[Congressional Record (Bound Edition), Volume 156 (2010), Part 2]
[House]
[Pages 2211-2217]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    A SECOND OPINION ON HEALTH CARE

  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 the minority leader for 
giving me the opportunity to spend some time with my colleagues tonight 
on the House floor talking about, yes, one of the most important issues 
not just of the day, but of the year, and in fact the past year-and-a-
half, and that is, of course, the issue of health care in this country.
  Colleagues, I know that we all watched very closely, as did men and 
women across the country last Thursday, when there was a health care 
summit at the Blair House. Leadership from both the majority Democratic 
Party and the minority Republican Party, my party, were invited to the 
White House, about 20 on each side of the aisle, moderated by none 
other than the President himself.
  I think, Mr. Speaker, that that was a good thing. I commend the 
President for calling that summit. I think that each side, leadership 
and Members, particularly I think my colleagues from the Senate and our 
colleagues from the House, the medical doctors, did a great job of 
explaining their view and position on health care reform, alternative 
ideas which I think the President listened very carefully to.
  It is hard to know what actually came out of that particular session, 
seven hours of dialogue, the whole thing televised. But, again, Mr. 
Speaker, I think it was good that we showed that there can be some 
comity and bipartisanship in this body and in the Congress. Indeed, it 
was a good opportunity.
  Well, here we are almost a week later and we get an announcement from 
the Associated Press just moments ago, Mr. Speaker. I was reading my 
BlackBerry, and apparently the President is going to come forward 
tomorrow yet again with some change to the health care plan even 
different from the 11-page change to the Senate bill that was posted on 
the Internet last Monday in anticipation of the health care summit on 
Thursday. I don't know what that is going to say, Mr. Speaker. I don't 
know what the President has in mind. Maybe we will spend a little bit 
of time this evening talking about that.
  I am pleased that my good friend and fellow physician co-member of 
the House GOP Doctors Caucus and fellow OB-GYN specialist from the 
great State of Tennessee, Dr. Phil Roe, has joined me, and we will 
engage in a colloquy.
  But I just wanted to kind of set the stage tonight for our colleagues 
and say to both sides of the aisle, Mr. Speaker, and also to the 
administration, especially to the administration and to the President, 
again, I am not sure what we will see tomorrow, Mr. President. I look 
forward to very carefully looking at any proposals, especially if they 
are adopting some Republican ideas so that we can do these things, 
these important things for the American people, in a bipartisan way. We 
were elected to do that.
  But I would very much liked to have been at the Blair House last 
Thursday. In fact, Mr. Speaker, the President knows that, or at least 
some of his staff knows. I don't know if he ever got to read my letter 
when I requested to come and speak on behalf of the Doctors Caucus in 
the House on the Republican side. I didn't get to go, but Dr. Charles 
Boustany, our colleague from Louisiana, a cardiothoracic surgeon, was 
there, and did a great job. I am awfully proud of Dr. Boustany.
  But had I been there, had I had that opportunity to get my 5 minutes 
of fame or whatever, I would have said to the President, You know, one 
thing that you have done that I think is probably one of the most 
important things in regard to health care reform, that is money that 
was allocated, $19 billion in fact, to try to get electronic medical 
records in the hands of every practicing physician in this country, all 
750,000 of them, and every hospital in this country, so that we could 
clearly reduce medical errors, we could ultimately save lives, and, in 
the long run, save money.
  This is an idea that I think, at least from this Republican 
viewpoint, Mr. Speaker, is bipartisan, and I commend the President. 
President Bush had the same idea, and again it was a plan to get fully 
integrated medical records by the year 2014-2015. So we can do things 
in a bipartisan way.
  There are a number of other things that Dr. Roe and I would like to 
talk about, Mr. Speaker, tonight. We don't need to spend $1 trillion. 
That expenditure on electronic medical records is something like $20 
billion. Now, $20 billion is a lot of money, but it is a long way from 
a thousand billion, and that is a conservative estimate by the CBO: $1 
trillion for this 2,700-page reform. We don't need that, Mr. Speaker.
  Again, I am not sure what the President is going to say tomorrow, but 
I hope that finally he will be listening to the American people and 
realize that there are some targeted things that were mentioned, yes, 
by Democrats and Republicans, but the President I think wants to adopt 
some Republican ideas, and we are talking about things especially like 
medical liability reform.
  The CBO gave a very conservative estimate of saving $54 billion over 
10 years. But if it is the kind of medical liability reform that is 
comprehensive, fair, absolutely fair and balanced, so that patients who 
are injured by practitioners of medicine and by facilities that are 
practicing below the standards of care, that they absolutely have a 
redress of their grievances and a decent recovery.
  But the President, Mr. Speaker, in the bills that we are currently 
looking at, the House and Senate bills, there is just a pittance, like 
$25 million worth of grants to States to look at it, to study. We keep 
creating these study commissions, but not even allowing States who have 
already capped noneconomic damages, so-called pain and suffering--in 
many instances these are these frivolous lawsuits--those States 
wouldn't even be eligible for any of this $23 million in grants.
  So I hope his comments tomorrow include adoption in a new bill or a 
modification, and hopefully a vast shrinkage of the existing bill, and 
that it is true medical liability reform.

                              {time}  2000

  Because that's the only way we save lives and save money and bend 
that cost curve down in the right direction.
  So with those opening remarks, Mr. Speaker, I want to yield time to 
my colleague from Tennessee, Representative Phil Roe.
  Mr. ROE of Tennessee. Thank you, Dr. Gingrey, for yielding. As I was 
sitting here, I think what we should do is go back a year. Obviously, 
last year when we first began this session we knew that health care 
reform was

[[Page 2212]]

going to be on the front burner. The arguments that I heard for the 
need of it being on the front burner were the same as I heard over 20 
years ago, which were rising costs of care, decreased access to care. 
And we have viewed those things, I think, over a period of time and 
understand that we have the best quality health care in the world in 
the United States, but it is expensive. So the cost is a huge issue. 
And that's one of the things that I think in this current bill is not 
being addressed adequately, or has not been.
  One of the great disappointments I had during the debate on this 
health care bill was the fact that in our Doctors Caucus on the 
Republican side we have 14 Members, now 10 physicians. We have an 
optometrist, dentist, psychologist. And not any of us were consulted in 
any meaningful way in putting together, on the House side, an over-
2,000-page bill.
  Let's summarize that bill a little bit. The House bill that was 
passed has a public option in there. That is not the case in the Senate 
bill. In the Senate bill and the House bill there are both individual 
and business mandates to purchase insurance. We have never in the 
history of this country on a Federal level--and you hear it compared to 
a State issue of car insurance. It's not the same thing. We've never 
done that before. So there are some distinct differences in these two 
bills. And they are now coming to the House. It passed in the House by 
220-215; and in the Senate, 60-40.
  Now the President, and Dr. Gingrey mentioned this, several of us have 
attempted on numerous occasions to go to the White House and sit down 
in a bipartisan manner and lay out literally hundreds of years of 
experience and go over with him what we saw work and what didn't work.
  And what I saw in my State in Tennessee back 16 years ago was we 
looked at access, we look at rising costs, and people's inability--
losing their insurance. The same issues as today. We asked for a waiver 
from the Health and Human Services to start a new managed care plan 
called TennCare. I've discussed it here on the House floor, and I'm not 
going to go into the details, but just to say that bill, that project, 
when it first started, was a $2.6 billion project in the State of 
Tennessee to cover people. We had a lot of uninsured people. We wanted 
to get as many people covered as we could.
  In doing that, in 10 budget years in the State of Tennessee that had 
gone to an $8 billion program. It had tripled in costs. And so we found 
out unless people had some skin in the game, unless they had some 
different incentives than we had, the costs would escalate. As a matter 
of fact, it escalated so much that it took up one-third of the State 
budget, and every new State dollar we took in went to the health care. 
So the Governor, who's a Democrat, and the legislature, which was 
Democrat and Republican, split, had to do something about it because 
the State simply couldn't afford it.
  What I see in this current Senate bill is a massive expansion of the 
same program that failed in the State of Tennessee. And to show you how 
bad it is right now in our State, we're having to limit doctors visits. 
That's right now, currently, I'm talking about. Not with this added 
part. Remember, in the Medicaid program, the State has a match. That's 
why the Nebraska carve-out was such a problem for other States, because 
there is a match that's required in Medicaid: the Federal Government 
provides so much money, the State provides so much. Well, our State 
can't provide any more. So we've cut the rolls of over 200,000 simply 
because the State of Tennessee doesn't have the money for the current 
plan, not the very expansive plan that we've talked about.
  I think last week--I agree with you, Dr. Gingrey, it was a year 
overdue. It should have happened a year ago. It was good going to show 
that there are philosophical differences between how you approach 
health care. Basically, do you want a larger--I won't say nanny State--
but ever-expanding government to make those decisions, or individuals 
to make those decisions? Certainly, I believe that individuals should.
  When you look at this plan that's there now, I can tell you it says 
it's budget neutral. There's some gimmicks that have been played. Paul 
Ryan very clearly pointed those out in the $500 billion that is being 
carved out of an already underfunded, failed Medicare plan; 2016, that 
goes upside down. In other words, more money is going out than coming 
in. If you take $500 billion out of that, you've just created another 
liability for the Medicare program.
  I will tell you, if you take that much money out, three things will 
occur. One, there will be decreased access to care because doctors are 
not going to be able to take the patients. They won't pay. Number two, 
the quality will go down if you can't go in. And, thirdly, the seniors 
will pay more for the care they're going to get because they'll have 
to. There won't be any other choice.
  We talked about some simple things that I think we could do. As you 
pointed out already, there's a 2,700-page Senate bill out there. We can 
cover two-thirds of the people in that Senate bill with two paragraphs. 
Number one--and it's in the House bill--it's simply to allow young 
people who don't have health insurance after they get out of high 
school or college to stay on their parents' plan until they're 26 or 27 
years old. Just pick your number. That will cover 7 million young 
people. Number two, sign up the people who are already eligible for 
SCHIP, the State Children's Health Insurance Plan, or Medicaid. Already 
you have got those plans in place. Have adequate funding. That will 
cover, Dr. Gingrey, almost 20 million people. This complicated Senate 
plan covers 31 million people.
  You hear people talk about bending the cost curve, keeping costs 
down. Dr. Gingrey talked about it a little bit on medical liability 
reform. Without liability reform you will never be able to completely 
reverse this cost escalation. Why? Because doctors will order tests to 
protect them in case there's no disincentive for them not to. Again, an 
experience we've had in our State: 35 years ago we formed a mutual 
company, State Volunteer Mutual Insurance Company, to protect 
physicians. When I first went into practice, my premiums were about 
$4,000 a year, probably much like yours were. When we left, a physician 
who took my place was $74,000. It's gone up almost 18 times, over that 
period of 30 years, the increase in premiums.
  And what have we gotten for that? Well, over half the premium dollars 
that I paid in for 35 years, gone for attorneys, both defense and 
plaintiff attorneys, not to the injured party. Less than forty cents on 
the dollar actually went to the injured party. So we've got a bad 
system to basically compensate people who have been legitimately 
injured. So until you get that fixed, you're not going to ever 
completely bend the cost curve. You've got that to deal with.
  I think the waste and fraud, everyone agrees with that. There's 
waste, fraud, and abuse in the Medicare program, absolutely. I do have 
the President's letter. And the four things that he agreed to discuss 
were waste, fraud, and abuse. I think we all agree on that. Both sides. 
I don't think you'll get any disagreement there. The liability reform 
is just more study. The study that he was talking about was to not 
limit attorneys' contingency fees and caps on damages. Well, that's the 
two problems that are causing the problem right now. And in Texas, 
which we've already done the experiment, in 2003 they passed liability 
reform. And what's happened in Texas? Well, premiums have gone down 30 
percent and physicians have streamed into Texas. Almost 15,000 new 
doctors have applied for practice in Texas.
  Mr. Speaker, the third thing that the President has in his letter is 
the inadequate payment for Medicaid patients. In our State, they pay 
less than 60 percent of the cost of actually providing the care. So 
physicians are not able to take as many of those patients, and many of 
them limit or don't see Medicaid patients. He said he would be willing 
to look at that if it's fiscally responsible. The other is to encourage 
health savings accounts, which has been one of the centerpieces of 
personal responsibility.

[[Page 2213]]

  One of the things that has bothered me in this bill, that supposedly 
the President said in this chair here not long ago, that he wouldn't 
sign any legislation that wasn't budget neutral. Well, the sustainable 
growth rate, as you and I both know, are how doctors are paid by 
Medicare. As a matter of fact, right now there is no--we have had no 
``doc fix,'' we call it. There's a 21 percent cut in the budget right 
now for that that will occur this week if we don't do something this 
week. If there's a 21 percent cut in those payments to our physicians, 
then you're going to see a lot less Medicare patients have access to 
their doctors. And that is a very bad thing.
  So I think there are some good things about what the President said 
here. I agree with that. Then there's some things that just don't mesh 
with the current legislation.
  I want to talk about one other thing, and then I'll yield back. One 
of the things that when you see CBO and you see all these estimates, 
you have to go back and just look at history. When Medicare was first 
debated on this very floor right here, and passed, it was a $3 billion 
program. 1965. The estimates then were it would be a $15 billion 
program in 1990. Flash forward to 1990. It was over a $90 billion 
program. Today, it's over a $400 billion program.
  So if you look at those estimates and look at the history of our 
estimate in Tennessee that we were going to actually save money, keep 
premiums down. And, Dr. Gingrey, what's happened when the bigger--these 
programs that come along that don't pay the cost of the care. Medicare 
pays about 80, 90 percent of the cost of providing the care, and 
TennCare or Medicaid pays about 60 percent of the cost. Those costs get 
shifted. And they get shifted to business and individuals. We think, in 
Tennessee, it might add as much as $1,800 per family who have private 
health insurance. So it's a hidden tax. We can't continue to do that, 
or you'll drive the insurance companies out of business.
  Certainly, the insurance companies, we have every right, I think, to 
look at them very seriously. I know when I left practice, I had a case, 
and one of the last cases I did, I spent as much time getting the case 
approved as I did actually doing the case, almost. So there's some 
insurance reforms that need to be out there. You've experienced the 
same exact thing. A lot of frustration on my part there, also.
  I yield back to the gentleman.
  Mr. GINGREY of Georgia. Dr. Roe, thank you so much. I hope you will 
be able to stay with us for a little bit more time tonight as we 
continue the colloquy.
  Mr. Speaker, I wanted to show a few slides to our colleagues. Of 
course, starting with the Second Opinion, the subtitle: When will the 
White House listen to the American people? When, indeed, Mr. Speaker, 
will the White House listen to the American people?
  In the second slide, let's just go back to last August, 7 months ago. 
Americans attended town hall meetings across the country in record 
numbers. In fact, my town hall meetings, instead of having 40 or 50 
people there, I had 1,500. And I'm sure other Members experienced the 
same thing. These people were asking that the Democratic majority stop 
their plans to implement a government takeover of health care. And 
here's a quote, Mr. Speaker, from ABC News, and the date is August 5, 
2009. That's when all these town hall meetings were going on across the 
country. I quote from the newspaper, There were no lobbyist-funded 
buses in the parking lot of Mardela Middle and High School on Tuesday 
evening, and the hundreds of eastern Maryland residents who packed the 
school's auditorium loudly refuted the notion that their anger over the 
Democrat health care reform plan is manufactured. That's what ABC News 
was saying back 6 months ago.
  Now fast forward to today, March 2, 2010. Americans are still trying 
to be heard by the White House and Democratic leaders as Democrats 
continue to try and ram a government takeover of health care through 
the Congress by any way possible. This is a quote from Rasmussen, the 
polling guru. Everybody's familiar with the Rasmussen poll: February 
23, 2010, just last week, Voters still strongly oppose the health care 
reform plan proposed by President Obama and congressional Democrats and 
think Congress should focus instead on a smaller plan, smaller bills, 
that address problems individually rather than a comprehensive plan.
  Well, Mr. Speaker, that's what we're talking about tonight, that's 
what Dr. Roe is discussing, that's what I said in my opening remarks, 
about had I been at the Blair House, what I might have said, very 
respectfully, to the President, to Majority Leader Reid, and to the 
Speaker of this House of Representatives, Ms. Pelosi.

                              {time}  2015

  The American people were not an angry mob, as they are not today, my 
colleagues. They are men and women, a lot of seniors, yes, very 
concerned about the massive takeover by the government. And that is the 
thing, the bottom line that the people fear the most, is having 
government take over every aspect of our lives. Indeed, colleagues, we 
are talking about, and we all hear this quote and don't argue with the 
statistics, this is one-sixth of our economy; $2.5 trillion a year on 
health care.
  We see the same thing, quite honestly, happening in education. We 
have a bill on the floor tomorrow, Mr. Speaker, a bill with a special 
rule in regard to telling school systems all across this country how 
they can discipline children. I am sure there are some concerns and 
there may be some abusive behavior in very small pockets and a small 
problem. But we have this attitude up here, Mr. Speaker, that the 
Federal Government knows best, and we have these knee-jerk reactions to 
things, and all of a sudden we make this huge mountain out of a mole 
hill, I think, in some instances and say the Federal Government has to 
take over; that school boards, elected by a local community, can't run 
their local schools. I think that is hogwash, quite honestly.
  The American people have spoken about this. They want us to correct 
the things that they can't deal with themselves. And yes, they want us, 
Mr. Speaker, to rein in the abuses, in this instance, of the health 
insurance industry. But you have to understand, colleagues, that there 
are a lot of good, honest, ethical men and women in this country who 
work in the insurance industry, whether they are selling life insurance 
or property and casualty, or health insurance. Independent agents.
  And there are some great health insurance companies, large companies, 
small companies, probably over 3,000 total. We need to be careful that 
we're not beating up on them so bad that all of a sudden we destroy an 
industry, and how many hundreds of thousands of jobs in the process.
  Mr. ROE of Tennessee. Will the gentleman yield?
  Mr. GINGREY of Georgia. I would be proud to yield for comments from 
my colleague from Tennessee.
  Mr. ROE of Tennessee. You make a great point. We are not here 
defending them. But to put this in perspective, if you took all the 
profits that the health insurance industry made, it would be 2 days of 
the health care of this country. That is how much it is: 2 days out of 
365.
  Mr. GINGREY of Georgia. I thank the gentleman for pointing that out. 
This is the kind of wisdom that we need to hear and need to stop and 
think.
  Certainly Dr. Roe would agree, and I fully agree, Mr. Speaker, that 
if insurance companies are rescinding, is the word that is used, a 
rescission action, rescinding a policy after the fact. Somebody has got 
health insurance for their family, including their children, and they 
have a teenage daughter, and she, lo and behold, has to go into the 
hospital for an emergency appendectomy. The surgery is a success, 
everything goes fine, and they expect that the insurance company will 
pay whatever is above the copay and the deductible. And then all of a 
sudden they are told, ``Well, no, we've looked back through your policy 
that you took out, Dad, for the family 10 years ago when

[[Page 2214]]

your teenager was just 3, and you gave us the wrong birth date, or you 
failed to dot an I or cross a T, and therefore this $20,000 bill, 
you're on your own, buddy.'' Well, that has to stop. Of course it has 
to stop.
  And this also not allowing people with preexisting conditions, 
particularly if they are in the individual market, just make it so 
impossible, either deny or make the premiums four times the standard 
rate, and that essentially is denial, too, isn't it, Mr. Speaker? Well, 
Dr. Roe and I agree, and everybody in this body, all 435 of us agree 
that we need to stop things like that. Those things can be done, but it 
doesn't take 2,700 pages and 32 additional Federal bureaucracies to 
deal with that.
  Again, I don't know what the President is going to say tomorrow. I 
read that AP report that he is going to indeed address four subjects in 
maybe yet another bill, or maybe in addition to the current Senate 
bill, that were brought up last week on Thursday at the Blair House by 
the Republican Members that were there. Let me just on my BlackBerry, 
Mr. Speaker, refer to that. And just for my colleagues, maybe some of 
you had already read that.
  The proposals President Obama listed are four: Number one, sending 
investigators disguised as patients to uncover fraud and waste. I want 
to get back to that, Mr. Speaker, in just a minute. Expanding medical 
malpractice reform pilot programs. Sounds good to me. Increasing 
payments to Medicaid providers. Absolutely. If we are going to have any 
Medicaid providers, I hope we will do that. And last, the fourth thing, 
and I am really interested in reading about this because I'm most in 
favor of it, expanding the use of health savings accounts.
  But I do want to go back to that first one, Mr. Speaker, if I may. 
Sending investigators disguised as patients to uncover fraud, waste, 
and abuse. I know that was brought up at the Blair House by a 
Republican, but, quite honestly, if we don't already, Mr. Speaker, have 
enough Inspector Generals within CMS and other government programs, 
health care, TRICARE, the veterans program, CHIP program across the 
country, I think we could do a better job with combating waste, fraud 
and abuse than sending undercover patients into doctors' offices.
  I haven't practiced in a while, but I spent 31 years, Mr. Speaker, as 
a medical practitioner, it has only been 7 or 8 years since I 
practiced, but I worried all the time about making sure that I didn't 
make a mistake, that I ordered the sufficient number of tests. And in 
fact, I practiced like everybody else, probably Dr. Roe as well, I 
welcome his comments on this, what we call defensive medicine. And many 
times getting a blood test, or an x-ray, or a CAT scan, or an MRI, or 
something that I knew wasn't necessary. I hoped that it wouldn't be 
harmful to the patient. If you draw too much blood, you can certainly 
turn them into an anemic patient.
  And, Lord knows, we had a hearing just last week, Mr. Speaker, in the 
Energy and Commerce Committee about x-ray exposure, particularly from 
MRIs and CAT scans and things that you really don't know if 10, 15, 20 
years from now if that exposure couldn't indeed lead to a cancer that 
that patient might not otherwise have contracted. So all of that 
defensive medicine that we practice, and my colleagues, the OB/GYN 
specialists, are in town this week, and I have had the conversation 
with them, so I know that we need to stop that.
  But this business of saying we're going to disguise people and have 
them go into a doctor's office as a fake patient, I sure hope they 
don't go in as a fake patient and decide to have a hemorrhoidectomy to 
see whether or not the doctor is qualified. Some of this stuff is a 
little bit ridiculous, I think.
  I want to yield to my colleague from Tennessee, because he's got 
almost as much clinical experience as I have. I would like to know how 
he feels about that particular aspect of reducing waste, fraud, and 
abuse.
  Mr. ROE of Tennessee. I would like to go on record tonight with you 
as naming this ramming this bill through this month March Madness. And 
I am not talking about basketball. It would be madness to do that now. 
And I will just tell you why I believe that.
  Six o'clock the night after that summit last week, I just happened to 
have a telephone town hall and had 1,100 people vote in a poll. There 
were four questions: Number one, do you want to pass this bill as it 
is? Number two, do you want to take a clean sheet of paper and start 
over? Number three, do you want to just scrap it and work on jobs? Or 
number four, do you not have an opinion on this? Five percent of those 
1,100 people who voted said to pass the bill as is. Thirty-eight 
percent said get a clean piece of paper and start over. Fifty-two 
percent said just stop altogether and let's get to working on getting 
people back to work in this country; start on jobs. And then 5 percent 
were undecided.
  As you can see, that CNN poll right there showed 73 percent of 
Americans think we should start all over or do nothing. So it is not 
that much different than the very poll I did of 1,100 people voting. 
Mine was not a scientific poll. I want to point that out. It was just a 
telephone town hall poll. I don't want to pass it off as anything it is 
not.
  Mr. GINGREY of Georgia. Thank you for sharing that with our 
colleagues in regard to the tele-town hall meeting and the poll that 
you conducted with your constituents in Tennessee. You referred to this 
next slide that I have got titled, and I want to point it out to my 
colleagues, ``What Americans Want.'' Just like Dr. Roe said, poll 
numbers, 73 percent of Americans think Congress should start over on 
health care reform, or if they can't start over and get it right, do 
nothing.
  I mean for goodness sakes, this business of when you are talking 
about health care and somebody comes along and says to you, ``Do 
something, even if it's wrong,'' think about that for a minute. Do 
something even if it's wrong? Regarding health care? Regarding an 
operation? Regarding a delivery of a child? No. Don't do something even 
if it's wrong. You better get it right. And if you can't get it right 
with what your plan is, drop the plan.
  Then going on the bottom half of this slide, Mr. Speaker, 56.4 
percent of people indicated they would prefer Congress to tackle health 
care reform on a step-by-step basis, not take the comprehensive 
approach as embodied in legislation that passed the House and Senate 
last year but is now stalled, thank God, for the past month.
  I want to yield to my colleague so he can further elaborate on this.
  Mr. ROE of Tennessee. Thank you for yielding.
  One of the things that is not mentioned in the President's letter 
that I am looking at here is that certainly people who are either pro-
choice or pro-life do not want, a vast majority do not want taxpayer 
dollars spent on federally funding abortions. The way the Senate bill 
is written, the way the House bill without the Stupak amendment, it 
does do that. The Stupak amendment in the House bill forbids that. The 
Senate bill does not. And nowhere in this language--why can't we just 
come out and say a vast majority of the people do not want that? And we 
should be able to come out and say that no Federal dollars will be used 
to fund abortions in this health care takeover. I think that is fairly 
simple.
  We saw how the Stupak amendment passed with an overwhelming majority 
in the House. It did not do so in the Senate. But I think that is 
fairly simple. We ought to be able to say that. The President ought to 
be able to say that right now, tomorrow. He should be able to come out 
and say just that.
  The second thing you brought up a moment ago were preexisting 
conditions. That is for you and I, where I would see it as a physician 
would be in a patient I diagnosed and would have a breast cancer and 
maybe lost her job or retired from teaching or whatever it may be, and 
then she is uninsurable. Well, that is unacceptable. That is absolutely 
unacceptable. I fought with that for 30 years in practice. Preexisting 
conditions are a problem in the individual market. The year I ran

[[Page 2215]]

for Congress, I was in the individual market. It was tough to find 
insurance. It is expensive, and most people can't afford it. And small 
businesses. Seventy percent of our jobs are from small businesses. So 
how do you create a situation where small businesses can afford this 
and become larger groups?

                              {time}  2030

  Well, I know it doesn't make sense, and I have never been able to 
understand why anybody would care if you sell insurance across the 
State line. I use the example of Bristol, Tennessee and Virginia. There 
is a city in my district where State Street has a line right down the 
middle of the street. On one side, you are in Virginia, and on one 
side, you are in Tennessee. One side you've got a different insurance 
policy than the other side of the street. That makes absolutely no 
sense. You don't get your homeowners that way, your life insurance. Car 
insurance you can buy across State lines. It makes no sense.
  I can see why the insurance industry wouldn't want you to do that 
because it creates competition. And then what you allow people to do 
once they can shop across State lines, because there are vast 
differences, you can get on the Internet and find out what a life 
insurance policy costs you anyplace in the country. You can evaluate 
whether the company is solid or not, and you know what you're buying. 
You can find out. It is transparent.
  We need transparency in insurance rates, and we need to allow small 
businesses to form groups. You can call them association health plans, 
group plans or whatever. But if you can spread those risks over 
thousands of people, then the preexisting condition goes away. And I 
can't imagine why anybody would object to that. That's not here in the 
President's plan. He's got this exchange that's government regulated 
instead of the free market regulation. I think that's a huge difference 
in the way we look at this. Do we want government regulating it? Yeah, 
you want some. We have antitrust laws. Absolutely you do. But we want 
the free market to work because it works much more efficiently, and 
that's two of the basic differences in these two----
  Mr. GINGREY of Georgia. Dr. Roe, if you will yield back to me for 
just a second, I want to continue on this point that you are making. I 
think what you just said, if I understand it correctly, Mr. Speaker--
what Dr. Roe just said is that if we would allow individuals to go 
online, they wouldn't have to get in their car. I wouldn't have to 
drive to Tennessee to apply, to sign up for a health insurance policy 
that's offered in Tennessee. From the comfort of your home, you do it 
over the Internet.
  And if we would simply allow that--and also, by the way, allow small 
employers that maybe employ 10 or 15 people to come together with 
others in what we refer to as an association--and very quickly, you 
could get to 1,000 or more and form an association, and that way you 
spread the risk. You have some people that have preexisting conditions. 
You have some people that have had a heart attack or already have high 
blood pressure or whatever. But if you spread it among 1,000 people, 
you have lots of healthy people in that association, so you are able to 
bring down the cost.
  And the same thing with individuals being able to buy across State 
lines because they're part of a--people all across the country in every 
one of the 50 States might be getting on that computer and buying a 
plan that's offered in the State of Tennessee or in the State of 
Georgia. And that way, as I understand what Dr. Roe is saying, Mr. 
Speaker, you wouldn't need these exchanges because that would be the 
exchange.
  And then to sort of complete the thought, you also--within every 
State, or you could come together on a regional basis if you wanted to 
with neighboring States. You could have these high-risk pools within 
the State so that individuals that do have these preexisting 
conditions, these insurance companies, health insurance companies that 
offer their products within a State, they would have to participate, 
and they would have to agree that, Hey, you take one high-risk patient; 
I will take a high-risk patient. You take another one; I will take 
another one. And do it in a fair and balanced way and not have the 
premiums be more than, say, 2, 2\1/2\ times the most standard rates. 
Then if they are low-income, but yet they don't qualify for Medicaid 
because they're not quite that low but they certainly can't afford the 
premium, then the State and the Federal Government can help with some 
subsidies. But not this business of $500 billion worth of subsidies. 
That's what's causing this bill to be so expensive. In fact, you know, 
you cut money out of Medicare, $500 billion out of Medicare, tax the 
American people $500 billion.
  So, Mr. Speaker, Dr. Roe is offering us--it's a Republican idea, 
yeah, but it ought to be bipartisan. And we talked about it at the 
Blair House last week. So we really don't need these exchanges, do we, 
Dr. Roe? And I will yield back to you.
  Mr. ROE of Tennessee. I can't imagine why anybody would mind if you 
bought your health insurance exactly like you buy any other insurance 
policy you want to. I don't know how you could possibly object to that. 
Let's take Realtors, for instance. Almost all realty shops are small 
businesses. In our community, 10 or 15 people would be a large realty 
store. There are over 500,000 Realtors in America. If they could come 
together as an association and buy their insurance through that 
exchange or through that association, I should say, preexisting 
conditions would go away. It's just not an issue if you've got 100,000, 
200,000 people.
  People talk about the FEHBP, the plan that the Federal Government 
has. That is the same thing. You have 9 million people in that plan. 
You share those risks, and you can then negotiate lower rates.
  Another thing I think that we need to talk about tonight are health 
savings accounts. I want to talk about that for just a minute because 
most people don't really understand it. You hear it's just for rich 
people and so on. That's a big argument you hear. Let me explain to 
people what a health savings account really is.
  You are given money, whatever the number is. The way we've done since 
World War II is that we've gotten our insurance and we pay a small 
copay or deductible, and it is 80 percent up to a certain point and 
then it's 100 percent after that. Well, that means at the end of the 
year, if you have been totally well, the insurance company keeps all 
your money. That's your money you are paying in, and you are getting 
some of that in lieu of a salary. What that HSA does is, let's say you 
put $3,000 or $5,000 in. I have had a health savings account, and we 
put $5,000 in that health savings account. If you got sick and used the 
$5,000, you would pay 100 percent after that. So that is my money I am 
dealing with. At the end of the year, if I have been healthy, I have 
had a healthy lifestyle, I don't smoke, I exercise, I eat well, take 
care of myself, I get to keep the money. I roll it over, and then next 
year I can use it. And after a number of years, you may have many 
thousands of dollars that you can use for long-term care.
  Now, again, the argument I hear is that only rich people do that. 
Well, let's look at my own office. We have 300 or so people that get 
insurance through our medical practice, and 84 percent use a health 
savings account. They manage their own health care dollars. They like 
it a lot because they then become negotiators for their health care 
costs. They come to my office, and they may negotiate a price for a 
visit. They may go to whatever procedure they may have. They may go to 
the hospital and say, I want your lowest price, and they can get that 
by negotiations, and that will bend the cost curve down. What 
continually makes the cost curve go up is that we're shielded from all 
the costs of the health care.
  Mr. GINGREY of Georgia. Dr. Roe, if you will yield back, and I think 
you make a good point. And I hear the same argument, Well, only people 
that are well-to-do, well-off, high-income people can afford to have a 
health savings account in combination, Mr. Speaker, with that low 
monthly premium and a high deductible that Dr.

[[Page 2216]]

Roe just explained so well. But I have seen statistics, and I think 
they're accurate, that 50 percent of people that have these high 
deductible, low monthly premium combined with a health savings account 
make less than $50,000 a year. And some 75 percent of them make less 
than $75,000 or $80,000 a year. So we're not talking about wealthy 
people. I think Dr. Roe makes a good point.
  By the way, Mr. Speaker, as I was reading in the Associated Press 
about what the President might include tomorrow, these four things I 
did ridicule a bit, this idea of combating waste, fraud, and abuse with 
fake patients. I have embellished or maybe overstated, but I wanted to 
make a point, Mr. Speaker. But as far as expansion of health savings 
accounts, I say to the President, Kudos, Mr. President. I am looking 
forward to hearing about that, and I hope that this report from the 
Associated Press is true.
  I also hope, Mr. President, that the report about expanding the 
medical liability reform is true, although I would guess that it 
doesn't go nearly far enough, because this report, if it's accurate, 
Mr. Speaker, says instead of $23 million worth of grants to States to 
enact pilot programs on alternative ways of dealing with medical 
liability issues, it increases that amount to $50 million. Well, that's 
not much, and that's not really, I don't think--and I think Dr. Roe 
would agree with me--going nearly far enough to do what we need to do 
in regard to caps on pain and suffering judgments, which sometimes can 
be in the millions of dollars in a frivolous case.
  And then a couple of other issues, Mr. Speaker, regarding medical 
liability reform. The defendant in a medical malpractice case could 
include somebody that was just covering--let's say as an example, Dr. 
Roe has a patient and asked Dr. Gingrey to step in and say hello to 
that patient on Sunday morning while Dr. Roe takes his family to 
church, and Dr. Roe is going to operate on that patient the next day. 
Dr. Gingrey just walks by and says hello to the patient and lets her 
know that Dr. Roe will be in later in the evening, and that's the only 
contact that Dr. Gingrey has with this particular patient. Well, if 
something, Mr. Speaker--and it's not likely that anything would go 
wrong under the care of a doctor like Dr. Roe, but sometimes things do, 
and that Dr. Gingrey who just really had essentially nothing to do with 
the patient's care would be drug into court. And if he or she had the 
deepest pockets and the most liability coverage, then they would be the 
ones that would be responsible for most of the judgment and settlement 
or whatever. So we need some robust reform. And I hope that the 
President, Mr. Speaker, is talking about that.
  I yield back to my friend to see what his thoughts are on that.
  Mr. ROE of Tennessee. I thank the gentleman for yielding. I will just 
point out the California experiment. They did caps on pain and 
suffering in 1976, and premiums across the country for malpractice have 
gone up over 1,000 percent during that time. In California, it was 
about 300 percent. So it's been a huge decrease. Texas was similar. 
They have had a 30 to 50 percent reduction in malpractice premiums. And 
doctors--especially high-risk doctors like yourself and myself--many 
counties in Texas now have an obstetrician which before they did not 
have. Over half the counties in the State of Tennessee do not have an 
OB/GYN doctor in the county. So it is an access inequality problem when 
you can't get to a doctor. And many of our physicians are leaving the 
practice, which is very worrisome, because you want your most 
experienced people staying with it.
  We have another problem, I think, with this plan. I do believe that 
from what I have heard in my own district, there is no question. I came 
out of church the week before Christmas, and one of my friends there 
said, Doc, he said to me, What's the Senate going to do with this 
health care bill? This is after the House had passed it, and it was 
about Christmas Eve when they were getting ready to vote. And I said, 
Well, I think that they're going to try to fix it. He grabbed me by my 
shirt, by my coat lapels, and he said, You fix your cat. You kill this 
bill. What he was saying was that this comprehensive, almost 
incomprehensible bill needed to be shelved, and we needed to start from 
scratch and go all over.
  I think last week was a start, but it was a year too late. You had so 
many people that had put their neck out and said this absolutely has to 
be in a bill when it didn't have to be. I can think of four or five 
things we ought to be able to agree on in a minute, and those would be 
selling across State lines. I think certainly forming association 
health plans, doing away with preexisting conditions. I think we all 
can agree on that. I think meaningful malpractice reform we can agree 
on. I think letting young people stay on their parents' health plan 
until age 27. I think just signing up people who currently are eligible 
for the current programs we already have. Those are five things right 
there that we ought to be able to agree on in a minute and we can do.
  Mr. GINGREY of Georgia. Dr. Roe, yielding back to me for a second, 
we've already talked about the health savings plans and expanding that 
and allowing people--if there still is an exchange, and you and I have 
talked about it, Mr. Speaker. Dr. Roe and I have talked about it, and I 
hope our colleagues understand this. We don't think that we have to 
have this exchange, this expensive exchange where you have to subsidize 
people's premiums. That's how the President was able to say last week, 
Mr. Speaker, that 47 percent of people in the exchange will be paying 
less than they currently are for their health insurance. Well, yeah, 
they are paying less out of their pockets, but they're reaching in 
everybody else's pockets--John Q. Taxpayer--to help them pay those 
premiums. So really when you do a little fact check on that, you find 
that most people under that plan are going to end up paying more.
  And what Dr. Roe is talking about in the four or five things he 
mentioned, of course, even if you had an exchange, you shouldn't say to 
people that the only kind of policy that they can buy is a first dollar 
coverage, the most expensive kind of policy, when young people, healthy 
people and people who are just out of college or just out of high 
school or just back from the military and they are trying to pay for a 
car, they're trying to rent an apartment or buy a little starter home, 
or buy an engagement ring for their fiancee, and the last thing they 
can afford is $15,000 a year for a first dollar coverage health 
insurance plan that they don't even need. So what's still in the bill, 
it prohibits a person from having one of these plans.
  Mr. ROE of Tennessee. Would the gentleman yield?
  Mr. GINGREY of Georgia. It's counterintuitive, isn't it, Dr. Roe?
  And I yield back to you.

                              {time}  2045

  Mr. ROE of Tennessee. One of the things that this plan does, it 
mandates a certain level of coverage. You have to purchase a certain 
level of coverage, and it is a fairly expensive piece of coverage. An 
example would be for fertility. I can assure you that in my family, we 
don't need that coverage. I should be able to purchase the coverage 
that I need. There are issues in there that I just don't need any more. 
For example, pregnancy coverage is something I don't need. I should be 
able to go buy, or a person should be able to go buy, just like when 
they buy the homeowner's policy that they need, that is what they 
purchase. You should be able to do the same thing for health insurance.
  That is one of the problems with mandates. Some States have as many 
as 60 State mandates that you have to have in an insurance policy to 
sell insurance in that State. One of the problems with it is if you are 
allowed to buy across State lines, you can go buy a policy that fits 
your needs and your family's needs. You make that decision; the 
government doesn't make it for you.
  Mr. GINGREY of Georgia. That is exactly right, Dr. Roe. I have a 
daughter who lives in the great State of New York. Her health insurance 
policy covers so much more than many of the

[[Page 2217]]

policies cover in the State of Georgia, for example. And it is much, 
much, more expensive as a result of that. So Dr. Roe makes a good point 
of buying across State lines.
  One thing before our time expires, Mr. Speaker, I want to just say 
again that hope springs eternal. I don't know what the President is 
going to say to us tomorrow, but I hope that I like what I hear because 
the American people need relief. But as we stand here tonight, what is 
still in these bills? Well, a government takeover, that is one thing. 
Price controls is another. Individual and employer mandates, and I 
don't know that it is really even constitutional to say to an 
individual in this country you, under the penalty of law, fines, and 
jail time, have to buy health insurance. We hope they do, and we hope 
we create the environment where we can bring down the price and people 
can afford--maybe it is a health savings account combined with a high 
deductible, low monthly premium, but to hold a gun to their head and 
say they have to do it, no, that is not right. That is not 
constitutional.
  In the bill, there is no meaningful medical liability reform. Again, 
hope springs eternal, but the bill puts Washington bureaucrats in 
charge of defining quality health care. That is where those 32 new 
bureaucracies do their work. It cuts $500 billion over all Medicare, 
but $120 billion of that is cut out of Medicare Advantage, and 20 
percent of our seniors get their care from Medicare Advantage. Why do 
they call it Advantage? Because it is an advantage. It covers wellness. 
It does screening, appropriate screening. It keeps people healthy so 
they are not spending all of that money in the last weeks or months of 
their life.
  Finally, this bill raises taxes to pay for new entitlement programs, 
and it gives the government-run plan a beachhead to eliminate the 
private insurance market. And, unfortunately, many of our colleagues, 
Mr. Speaker, have said it loud and clear, whether members of Energy and 
Commerce, or Ways and Means, or Education and Labor, that they want the 
government to take over, just like it exists in Great Britain or Canada 
or other countries. The American people don't want that. They want us 
to do something in an incremental way, and I think we can do it and do 
it in a bipartisan way.
  Mr. ROE of Tennessee. Just a very short comment. This weekend, Dr. 
Gingrey, Mr. Speaker, I had three friends, people I know, diagnosed 
with some very serious illnesses. It just happened. These three men 
that I know extremely well, all of them, are getting the highest 
quality care anywhere in the world, and they don't have to go far from 
home to get it. I think one of the things that the American health care 
system has brought to us are new innovations, lengthening of our life 
span, and the procedures that are done today to extend and improve the 
quality of life. I am glad to hear no longer, and I heard it for a 
year, and it was very bothersome and troublesome to me, to hear the 
other side talk about how bad health care was in America. We certainly 
have a problem getting health care at an affordable price to all of our 
citizens, there is no question that is true, but the care that everyone 
gets is good care.
  I can tell you that I have done it myself for people who couldn't 
pay. And I would stand here and hear people talk, and I am one of the 
few people on this House floor who had to get up and go to the 
emergency room at 3 in the morning and see a patient who doesn't have 
health insurance and try to work him through a system and get them 
care. It isn't easy. We can do better, and we sure can do better than 
this bill right here.
  Mr. GINGREY of Georgia. I thank Dr. Roe for being with me tonight, 
Mr. Speaker. There are 14 health care providers on the Republican side. 
Ten of them are M.D.s. There are five M.D.s on the Democratic side. We 
have two doctors in the Senate. We probably have 500 years in clinical 
experience in the aggregate. Let us help.
  In closing, I want to refer to my colleague who was here a number of 
years ago, Dr. Roy Rowland, a member of this body when the Democrats 
were in the majority. Back in the early 1990s, Dr. Rowland, a family 
practitioner from Dublin, Georgia, he had a bipartisan bill back then 
that he worked very closely on with his Democratic colleagues and his 
Republican colleagues, and he presented that bill. I think it was 
called the Bipartisan Health Reform Act of 1994, and he offered that in 
lieu of HillaryCare. Unfortunately, the Democratic majority didn't 
accept it. Don't make the same mistake this time, Mr. President. Let's 
do it in a bipartisan way and in a small, incremental way.

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