[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[House]
[Pages 28256-28262]
[From the U.S. Government Publishing Office, www.gpo.gov]


                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Georgia (Mr. Gingrey) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank you for the recognition, 
and I thank on the minority side, my side, the Republican side for 
allowing me to take this hour this evening to talk about health care 
reform and talk about what happened on the floor of the House today in 
regard to what's known as the doc fix bill. I think it's very 
important, Mr. Speaker, that we take this time so that all of our 
colleagues will have a full understanding of what's been going on. 
Certainly we've all been here, but we each have not had equal access to 
the deliberations and the writing of bills and the writing of 
amendments and of course motions to recommit and this sort of thing. So 
this, hopefully, Mr. Speaker, will be an information hour for all of 
our colleagues as we move forward.
  When the bill was first marked up--the bill, the Pelosi health care 
reform act of 2009, Mr. Speaker, when it was first marked up back in 
July of this year in the three committees of this House, the Energy and 
Commerce Committee, the Ways and Means Committee, and the Education and 
Labor Committee, there were certain issues that gave me great pause. I 
do happen to sit on one of those three committees, Energy and Commerce.
  When we began to mark up that bill at the time, Mr. Speaker, as you 
recall, it was H.R. 3200. Now the bill that we voted on and passed last 
Saturday night is H.R. 3962. But in their original bill, and in the 
bill that has passed the House, I had great concern, as did many of my 
colleagues, especially on this side of the aisle, Mr. Speaker, with a 
section in there called Comparative Effectiveness Research Council. We 
had trouble with another section in there that created something known 
as the health services coordinator. But let me get back to that 
Comparative Effectiveness Research Council, Mr. Speaker, for just a 
second because basically, as you read through that portion of the bill, 
it was obvious that these bureaucrats would decide based on hopefully 
accurate research, scientific research, what was the best treatment for 
each and every disease known unto man, but that hopefully it would be a 
recommendation that this research council could give to our practicing 
physicians.
  We know, Mr. Speaker, that medicine is not an exact science like 
physics and chemistry. It's a science, yes, but not an exact science. 
There is a lot of art to the practice of medicine. Doctors have a sixth 
sense, if you will, many times where a diagnosis is made based on just 
an observation or a feeling or, indeed, a sixth sense and not 
necessarily a scientific test or a specific lab result. So that was 
why, Mr. Speaker, I felt very concerned with this Comparative 
Effectiveness Research Council, if this bill is enacted in its current 
form.
  Of course it looks like the Senate is going to be taking up the bill 
sometime soon. And if this is in there, indeed, these people, these 
bureaucrats, these nonmedical government folks will have the 
opportunity to say, Doctor, you can or cannot do that procedure. You 
can or cannot order that test. You can or cannot prescribe that 
medication based on, hopefully, what is best based on research. But 
could they do it, Mr. Speaker, simply based on cost? And the answer, 
regrettably, is, yes, they could. Yes, they could. That's why I 
proffered,

[[Page 28257]]

submitted an amendment when we were marking up the bill that said that 
no bureaucratic decision or recommendation from this Comparative 
Effectiveness Research Council could force a physician, especially 
based on cost, that could lead to denial and eventually to rationing.
  Now that seemed like such a good amendment, Mr. Speaker, that I was 
very optimistic, indeed, that my colleagues on both sides of the 
aisle--there are about 56 of us on the Energy and Commerce Committee. I 
think there are 35 Democrats and 21 Republicans. But I was optimistic. 
And yes, indeed, that amendment passed on a voice vote, and people on 
the committee I think realized that that was a concern, and they didn't 
want this to happen either. Now unfortunately, Mr. Speaker, when the 
Speaker--you are sitting in for her--but when the Speaker of the House 
of Representatives, Nancy Pelosi, got the three bills from the three 
committees and sort of combined and came up with H.R. 3962 that, 
indeed, we voted on last Saturday night, that amendment disappeared 
miraculously, as did 15 other Republican amendments that were passed in 
committee. And in the dark of night, poof, they're gone.
  You know, this is a pretty serious retraction, subtraction from the 
bill, and my fear, my concerns, Mr. Speaker, just this week have really 
come home to roost. Now I don't know how many of my colleagues have had 
the opportunity to read about, see about on television the United 
States Preventive Services Task Force, an entity embedded within the 
Department of Health and Human Services. Oh, by the way, Medicare and 
Medicaid is also embedded within the Department of Health and Human 
Services. Well, this little-known-to-some but well-known-to-many United 
States Preventive Services Task Force has come out, Mr. Speaker, with a 
recommendation that says that women should no longer practice breast 
self-examination in trying to detect early, at the earliest 
opportunity, if they have a suspicious lump.
  They went even further and said that women should not routinely have 
a mammogram done every 2 years starting at age 40; they should put that 
off until age 50.
  Now when an entity like this makes a recommendation, Mr. Speaker, it 
eventually becomes not a suggestion, but it essentially becomes, for 
all intents and purposes, a mandate.

                              {time}  1745

  Now, Ms. Sebelius, the Secretary of Health and Human Services, 
immediately said, no, no, doctors can still do whatever they want to. 
We are not telling the doctor what to do.
  But, Mr. Speaker, as most of my colleagues know, I am a physician, 
and I just happen to be an OB/GYN specialist and practiced for 26 years 
before I had the privilege to be elected to Congress back in 2002. I am 
also a very proud member of the American College--a fellow we call it--
of the American College of Obstetrics and Gynecology, and I am a board 
certified fellow. The recommendation from our college, our 
subspecialty, has been to commence routine screening mammograms for 
women at age 40 and to do that every 2 years, and of course not only 
allow, but to encourage and even to teach them how to do breast self-
examination, probably commencing that in their early thirties if not 
their late twenties. It is something that I am just shocked that any 
so-called credible organization other than my own subspecialty of OB/
GYN or, indeed, the American Cancer Society would make that kind of 
recommendation, and they haven't. I think they are appalled at this 
recommendation.
  And like I say, when the Secretary of Health and Human Services says 
not to worry, doctor, patient, you can continue to do whatever you want 
to, but the patients are already very confused and frightened. And even 
if the doctor recommends to, let's say, a woman in her early forties, 
Hey, it is time to get that mammogram done. I don't feel anything on 
the exam, and I am glad you are checking yourself on a regular basis. 
Everything looks good, but it is time to go ahead and get that 
screening mammogram because we would certainly hope, if you are 
unfortunate enough to develop breast cancer, that we can detect it with 
the mammography, which is an x-ray, before a lump has developed, 
certainly before the patient can feel it, and certainly before the 
doctor can detect.
  You write out that prescription and that order and you send the 
patient to the hospital and she gets over there and she is told, Well, 
we can do it, but you are going to have to write us a check or you are 
going to have to pay cash for it because your insurance company doesn't 
pay for this anymore, and they don't pay for it anymore because the 
U.S. Preventive Services Task Force of the U.S. Department of Health 
and Human Services says it is not necessary. We will be glad to do it. 
You have to write us a check, cash on the barrelhead, and we will do 
it; otherwise, we will see you in 10 years, at age 50. And at that 
point, that patient might happen to have, since she has been 
discouraged from doing breast self-examination, cancer the size of a 
golf ball, and that being cancer that has already spread to the point 
where her chances of survival over a 5-year period of time is down 
around 10 percent instead of 95 percent.
  Mr. Speaker, this is serious stuff. This is life and death that we 
are talking about. That is why so many of us are so concerned about 
this massive takeover of our health care system by the Federal 
Government, by bureaucrats. We have got 13 practicing physicians on our 
side of the aisle that probably, in the aggregate, have 400 years of 
clinical experience. All kinds of specialists. In fact, I have a family 
practitioner with me tonight.
  Mr. Speaker, maybe you wish that we had been consulted, and there are 
four or five doctors on the Democratic majority side. I don't think 
that they were consulted. It is a waste of talent and the waste of an 
opportunity for bipartisanship. This is the result of it, though. This 
is what happens when things are done behind closed doors. Folks 
overlook, forget. I am not saying that it is deliberate, but the 
unintended consequences have life and death consequences.
  And with that, I yield to my good friend, the gentleman from Athens, 
Georgia (Mr. Broun).
  Mr. BROUN of Georgia. Dr. Gingrey, thank you so much for yielding 
tonight, and I appreciate the opportunity to come here to try to help 
our colleagues and hopefully the American public to understand what we 
are dealing with with this PelosiCare bill. And what is apparent thus 
far, since it has just been out, I can't say for certain, but it is 
apparent within the Senate bill, the ReidCare bill, of where we are 
going as a Nation.
  The American people need to understand something very clearly, and 
that is there is going to be rationing of care, as Dr. Gingrey was just 
talking about, and we are already seeing the beginning of this.
  Mr. Speaker, over the August break, I went up to Canada and I talked 
to Canadian patients. I actually lived in Canada many, many years ago 
for a short period of time. I didn't talk to doctors, but I talked to 
Canadian patients, since we hear our Democratic colleagues holding that 
up as the kind of model we need to go to.
  Mr. Speaker, the American people need to understand very clearly that 
the Canadians have marked rationing of care. I talked to women in their 
forties and fifties who never, ever have been told that they needed a 
pap smear and never have had one. What Dr. Gingrey was just saying, Mr. 
Speaker, about this recommendation that women not have mammograms until 
they are after 50 years of age, I have seen patients in my own medical 
practice in their thirties who have been diagnosed and treated for 
breast cancer. In fact, I had one lady 29 years of age in my own 
practice who found a lump in her breast. She came to me, she got a 
mammogram and went to surgery and was found to have breast cancer at 29 
years of age.
  Mr. Speaker, this is the beginning of the process of rationing of 
care that we already see the Federal Government doing just in 
anticipation, in my belief,

[[Page 28258]]

of what the PelosiCare, the ReidCare, the ObamaCare bill is going to 
do. You see, the Democratic Party's health care reform plans which have 
been introduced in the House and the Senate will allow you to have 
anything that you want as long as the boss would allow you to do it. 
Boss Hogg is going to determine whether a patient can have a mammogram, 
as we already see in the Federal Government saying we need to stop 
these mammograms for patients that desperately need them from a medical 
perspective.
  Mr. GINGREY of Georgia. If I understand the gentleman correctly, Mr. 
Speaker, the gentleman is holding a poster. That poster is a 
representation of this health choices administrator in this new bill, 
this H.R. 3962 which has already passed this House, and it also could 
be representative of the U.S. Services Task Force. And I want to yield 
back to the gentleman from Athens, Georgia, and I want us all to focus 
in just for a minute on Boss Hogg, because I think it is a great 
characterization of what we are trying to point out here.
  Mr. BROUN of Georgia. This comparative effectiveness panel that is 
going to be set up in Washington, D.C., they are going to look at how 
to spend dollars. They are going to use age and dollars on how to make 
health care decisions, which means that senior citizens are going to be 
denied care because they are going to determine that it is not 
effective to spend dollars on seniors' care as opposed to spending it 
for young people's care. So this mammogram recommendation is just the 
harbinger of where we are going.
  One other thing, Mr. Speaker, that the American people need to 
understand is that not only Boss Hogg is going to tell them whether 
they can have surgery, whether they can have a mammogram, whether they 
can have a pap smear, whether they can have lab tests, MRIs, CAT scans, 
but Boss Hogg and another group is going to tell the American people 
what their health insurance looks like.
  So we have heard the President over and over say that if you like 
your current health insurance policy, you can keep it. That is a bald-
faced lie. It is not true, because the health care czar panel is going 
to dictate every single health care policy in this country. Not only in 
the public exchange, but also everybody's private insurance in this 
country is going to be dictated by Boss Hogg, the health care czar 
panel in Washington, D.C.
  They are going to say whether that insurance will pay for insurance 
coverage for those mammograms, and they are going to use this 
recommendation that just came out this week to deny women under the age 
of 50 of being able to get those mammograms that their doctor thinks 
that they need and that they think that they need. There are medical 
indications for those mammograms, but Boss Hogg is going to say ``no'' 
because it does not fit within the parameters of the insurance that the 
Boss Hogg health care czar panel is going to put into place.
  Mr. GINGREY of Georgia. I thank Dr. Broun for that point.
  As we continue this colloquy, Mr. Speaker, Boss Hogg could also 
restrict other screening procedures. It is probably never going to be 
proven that screening, mass screening for many different diseases is 
going to be cost effective, but it is going to save lives. You ask 
yourself, if we are going to get to the point where Boss Hogg or the 
health choices administrator or the U.S. Preventive Services Task Force 
or the Comparative Effectiveness Research Council decides that 
something is not going to be cost effective, as Dr. Broun points out 
occurs in Canada. And he has some experience. He lived there. We know 
it occurs in the U.K. They have a group, an oversight entity that goes 
by the nice acronym of NICE, N-I-C-E, the National Institute for 
Clinical Excellence, but it is a rationing body that decides what can 
and cannot be done.
  Indeed, talking about breast cancer, Dr. Broun, the survival rate, 
the 5-year survival rate for breast cancer in the U.K. is something 
like 15 points lower than it is in the United States, and it is simply 
because they are denied these routine screening procedures.
  The point I also wanted to make in regard to other things, how many 
children, how many young children have to be screened with a blood test 
for sickle cell anemia before you find one? How many young children in 
preschool have to have a hearing examination before you find one that 
is hearing impaired, or vision screening before you find one that is 
visually impaired? How do you put a dollar value on these kinds of 
things, Mr. Speaker? You cannot do it. And if you start trying to do 
it, then you ration everything and it becomes a matter of what is a 
person's life worth, whether it is at the beginning or the end.
  I yield to my colleague.
  Mr. BROUN of Georgia. I thank you, Dr. Gingrey, for yielding.
  Carrying down that same road that you were talking about, I have 
practiced almost four decades as a family doctor. I have done 
colonoscopies and sigmoidoscopies. We do routine digital rectal 
examinations on patients for prostate cancer. We do PSAs routinely in 
screening. We do cholesterol screening and blood sugars and hemoglobins 
and all of these different tests that the American people wouldn't 
understand unless they have those diseases or have studied those 
things.

                              {time}  1800

  But you're exactly right, Dr. Gingrey. The screening for, for 
instance, colon cancer, we do a lot of checking stools for blood, doing 
flexible sigmoidoscopies even colonoscopies for colon cancers. 
Frequently even at colonoscopies we take out polyps that could turn out 
to be cancer if they're not removed.
  This cost-effectiveness panel, Boss Hogg, very probably is going to 
cut off all that screening. And you're going to have more people get 
prostrate cancer, more people get colon cancer, more people get breast 
cancer, more ladies get cervical cancer because those screening tests 
that Dr. Gingrey is talking about, Mr. Speaker, very probably are going 
to be cut off and denied to patients because they have to stop paying 
for all these tests because of the comparative effectiveness. 
Particularly when you look at it, young people from old people compared 
to how you spend your dollars, we're going to have tremendous rationing 
of care.
  So everybody in this country is going to have their insurance 
dictated by Boss Hogg, the Federal Government. Everybody is going to 
have their care dictated by Boss Hogg, the Federal Government. 
Everybody in this country is going to have a Federal bureaucrat 
standing between them and their doctor. It's not right and the American 
people need to stand up and say ``no'' to the ReidCare bill. They need 
to say ``no'' to the PelosiCare bill, no to ObamaCare. And let's lower 
the prices for everybody.
  Republicans have many, many bills that we've introduced. I have 
introduced one myself, H.R. 3389, which is a comprehensive bill. It 
does not add one nickel of increased spending to the Federal 
Government, and it puts the patient and doctor in charge of those 
health care decisions.
  Dr. Gingrey, I appreciate your doing this Special Order, and I 
appreciate your bringing these very pertinent things to the attention 
of the American public by doing this Special Order. And I just applaud 
what you're doing here because in Hosea 4:6 God says, ``My people are 
destroyed for lack of knowledge.'' And the American people are going to 
be destroyed for a lack of knowledge about what this PelosiCare bill is 
going to do or the ReidCare bill is going to do that Barack Obama is 
pushing down the road. We've got a steamroller of socialism that's 
going to cost jobs and destroy the quality of health care, and the 
American people need to stand up and say ``no.''
  Thank you, Dr. Gingrey. I appreciate it.
  Mr. GINGREY of Georgia. Representative Broun, Dr. Broun, I thank you 
very much.
  Before we move on, Mr. Speaker, to another subject that's hugely 
important, indeed, what we took up here today on the floor of our great 
House of Representatives, I just want to make one closing comment in 
regard to this

[[Page 28259]]

issue of rationing of care and in particular in regard to this new 
recommendation to dumb down the care, indeed, the screening, for breast 
cancer. I don't know how to put it any other way than to say that it 
dumbs down that care and that opportunity for early detection and lives 
saved.
  Mr. Speaker, there are female Members of this body, great, great 
Members on both sides of the aisle, women that represent their 
districts all across this country that serve in this 435-Member House 
of Representatives. And, unfortunately, a number of them, a number of 
them have been stricken with breast cancer. In fact, Mr. Speaker, it 
may have even been before you were here that a Member on our side, a 
wonderful, wonderful Member from Virginia, struggled with her breast 
cancer for several years with great, great courage and fortitude and 
hopefulness and faithfulness, and God called her home. She died from 
the spread of that breast cancer. And it was such a sad day.
  And then I think of Members, Mr. Speaker, on your side of the aisle 
that at a young age, in their early 40s, have been stricken with breast 
cancer, women with beautiful young toddler children. I've seen them 
walking down the Hall of the Cannon Building, you know, a great Member, 
a great friend, but I'm very thankful for her that early detection 
occurred because of, I don't know, probably a combination of breast 
self-exam but maybe it was mammography, and we hope and pray and really 
feel very confident that our colleague has a complete cure.
  So when we bring up a subject like this, it's not to be morbid and 
not to scare people, Mr. Speaker, but just to inform in the reality and 
the unintended consequences sometimes of the things that we do. 
Particularly when we draft 2,000-page bills that you don't bring 
everybody together on both sides of the aisle in a bipartisan way and 
utilize the doctors, the doctors, not just the leadership and people 
that have been on these committees of jurisdiction for 30 years who 
write these bills in the dark of night and then just throw them out 
there in front of us and say you've got 24 hours to read it and vote up 
or down and, oh, by the way, you can't amend, it's a closed rule. It's 
wrong. It's wrong but it also is dangerous.
  Mr. Speaker, in the time that I have remaining, I want to shift gears 
a little bit because today on the floor of the House the main thing 
that we dealt with was a bill called H.R. 3961. Now, the number is 
insignificant really except to look it up on the Internet, but let's 
call it what most people would recognize it as, certainly most 
physicians, all physicians across the country would understand, the 
``doc fix'' bill. The ``doc fix'' bill.
  Our physicians for the last 15-or-so years, maybe more, maybe closer 
to 20 years, but there is a flawed formula for calculating how much 
they are reimbursed for the procedures that are done under the Medicare 
program. And for the last at least 6 or 7 years when you calculate that 
formula--we'll call it for abbreviation purposes the SGR formula, 
sustainable growth rate--and every year for the last 6 or 7, the 
calculation says you doctors who are just barely breaking even, maybe 
not even breaking even, maybe losing money, seeing Medicare patients 
out of the goodness and compassion of your heart, for which we commend 
you, are going to have to take next year a 5 percent cut, and then we 
calculate it and then the next year a 4\1/2\ percent cut, and on and on 
and on.
  Well, each year over the last several years, we have come in and 
passed a law that would say we're going to mitigate that cut for this 
year, and we're going to let you get reimbursed on the basis of what 
you got last year and we're going to bump it up 1 percent or .5 percent 
or whatever, and we're going to do that for a couple of years.
  We literally are going to kick the can, kick the can down the road, 
Mr. Speaker. You know that expression. Because that's what we're doing. 
Maybe we kick it soccer style. But the problem doesn't really go away. 
So the next time in the aggregate, instead of a 5 percent cut, you've 
got a 10 percent cut or a 15 percent cut. Indeed, January 1, 2010, in 
the aggregate that cut will be 21 percent if we don't do something 
about it.
  Well, Mr. Speaker, what the Democratic majority and what President 
Obama said to the American Medical Association way back in June is in 
this bill, this health reform act that we're going to pass that we're 
going to totally reform one-fifth of our economy, we're going to have 
in there a permanent fix for the doctors. We're going to solve the 
problem.
  And, doctors, also we know you have another concern. Mr. Speaker, 
you're aware of this. My colleagues, I know are aware of it. You 
doctors have this concern over medical malpractice and this need to 
defend yourself against these frivolous lawsuits by ordering all these 
tests on patients that are not only unnecessary but indeed could be 
downright dangerous to the patient, but yet you keep doing them because 
you don't want to be dragged into a court of law and have some slick 
attorney or some expert witness hired by some very capable, smart 
attorney saying, Oh, yes, this doctor practiced below the standard of 
care because he didn't order a fizzle phosphate level, whatever the 
heck that is.
  So I was so thrilled when Mr. President said to the AMA, Mr. Speaker, 
that there would be medical liability reform. We would solve the low 
payment based on that flawed formula, SGR, and we would at last have 
medical liability reform.
  This bill, 3962, that we passed last Saturday night had none of that 
in there, and the Democratic majority just took out the ``doc fix'' 
because, guess what. To do it costs about $290 billion, Mr. Speaker, 
and would push the cost of this massive monstrosity of a bill over the 
$900 billion, which the President had put a cap on, a ceiling, and said 
he wouldn't sign anything that cost more than $900 billion. I say even 
if you pay for something that costs $900 billion, if the final result 
is an Edsel, you have not accomplished very much.
  But, indeed, the bill was pulled out and the President and Ms. Pelosi 
said, basically, not to worry, not to worry. We're going to come and 
we're going to introduce this bill as a stand-alone, and indeed that's 
what we did today, 3961, and we're going to pass it. But you know what? 
It ain't paid for. And whether it costs $210 billion, $230 billion, 
$275 billion, I'm not sure of the exact figure, but it's north of $200 
billion, and my Georgia Tech math tells me that that's about a quarter 
of a trillion dollars. It's going to cost that much money and we're not 
going to pay for it.
  The debt now is something like $12 trillion. So we're going to add 
another quarter-trillion dollars to the debt. In fact, we're going to 
even have to add to the debt ceiling because we're going beyond what 
the law allows us to do.
  So, Mr. Speaker, my side of the aisle looked at this very carefully, 
particularly the physician Members, the 13 of us that form the GOP 
Doctors House Caucus. And we said, you know, we want to do right by our 
doctors and we want to do right by our patients and we want to do right 
by the country, and we can fix this and we can pay for it. So we had 
one opportunity today to offer a motion to recommit with our design of 
how we pay the doctors a 2 percent increase every year for the next 4 
years under Medicare and we pay for it.
  And the way we pay for it, Mr. Speaker, in that motion to recommit, 
is to have that medical liability reform in the bill among a couple of 
other things to generate revenue, and it's revenue that the CBO says is 
at least $54 billion. So our motion to recommit, our bill, on ``doc 
fix'' is paid for. It's a real ``doc fix.''
  But you know what, Mr. Speaker? You were here. All my colleagues were 
here. We got ruled out of order. The Chair said our motion to recommit 
was nongermane because H.R. 3961, the Democrats' ``doc fix'' bill, the 
$290 billion not-paid-for bill, well, we weren't consistent with that 
because we paid for our bill; therefore, it was nongermane. Now, what 
can kind of idiocy, what kind of idiocy is that, Mr. Speaker and my 
colleagues?
  This is something the American people need to understand, and 
certainly I

[[Page 28260]]

think the doctors understand. We had an opportunity to do this and do 
it right, and we were denied even to vote on that motion to recommit. 
It was tremendously disappointing to me because, Mr. Speaker, I had the 
opportunity, the privilege, the distinction of offering that motion to 
recommit, and I wanted to explain to my colleagues exactly what our 
bill does. And the chairman of the Energy and Commerce Committee denied 
me the opportunity even to speak, getting the Chair to rule that our 
motion to recommit was nongermane.

                              {time}  1815

  So every time I tried to speak, I was gaveled down. Mr. Speaker, 
that's not what the American people want. If we were in the leadership, 
they would be appalled. I think they're appalled tonight with your 
party in the leadership. The American people don't want that. They want 
Members to have an opportunity to represent their districts, to 
represent their principles, and to represent and fight for this country 
and not be silenced.
  And that's what happened on this floor today. And it's got to stop, 
Mr. Speaker. It's got to stop. And we will continue to fight. This bill 
that was passed here today, there was not--I think there may have been 
one Republican that voted for it, and there were 9 Democrats that voted 
against it. So there was bipartisan opposition. But your party, Mr. 
Speaker, had the votes, and you passed it.
  But it's a sham of a bill, and you know it, because the Senate, 3 
weeks ago, totally rejected the bill with 14 Democratic Senators voting 
no. They couldn't even get a cloture vote. That bill is dead on arrival 
when it gets to the Senate. Our bill had an opportunity to pass and get 
to the President's desk and give the doctors relief for the next 4 
years, at least. But, no. We had to do it the same old same old way of 
forcing things on the American people. It's not right, Mr. Speaker, and 
it's not going to stand.
  I appreciate the opportunity, as I said at the outset, to come and to 
talk about this with my colleagues, because I only had 5 minutes to 
speak about our motion to recommit this afternoon. Five minutes to 
explain, not hyperbole, not harsh rhetoric, just to explain what our 
bill did in contrast to 3961, the majority bill, which, as I say, is 
not going anywhere and the Democratic leadership knows it's not going 
anywhere. So it is a sham. It's not a ``Doc Fix,'' it's a ``Doc 
Trick.''
  And I want to be, as I move to wrap up, I want my colleagues to just 
look at this one chart, one poster that I have to show. And this is my 
depiction of a Trojan horse. And you might not can read this writing, 
but on the Trojan horse is a saddle, and it says, the Democratic ``Doc 
Fix'' Bill, H.R. 3961. But on the back of the horse you see the overall 
health care reform act, the Pelosi Health reform act of 2009, yes, with 
the $500 billion cuts to our precious seniors under the Medicare 
program, kind of slipping right on in there. That Trojan horse is this 
democratic ``Doc Fix.''
  But when they, and if they, and I hope and pray to God, Mr. Speaker, 
that it doesn't pass, but if it does, this is what's going to happen to 
the American people, not only to our doctors, but to our patients and 
especially to our seniors.
  With that, Mr. Speaker, I want to yield a little time to my great 
friend from Texas, Judge Louie Gohmert.
  Mr. GOHMERT. And I appreciate my friend for yielding, and the great 
points that he's been making as a physician, someone who is used to 
healing people and taking care of people, and it's great to have your 
insights as a physician. But the points you've made are so right on 
target. As our friend knows, they added on what they call the PAYGO 
provision to the end of this bill, saying, all right, from now on we're 
going to start paying for things and having offsets so we don't add to 
the American deficit.
  Mr. GINGREY of Georgia. After we don't pay.
  Mr. GOHMERT. After we don't pay. And that's the thing. They put the 
PAYGO provision in the rules when they took the majority and have 
repeatedly ignored it over and over. Well, this past summer there was a 
bill that they called the PAYGO bill, and it was, they said, now, we 
realize we put this in the rules, that we would have to provide, if 
we're going to add money to the deficit, well, we're going to have to 
come up with some way to pay for it so that doesn't add to the deficit.
  And so this past summer, there were 24 Republicans who were 
persuaded--you know, even though they haven't meant it for the last 
2\1/2\ years, they've repeatedly violated their PAYGO provision, this 
time they really, really, really mean they're serious about PAYGO. And 
I knew they hadn't, when they were really serious, and when they were 
really, really serious they were going to abide by the PAYGO rules. But 
this time I thought, you know, they're going to put this in a stand-
alone bill, so certainly they would not want the flak of coming back. 
And I voted with my friends across the aisle, the Democrats, that they 
couldn't just bring up a bill unless there was money provided in the 
bill that would make it deficit-neutral. And so I voted for that.
  Well, they fooled me. Here they come right back with a bill costing 
hundreds of billions of dollars, and they said, you know, what, that 
PAYGO stuff we passed in July? We still mean it, and we really, really, 
really, really mean it this time, but we're going to add it on and 
start applying it after this bill.
  Well, that is just so incredible. I mean, the American people, as 
we're seeing, are not stupid. They realize what's being done.
  Mr. GINGREY of Georgia. Reclaiming just for a second on this point. 
The gentleman from Texas, Mr. Speaker, is so right. And to do this, of 
course, now they're going to have--they're going to go over the current 
debt ceiling by law. They're within, I think, $70 billion of the 
current debt ceiling, so they're going to have to, in the next couple 
of weeks, before Christmas, they're going to have to increase the debt 
ceiling once again.
  And you know what? That's not going to be a stand-alone bill, because 
they don't want that, the light of day to shine on that. That's going 
to be embedded in something else, is it not, my friend?
  Mr. GOHMERT. It certainly will be. You figure that's what they'll do 
so that maybe people may not notice that they've yet again increased 
the deficit. And that was one of the things they ran on and took the 
majority for in 2006. There was too much spending. And now, they have 
just come in and taken that, as somebody said earlier today, I mean, 
it's deficit spending on steroids.
  But even more than that, coming back to health care, I don't want the 
government between me and my doctor. I don't want insurance companies 
between me and my doctor. And for a long time now, we have had not 
health insurance, but health insurance companies managing health care. 
And I appreciate insurance. I think it is extremely important to help 
us ensure against unforeseeable events. But some of us have talked 
about and have pushed, on our side of the aisle, the health savings 
account. Everything that--all of the bills that have been proposed from 
the other side make detrimental cuts and damage to the health savings 
account. That is the one area where people in their twenties and 
thirties now are given incentives, and their employers, and they start 
paying into health savings accounts now.
  Most of them, the statisticians tell us, by the time they're ready to 
retire, they will have so much money in their health savings account 
they could continue to pay out of that to buy a catastrophic care 
policy. But they won't need the government between them and their 
doctor. They won't need an insurance company telling them, well, that 
medicine is not covered, that treatment's not covered. They've got 
their own money. And in the meantime, we could even have health savings 
accounts. It would be cheaper than what we're doing just to let seniors 
have health savings accounts and buy them catastrophic care, provide 
the health savings accounts and the insurance, and then, for the first 
time in the

[[Page 28261]]

history since we've had Medicare, seniors would have nobody in the 
government standing between them and their doctor, them and their 
treatment.
  That's the kind of thing I know, talking to friends on this side of 
the aisle, we want. We don't want an intermediary between patients and 
their doctors, not the government, not the insurance companies. And 
we've got plans, we've got bills, we've got suggestions, and everybody 
on our side of the aisle has been shut out. And this bill today, a 
``Doc Fix,'' was a ``Doc Tricks.'' And I'm hoping and praying my doctor 
friends understand that this was not going to address their needs. It 
looked like a fix. This wasn't going to pass the Senate. This was an 
effort to drive a wedge between physicians and the people that believe 
politically in the Constitution the way they do.
  Mr. GINGREY of Georgia. Mr. Speaker, reclaiming my time, the 
gentleman from Texas is dead on. He's absolutely right. This 3961, the 
so-called ``Doc Fix,'' and Representative Gohmert and I agree, it's a 
``Doc Trick.'' It mitigates the 21 percent cut that's coming due 
January 1st. And it gives a positive update, I think, of 1 percent for 
1 year. But then after that, Mr. Speaker, here comes the trick that 
Judge Gohmert was talking about. There's going to be a formula, a new 
formula, not the SGR, but this new formula, based on GDP. So if you're 
a primary doc and you're doing examinations, histories and physicals in 
your office, so-called ``evaluation and management,'' you get GDP plus 
2 percent.
  But if you're a specialist, like I was, an OB-GYN or, say, a 
urologist or general surgeon, it's going to be GDP plus 1 percent. 
Well, if the GDP is a negative number, then here again the doctors have 
no confidence that they're going to get paid a decent reimbursement for 
their services. So indeed, it is a trick. It is not a fix.
  Mr. Speaker, I want to take an opportunity--we've been joined by our 
good friend from Missouri, who has been with us on a number of 
occasions on health care and other issues, and I want to yield to him 
some time. And I'll yield to the gentleman, Representative Todd Akin 
from Missouri.
  Mr. AKIN. Well, it's just a treat I have a chance to join on the 
floor a couple of my very good friends. We've got a guy who's a medical 
doctor and a Congressman. We have a friend of mine whose a lawyer, an 
attorney, of course, and also a judge, and here I am the engineer. I 
guess it's almost setting up the beginning of a joke or something. 
You're talking about the cost of this bill that was unfunded today. 
We're talking about, and the numbers have been different. I've heard 
different people quote things. The lowest number was $210 billion. The 
higher number was $279 billion, as I recall, somewhere in that 
neighborhood of a quarter of $1 trillion.
  Now, just the amount of money that I have to pay bills, that amount 
of money is a little beyond my imagination, so I'd like to try and 
think of how much really are we talking about here. And I think maybe 
it helps to put it into perspective. Democrats and some Republicans 
were critical of George Bush for spending too much money. His worst 
year, in terms of creating a deficit, or creating a debt within a year, 
was 2008. That's when the Democrats ran the House here, and that was 
his biggest spending year, and he ran up a deficit of 250 something, 
no, excuse me, 450-some billion dollars, which was too much money, and 
various people thought we shouldn't have spent so much money--450.
  Now, if you take a look at 2008, then you move to 2009 and you have 
President Obama spending, with a Democrat Congress, and that's $1.4 
trillion. So we're talking about three times more money was spent 
beyond our budget in 2009 than in 2008. So putting those numbers, 
you've got 450 for Bush, 2008; $1.4 trillion, 2009. And now, on top of 
that, you're talking about here 250, perhaps, billion dollars in 
addition, which is not small change when you're already way beyond with 
the budget.
  And I recall my good friend from Texas, he has a down-home way of 
putting things that Missourians like me can understand. He says, this 
time I really, really, really am going to do it. It reminds me of 
trying to get through high school. You guys were really smart in 
school. But, you know, I always had trouble trying to study. And there 
would always be a test coming up. I'd say, God help me in this test 
because next time I really, really, really will study for this test.
  Mr. GINGREY of Georgia. If the gentleman would yield. Is that similar 
to a triple-dog dare?
  Mr. AKIN. That may be almost a triple-dog dare. I've also heard it, 
now that I'm starting to get older and have to push my hands away from 
the cookie platter, you know, that I'm going to start my diet to lose a 
little bit of weight, but it's going to start tomorrow, you know.

                              {time}  1830

  Maybe just the day after tomorrow, but that is when I am going to 
start up. I really am going to do it, it's just not going to happen 
right now.
  Mr. GINGREY of Georgia. I thank my colleagues. And they're well on 
target, of course. We're just, Mr. Speaker, trying to make sure that 
all of our colleagues, all of our colleagues and their constituents 
understand that we on this side of the aisle, the Republican Party, we 
feel that we have the best health care system in the world. We think 
doing routine screening mammograms starting at age 40 and emphasizing 
and recommending breast self-examination, screening young African 
American children for sickle cell anemia, doing routine screening of 
hearing and vision in preschool for all of our children, we think all 
of these things are good.
  We have a great health care system, and it's not perfect. We know 
that there are things that can and should be done. But in an 
incremental way, Mr. Speaker. Not spending $1.5 trillion, not spending 
$900 billion. I guess the Senate got a score of $785 billion, and 
they're just elated.
  Mr. Speaker, when you spend $250 billion--when you spend $100,000, 
for that matter, on something that is bad for the American people, you 
have done them a grave disservice--and especially all of the spending 
at a time when our unemployment rate is 10.2 percent. Some of us have 
members of our own family who have children who have lost their jobs--
16 million across this country.
  And we have this situation in Afghanistan where a four-star general, 
Mr. Speaker, a commander who was put there by President Obama, says to 
his Commander in Chief, ``Mr. President, I need help. We can win. I 
need help.''
  Well, how can that not be a higher priority than totally reforming 
our health care system, throwing the baby out with the bath water, 
spending a trillion dollars, or $2 trillion, or $2\1/2\ trillion? How 
can that be more important than putting people back to work?
  The President, Mr. Speaker, was just over there on a 9-day trip. I 
wish he had been right here inside the Beltway in the Oval Office 
working on this issue and this economy. But I hope while he was over 
there that he got some advantage out of it, Mr. Speaker, and maybe 
asked Hu Jintao, the Chinese President, to write him a check for $210 
billion so he can bring it back and pay for this Trojan horse that we 
just passed here on the floor of the House today in the name of H.R. 
3961.
  I want to yield to my good friend from Texas, Judge Gohmert.
  Mr. GOHMERT. Thank you.
  I just had a quick question back to my physician friend, Dr. Gingrey 
from Georgia.
  If my friend were in his doctor's office in Georgia and somebody from 
Washington came and said, ``Look. I want to get this message out to all 
of your doctor friends. Here's what we're going to do. We're going to 
cut $500 billion in reimbursements to you and your friends, but you 
need to be ecstatic because we've got a bill that's not going to pass, 
it won't ever get through the Senate, but it will get you back $250 
billion of that $500 billion we're going to cut. Aren't you happy?''
  Would you really trust that person from Washington that came with 
that kind of news?
  Mr. GINGREY of Georgia. I have heard it said, ``I'm here from the 
government. Trust me. I'm here to help you.''

[[Page 28262]]


  Mr. GOHMERT. That is the kind of trust that is being asked.
  Mr. GINGREY of Georgia. I think Mr. Reagan said it right. ``Trust but 
verify.'' The verification is yet to come.
  Mr. GOHMERT. And when you do verify, you see this is not a fix for 
the doctors, and it's going to have to be addressed next year. It's 
called a 10-year fix, but it's not really a fix that is going to fix 
anything for very long. It's just a game being played here in 
Washington, and we want something better.
  When I think about our seniors, the relatives of mine that are 
seniors, and think about somebody cutting the care to their doctors; 
and then I hear from doctors who say, ``Look, I'm younger than I 
anticipated retiring, but with the games you guys are playing, I'm 
about ready to hang it up.'' I know if they do, because of the areas of 
service they provide to our seniors, to those who need care, there's 
not going to be anybody there to fill those needs, and they're going to 
be in lines if we keep doing this stuff to our doctors.
  We can't be playing games like this with our doctors. It's unfair to 
the seniors. It's unfair to those who need health care. It's time to do 
a real fix of the health care system--not the games played with this 
ridiculous 2,000-page bill--but a real bill that will get people in the 
government and from insurance out from between patients and their 
doctors; give patients coverage, give them control, and let health care 
finally be healed of this government disease that has afflicted it for 
too long.
  Mr. GINGREY of Georgia. I thank the gentleman from east Texas so much 
for being with me tonight.
  Mr. Speaker, as I bring this to a conclusion, let me just say that we 
hear the term all the time in the military about collateral damage, and 
we worry about it. Every time we fire a rocket or use a predator drone 
to get the really bad guys, we worry about collateral damage.
  Well, we should be just as worried about collateral damage in the 
social programs that we are enacting up here as the representatives of 
the people, especially when it's dealing with health care, because in 
both instances, both in the military and socially, the collateral 
damage can result in lost lives. We're talking serious business here. 
We will continue to fight for the right thing.
  With that, Mr. Speaker, I yield back the balance of my time.

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