europe. But we have 
examples that are a lot closer to take a look to see if this is a very 
good idea. We could look much closer, to Massachusetts and to 
Tennessee, where similar programs of government takeover of health care 
was tried in those States, both abysmal failures.
  What else did we learn from those States? Well, one of the things 
that has been going on here in this debate about health care, you're 
getting a lot of conflicting statements and opinions. What I am going 
to do here, with a couple of the charts that I have, is to give you 
some that have come directly from our President, and we're going to 
take a look at them here in the next few minutes and just see what 
really seems to be the truth.
  Most of this plan can be paid for by finding savings within the 
existing health care system, a system that's currently full of waste 
and abuse. It's as though our current health care system has got line 
items on the various budget tabs that say ``waste'' and ``abuse,'' and 
we can just take money out of those accounts. It's not quite as simple 
as that. He is saying that this plan can be paid for by savings. Well, 
when you take a look at the fine print, you find out where the savings 
are coming from. We're taking it out of Medicare. That is one of the 
places it's going to be subtracted, and in other places there will be 
major tax increases. So that is going to be part of where this cost is 
coming from.
  Now, you could also take a look at America and say, well, what has 
our experience been with government-run health care? We have two 
programs. One is called Medicare and one is called Medicaid. We had the 
Office of Management and Budget which, in the days that these programs 
were proposed, made estimates about how much they're going to cost. The 
only trouble was their estimates were a little bit low. The politicians 
didn't want those people to say it's really going to cost this much, 
because if they saw how much it was going to cost, people would have 
said, Baloney, that's too expensive. We can't afford that. So the 
estimates on each of these were many, many, many times lower by orders 
of magnitude--not by percentages, but by orders of magnitude--less than 
what these programs cost.
  Now you take a look at what's going on here with Medicare and 
Medicaid and the expensive increase going on over time, and what you've 
got going with these three major entitlements programs--Social 
Security, which is not as much medicine, but the other two--what you 
have is basically an economic crash that's going to happen to America.
  It's going to happen somewhere, because when you get--these programs 
have absorbed so much of our budget that you're getting into this near 
20 percent line of taxation. At about 20 percent, what happens, if the 
government raises taxes, they don't take in any more money. Doesn't 
that sound like a weird thing to say? If the government gets taxes too 
high, they don't actually get in more money. The way that works is that 
when you run taxes too high, eventually you just stall the entire 
economic system in America, so you get less revenue.
  Think of it a little bit like this. Let's say that you were king for 
the day and

[[Page 26098]]

you had to tax a loaf of bread. So you think to yourself, well, I could 
charge a penny a loaf and collect some revenue from bread sales. Then 
you think, well, maybe I could charge $100 for a loaf of bread. You 
say, No, no one would buy a loaf of bread for $100. So somewhere 
between a penny and $100 is some optimum tax that you could charge for 
a loaf of bread if you were the king for the day, and anything above 
it, if you run the taxes up, you actually get less revenue.
  There is a certain height that the government can run taxes, and then 
it just doesn't work. So these government-run medical programs are 
increasing in cost to such a degree that they're going to create a 
crisis economically in out-years.
  So, if these programs--which were done very carefully, and we have 
good people trying to administer them--are making the country go 
bankrupt, is it so easy for us to take the whole enchilada, to take all 
18 percent of medicine in America and have the government run it? Well, 
I'm not so sure we can do it by just waste, fraud, and abuse and taking 
money out of Medicare. It seems like the experiences in Massachusetts, 
the experiences in Tennessee, even our own experiences with Medicare 
and Medicaid don't give us a lot of confidence.
  Here is another statement by the President. Here is what you need to 
know: First of all, I will not sign a plan that adds one dime to our 
deficits, either now or in the future, period. Boy, that made me feel 
good when I heard him say that. The President is just letting us know 
that he's not going to get on any plan that's going to spend too much 
money or put us in any kind of debt, except for the fact I started 
asking some questions.
  Let's see. Well, what's happened since the beginning of the year? 
Well, at the end of last year, we had half of the Wall Street bailout, 
and then we spent the other half of the Wall Street bailout. Special 
deals for Wall Street. Now that's not something that's exactly good for 
our budget deficit.
  Then we've got this economic stimulus bill that was really not a 
stimulus bill whatsoever, but it was basically a big expansion of 
welfare. That's $787 billion. This is a big sucker. We were told if we 
didn't pass this, by golly, unemployment would get over 8 percent. 
Well, we passed it, and unemployment is now over 9 percent.

                              {time}  1615

  So they're talking about maybe doing another stimulus bill. Then 
we've got this SCHIP, and we've got the appropriations bill and the 
IMF. So this amount of spending totals about $3.6 trillion, and we 
don't have that money. So, when I'm told that we're not going to spend 
a dime to do this health care thing, it makes me a little skeptical.
  How do you sort this stuff out? With some of it, you can't always 
believe exactly what you hear or the sound bites.
  The assumption that we've seen, particularly in the proposals of the 
Democrat Party, have been what they call ``comprehensive.'' That means 
they're going to basically redo the entire system. The Republican Party 
has suggested quite a number of different changes that could be made 
without entirely burning down the barn. Those changes are now, I think, 
50 some different, separate bills. I could name just a few, and I think 
it's important to clarify the record because sometimes people come on 
the floor and say that the Republicans don't have any ideas. That's not 
true, of course. Let me just list a few different things that 
Republicans are very comfortable with. They are ideas that will reduce 
the cost of health care in America, and they will make it so that it's 
more affordable for many, many citizens.
  The first would be that we have a problem with trial attorneys and 
tort reform. In various States, there has been legislation to reduce 
what trial attorneys can do in terms of suing doctors. The result has 
been that doctors are still accountable for the medical procedures they 
perform, but you can't come up with outlandish kinds of punitive 
damages, which really run the cost of health care up. So medical 
malpractice reform is something that a great number of Republicans 
support, and in States like Texas, it has resulted in massive decreases 
in the cost of insurance and health care. So that's one proposal.
  I have not seen much as to that in the different proposals from the 
Democrats in the House or in the Senate. Although the President 
mentioned it, there is a question as to whether or not he was very 
serious about doing anything legislatively.
  There are other kinds of proposals. Another is the way the Tax Code 
works. Right now, if you work for a great big company, you get to buy 
your health insurance with pretax dollars, but if you're self-employed 
or work for a small company, you can't do that. Republicans believe in 
justice. We believe that the Tax Code should be applied consistently 
and uniformly, so we believe that people should be able to buy their 
medical insurance with pretax dollars all the way across the board 
whether you work for a big company or whether you are self-employed or 
whether you work for a small company.
  Another proposal that the Republicans would make which makes a lot of 
sense--and this isn't something the insurance companies necessarily 
like, but it does make sense, and it prevents some of the monopoly 
situations that can occur with the insurance industry when they have 
heavy control in one geographic area. It is the idea that you'd be able 
to buy medical insurance across State lines.
  To give you an example of how that might work, I'm from the State of 
Missouri, and we have, for instance, in Missouri a city which is Kansas 
City. We have Kansas City, Missouri, but the other half of the city is 
in Kansas City, Kansas. They're both sides of the river. So you have 
one city, and that city has a group of medical providers, but it is in 
two separate States. This legislation would allow you to do some 
shopping. If you lived on the Missouri side and if you could get 
medical insurance less expensively in Kansas, you could buy your 
insurance across State lines. What this does is it increases the amount 
of competition. Therefore, it helps to drive down costs.
  We are not trying to repeal the law of supply and demand. We are not 
going to promise that everybody in America can have Cadillac care at no 
cost. That's just an empty promise, and it's deceiving people to try to 
create that impression, but there are many things we can do to improve 
what's going on.
  If you stand back at a distance and look at health care in America 
and ask, Well, what really is the problem? one way to look at it, which 
I think is particularly helpful, is to say, look, you've got the 
provider system--that is the actual medical care that we're giving 
people in America--and then behind that you have the pay-for system. 
The pay-for piece is what's broken, not so much the provider side. 
Certainly, there can always be improvements to the care that we give. 
Some hospitals give better care. Some doctors do a better job than 
others, and you can always make improvements, but in general, American 
health care is pretty good. It's the way that we pay for it which is 
increasingly problematic. The reason for that is that two-thirds of 
Americans are paying for another one-third who isn't paying anything, 
and that just inherently, economically, causes problems. So there are 
some things that we can do.
  Many Republicans support these ideas, again, of lawsuit reform so 
that we don't have these tremendous punitive damages where doctors have 
to practice defensive medicine. We like the idea of allowing health 
insurance to be purchased across State lines, and we think that, when 
you purchase medical insurance, taxation should be consistent across 
the board.
  There are a lot of other ideas we have. Another one is the problem 
with the fact that you lose your health insurance if you change jobs or 
something. That's not a good deal. You're a responsible person; you're 
working hard for some company; you have medical insurance; you have a 
wife and some kids; they're covered under your policy. Then if you lose 
your job, all of a sudden, my goodness, now you have a child or a wife 
with a preexisting condition, and you're really up a creek

[[Page 26099]]

without a paddle. That's not the way health insurance should work. We 
think insurance should be changed so that it's portable and so that you 
can continue to carry your insurance with you from job to job. So those 
are just a few ideas.
  There are many ideas that Republicans support, but we don't think, 
when you have 100 million Americans with good health insurance and who 
like the relationships with their doctors, that you need to scrap that 
whole thing to try and address--whatever it is--the 10 or 20 million 
who don't happen to have insurance. We don't think you need to burn 
down anything in order just to treat the few. These are some concerns.
  When you hear, Oh, this isn't going to cost too much, $3.6 trillion 
is an awful lot of money in the hole. The Republican President who 
preceded our current President may have spent too much money, but he is 
a mere piker by comparison to what has been spent here even in the last 
9 months.
  Here is another statement. First, if you're among the hundreds of 
millions of Americans who already has health insurance through your 
job, Medicare, Medicaid or the VA, nothing in this plan will require 
you or your employer to change the coverage or the doctor you have. 
Well, that sounds pretty good. It sounds pretty darned good. The only 
trouble is it isn't necessarily so.
  First of all, if you happen to have Medicare, we already saw that the 
plans that are being proposed by the Democrats are going to take, 
depending on which plan you look at, somewhere in the range of $100 to 
$500 billion out of Medicare. So, obviously, if you're somebody who is 
having part of that money as part of your Medicare, that's going to 
change.
  There are other changes that will occur with this proposal. These are 
other opinions as to whether or not you can really keep what you have.
  Here is one. Jonathan Gruber. He is an MIT health economist: With or 
without reform, that won't be true, speaking specifically of this 
statement. His point is that the government is not going to force you 
to give up what you have, but that's not to say that other 
circumstances won't make that happen.
  So, in other words, what happens is, if the government does this sort 
of public option idea and then they say everybody has got to change 
their insurance to be the same as the public option, well, essentially 
what has happened is what you had before is going to change underneath 
you whether you like it or not. It's going to be changed because the 
government will be getting into this 18 percent of the health care 
business. So that was his perspective on, ``if you like it, you can 
keep it.''
  One of the huge things which, perhaps, frightens me the most about 
this whole health care debate is the problem of rationing. You see, 
there are really only two ways to control the costs of health care. 
There are really only two ways. One is that people take money that they 
earn and pay for it. The second way is that the health care is rationed 
by somebody, and somebody says you can get it or you can't get it. 
Guess who makes those decisions when the government runs health care. 
It's not an insurance company. It's not you. It's not your doctor. You 
guessed it. It's Big Brother. Big Brother decides who gets the 
insurance and who gets the health care.
  The question then becomes: Well, how do they decide? Well, they've 
got to come up with some sort of a fair way, so they get their 
calculators out, and they start calculating: Well, if you're this age, 
you can get this, but if you're this age, you can't get it. We don't 
think it's appropriate for someone this young to get this kind of test. 
You can't get it. So you have the government, essentially, rationing 
health care.
  Now, we can hear the Democrats say, Oh, no, no, no. That's never 
going to happen. We wouldn't have that happen. So we simply did a 
little test. We offered this amendment, which was Dr. Gingrey's. It's a 
simple, little, one-sentence amendment. These are not amendments that 
happen here on the floor. These are amendments that happen in committee 
because they won't let us do these amendments here on the floor. Here 
is his sentence:
  Nothing in this section shall be construed to allow any Federal 
employee or political appointee to dictate how a medical provider 
practices medicine.
  In other words, this amendment is saying your doctor-patient 
relationship is sacrosanct. They're the ones who make the decisions. 
The doctor and patient determine what your health care is going to be. 
We're not going to let any--what does it say?--Federal employee or 
political appointee. That means bureaucrat; that means czar; that means 
commissar. They're not going to tell you. It's going to be you and your 
doctor making the decisions. That's what this amendment says.
  Well, when this amendment was offered in committee, as you can 
imagine, they took a vote on it. Well, how did the vote go? This is the 
Gingrey amendment. The Republicans voted for it, the 23 of them who 
were there, and none of them voted against this amendment. They said, 
No. As for this doctor-patient relationship, we need to keep that. No 
matter what we do in health care, keep the doctor-patient relationship. 
In fact, the Democrats voted 32 against it, with only one voting for 
it. So guess what happened? This amendment failed.
  Does that give you any source of confidence that you're not going to 
get rationed health care if Big Brother government gets into the act? I 
think not.
  Here is another statement. Again, this is our President: ``There are 
those who claim that our reform effort will insure illegal immigrants. 
This, too, is false. The reforms I'm promising would not apply to those 
who are here illegally.''
  Well, you know, we've got a recession going. There are a lot of 
people without jobs. You've got an unemployment rate at 9.7 percent. 
The idea of saddling the American public with having to pay for illegal 
immigrants to come to this country for health care is a hard sell, and 
it may be asking an awful lot of the American public to say we're not 
only going to have to pay for all of our own health care as well as for 
the people from other countries who want to come here for free health 
care.
  So the President recognizes that this is kind of a hard sell. He 
said, ``Now, there are those who claim that our reform effort will 
insure illegal immigrants. This, too, is false.'' Well, is it really 
false? Let's just check this out. Exactly what does the Pelosi bill 
say?
  This is the Congressional Research Service. It's not Republican. It's 
not Democrat. Their job is to read the bills and to render an opinion 
on basic questions. Here is what they say:
  Under H.R. 3200--that's the Pelosi health care bill--a health 
insurance exchange would begin operation in 2013, and it would offer 
private plans alongside a public option. H.R. 3200--that's Pelosi's 
bill--does not contain any restrictions on noncitizens, whether legally 
or illegally present or in the United States temporarily or 
permanently, participating in this exchange.

                              {time}  1630

  Now, this is not a Republican, these are staffers that work for the 
U.S. Congress, and they are saying that this bill here does not, when 
people go to get insurance or when they go to get health care through 
this exchange, which is one of those boxes on that chart, there is 
nothing to say whether you are here legally or illegally, or if you are 
just simply visiting, anybody can get this. This Congressional Research 
is saying that the President is just flat wrong.
  Well, is there any other way of checking this thing out? Yes, there 
is, as a matter of fact. It was done with another amendment in 
committee, a Republican amendment. Here it is. This is the Heller 
amendment.
  In order to utilize the public health insurance option, an individual 
must have had his or her eligibility determined and approved under the 
income and eligibility verification system and the systematic alien 
verification for entitlements. What this is saying essentially is if 
you are going to get this health care paid for by the public, paid for 
by the American people, if you are going to get that, you've got to 
prove that you are a citizen here. So this is an amendment. It's 
offered in committee. What happened in committee? Well, here it is. 
Heller amendment.

[[Page 26100]]

  The Republicans, in this particular committee, 15 voted for it, none 
of them voted against it. The Democrats, 26 voted against it. So, guess 
what happened? The amendment failed.
  Well, it's pretty hard to believe the President when he says we are 
not going to have illegal immigrants coming here to get health care, 
and that that's false when the Democrats vote down an amendment to 
specifically prohibit that. That's a very, very hard thing to 
understand. In fact, I don't believe what the President said was true, 
and neither do other people.
  One more misunderstanding I want to clear up, and this is the 
President: Under our plan--the Pelosi plan--no Federal dollars will be 
used to fund abortions and Federal conscience laws will remain in 
place.
  That seems like a pretty reasonable thing to me. You know, America is 
very divided on the abortion issue. Some people think that people 
should have the right to have an abortion. Other people think it's 
killing a child. Americans don't agree on that subject. But is it 
reasonable to force every taxpayer to pay for abortions? That's a 
different question than whether you approve of abortions or not.
  So the President says this is a misunderstanding. No Federal dollars 
will be used to fund abortions. Well, how do you test something like 
that? I know. We've got some astute people paying attention here today, 
and you are going to understand, yes, there is a way to test whether 
this is true. The way to test it is, of course, with an amendment in a 
committee. Was an amendment offered? Yes, it sure was offered. Here's 
the amendment. This is Stupak. This is a Democrat Congressman who 
offered this amendment: No funds authorized under this act may be used 
to pay for any abortion or to cover any part of the costs of any health 
plan that includes abortion.
  Well, that's a pretty good amendment, offered actually by a Democrat 
this time. Let's see. How did this one come out in terms of how the 
committee voted? Twenty-two Republicans voted for that amendment and 
one voted no. Here's the Democrats: five voted for it, the guy 
probably, and four others; 30 voted against it. What's the total? The 
total is that this amendment, like the other ones, failed.
  What does that mean? Well, it means the bill doesn't say what's going 
to happen with abortions, and yet you know what will happen. Because if 
the real intent were to make sure that we don't get in the point where 
American tax dollars are being used to pay for abortions, if the intent 
were there, we would simply have language like this in the bill. 
Language like this is not in the bill, and there is a reason for that. 
It's because the intention is to be doing taxpayer funded abortions. 
What the President again says does not stack up with reality.
  Now, all of these questions come back to something that for all of us 
is very, very personal. Health care is the care of our own bodies. We 
have to live inside these bodies. That's the situation with it. If we 
are going to be tampering around with 18 percent of our economy, you 
think, boy, oh boy, we need to be careful and give a little bit of 
thought to what we are going to do. In fact, one of the things that you 
would want is you would want as many smart people as possible paying 
attention and giving input to what the bill should look like. There 
should be copies of the bill that are available. Before a bill comes to 
the floor for any kind of vote, it should be out for at least several 
days so people have some kind of chance to read the legislation. Yet we 
have seen over the period of the last 9 months that a number of major 
pieces of legislation have come to this floor without time for the 
Members to read them. In fact, I recall not so many months ago being 
right here on this floor, and it was almost comical if it weren't, in 
fact, true, and that was another Congressman from Texas stood up and 
inquired of the Speaker and said, is it traditional that when we are 
debating and voting on a bill that there is a copy of the bill in this 
Chamber?
  The young lady who was Speaker at that time inquired of the 
Parliamentarian, and he said, Yes, it's customary for there to be a 
copy of the bill in the Chamber. Pretty soon the same guy stands up 
again and says, Another point of inquiry. I am having a little trouble 
finding the bill, and you said there is supposed to be a bill in the 
Chamber. If you could direct me to where I might find that bill.
  After some talking up at the dais, he was told that you find the bill 
up behind me on the dais. So a third time he comes to the floor and he 
says, I still can't find the bill. Well, the bottom line, the fact was 
that the Clerk was still putting amendments that were passed at 3 
o'clock in the morning, 300 pages of different amendments that were 
being shoved into this 1,000-plus page bill, and there wasn't a copy 
here on the floor and we were voting on it.
  One of the great concerns that we have if we are going to go in and 
basically tear apart the system that 100 million Americans are using 
for health care today and re-create that whole thing with this 
particular government proposal, if we are going to do that, there are 
an awful lot of people that want to have a chance to take a good look 
at this proposal and say, is this really something that we want to be 
doing, and do we really want to go the route of Massachusetts and 
Tennessee and the European countries that went to a government-run 
system? Do we really want to go there? Or are there other proposals and 
alternatives that could be done that would be a little less radical and 
drastic?
  As I mentioned before, the Republicans have got quite a number of 
ideas and proposals that don't tear the whole system to pieces but at 
least allow us to make some selective changes which will make health 
care less expensive and more available to many people.
  I have talked about what a few of those were. One of them, of course, 
is tort reform, so we are not practicing defensive medicine. Another 
one of those is the idea that you could buy your health insurance with 
pretax dollars, not just if you work for a big company but if you work 
for a small company or even self-employed. We have also talked about 
the idea that you could buy your medical insurance across State lines, 
creating more competition between insurance companies.
  There are other kinds of ideas. One is called associated health 
plans. That would allow small businesses to get together with other 
small businesses, pool their employees and buy health care in bulk. In 
other words, it's a little bit like going to Sam's Club or some place 
that buys products in large quantities in order to get a discount.
  That kind of proposal was passed a number of different years by 
Republicans, it was blocked by Democrats in the Senate, but that's 
another possible idea. Certainly we believe that if you lose your job 
or decide to change jobs, that the insurance that you are paying for 
should be something that you could take with you. We call that 
portability.
  So when you go from one job, and let's say you are going to be self-
employed or a small business, you are going to get in a situation where 
you are uninsurable. We do not support the idea of making a raid on 
Medicare. That's what's being proposed to pay for about half of some of 
the Democrat proposals, is to take a large portion or a significant 
amount of dollars out of some of the Medicare proposals and health 
care. That doesn't seem to make sense.
  We have a grave concern because of the tremendously high costs of 
what we have already tried with Social Security and Medicare, a grave 
concern that really what's being proposed with this kind of a 
government-run system is way beyond the limits of what we can 
economically finance. We don't believe that you have to take the whole 
thing apart just in order to make some important changes.
  There are many other kinds of proposals that are out there in health 
care. In my home State of Missouri we have a phrase, if it ain't broke 
don't fix it. We have a very large part of our health care system that 
ain't broke, and so I am not really sure that we want the government to 
take it all over, but, rather, that we make selective changes in 
certain places where there are problems.
  Like some of the previous speakers, I have had some experience. My 
body is

[[Page 26101]]

getting a little older now, I am 62, and have had a little bit of 
situation and experience with doctors and hospitals and things. In my 
case, I came here to Congress just about 9 years ago feeling fit as a 
fiddle and still felt in my early fifties bullet-proof and everything 
was fine, I thought. But I had also had some insurance that wasn't very 
good, provided courtesy of my own State, the State of Missouri, so it 
had been hard for me to get in to see the, quote, gatekeeper that they 
had.
  We came here to Congress, and it turns out that there is a place 
where I could get a physical and kind of fit it into my job of going to 
the different hearings and all, and they gave me the results of my 
physical. They said, yes, Todd, you are fit as a fiddle except for one 
little detail: You have cancer. That, of course, sort of gets your 
attention.
  As it turned out, after a series of tests and different things, 
within the first couple of months I was a Member of Congress, I had a 
radical prostatectomy, that's prostate cancer, and it's sort of the 
equivalent in men of breast cancer in women. It's the most common kind 
of cancer. So I have a particular sensitivity to people who have been 
diagnosed with cancer and for those who struggle to survive cancer.
  You take a look at what happens when you have government-run systems 
in terms of cancer care. Here's some of the statistics for men and 
women. Here it is in the United Kingdom and here it is in the United 
States. Now, these numbers can be calculated in kinds of different 
ways, but the point of the matter is that when you have a government-
run system, one of the effects of that is you have got waiting lines, 
and waiting lines are not good deals if you have got cancer. If you've 
got cancer or you've got heart disease, which are the two leading 
killers of Americans, you don't want waiting lines. You want to be able 
to move immediately on your situation.
  In England, they have waiting lines. If you've got cancer, they do 
this test and that test, that waiting is deadly, as these statistics 
show. Your chances of survival overall in England is maybe 50 percent 
and these numbers show, well, 10 percent better. Other numbers show 
even more.
  U.S. companies have developed half of all the new major medicines 
introduced worldwide over the past 20 years. Why do you think that is? 
Do you think the countries that have the government running all the 
health care are going to develop new ways of doing things? What's the 
incentive? Why is anybody going to take the risk? Why would the 
government develop things?
  No, what happens here, because America still has a free system of 
health care, our companies are developing a great number of worldwide 
different changes. One out of every three Canadian physicians sends a 
patient to the United States for treatment each year. The Canadians 
have a government-run system, but guess where they go when they have to 
wait too long in line. You go south. You go to America to get our 
health care.
  The bottom line of the matter is that the quality of care in America, 
when you take a look at things like cancer, is significantly better. I 
am thankful for it.

                              {time}  1645

  I had another experience which I wish I had not had last summer. My 
own father is 88-years-old. He was going to a doctor who had developed 
cancer himself, so the doctor retired and my father had to look for a 
new cardiologist. So we found the name of one who we had heard was a 
pretty good doctor. He went to see the cardiologist. The cardiologist 
took a look at him and said, Let's see, you are on these and these and 
these medications. What else has been done lately for your heart?
  My dad said, well, nothing.
  He said, we are going to get you in here tomorrow and get you a 
chemical stress test.
  I had never heard of it. But the bottom line was he didn't do very 
much walking on the treadmill. The doctor said, Stop, that will be all 
we need. Thank you. He said, You need to come in for an angioplasty-
type thing, which turns out at 88-years-old, you are given anesthetic, 
they knock you out, and they come in from a vein or artery in your leg 
and look around inside and see what is going on.
  So he survived that okay. And I was there at the meeting on a Monday 
morning, and the doctor said, Well, the bad news is that there is 
nothing we can do with stints. Your heart is all clogged up and you are 
going to have to have a bypass. Well, at 88-years-old, that gets your 
attention. So we said, What are the numbers?
  The doctor said, Well, you have got about a 10 percent chance of a 
major complication at 88 from a bypass. But if you don't do it, you'll 
have a 50 percent chance you will have a major heart attack in the next 
year.
  Well, we took a look at the numbers and the decision was easy. The 
next day my father was in for a seven-way heart bypass. That was on 
Tuesday. He was home from the hospital on Friday, and he is home now--
this was last July--he is home now and he is doing fine.
  That time period in the United States, in St. Louis, took less than 
three weeks from his seeing a new doctor to being home from a seven-way 
bypass. That is not waiting lines. That is not government-run. That is 
not socialized medicine. That is free enterprise. And that is what I 
have heard people on this floor running down, saying American health 
care is lousy and it is no good. And I am simply saying, I don't know 
about other people, but if I were in another country, I would want to 
come to the good-old-USA to get my health care, and there is a whole 
lot of people voting with their feet to come to this country.
  So the idea of torpedoing our whole system and saying we are going to 
throw everything upside down and basically turn it over to a government 
kind of run system doesn't seem to make sense.
  Are there changes that should be made? Yes, there are. Have the 
Republicans proposed a number of those changes? Yes, they have. Are a 
number of those changes widely perceived by the American public as 
being necessary, such as tort reform? Yes, they are widely perceived. 
Are those changes part of the Democrat bills? Many of them are not.
  There are things that we can do, but I'm not sure that the government 
takeover and this kind of system is where we really want to go. I think 
a lot of Americans are coming to the same kind of conclusions. They are 
saying, yeah, there are some things we need to do, but let's just wait. 
We have 100 million people insured and doing reasonably well. Do we 
want to scrap all of that for another 20 million or 10 million that may 
not have it?
  So, you get to the bottom line, the bill that the Senate has come up 
with is not dissimilar to ones that we think may come out of the House. 
Of course, we don't know. We are not part of those backroom, closed-
door meetings. I am a Republican. We are not included in the 
discussion. But we can guess somewhat from what we are hearing in the 
media and what the Senate has done, and we can say that the proposals 
that we are seeing are, first of all, going to raise people's premiums.
  Who is going to be paying more? Well, first of all, seniors on 
Medicare are going to have less money in Medicare, because the Senate 
version has got Medicare cuts at $500 billion. I don't know if the 
House version is as high as that or not.
  There are going to be higher premiums. Who is going to be paying for 
those? Well, some of the people that are going to have to pay for the 
higher premiums, aside from the average people on the street, are going 
to be small business people.
  Now, small business people right now are pretty important to us. 
Small business people, people with 500 or fewer employees, employ 79 
percent of the jobs in America. And we have got, whatever it is, close 
to 10 percent unemployment. So you want those small business people, 
you want those small businesses to be strong. You want them to have 
extra liquidity. You want them to be investing in new equipment, in new 
processes, and you want the

[[Page 26102]]

innovators and the people who are inventors to be spending money to get 
new ideas going. And that is what gets the new jobs going.
  So, how is it going to help? First of all, if you tax them a whole 
lot on energy, which we voted to do, but now you are going to tax them 
some more to raise premiums, and you are going to say, We are going to 
tax you even more to provide insurance for your employees. That is 
going to make them want to get rid of some employees, not hire more 
employees.
  The other thing that happens is, when the government jumps into a 
market it reduces your choices. And eventually, over a period of time, 
and even the liberal Democrats who propose the government takeover of 
all health care--the more liberal Democrats want the government to take 
it all over; the more conservative say no, we don't want that, but we 
think if the government did a little bit, it is okay--well, the people 
who are pushing more for the government to take it all, they all say 
the government option is going to ultimately lead to the government 
being more and more involved in health care. What that does is it 
reduces your health care choices. So you don't have options; you have 
one option.
  You know, I can think of something a whole lot worse than some 
insurance agent or person working for an insurance company getting 
between the decisions you and your doctor need to make about health 
care. There is something worse, and that is a bureaucrat. Because with 
the insurance person, if worse comes to worse, you can move to some 
other insurance. If it is a bureaucrat, you have no choice in these 
other foreign countries.
  The delays and the slowdowns to health care, of course, are deadly 
with heart disease and with cancer. So that is a bad thing. And then, 
of course, the old standard, billions of dollars in new taxes. Is that 
what we want to do to a struggling economy, to add billions and 
billions of dollars in additional taxes on an economy that is 
struggling with a 10 percent unemployment rate? Is this the time to be 
doing something like that? I think not.
  I think that these kinds of costs say that what we need to do is take 
the system we have now, selectively look at certain specific problems, 
and let's put solutions together that address those problems. But let's 
not try to re-engineer all of civilization and all of society, saying 
that we now have this fundamental right to health care and the 
government has got to provide it for everybody. It sounds really good, 
but when you see the cost, this has led to that kind of amusing phrase: 
If you think health care is expensive now, just wait until it is free.
  This has been the effect. And these effects here are what we would 
predict and project if we make the mistake of following the Europeans, 
the Soviet Union before them, and Massachusetts and Tennessee, that 
have all played with these highly complicated government takeovers of 
health care. This is not the way that we think we should be going.
  It is interesting that the polling data suggests that the American 
public, when you ask them what you want to do, they say, Yeah, we ought 
to make some reforms to health care. Everybody agrees to that. But they 
don't agree they want it all done with a government system. So that is 
pretty much where we are at this time.
  I am joined by a colleague, a friend of mine from Louisiana, if you 
would like to make a comment or two. I think we are running close on 
time.
  Mr. SCALISE. I want to thank my friend from Missouri for your 
leadership on this issue. This is an important issue.
  As we are discussing health care, I think what is frustrating so many 
American people is that they are seeing what is happening here in 
Washington. Right now there is a back-room deal being cut where 
literally the liberals running Congress are rewriting this government 
takeover of health care, and the American people deserve and want to 
know what is actually in the bill.
  I think what frustrates the people the most is they look at all this 
massive spending, $1 trillion in new spending. How many people really 
think the $1 trillion spending with this government takeover of health 
care is not going to add another dime to the deficit?
  People clearly know not only is this going to be a massive spending 
bill, but it is a massive tax increase, over $40 billion of new taxes, 
most of which is going to go on the backs of American families and 
small businesses. And then the cuts that senior citizens know are 
coming, $400 billion in cuts to Medicare, including programs that 
people like, like Medicare Advantage.
  This is not the way to do health care reform. We need to fix what is 
broken, but we don't need to break what is working in health care. 
Unfortunately, their bill is nothing more than a government takeover 
with taxes and mandates that the American people don't want.
  Mr. AKIN. I appreciate your perspective. It seemed to me almost that 
one of the dangerous things to do legislatively is to have an agenda 
and then just try to figure out some excuse to give you a chance to do 
what you wanted to do before you even started. And it almost seems as 
though, instead of taking a look at the system, selectively saying, 
Hey, let's take one of the hardest things, say preexisting conditions. 
That is a tough nut to crack. Let's just focus on that. Let's get 
everybody, Republicans and Democrats together, to take this one nut, 
define what we want to do, and see if we can't fix that one problem--
instead, it was like, we don't need your opinion at all. Our staffers 
will write the bill. We will talk about it. We will cut some deals. We 
have to cut some deals, because we don't have enough votes to pass it. 
So we are going to have to do something for the insurance companies so 
that they don't have any liability in certain situations. We got to do 
a deal.
  And you start putting the deals together so you get enough votes to 
try and pass it, and you cobble something together in the dark of 
night, bring it to the floor and hope nobody reads it too closely, 
because if you look at the details you are not going to like it.
  Instead, maybe it is a little bit more deliberate, but you define 
what the problem is. You say, okay, let's put all of our resources on 
doing this the right way. Any idea is okay, and let's just have a good 
and open debate. The American public can be part of it and see what 
that is.
  We didn't do that in this big bailout bill, and we didn't do it in 
this stimulus bill. That is what really made people mad. Then that huge 
cap-and-tax bill over here, to have a 1,000-page bill with 300 pages of 
amendments passed at 3 o'clock in the morning, not a copy on the floor 
and we are voting on this thing, the biggest tax increase in the 
history of the country the House just passed a number of months ago, 
that makes people upset. They say, wait a minute. You guys at least 
could read the bill.
  No, we couldn't read the bill.
  What do you mean, you couldn't read the bill? It gets them mad.
  You say, well, there wasn't a copy on the floor.

                          ____________________