[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 26599-26606]
[From the U.S. Government Publishing Office, www.gpo.gov]




                             DOCTORS CAUCUS

  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.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank you very much, and I am 
proud to spend the next hour as the party of naysayers, as our young 
colleague from the other side of the aisle just described us. We have, 
Mr. Speaker, on occasion been accused of being the Party of No.
  I have a number of colleagues with me this hour, one of them being my 
good friend and fellow Georgian, fellow

[[Page 26600]]

physician, Dr. Paul Broun. He and I on a number of occasions just this 
past Monday, yesterday, I guess, did a number of events together in our 
great State of Georgia.
  We said to editorial boards and television stations, we are the Party 
of No, guilty as charged; but we don't spell it n-o, we spell it k-n-o-
w.
  Maybe we do on occasion spell it ``no'' when we say, Mr. Speaker, we 
say to the Speaker, Nancy Pelosi, that, heck, no, we don't want this 
form of health care change to one-sixth of our economy with the Federal 
Government literally going into the exam room with a bunch of 
bureaucrats and coming in between a doctor and a patient.
  Dr. Broun and I, Mr. Speaker, and many of our colleagues on this side 
of the aisle who are part of the GOP Doctors Caucus, there are about 15 
of us, 12 M.D.s, some dentists, optometrist, a clinical psychologist 
and author, we are very proud of our almost 400 years of clinical 
experience, Mr. Speaker.
  We are very disappointed, of course, that we were not able to offer 
some of the knowledge, the k-n-o-w part of knowledge, to this debate.
  We sent letters, of course, along with many of our colleagues on the 
Republican side of the aisle to President Obama, especially after 
hearing from him in the so-called State of the Union when he really 
took the opportunity to use this Chamber and to call together a joint 
session to speak to the Nation on health care and made some very 
distinct promises in regard to the need for medical liability reform, 
as an example, which we don't see one word of, essentially, in H.R. 
3962.
  What little bit, what little tiny piece of medical liability reform, 
adds an insult, Mr. Speaker, to those States that have already enacted, 
successfully, I might add, medical liability reform like our State of 
Georgia, like the great State of Texas and the great State of Florida, 
when it goes on to say these grants, this little minuscule amount of 
money in the millions, not billions or trillions, which is more 
applicable to H.R. 3962, when they say none of these grants are 
eligible for States that have already enacted any meaningful medical 
liability reform that limits contingency fees for trial lawyers, or has 
any caps on noneconomic judgments, awards.
  That's the only medical liability reform, Mr. Speaker, that has ever 
been proven to be effective in the great State of California that, of 
course, enacted that legislation called MICRA back in 1978. It's pretty 
frustrating; it really is.
  We are here tonight, Mr. Speaker, to speak to our colleagues on both 
sides of the aisle. We want to do that in a very respectful way and, 
again, as I say, to try to impart knowledge to the issue. We have a lot 
of ideas in regard to what could be done to help improve the greatest 
health care system in the world that's not perfect. We recognize that, 
and I think all Members, Mr. Speaker, recognize that in both Chambers. 
We are willing to work in a bipartisan way given the opportunity. 
Unfortunately, we have not been given that opportunity.
  That's why we keep taking advantage of what little opportunities we 
have like these Special Orders late at night, or maybe 1-minutes. I 
think on our side of the aisle we have 178 Republicans in this House of 
Representatives, and I think 120 gave 1-minute speeches today talking 
about the Republican alternatives, a way to do this, to help make sure 
that we bring down the cost of health insurance, for those who, if it's 
10 million, I don't know the total number, of 300 million people in 
this country who cannot afford health insurance. We want to bring down 
the price of the cost of health insurance so they can have access, but 
also to bring down the cost of health insurance for the 85, 88, 90 
percent of people that do have it, but it's just a little bit too 
expensive.
  We can do that and that's what we are going to be talking about 
tonight, Mr. Speaker, about ideas, bills, individual bills. I think 
there are something like 53. I have introduced legislation over and 
over. This is my seventh year, my fourth term as my great constituents 
from the 11th of Georgia know, that would save, as a Congressional 
Budget Office, not me doing the number crunching, but the nonpartisan, 
Director of the Congressional Budget Office, Doug Elmendorf, hired by 
Speaker Pelosi, said that, you know, medical liability reform could 
save $54 billion over 10 years. I mean, that is a significant chunk of 
money.
  We all know that a real concerted effort on reducing waste, fraud and 
abuse could save another $20 billion. From our perspective, from the 
Republican alternatives that we are offering, we wouldn't spend more 
than that amount of money. But we would make those two integral parts 
of the reform that we would offer, and that we have offered, we will 
continue to talk about.
  We don't spend $1.1 trillion of taxpayers' money when this country is 
already $11.2 trillion in debt and that we just got through with the 
fiscal year, I guess, 2009 fiscal year with a $1.4 trillion deficit, 
Mr. Speaker, four times the largest previous deficit in the history of 
this country.
  To say that, oh, well, look, we have got the numbers here and the 
Congressional Budget Office says this plan of ours is going to save, 
over a 10-year period of time, it's going to save $100 billion; but to 
save 100 billion, we are going to spend 1.1 trillion.
  You know, when you do the subtraction, I think that makes you, what, 
900-and-some-change billion dollars in the hole.
  My Georgia Tech math, six quarters of calculus, I believe my high 
school arithmetic would tell me that that's not a real good deal for 
the American taxpayer. We are here tonight to talk about this, Mr. 
Speaker.
  I am proud to have some of my colleagues from the GOP Doctors Caucus, 
and I want to yield to them. We will engage in a colloquy, and we will 
have a meaningful hour this evening so that Members on both sides of 
the aisle, and if there are any folks out there in the good old USA 
watching, I know there are some elections going on today, Mr. Speaker, 
that a lot of folks are very interested in, and maybe they will be 
tuned into that. But in any regard, we appreciate the opportunity.
  I yield to my good friend and physician colleague from the great 
State of Georgia who represents Athens and my hometown of Augusta, 
Georgia, and a fellow classmate at the Medical College of Georgia, 
family practitioner, my good friend, Dr. Paul Broun.

                              {time}  2130

  Mr. BROUN of Georgia. Dr. Gingrey, I appreciate greatly your doing 
this Special Order tonight, and I appreciate your yielding me some 
time.
  When I spoke on the floor this morning in 1-minutes, I started off my 
speech by saying when I graduated from the Medical College of Georgia 
in Augusta, Georgia, and got my MD degree, we in the medical college 
all swore to the Hippocratic Oath. One of the clauses in the 
Hippocratic Oath was ``I will do no harm.''
  The Nancy Pelosi health care insurance bill, it is not about health 
care. It is about insurance, and, actually, it is about power. It is 
not even about health care. But the Nancy Pelosi health care insurance 
bill will actually do a tremendous amount of harm for me and all of our 
medical colleagues who continue to practice medicine, so it is going to 
destroy the quality of care.
  It is also going to destroy the Federal budget. Dr. Gingrey, as you 
were talking about, it is going to spend over $1 trillion in what I am 
describing as voodoo economics or zombie economics that CBO utilized in 
scoring this bill, because they made some assumptions that are just 
totally untenable. They are just not going to happen. Since they are 
projecting the growth of Medicare is going to be half of what it has 
been historically, that is not going to happen. They haven't counted 
into the scoring a lot of issues that are going to balloon the costs to 
the American people.
  So the Pelosi health care insurance bill is going to destroy our 
economy, and it is going to create a tremendous debt. It is going to 
destroy people's private health care plans that they have today. If you 
continue to buy private health insurance, the American

[[Page 26601]]

public's premiums are going to double and triple. So it is going to 
destroy the budgets of families all across America.
  It is going to destroy the State budgets, because it is going to have 
a tremendous unfunded mandate on the States because of the large 
expansion of Medicaid; thus, the States are going to have to go get 
that money from somebody, and they are going to increase taxes. They 
are going to have to. They have no other choice but to increase taxes.
  Mr. GINGREY of Georgia. If the gentleman will yield for just a 
second, Dr. Broun, in that regard, Mr. Speaker, I ask the gentleman 
from Georgia, this Medicaid increase in Nancy Pelosi's health reform 
bill, H.R. 3962, what kind of dollars are we talking about here? What 
kind of burden are we talking about, unfunded mandate that that would 
put on the State, and how does that come about?
  Mr. BROUN of Georgia. Well, in increasing the Medicaid rolls that the 
State government has to fund, the Federal Government is going to help 
by giving money to the States, but the States are going to have to come 
up with the matching.
  Just in our State of Georgia, it is estimated the State of Georgia is 
going to have an extra $1 billion that Georgians are going to have to 
come up with in increased taxes just for this Federal mandate on our 
State alone. It is billions and billions of dollars on every State in 
this country, so it is a huge burden on the States.
  So it is an unfair taxation that is pushed off on the States, and 
every person, even the middle class, who our President said he was 
going to protect, the middle class is going to be burdened with a 
tremendous tax burden because of the mandates.
  Some of them aren't direct taxes. As I have already mentioned, their 
health insurance premiums are going to really double or triple. That is 
really a tax, because it is a cost shifting from the private insurance.
  Mr. GINGREY of Georgia. If the gentleman would yield back to me just 
for a second, Mr. Speaker, I wanted to ask the gentleman, why is that a 
problem for the States? Mr. Speaker, you and I both know that here in 
the great Congress, these Halls of Congress, if we want to spend money, 
if we want to overspend, we just print more money out. I think we have 
red ink of about $275 billion, and that is why today in the Federal 
Government we have this debt of $11.2 trillion. Can't the States do the 
same thing?
  Mr. BROUN of Georgia. No, sir. Well, thank you, Dr. Gingrey. The 
States are prohibited from printing money under the Constitution. 
Actually, we should be preventing the Federal Reserve from printing 
money like they are doing, and the Congress has the authority to do 
that, if we just take that power back from the Federal Reserve, and I, 
as an original intent constitutionalist, think we should do that.
  It is our prerogative as Members of Congress to manage the money 
instead of the Federal Reserve, and it shouldn't be the Federal Reserve 
doing it. We should be doing that here in Congress.
  But the States can't do that, so they are going to have this 
tremendous economic burden. Our Governor, Sonny Perdue, is struggling 
trying to make the budget come out in black ink in our State. Because 
we have a balanced budget amendment to our State constitution, the 
State of Georgia cannot spend more money than it brings in, 
technically, under our constitution.
  So if we as a Federal Government put a tremendous burden of $1 
billion on the State of Georgia, which is already struggling, already 
furloughing workers, they are not replacing workers, State services are 
being cut, teachers' salaries and furloughs and cuts are being put in 
place, and we add $1 billion to the State of Georgia, an economic 
burden, that money has got to come from somewhere.
  The Federal Government is not going to give it to Georgia. It is not 
going to give it to Louisiana. It is not going to give it to Texas, New 
York, Vermont, or Minnesota. The States are going to have to come up 
with those dollars, and the only way they can do that is through higher 
taxes, as well as cutting more services than what they are doing now.
  You take States like Michigan, where the unemployment is so high, 
raising taxes is going to further wreck their economy. So this is going 
to destroy the American economy as well as the States' economies.
  We are going to be destroying lives with this bill, because this 
bill, the way it is written today, is going to allow taxpayers' dollars 
to pay for abortions. Now, the Democrats have put some mumbo-jumbo 
language in there, and it is really a ruse. What they have done is they 
say private funds can be utilized to pay for abortions through the 
public insurance system. They call it the public option. But it is not 
an option; it is a mandate.
  It is actually something that the leadership of the Democratic Party, 
from the President to many of the leadership in their own party, have 
said that this is just a step to a single party payer health insurance 
program. So it is going to destroy private insurance here in America 
too.
  So what this Nancy Pelosi health insurance bill is going to do is 
destroy everything that is good, and good with our health care system. 
And what is most important, it is going to destroy the quality of care 
our seniors are getting, because they are going to get the short shrift 
of all of this.
  They are going to draw the short straw, because the Democrats put 
something in the bill, something that is called comparative 
effectiveness research in the stimulus bill, and now they have set up a 
panel that is going to use that comparative effectiveness to determine 
how best to spend the dollars. And when you have limited dollars, they 
are going to decide is it better to spend the money on a well person 
who is 25 versus a sick person who is 70.
  So the seniors' health care provision is going to be destroyed. We 
are going to have more people pushed, because Medicare Advantage is 
going to be destroyed, we are going to have move people pushed off on 
the Medicare system, which is going to further increase the burden on 
the current Medicare system. So we are going to have further rationing 
of care, particularly for the seniors. So they are going to be told 
they can't get tests, they can't get surgeries, they can't get 
medications that they need, and it is going to be absolutely disastrous 
for seniors.
  Mr. GINGREY of Georgia. If the gentleman would yield, Mr. Speaker, I 
wanted to have the opportunity to ask the gentleman to share with us a 
little bit. He is mentioning about this comparative effectiveness 
research council and how, based on, hopefully, Mr. Speaker, qualified, 
good, solid research, and to not only recommend to our doctors across 
the country, the 850,000 of them, many of whom are primary care 
doctors, and we will hear from another primary care doctor, John 
Fleming, with us tonight from Shreveport, Louisiana, in just a few 
minutes.
  To suggest is one thing, Mr. Speaker, but to mandate based on 
comparative effectiveness research, which our hardworking men and 
women, taxpayers of this country, are paying for that, and many, many, 
if not most of them are making less than $250,000, by the way, Mr. 
Speaker.
  But what I wanted to ask Representative Broun to share with us is not 
only the fact that our seniors, as he suggests, Mr. Speaker, and I 
agree with him, could get thrown under the bus by this rationing that 
comes from this comparative effectiveness research study that says, oh, 
that won't work. Let's do something cheaper, and, you are too old and 
it is not going to be cost-effective so you don't get it.
  But I would like for Representative Broun, if he would, Mr. Speaker, 
to share with us about these pay-fors. Ms. Pelosi and President Obama 
says it has got to be paid for. He won't add one dime to the deficit. 
It has to be paid for. I would like for Dr. Broun to talk to us a 
little bit about where some of this money is coming from, this $1 
trillion so this health care reform is paid for.
  I yield back to the gentleman.
  Mr. BROUN of Georgia. Thank you, Dr. Gingrey. The pay-fors are 
through

[[Page 26602]]

higher taxes, particularly on small business, as well as individuals 
who are considered rich. We are supposed to be treated equal under the 
law, but a lot of our colleagues on the other side don't think that is 
factual any more, that we need to be treated unequally under the law, 
which is totally unconstitutional and is against the 14th Amendment to 
the Constitution, basically.
  But what it does is this is going to destroy jobs because of the 
mandates upon small business. There are a lot of taxes and a lot of 
fees, and there are even fees and taxes on individuals who don't take 
their employer-offered health insurance. So it is going to force 
everybody in this country basically to take whatever insurance is 
dictated by the health care czar panel here in Washington.
  So taxes, the only way they get to any semblance of controlling the 
amount of money that this bill calls for, which is way over $1 
trillion--and, in fact, I think that is going to be very low. When we 
saw Medicare presented, the Congressional Budget Office miscalculated. 
Their calculation was almost one-tenth of what the true cost was over 
the decade following passage of Medicare, and I think that is what we 
are going to see with the Pelosi health insurance bill, too.
  But there are tremendous taxes on everybody in this country. And it 
is going to be a tax on the middle class, because they have got to tax 
durable medical equipment. That is going to go up. They are going to 
tax the Cadillac insurance plans. So that means people who have good 
insurance, privately provided today, that is going to go up. There are 
going to be taxes on small businesses.
  Right now, the bill says if an individual makes over $500,000 or a 
couple over $1 million a year, that is adjusted gross income, that they 
are going to have a big tax on them. Well, a lot of those people are 
actually small business men and women, and that is their adjusted 
gross.
  They are filing their personal income tax return as a Sub S 
corporation or as a limited liability partnership, like a lot of 
physicians, accountants, and lawyers have. Small businesses, they are 
going to be taxed, taxed, taxed, and that is the reason that the 
experts say 5.5 million jobs are going to be destroyed. People are 
going to lose their job because of this Nancy Pelosi health insurance 
plan.
  Mr. GINGREY of Georgia. If the gentleman will yield back to me, Mr. 
Speaker, I thank him so much for bringing that factual knowledge to us.
  Absolutely, this figure that he just quoted, Mr. Speaker, of 5.7 
million, I think, additional jobs would be lost because of this bill, 
it is not something that Representative Broun just pulled out of the 
air. In fact, Mr. Speaker, the Chief of the Council of Economic 
Advisers to the President, Christina Roma, is the one that said that. 
That is where my good friend and colleague from Georgia, Representative 
Paul Broun, got those figures from.
  He mentioned one other thing, before I go on to our colleague from 
Louisiana, and I am sure that we will talk about this as we go on this 
evening, the health choices commissioner, a very powerful new czar 
under this program, would say to the employers across this country, you 
can have anything you want. You can offer any health insurance policy 
plan you want, Mr. Speaker, as long as what Henry Ford said many years 
ago, you can get any color of T Model Ford that you want, as long as it 
is black.

                              {time}  2145

  I draw my colleagues' attention to this poster I have regarding that 
assembly line way back in the early part of the 20th century.
  I thank the gentleman from Athens.
  At this point I want to yield to a fellow member of the GOP Doctors 
Caucus from Shreveport, Louisiana, and that is my good friend Dr. John 
Fleming. 
  Mr. FLEMING. I thank the gentleman, Congressman Gingrey, again, a 
physician colleague as well as a congressional colleague; of course Dr. 
Broun as well and others. We have done this a number of times. It's 
always enjoyable and important for the American people to see the 
physician perspective.
  What I would actually like to do is to go over the fact that it's 
been said many times by Democrats here and everywhere that we are the 
party of ``no.'' We offer no solutions. And I have to remind people 
constantly that I ran on a pro-reform campaign to be elected to 
Congress last year. So it's very important to me as a physician to see 
true reform, not a government takeover of health care, but reform of 
what is really an excellent system. And we have had several plans that 
we are ready to offer, but now that we are getting to a point where 
there is actually going to be a Democrat plan on the floor perhaps this 
week or the next week that will be voted on, we're now ready to offer 
our substitute. And I wanted to contrast and compare for a moment how 
these two plans differ, and I will just hit the high points.
  Number one, the Pelosi plan cuts Medicare by $500 billion. That's a 
half trillion dollars. It cuts it out. No explanation. No plan. No 
strategy. We have had Medicare for 45 years. No one knows how to reduce 
fraud, waste, and abuse any more than it has. In fact, we know that the 
larger the entity, the higher the fraud, waste, and abuse is. Our plan 
does not cut a dime out of Medicare.
  The CBO estimates in PelosiCare that it will cut over $150 billion to 
Medicare Advantage, the private option of Medicare, which 25 percent of 
Americans, seniors, if you will, have chosen. It will take that program 
out completely. That will knock about 6 to 11 million seniors off of 
Medicare Advantage. And not only will they lose preventative health, 
the eyeware, and all the other benefits that go with it and the 
efficiencies and the preventative health, as I say, but they will be 
required to go out in the market and buy Medigap coverage; that's 
additional coverage. Our plan does not touch Medicare Advantage. It 
keeps it fully intact.
  Here's a very interesting one: the CBO says that under PelosiCare 
that part B premiums will increase by $25 billion, and part D, the 
medication part, will increase by 20 percent. Again, ours does not 
increase those costs one iota.
  Mr. GINGREY of Georgia. Reclaiming my time for clarification, in 
regard to the Medicare Advantage program that the gentleman from 
Louisiana was just talking about, I wanted to ask him, Mr. Speaker, if 
under those Medicare Advantage plans, which, by the way, some 20 
percent, 11 million seniors, 20 percent of seniors under Medicare--for 
some strange reason, Mr. Speaker and my colleagues, they pick that as 
their delivery system of choice because of some of the reasons the 
gentleman from Louisiana outlined. And I wanted to ask the gentleman, 
Mr. Speaker, if that in many cases does not also include prescription 
drug coverage, which would obviate their need for paying a monthly 
premium under part B.
  And I yield to the gentleman.
  Mr. FLEMING. Thank you. Yes, you're quite correct, many things that 
go beyond the standard Medicare. And Americans have learned that that 
is a good bill. It's private insurance using Medicare dollars. In fact, 
many of us would like to see us, instead of having more government 
running of health care, to actually have current government programs 
run in the private sector, where things can be done far more 
efficiently.
  Also, there is a mandate, all employers, essentially all employers, 
will be imposed an 8 percent payroll tax under PelosiCare, absolutely. 
Under our plan, no mandate, no individual mandate, no employer mandate.
  As pointed out, as many as 5.5 million jobs will be lost as a result 
of increased taxes, which will add to, of course, the overhead for 
average businesses.
  Now, get this: currently businesses are at a marginal rate of 35 
percent taxation. When the Bush tax cuts expire in the next year, that 
will jump to 39 percent. But added to it with the Pelosi health bill, 
there will be another surtax added of 5.4 percent, which will then take 
it up to 45 percent. So we're

[[Page 26603]]

looking at a 10 percent increase in marginal tax rates. Now, tell me 
that that will not cause joblessness. There's no way around that.
  Also employers will be required to pay at least 72.5 percent of the 
premiums. There will not be the flexibility that they have today to pay 
less if they can't afford more.
  Will PelosiCare have medical malpractice reform? Not only will it not 
have it, but the so-called pilot studies that will be offered out 
there, a measly few million dollars to do that, the only States that 
can do that are States that do not have laws that restrict lawyer fees 
or awards or rewards--should I use the word ``rewards''--awards for 
damages. So that means that we can, of course, reform medical 
malpractice as long as we don't do anything to lawyers, which, of 
course, is the biggest interest group, I think, in this bill to begin 
with.
  There are many things, Mr. Speaker, that are going to just blow the 
budget out. And I would say in summary that everyone, middle class and 
above, is going to be affected by this in a negative way.
  And here's how they are going to be affected: they're either going to 
be paying higher insurance premiums, or they're going to be paying 
higher taxes or both. And the government will be deeply involved in 
every decision in life. Their lives will be managed by the Federal 
Government, micro-managed, if you will. And if you're a senior, you're 
going to have increasing difficulty in finding a provider, a hospital 
or a doctor. It's already true with Medicaid, the other government-run 
program, which, by the way, is going to increase to 25 percent of human 
beings in this country from where it is today.
  And most people who are on Medicaid cannot find doctors as it is. 
Where are these doctors going to come from? Because you see, Mr. 
Speaker, the problem is, and again look at Cuba, look at North Korea, 
look at Canada, look at the United Kingdom, they all have universal 
coverage, but universal coverage doesn't mean you're going to get 
treated. Only one out of six people in Canada has a family physician. 
So the answer is always in these countries that are government-run 
systems, yes, you're not going to have to pay that; yes, it's fully 
covered; but you're just going to have to wait a couple of years to get 
it.
  And some things that are common in the vernacular in Canada and the 
U.K. is, yes, you have cancer, but, no, we're not going to treat it, 
we're going to watch it. You will never hear a doctor say that in the 
U.S.
  Mr. BROUN of Georgia. Will the gentleman yield?
  Mr. GINGREY of Georgia. Reclaiming my time, before we go to the other 
doctor from Louisiana, I think the gentleman from Georgia wanted to 
engage maybe in a colloquy and ask a question, Mr. Speaker.
  Mr. BROUN of Georgia. Thank you for yielding, Dr. Gingrey.
  What I wanted to bring up, Dr. Fleming, is that during the August 
break I went up to Canada and talked to folks about their universal 
health care system. And the American public need to understand what 
their situation is up there. I found women in their 40s and 50s who've 
never been told that they needed a pap smear, never been told they 
needed one. Never had one. Why? Because the doctors won't take the time 
to counsel with them and won't take time to do the pap smear because 
doctors have to rush people through the office so quickly just to see 
the capitated amount just to make a decent living.
  The average time spent, I was told by many, many patients up there, 
was 5 minutes with a doctor, 5 minutes. I was told that if you have 
high blood pressure, diabetes, and high cholesterol, you have to make 
three appointments to see the doctor and they'll just give you 
medicines for those three things one at a time. You can't go counsel 
with your doctor for any period of time.
  But most importantly, and back to the reason I asked you to yield a 
moment or two, is that in Canada they pay a tremendous amount of taxes. 
Even the lowest income people pay a tremendous amount of taxes to pay 
for their health care system. They have a provincial and national sales 
tax just to pay for their health care of 7 percent in British Columbia, 
where I was, a 7 percent sales tax just to pay for national health 
insurance. Plus on top of that, they have an income tax. I was told by 
a guy making under $50,000 a year, he said he paid 60 percent of his 
income, 60 percent of his income was paid in taxes to help pay for 
their national health insurance program.
  Mr. GINGREY of Georgia. Reclaiming my time, Mr. Speaker, I certainly 
know of what the gentleman from Georgia speaks.
  I had an opportunity last year to visit in Taiwan, the country of 
Taiwan, our great friends. And they also, like the U.K. and Canada and 
some other countries, have this government-run single-payer, sometimes 
referred to as national health insurance. They have a very similar 
program, Mr. Speaker, to what Dr. Broun was just referring to. And when 
I was visiting in Taiwan, I made sure that I had an opportunity to 
visit with the Minister of Health; and I asked them to describe the 
system to me, and Dr. Broun has just done a great job of sort of a 
mirror image of what goes on in Canada. And I also had an opportunity 
to ask some of the Taiwanese citizens about the national health program 
and what they thought about it.
  And, Mr. Speaker, here is just a little bit of what they said, their 
response. And I think my colleagues need to understand this so they can 
share this information, and I hope they will on both sides of the 
aisle, with their constituents:
  They said we really like this system, this national health insurance 
system, here in Taiwan, which has been in place since 1997.
  And I said, What's so good about it?
  And, Mr. Speaker, their response was, well, kind of like what Dr. 
Broun said, We only have to wait about 5 minutes. The queue is very 
short. They really get you in quickly, and you get to be seen by a 
doctor, and in general on average that visit takes about 5 minutes. 
And, Mr. Speaker, also they said almost every time you leave the 
office, you have a handful of several prescriptions, which is really 
good, according to them.
  Mr. Speaker, of course I'm a physician and I know that in my 
practice, and my colleagues, I'm sure, experienced the same thing, 
people want to ask you questions. And a lot of time that's spent you 
can't charge them for and you don't want to charge them for it, but you 
want to be able to give them time to ask questions. I said, well, how 
about if you want to ask the doctor a question?
  And, Mr. Speaker, the response was, Well, they don't really encourage 
that because they have a quota of seeing a certain number of patients a 
day, and if they sort of drag behind and take more than 5 minutes, then 
their evaluation at the end of the year, Mr. Speaker, is not so good.
  So it's a mess is what it is. It's an absolute mess. And the reason, 
Mr. Speaker, my colleagues even bring it up is because this idea, in 
our opinion, in our humble opinion, of having a public option competing 
with the private market is so that the big arm--I should say the big 
foot--of Federal Government can get right there one step away from 
taking over the entire health care system in this country; and we then, 
within a very short period of time, 3 to 5 years, have a system very 
similar to the U.K. and Canada and Taiwan.
  The American people don't want that, I submit to my colleagues; and 
that's why we're fighting this tooth and nail and will continue to 
until we defeat it.
  Mr. BROUN of Georgia. Will the gentleman yield?
  Mr. GINGREY of Georgia. I will yield to the gentleman, and then I 
will yield to Mr. Fleming so he can finish up and then Dr. Cassidy as 
well.
  Mr. BROUN of Georgia. I just wanted to come back to the point that I 
just was making so that the Speaker himself can understand and the 
American people who are listening here can understand that the lowest 
income workers who are trying to make a living, struggling today to 
make a living and make ends meet, maybe they do or

[[Page 26604]]

don't have insurance today, they're going to pay a heavy, dear price in 
increased taxes by this bill, the Pelosi health care bill.

                              {time}  2200

  It is going to destroy their own personal budgets because of this 
bill if it ever gets passed into law.
  I want to remind, Mr. Speaker, if I can speak out to the American 
public, I would tell them that the Republicans are the Party of Know, 
K-N-O-W, because we know how to lower the cost of health care. We have 
53 bills that have been introduced. Some of them are comprehensive, 
such as my bill, H.R. 3889, which is totally private, doesn't increase 
taxes for anybody. It doesn't put mandates on anybody or anywhere and 
totally looks to the private sector and will lower the cost of health 
care. We have many Republican bills that will help lower the cost for 
everybody if our bills could just be heard on the floor.
  But the American people need to demand that the Pelosi bill be 
defeated, destroyed, so we can go back to the drawing board, we can go 
back to the table and work in a bipartisan way and have Democratic and 
Republican ideas, and we can find something that is right for America 
that will lower the cost of health care.
  The Pelosi health care bill will skyrocket the health care costs for 
everybody, skyrocket taxes, and we have to stop it.
  Mr. GINGREY of Georgia. I yield to Dr. Fleming for any concluding 
remarks. I would welcome my colleagues to remain on the floor and let's 
continue this discussion. We have, I think, another 20 minutes.
  Mr. FLEMING. I thank the gentleman. To conclude my comments, I was 
comparing and contrasting the Pelosi bill with the Republican bill. The 
bottom line, Mr. Speaker, is there are only two ways you can control 
costs. There is the Nancy Pelosi way where you have an extremely large 
governmental system that disconnects the patient and the doctor from 
the cost and it leaves it to the government, it leaves it to a very, 
very distant decisionmaker in the Federal Government to make decisions 
about our personal lives and put in force things that affect us that we 
have no control over. That is one way to do it, and that is ultimately 
leading to rationing and long lines, like Canada and the U.K. do it.
  The other way is a patient-centered perspective, which is the way the 
Republicans address it, and that is to leave the decisions between the 
doctor and the patient.
  If you stop there, you are not going to control costs. The way you 
control costs is to engage both the doctor and the patient into the 
cost. That is not to say that the patient pays all of the costs or even 
most of the cost. It is just to say through a health savings account 
and perhaps other methods, the patient is aware what is being spent and 
there is a certain reward for making good decisions as a consumer. And 
in order to do that, you have to connect the patient with the cost in 
some way, and that is where health savings come in, and you have to 
have transparency and clarity, which we do not have today. And if we do 
that, then we make very savvy consumers out of patients, and we have 
the doctors and patients do buy into it. All of the right decisions can 
be made in the exam room, and you don't need this giant bureaucracy to 
do that and create long lines. To sum it up, care delayed is care 
denied.
  With that, I thank you.
  Mr. GINGREY of Georgia. Mr. Speaker, at this time I want to yield to 
our other colleague, a member of the GOP Doctors Caucus from Louisiana, 
the Baton Rouge area, a gastroenterologist, our good friend, Dr. Bill 
Cassidy.
  Mr. CASSIDY. Mr. Speaker, what strikes me about this process is there 
actually is common ground here. We can agree on the goals we want. We 
want to lower cost and increase access and have quality care; but I 
think the problem we are addressing is there is a philosophical divide 
as to how we approach that.
  I liked what Dr. Fleming said when he spoke about if we can empower 
patients, we can lower cost. One example of empowering patients and 
lowering cost is health savings accounts, which the Republican 
alternatives all strengthen and the Democratic alternative weakens.
  A health savings account, imagine what is currently the case where a 
family of four puts up $12,000 a year. At the end of the year, if they 
haven't used any resources, they put up another $12,000, and the year 
after they put up another $12,000, but in a sense it is starting over 
every year. In a health savings account, you sluice off some of that 
money and put it into a banking account and the family controls that 
account. The patient is empowered to make wise financial decisions. If 
at the end of the year they have money left over in that account, it 
rolls over to the next year. They actually can hang onto it.
  Two examples of how this works, a friend of mine back home, a woman 
with some wealth, has a policy that pays for everything. As it turns 
out, she doesn't care what it costs because her insurance policy pays 
for everything. She said she doesn't look to see if her doctor gives 
her a generic or a name brand drug or what the bill is. She knows 
insurance will pay for it. She doesn't go through her itemized list to 
see if all expenses are appropriate.
  Contrast that with another fellow. I mentioned to him about the power 
of health savings account. He says, I have a health savings account. My 
doctor writes me a prescription and I know from experience, I tell him 
that it costs me $159. Notice he didn't say $160; he said $159. Because 
it is his own money, he is looking at the itemized deductions. He said, 
I have a health savings account. Do you mind writing me something less 
expensive?
  The doctor says, I'm sorry, tears it up, and writes him a generic 
that costs $20. The system just saved $139, not because a bureaucrat in 
Washington, DC said thou shalt, but rather because someone looking 
after his own financial interest made the best decision for his health 
care.
  We know this works on a systemic basis. The Kaiser Family Foundation 
did a study. They compared a family of four, their expenses with a 
health savings account and a wraparound catastrophic policy, with a 
family of four which had a traditional insurance policy. The family of 
four with the HSA catastrophic, they paid 30 percent less for their 
coverage than the family of four with the traditional insurance policy, 
and both families, if you will, were equally likely to access 
preventive services.
  So we see by controlling costs, we increased access to quality care, 
and we did it by bending the cost curve.
  What concerns me about the bill advanced by Ms. Pelosi is, according 
to the Congressional Budget Office, the inflation rate for these bills 
is 8 percent per year. Now, President Obama says we have to have reform 
because costs will double in 10 years if we do not. As it turns out, 
with the reform we have been presented, costs more than double in 10 
years. At a minimum, reform should not cost more than status quo, but 
actually it does. And if we don't control costs, we know that if we 
don't control costs, access is denied.
  Now, we can always make that up by increasing taxes, but when you 
start off with a bill that increases taxes by $730 billion, it doesn't 
leave a whole lot of room, Mr. Speaker, for increasing taxes any more. 
At some point your increased taxes drive up costs, which decreases 
access, which means you have to spend more and you increase taxes even 
yet more. It is not wise public policy.
  So in closing, I will yield back after saying that I think our 
Republican alternatives concentrate the power with the patient. It is 
patient centered, empowering patients. Contrast that with the bills 
that are before us which, frankly, concentrate power in Washington, 
D.C., by collecting taxes, 111 bureaucracies, boards and panels, which 
will again take power away from the woman with her doctor in the exam 
room in her hometown and transfers it to Washington, D.C., where 
someone will attempt to dictate how that interaction takes place.

[[Page 26605]]


  Mr. GINGREY of Georgia. Mr. Speaker, I thank the gentleman for his 
comments and for yielding back to me. I wanted to comment on one point 
he made in regard to the health savings accounts and the catastrophic 
coverage, the low monthly premium that is affordable, especially for a 
lot of young people in the job market for the first time and they are 
paying off their student loans and God knows what other debt they have 
got. It is a great thing, and it encourages personal responsibility.

                              {time}  2210

  Mr. Speaker, I want to make sure my colleagues know that one of the 
key components of the Republican alternative is to say that companies 
like Safeway that have these programs where if an employee shows 
personal responsibility and works very hard at wellness, at keeping 
themselves healthy--like if they're smoking, to stop, if they're 
overweight, to lose weight, if they have high cholesterol, to change 
their diet--to do things that would keep them healthy--as an incentive 
to them, Mr. Speaker--and this is part of the Republican alternative--
the employer, like Safeway and other companies, is able to reduce the 
out-of-pocket cost to the employee; and the out-of-pocket cost could be 
the monthly premium or a reduction of the deductible or the copay.
  Unfortunately, Mr. Speaker, under current law--HIPAA I think is the 
law--you can't cut that out-of-pocket expense more than 20 percent. 
Well, why not? Why not? If you have employees that have skin in the 
game, so to speak--I guess that's certainly true in regard to the 
specialty of dermatology--but if they are taking personal 
responsibility, then we say that an employer ought to be able to 
increase that discount to those employees up to 40 or 50 percent. Why 
not? There is not one thing in H.R. 3962 in regard to personal 
responsibility.
  Well, Mr. Speaker, I thank the gentleman from Louisiana. Also, I see 
my colleague from Athens is still here. I think he probably, Mr. 
Speaker, wants to talk about something in the bill called the health 
choices administrator, a very, very powerful--yes, another czar created 
by this bill, the health choices administrator. I want to yield to Dr. 
Broun and let him speak to that because I think he's got a slide that 
he would like our colleagues to pay attention to.
  I yield to Dr. Broun.
  Mr. BROUN of Georgia. Dr. Gingrey, thank you so much for yielding.
  This is the health care czar. The President said, if you have 
insurance and you like it, you can keep it. Nothing could be further 
from the truth; it's a boldfaced lie. The reason it's a boldfaced lie 
is because this bill requires the health care czar and his panel--this 
dude is going to be confirmed by the Senate, but the panel is going to 
be appointed by the President with no confirmation--they're going to be 
making health care decisions for everybody. And everybody, even private 
health insurance plans, have to be approved by the boss. So if you have 
health care insurance today and you like it, forget it because it's 
going away unless the boss says it's okay.
  So the Democratic health care plan, the health insurance bill that 
Nancy Pelosi has given us, you can have anything that you want if the 
boss approves it. And I thank Dr. Gingrey because this is his slide 
here.
  Mr. GINGREY of Georgia. If the gentleman would yield back to me for 
just a second.
  Mr. BROUN of Georgia. You bet.
  Mr. GINGREY of Georgia. Mr. Speaker, I know the gentleman from 
Georgia knows of what he speaks because some of my colleagues may not 
be old enough to recognize that poster, that caricature of the health 
choices administrator; but, Mr. Speaker, I want to introduce you to 
Boss Hogg--H-o-g-g I believe it's spelled, from Hazard County, 
Georgia--or H-a-w-g, I'm not sure. But anyway, I appreciate the 
gentleman from Augusta and Athens, my good colleague, physician 
colleague and classmate from the Medical College of Georgia, sharing 
that poster with us. And I thank him for being with us tonight.
  Mr. Speaker, I realize that our time is drawing to a close. We've 
probably got about 5 more minutes. I'm going to be spending the rest of 
the time concluding tonight.
  I also want to ask our colleagues to direct their attention to a few 
posters that I have, a few slides. This first one, of course, is--at 
the very outset what I wanted to emphasize was that the Republican 
Party, the loyal minority, if you will, does have a second opinion, and 
that's what we've been talking about here tonight.
  I think the most important part of our second opinion--and we 
listened very carefully, by the way, during the August recess, during 
those town hall meetings when so many seniors turned out, many of them 
fragile, so many veterans, many of them of the Vietnam era, World War 
II, with just multiple health problems and disabilities. They were so 
concerned about getting their Medicare cut or being thrown under the 
bus, so to speak, when the government takes over and starts rationing. 
And what they told us loud and clear is patients don't want government-
run health care. They don't want it. They've seen government-run Indian 
health care, as an example. They've seen many things that the 
government has run and made a thorough mess of. And this is life and 
death, this is life and death. And that's why they don't trust the 
government to run it.
  Mr. Speaker, our President, it seems to me, is not listening to the 
American people. In this next slide I want to point out that what 
they're saying and what they continue to say--in fact, this coming 
Thursday you're going to see--I don't know how many are going to come 
to Washington for what my colleagues refer to as a ``house call,'' a 
house call on Washington; but this is not the physicians making the 
house call. This is the American public, this is the patients, these 
are our constituents making a house call on Thursday at noon.
  I'm not sure whether we are going to have the opportunity to have 
them gather on the east steps where they can be seen by all, and all 
Members coming and going as we come to the floor and debate and vote on 
this, the most crucial issue that's been before us, I don't know, maybe 
in the history of this Congress, certainly in the 7 years that I've 
been here. But we're going to see a lot of people coming from all 
across this country. Whether they're constituents from Democratic 
districts or Republican districts, they're going to be here, they're 
going to be here. My colleague is going to talk about that, I think, in 
this next hour.
  Mr. Speaker, I would say to all my colleagues, you ought to tell your 
constituents to come. Get on a bus, drive up here, bring a caravan and 
tell the Members of Congress and the President and this administration 
what it is you want and what you don't want. And I know they're going 
to be saying no government-run health care. They're going to be saying 
don't cut seniors' care to pay for health reform. We can't even get an 
annual physical under Medicare. We don't have any catastrophic 
coverage. We have to pay a $900 deductible before we can even go in the 
hospital under Medicare. And they're going to say don't raise the 
deficit. I think they think that $1.4 trillion is quite enough deficit 
for 1 year.
  And they're going to say, Mr. Speaker, give us choices, but don't 
give us mandates. Don't force our young sons and daughters who are 
straight out of college to have to pay $900 a month for health care 
they don't need. Allow them, health choices administrator, allow them 
to pick a high deductible, low monthly premium with catastrophic 
coverage during the years that they are taking care of themselves and 
taking personal responsibility.
  And they're also going to say, Mr. Speaker, and I will say this in 
conclusion, they're going to say we want you Members of Congress, 
Democratic majority, Republican minority, we want bipartisan 
compromise. We think that you ought to go back to the table, take a 
clean sheet of paper, throw away these 1990 pages. We know you 
destroyed a lot of trees, but let's start over again with one sheet of 
paper and do it in a bipartisan way and think

[[Page 26606]]

first and foremost about the American people and not the next election.
  With that, Mr. Speaker, I yield back the balance of my time.

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