[Congressional Record (Bound Edition), Volume 155 (2009), Part 20]
[House]
[Pages 27867-27874]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore (Mr. Teague). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Iowa (Mr. King) is 
recognized for 60 minutes.
  Mr. KING of Iowa. Thank you, Mr. Speaker. It's my privilege to be 
recognized to address you on the floor of the House of Representatives 
here tonight along with my colleagues that I have had this great honor 
and privilege to serve with throughout these years and this 111th 
Congress. I sat and listened to my friends on the other side of the 
aisle as they began to talk through this health care debate, which we 
have addressed, I think, quite a great deal over the last couple of 
months. No longer is it a legitimate point that we haven't had an 
adequate time to debate, although I don't know that there is anyone in 
this Congress that can read and digest 1,990 pages and then read the 
amendment that was 40 pages long that turns this into a 2,030 pages 
national health care act that affects every aspect of our lives.
  This is not just nanny state, cradle to grave. This is conception to 
natural death or euthanasia, depending on which component of the bill 
one chooses to apply. There are carve-outs for euthanasia. There is at 
this point a Stupak amendment that is part of the bill, a Stupak-Pitts-
Chris Smith amendment that is a pro-life amendment and is very valuable 
to me and many others.
  However, there are grave concerns about the broad implications of 
this bill and the components of it that run anathema to the American 
Dream.
  I will just address some of the things that the gentlemen spoke of in 
the previous hour. One of them is that Republicans allegedly sat around 
and did nothing while they were in the majority. We had a narrow 
majority, and we did something. We pushed an agenda that was seeking to 
improve health care in this country and reduce or eliminate the 
necessary burden on health care.
  I made the point that we passed lawsuit abuse reform in this 
Congress. I believe the year was 2005. The lawsuit abuse that was 
passed was worked through the Judiciary Committee where I sat and where 
I participated in that language, and we modeled this after, of all 
places, a California initiative. Since that time, Texas has taken up 
the charge of reducing lawsuit abuse on medical malpractice in Texas. 
The doctors that were exiting the State have now turned around, and 
many of them have moved back to Texas and started their practices and 
other medical providers and practitioners have come into Texas.
  Now they do have an adequate supply of doctors, nurses and other 
medical practitioners that are there. But the cost that was diminished 
by the gentleman from Ohio, the cost of lawsuit abuse, even though the 
bill that was offered by leadership scored at only $54 billion, to the 
gentleman from Ohio--1 percent, he said, of the overall health care 
costs--I don't know about that number. I didn't run those numbers. It 
doesn't seem to me, Mr. Speaker, that $54 billion is a minuscule 
amount. It doesn't seem to me that $54 billion is loose change. It 
doesn't seem to me that $54 billion is pencil dust.
  Mr. Speaker, $54 billion is real money, and $54 billion is, though, a 
small percentage of the overall cost of lawsuit abuse when it comes to 
providing health care in America. Here are the numbers that emerged 
when one looks into the underlying costs of the lawsuit abuse. And the 
score that could come from the Congressional Budget Office cannot 
include all of this because they simply can't score some of the actual 
costs that don't index directly into the lawsuits themselves.
  It works like this: there are high costs in premiums that doctors and 
providers are paying, especially OB/GYN doctors, and access to those 
doctors and services is getting more and more limited. There are also 
costs involved with the litigation, costs involved with the 
settlements, whether they are in-court or out-of-court settlements.
  One might think that that's all the costs of the lawsuit abuse that 
is part and parcel of the overall costs of health care. But an even 
greater cost is the cost of unnecessary tests and procedures that are 
undergone by patients in this country directed by doctors in this 
country to avoid lawsuits, to protect themselves in the event of 
lawsuits, to minimize the risk and to also hold down their premiums for 
malpractice. So the cost overall of medical malpractice, the abuse of 
lawsuits for medical malpractice in America, the cost of the 
malpractice premiums coupled with the cost of the litigation, coupled 
with the cost of settlements both in and out of court, coupled with the 
unnecessary test tests, the defensive medicine that nearly every 
practitioner practices, whether it is something they can actually 
identify or whether it's a subliminal shift in their policy, all of 
those things together, the lowest number that can be applied is not 1 
percent, to the gentleman from Ohio. The lowest number I can find out 
there by anyone's logical representation is 5.5 percent. The number 
that I trust the most is the 8.5 percent number that comes from the 
health insurance underwriters representative. And 8.5 percent is a low 
number.
  Some of those numbers go up to 10.1 percent and on up into the 20s, 
24, 25, 28 and even 35 percent of overall health care costs. Now I 
won't range up in there into that one-fourth to one-third of the 
overall costs because I think that's a harder number to defend, 
although it may be true. But I do believe that I'm on very solid ground 
defending 8.5 percent of overall health care costs going to either 
premiums for malpractice, trial lawyers, those settlements or defensive 
medicine. Out of the overall costs of providing health care to America, 
8.5 percent comes to $203 billion a year. That's only 1 year. This bill 
gets scored over 10 years.

                              {time}  1745

  So, that $203 billion over 10 years exceeds $2 trillion, $2 trillion 
in the aggregate costs of premiums and litigation and settlements, 
unnecessary settlements. We're going to keep everybody whole. Those who 
are the unfortunate who are, I'll say, victims of medical malpractice, 
we're going keep them whole. We're going to make sure that their 
medical costs are paid for and their loss of income are paid for and 
there's pain and suffering there, but not the noneconomic damages, not 
that component that goes off into $7 million for spilling a cup of 
coffee on one's lap at McDonald's as happened, and I understand that 
that was negotiated down and reduced after the fact.
  So, 8\1/2\ percent of our overall health care costs going for lawsuit 
abuse. And we can reform a lot of that. We can reform a lot more than 
$54 billion of it, and it totals in its aggregate over $2

[[Page 27868]]

trillion, which in and of itself is enough to, according to the CBO, 
pay for Nancy Pelosi's socialized medicine plan, Mr. Speaker.
  I think this puts it in a perspective that's far more legitimate than 
was offered by the previous gentlemen in the previous hour, who also 
announced that if you make less than $89,000 a year, you're going to 
get a subsidy for your health insurance; $89,000 a year. And we're 
going to subsidize health insurance for people making $89,000 a year? 
Are they also going to be paying the alternative minimum tax, I wonder, 
Mr. Speaker? I suspect there will be many families if that is the case.
  We saw what happened when the majority sought to change the SCHIP 
legislation, that State Children's Health Insurance Program that 
provides health insurance premiums for low income--kids in low-income 
families. That passed in about 1997. I remember implementing it in 
about 1998, when I was in the Iowa State Senate, at 200 percent of 
poverty. The States could have adjusted that to some degree. Two 
hundred percent of poverty is the part that I supported. And I come to 
this Congress and the first effort on the part of Speaker Pelosi was to 
change the SCHIP program to 400 percent of poverty, to fund health 
insurance premiums for children in families of four that are earning at 
400 percent of poverty in my State, with the exemptions that were 
directed by Governor Culver, that meant that families of four making 
$102,000 a year could have their health insurance paid for by the 
taxpayers, the taxpayers who presumably, many of them are making less 
than $102,000 a year.
  And that seemed to me to be an outrageously high income to have the 
health insurance premium subsidized by the taxpayers and the Federal 
Government. Since that time this voracious appetite to share the 
wealth, to take from those who have earned and invested and established 
capital, those, a lot of them whose investments are the investments 
that facilitate the creation of jobs, or they create the jobs 
themselves, scoop from that capital and distribute that to those who 
make less, takes away the incentive from those who make less to make 
more.
  Why would anyone go out and take a risk and invest capital and start 
a business and employ people and create goods and services that have 
value to this economy, if they're just going--the Federal Government's 
just going to go in and tax your income, keep you from establishing a 
capital base so that you could grow that kind of a business and grow 
the jobs and take the money that you earn and funnel it over here, and 
to take the position that if you make $88,999 a year, Uncle Sam will 
cut you a check. And that check will go to--as long as you invest it in 
health insurance for your family, health insurance for your kids--
they're already covered, aren't they? Because this Congress passed 
ultimately at 300 percent of poverty, so that lowered that number down 
to $70,000, something like that, in my State.
  But speaking of 70,000, that happens to be exactly the number of 
families in America that would qualify for Federal funding for the 
health insurance premiums for their children who also paid the rich 
man's tax, the alternative minimum tax; 70,000 families in America 
would have health insurance premiums for their children paid for by the 
taxpayer.
  Meanwhile, they're writing an extra check for the alternative minimum 
tax because they make too much money in the eyes of Uncle Sam. Seem a 
little paradoxical, Mr. Speaker? Does it seem a little bit 
inconsistent? Does it seem a little illogical? Well, it is government, 
after all, and it's getting more and more illogical as time unfolds. 
But the statement that Republicans did nothing is not a factual 
statement. It's not even an opinion. It's a fact that Republicans in 
this House passed reform legislation in several different categories, 
and it was fought every step of the way by Democrats.
  And by the way, when it did get out of this House, in spite of them, 
then it was blocked in the Senate. I said at the time on the 
malpractice, the lawsuit abuse reform, that the block that took place 
in the Senate was the result of the Senate being a wholly owned 
subsidiary, presumably, of the Trial Lawyers Association in America. 
Since that time, that investment seems to have paid off in the House of 
Representatives, and today, we have a House of Representatives that 
does not have one dollar worth of lawsuit abuse reform in a 1 to $2 
trillion socialized medicine plan.
  Now, how could any group have such influence on the House of 
Representatives and presumably still, and I think even more so, in the 
United States Senate, that $2 trillion in the aggregate of abuse and 
cost in our health care in America, over this period of 10 years, more 
than $2 trillion, and we can't find one dollar worth of savings in 
lawsuit abuse reform, not one dollar in this bill that is a bill that 
was sent to this floor by Speaker Pelosi. Not one dollar. And yet, the 
same people can advocate for cutting Medicare reimbursement rates by 
half a trillion dollars, almost $500 billion, taken out of our Medicare 
reimbursements, Medicare reimbursements that only pay 80 percent of the 
cost of delivering the services.
  And the cost of delivering the services is not a cost that's 
calculated by the providers, by the health care practitioners, by the 
doctors and the nurses and the hospitals and the clinics. No, this cost 
of delivering the services is a number that's produced by Medicare 
itself. And then it gets a .8 multiplier across that number, and that's 
what they pay at Medicare. And so the White House has taken the 
position that there is waste, fraud, and abuse in our Medicare, and 
they're going to ferret that out. And they found some 10s and 20s and 
more billion dollars they've said of savings.
  These billions of dollars of savings that they can provide to reduce 
and eliminate waste, fraud, and abuse in Medicare seem to be a bit 
amorphous. It's hard to identify this and, in fact, the White House has 
said, well, we know it's there. We are going to go in and help pay for 
socialized, I put that in quotes when I say it, Mr. Speaker, ``their 
socialized medicine plan,'' by reducing and perhaps eliminating waste, 
fraud and abuse in Medicare reimbursement.
  So what do they do? They cut $500 billion, a skosh less, but $500 
billion, half a trillion dollars, out of Medicare reimbursement rates, 
and then have not put their finger on where the abuse is, where the 
fraud is, where the waste is. It's just, trust us, we know what we're 
doing.
  It reminds me of a Saturday night sitcom that I used to watch 
occasionally. And it was called Sledge Hammer! Sledge Hammer was a 
detective, and he had a sidekick named Dori Doreau. And they would go 
through a half-hour routine of criminals doing bad things, 
investigating them, and near the end of the show, something would 
happen such as Sledge Hammer would fall down the escalator, something 
would go up the escalator, tip off the railing, and it would go through 
this Rube Goldberg menagerie of calamities, and when the dust had 
settled, somehow Sledge Hammer was laying on top of the criminal and 
somehow there was a miraculous ending. And he would get up and say, 
Well, I told you, trust me; I knew what I was doing.
  Well, I have about that level of confidence in an administration that 
would tell us they're going to find tens of billions of dollars in 
waste, fraud and abuse, but they can't point their finger at it. And 
they just simply say, Trust us, we know what we're doing. And if you 
pass this national health care act then we will go into action and save 
this money to pay for it. But if we don't, do we actually have an 
administration that's willing to tolerate tens of billions of dollars 
on their alleged waste, fraud and abuse in Medicare? Are they holding 
the right to a legitimate integrity and fiscal responsibility in our 
government? Are they holding that right to a legitimate responsible 
government hostage to a bill, a bill that's socialized medicine?
  And so if we pass this socialized medicine bill, the Senate and the 
conference report, and it goes to the President, whom I believe will 
sign anything that says national health care in the title--if we do all 
of that, then we get

[[Page 27869]]

to find out this great secret in the White House: Where is all this 
waste, fraud and abuse in Medicare? I can tell you it's not in any 
significant amount in my district, Mr. Speaker. And I can tell you that 
because the providers that I have are getting significantly less than 
it costs to deliver that service.
  In Iowa, we not only are the lowest State in the union in Medicare 
reimbursements rates, but we also provide consistently some of the 
highest quality outcomes by the consistent measures that come out. Iowa 
ranks in the top five time after time after time in practice after 
practice and then in the aggregate and the composite. Often number one, 
more often number two. But we're in the top five consistently in the 
outcomes, medical outcomes.
  And yet, we're the lowest in the Nation in reimbursement rates. And 
Iowa is, and I can say this with great confidence, the very best 
combination of cost and quality of health care delivered in the State, 
but the lowest reimbursements rates in the Nation. And now the White 
House wants to cut half a trillion dollars from Medicare reimbursement 
rates. And my State, I believe, is the most senior State in the union. 
We have the highest percentage of our population over the age of 85 of 
all of the States in the union. That includes my mother.
  And in my district, the 32 counties in western Iowa, of the 99 
counties in Iowa, and among the 32 that I represent, 10 of the 12 most 
senior counties in Iowa are in the Fifth Congressional district, the 
district I represent. And so I believe I represent the most senior 
congressional district in America. Punished, presumably, by a half a 
trillion dollar cut in Medicare, based upon the very questionable and 
doubtful allegation that there are tens of billions of dollars of 
waste, fraud, and abuse in Medicare.
  I'm convinced it exists, Mr. Speaker. I think it exists in some of 
the large cities in the country, and I think it should be relentlessly 
and persistently rooted out. And we should take those criminals and we 
should do the perp walk with them, and we ought to get them locked up 
in prison where they belong. But you don't hold a principle that the 
American people have a right to, which is legitimate law enforcement 
and the elimination of waste, fraud, and abuse, you don't hold that 
hostage to an ultimatum that we've got to pass a national health care 
act, socialized medicine, in order to have good government.
  Good government is a right of the American people, and the American 
people need to demand that right. With the promise that, or the 
allegation, made by the gentlemen in the previous hour, that 
Republicans don't have any solutions--in fact the President himself has 
said Republicans don't have solutions. That statement was never 
supportable by fact. There have been at least 42 pieces of legislation, 
some of them comprehensive, introduced by Republicans in this 111th 
Congress alone. And the difference is we have logical, rational, free 
market freedom solutions that do not interfere and, in fact, heal up to 
some degree, the relationship between doctors and patients.
  And here are some of them. I talked about ending lawsuit abuse. The 
next one is to provide for people to buy health insurance across state 
lines. For example, a young man, 25 years old in New Jersey, would pay 
approximately $6,000 for a health insurance policy that, if he could 
buy it in Kentucky, across the state lines, would cost him around 
$1,000. And yes there is a difference in mandates. And that's part of 
the difference. But they have put so many mandates on the health 
insurance premiums in New Jersey that you don't have those kind of 
options. And because of the regulations and the burden and the cost, 
and maybe, just maybe, the White House could be right on some waste, 
fraud, and abuse up there. I'm looking forward to working with their 
Governor-elect as he becomes Governor and maybe we can help root out 
some of the waste, fraud, and abuse. And I'd like to see New Jersey 
rewarded for doing that.
  But, if people in America can buy insurance across state lines, and 
that $6,000 policy for the 25-year old man in New Jersey becomes a 
$1,000 policy for the 25-year old man in Kentucky, that dramatically 
reduces the cost of health insurance premiums in America.
  Another thing that dramatically reduces the cost of health insurance 
premiums in America is when people have access to, and can afford to 
purchase safely, catastrophic health insurance. Catastrophic is an 
essential component of health insurance, and that works in this way, 
especially when we have health savings accounts. Those health savings 
accounts that when we passed the HSAs in 2003 in this Congress, and it 
was enacted into law, if a young couple--and I did this in round 
numbers--so at age 20 had invested the maximum amount into their HSA 
for that annual year, $5,150 for a couple, say, at age 20, and they 
maxed out each year--it's indexed to inflation--and spent $2,000 in 
real dollars out of that in legitimate health care costs and accrued 
that at 4 percent, and when I did this math it was a logical thing, and 
it will be a logical thing again to accrue those investment HSAs at 4 
percent.

                              {time}  1800

  Throughout the 45 years of their working life when they arrived at 
Medicare eligibility rate having invested the maximum into the HSAs for 
that period of time and spent $2,000 a year out, they arrive at 
retirement with a health savings account of $950,000. Maybe it accrues 
it a little bit better. Maybe they spend a little bit less. But I am 
thinking in terms of well, sure, $1 million; a million dollars in an 
HSA.
  And what is the Federal Government's investment in that, Mr. Speaker? 
Well, the Federal Government wants to tax that million dollars. The 
government doesn't want people to have that money for any use of their 
own discretion when they arrive at Medicare eligibility age.
  I will submit that we want people to invest in a retirement account. 
We want them to manage that retirement account to include the whole 
continuum of their life, through an HSA, into a pension fund. I'd like 
to see them make that investment and manage their health and watch 
their diet, get their exercise, do the annual checkups, and be able to 
save those costs, those high costs of health maintenance by good health 
practices, see their premiums lowered because of it and see them 
rewarded by a growing health savings account so they can arrive at 
retirement with, let's just say, $950,000 in that account.
  Now, the liability that the Federal Government has today in today's 
dollars, to be fair, Mr. Speaker, when someone arrives at Medicare 
eligibility age, that means the cost of that entitlement for the 
balance of their life actuarially is about $72,000 per individual.
  So, if you have a couple that arrive at retirement today, the 
liability that the government accepts--which is taxpayers' money in 
Medicare costs--is about $144,000 for that couple to take care of their 
health care needs for the balance of their life starting at age 65. So 
the difference is roughly $800,000 and then adjusted for inflation of 
that liability itself.
  But Mr. Speaker, why wouldn't this Congress want to encourage people 
to invest in their health savings account and grow that health savings 
account and provide incentives for healthy practices, both exercise and 
diet and checkups, so that that health savings account became a 
retirement fund? And why wouldn't we at least, at a minimum, offer them 
that if you can arrive at retirement and Medicare eligibility and be 
able to purchase a Medicare replacement policy that would take that 
individual or couple off of the entitlement rolls, why wouldn't we then 
tell them, Keep the change, Mr. Speaker? Why wouldn't we say to the 
American people, Take this nest egg that you have managed and earned 
throughout your working life and use it to travel the world, retire on, 
give yourself a monthly pension to add to the other pension plans you 
might have--presuming Social Security is still there--add that to 
Social Security or will it to your children. You own it.

[[Page 27870]]

Why would we want to keep people dependent upon a government program 
that will end up rationing health care?
  By the way, we are already there, Mr. Speaker. It was announced today 
that there's a government directive that went out. A panel, a health 
care advisory panel, that women should delay their mammograms until age 
50 and then have those mammograms not every year but every other year, 
because there's too much anxiety involved in having those tests done 
every year and that anxiety is a factor that factors in.
  Think about this, Mr. Speaker. Is that really it? Or is this a 
Federal directive that ends up rationing health care? What about that 
41-year old woman who ends up with breast cancer and doesn't get a test 
until its too late? What about the difficulty of treating that disease 
of breast cancer when it goes beyond that point where it can be handled 
without radical surgery?
  We have a directive that came out from the Federal Government that 
delayed by 10 years a recommendation that women get mammograms and 
spaced those mammograms out from 1 year to 2 years. So now 50-year-olds 
getting a mammogram on their 50th birthday, their 52nd, 54th, 56th, and 
on. That cuts more than half of the costs of the mammogram tests, 
breast cancer tests, that are going on in this country if everybody 
follows that directive.
  I would suggest that the Federal Government ought not be giving those 
kinds of recommendations. But I will submit, Mr. Speaker, that this is 
a little preview, a little window into what the Federal Government 
would be doing if this socialized medicine bill should find its way 
through the Senate, through conference, and off the floor of the House 
and Senate and to the President's desk, where I am convinced he will 
sign anything that has a title on it that says ``national health 
care.'' This is just a little preview of what we will see.
  We will also see rules and regulations that will come down that are 
hard rules, not just recommendations. It will be the Federal Government 
is paying for this so that means you don't get a hip replacement if 
you're over a certain age, or a knee replacement, or certain tests, or 
certain cancer treatments. They will declare ``end of life'' to be 
something different than the families and the individuals consider it 
to be. It has happened in every country that has socialized medicine. 
And many of the people there just simply capitulate.
  A number was published the other day that 4,000 babies are born in 
Great Britain in the hallway and not in the OB section because they 
don't have room because the rationing of health care and the lack of 
practitioners causes women in labor to back up in the hallways and have 
their babies there rather than in the delivery room. That is just one 
piece of data for one country that is significantly lower in population 
than we are here in the United States.
  So I have suggested two things the Republicans are for: ending 
lawsuit abuse, allowing for the purchase of insurance across State 
lines.
  The third thing is to provide for portability. Let people own their 
policy so when they leave their job or move from their State or 
whatever that change in their life might be, that it is their policy, 
they get to take it with them, and they own it, and that will give them 
the freedom and mobility from job to job; freedom to be independent, to 
start a business, freedom to manage their own health care.
  Another component of this, Mr. Speaker, is 100 percent full 
deductibility of everybody's health insurance premiums. That's also 
something that I'm confident would be ridiculed by the other side of 
this argument. A hundred percent full deductibility.
  Now, why would it be that in America, a corporation that's hiring 
people can offer them a package of salary and benefits plan, write off 
that salaries and benefits plan as if it were wages, 100 percent before 
taxes, an above-the-line write-off. I mean, that's all right. But why, 
then, would it not be the case for a sole proprietor, for a 
partnership, for an LLC--unless they took a salary out and incorporated 
in order to take a salary out and deduct those premiums--an individual 
or partnership cannot deduct in the same fashion 100 percent of the 
overall health insurance premiums like a corporation that has employees 
can?
  Now I am going to suggest--and I think it is a fundamental principle 
here in America--that if anything is deductible for any entity, it 
ought to be deductible for every entity. I can't think of a single 
exception that tells me that that would be wrong.
  So I will take this position--and I have--that if corporation X, Y, 
or Z can deduct a premium for a Cadillac plan or an average run-of-the-
mill health insurance plan, if they can deduct a hundred percent of 
that premium, so should self-employed Joe the plumber, or John and Mary 
the farm operation, or the gas station people, anybody else that's out 
there; or an individual who is working for a wage for an employer 
that's not providing health insurance and wants to go out on the market 
and buy their own. I believe that that premium should be 100 percent 
deductible. If we did that, just simply provided full deductibility, 
that, Mr. Speaker, will insure another million Americans. And that 
gives us equity in this deductibility.
  I talked about HSA expansion. We also need, Mr. Speaker, transparency 
in billing.
  We have today cost-shifting going on in the health insurance industry 
and the health care industry, and when you have Medicare reimbursements 
that are coming in at significantly less than the cost of delivering 
that service, the cost of delivering the service at a minimum, along 
with some profit from profit margin--which is a good thing; it's an 
incentive for people to do well and a reward for those who are out 
there providing some of the best services and especially the innovative 
services--but the cost-shifting takes place when Medicare doesn't pay 
it all, it goes off onto some other entity, whether it be a private 
health insurance provider or whether it be an individual that might be 
self-insured. There are also the cases, I understand, of those that are 
uninsured.
  But we need transparency. We need to be able to take a look at these 
billings, and I am not interested in the names of the patients. But I 
am interested in the names of the institutions and the consistency or 
lack of consistency in the billing procedures.
  I believe that if you're going to get a hip replacement in San 
Francisco, then those people who would get that hip replacement from 
that provider in San Francisco should pay the same price. They should 
be billed the same price and there should be a legitimate attempt to 
collect the same price. I believe that if Bill Gates goes into the 
hospital and gets a hip replacement and Steve King goes in and gets a 
hip replacement, and Joe the Plumber goes in and gets a hip 
replacement, it's all the same procedures from all of the same 
providers; it all ought to be the same bill.
  If we did that, if we had transparency, that will bring together and 
reduce the cost-shifting because the American people will understand 
that they have to go shopping, they have to negotiate, they have to 
advocate, and if they have their health savings account that they're 
managing, they will have an incentive then to negotiate for a health 
care cost and outcome that's favorable to them and consistent.
  But instead, we patients in America, we are a lot like sheep. We get 
led into health care, and when we get sick, most of the time, much of 
the time, the patient in America doesn't pay the bill. They're not 
concerned about the cost. They simply show up at the clinic and the 
doctor examines them and says, All right. Now you need to go to a 
specialist here, here, and here. Run these tests. You show up at the 
hospital, the surgery is performed, if that happens to be what is 
ordered. And they generally heal up, they get great care and go home. 
And some don't address the bill at all. Some of them look at it but 
they know somebody else is paying the lion's share of that bill, and 
they're not concerned about the overall cost of their health care.

[[Page 27871]]

  Therefore, if an aspirin costs 20 bucks, they're not going to raise 
the issue. But if it is coming out of their pocket, if they're 
negotiating this, if they're trying to hold together the nest egg of a 
health savings account, then they're going to look at the cost; and 
they will look at the transparency in billing, and just the 
transparency itself will be a restraint from the cost-shifting. And the 
cost-shifting is kind of a big, not much spoken--not completely 
unspoken--but not much spoken problem that we have with health care in 
America.
  Four, association health care plans. This is Republicans. And this is 
legislation that we moved also through this Congress--that was blocked 
by Democrats--that allows people of professions to join together and 
bargain and negotiate and buy insurance packages within their 
professions. So let's say the plumbers get together and they negotiate; 
the accountants get together and they negotiate. In a similar fashion 
where credit unions exist and they have a membership that fits the 
definition, we can let people buy health insurance in the same way, by 
associating and buying health insurance.
  And a piece of this that I have briefly mentioned that needs to also 
be strongly sustained in this health insurance debate is catastrophic 
insurance. Catastrophic insurance is that insurance that as our health 
savings accounts grow, we end up with a nest egg.
  I gave you a description, Mr. Speaker, of how a young couple arrives 
at $950,000 in their HSA at the age of retirement. But let's just 
manage this in terms of $5,000, $10,000, $20,000, maybe $50,000 in an 
HSA. Now, if I am a young family and I happen to have been maybe 
working for 5 years and have been able to accumulate $20,000 in my 
health savings account, I am pretty comfortable to negotiate the lower 
premium with a $5,000 deductible or even a $10,000 or a $15,000 or a 
$20,000 deductible. That takes the premiums down dramatically and it 
provides an incentive for an individual to pay out-of-pocket for their 
minor health care costs, or pay out of the health savings account for 
the minor health care costs but to keep that nest egg intact. And 
instead of paying that higher premium, that premium that, by the way, 
if you're 40 years old in a family of four in Indianapolis, for 
example, that family would today be paying about $535 a month for their 
health insurance.
  Now, if you could raise that deductible and raise the copayment 
component of it, then that premium would go down and the savings would 
be something that goes back into--and at least figuratively if not 
literally and may be literally--the health savings account.
  The incentive for people to manage their health insurance premiums 
and the incentive for people to grow their health savings account needs 
to be expanded, not eliminated.
  But I haven't met anybody who can point to this health care bill, 
this 1,990-page monstrosity with a 40-page amendment, that can tell me 
that health savings accounts can even survive this bill in itself.

                              {time}  1815

  Mr. Speaker, I have listed through here Republican solutions, and 
Steve King solutions for health care. Some of these we have passed out 
of this House. It is false to say Republicans have done nothing. The 
record is replete with legislation that has passed the House of 
Representatives and legislation that has been introduced into the House 
of Representatives, at least 42 bills in this Congress, all blocked by 
Democrats, all blocked by the Speaker of the House.
  These logical solutions that I have listed, including ending lawsuit 
abuse, buying insurance across State lines, providing for portability, 
providing for full, 100 percent deductibility of health insurance 
premiums, expanding health savings accounts, providing for transparency 
in billing, providing for association health care plans, and protecting 
catastrophic insurance, all of those are Republican principles. Many of 
those have been blocked by this Democrat Congress.
  And I think it is not a question of whether Republicans have ideas. 
We have all kinds of ideas. We have moved some of them. Democrats have 
blocked all of them. Why did they do that? Why did Democrats block 
logical, free market, freedom-loving solutions to health care? Because 
their crown jewel is socialized medicine, 1,990 pages of socialized 
medicine that took months to leverage and arm-twist to get just barely 
enough votes to squeak by in the House of Representatives.
  Those are the facts. And this bill provides some really ugly things 
that happen to the American people. For example, here are some real 
numbers, Mr. Speaker. A healthy, 25-year-old male in Indianapolis today 
would pay about $84 for a health insurance plan. This is a typical 
plan. The same plan under the bill that passed the House, the premium 
would go to $252 a month. That is a 300 percent increase in the 
premium. It triples the premium for that young man.
  Now, why would we triple the cost for people who don't have a lot of 
risk and a lot of liability, especially if they are at the entry level 
of their income? And we are raising the costs on people at the lowest 
level of their income. You go around to the other end of this, and if 
you take a couple that is roughly 60 years old that have some marginal 
health, I will say a less healthy 60-year-old couple in Indianapolis, 
they would be paying about $1,169 a month for a similar health 
insurance plan. That adds up pretty good over a year. And their premium 
under this bill would actually be reduced about 11 percent down to 
$1,043. Now maybe that makes a difference to that older couple. 
Presumably, though, someone at 60, they will be making more money than 
they did when they were 25. They will be making more money than that 
25-year-old that sees his premiums tripled so we can reduce the 60 year 
olds by 11 percent.
  This is a transfer of wealth in America, a transfer of risk and 
liability. And by the way, that 40-year-old family with two children, a 
family of four, mom and dad around 40 years old that are paying $535 
today in Indianapolis, would be paying $1,187 under this new bill. That 
is a 221 percent increase in the premium.
  That should tell us what is going on, Mr. Speaker. These are bad 
things for America.
  I am going to go down through a little bit of this. Here are the 
principles that have been laid out by the President.
  He argues that the economy has been and remains and he would argue 
that it has stabilized somewhat in a downward spiral, that we are in an 
economic crisis. This is part of the dialogue that we have heard over 
the last year and a half or so. He has said that we can't fix the 
economy unless we first fix health care. Does anybody remember that? We 
can't fix the economy unless we first fix health care.
  What is the problem with health care? Two things. According to the 
President, we spend too much money and we have too many uninsured. Now, 
we spend too much money is the allegation because it is being pointed 
out that a lot of the industrialized world will spend an average of 
about 9.5 percent of their gross domestic product on health care. We 
will spend about 14.5 percent. Some will give you a number that it goes 
up to 16 percent and maybe a little more. I am comfortable with the 
14.5 percent number.
  I am not here to argue that we do not spend too much on health care. 
I think we spend somewhere around $203 billion a year unnecessarily 
when it comes to lawsuit abuse in America. So that is a number that I 
would subtract a large share of that from the cost of our overall 
health care before I get down to we are not spending too much. But we 
also make more than those countries that are spending 9.5 percent.
  We have the best health insurance industry in the world, and we have 
the best health care delivery system in the world with the best 
individual outcomes for practices in the world. And they will argue 
that there are civilizations, societies, countries, cultures with 
policies where people live longer than they do in the United States. 
They don't seem to want to dig down and ask why.
  First, just a couple of months ago we got the announcement that the 
life expectancy of Americans has been readjusted upwards 2 years. Two 
years. Now

[[Page 27872]]

the numbers that are being quoted by the other side, by the Democrats 
that are pushing socialized medicine, they don't take into account that 
adjustment in the extension of the life expectancy.
  They will argue that our infant mortality rates are higher than a lot 
of the rest of the industrialized world. I will argue, Mr. Speaker, 
that we count the babies that die. We have a more accurate data system 
and reporting system than most, if not all, of the other countries, so 
our infant mortality is going to be higher than it is going to be in 
countries that don't record the infant deaths.
  These are not measures of the health care system unless you drill 
down into it and come up with a reason as to why, if there is a society 
that lives longer, who are they and why. Do they abuse substances less? 
When you subtract the fatalities from car accidents and suicides, 
perhaps, and those that are dying from other kinds of accidents, are we 
a more active society? Once you make those adjustments, I don't believe 
it holds that Americans don't have the kind of life expectancy that 
competes with any country in the world. I believe we do.
  And I believe we have, again, the best health insurance industry in 
the world and the best health care delivery system in the world. But 
the President has been very critical of our costs and our uninsured.
  So aside from the costs, the other point is too many uninsured. Well, 
the uninsured in America are on this chart, Mr. Speaker. It comes out 
to be this. Their number is 47 million; 47 million uninsured.
  Now, if we just accept that number, that sounds like a lot. We have 
to ask the question: Who are these 47 million? Well, first of all, it 
does include 9.7 million who qualify for a government health insurance 
program, mostly Medicaid, but don't bother to sign up. So that is 9.7 
million.
  The second number are there are those who qualify for an employer-
based plan but don't bother to sign up. That number is somewhere around 
6 million.
  And then those who make over $75,000 a year, that is around 6 
million.
  Those eligible for government programs, 9.7 million. It shows 10 
here.
  Eligible for employer-sponsored, 6 million.
  Then you have those undocumented, noncitizens, about 6 million, and 
then there is another 4 million who are legal immigrants but are barred 
by law from government programs. So altogether, illegal aliens and 
immigrants are around 10.1 million.
  When you subtract these numbers, illegal aliens and immigrants, from 
the 47 million, those who qualify for Medicaid from the 47 million, 
those who qualify under their employer and don't sign up, and those who 
make over $75,000 and don't bother to buy any kind of health insurance 
program, now you are down to Americans without insurance who do not 
have affordable options. That is 12.1 million. I like my other chart 
better. The number is 12.1 million.
  So 12.1 million Americans without health insurance and those without 
affordable options is less than 4 percent of the overall population of 
the United States. This is how this breaks down in these categories, 
and this yellow-orange segment is the segment of the overall 47 million 
uninsured that don't have affordable options.
  Now, this piece right here, Mr. Speaker, I will put this on the 
broader chart of the overall American population. This is the 
population of the United States at about 306 million. You can see that 
84 percent of Americans are insured, and 85 percent of Americans are 
happy with the policy and the program that they have.
  So it is the vast majority of Americans, these little pie slivers up 
here go down through this category. The yellow and black are illegal 
immigrants and aliens. And, Mr. Speaker, I am not for providing health 
insurance programs for illegals. If they broke into the United States 
and violated our laws, I am not going to set a carrot out there and 
reward them for breaking our laws and giving them taxpayers' money and 
handing them a health insurance policy. That is what some people like 
Luis Gutierrez and others are for, and Mike Honda of California are 
for. Steve King is opposed, and I will stand in opposition of 
socialized medicine and funding illegals under that program. But that 
is what these slivers are here, the yellow and the black.
  Then this orange piece here, these are the individuals earning over 
$75,000 a year. I think they can find another solution other than a 
subsidy from taxpayers in the market system.
  And the green are those eligible for a government program, these 9.7 
million who just didn't bother to sign up for Medicaid. We don't need 
to provide for them. It is already there. They will get coverage 
whether they sign up or whether they don't, but we can't solve it with 
this solution.
  Then those eligible for employer-sponsored plans, about 6 million, 
and they don't bother to sign up or opted out.
  So you are down to this 4 percent. This red one here is the only one 
that I am concerned about, 12.1 million Americans out of 306 million, 
less than 4 percent of our population, and for that, for this red 
sliver, Mr. Speaker, Democrats have a magical solution for too many 
uninsured. Socialized medicine, a single-payer plan, incrementally 
imposed upon America by setting up a health choices administration czar 
that writes new rules. And in the bill, the result is, reading the 
language, the cancellation of every health insurance policy in America, 
whether it be 2011 or 2013, they all have to go back and reboot, push 
the reset button, push control, alt, delete and see if they can write a 
health insurance policy that would comply with the new regulations that 
will be written by the new health choices administration czar. That's 
where we are. So 1,300 companies, 100,000 policies, none of them can be 
guaranteed under this bill that a single policy qualifies with the 
whims or the regulations that would be written by the new czar yet to 
be appointed even though he would be confirmed by the Senate.
  I see my friend from Texas has arrived. Congressman Mike Burgess is a 
medical doctor. He has lived this. He sees this agenda and sees how 
this actually happens in real life. He has been a fighter for freedom, 
and I yield to the gentleman from Texas.
  Mr. BURGESS. I thank the gentleman for leading this important 
discussion tonight because it is critical that people understand not 
only what is at stake but what realistically is possible.
  The programs that are talked about in the bill that was passed here 
late on Saturday night by the slimmest of margins, none of those 
programs are going to be available the day after the bill is signed, or 
the day after the day after the bill is signed. In fact, it is going to 
take time to construct this massive new government entitlement program/
insurance program. And as a consequence, it will be some 4 years before 
those programs are available to help the people that were in the 4 
percent margin of folks who are uninsured.
  Now, the gentleman talked about the health benefit czar, whatever we 
are going to call that person that is yet to be named, and we don't 
know what that office will do, what their responsibilities will be, but 
here is what we do know. We do know we passed a 2,000-page bill and it 
goes over to the appropriate Federal agencies and all of the rulemaking 
starts.

                              {time}  1830

  Think back to 1996 when this Congress passed a bill called HIPAA, and 
HIPAA was supposed to give us portability in health insurance. And it 
was a good thing. People needed to have portability in health 
insurance. But a little paragraph in the bill that required some 
privacy provisions to be included in the bill turned into, what, 10,000 
pages in the Federal Register, and every doctor's office across the 
land in early 2000 had to start complying with these.
  You know, you go to the doctor's office now and the first thing 
you've got to do is sign three forms. You've got to sign them every 
time you go in, and

[[Page 27873]]

they are the HIPAA disclosure forms. Congress, your Congress, required 
your doctor to do that. And to be perfectly honest, doctors' offices 
were never the problem with disclosure of sensitive information in the 
first place. But we are the recipients of that.
  Okay. Now we've got a 2,000-page bill. It is going to go over to the 
Department of Health and Human Services, and all of the rules and 
regulation are going to be written regarding that 2,000-page bill. 
Remember a single paragraph led to thousands of pages in the Federal 
Register and thousands of comments on the rule-making.
  Well, we do have a Secretary of Health and Human Services, Secretary 
Sebelius. Part of that agency that will be charged with writing these 
rules and regulations is the Center for Medicare and Medicaid Services. 
We do not have an administrator in the Center for Medicare and Medicaid 
Services. CMS has lacked an administrator since a week before 
inauguration when the previous administrator who was under the Bush 
administration said thank you very much and left. And that agency has 
been without an administrator since that time.
  Now, why is that important? Because this is the individual who is 
going to have to sift through all of the legislative language in this 
bill, match it up with the Social Security Act and Medicare Act, put 
all of these things together and write the rules and regulations under 
which your doctor's office will have to practice. And we don't even 
know who that individual is. It may be someone quite competent. It may 
be someone who is just a political appointee. We don't know, and 
therein is the problem.
  Now, the gentleman has done a very eloquent job of talking about the 
4 percent of the people that we actually likely set out to help when we 
started down this road. And I'm sure the gentleman heard it in Iowa 
during the summer. I certainly heard it in north Texas in my town 
halls. At that time it was only a 1,000-page bill. I can only imagine 
what they're saying about a 2,000-page bill. We don't want a 1,000-page 
bill to take care of a problem that actually could be taken care of 
with simple reform within the insurance industry.
  The problem that needed to be corrected was the individual who had a 
tough medical diagnosis, a preexisting condition, who loses their job, 
loses their insurance, doesn't get coverage within the appropriate 
timeframe and therefore is excluded from coverage for time immemorial 
because of this tough medical diagnosis.
  Someone my age loses their job, has a heart attack, their insurance 
coverage lapses. They're going to have a tough time getting back in. 
These are the people we heard from during the summer. Yes, we didn't 
want the Democrats' bill, but we do need some help for this segment of 
population who falls into that category. They want insurance. They 
would even be willing to pay a little more for the insurance because 
they recognize their human vulnerability is now on display. Yet they 
cannot find it at any price.
  And some of the things that we could have talked about, had we been 
reasonable about this, had we been truly bipartisan about this, is we 
could have talked about what type of insurance reform. And, in fact, 
the President, when he stood here before the House of Representatives 
in September acknowledging that it's going to be 4 years before any of 
this stuff becomes available, he referenced John McCain's discussion 
during the campaign a year ago where perhaps something like an upper-
limits policy or a high-risk policy would possibly bridge that gap 
during those few years until their new policies are available. Well, I 
would just simply submit if we would have spent the effort working on 
that bridge policy, if you will, maybe the rest of this stuff would not 
have been necessary.
  There are ways to get at this, with high-risk pools, with 
reinsurance, subsidize those States that are willing to participate in 
that. The Congressional Budget Office estimated it would cost $20 
billion over the 10-year budgetary cycle in order to beef up those 
high-risk plans to be able to accommodate those individuals who are 
involved, even make it a little more generous than that if you want. 
For heaven's sakes, $20 billion over 10 years is a far sight less than 
a trillion-plus dollars over that same 10-year interval.
  And I would suggest that this Congress, if they were willing to pass 
the liability reform the gentleman referenced, save that $54 billion 
that the Congressional Budget Office said we could save, and put all of 
that money toward helping those people with preexisting conditions, we 
could go a long way towards solving these problems.
  Mr. KING of Iowa. Reclaiming my time, I would like to pose a question 
and ask your response.
  In the previous hour, the gentleman from Ohio alleged that that $54 
billion that would be saved by the lawsuit abuse reform would only be 1 
percent of the overall cost of our health care; therefore, it's of 
small consequence and apparently not worth the trouble to take on the 
trial lawyers for that 1 percent. And I've made a response to that, but 
I would offer to the gentleman for his viewpoint since that is a field 
of your expertise.
  Mr. BURGESS. Well, in fact, that is a fairly narrow window that 
they're looking at. They're only looking at in the Federal system 
Medicare, Medicaid, SCHIP, Indian Health Service. The Federal 
Government pays about 50 cents out of every health care dollar that's 
spent in this country; so in effect you could double that number to 
$100 billion that you would save over all persons who are insured, 
covered, cash customers, and those covered by Federal programs.
  In Texas we did pass significant liability reforms back in 2003. It 
has made a substantial difference in Texas. I will just tell you from 
the standpoint of a practicing OB/GYN doctor, in 1999 the cost of a 
policy for a million dollars of liability coverage in the Dallas/Fort 
Worth market was around $25,000. It had more than doubled to $57,000 by 
2002. It is back down now to $35,000 in the years since this bill was 
passed. So there is an immediate substantial benefit in premiums, but 
the big savings come in the backing out of defensive medicine that is 
practiced.
  Mr. KING of Iowa. Reclaiming my time, I thank the gentleman from 
Texas.
  In the minute or so that we have left, I have in here in my hand a 
list of the new Federal agencies that are created by this bill.
  This is the old chart for H.R. 3200. That's pretty scary. This is the 
new chart, and in the middle of that is the old chart. Now, here are 
all the new agencies that are created. Well, actually maybe not all of 
them. I've just highlighted a few of them on the front.
  The program of administrative simplification, I think they know 
they've got something complicated. Health choices administration, that 
is the scary part, this guy right here. That's the new commissar-
isioner, referenced by the gentleman from Texas. The qualified health 
benefits plan ombudsman, which tells you no one can deal with this 
bureaucracy so you have to have an intermediary already written into 
the bill. I don't know if you have to have somebody to deal with the 
ombudsman.
  The health insurance exchange, where all of these policies and 
insurance companies would have to be approved. The State-based health 
insurance exchanges as well. Public health insurance option, well, 
that's the one that will squeeze out the private insurance companies.
  The list of the colossal magnitude of this socialized medicine bill 
goes on and on: 111 new agencies, 2,030 pages altogether, and the 
bottom line of it is, Mr. Speaker, the dramatic reduction of Americans' 
choices and thereby our freedom and liberty under assault by people who 
believe that we have to have a nanny state and live under socialized 
medicine. And I stand in opposition and I will fight this all the way. 
And I do believe the American people will rise up and kill this 
socialized medicine bill.
  Kill the bill, Mr. Speaker.

[[Page 27874]]



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