[Congressional Record (Bound Edition), Volume 156 (2010), Part 2]
[House]
[Pages 1933-1939]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE SUMMIT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. BURGESS. Thank you, Mr. Speaker.
  Well, we have had quite a day here in Washington, D.C., in your 
Nation's capital. The 6\1/2\ hour health care summit that was held down 
at the Blair House right adjacent to the White House has mercifully 
concluded. And as the saying goes up in Washington, everything's been 
said, everyone has said it, so it was time to go home. But for those 
who haven't had quite enough discussion about health care today, maybe 
we can spend just a little while longer talking about some of the 
things that we heard today and some of the things that we maybe perhaps 
didn't hear today.
  One of the things that I do want to stress, we heard several times in 
the past several weeks that the Republicans don't have ideas. In fact, 
that was one of the admonitions of the President on starting this 
summit was that the Republicans didn't have ideas, and he wanted to in 
fact show the country that the Republicans were devoid of ideas. But 
nothing could be further from the truth. If anything, we saw today 
abundant Republican ideas. Some may say there are too many Republican 
ideas, too many to fit in one room.
  I wanted to spend a few minutes tonight talking about some of those 
ideas on our side. I have a Web site, Mr. Speaker, that is devoted 
entirely to health care policy. It is from the Congressional Health 
Care Caucus. The

[[Page 1934]]

Web address is www.healthcaucus.org. And under the Health Caucus Web 
site, under the Issues tab, I think it is the second heading, is a 
Prescription for Health Care Reform. Anyone is free to go to that site 
and click on the Prescription for Health Care Reform, follow the links, 
and they will be taken to a one-page description of nine different 
bullet points on health care reform.
  In fact, there is even a little segment to record comments if someone 
would like to leave their ideas or their thoughts on the paper. Or if 
someone thinks of other things that might in fact be included, we 
welcome those comments on the Web site.
  I am just going to briefly go through this list, and then I have got 
some other observations that I want to make on the summit that occurred 
today. And we will be joined from time to time by other Members of 
Congress, and I want to give them an opportunity to speak. But under 
the Prescription for Health Care Reform, certainly everything I heard 
this summer was, we don't want a 1,000-page bill. People really didn't 
want a 2,000-page bill after we came back and revamped it after the 
summertime. But what did people want Congress to do on health care?
  There are people who have legitimate concerns that the system is not 
functioning in an optimum fashion. We do have great health care here in 
America, but there are distributional issues. The employer-sponsored 
insurance system does work well for the 60 to 70 percent of the 
population that is therein covered, but in fact there are problems for 
people who are outside the employer-sponsored insurance system, and 
there are certainly problems that all of us face with the advancing 
cost and complexity of health care.
  So just running down the list, insurance reform that would include 
limitations on insurance companies excluding people for preexisting 
conditions, and guaranteeing access to insurance. Now, one of the 
fundamental differences on the Republican and Democratic approach to 
this is that the Democrats want to have, and the President wants to 
have, a mandate. That is, you are required to buy a product, an 
insurance product.
  It is interesting because during the campaign in 2008, President 
Obama, when he was a presidential candidate, actually moved away from 
mandates. Candidate Hillary Clinton during her candidacy was in favor 
of mandates. Barack Obama was less enthusiastic about mandates. He did 
feel that there should be a mandate for children. We don't hear much 
discussion about that anymore. In fact, I don't think I heard that 
during the 6\1/2\ hours of debate today.

                              {time}  2030

  But mandates really have no place in a free society. There's some 
argument as to whether or not it would even be constitutional for the 
Federal Government to require someone to purchase an insurance product 
that they might not want. So there are legislative products out there. 
And this is the point I want to make. When people say, oh, we can't 
start all over, this would be too taxing. There are a couple of bills 
out there that I would encourage, Mr. Speaker, people to look at. H.R. 
4019, a bill introduced by Nathan Deal of Georgia; H.R. 4020, a bill 
introduced by myself. Those two bills, taken in conjunction, would go a 
long way towards eliminating the problems with preexisting conditions.
  Another bill to address the tax fairness or the tax inequity that 
exist in the health insurance market today introduced by John Shadegg, 
H.R. 3218, the Improving Health Care for All Americans Act, that would 
allow the same benefits, no matter where you get your insurance, 
whether it's through employer-sponsored insurance or in the individual 
market, the same benefits should accrue to an individual as accrue to a 
business.
  Medical liability reform. Texas and California have taken big strides 
in medical liability reform. So why do I care? If Texas has fixed their 
problem with medical liability, why would I care about that? Well, I 
care because the cost of defensive medicine is significant. And since 
the Federal Government is the purchaser of about 50 percent of all the 
health care in this country, the costs of defensive medicine that drive 
up the price of Medicare and Medicaid, those costs need to be brought 
back under control, and medical liability reform is a way to do that.
  Portability. Allowing patients to shop for health insurance across 
State lines, again, a bill introduced by Mr. Shadegg is H.R. 3217, the 
Health Choice Act.
  To back up for just a moment to medical liability reform, H.R. 1468, 
the Medical Justice Act.
  We're about to bump up against an important deadline on Sunday night, 
and that is the expiration of the prevention of a reduction in payment 
to doctors who take care of Medicare patients. We go through this time 
and time again. It is time for Congress to fix the physician payment 
reform, and H.R. 3693 would do just that.
  Do we need to be worried about if there are going to be doctors there 
to see us when we get sick in the future? I think that is a concern, 
and I think that is something where Congress might play a role. Doctors 
to care for America's patients, the Physician Work Force Enhancement 
Act, H.R. 914. People ought to be able to know what the cost is when 
they go to the doctor or the hospital.
  How about a bill for ensuring price transparency? H.R. 2249, the 
Health Care Price Transparency Promotion Act. Prevention and wellness 
programs, we all agree, during the hearings this summer, the 
individuals that come in who worked at Safeway and talked about how 
health promotion and wellness was saving them money, firms like 
Allegiant in Omaha, Nebraska, brought in great stories about how they 
had involved their employees in living healthier lifestyles and reaped 
the benefits from lowered insurance costs.
  An odd thing about the way we do things at the Federal Government, 
we're actually going to have to change the HIPAA laws, the privacy 
laws, a little bit in order to have this type of legislation be passed. 
But that's certainly within the purview of Congress and within the 
ability of Congress to do that.
  But prevention and wellness programs, although I do not have the bill 
number attached to this, we had several amendments in committee and in 
the Rules Committee leading up to the passage of the Democrats' bill 
this fall that dealt with prevention and wellness. The legislative 
language is written. It is not in bill form right now because it would 
require a simultaneous modification of the HIPAA laws in order to allow 
that to happen.
  And finally, I mentioned before, mandates. No place in a free 
society. And this is one of the fundamental differences between the 
President and myself. He wants to force everyone to buy an insurance 
policy. He said that's the only way to bring costs down. I would submit 
that if the insurance companies know you have to buy their product, 
their prices are not likely to go down. In fact, if you're required to 
buy their product under the penalty of law, with the IRS as the 
enforcer, it is very likely that the cost will go up because no one 
wants to run afoul of the Internal Revenue Service.
  And then we make insurance companies lazy. Why bother to compete with 
a better product? Why try to create a program that people actually 
want? You've got to buy it anyway. The government's going to force you, 
you're going to buy my product, I don't even have to make it something 
that you want, and I can charge you more for it. Mandates make 
insurance companies lazy.
  We actually have a model for what works in this endeavor, and that is 
when the Medicare part D program rolled out, then Administrator of the 
Center for Medicare and Medicaid Services, Dr. Mark McClellan, 
required, out of six classes of pharmaceuticals, there were six 
protected classes of drugs. Within each class, an insurance company had 
to offer two choices, and using that as the parameter, the companies 
did produce the plans that people wanted. The product, part D, has been 
very popular. Ninety-two percent

[[Page 1935]]

of seniors now have credible drug coverage under Medicare because of 
the flexibility and the desirability of these programs. The cost came 
in way under budget, and 92 to 94 percent of seniors are satisfied or 
very satisfied with their prescription drug coverage, so a program that 
indeed worked. And the whole emphasis was to make this look more like 
insurance and less like an entitlement.
  Creating products people want is a better way to go about getting 
meaningful change in the insurance market than giving the insurance 
companies a license to steal, which is what a mandate would be, in my 
opinion.
  I have some other observations on the day's activities, but I wanted 
to yield such time as he may consume to my good friend from 
Pennsylvania, Mr. G.T. Thompson, who in a former life was a health care 
administrator. I know it's odd that a doctor and a health care 
administrator would get along, but the two of us do get along very 
well.
  G.T., I will yield to you such time as you may consume.
  Mr. THOMPSON of Pennsylvania. Thank you, Dr. Burgess. I really 
appreciate what my good friend from Texas is doing in terms of his 
leadership with the Congressional Health Care Caucus. It's refreshing 
in this Chamber to deal with folks who have the facts and have the 
experience to make informed decisions when it comes to such important 
topics like health care. I think of all the issues that come before 
this Chamber, there are probably few things as intimate to our 
individual lives as health care. And to observe this process over this 
past 14 months, where bills are written as I look at these bills, 
1,000, 2,000, 3,000 pages, which has been special agendas for, you 
know, just misled government-run health care, it's apparent to me that 
those who are writing those bills have very little experience, if any 
experience in health care. And so it's been a real privilege to be able 
to work with you and under your leadership to really look at the 
solutions that we need to have.
  Now, as I travel around, and I did, my background was 28 years 
nonprofit community health care where I, in the hospitals, the health 
systems I come out of, we work very hard to be partners with our 
physicians.
  And so what am I hearing? As I travel in my congressional district 
and I listen to folks throughout the country, I haven't met anyone that 
says, just don't do anything. The commitment is that, as I talk with 
folks, that they feel that they like the health system we have. Can we 
improve it? I think there's an acknowledgment that we can do that. And 
I've certainly spent my professional career serving my patients first 
as a therapist and a rehabilitation services manager and ultimately as 
a nursing home administrator. And looking at four dimensions of health 
care that we should always continue to strive to improve. Number one is 
cutting cost. And that's just not cost for a certain segment or a 
certain group, but cutting cost of health care for all Americans, which 
we're committed to that with the solutions you've talked about. It's 
about improving access, increasing access and improving quality and 
strengthening that decisionmaking relationship between the patient and 
the physician, not allowing government or a bureaucrat to be that wedge 
in between.
  As I talk with people about health care, and I've been doing that 
since I came to Congress, that's what they're asking for. The people I 
talk to, they like the solutions. They like the bills that we've 
introduced as far back as last July that dealt with medical malpractice 
reform, tort reform that drives the cost of the health care up for all 
Americans through both the premiums for medical liability insurance 
that has to get absorbed into the cost of doing business, those premium 
costs get passed along as a part of the fees, and not just the premium 
fees, but then there's the cost of defensive medicine that occurs, with 
extra tests that are ordered, not so much maybe to serve our needs and 
whatever particular illness or disability we come to the doctor for, 
but to provide a record that shows that the physician has exhausted 
every possibility.
  It's things like many of the solutions you talked about, allowing to 
purchase across State lines. It fascinates me that you can go to the 
Internet and you can go on a Web site, some of them got little critters 
like lizards on them, and you can purchase car insurance and get the 
best value, the best product for the best cost. You make that decision 
as an individual. And yet we are barred from purchasing health 
insurance across State lines.
  In States like Pennsylvania, especially rural Pennsylvania where I'm 
from, if you have choices, you have just a couple of choices. Maybe if 
you're lucky, you have three choices to pick from. And a lot of people 
say, well, I want the insurance that you have as a Member of Congress. 
Well, I'm quick to tell people, I worked nonprofit community health 
care for hospitals for 30 years. I'm paying more today as a Member of 
Congress than what I ever paid for health care. But what I would like 
every American to have, certainly every constituent in my district that 
I have today are just lots of choices. And we do that by allowing 
purchasing across State lines, more competition. That's a good thing. 
Competition brings the cost down and raises quality. I don't care what 
you're purchasing, that's a principle that lasts.
  Certainly, a formation of association health plans, and preexisting 
conditions, as you've talked about. I mean, those are all just a few of 
the different parts of the proposals that Republican Members have 
introduced and are pending bills that are right here that the Speaker 
could elevate to the floor at any moment so that we could actually take 
an up-or-down vote on these. I think the American people would vote 
yes. I see a thumbs-up from the American people as we talk about these 
different proposals.
  Preexisting conditions, that's a tough issue, but we're addressing 
that within the proposals we have. Just because you're born with a 
preexisting condition or you happen to have the misfortune to develop a 
disease such as breast cancer or prostate cancer in the course of your 
life doesn't mean that you shouldn't be able to afford to be able to 
purchase affordable health insurance. We address that in the solutions 
that we put forward. I'm so very proud of all of the representatives 
from the Republican Caucus who were at the Blair House today. I thought 
they did an outstanding job of representing the American people and 
ideas that the American people are looking for.
  You mentioned about workforce issues, and to me that was something 
that I came to Congress just looking as a crisis. Starting with rural 
America and underserved urban areas first, the baby boomer generation, 
my generation, we're beginning to retire in tremendous numbers. And in 
those areas where our physicians, our nurses, therapists, technicians 
are retiring, this payment system will get changed if we don't 
proactively address those workforce issues. If you don't have a 
physician in your community to provide services, you do not have access 
to quality care. And so because we've been misled with these 1,000, 
2,000, 3,000 pages, all the attention's been drained in the wrong 
direction, we're missing the bigger issues that, frankly, we've been 
talking about. We've got bills that address some of the workforce 
issues, and so it's time to get beyond the misinformation and the 
misdirection that my Democratic colleagues have been putting together 
in these 1,000, 2,000-page bills, and get to the business of really 
addressing the real health care issues.
  Mr. BURGESS. I thank the gentleman for his work on these issues. I 
thank him for always being willing to be involved in these. These are 
tough problems. These are complex problems.
  You know, the activity today, I referred to it earlier today on a 
radio show as the Blair House project, not to be confused with the 
Blair Witch project. There were times when it did seem to be that there 
probably were some spells being cast.
  The other thing that really had to strike you in watching the 
discussion today is that there are fundamental

[[Page 1936]]

differences as to the role in government, fundamental differences as to 
the involvement in government.

                              {time}  2045

  You know you can't help but be struck. Here we've worked on this 
concept now for 13 months. The President was sworn in the 20th of 
January of last year. Here we are at the end of February, and still no 
bill is across the finish line. Boy, I thought it would have happened 
much, much more quickly. In fact, had the energy that was put into the 
stimulus bill been put into a health care bill, in all likelihood they 
could have passed whatever they wanted in February of last year. 
Instead, they chose to work on the stimulus first and then cap-and-
trade and then gradually, gradually, gradually, their capital bled away 
to where they did not have the votes necessary on their side to pass 
one of these bills.
  And this is the fundamental problem that is happening with the 
President's plans and the Democrats' bills in the House and the Senate 
right now is they do not enjoy popular support. Pick your number: 56, 
58, 75 percent of the American people who do not support this 2,000-
page monstrosity that literally required bribes to bring Senators down 
to the well to pass this bill Christmas Eve. The American people saw 
that and they rejected it.
  They might trust us--I am not sure that they will--but they might 
trust us to work on some of these individual concepts one at a time. 
But at the very end of the summit today, the President decried 
incrementalism and said we have to be bold and we have to move forward 
with a large bill.
  Why? Why do we have to do that? The programs to deal with preexisting 
conditions would involve risk pools to be sure. Reinsurance options for 
States, yes, it's going to require some Federal subsidy. The 
Congressional Budget Office has estimated $25 billion over 10 years. 
They may be a little bit light on that, but still we're nowhere near a 
number like a trillion dollars, which is scaring Americans to death.
  We could provide some help in that market. The States could provide 
some help in that market. We could ask our partners in the insurance 
industry to voluntarily or by law cap their premiums at some level so 
that the person who was in this market did not find the costs so 
daunting that they simply gave up and did not get insurance.
  Now, all of these great programs that the President and the Speaker 
talk about that they're going to give to the American people at no 
charge, none of these programs start for at least 4 years.
  Now look, here we are 13 months into a new administration and the 
administrator at the Center for Medicare and Medicaid Services is not 
there. He hasn't even been appointed, much less confirmed by the 
Senate. That is the individual who is going to be responsible for 
taking this 2,700 pages of legislation that we give them and turning 
the legislation into rules and the Federal rulemaking process. That is 
going to be an enormously difficult task. It is going to take 4 years 
to work through all of that and impugn all of the legislative intent 
and make those Federal rules and leave the rulemaking period open long 
enough so that people can comment on it. That is an enormous task. It's 
not going to happen overnight.
  So the people that come to us and say, My premium's going up too 
much, I want you to take it over, they're not getting anything for at 
least 4 years.
  Now, in the meantime, what if we took an approach--and, in fact, it 
was an approach that was talked about by Senator McCain in the fall 
campaign of 2008. What if we took the approach of we're going to take 
existing risk pools of the States--34 States have already created. 
We're going to emulate the best practices of the best States. We're 
going to allow for some reinsurance options if companies are willing to 
take on higher-risk individuals so that no individual insurance company 
is tasked with too much in the way of financial loss, and we're going 
to cover this group of individuals.
  I heard it over and over and over and over again this summer at town 
halls, Stop what you're doing. We don't want you to destroy the system 
that is working well for 65 or 75 percent of the country. We want you 
to concentrate on those individuals who, through no fault of their own, 
have suffered a tough medical diagnosis, have lost their job and 
employer-sponsored insurance, couldn't keep up with the COBRA payments 
and now find themselves having fallen into that dreaded category of 
uninsured with a preexisting condition.
  While we're at it, we might look at the COBRA system. COBRA was 
placed as a protection to help people who had employer-sponsored 
insurance but they lose their job. So employer-sponsored insurance 
means the employer generally pays about two-thirds of the premium; the 
employee pays about one-third of the premium. When you lose your job, 
you can't continue that insurance. But in all likelihood, your employer 
is not going to pay their two-thirds any longer because you're no 
longer their employee. But for 18 months, you can pick up the whole 
premium and pay that with a small administrative charge--I think it's 
102 percent of the premium--and you can continue your insurance for 18 
months and not fall into the category of uninsured. And if you have a 
preexisting condition, you continue to be covered at that cost.
  But that's a tall order for someone who just lost their job to 
continue to carry that degree of premium. What if we allowed people--
instead of you had to keep that same insurance your employer provided 
you, what if we allowed them into a lower-cost, high-deductible plan 
for those 18 months and still preserved their insurability during that 
time, so that when they found employment, they would not fall into that 
same category again. Or they might even decide to continue that high-
deductible policy with a lower premium and continue to have the 
protection of health insurance without falling into a preexisting 
category.
  But we never really worked on those issues. We just decided we were 
going to do this big bill, and it was going to have mandates, and it 
was going to have a public option, and this is the way it was going to 
be. But to tell you the truth, for 4 years there is no help. There is 
taxes. For 4 years there is the immediate Medicare cuts, but the 
benefits don't start until year 4 or 5 or possibly even 6. We don't 
even know how long it's going to take to set up those programs. And 
again, we don't even have the administrator at the Center for Medicare 
and Medicaid Services. The President needs to nominate one. The Senate 
will then have to confirm them. We may still be months away from 
filling that very important bureaucratic job over at the Department of 
Health and Human Services.
  I'll yield back to my friend from Pennsylvania
  Mr. THOMPSON of Pennsylvania. Some of the observations of just 
watching the summit, as I guess it was called--I have a question for 
you. I will come back to you for that.
  Some observations of the proceedings that I watched today when I had 
an opportunity to tune in in my office--I wasn't on the invitation list 
to be there. It was pretty limited invitations. But I heard--and I 
don't know which leader it was, whether it was the President or the 
Speaker or whom, made comments there were absolutely no Medicare cuts 
that are involved in this. And yet the fact is the Congressional Budget 
Office Director, Doug Elmendorf, back on December 19, just a month ago 
or 2 months ago, noted that there were Medicare cuts, and those 
Medicare cuts built into this impact all areas of health care from 
hospitals to skilled nursing to home health to hospice. Hospice, which 
is a wonderful service for people who are in the final stage of dying, 
where they have the support of compassionate health care professionals 
surrounded by family to be able to die with dignity, and yet that is an 
area, one of many areas of Medicare cuts that are slated for under 
these proposals.
  In my responsibilities across many different settings of health care, 
I have to say that there is a lot of reasons why commercial health 
insurance is expensive. Tort reform I would put right on top of the 
list.

[[Page 1937]]

  But maybe even higher on the list, I would say, is the Federal 
Government. The Federal Government pays--underfunds and has 
systematically underfunded the costs of health care--the physician, the 
hospital for Medicare payment. For every dollar of cost of providing 
care, the Federal Government pays 80 to 90 cents. For medical 
assistance, it's maybe, if you're lucky, 40 to 60 cents. It depends on 
the State. The commercial health insurance pays, on the average across 
the Nation, 135 percent of costs. And the primary reason for that is 
the hospitals' physicians have to negotiate at that rate. If they 
don't, they can't make up for what the government does not pay.
  So what are some of the other costs that I heard today that really 
intrigued me?
  I heard the Democratic leadership claim that it was going to bend the 
cost curve, meaning it's going to bring the cost down for everyone. 
Yet, what we saw was the administration's actuarial--the professionals 
that work for the White House, that look at those numbers and do those 
cost projections--have found the Senate bill, in fact, will not 
decrease health care costs. The Center for Medicare and Medicaid 
Services, who you just talked about, the Medicare professionals, their 
finding was that those were going to increase expenditures by $222 
billion, with a ``b,'' billion; not hold costs, not cut costs, but will 
expand the costs of health care.
  And the President today was very up front in his comments where he 
said that, yes, this proposal will increase premiums for the average 
American and American family by 10 to 13 percent. Well, I thought the 
number one thing we were looking at here is decreasing the cost of 
health care, making it more affordable. How do you truly get access to 
greater health care? Well, you bring the costs down so people can 
afford it.
  So I was curious to get my good friend's opinion. This morning when I 
woke up and I knew this was going to occur, it struck me as I was 
walking to the Capitol, was this going to be a health care summit today 
or a health care plummet? And to me, the indicator was whether the 
President showed up with either a white board, a large white board that 
was blank that we could start over and do what the American people 
want, and that would be what today's events would be--it really would 
be problem solving, because that is what Americans are looking for, 
problem solvers--or would he show up with a rather large hammer and 
really try to hammer through, push through Big Government, bad ideas 
that the American people, in a large majority, have rejected.
  So I yield back to my good friend just to get your impressions of do 
you think it was a health care summit today or a health care plummet.
  Mr. BURGESS. I was criticized on a news show earlier today referring 
to this exercise as a 6-hour photo op. Probably I would fall into the 
category as a ``plummet.''
  Isn't it interesting that, yes, premiums for the average family may 
increase for 10 to 12 percent, but that's okay. Instead of an apple, 
you get an orange, so you're coming out better in the deal.
  Now, yesterday, in our Committee on Oversight and Investigations, we 
hauled in Anthem Insurance Company in California. And Anthem, to their 
great discredit, chose right now as a time to increase their premiums, 
and they have become the whipping boy and the poster child. And I will 
concede, I think they raised their premiums too fast. They were tone 
deaf. Their highest premium increase was 39 percent. Their average was 
25 percent. Twenty-five percent. Okay, that seems high, but the 
President's already said 12 percent. Yeah, that's okay because you get 
an orange instead of an apple, so after all, you're good in that 
transaction.
  So I guess if Anthem wanted to raise their rates, they probably 
should have stayed at that 12 percent rate. They would have been right 
in line with the President of the United States. They could have raised 
their rates and all been happy about the transaction. Instead, they 
overshot. They hit an average rate of 25 percent and, as a consequence, 
found themselves sworn in under oath in our committee having to absorb 
the ordeal that we put people through when they come before our 
committee.
  Mr. THOMPSON of Pennsylvania. I have to wonder with that because I 
see premiums like announcements, and they are going up. And this is why 
we're committed to doing the right type of smart government solutions 
to bring the costs of health care down, the premiums down. Giving a 
license to 12 to 13 percent additional increases, that's unacceptable 
to me for the American people.
  I have to wonder how much of what's going on in Washington and these 
health insurance companies as America is watching the debate here, 
that--you know, giving this approach that the Democratic leadership, my 
good friends and colleagues on the other side of the aisle are taking, 
how much is that driving up premiums right now because they don't know 
what's coming. They don't know the premiums. There is a lot of 
uncertainty.
  I mean we, not too long ago, passed a credit card bill under similar 
circumstances. It was going to provide all kinds of limitations and 
impose new conditions on really what has been kind of a free market 
type of process, and what I have seen, actually, as a result one of the 
unintended consequences, is some of those interest rates--before the 
new regulations kicked in, some of those interest rates went way up as 
an unintended consequence of government overreaching, government-run 
approach.

                              {time}  2100

  I have to wonder if what we are seeing with some of these more 
recent--like the situation you just talked about, may be an unintended 
consequence of just the wrong-minded direction that our Democratic 
colleagues are taking this health care debate in, as a reaction by the 
health insurance industry.
  Mr. BURGESS. It's interesting, perhaps the one thing that would 
provide the right impetus in the competition to hold down those costs 
we are not going to do, and that's the ability to buy across State 
lines.
  In the individual market, buying a policy for a family of four in New 
Jersey is $10,000 a year. Your State of Pennsylvania, $6,000 a year, my 
State of Texas, $5,000 a year. As long as people know what they are 
purchasing, I don't see why it is reasonable to restrict someone from 
having a policy that may be more affordable.
  My insurance premiums have decreased by about 50 percent over the 
last 2 years. Not because I am a Member of Congress and I get a special 
deal, but I said, you know what, I can no longer afford this high 
option PPO insurance that is available to us in Congress, so I have 
elected to go into what's called a high deductible health plan with a 
health savings account. I actually had one several years ago when I was 
in private practice. I liked it.
  I liked the fact that I was the one who got to choose which doctors 
and facilities I got to use. I didn't have to call 1-800-California to 
get an X-ray preapproved. I wrote the check and I controlled the money, 
and I made the decision about who I saw and when. So I have gone back 
to that type of policy, and I will tell you I am very satisfied.
  We have improved from the old medical savings account in 1986 to the 
Health Savings Account improvements that started in 2003 and continue 
to this day. Preventive care is now included as part of the benefit in 
a high deductible health plan because the insurance company has an 
interest in making sure if you have a problem that it is diagnosed 
early, while it is less expensive to treat, and I think ultimately 
that's a good thing.
  I have chosen a plan that does not have prescription drug coverage 
because after we passed the prescription drug benefit in Medicare in 
2003, one of the unintended consequences was we changed the market so 
that now many generic medicines are available at Wal-Mart for $4 a 
month. I try to find those bargains for those medicines if I should 
need one. I try to find those bargains

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at Wal-Mart or go to an over-the-counter variety, which is much cheaper 
than the name brand that is bought at the pharmacy, and you can 
actually achieve significant savings.
  I am motivated to do that because it's my money that I am spending 
for those compounds. Yes, I could have paid more for PPO insurance and 
then, yes, I could have had a nice mail order, even gone down to my 
pharmacy and gotten brand names, but I have found that, hey Prevacid is 
over the counter now. It costs a fraction of what it used to cost a few 
years ago. Even before that, Prilosec was a similar medicine, not quite 
the same thing, but that was available in a generic form over the 
counter at that time at a fraction of the cost of the 30-pill bottle of 
Prevacid that I was taking before.
  So it makes the consumer more informed and motivated. Here is how you 
hold down health care costs: Let me be the decisionmaker about that. 
Don't tell me from a comparative effectiveness board that, hey, this 
medicine is just as good as this medicine, and so this is all you get 
because this is what we are buying for you this month.
  Let me have some of that money back to spend myself, the premium that 
I pay every month, a portion of that goes into the medical savings 
account. Every year that it accrues and grows larger it's tax deferred 
until--if I don't spend it on health expenses I would obviously have to 
pay taxes on it when I took it out. As long as I spend it for 
legitimate medical purposes, hey, that's pretax dollars. That's 
probably the best deal you could do in the individual market. So these 
are changes that we actually ought to encourage.
  I was stunned today to hear the Democrats admit, you know, we agree 
on a lot of this stuff that we have got here on these sheets, but, 
well, we don't do the health savings account thing. My goodness, that 
is the one way to really start to bring--you talk about bending the 
cost curve, that's one way. Get a motivated patient, educate them about 
some of the options that they have, and, oftentimes, not oftentimes, 
almost always they will make the right decision. I cannot tell you how 
many times in my medical practice if I recommend a test, a CT or MRI 
scan, a CAT scan or an MRI scan, and the next question from the patient 
back to me was not, Doctor, is it really necessary, or, Doctor, is this 
safe to do this, the next question was, well, does insurance cover it? 
If it did, there were no more questions. Go ahead and have the test.
  I, on the other hand, with the type of policy that I have, yes, I may 
have hurt my knee or shoulder bad enough to go get a CAT scan, or I may 
make the decision that, Doctor, with a little ice and tincture of time 
would this not perhaps resolve on its own? Yes, it could, and if it 
doesn't get better in a week we could still do the CAT scan and we 
won't have delayed beyond the therapeutic interval, so it is okay to do 
that.
  I am happy to take that advice and not have the test. If I don't feel 
better in a week or 10 days or whatever the prescribed time limit is, 
fine. Go get the test, and I will still be able to write the check and 
have that done. Here is how you bend the cost curve down. You get the 
patient involved, put the power back in the hands of the patient. Let 
the patient and the doctor make those decisions.
  Don't make them buy the insurance at 1-800-California, but don't make 
them buy across the street at Health and Human Services. Let the 
patient and the doctor make those decisions. Every doctor has had the 
unpleasant experience of having called a preapproval number and have 
their patient denied a test or a procedure or a surgery, and then you 
have got to go to bat for them and prove all of these things. It is an 
enormous nuisance, and I hated it every time it happened.
  On the other hand, in the Medicare and Medicaid system, they go ahead 
and cover that, but maybe 3 or months from now, maybe a year from now, 
they call you back and say, you know, we don't think that 
hospitalization was actually necessary, and we are going to deduct what 
we pay to you from the next round of payments that we give you for your 
next round of Medicare and Medicaid patients.
  That is beyond frustrating because at that point you may not have at 
your immediate disposal the documentation that you at least would have 
had with a preapproval process. Neither is a good occurrence in a 
doctor's office. We need to come to some sort of consensus. But, as 
much as I hated the preapproval process, I see now, dealing with these 
large, large Medicare and Medicaid outlays, why it is necessary 
sometimes to assess medical necessity and why it is necessary sometimes 
to seek that preapproval, perhaps in our Medicare system.
  If we really were serious about bending the cost curve, instead of 
just cutting doctors' payments--and that's what we do, we say, well, we 
will pay 20 percent less this year than we did last year--what's the 
practical effect of that? Well, the doctors' costs are fixed. He is not 
paying less for electricity to light his office this year than he was 
last year. His office help certainly didn't come in this year and say, 
hey, you know what, we can all take a pay cut because we love working 
for you.
  That doesn't happen. His costs go up every year. The reimbursement 
rate goes down because Congress says, hey, we are spending too much 
money. What is the practical effect of that? The practical effect of 
that is, you know, I was able to pay my bills and take something home 
last year seeing 18 patients a day. But you know what, this year I have 
got to see 25 patients a day. And maybe if I can squeeze an extra 
procedure or two out, maybe I should do that because I have got to make 
up that difference somewhere.
  So we have gone about this the wrong way. We are ratcheting down 
costs at the provider, and yet the doctor, he or she is the one who 
picks up the pen and writes the prescription, orders the 
hospitalization. The most expensive item in the doctor's office is 
their ballpoint pen most of the times because the doctor is the one 
making the decisions about that medical care.
  Wouldn't a different way to look at this might be to say, Doctor, we 
are not going to cut your pay this year. We are, in fact, going to pay 
you a little bit more. We hope you will see fewer patients and maybe 
take a little bit more care and a little bit more preventive medicine 
and education with those patients along the way. It would be a 
phenomenal thing to look at but we never tried. We just cut the 
doctor's pay and said, whew, we got through it this year, the doctors 
are all mad but maybe they won't remember come November, and we will 
cut them again at the end of the year.
  We are probably going to bump up against the clock. I do want to make 
this point from what we talked about the cost of insurance at the 
hearing we had yesterday.
  It is important to understand, I think, that Speaker Pelosi, Harry 
Reid, President Obama, their health proposals would not make health 
insurance significantly cheaper for America's families. Under the bill 
passed by the House in November, H.R. 3962, a family of three making 
just under $55,000 a year and buying now a plan in this new exchange 
that's going to be set up and created by the bill, they would have to 
personally contribute after a tax credit about $5,500 a year in 
premiums. Additionally, this family would also pay $4,000 of out-of-
pocket costs exclusive of the premium--copays and drugs that weren't 
covered--so this family would pay about $9,500 for a family of three 
that earns $55,000 a year in the Health Insurance Exchange.
  I think it's important for people to understand that when we pass 
these bills and it's all settled and done, it doesn't mean free 
insurance. It doesn't mean free health care. It means, yes, you have 
got a government option here for buying insurance, but it's still going 
to cost something. It is still going to be an expensive item in that 
family's budget every year, and we are misleading people by telling 
them that, hey, we need to pass this bill because too many people don't 
have health care.
  True enough, the person who has no income and no job will now have 
access to Medicaid, which they may not have had before, but the average 
person

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earning a reasonable salary is still going to find that the cost, the 
expense they paid for health insurance, is going to be significant. 
Here is the rub: If we pass this bill, this won't be an optional 
expense in their budget. They will be required to buy this, and the 
enforcer is going to be the Internal Revenue Service.
  Now, Mr. Thompson, you brought up the online purchase of insurance 
for automobiles that has the cute little lizards and cave men on the 
logos. People will sometimes bring up to me, well, why, why not have a 
mandate. After all, there is a mandate to buy car insurance in your 
State, so, what would be the matter with having a health insurance 
mandate?
  Here is the key. In my State, this is a State decision that in the 
State of Texas, people have to carry insurance if they are going to 
exercise the privilege of driving on the roads of the State of Texas. 
Health insurance is a different animal, and for the Federal Government 
to require, not a State government, but the Federal Government to 
require the purchase of health insurance is taking us in the direction 
of loss of liberty that none of us have really ever encountered before. 
It is a new concept.
  So if a State wishes to exercise a mandate, which they have done in 
Massachusetts, then that's a State decision and that decision will 
either be supported or rejected by the voters in that State, but for 
the Federal Government to create for the first time a mandate, a 
requirement that a person purchase a product just for the privilege of 
living in this country, again, we are going down the road of loss of 
freedom that, again, I don't think people really want to go there.
  Now, you will also hear, and it's so strange to hear the comparison 
of we have got to have a mandate as you do with automobile insurance, 
and you know what, you can buy that consumable insurance online. What 
if, instead of, if we had our thinking right, we would let the health 
insurance be available online, let the plan finders be available online 
and, if people think it's necessary to have a mandate, let that be a 
State decision. Let that be a State decision if the exchange is--right 
now you have, and I don't know the precise number, 30 or 34 States 
whose attorney generals are drawing up legislation to prevent their 
States from or prevent their citizens and their States from being 
required to follow an illegal Federal mandate.
  Mr. THOMPSON of Pennsylvania. Pennsylvania being one of those, 
absolutely.
  Mr. BURGESS. It just shows you the type of tension that we are going 
to set up between the State and Federal Governments if we were to pick 
up and pass either the House or the Senate bill and send it down to the 
President for his signature.
  Mr. THOMPSON of Pennsylvania. Well, you have touched on so many very 
important issues during that time, during the course of this hour. I 
certainly want to come back to--you know, when I started in health 
care, I mean, the patients were not a part of the treatment team, they 
were, you know, everyone kind of focused their energies on the patient, 
the individual, the consumer, but they weren't included in health care 
decisions. So much has changed in at least three decades.
  Today, I don't know of any health care professionals that don't 
consider the patient themselves a very important part of the treatment 
team, and it's so important that individuals take that, exercise that 
self-responsibility to be informed and to make decisions and to take 
control of their health care, extremely important.
  You also talked about, you were talking about the stress on 
physicians, and it's significant. In Pennsylvania, the average age of 
physicians in Pennsylvania is 50. Many that I talk with, they look at 
the challenges of practicing medicine today. In Pennsylvania, we have 
terrible medical malpractice costs. We export our physicians. We train 
a lot of them, but we export them to States like Texas. You know, we 
don't keep them. And many of the physicians I talk with that are 50 and 
older, they look at what they have accumulated in their lives, and they 
look at how much they are spending each year, whether it's medical 
malpractice, these additional costs or regulations that are coming, the 
extra costs they had to put into practice to comply with Federal 
mandates like the HIPAA law from the 1990s.

                              {time}  2115

  And they are saying, you know what? Why don't I retire now while I 
can at least retain a little bit of what I've earned so I can have some 
type of future enjoyable retirement? That would contribute so much to 
our access issue in States like Pennsylvania where citizens are not 
going to have access to quality care. I see that as a significant 
unintended consequence as a part of what my friends across the aisle 
are proposing and pushing at us.

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