[Congressional Record (Bound Edition), Volume 155 (2009), Part 8]
[House]
[Pages 10202-10207]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         HEALTH CARE IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized 
for half the time to midnight.
  Mr. BURGESS. Mr. Speaker, I have come to the floor tonight to talk 
about health care, but some of the comments that we have just heard in 
the last hour, I just feel obligated to respond. I cannot let the 
fantasies that are put forward on this floor stand unchallenged.
  We heard the statement made that no investment in renewable energy 
occurred in the last 8 years. That is absolutely preposterous. The 
State of Texas has one of the most aggressive renewable portfolio 
standards in the country. In fact, the State of Texas is the leader in 
the generation of wind.
  And this did not spring from the Earth fully formed on January 21 of 
this year. This has been the product of well over a decade of hard work 
back in the State, our renewable portfolio standard that, I might add, 
was signed into law by Governor George W. Bush back in the 1990s in the 
State of the Texas.

                              {time}  2240

  Please, let's have the debate, but let's argue from the standpoint of 
facts. Let's not continue to engage in this fantasy that nothing has 
occurred over the last 8 years. Nothing makes the American people more 
angry than to hear this type of falsehood repeated over and over again.
  Texas is the leader in the production of wind energy. We have an 
aggressive renewable portfolio standard, and all of that was initiated 
under the governorship of George W. Bush. It has been continued under 
the Republican governorship of Rick Perry and, yes, during the 8-year 
Presidency of George W. Bush.
  Thank you for letting me get that off my chest. Now on to health 
care.
  Mr. Speaker, the Health Caucus Web site went live this week, 
www.healthcaucus.org. I formed the Health Caucus earlier this year 
because I felt it was important to have a forum to talk about some of 
the changes, some of the things that we are seeing in this health care 
debate. The Health Caucus is not a legislative caucus. We're not going 
to write the law. That never was the intention of the Health Caucus. 
But the intention of the Health Caucus was to provide a forum where 
ideas can be exchanged, and, indeed, that's exactly what has happened. 
And I want to talk about a couple of those that we have had recently.

[[Page 10203]]

It was to provide a vehicle for Member education so Members who perhaps 
weren't as familiar with issues surrounding health care would have an 
opportunity to avail themselves of recent information and prepare 
themselves for the debates, prepare themselves for the legislative 
process that's going to be ahead of us.
  Certainly a great deal of effort in the Health Caucus is spent 
towards staff training, to prepare the communications staff for Member 
offices on how to communicate with constituents about health care, how 
to communicate effectively in the health care debate that is going to 
be ahead of us. And probably most important or one of the most 
important functions of the Health Caucus that was recently formed is 
outreach.
  We spend a lot of time here in Washington, we spend a lot of time in 
windowless rooms in the basement of the Capitol of the new Capitol 
Visitor Center. And as beguiling as those accommodations are, it always 
seems that we have the same discussion with the same people rehashing 
the same ideas over and over and over again. And yet out across the 
country, there are men and women who are engaged and involved in this 
debate. They are engaged and involved in the actual delivery of health 
care, taking care of actual real patients on a day-in and day-out 
basis. They kind of know what works; they kind of know what doesn't. 
And it is so important for us to go out and solicit those stories, take 
the advice of the men and women who are working in the health care 
industry, and bring that information back to Washington, learn from 
what works, learn from what doesn't work. There is no reason that we 
should continue policies or try to develop policies that have been 
proven not to work, say, in a State jurisdiction or a State venue, but 
it is very important that we learn from those things that do work 
because we are going to be called upon at some point this year to do 
something, and it remains to be seen what, but to do something with 
health care in this Congress.
  Now, the Web site, www.healthcaucus.org, that Web site is available. 
There are links on that Web site to the various forums that have been 
held where ideas about health care are exchanged. And they're not all 
Republican ideas or Democratic ideas. We seek to have a balance of 
opinion. In fact, the very first forum that I held earlier this year 
had Karen Davis from the Commonwealth Foundation, Grace-Marie Turner 
from the Galen Institute, ostensibly one speaker from a little bit left 
of center, one speaker from a little bit right of center. We have had 
other speakers from the Commonwealth Foundation come and participate in 
some of our member organizations as well as other members from the 
Galen Institute. It's important to expose Members to ideas from both 
sides of the political stripe.
  Today's forum was no exception. We had a lively discussion, in fact, 
in the Capitol Visitor Center. I will talk a little about the panelists 
and their presentations later. But, again, a Webcast of today's forum 
is available for anyone who wants to go to www.healthcaucus.org and 
view that. When we do these events, they are Webcast live. It's not 
always possible to compete for C-SPAN coverage, but we do generally 
Webcast these events live. And the audience that is seated at the forum 
is certainly free to ask questions. These events are open to the press, 
and questions can be submitted over the device called ``Twitter'' that 
many people use for instant message communications. So today's 
audience, for example, we had probably between 50 and 70 people in the 
audience, and we had a similar number who were watching live on the 
Webcast. And, indeed, we did pose a couple of questions from folks who 
sent in questions via e-mail and Twitter. We did pose some of those 
questions to the panelists in the course of that forum.
  Also up on the Web site are brief, minute interviews primarily with 
the panelists who have come and talked, but we have had some other 
individuals that have just been part of the discussion and part of the 
debate as we go along. Dr. Mark McClellan, the former head of the Food 
and Drug Administration under the Bush administration, former head of 
the Centers for Medicare and Medicaid Services, graciously provided me 
a brief video which is up on that Web site and also available on 
Youtube. Today the policy forum was titled ``Making Health Care 
Affordable Without the Government.''
  You know, it was interesting, yesterday one of the papers that is 
published up here in Washington called Politico had an article, and, in 
fact, it was a front-page article yesterday, talking about the health 
care reform debate as it's unfolding; in fact, talking about how it 
appeared that the Democrats are ahead of the Republicans in the health 
care debate. Some statements were made that were perhaps a little bit 
hyperbolic, a little bit overblown. It's not that there is no 
Republican health care plan right now. There are many Republican health 
care plans. The challenge is to get us all to agree on a set of facts, 
a set of principles, and a health care bill going forward. But I would 
point out that that is no different from the difficulties that are 
being encountered on the other side of the aisle.
  In fact, last fall during the Presidential campaigns, the 
presidential debates, Senator Baucus, the chairman of the Senate 
Finance Committee, produced a white paper. He had a forum over in the 
Library of Congress and invited many of the stakeholders, many of the 
players who are involved in the issues around health care reform, and 
produced a white paper. Many of us thought that this white paper was, 
in fact, a prelude to legislation and, in fact, that this legislation 
would likely appear just shortly before the November elections. It's 
perhaps somewhat of a surprise that that legislation has not come 
forward yet. In fact, there was a recently released letter to President 
Obama from the Democratic leadership in the other body stating that 
indeed there would be a bill to mark up by early June. So you can see 
it is difficult not just for Republicans, but it is, indeed, difficult 
for Democrats. You've got lots of different and differing 
constituencies to be represented, and it is a challenge to bring 
everybody together, get everyone reading from the same page, and then 
going forward with a unified plan.
  My suspicion last fall was that that would be very quick to 
materialize from the other body, from the Democratic leadership in the 
other body, and perhaps not too surprising that the Republicans are 
where they are, but very surprising that we had not yet seen more as 
far as a fully formed plan from the other side.
  A question came up during the forum today: What do you think of 
President Obama's health care plan? And that's a tough one because I 
don't know if anyone can honestly tell you right now today what the 
President's health care plan is. In fact, during the Health Care Forum 
that he put on at the White House a few weeks ago, he was very careful 
to say that this is legislation that will be developed by the United 
States Congress. It will come through the appropriate committees on 
both the House and the Senate, that he would provide guideposts and 
guidelines and boundaries going along, but the legislation would be 
developed from the congressional committees. And that's a reasonable 
thing for the President to say because 15 years prior, another 
President who was new in town and was trying to also effect some major 
changes in the way health care is delivered in this country went 
entirely the other way.

                              {time}  2250

  He said, we are going to sit down within the confines of the White 
House--again, one of those small windowless rooms that we have so many 
of up here in Washington, D.C.--500 lawyers behind closed doors, and we 
are going to generate a health care plan, and, by golly, the Congress 
will like it. But it turns out they didn't. And, as a consequence, no 
health care reform was done in 1993 and 1994 and the argument 
languished for many years, 15 years after that.
  It's not that nothing happened, I do want to stress. We keep hearing 
that

[[Page 10204]]

the status quo is not acceptable. I will submit to my colleagues on 
both sides of the aisle here in the House, men and women, American 
medicine has not sat still during the last 15 years. In fact, there 
have been dramatic changes in health care in the last 15 years, 
dramatic changes in the science of health care, dramatic changes in the 
delivery of health care.
  One of the changes that came about as a result of the Republicans 
having a plan back in 1993 and 1994 to offer, as a counter to the 
Clintons' plan, was the concept of the health savings account. At the 
time they were called medical savings accounts.
  They came along after the Republicans took control of Congress in 
1995. I think it was 1996 or 1997 that the first health savings 
accounts became available. They have matured over the last 10 or 15 
years. In 2003 we expanded, and now they are called health savings 
accounts. But that program was expanded and some of the more onerous 
red tape was removed.
  And now you do have a system that provides health insurance, on the 
individual market the high deductible health plans for probably 
anywhere between 7 and 14 million people. And these are individuals 
that at least almost half would not have insurance were it not for the 
availability of this product.
  I know that because back in 1994, I attempted to buy an individual 
policy for a family member and could not find one at any price. I was 
prepared to write a large check in order to get that insurance 
coverage, and it just simply was not available.
  Fast forward to the present time, you can go on to the Internet, to 
the search engine of choice and type in ``health savings account'' and 
find that there are a variety of programs, a variety of products that 
are out there and available and priced at a reasonable amount. A 25-
year-old, such as I was trying to purchase insurance for back in 1994, 
a 25-year-old now for a high deductible policy, a good product, a PPO 
product from a well-recognized company that would be listed on the 
stock exchange, so you would know they were a reliable company, those 
policies are available for between $75 and $100 a month.
  To be sure, there is a high deductible. But, of course, under the HSA 
laws there is the ability to put a medical IRA, a tax-deferred account 
away to help defer those high deductible expenditures. And, over time, 
this can be a very satisfactory type of insurance to have. In fact, 
it's the type of insurance that I carry. We have a health savings 
account option through the Federal Employee Health Benefits Program. It 
costs about half of what the high-option PPO costs. So I am saving the 
government money. I am putting money away in a medical IRA.
  And, in fact, the HSA that is available is very conscious about 
making sure you have your routine studies done, your routine medical 
care done. I get e-mail alerts all the time reminding me I need to take 
care of this or that, and it's a good program. It's one that I think 
shows a lot of promise for into the future. But I do digress.
  Right now, currently, President Obama does not have an official White 
House health care plan that's out there, so it was very difficult to 
provide a precise answer to the gentleman's question today in the 
forum.
  During the fall, we heard some campaign rhetoric on what some of 
the--perhaps the proposals that President Obama would put forward. We 
heard discussion of a mandate for covering children. I don't hear much 
talk of that currently.
  You hear some talk currently of there being some sort of government-
run public plan, either a Medicare, Medicaid or some other type of plan 
to compete with the private sector.
  There is some unease on both sides of the aisle about this type of 
program, but, nevertheless, these are the relatively broad areas that 
are being talked about under the Obama plan. There is no specific Obama 
plan.
  So it's a little bit, again, a little bit overly critical for the 
newspaper article yesterday to say there is no Republican plan. Well, 
there is no Republican House plan, but there is no Democratic House 
plan. In fact, there is no White House plan that is being talked about.
  The other thing the article said, there is no Republicans leading the 
charge. I would submit to you that I have been on the floor of this 
House an hour, at least 1 hour out of every month for the last 2\1/2\ 
years. As many people who suffer from insomnia who from time to time 
turn on C-SPAN, Mr. Speaker, will recall that I have talked on this 
subject, sometimes at painstaking length.
  And I would just say that there are a number of leaders on the 
Republican side in the arena of health care. It perhaps does not get 
the billing that the energy debate does, perhaps does not get the 
billing as the security debate, but, nevertheless, suffice it to say 
that there are good and engaged and energetic people on the Republican 
side who are working this area.
  One of the things that did concern me about the article is it points 
to findings from a Kaiser health tracking poll that said 58 percent of 
Americans lack confidence in the Republican Party to do the quote, 
unquote, right thing for health care.
  And that does concern me and that is why, when I put together the 
Health Caucus, I wanted to be sure that we included the communications 
arm of Members' offices because people do want to hear Republicans talk 
about health care. In fact, that's one of the things that comes out 
consistently in the polling. They do want us to talk more about health 
care. They want to hear our ideas.
  In fact, during the months of the Presidential campaign, from time to 
time I would be tasked to participate in a debate. Well, after the 
debate was over and both candidates' points were discussed, as things 
were winding down and the podiums were being taken away, invariably, 
invariably I would have a throng of people around me wanting to hear 
more. Is there really a way to do this without the government taking 
everything over?
  And I would submit to you that there is, and I would submit to you 
that we are closer now to achieving that state than we really ever have 
been at any time, certainly in my professional time, having practiced 
medicine for 25 years before I came to Congress some 6 or 7 years ago.
  Isn't it ironic that we are perched on the threshold of being able to 
provide more care at lower cost and better quality to more people under 
the existing system, and we are talking about doing things that might 
fundamentally disrupt the system. And I will tell you that's one of the 
very difficult things both sides have to wrestle with.
  You heard it repeatedly during the Presidential campaign. Both sides 
said if you like what you have got you can keep it. Of course they said 
that. Polling shows 65 to 68 percent of Americans are satisfied or very 
satisfied with their health care and do not want it to change.
  Yes, they are concerned about the number of people who are uninsured 
or underinsured. They want to see that segment of the population get 
some help, but they are also terribly concerned that, in the process of 
doing so, will undo what they have.
  And that is a great concern. Again, it's something that has to be 
borne in mind by both sides when they talk about doing anything to the 
health insurance market.
  When Republicans talk about we would like to see more people own 
their own insurance policies, some people are concerned because that 
might undo the employer-sponsored insurance that so many people like. 
When the Democrats talk about we want a robust option to compete with 
the private sector, people are legitimately concerned that there will 
be a crowd-out and drive-out of the private sector, and they, indeed, 
will lose what they have.
  The old adage is, if you like what you have got you can keep it right 
up until the time we take it away from you. Both sides have to be 
mindful of that concern.
  You know, in any case, we have got to continue to move forward in 
this debate, and it's important that we Republicans, my side of the 
aisle, continuously challenge and continuously

[[Page 10205]]

try to penetrate the echo chamber that surrounds Capitol Hill and hear 
from Americans that are on the front lines of delivery of health care 
all over the country.
  At some point, both sides are going to unite behind a plan. Both 
sides maintain they want to unite behind a plan that actually will 
work, and both sides will be required to take their ideas to the 
American public.
  Now, certainly Democrats have an advantage. They have a huge size 
advantage here in the House of Representatives. My committee, the 
Committee on Energy and Commerce is no contest. The Democrats can pass 
anything they want with no Republican input. It is not necessary for us 
to even show up and vote most days because they are going to overwhelm 
us with their numbers in committee and subcommittee.
  The Rules Committee upstairs, a 9-4 ratio, Democrats to Republicans. 
We are not going to win any of the arguments in the Rules Committee.
  It is very possible that we will win no arguments here on the floor 
of the House. It's possible the Democrats can pass whatever they want.
  Where it is possible for Republicans to make a difference, and this 
is why it's so important that we be able to communicate these issues, 
is we can win this in a court of public opinion.

                              {time}  2300

  And that is really where this battle is going to be fought, probably 
late this summer, but certainly into the fall.
  Now, a lot of people have asked me about the time line, what I see 
ahead as far as the time line for health care reform. We've heard 2 
hours tonight on energy tax, cap-and-trade. We're going to do that in 
our committee before we do health care. Sometime before the end of next 
month, before the end of May, we will have that work done in our 
committee, or at least that is what the chairman has told us, and we'll 
clear the decks for health care in committee starting in June or July.
  I would submit to you, having watched then-President Clinton 15 years 
ago deliver his speech here on the floor of the House to a joint 
session of the House and Senate, and I think it was about the third 
week in September of 1993, and he gave a wonderful speech, had everyone 
in the room mesmerized. Go back and get the video of it and watch it. 
It was a wonderful speech. But it was about 3 months too late because 
they were already into an election time and, as a consequence, the 
ability to get a big concept like that through the Congress was 
severely compromised.
  By the end of September, first of October, a lot of Members here are 
thinking about their re-election. The House of Representatives has 2-
year terms, remember. And we are about to finish our so-called off 
year. Our off-year lasts about 6 months, and it will be done by the 
middle of the summer. So the time window is real very, very narrow for 
getting a big concept like this through.
  Add to that the fact that we are going to do some major piece of 
legislation on climate change, energy, energy tax, whatever you want to 
call it. That will be a big push to get that done.
  And the President said in his speech last week that he is going to 
sign a major banking regulatory bill before the end of the year. Those 
are three very big things to get done. And that's a lot on the to-do 
list, and we're already halfway through April of this year. And we 
really haven't gotten the guts of any one of those bills to get to the 
House floor. So the window of opportunity may be closing faster than 
some people realize.
  Just briefly, today's forum, we had three great folks come and talk 
to us. We heard from Rick Scott, we heard from Greg Scandlen, we heard 
from Dr. Nicholas Gettas who is the chief medical officer at CIGNA, a 
family physician who gave a wonderful talk about how important it is to 
have things like care coordination; how important it is to have things 
like disease management to be able to manage the exponential increase 
in the rising cost of care. Rick Scott talked about a number of 
outpatient clinics that he runs in Florida and how he manages these 
clinics by absolute transparency. Everyone who comes in knows exactly 
what it's going to cost for any procedure that's done, and there is a 
cap. There is a limit on the amount that can be charged on any patient 
visit.
  And how about this: if you come in to see a doctor in the clinic, 
say, you've got a viral syndrome, a little cough, a little runny nose, 
scratchy throat; 3 days later you've taken the medicines they're giving 
you; not only are you not better, you're worse, you can come back in 
for a reevaluation, and according to Rick Scott, the patient would not 
be charged for that revisit within 3 days' time, if, indeed the patient 
felt that the treatment was--or they were not responding to the 
treatment that was recommended on the previous visit. So a very forward 
way of looking at things, both in the outpatient clinic sitting, by 
being very transparent about price, and with Dr. Gettas within CIGNA 
Health Care, found that by anticipating problems, covering problems 
early, taking care of problems early, they could significantly hold 
costs down. And both of these are different sides of the same coin. 
They both are what are called consumer-directed health care, where you 
engage and involve the consumer. You engage and involve the individual 
in the control of, as an active participant in their health care, and 
you tend to get the ability to lower cost without resulting in denying 
care and without pulling that ratchet that we love to pull, that 
reduces reimbursement to the physician and creates so much anxiety in 
our physician community across the country. So these were two very 
forward looking statements that we, three very forward looking bits of 
testimony that we heard today. And I would just encourage people who 
are interested in learning more about this, it's www.healthcaucus.org.
  Now, tomorrow morning, for the Member briefing, we're going to have 
Ramesh Ponnuru, who is the senior editor of the National Review, came 
to my attention because he wrote an article that appeared in the Dallas 
Morning News over the break, and he was also talking about ways we can 
increase affordability; very, very important concepts. He talked about, 
you know, some people are concerned about universal coverage. Other 
people are concerned with the desire to reduce costs. Turns out when 
you poll this, the people who have the desire to reduce costs are much 
more than those that desire universal coverage. People are concerned 
about flexibility and policy design and benefit design, and there ought 
to be ways that we can get around some of the State regulatory 
problems, the State regulatory burdens that cause insurance in some 
locations in the country to be priced so high that literally prices 
some people out of the market.
  Another concept that Mr. Ponnuru brought up was the ability to bring 
more people into, if you hold down costs, the ability to bring more 
people into a state of insurance coverage. In fact, Steve Parenti out 
of the University of Minneapolis did an economic study, which indicated 
that in excess of 20 million people could be brought into coverage 
simply by doing things that will hold the price of care down.
  What about individuals with pre-existing conditions? And this can be 
a terribly difficult, difficult problem to deal with. But, you know, 
we've got 34 States right now that are doing what are called assigned-
risk or high-risk pools. Some are working better than others. We ought 
to look at those States, take the best practices from States that are 
working well and create at least a floor below which no State would go 
on learning from these best practices.
  To be sure, it is going to take some shared support from the 
insurance company that is providing the insurance, probably will have 
to be a cap on insurance premiums so that they will stay affordable. 
The State and the Federal Government are likely going to have to 
participate, depending upon income levels, but likely have to 
participate in that shared support.
  But it just goes to underscore that doing these three things, where 
we no longer discriminate against someone in

[[Page 10206]]

the Tax Code, where we provide someone the ability to buy an affordable 
insurance policy in a reasonable fashion, and we take care of, or 
provide for contingencies for people that have pre-existing conditions, 
we've gone a long way towards solving a lot of these problems.
  And then, just like Dr. Gettas relayed this morning, add to that the 
care coordination, disease management, the electronic medical records, 
infection control, the kinds of things that you want to do because 
they're the right things to do and they provide better care at a lower 
price. Accountable care organizations are one of the things that I 
talked to Dr. Mark McClellan about. These are all ways of holding costs 
down. And you've actually got the nidus of an almost pretty workable 
health care plan just right there in the last 30 or 40 words that I 
spoke. So it's not terribly difficult to construct something. What's 
difficult is to construct something that more of us can agree on than 
disagree on, and that's certainly the challenge that is ahead of us.
  Certainly, the work done through the Health Caucus is going to 
continue. I did have an opportunity to go to Omaha last Friday and 
speak with doctors at Alegent Medical Center in Omaha, heard from them 
about a number of their concerns.
  You know, I'm from Texas and we passed a bill in 2003 dealing with 
medical liability, a bill that put caps on noneconomic damages. Other 
parts of the country, issues of medical liability are still front and 
center as far as doctors are concerned, and I did hear a little bit 
about that in Omaha, a lot of concern that if we really push things in 
the government-plan realm, that public option, if that's really what 
catches on, and that's what's going to be the model for reform, that 
the concern there is that in those settings there's very little 
incentive to hold down costs, and what we end up doing in these 
government plans, and we certainly do it in Medicaid and we certainly 
do it in Medicare. In fact, if we don't do something by the end of this 
year, doctors across the country are facing a 20 percent cut in 
Medicare reimbursements.

                              {time}  2310

  We go through this type of machination all the time because one of 
the only leverages we have to pull to hold down costs is to decrease 
reimbursements to providers.
  I did hear from one gentleman in Omaha who felt that the way forward 
was going to be an individual mandate that required everyone to 
purchase health insurance. We need to be careful. Certainly, there are 
some States that have done that on an individual basis, and certainly 
we need to look at and learn from those States that have explored with 
mandates. We do get some information back that, yes, more people are 
covered but that, yes, costs have gone up. Insurance companies are only 
human. You tell them that, yes, now everybody is going to have to buy 
your product and, doggone it, wouldn't you know that the price just 
crept up a little bit.
  You do have to be careful about pricing products out of the range 
where people can afford them because, if you put an individual mandate 
out there and say you have to buy insurance or you're going to get a 
fine, some people will look at the cost differential and will say, 
``You know what? The fine is cheaper than the insurance,'' and it never 
crosses their minds that actually the insurance is something of value 
that they need. They will just simply pay the fine, will pocket the 
extra cash and then will hope that they'll be able to get care if they 
do, indeed, ultimately get sick and need that care. So mandates, in my 
opinion, are something that we need to be extremely judicious of in our 
approach there.
  We just finished tax time. The IRS. There is no bigger and harsher 
mandate out there than what the Internal Revenue Service places on each 
and every American. We know that, if we earn above a certain level 
every year, we've got to file a tax return. We know, if we don't and if 
we don't pay our taxes, the retribution will be swift and it will be 
certain. Well, almost. I mean there are a few exceptions. Members of 
Congress and some members of the administration, perhaps, don't have to 
pay taxes, but for most Americans, we know that this mandate out there 
from the Internal Revenue Service exists and that the consequences are 
extremely unpleasant if we do not comply.
  What is the compliance rate with the IRS? What is the voluntary 
compliance rate with people who pay their income taxes? Well, it's 
about 85 percent. Right now, we have a voluntary system of insurance in 
this country. We don't have a mandate. What is our compliance rate? 
It's about 85 percent. So, before we go down the road of mandates and 
of putting yet more governmental control into people's lives, I think 
we ought to look at what the other options are. Well, the other options 
are keeping the product at an affordable price and to actually create 
programs that people want.
  When part D in Medicare was constructed a few years ago, it was done 
very, very carefully so that there were six protected classes of drugs 
that had to be covered, that had to be provided for anyone who wanted 
to provide a prescription drug benefit. Okay. There are six classes of 
drugs where you have to at least offer two choices in each of those six 
classes of drugs. Now, the original cost for the prescription drug 
benefit--I forget the number--is reported to be at $35 or $37 a month 
under the plan that was constructed by the Centers for Medicare and 
Medicaid Services; but with the competition by allowing many people to 
participate, in fact, we were criticized because there are too many 
plans out there, and it's hard to choose. There are some plans out 
there, but the price for that prescription drug coverage was down at 
about $24 or $25, easily $10 per month under what it would have been 
under the program designed by the Centers for Medicare and Medicaid 
Services, and those prices have held now over the past 3 years. It's 
not that there weren't some problems with the initial rollout, but by 
and large, 9 out of 10 seniors are satisfied with their prescription 
drug coverage, and over 9 out of 10 seniors have some type of credible 
drug coverage. So we have exceeded what we would have expected with 
voluntary coverage. We have exceeded those numbers, and the 
satisfaction rates are high.
  Well, maybe that's a model that we ought to look at. How was that so 
successful?
  It was so successful because we offered a lot of choice. It was so 
successful because there was competition between the companies that 
were involved. Yes, there were some significant parameters laid down. 
Dr. McClellan would not budge on the concept of the six protected 
classes of drugs. Now I don't remember all of them, but they dealt with 
anti-inflammatories and anticancer drugs. There were six classes that 
he said you had to offer, and each of those classes had to have at 
least two different offerings. You didn't need to offer everything 
within that class, but you had to have at least two choices for 
patients in that. Again, the result is a program that has gained wide 
acceptance and that has enjoyed significant popularity.
  So I would submit that that would be a better model to follow than 
the IRS model where we put a big, bad penalty out there if you don't 
comply, and we still see that 15 percent of the people are still 
willing to take their chances and stay away from the mandate.
  The city of Dallas, Texas, close to my home, has an individual 
mandate for car insurance, and they were having difficulty with 
compliance. People would just not purchase the car insurance. So now my 
understanding is, if you get a traffic ticket in the city of Dallas and 
you cannot provide proof of insurance, they'll tow your automobile. 
Well, you can't really do that in health care. It just leads to all 
kinds of bad news stories when you go and repossess people and lock 
them up for not having health care insurance.
  How are you going to enforce that individual mandate? We're going to 
have to ask ourselves: To what limits are we going to go? Is it going 
to be purely a monetary penalty? What are going to be the consequences 
of not providing that mandate?

[[Page 10207]]

  Remember back during the campaign, then candidate Obama talked about, 
if he became President, he would have a mandate to cover children--a 
noble concept to be sure, but nobody could really ever define what was 
a child as far as: Is that age 18, 19, 25, 30? I heard every one of 
those numbers during the course of the Presidential debate depending 
upon the audience that was hearing the information.
  Who is going to be responsible for a 23-year-old who had moved out of 
the home? Obviously, the parents are going to be looked to for the 
responsibility of a mandate for children if we're going to mandate 
children's insurance, but what about a 23-year-old who is on his own, 
perhaps off and not living with his parents any longer? Who is 
responsible for paying that insurance premium? Is it still the parents? 
Is it the parent's employer? Is it the child, himself, or the child's 
employer? No one could define it. It becomes very, very difficult, and 
there are lots of areas where corners can be cut. Unfortunately, it's 
in just the areas where those corners are cut where you typically get 
into the bad problems where someone finds himself without the coverage 
that he so desperately needs.
  When we look going forward at the very programs and plans that might 
be available, one of the things that concerns me greatly about the so-
called ``public option plan''--and during the campaign this was always 
talked about--is that we will have insurance coverage for everyone who 
is uninsured today. Insurance coverage will be available that's just as 
good as a Member of Congress'. That's the Federal Employees Health 
Benefits Plan.
  Now, remember. There are a variety of products available under the 
Federal Employees Health Benefits Plan. I chose a Health Savings 
Account, which again saves the government money, but who's going to get 
to pick and choose which of those plans it is? Even with more on the 
low options side, we're still talking about a tremendous amount of 
money. How much money were we talking about putting into this?
  Well, in the President's own budget that he submitted to Congress, he 
said $650 billion is the down payment on health care. That's over a 10-
year budgetary window, so that's about $65 billion a year. Is $65 
billion a year going to pay for insurance in the Federal Employees 
Health Benefits Plan for 40 or 45 million uninsured individuals? I 
don't think so. It's not even going to be close.
  Steve Parente, the economist from the University of Minneapolis, 
estimated that cost to be somewhere north of $700 billion a year. The 
$60 billion a year actually buys you a slimmed-down Medicaid product.

                              {time}  2320

  Now, many people have difficulty--different States do things 
differently, but Medicaid has--without the cross-subsidization from the 
private sector, Medicaid would have a very difficult time providing the 
coverage that we're required to provide.
  So I feel I'm at the end of my time. Obviously, it's not the end of 
this discussion. We'll be back to do this again many more times before 
the time is through.
  I yield back my time.

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