[Congressional Record (Bound Edition), Volume 155 (2009), Part 20]
[House]
[Pages 26756-26763]
[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. Thank you, Mr. Speaker.
  It's a pleasure to be able to once again join my colleagues and 
others who might be interested in listening in to our discussion on 
this compelling subject of health care, which has absorbed the 
attention of people political and the people who work down here at the 
Capitol, lo these many months. We are on the verge of perhaps taking a 
landmark kind of vote as to the direction that we are going to go in 
health care.
  I was preceded by one of my colleagues, an esteemed colleague, who 
was asking the question, Why would we do something that would keep us 
from being a prosperous and happy and a nation reflecting leadership in 
the world?
  The reason that America has been in the past prosperous and happy and 
has enjoyed world leadership is not because we have rushed headlong 
into European socialism but because, instead, we have adopted the path 
of freedom. Freedom has its drawbacks. One of the drawbacks of freedom 
is that people can fail and that there are responsibilities required of 
citizens.
  When a government tries to insure everybody about everything that can 
go wrong, unfortunately, it's trying to repeal the basic laws of supply 
and demand; and we are no more effective in doing that or has any 
government in history been effective in doing that than repealing the 
law of gravity.
  I was aware that there was an attempt one time--I was told it was in 
the State of Tennessee--where the teachers unions were frustrated at 
trying to teach students about pi, that little funny-looking thing with 
the number 3.1415 after it. They decided that it would be easier in 
terms of teaching to change pi from 3.1415, to just make it 3, to keep 
it simpler.
  I'm not sure how the wagon wheels in Tennessee went after that 
legislative change was made. I imagine that mathematics continued to 
operate under the same set of laws in spite of what the legislature 
said. Now there are many things that Americans agree to on the subject 
of health care. It doesn't have to be particularly complicated.
  One of the big problems is covering preexisting conditions. This is 
something that happens when people could be quite responsible, work 
hard at a job; but all of a sudden after a number of years, something 
comes up, either a child, a wife or a husband, someone in the family 
develops a medical condition which you didn't see coming, which is 
going to break the back financially of the house, and something which 
occurs in America too frequently. We must deal with that question. I 
think Americans agree that we need to deal with it.
  Stopping the cost shifting and reforming medical liability law. The 
cost shifting, if you take a look at the problems in American health 
care today, you could think of American health care in a sense in two 
halves. The first half is the front half. That's the provider system. 
It's the doctors, the nurses, the hospitals, the many staff people and 
the fancy equipment that continues to provide Americans with the very 
best health care in the world. If you don't believe that, in spite of 
people complaining about American health care and talking about all 
these problems, if you are a multimillion-dollar sheikh from Bahrain or 
whatever and you are sick, guess where it is that you want to come get 
your health care? Yes, you've got it right--good old America. People 
vote with their feet and come to our country. That's the provider 
system.
  The back half of that system is how do you pay for it, and that is 
the part of the system that is feeling increasing stress. If there is 
something broken, certainly the back half is the place where there are 
the most problems. From a macro level, if you take a look and say, 
well, what really is the problem? The problem is pretty simple; that 
is, two-thirds of Americans are paying for the system and one-third is 
not. As the people that are not paying anything for health care 
increase in number, it puts more pressure on the people that do pay, 
and that is creating a lot of cost-shifting and problems.
  So one of the things we've got to do is stop the cost-shifting, and 
one of the

[[Page 26757]]

ways that you can reduce the cost of health care in America is 
reforming medical liability law. Unfortunately, the bill that's being 
considered by the Democrat Congress, the Pelosi bill, goes exactly in 
reverse in liability and says that States that have already on a State-
to-State basis passed medical liability reform are not going to be able 
to have those laws take place. We are going supercede the law of a 
whole series of States in order to raise the price of health care. This 
bill is going in the wrong direction if we are trying to save money. 
More on that later.
  Making people sure that they can keep the insurance coverage that 
they like. Today, there are about 100 million Americans who have 
insurance coverage. They have relations with doctors, they are 
reasonably comfortable that they are getting good medical care, and 
they really don't want to change that. They don't want us, because 
there may be some problems in the system, to, in a sense, burn down the 
barn in order to kill a few rats, or, as another person has phrased it, 
to say, When you've got a leaky sink, you don't remodel your entire 
kitchen. Many people who have insurance coverage that they like are 
going to be affected by a plan that's thousands of pages long, 
trillions of dollars in expense, and essentially tries to remodel an 
entire kitchen or, if you will, burns down the barn.
  And then preserving the doctor-patient relationship. If there's 
anything that I think is more personal or more important in the health 
care debate and discussion, it is this very question. I don't think 
anybody wants to be sick, but when they do get sick, they try to find a 
doctor that they trust.
  Maybe, after getting a couple of opinions, they decide on some course 
of action, they and the doctor; the patient and the doctor decide on 
what is best for their health care. And whenever something gets in the 
way of that decision-making, it tends to be, by definition, a very bad 
outcome.
  We want to preserve the doctor-patient relationship. There are 
several things that get in the way of that relationship. One that has 
been too common would be the fact that some insurance companies will 
try to second-guess the doctor, claim that they have some medical 
expertise, that the doctor is being too cautious, that we don't really 
need to spend this money. Insurance companies do that sometimes. We 
have found that in the Pelosi bill, there is even a section which 
preserves, under ERISA, the insurance company's right to second-guess 
the doctor-patient relationship and then, if something goes wrong, to 
avoid any financial or legal responsibility for that decision.
  There was a press conference earlier today on that very same subject, 
pointing out the exact pages in the bill and how this section, which is 
pretty onerous, the fact that a patient can make a decision with a 
doctor and be second-guessed by an insurance company and when the 
decision goes wrong, the insurance company skates without any 
liability. That's part of the Pelosi bill. We don't want insurance 
companies coming between a patient and a doctor. That press conference 
was led by Congressman John Shadegg, who did a very good job and has 
raised some very serious questions in this regard.
  There is something worse, believe it or not, than an insurance 
company coming between a doctor and a patient, and that is a Federal 
bureaucrat coming between a doctor and a patient. If the Federal 
Government decides, just like the auto industry, the insurance 
industry, the banking industry, the student loan industry and all these 
other places that it wants to get into the medical business, which the 
Pelosi bill puts them in that business, then in order to control costs, 
what's going to happen is you are going to end up with bureaucrats with 
nice big calculators and they'll figure out whether or not you qualify 
to get medical care.
  Now we need to make a distinction between two very important things. 
The first thing is medical insurance; the other is medical care. In 
foreign countries, all of the citizens have medical insurance. That's 
wonderful. But if the medical insurance doesn't result in medical care, 
it doesn't do you much good. One of the things that happens in foreign 
governments, the whole idea of a government-run medical care, they 
can't provide Cadillac kind of medical care for everybody in their 
country because they can't break the laws of supply and demand. And so 
how do they control costs? Well, they control costs with these 
bureaucrats with their calculators.
  If you're a certain age, and you want to get this particular test, 
``Sorry, Bub, here's some aspirin. Go home and sleep it off.'' Now 
that's called rationing. If you are a more political government and you 
don't want to get your citizens quite as mad at you, instead of just 
telling somebody to go home and die, what you can do is you create 
these waiting lists; so you can say to some woman who's pregnant, You 
can have your C-section in 14 months. She might start scratching her 
head saying, I don't think you're doing me any favors with that. But we 
also see that in the socialized medicines of other countries, these 
long waiting lists.
  The result of that, of course, is that in certain kinds of illnesses, 
the waiting list is very dangerous. Certainly in heart disease, which 
is a leading cause of death in America, if you have a long waiting 
period, that's not a good thing.

                              {time}  1845

  Likewise, in cancer, cancer is something that you want to catch 
early. If you do, you can have some very good outcomes. If you don't, 
the outcomes are far more gloomy. And so timeliness is very important. 
And when you are trying to keep your costs low, with the government 
trying to manage their budget, what they are going to do is create 
waiting lists which then have bad outcomes. And that is what the record 
shows of survival rates in cancer, for instance, in the U.K., which is 
a socialized system as opposed to a more free enterprise system in 
America.
  Now these are things that Americans agree to. The question is what is 
being proposed, will it help these things and what is the cost?
  In fact, when we take a look at the issue in most any department of 
the Federal Government, when the government does something, or 
particularly if it does too much, we see some outcomes that are pretty 
common, regardless of what area of government that it is. We see 
bureaucratic rationing, which I was just talking about, inefficient 
allocation of resources, degraded quality, and excessive expense. All 
of these things come when the government does too much.
  Well, would the government takeover be something that would qualify 
as the government doing too much? I think the old adage that ``if you 
think health care is expensive now, just wait until it is free'' might 
apply here.
  Is the government doing too much with the Pelosi health care 
proposal? The first thing to understand, and this is actually a chart 
that was drawn up on the earlier Pelosi bill, which I believe was only 
about a thousand pages, the new version of this plan, which is very 
similar, is 2,000 pages. So this chart may not be completely accurate. 
In fact, it may be too simplified.
  What you have here, every one of these colored boxes is some new 
bureaucracy, some new moving part that is created by the Pelosi health 
care proposal. You can see, trying to take a thousand-page bill and 
putting it on a chart, it is going to look a little complicated. But if 
you think about it, we are going to be taking one-sixth of the U.S. 
economy and then we are going to turn that over to the Federal 
Government to run with this proposal.
  So you have the consumers. It is almost like a maze. Can the 
consumers get over to the doctors, or not?
  So one of the things that you run into when the government does this 
is tremendous complexity. That is why when the President last July came 
here to the Congress and said we need to get this done, none of the 
other Presidents before me could get it done, but I am determined to 
get it done, so you need to put a bill together and I would like to 
have it done before the end of July, he was asking for a pretty tall 
order. In fact, he was asking for the impossible because trying to put 
this together,

[[Page 26758]]

even if you buy the assumption that the government should take over 
health care, is not a simple procedure. This gives just a little bit of 
the sense of how complicated that is.
  Now one of the other things that you have to associate with a high 
level of complexity is also a high level of cost. We have a number of 
statements that were made by the President, and certainly he has the 
bully pulpit. Everyone listens when he speaks, and he makes a number of 
different statements which I would take a look at those and see how 
really accurate are they.
  This is one of his statements before the Joint Session of Congress 
that was on August 9 before the summer break. ``Most of this plan can 
be paid for by finding savings within the existing health care system, 
a system that is currently full of waste and abuse.''
  This sounds pretty good on the surface. We can simply take the health 
care system that we have, and there are pockets of waste and abuse, we 
tap into that like unused oil, and we can all of a sudden come up with 
something that the Federal Government runs which is going to be less 
expensive because we can pay for this government-run system by using 
waste and abuse. It is almost as though waste and abuse are a line item 
in the budget and we simply pull money out of the waste and abuse 
account and we stick it into health care, and we have everything taken 
care of financially.
  Unfortunately, the government running various entities does produce a 
tremendous amount of waste and abuse, but it is not so easy to squeeze 
that fat out of the system. It is not a simple line item. The place 
where he is looking for this waste and abuse turns out to be an area 
that is politically highly controversial, particularly taking it out of 
Medicare.
  Let's take a look at this efficiency that he is talking about that he 
can create by having the government take the system over. We do have 
some experience. We have experience of two other government, Big 
Government entitlement programs in the area of medicine. One is known 
as Medicaid; the other, of course, is Medicare. The other big 
entitlement is Social Security.
  If we look at Medicare and Medicaid, if we look at the history of 
those two government-run medical systems, what we find is when the 
Congressional Budget Office scored those bills when they were passed by 
Congress some many years ago, it was found that their estimates were 
extremely optimistic and very low. In fact, in the case of one of them, 
the estimates were more than four times too low and the other one, as I 
recall, even many times more than that. So we are not saying a couple 
of percentages off, not 10, 20, 30 percent off, we are talking about 4, 
5, 600 percent, that these things were estimated to be lower in cost 
than they were going to be. And worst, what we see with this chart, we 
see that the cost of these programs is rapidly expanding. In fact, they 
are expanding so fast that people, both conservative and liberal alike, 
will say that these three entitlements will destroy the financial 
solvency of the United States in a period of time. This chart shows 
that being somewhere in the 2052 range.
  Why would that be? Well, part of it is that the actual revenues that 
the Federal Government takes in are to a degree limited. That seems 
like an odd thing to say because you think, can't we always crank up 
the taxes? If 24 percent, or 28 or 18 percent tax rate isn't enough, 
let's kick it up to 50 percent. The problem is that the mechanisms that 
the Federal Government has to try to increase taxes, what happens is 
they can increase the tax but the government revenues don't go up. Now 
that might seem like a really odd thing. Let me stop and explain what I 
am talking about.
  You would say if you raised taxes, you are going to get more money. 
So aren't you saying that water is running uphill or something to say 
that raising taxes doesn't generate more money? Well, in fact it does 
not at a certain point.
  Let's use the illustration that you are king for a day. Your job is 
to put some taxes onto a loaf of bread and you think about Americans 
buying loaves of bread. You think, well, I can raise a certain amount 
of tax if I just put 1 penny on a loaf of bread. But then you think to 
yourself, or I can raise a whole lot more if I put $100 on a loaf. But 
nobody would buy a $100 loaf of bread. So common sense tells you 
somewhere between a penny and a hundred dollars, there is some optimum 
point where people will still be buying a lot of bread, but if you 
raise the tax more, no one will buy bread any more. So there is this 
sort of optimum taxation.
  What this chart in actual Federal revenue shows is what that point 
is. So what happens is you can raise taxes above it, but what you do is 
stall the economy. Therefore, even though you have a high tax rate, you 
end up getting less money in the government.
  Just to give you an example of how that principle worked, when I was 
first elected in Congress in 2001 and 2002, we were in a recession. If 
you took a look at the Federal budget, there were a lot of liberals and 
Democrats complaining about the large tax cut that President Bush and 
the Republicans passed. They said, that is costing us billions of 
dollars. Actually, we were following President Kennedy's model, Ronald 
Reagan's model, and Bush II followed that same pattern, realizing that 
if you reduce the taxes, you can actually increase the Federal revenues 
because the economy pulls out of a recession and gets going.
  But if you were to add the supposed cost of those tax cuts to the 
cost of the war in Iraq and Afghanistan, add that all together, it was 
less money than the cost of the recession. So when the economy gets 
flat, it not only hammers mom and dad back home, it hammers the States 
terribly because many of them are balanced budget, and it also affects 
the budget of the Federal Government.
  So as these programs grow out of control, what is going to happen is 
there is going to come a real financial breaking point.
  So we are told that the government taking over all of health care is 
not going to follow this pattern, this is the government taking over 
some of health care, but in fact if we take over all of it, my 
goodness, we are going to have all kinds of savings. Well, if you 
believe that, I think there are some people that sell swampland in New 
Jersey.
  So this is the track record of government control of health care. Now 
that is not the only example. There are other examples such as 
Massachusetts and Tennessee, and they have tried this government 
takeover and the government providing insurance for health care, and it 
hasn't worked for them and it has raised their cost of medicine in 
those States to the point that it has threatened the provision of good 
medical services.
  So you have in response to the Pelosi health care bill, the Democrat 
Governor of Tennessee calling it ``the monster of all unfunded 
mandates.'' So in order to keep the cost of the Pelosi plan under $1 
trillion, guess what, they are cost shifting costs to the States and 
even the Democrat Governor of Tennessee, who has had experience with 
this type of program, is saying that this is the monster of unfunded 
mandates. In other words, the Federal Government makes the State do 
something which is going to cost the State a whole lot of money.
  Let's go on here. This is a statement by our President. ``Here is 
what you need to know. First, I won't sign a plan that adds one dime to 
our deficits, either now or into the future, period.''
  Boy, do I feel better when I read that. The President is telling me 
he is not going to sign a bill that adds one dime to our deficits, 
either now or into the future, period.
  This is one of those things you better make sure that you know what 
``is'' is and what is this really saying because in a technical sense 
he can make the statement that he is not going to add one dime because 
it appears that he is going to add over a trillion dollars, and even 
that doesn't show the accurate cost. So let's be careful when we take 
this statement. Does he really mean that this is something that is 
going to be financially solvent and is going to really work well? Or is 
he just being a little bit cute and saying he isn't going

[[Page 26759]]

to add a dime, no, he is going to add a trillion dollars.
  Well, it turns out that the Pelosi health care plan is going to cost 
over a trillion dollars.
  Well, we have taken a look at how serious is the President since the 
beginning of the year. How serious is he in worrying about excessive 
spending in the Federal Government. Well, certainly President Bush was 
accused for overspending. But it turns out he was merely a piker 
because this year isn't even over yet, and the total spending from the 
Obama administration and the Pelosi administration is $3.6 trillion. 
Now, the worst year that President Bush had was when the Democrats 
controlled Congress, and it was about somewhere in that $400-plus 
billion of deficit. And here we have $3.6 trillion in less than a year.
  So when he says he is not going to add a dime, we have to say, wait a 
minute, I am not sure that passes the sniff test. Here we have the Wall 
Street bailout, half of that was under this administration. That is 
$350 billion. Then we have the so-called economic stimulus, I call it 
``porkulus,'' it didn't have much stimulus in it at all. That is why 
unemployment is high.
  We were promised if we didn't pass stimulus, why unemployment would 
get as high as 8 percent. We passed it, and it is 9.7 percent and 
rising. That was $787 billion. That is a chunk of change, it really is. 
In fact, as we went through the year, we had already spent all of the 
money that the Federal Government was going to collect this year by 
March or April, as I recall.
  SCHIP, another $66 billion. And here are these appropriations at 410, 
and then we have these other tax bills that are coming along trying to 
compensate for this incredible $3.6 trillion level of spending.
  So when the President says I am not going to sign a bill that adds 
one dime, we say maybe not a dime, but you are talking over a trillion 
dollars and that is not even talking about what is being shifted to the 
States.
  I would like to take a look at some of the other comments that have 
been made because I think trying to get a little bit of truth into this 
debate and kind of balance things out, it is very helpful tonight.
  This is a very nice promise. I really like this promise. First, and 
this is the President again, ``First, if you are among the hundreds of 
millions of Americans who already have 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.''
  Whew. That is good news. Do you know there are a hundred million 
people in America who have health insurance. They have doctors, and 
they are very pleased with their health care and they are not so sure 
that they want the Federal Government to come in and stir it all up and 
change it.

                              {time}  1900

  So if we can assure those hundred million Americans that already have 
insurance that they like that everything is going to be okay, then the 
idea would be let's just try and fix the--however many, people argue 
about it--10 to 20 million who do not have insurance that could have 
insurance that don't, well, then that would be okay.
  Well, the question is is this true. We heard the last one the 
President said, that he's not going to add one dime. Now he's saying 
that you can keep what you've got. Well, that's a great promise. I wish 
that one were true because I think that's really nice, a lot of people 
would like to keep what they have.
  Here is an MIT health economist, Jon Gruber. He said, in reference to 
this claim, With or without reform, that won't be true, said Gruber. 
His point is--that is, the President's point is--that the government is 
not going to force you to give up what you have, but that's not to say 
other circumstances won't make that happen. In other words, what's 
being said here is, yeah, the plan doesn't specifically say you can't 
have your current insurance and your current doctor, but it does say 
that all of these insurance plans have to be just like the Federal 
Government's insurance plan at some time in the future. And that being 
the case, the insurance company is going to change the plan that you 
have or go out of business, or quit offering it, or whatever a whole 
series of alternatives might be. Therefore, this statement is not true 
either.
  In fact, what's going to happen is, just as we've talked about, this 
is the government takeover, either slowly or rapidly, of one-sixth of 
the U.S. economy. And so the idea that you can keep what you have and 
everything is going to stay the same, you could say that, and maybe it 
will stay the same--for today and tomorrow and next week and next 
month, but next year, maybe not; 2 years from now, certainly not; 4 
years, very, very different. So, yes, can you keep what you've got and 
enjoy your insurance and your doctor? Yes. For how long? No promise on 
how long.
  Then we have another promise here. There are those who also claim 
that our reform effort will insure illegal immigrants. This, too, is 
false. The reforms I'm proposing would not apply to those who are here 
illegally. Well, I think a lot of Americans should think, my golly, 
you're going to spend another $1 trillion charging all kinds of 
Americans a lot more money to have this government-run health care 
plan, and they're thinking to themselves, I'm not sure I can afford to 
pay for people who come here illegally over the border to try to get 
free health care off the back of the American workers.
  So there is a legitimate concern, and of course that's already 
happening around some of our borders. It's very hard to get into 
emergency rooms in many hospitals because people come here from other 
countries and just walk straight to the emergency room and get care. 
And of course all that cost is being shifted to other hardworking 
Americans.
  And so, this is a good promise that the President made. I wish this 
one were true, too. This would be really good if this were true; like 
the other ones, it would be nice if they were true.
  There are also those who claim that the government will insure 
illegal immigrants. Well, okay. So what's the truth here? Well, one of 
the ways to check on whether that's true, we have an organization here 
in the Congress called the Congressional Research Service. They're a 
bunch of people who are experts at researching things. They're expert 
at law. And they're not Republican. They're not Democrat. They're not 
particularly biased. Their job is just to say just the facts, ma'am, 
just the facts. Here's what they said about this statement. This is the 
Pelosi health care bill before it was beefed up by another thousand 
pages, but the section that's in the bill is the same, relatively 
speaking, in dealing with this problem.
  This 3200 health insurance exchange would begin operation in 2013 and 
would offer private plans alongside a public option. H.R. 3200 does not 
contain any restrictions on noncitizens, whether legally or illegally 
present, or in the United States temporarily or permanently, 
participating in the exchange. So what this is saying is, well, you 
know, the President can say the illegals won't get the service, but the 
fact of the matter is the way the bill is written, people who are here 
illegally can sign up and get the service on the backs of the 
hardworking American taxpayers. And so what the President said again is 
not true.
  Now, there are other ways to try to tell whether something is true 
other than just something like the Congressional Research Service. One 
of those means of telling if something is true or not is to offer 
amendments. Now, because of the great transparency that we've been 
promised, there will not be any amendments here on the floor; if there 
are, it's going to be one or two.
  Members who are concerned about, for instance, illegals, making sure 
that they have to prove their citizenship before they sign up for free 
health care, people who are concerned about that might offer an 
amendment. The amendment might say, hey, before you get into this 
exchange and get this insurance, here's the deal. What you have to do 
is you have to prove your citizenship. And so an amendment such as

[[Page 26760]]

that was offered in committee. It can't be offered on the floor because 
of our procedure. The Democrat Party does not want to have a lot of 
those amendments on the floor. And especially with a 2,000-page bill, 
it's true, we would be here a long time.
  Some of those amendments are kind of important, but they don't want 
to take those votes. But those votes occur--although the public doesn't 
see them as much--in committees. That amendment to make sure that 
illegals didn't get health care was taken in committee. The vote was 
just about a straight party line--Republicans for it, Democrats against 
it. And so, with that amendment failing the way it did, it doesn't give 
people any comfort that what the President has promised is true, or 
that perhaps it almost seems as though it is disingenuous.
  A similar criticism and complaint--there's a lot to talk about in a 
2,000-page bill, my goodness. This is another statement that was made 
by our President, and it is, he says, a misunderstanding. ``And one 
more misunderstanding I want to clear up--under our plan, no Federal 
dollars will be used to fund abortions, and Federal conscience laws 
will remain in place.''
  Well, this is a pretty controversial question. Most people know that 
America is deeply divided on the abortion issue. There are many good-
meaning Americans who believe that abortion is the killing of an 
innocent child. And there are good-meaning Americans, I suppose, who 
think that abortion is a choice question and a mother should be able to 
kill her child. Well, people are going to disagree on that. But this 
is, in a way, a different question.
  And it's interesting that the people who want to have abortion rights 
say that people should have choice, and yet in this particular question 
there is no question of choice at all, because when it comes to paying 
your taxes, you don't have any choice. The tax man comes to your door. 
If you don't pay your taxes, you go to the free hotel. And so paying 
taxes is compulsory, there is no choice involved in it. And is it 
reasonable--at least you have to acknowledge, or some people think it's 
wrong. Is it reasonable to tax them and have their money go for paying 
for abortion services for people all over the country? And so this is a 
very big ethical question. In fact, the National Right to Life and some 
of those groups would rate this as one of the biggest decisions on the 
abortion question since Roe v. Wade or Doe v. Bolton.
  So these questions are something that is percolating within this 
overall health care bill of thousands of pages. And the President's 
saying, hey, don't worry about it. We're not going to use taxpayer 
money to fund abortions. The only trouble is that, like the illegal 
immigrant question, an amendment was offered in a committee--it would 
never be allowed on the floor, but it was offered in committee--and 
that amendment said that we're not going to be using any of these 
Federal dollars and that we will not be funding abortions with Federal 
money. Again, that was close to but not entirely a party line vote. 
That amendment failed.
  So as it fails, it leaves you with the irrevocable kind of conclusion 
that we're not going to have protection. In fact, the bill--or even if 
the bill doesn't do it, under Federal rules and regulations, you will 
have people getting abortions using taxpayers' money. This is something 
that actually quite a number of pro-life Democrats are hung up about, 
and there is a big argument about this subject. I've never been invited 
to those meetings. I'm a Republican. But it is interesting to note that 
again the President says one thing, and yet in fact, when you look at 
the committee votes and the amendments offered in committee, this is 
not true.
  One of the things that's interesting to look at, you can look at 
health care from so many different angles. One of the angles that's 
interesting is what is it that women want, because it turns out in 
families, many times women are the ones that are involved in the 
details of the family health insurance, making health insurance 
decisions for families. And here is a survey that's just been conducted 
October 19-25, 2009. So this is a very, very recent survey, independent 
women for a nationwide survey. So they were polling people from all 
over this country.
  Let's see, what did the survey say? Well, first of all, 64 percent of 
American women would rather have private health insurance than a 
government-run health insurance plan. You know, it's interesting. In 
the political world, you can ask questions in several different ways. 
One thing you could say is, ``Would you like the government to buy you 
a house?'' And you think, hey, that sounds pretty good. The government 
would buy me a house, really? ``Hey, Congressman Akin, I would really 
like it if the government bought me a house.'' So if you said, ``Would 
you like the government to buy you a house?'' probably a lot of people 
would say, ``Well, yeah.'' You could ask the same question a different 
way, ``Would you like to live in government housing?'' I don't think 
you would find as many people that want to live in government housing. 
Well, this is a situation here like that.
  They're saying 64 percent of American women, that they would rather 
have this private health insurance than a government-run health 
insurance plan. And that's actually kind of common sense, because, for 
one thing, if you like the idea of having some flexibility and choices, 
if you don't like your private health insurance, guess what you can do? 
You can go try and find somebody else. What happens if your only choice 
is a government-run plan? Well, that's just like Henry Ford. You can 
have any color car you want as long as it's black. And the nations that 
have health plans that are run by the government, when you get some 
sour and unresponsive and underproductive Federal employee running a 
hospital and the hospital care is terrible, what are your alternatives? 
Are you going to call your Congressman and say, hey, they haven't 
mopped the floor and changed the sheets in X, Y, Z hospital? How much 
good is that going to do you? So these women here, they weren't born 
just yesterday. They would rather have private health insurance than 
government.
  Sixty-six percent of them described their insurance as excellent or 
good. So you have a great number of Americans, that's that 100 million, 
or at least a good number of them, that are saying their current health 
insurance is excellent or good. What that means is that, as I was 
saying as we started our discussion on health care, that that provider 
network is, in America, still pretty good. You don't find so many 
Americans going to Canada for health care or to Mexico for health care, 
but you do find a fairer number of Canadians coming to America for 
health care or Mexicans coming to America for health care. So it's not 
surprising that we find two-thirds of these women saying that they 
think their health care is excellent or good.
  Seventy-four percent of them describe their health care as excellent 
or good. Let's see now, what's the difference here? Health insurance. 
Oh, health care. This is health insurance; this is their health care. 
So while they weren't quite as crazy about their insurance, they said 
their health care, 74 percent of them--again, this is the case of the 
old sheikh that's sick. He wants to come to the USA to get his health 
care. These women are saying the same thing. Seventy-four percent of 
them said that actually their care is excellent or good. It doesn't 
make too much difference what you think of your health insurance in a 
way if you're getting good care.
  On the other hand, you can have wonderful health insurance, but if 
you don't get any medical care, it's like paper Monopoly money. It 
doesn't do you any good.
  Then here is 75 percent want few to no changes made to their own 
health care. So this, again, is where a lot of people are. They would 
like to keep what they have, they're comfortable with what they have, 
and they don't want us to remodel the kitchen when the drain in the 
sink is stopped up. They just want to fix the plumbing, but they don't 
want to remodel the entire kitchen. That makes a whole lot of sense. 
And actually, from a legislator's point of view, it also makes a lot of 
sense.

[[Page 26761]]

  What you're seeing going on politically right now is an attempt to 
move a bill, to nationalize one-sixth of the U.S. economy. That is a 
very ambitious project. While I think the Democrats are wrong in trying 
to do that, I will take my hat off to them at least in the fact that 
they're doing something that is incredibly ambitious and probably more 
than what the legislative process can handle in a short period of time.
  So part of the problem is is that you just have a whole lot of people 
that like things the way they are, and so trying to change that for 
everybody is particularly difficult. And this is kind of a women's 
perspective on what they're seeing and what's going on.

                              {time}  1915

  Now, there are a lot of other perspectives on this bill, and that's 
part of the problem that this bill has, which is that a lot of people 
don't like it.
  One of the groups of people that really doesn't like it is seniors. 
Seniors have gotten used to and are dependent on Medicare. Of course, 
Medicare costs are going up a lot, but they don't like the fact that a 
lot of this bill is going to be paid for through cuts in Medicare. 
That's something that tends to antagonize older voters, and many of 
them are very consistent voters. So this is a group of people that 
doesn't like it.
  Another group of people which particularly does not like this 
government takeover is going to be that of the people who run small 
businesses or who own small businesses, because what this bill is going 
to say is: You must insure all of your employees, and you've got to do 
it in this, that or the other way. Therefore, it's going to raise a 
whole lot of costs for your employees if the government is going to be 
taking over health care and is going to be demanding these things of 
small business.
  The result is that what we've been doing to the small businessman is 
hammering him just like a giant sledgehammer in some kind of circus 
tent. We're hammering him down into the dirt. First of all, we're going 
to let the dividend capital gains tax cuts expire, so he's going to get 
a tax increase from that. Next, we passed a bill here in the House, 
which is called cap-and-trade, or cap-and-tax, which is the biggest tax 
increase in the history of the country supposedly to take care of the 
dangerous gas CO2 and global warming. That has a very huge 
tax increase. That is going to also raise the energy costs to small 
business.
  So now they're not only getting the tax increase of the expired 
capital gains dividends, which is the money they use to invest in new 
plants and equipment, but also they're going to get hit with an energy 
tax. Now, on top of that, we're going to try to balance the books of 
this health care plan on the backs of the small businessman.
  The trouble with doing that--and this was tried by FDR in the Great 
Depression--is that you can drive the small businessman so far into the 
dirt that you make him close his business down, and that has some 
effect on employment. In fact, small businesses in America employ--if 
you call ``small business'' 500 or fewer employees, 80 percent or 79 
percent of Americans work for these smaller sized companies. So, if you 
hammer them into the dirt in terms of taxing and taxing and taxing, 
what is going to happen is you're going to have increased unemployment. 
It's not a big surprise to see what we've got going.
  Hey, we're joined here in the Chamber by a good friend of mine. There 
is so much going on in health care, I would just encourage you to join 
in like it's a dinner conversation, my friend, and just share what 
you're thinking. We're even talking about a vote here within some days.
  Mr. LATTA. I thank the gentleman for yielding, and I appreciate your 
hosting this very special Special Order this evening.
  Where I come from in Ohio, we are very, very hard hit. Our 
unemployment rate is one of the highest in the State in our district. I 
represent the largest manufacturing district in Ohio. I represent the 
largest agricultural district in Ohio. At this time last year, we were, 
according to the National Manufacturers, about the ninth largest in 
manufacturing.
  Mr. AKIN. Well, that's a very important fact. Don't go too fast. What 
you're saying is your district is the ninth largest manufacturing 
district in the country?
  Mr. LATTA. We were at this time last year, but we've slipped to 15th 
now.
  Mr. AKIN. You've slipped to 15th?
  Mr. LATTA. Yes.
  Mr. AKIN. So what is your take on manufacturing? Because we were told 
old people don't like this bill because it's cutting Medicare. Small 
businesses don't like it because they're getting hammered one more time 
into the dirt with tax increases. Let's talk about manufacturing 
because, in a way, that's the backbone of American industry.
  Mr. LATTA. Absolutely.
  Mr. AKIN. What is your take on this? How does this work?
  Mr. LATTA. Well, I'll tell you. You know, when we were all home 
during the August work period, I went through I don't know how many 
different factories, and I went through lots of small businesses.
  As one example in particular, I had a gentleman walk up to me. He was 
a factory worker. He said, You know, I'm really not sure what you all 
are talking about there in Washington. He says, If I can't put a roof 
over my family's head, if I can't put food on the table, health care is 
not the top issue for me.
  People are all concerned about health care, but as to where it is in 
the priority ranking, it's at survival right now. We've got a lot of 
folks out there who need to survive. At the same time, you have a lot 
of these smaller businesses--you know, when I talk about smaller, it 
could be a factory of about 150-170 which is now down to 29-35 people, 
and they're just hoping they can keep the lights on. When they see and 
hear that Washington might impose a mandate on them, especially at that 
8 percent level, they say, Well, we're not going to survive.
  Mr. AKIN. Let's get back and get those numbers. We were just talking 
about this last night.
  We've got small business and even manufacturers that have been 
hammered so hard now that they're struggling for breath.
  Mr. LATTA. Absolutely.
  Mr. AKIN. We're going to nail them with another, possibly, 8 percent 
cost. This is 8 percent.
  Also, what's going to happen to the dividends and capital gains? 
That's going to go up through this bill, too. So, not only do we have 
additional taxes on top of the other taxes, on top of the ones that are 
going to expire and go up--you've got all of that coming down the pike. 
Also, they don't see any end in sight.
  So we have created an environment where there are a lot of unknowns. 
If you don't know what's going to happen the next month, when we get 
done with this tax, we're going to go to another one. What you're going 
to do is you're going to try and play it safe and see if you can 
survive. Am I on the right track?
  I need to just thank you. Congressman Latta is from Ohio, and he is 
really an upstanding young Member. Your opinion is very important, and 
Ohio is a very important State, particularly because of the 
manufacturing base.
  Mr. LATTA. Absolutely. You hit the nail on the head.
  All of these companies that are out there struggling right now look 
at everything. Health care is a huge issue to them. Cap-and-trade is an 
issue out there--the electricity costs to keep the machines running. 
Then we had the second highest corporate tax rate here in the United 
States.
  If you put these all together, plus you throw in the EPA and the 
environmental things that have to go on at these companies, and if 
they're owned by a parent company that has a plant someplace else in 
the United States, they can say, as in our situation, Well, you know 
what? Your costs go up too great in Ohio. You're just going to have to 
move.
  There are some companies out there that are multinational and they've 
said, You know what? We're to the

[[Page 26762]]

point that, with any more costs, it would be cheaper for us to actually 
make it on the Pacific Rim and ship it here, and then we won't have to 
worry about all of these costs, and there's the product.
  Yet, you know, health care is one of those things that everybody 
wants to make sure that we have; but at the same time, we've got to do 
it in the right manner, and that's what a lot of folks back home are 
very concerned about, because I don't care if you're a senior citizen 
and you're on the Medicare side or if you're a businessowner. Again, 
these businessowners are the ones who are very frightened because 
they're the ones who keep people employed on Main Street.
  In talking about Main Street, not too long ago, I was out on one of 
my Main Streets in my district. One of the businessowners asked, Bob, 
you know, is this thing going to pass? He said, You know what? You're 
looking at my business right now, and I will not be able to survive, 
with the numbers that I'm seeing from Washington right now, under this 
legislation.
  Mr. AKIN. You know, a wonderful part of America are these different 
expressions. There is such a diversity of people in our country, and I 
guess that's probably why we serve here. We just love this country and 
love our own constituents and all.
  In representing Missouri, we have some kind of rural expressions that 
are fun. One of them is ``hunker down.'' Sometimes you'll hear people 
in Missouri say, ``Hunker down.'' Then, if they're really serious about 
it, they'll add to this. ``They're hunkered down like toads in a 
hailstorm.''
  It paints a picture, but that is, to a degree, the picture of the 
small business man and of the manufacturer in America just being hit, 
not with hailstones but with tax on tax on tax, and we wonder: I can't 
understand why there would be unemployment.
  Do you see?
  The thing that's tragic about this is the fact that the government 
has tried this before. They tried this before, and they created the 
Great Depression.
  You had this little British economist, little Lord Keynes, running 
around, saying, Hey, I've got a brilliant idea. Why doesn't the 
government just spend tons of money, and by spending lots of money, it 
will get the economy going, and we will jump-start--I don't know if he 
used the word ``jump-start.'' I don't know if they had car batteries 
back then. I guess they did. We're going to jump-start the economy by 
the government spending tons of money.
  So FDR thought that's a pretty good idea. Plus, it's not bad politics 
if I can run around like Santa Claus with the paychecks, you know?
  So he gets Henry Morgenthau as his Secretary of the Treasury, and 
they test out this nifty theory. So they go out and spend tons of money 
year after year after year, hoping to see unemployment come down.
  At the end of, I think it was 9 years, Henry Morgenthau came to this 
body, to the Ways and Means Committee, and he said, Gentlemen, we've 
tried this idea, and it doesn't work. He says it that simply: It 
doesn't work. All that has happened is that unemployment is as bad or 
worse than it was before, and we have a whole lot of debt to boot. 
Those were his words.
  So what we're seeing is this idea of just taxing and taxing these 
businesses, and unemployment is just going to kill us because they're 
not going to be hiring people when they're hunkered down, worrying 
about what the next tax is going to be or whether it's going to put 
them out of business. They're going to be playing things very 
conservatively. Plus, it's hard to get loans for them.
  Mr. LATTA. If the gentleman would yield.
  Mr. AKIN. I do yield to my good friend.
  Mr. LATTA. You hit on a very important point right here. One of the 
things they're talking about right now is that we've been coming out of 
this recession into a jobless recovery. When you have these 
unemployment rates----
  Mr. AKIN. Wait a minute now. I've heard this term ``jobless 
recovery.'' I'd like to pick at these words a little bit. ``Jobless 
recovery.'' Do you think that's the same thing as a plastic glass or a 
jumbo shrimp? I mean, how is it a recovery if nobody has a job? I sure 
hope I don't suffer too much with that kind of recovery.
  Mr. LATTA. It's the way they define when you're coming out of a 
recession.
  Back in 1982, when I look at that recession, one of the things that a 
lot of people point to is that it was very, very tough. We all remember 
coming out of the Carter administration with double-digit unemployment, 
with double-digit inflation and with a 21\1/2\ percent interest rate. A 
lot of people also said the same thing: You know what? It's tough, but 
at the end of the day at some point, that factory down the street is 
going to reopen, and I'm going to get my job back.
  In this case, we've got so many companies out there, especially in my 
district, that are saying, You know what? We've cut as much as we 
possibly can. We're going to do as much as we possibly can to make sure 
we can just keep the doors open, and we find right now that we can 
survive with what we've got.
  When they say ``what we've got,'' it's the employees who are on the 
floor right now. They say, We're not going to hire anybody else.
  That's the scary thing because now, all of a sudden, we're going to 
have all of these young people coming out of high school, coming out of 
trade schools, coming out of community college, and coming out of 
college. Where are they going to go? Because we've got more and more 
people saying, I can't retire. I've got to keep working because I'm not 
sure what I'm going to have down the road.
  There are all of these things that, I think, have got to really be 
looked at. That's why, I think, the American people have said to us, 
especially in my district, We all agree. There's not one person in this 
body right here who would say we should not do something about health 
care in this country; but it's how we do it, how we proceed. It's 
slowing it down. The American people want it to be the best thing, not 
something that's rushed through, not something that's in a 1,990-page 
bill.
  Mr. AKIN. Here we go again. It's this tremendously long, complicated 
bill, a complicated plan, and it almost looks like just another attempt 
where we already determined when we started that what we really want is 
the government to run it all.
  We've got the government firing the president of General Motors, 
running General Motors, running the insurance companies, running the 
banks, deciding what executive salaries are going to be, and that's not 
good enough to have the government doing that. We want the government 
to take over student loans, so we passed that this year, still letting 
private people do the student loans. There's $1 trillion in extra 
spending to cover all of these student loans. Now what we want to do is 
take over all of health care.
  I mean, this is kind of ambitious. You know, this is a little 
overwhelming. My constituents are a combination of scared and angry 
about what's going on down here. I think it's important for us to offer 
simple solutions, and we've got a simple solution if you want something 
immediately that you can do, and that is, tomorrow at noontime, 
Americans are coming from all over this country to meet on the steps to 
talk about this whole thing and to express their opinions of whether 
they really think that a bill that raises premiums, that reduces health 
choices, that delays and denies care, that costs $500 billion in 
Medicare cuts and $729 billion in new taxes is the solution that they 
want to this problem.
  People who want to say ``no''--at least I think a lot of them want to 
say ``no.'' I don't know what they're going to say because they're 
coming here tomorrow at noontime to this Capitol to express their 
opinions. They were invited by a bunch of us who are just plain old 
Congressmen, not leadership. They were just invited. You all come. Come 
talk to us about what's going on here. If people kind of get upset, 
this is the place to express your opinion.
  I would yield.
  Mr. LATTA. I thank the gentleman for yielding.

[[Page 26763]]

  Again, that's what happened during the month of August and when we 
were back home. We were out in our districts, and the people got to see 
us and talk to us face-to-face, and that's what they really want to do. 
They want that opportunity to say, I want a piece of my voice to be 
heard on this.
  One of the things, I think, that has been missing in this is that I 
came from the Ohio legislature, and I chaired a couple of committees in 
the house and the senate. One of the things that, I think, is very 
important is that we have people come in, be able to testify and be 
able to face the members.
  Mr. AKIN. Yes.
  Mr. LATTA. I think what we ought to have been doing during this whole 
period of time here is that we should have taken this back onto the 
road, and we should have had committee hearings across this country so 
that Americans could have gone to their States and to wherever it would 
be that the Members would be holding the hearings for the three 
different committees here in the House which were hearing this piece of 
legislation. I think that's what we should have been doing because, 
again, people feel left out. The most dangerous place for me to go, for 
my wife to send me, is to the grocery store after church.
  Mr. AKIN. After church to the Rotary Club, that's dangerous?
  Mr. LATTA. Well, it's the grocery store.
  Mr. AKIN. Oh, the grocery store. I'm sorry.
  Mr. LATTA. Because what happens is that people come up to me, and 
they want to talk. I go home every weekend, and I don't care if it's at 
the grocery store or at the gas pump. You know, it could take 45 
minutes to an hour sometimes.

                              {time}  1930

  Mr. AKIN. They are saying, Bob, wait just a minute before you walk 
out with that loaf of bread. The loaf of bread is stale by the time you 
get out of the store.
  Mr. LATTA. The American people want to be heard, and I think that is 
one of the things they are really saying here is wait a minute, I don't 
think we are being heard in this discussion.
  Mr. AKIN. Well, a lot of us are going to go out on the steps and we 
are going to listen to what those people have to say. I think you 
committed to be going out there too and be available. And we are going 
to talk. There are going to be a lot of interesting people, people 
doing some singing and all kinds of things, people making some little 
short talks and discussion. And that is a healthy thing in America, to 
have that freedom to have free speech, to talk, and to come to the 
Capitol building and to let people know what you think about this.
  Of course, there is a different philosophy than this kind of take 
everything apart and rebuild it, and that is that there are some 
specific things that can be done that reduce health care costs that 
Republicans almost uniformly support.
  One of them is tort reform, limiting the punitive damages. We know 
that in other States where that has been tried it reduces the cost of 
health care. We also know in other States where the government takes 
over health care, that the costs go out of sight. We have seen that in 
Massachusetts and in Tennessee. But we have seen in my own State of 
Missouri and Texas and other States, there is a distinct reduction in 
health care costs when you limit some of those punitive damages.
  It doesn't mean that doctors don't make mistakes and shouldn't be 
held accountable. But the other thing is you don't rape the system and 
run the costs up so that every doctor is forced to practice defensive 
medicine.
  Mr. LATTA. If the gentleman will yield, when we are talking about 
punitives, we are not going to say to people limit the economic 
damages. It is the noneconomic damages. Because it took us quite a few 
years in the Ohio legislature to finally get a small portion of that 
passed, but we saw changes almost within a year in what was happening 
out there.
  Mr. AKIN. Did you pass one in Ohio? Did you limit the punitive 
damages in Ohio?
  Mr. LATTA. That is one of the things we had to do on some of the 
noneconomic damages, and, again, it was only a small portion, because 
we had to pick certain areas and we picked the one area, and we watched 
those things come down. Because what happened was as soon as we passed 
the legislation, as soon as it was signed into law, it was challenged 
in the Ohio Supreme Court and it was upheld for being constitutional. 
But those are the things you have to do.
  Those are the things when you are talking about doctors not having to 
practice that defensive medicine, instead of running four, five or six 
tests, maybe they only have to run the two. But they are going to run 
the four, five or six tests. Why? Because if it is in your neighborhood 
and the courts have been saying why haven't you done this, you have got 
a problem. That is why these doctors say I have to do it, because 
otherwise I am going to get sued and my malpractice insurance is going 
to say you didn't do what you should have done, and now you are in 
trouble.
  Mr. AKIN. So there is the problem. That is one place that Republicans 
have talked about where there is a specific thing that you can do. And 
there are other things. We talked about the idea of letting people buy 
their medical insurance across State lines.
  The other thing in this 2,000 pages, there are a lot of loopholes and 
trapdoors. One of the things that is amazing to me is they do the 
opposite of tort reform and they say any State that has passed any tort 
reform, that that gets waived in order to get this government 
insurance. So you are going to be taxed whether you take it or not, but 
if you want the benefits of your citizens being taxed, you have to 
basically back off from tort reform. That is kind of a weird trapdoor.
  Mr. Speaker, I thank my good friend from Ohio, Congressman Latta. It 
has been a treat having you here.

                          ____________________