[Congressional Record (Bound Edition), Volume 156 (2010), Part 2]
[House]
[Pages 2387-2394]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          HEALTH CARE TAKEOVER

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Missouri (Mr. Akin) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. AKIN. Mr. Speaker, it is a pleasure to be able to join you, my 
colleagues, and those gathered in various places around the buildings 
here near the Capitol.
  I have had the opportunity, having served in government as a 
legislator for a number of years, to serve both in the majority, in the 
minority, but also in the wilderness. This last year and a half has 
been different; I have served in the wilderness because we have 
actually come up to the edge of the abyss with a piece of legislation 
that promises to be so threatening and so destructive to our country 
that should we decide to swallow this poison pill and pass this piece 
of legislation, America will never be the same.
  I have seen, in the majority and in the minority, pieces of 
legislation which are harmful and that may be poor solutions to some 
particular problem or solutions to a problem that doesn't exist or 
excuses just to have more taxes and more government control, but we 
have never quite seen a threat like the threat that confronts America 
today, and we, you and I, my friends, who love the red, white, and 
blue, are looking off the edge.
  I don't know if you have ever stood on the edge of the rim of the 
Grand Canyon and looked thousands of feet downward, or if you have ever 
been on the top of some high skyscraper or bridge and looked off into 
empty space, but that is where we stand tonight. That is where we stand 
this week or next week in America. We are standing looking into the 
abyss, into a piece of legislation which is quite possibly going to be 
passed. And if it is passed, it will leave our Nation very, very weak, 
much weaker and unlike anything that we have seen before.
  It threatens to do two major things: to destroy the quality of health 
care in America, and to destroy the fiscal integrity of our very 
country. I am talking, of course, about an old topic, a topic that has 
been debated now for more than half a year here in Congress. It has 
absorbed the attention of the Nation, and it is an interesting topic 
because the more that it has been around, it seems the more the public 
is aware of it, and the more they see of it, the more they don't like 
it. In fact, as you start to take the covers off the legislation on 
health care, it becomes a very ugly picture, and the American public is 
wise. In fact, the statistical information suggests that at least 20 
percent more Americans believe that we would be better not passing this 
piece of legislation and a great majority think we should just scrap it 
and start over again by systematically defining a problem and fixing it 
rather than having government take over all of health care.

                              {time}  1915

  Now, the process, the way that the legislature works historically has 
been so boring that none of the American public pay any attention to 
it, but that has changed since we have been in the days of looking into 
the abyss, the abyss of the destruction of health care and the 
destruction of our economy. And people are becoming conscious of how it 
is that bills are passed and how they become law.
  What would be required to have this health care bill passed would be 
a process that people call reconciliation. What that means essentially 
is that the bill would end-run or bypass a safety process in the U.S. 
Senate. The U.S. Senate has a very conservative way of operating, and 
that is that you can have a bill that you have 51 Senators who would 
vote for it--so it would pass if you had a chance to vote on it--but 
they put this extra caveat, that you have to have 60 Senators agree to 
bring it up for a vote. So in a sense, everything in the Senate 
requires a 60 percent approval before it goes to a final vote.
  Now, there is an exception to that, and that is because of the 
necessity of dealing with the budget and spending and taxing and some 
of those issues, that on certain financial kinds of transactions, 
because of the fact that we can't afford a gridlock, we allow a 50-vote 
majority to be able to move something along, and that's called 
reconciliation. But it is not a process that is typically used for a 
completely new bill on a very broad subject, which is not just 
specifically a financial kind of thing.
  We have this quote from our President on this subject of 
reconciliation, he says, ``Reconciliation is, therefore, the wrong 
place for policy changes.'' Now, wait a minute now, this is the 
President saying ``reconciliation is, therefore, the wrong place for 
policy changes. Isn't the health care bill a policy change? I guess it 
is. It's a whale of a big policy change.
  In short, the reconciliation process appears to have lost its proper 
meaning. A vehicle designed for deficit reduction and fiscal 
responsibility has been hijacked to facilitate reckless deficits and 
unsustainable debt. Well, I wish the President would pay attention to 
his own words. This is what he said, Reconciliation is not a place for 
policy changes, and yet the health care bill is a massive policy 
change. It will take over about one-sixth of the U.S. economy. The 
government will step in and effectively run one-sixth of the U.S. 
economy with all kinds of rules and regulations and bureaucracies. I 
guess that's a policy change, Mr. President.
  In short, the reconciliation process appears to have lost its proper 
meaning. Indeed, it does. A vehicle designed for deficit reduction and 
fiscal responsibility, that's what the reconciliation process was 
supposed to be about, and in fact it's going to be hijacked. It's been 
hijacked to facilitate what? To facilitate jamming down the throats of 
the American public a bill that America clearly does not want us to do. 
They want to take the reconciliation process as a mechanism to jump 
with all of America into the abyss.
  So I think it's interesting that after the votes, particularly the 
vote in Massachusetts where the Democrats do not have 60 votes in the 
Senate, they don't have one Republican that would support this bill, 
not one, for people who have served in the legislature, that is a huge 
warning sign. When you see a total party line vote on something, that 
means there's some problems.
  Usually in the legislative process, if it's been done properly, a lot 
of people

[[Page 2388]]

have a chance for input, people have a chance to improve and say this 
part seems to be a little radical, let's go back this way. Usually what 
you have is more of a mix of people. When you see something being 
jammed in a process that is not designed--that is, reconciliation--for 
this massive policy change, and you see not one Republican voting for 
it, that should be a warning sign for people everywhere, and it is a 
misuse of reconciliation.
  And so while the public is saying in poll after poll, survey after 
survey, phone call after phone call from our districts, stop this 
train, do not jump into the abyss, do not allow the Federal Government 
to take over one-sixth of the economy, and yet, what do we see? We see 
a tremendous determination to jam this bill through, whether the 
procedure fits or not. But it's my way or the highway, and we're going 
to do it because we know what's best for you.
  This is a very high-handed approach, and it is something that does 
not--never does and never will--produce a good consensus in America. It 
will be something that will divide America, create a tremendous amount 
of tension and pressure, end up with lousy health care, and a Federal 
budget that is even more out of control.
  Now, if you take a look down here, we have another quote from the 
Speaker of the House, Nancy Pelosi, and it says, ``This will take 
courage.'' In other words, for the Democrats to vote for this bill, it 
will take courage. What does that mean, it will take courage? Well, if 
it takes courage, it means somebody is going to be mad, somebody is not 
going to like it. And so you have to be courageous and stand up to 
somebody who doesn't want you to vote for this bill. Who do you think 
the ``somebody'' is? Is it the Republicans? The Republicans don't like 
it, but we have 80 votes less than the Democrats, so we can't say much 
of anything about it other than explaining why we don't like it. But 
our votes don't make the difference.
  Nancy Pelosi has a whole lot of extra votes. She could have 20 or 30 
people vote no and still pass this bill. So why does this take courage? 
Well, it takes courage because somebody doesn't want it, somebody very 
much doesn't want it, and they're going to be mad if it's jammed down 
the throats of the American people. Who is the somebody going to be? 
You got it, the American public.
  People are not going to like this bill. So if you vote for it, the 
point she's making is you're risking your seat because people are going 
to be mad. It's interesting when the leader is saying it's going to 
take courage. That says somebody doesn't like it.
  Now, are there some reasons why people don't like the bill? Well, 
first of all, this is a rough flowchart trying to describe what happens 
when the government takes over one-sixth of the U.S. economy. 
Obviously, there's a whole lot of things being done by private 
institutions which will be replaced with government institutions, and 
they've got to figure out how to replace it all. So no wonder it takes 
almost 3,000 pages of bill to try to put some sort of a scheme together 
for the government to be running the health care business.
  Now, on the surface of the whole situation with this bill, this is 
not an easy sell. As you know, this bill has been around for more than 
half a year--I guess it's three-quarters of a year. People don't like 
it very well. The President thinks it's a beautiful bill, but the more 
that people see it, the less they like it; they think it's an ugly 
bill.
  Well, let's just think about the logic of this, stand way back away 
from all the details of health care. We've got Medicare and Medicaid, 
both of those have to do with medicine. They are both very large 
Federal entitlements, Medicare, Medicaid. In fact, the great challenge 
to the American budget are three entitlements. People say earmarks is 
what it's all about. Earmarks are 1 percent. Earmarks are not the thing 
that's really a threat to the budget. The thing that's a threat to the 
budget are three entitlements: Social Security, Medicare, and Medicaid. 
Two of those have to do with health care--Medicare and Medicaid. And 
what's the problem with Medicare and Medicaid? Well, they're 
financially broken, and if they continue as they are right now without 
changing those laws, they will bankrupt our country.
  So we've got Medicare and Medicaid, government programs that are 
currently bankrupting our country. And so what are we trying to sell 
the American public? Oh, hey, we've got the government running Medicare 
and Medicaid, they're bankrupting our country, so let's take over all 
of health care with the government. There is something intuitively 
counterintuitive about that, isn't there? Why would you want the 
government to take over something that it's already messing up, that 
not working financially, that is in the process of bankrupting our 
country. If you can't do it in a smaller area of Medicare and Medicaid, 
why do you want to expand it to everybody?
  So this is kind of a hard sell for the President, and that's why it's 
taking a lot of courage and why this bill is not moving any too fast 
and why the public doesn't like it. But there are many, many other 
reasons. You can see the complexity here, and as you can imagine, when 
you start to look at the details, you find that it is full of a lot of 
little devils. One of the things that you find--and I think one of the 
little devils that is perhaps most noxious to a lot of American 
people--are the special deals. You see, when you have a piece of 
legislation that's going to take a lot of courage, you have to put some 
sugar in it to make people vote for it. And the sugar, of course, comes 
in the special deal form.
  So what you find in the legislation--to the best of our knowledge, 
because the idea about transparency and openness we have not seen, and 
so we don't actually see exactly what's in this bill in its final form, 
but you see what it was like in the House, we saw what it was like in 
the Senate. But we find that it has some of these special little 
things, that is, that it's going to take $500 billion out of Medicare, 
but is it taking $500 billion out of Medicare all the way across the 
country? No. In fact, in the State of Florida, it's not going to take 
any money out of Medicare Advantage at all. So it won't be coming out 
in Florida, but in the other States, they do take it out. Well, that 
was a special deal for somebody in Florida.
  Then we've got special deals for--I think it was called Louisiana 
Purchase II for Louisiana; special deals for Massachusetts that 
Medicare gets these special reimbursements there; going to build a 
hospital, as I recall, in New Jersey, but not in other places. So you 
have special deals. That's one of the things that makes this look ugly 
to the voters because you're not treating every State the same; you're 
making some States pay more and other ones don't, and you're making 
some special adjustments for various people.
  You find there are special adjustments for people who work in a labor 
union, but somebody who works the same kind of job in a company that's 
not in a union doesn't get the same break as if you are in a union. So 
again, this is one of those special deals. The American people in 
general see that and say that isn't fair, that isn't right, that isn't 
good legislation, that's special deals. We don't like special deals 
because they don't treat people equally before the law.
  Now, when you take a look at the complexity of this chart, what it 
suggests is that this is going to be expensive. Not only is it going to 
be expensive, if you've got a problem and you fall through the crack 
somewhere, you may never get over to getting any health care at all 
because it has got so much redtape and bureaucracy. And so the whole 
idea of this kind of a system working well and providing good quality 
service is a little bit hard to understand. And when you take a look at 
the failings of Medicare and Medicaid in terms of the projected way 
that they're going to take our country into bankruptcy, do you really 
want to expand all of health care into these categories? So there is a 
fiscal sanity kind of component.
  One of the ways to take a look at the bill and to ask some questions 
and to

[[Page 2389]]

get a sense of what's going on as to why this bill is unpopular as 
people study it and see more and more of it, these are some comparisons 
of what the health care proposal does. This is the old Democrat bill, 
this is the President's new online bill, and this would be the 
Republican alternative, or alternatives. So we have three different 
bills in comparison here, and a comparison based on a number of 
different criteria. I think it may be helpful to take a look at some of 
those.
  First of all, it says here that it imposes half a trillion in 
Medicare cuts. We talked about that just a minute ago. This bill is 
going to cut Medicare. You always heard the Democrats saying the 
Republicans are going to take your Medicare away. That didn't turn out 
to be true, we have not done that, but this bill does. This bill is 
going to cut $500 billion out of Medicare, and the answer to this of 
course is yes, the old Democrat bill did that. That's the yes. The 
President's new bill is going to do the same thing. So it's going to 
impose a half a trillion in Medicare cuts. The Republican alternative 
does not.

                              {time}  1930

  So this is one of those situations where people are a little 
uncomfortable. Medicare is having trouble financially, and doctors are 
not being reimbursed very much in Medicare, so they're starting to not 
accept new patients because they're not being reimbursed enough to make 
it worth their while to take patients. If that's a problem in Medicare, 
why are we going to pull half a trillion dollars out of it? That's one 
of the ways you can look at these bills. So there is a difference. The 
Republicans are not proposing that, but both the President's new online 
bill and the Democrats' bill do that.
  Then it also enacts job-killing tax hikes and government regulations, 
costing hundreds of billions of dollars. It's a $1 trillion bill, which 
is a conservative estimate. This bill is going to cost a lot more than 
$1 trillion. How do you pay for it? Guess what. By tax increases--
right?--and with cuts to Medicare. So the tax increases here are going 
to come from where? Well, a lot of them come from small businesses. 
When you tax small businesses a whole lot for their employees, guess 
what's going to happen? They're not going to be able to hire as many 
employees, so this bill then has the effect of causing unemployment.
  So, in our particular climate, with unemployment near 10 percent in 
America and with not a lot of sense of hope that that employment is 
going to turn around in a hurry because of very badly shaped policies 
by the Federal Government, particularly policies which hammer small 
business owners, to have this bill which is going to tax heavily small 
business owners and which is going to put tremendous new government 
regulations on them which will cost billions of dollars is not 
something, from an unemployment point of view, that is a very good 
idea.
  This is going to be done by the old Democrat bill and the President's 
new proposal. The Republican alternative, it won't surprise you, is not 
enthused about tax increases, and we don't know that that's the best 
way to be dealing with some of our problems in medicine.
  I am joined by a very good friend of mine, Congressman Bishop. I 
would very much appreciate his perspective as to what we are talking 
about.
  I've just been saying--and I don't think I am overdramatizing this--
that, to a degree, it's my sense that America is standing on the edge 
of an abyss, like looking over the Grand Canyon or something, and that, 
if we step off the edge and misuse this reconciliation process, we are 
going to damage our country in a way unlike anything that we have seen 
before.
  Please join me.
  Mr. BISHOP of Utah. I appreciate being able to join the gentleman 
from Missouri here, and I appreciate his efforts so far in explaining 
the differences in these particular bills.
  I want to echo that I agree with you that we are in a precarious 
situation. There are those who would tell us that the most important 
thing we could do right now is to pass something. A lot of bad pieces 
of legislation and policy changes have happened when we have simply 
passed something that was there. Our goal on this particular issue 
should be to pass the right type of reform, not just something. Until 
we get the right type of reform, we should never actually quit looking 
to form a way that is best in providing options and choices to the 
American people.
  I am assuming, when you started, that you talked about some of the 
four supposed, alleged, Republican proposals that were added today. You 
know, when I first saw that, I thought somebody was pulling my leg. It 
was a joke. I find it ludicrous and somewhat insulting to the American 
people that there are actually those who believe, if you take a $1 
trillion program which transfers power from the American people to 
bureaucrats in Washington, by adding more spending for a few studies 
and for a few small, little tweaks here and there, that that's actually 
better and that that's going to buy people's support.
  I think one of the things, maybe, we have done too long in both 
Houses of this Chamber, perhaps with both parties, is we've spoken too 
long about it. We've been giving speech after speech as if that's going 
to convince Americans to go along with this program. What we should do 
now is listen to the reasons Americans have complaints about the core 
program that is before us.
  I appreciate what you're doing up there. You're going through some of 
the core problems in this particular bill--that a few little add-ons, 
which cost even more money, are not going to sell this core problem 
issue.
  If I could say just one more thing--go ahead.
  Mr. AKIN. It sounds like what you're saying is that you can chrome-
plate a pig, but it's still a pig when you're done. Go ahead. Yes.
  Mr. BISHOP of Utah. I've actually been trying to think of a lot of 
metaphors here, and I don't think any of them really work terribly 
well.
  Except I do remember one time when my oldest kid was about 3 or 4. He 
had been given a candy bar and was supposed to participate in a 
program, and he didn't want to go up and join the other kids in the 
program. So I took his candy bar away. I said, If you go up there and 
perform, I'll give you a candy bar. Of course, he was dumb enough to 
accept that, and he waddled right up there and did the program, and I 
gave him his candy bar back.
  I hope that people don't think, just by giving me my candy bar back, 
I'm going to buy this program, because the program hasn't changed. It 
is still fundamentally flawed.
  A reporter just asked me, Don't you think these bills should have an 
up-down vote? Well, here in the House, everything is an up-down vote.
  Also, the bills that have been introduced by Representative Shadegg 
and by Representative Price have a different approach to solving the 
problem and to reforming our system, which is based on giving power to 
the people so that people can make choices. Representative Akin, I 
think they deserve an up-down vote in this body as well. Instead, they 
have been prohibited from even being discussed in committee or on the 
floor.
  Mr. AKIN. So, in other words, what's happening is you have other 
approaches to solving some of the problems of health care, not trying 
to have the government take it all over but, rather, to fix various 
component parts. We have a Rules Committee. If you want to offer a 
suggestion, for instance, they prohibit you from offering it as an 
amendment to get an up-or-down vote on it; is that correct?
  Mr. BISHOP of Utah. Yes. I would simply suggest to the leaders of our 
Congress and to the President, instead of saying, If you have ideas, 
give them to me, and I'll make a choice on whether they're good or not, 
put the ideas on the floor.
  Mr. AKIN. Well, that's the way the process has worked. Yes. Go ahead. 
Right.
  Mr. BISHOP of Utah. Put those ideas on the floor, and let all of 
those ideas be fully debated in front of the American people. Give an 
up-down vote on every idea that's out there. Just perhaps, just 
perhaps, we will find that

[[Page 2390]]

there is a needed reform to our health care system that actually meets 
the needs of the American people, that does not cost them out of 
existence, that does not cut jobs, and that does not move power away 
from the people back here to Washington. It allows people and their 
doctors to chart their own futures.
  I have said it a couple of times when I've talked to you on the floor 
here on this issue: the State of Utah launched last year a reform of 
the health care system based on Utah's unique demographics. We have the 
youngest State in the Nation. Our median age is younger. We also have 
probably more small businesses which don't provide insurance than in 
most States. We need something specifically for our need, and we have 
launched a program that is well designed with fundamentals. It still 
needs to be tweaked, and it still needs to be worked on, but it is 
based on our needs and on our demographics. If either the Senate or the 
House bill, these one-size-fits-all programs, were to pass in any form, 
it would totally destroy what the State is trying to accomplish.
  We are not the only ones with brilliance here. We are not the only 
ones who care about people. We should be partnering with States to come 
up with new and creative ideas to meet the individual needs of our 
people in their individual areas, and we flat out are not allowing that 
to take place.
  Mr. AKIN. We are basically muzzling a lot of the representative 
process.
  As you said, there have been different analogies. You talked about 
your son with a candy bar. Another one was the idea of a kitchen that 
has a broken sink. When you hire a plumber to fix the broken sink, you 
don't remodel the entire kitchen. Of course, that's the model that the 
Democrats have been using. It's the concept of, Ha, the sink is broken. 
Therefore, we can remodel the whole kitchen. They have the idea of 
remodeling the kitchen, and they've been wanting to do that for a very 
long time. The broken sink is now the excuse to remodel the whole 
kitchen.
  I think the point of the matter is that the American people would be 
more comfortable and the legislative process would work better if we 
were to say, ``Let's define a specific problem in the health care 
system.'' Instead of having the government take it all over, let's try 
to solve that one individual problem. I guess it depends on how you 
explain it or say it.
  If I were to ask, Gentleman, would you like the government to buy you 
a house, you might be tempted to say, Well, that sounds pretty good. 
Yet, if I were to ask, Would you like to live in government housing, 
you might think, I'm not so sure I want that. That may be a little bit 
of an analogy to explain what we've got here.
  The idea is to say, ``Hey, don't you want free health care?'' But the 
other way of looking at it is, Do you really want the government making 
health care decisions, or would you prefer that your doctor makes those 
decisions? So it depends how you say it, but the American public has 
gotten wise to this, and that's why you've got at least 20 percent more 
in the number of Americans who don't want this program.
  Mr. BISHOP of Utah. Well, I think the gentleman has also brought the 
other chart down here, which you probably used earlier, which is how 
the system would be structured. Now, when the first bill was presented 
by our good friends on the other side, that was the structure. I hate 
to say this. Over all the times we've just discussed it, that typical 
Washington approach of convoluted, complex patterns and about people 
making decisions hasn't changed at all. As we have come through and 
have supposedly come up with this new idea that has a few tweaks from 
the Republican side, there has been no compromise on the basic problem, 
which is that structure.
  Mr. AKIN. You know, I kind of like this chart because I think that 
some entrepreneur could make money with this chart. If you were to just 
shrink it down a little smaller and add some additional lines, you 
could start over here. These are the consumers. These are the people 
who are sick. The medical professionals are over there. You could sell 
it to restaurants as a placemat and give people crayons, and customers 
could try and draw and see if they could get through the maze to get 
over to the health care professionals, because that's a little bit how 
this looks.
  Now, maybe that sounds like a silly thing to say; but, gentleman, 
you're in the business in your office--among other parts of the work 
that we do as Congressmen, we get phone calls from our constituents. 
Our constituents want us to help them solve problems that they're 
having with the Federal Government. I'm thinking, if this system gets 
put in, I'm going to have I don't know how many thousands of people 
every day on my phone, saying, ``I need this kind of medical care, and 
I can't get through this system''. They're going to ask me to help them 
do it. I'm going to say, ``Fat chance. This is a mess.''
  Mr. BISHOP of Utah. I think you're absolutely right, and I think 
that's one of the reasons a lot of people have changed their opinions. 
A lot of people have grave concerns about this type of a program, a 
one-size-fits-all, Washington-based program.
  I've also had some other people calling me, a lot of people with 
grave concerns and with a great deal of anger over everything that's 
going on. There are some who have simply asked, ``Why can't you just 
sit down and compromise? Why can't you work things out?'' I think I 
join with you in saying I am more than happy to sit down and work with 
anybody who will work with me.
  The bottom line is we have not been allowed to work together, which 
is why I was saying earlier to let those other ideas, the other bills, 
have an up-down vote as well. Bring them to the floor and allow a true 
debate on all ideas. Don't siphon the ideas down to what is allowable 
by the leaders of Congress. Allow us to actually work together. As I 
think you intimated, there are some things, certain provisions, on 
which both Republicans and Democrats do agree. Let them stand by 
themselves and see what we can actually accomplish without taking an 
idea on which we basically all agree and then adding 10 or 15 bad ideas 
on which we fundamentally disagree and saying, Okay, it's take it or 
leave it.
  Mr. AKIN. Well, you know, I hate to admit how many years I've served 
in the legislative body. I started by saying I've served in the 
majority, in the minority and now in the wilderness.
  As to most legislation I've seen that works pretty well, surprisingly 
enough, people are sold on it. There is a process of a bunch of people 
coming together, defining a problem, working on a solution. Frequently 
when they start, the bills are pretty rough, are pretty hard to 
understand, and have a lot of questions and problems in them; but as 
more and more people have a chance to work on them, to roll their 
sleeves up and have input in them, the bills get refined.
  In the business world, if you want to mess something up, you send it 
to a committee. In the political world, when committees work on 
legislation, they tend to refine the product. After a period of time, 
what happens is you have certain ideas that some people just can't 
tolerate, and you tend to throw the radical stuff out. What you can 
agree to comes together. When that happens and particularly when it 
happens across party lines, you don't have major fundamental reform, 
but you change, and you fix things in ways that solve people's 
problems.
  What happened this year is we had 80 less seats than the Democrats, 
so they thought, We don't need the Republicans. The dickens with the 
Republicans. We've got such a majority that we can do whatever we want. 
As they've marched off to totally change all of health care, now 
they've gotten kind of in a jam because they're realizing the public is 
not agreeing with it, and they don't have one Republican vote. That's 
very, very unusual politically that there is not at least one 
Republican who would vote for a bill.
  That says that this has been such a partisan kind of approach, and 
that's why there is cause to scrap it. It's not that people are going 
to go back to ground zero in health care, but they're

[[Page 2391]]

saying this approach right here is just too much.
  Mr. BISHOP of Utah. I would be very hesitant to try and ascribe any 
motives as to why things happened the way they did.
  What we do know is, historically, when major changes of policy have 
taken place, even when they have been hotly debated, even sometimes 
when cloture has been approached over in the Senate, the final product 
has had a lot of majority and minority votes coming together.

                              {time}  1945

  It was not this divisive of an issue that was trying to be pushed 
through in, once again, a very partisan and divisive way.
  I think you are right. What Republicans are saying is there are other 
ideas that still have to be out there, and what is more important for 
us is to do the system and do the reform the right way the first time. 
It is very difficult once something is established to go back and fix 
it. It is best to do it right the first time, and we are not doing that 
here.
  Mr. AKIN. You are right. The thing about legislation, because it 
affects so many people, it is so expensive and what you sometimes 
create can never be taken back, it is absolutely crucial that we get 
this thing right the first time. We would be far better off--I guess it 
is maybe a little bit like choosing a wife. You want to be sure you 
choose the right one the first time. It is less expensive that way.
  This is something you want to get it right the first time, and if 
there is doubt, if there are questions, then it says it is probably 
better to slow up and take a good look at what you are doing.
  Now, there are some things about the bill that are being proposed 
here that are just completely anathema to many, many Americans. I think 
if you have to say, well, what would some of those things be, I 
mentioned the special deals. People don't like that.
  But if you get to the heart of what is going on in health care, it is 
that relationship between you when you are sick and your doctor. We 
call it the doctor-patient relationship. I think that is fundamental to 
our understanding of what good health care has to start with, and that 
is that you have got qualified, professional doctors who work with 
somebody who is ill. The family and the doctor come together and they 
put together a solution as to what is going to happen and what the 
doctors can do to help you with your health.
  Now, one of the things that gets people very upset, and with good 
reason, is when somebody butts in to that doctor-patient relationship. 
One of the examples that we have seen too frequently is that we have 
allowed insurance companies sometimes to jump into that doctor-patient 
relationship, and they say, oh, we are not jumping into the doctor-
patient relationship; it is just that we are deciding what we will fund 
and what we won't fund. In other words, the doctor says you need to do 
X, Y, and Z, and the insurance company says, oh, you don't need to do 
that. So we don't like it when somebody who is not a medical 
professional starts to superintend over our health care and we don't 
have any control of it.
  What is even worse is that when the doctor makes a medical mistake, 
he is going to get sued, but when the insurance company says you don't 
need to do that and then you up and die and your relatives say, hey, 
the insurance companies just cost a life, well, it turns out they don't 
have any medical liability. That is not a good situation.
  But it is not the worst situation. Something worse could happen. It 
is this. This is what is worse. Instead of an insurance company, which, 
if you want to, if you have to, you can change your insurance company, 
this is going to put a government bureaucrat between you and your 
doctor, and that is something that I don't know a single Republican 
that likes that idea.
  We don't think we want government bureaucrats getting between you and 
your doctor. And how is that going to happen? Well, because the 
bureaucrats have got their calculators, and as they calculate, they 
say, how old are you? What are the statistical chances of this? Whoops, 
you don't get this care.
  So the bureaucrats say, we are not going to allow you to get this 
kind of health care. And the doctor says, no, I understand the 
statistics, but in this case this particular medical treatment is 
necessary. And the bureaucrat says, no, you can't get it. That is one 
of the reasons why in the United Kingdom health care death rates are 
much higher than they are in America, because of the fact that the 
bureaucrats say, no, you can't get any care.
  Mr. BISHOP of Utah. If I could get the gentleman to yield for just 
one second.
  Mr. AKIN. I do yield to my good friend from Utah.
  Mr. BISHOP of Utah. I think it is well to reemphasize that fact that 
not everyone will get what they want in this particular program. I was 
told that once again today, the President, in his remarks, said, if you 
like your plan, you keep your plan; if you like your doctor, you can 
keep your doctor.
  Now, if that line sounds familiar, it is because it was a staple in 
the rhetoric for all of last year, with a couple of problems. I have 
been told that media outlets like the Associated Press and ABC News 
debunked that claim, showing that that cacophony of programs and lines 
going through, that that simply was not the case. And the White House 
then said, well, we are not taking that line literally, and eventually 
it was removed.
  It is coming back now, but it still is not accurate. The problem is, 
if you like what you have, you may not end up keeping what you like. 
You may end up being told what to do, which is the problem every time 
when you try and transfer power from individuals back to Washington to 
tell us what is best for us. We sometimes may not agree. And that is 
the sad part.
  That is the fundamental problem that a few tweaks around the edges 
can't solve. But that is a significant problem. And I think the 
gentleman from Missouri hit the nail on the head when he said this is 
one of those fundamental issues, which is why this program should not 
be forced through, but you should back up and start again with 
something that doesn't have that premise of Washington being empowered 
to tell us how we will live our lives.
  There are 8,000 State legislators out there, all of whom are bright, 
all of whom can come up with programs for their States. Allow the 
States to be the laboratory of democracy that Louis Brandeis used to 
talk about. We can do better. We can do better. This is not good enough 
for us to force through, just so we can say we did something. There is 
a better approach to it.
  I yield back.
  Mr. AKIN. I couldn't agree with you more, and I do think that is a 
fundamental question. And when people talk about compromise, I would 
picture people on the outside of Congress saying, why can't those 
people just get together, solve a problem, bury their partisan hatchets 
and just serve the American public?
  Part of the reason why you don't see that is because there are really 
fundamental differences of opinion on what you do with health care, and 
one of the very, very big ones is that question: Is it going to be 
between you and your doctor or is it going to be between you and the 
Federal Government and some doctor that they choose? And that is a 
very, very big difference in opinions on health care, and this system 
forces the Federal Government between you and your doctor, and it is 
why it doesn't have any support, among other reasons, from Republicans.
  There are a couple of other things here we probably ought to talk 
about, because when we talk about health care being too expensive, one 
of the things that really increases the cost of health care has been 
attorneys, particularly trial attorneys who are going to sue doctors 
for having done the wrong thing.
  Now, there are times when doctors do the wrong thing. There are times 
when doctors do the wrong thing. They need to fix it and need to pay 
for some of the damages that their actions caused. But this is more 
than that. These are these

[[Page 2392]]

punitive lawsuits with millions of dollar claims. And what does that 
do? It adds a tremendous cost to the cost of health care. So, one of 
the ideas, if you want to reduce the cost of health care, is that you 
want to have what is called tort reform.
  We were promised in Baltimore by the President that certainly he 
believed in tort reform. But as we take a look at the legislation that 
we have got, one of the things that you find is that the supposed tort 
reform in this bill, the old Democrat bill, and I believe the 
President's new bill, although I am not sure this is in there, is the 
fact that the States that have enacted tort reform, such as my own 
State of Missouri, the States that have enacted tort reform, they 
cannot keep that tort reform in place when this medical bill goes in. 
So it gets rid of tort reform instead of making tort reform.
  Now, I said that costs a whole lot of money if you don't have tort 
reform, or tort reform is a good idea to reduce the cost of health 
care. In the State of Missouri, it has dropped the cost of health care 
significantly, I am talking in excess of 10 or so percent, States that 
have decent tort reform. It reduces the cost of medicine. So, that is a 
reform that Republicans wanted to do, and it is not included in the 
bill, which is the tort reform.
  I do yield.
  Mr. BISHOP of Utah. If I could maybe add to that, because I think you 
have hit on one of the things I think is essential if we are really 
going to reform the health care system, because we do have two 
problems. One is people being covered by insurance, but the second one 
is the overall cost of the system. If you don't address both of those 
problems, you haven't really done a good health reform.
  Mr. AKIN. The cost of the system, and what is the other?
  Mr. BISHOP of Utah. Coverage of individuals, being covered and having 
the costs overall. Because even if you have insurance, it still is very 
expensive, and the costs keep going up. So we have to deal with both of 
them.
  A key element, a crucial element that everyone within the medical 
community will tell you, is if we don't do cost reform dealing with 
tort issues, if we don't deal with the massive amount of litigation 
that forces doctors to do more and more procedures just so they are 
covered just in case someone decides to sue them, we will never 
actually get a handle on the costs of health care that keep going up.
  Once again, the President has said in past speeches he is willing to 
look at that. But in one of the four proposals he seemed to add as a 
sweetener to this deal, it was not to actually have malpractice 
resolutions, but simply to study alternative malpractice resolutions.
  Now, that ain't it. A study, we have been doing that for a long time. 
We know what the problem is.
  Mr. AKIN. It seems to me the study has already occurred. Various 
States have done it, tried it, and it saved a lot of money. What more 
do we need to study on it?
  Mr. BISHOP of Utah. So adding that as something to improve the system 
doesn't improve the system at all. It is nothing. What we need to do is 
actually implement those. And you are right. Once again, even my home 
State, the legislature once again is addressing on a State issue that 
concept of tort reform and litigation limitations. It is essential, and 
we need to do that.
  That is one of the issues on which I think both parties could easily 
come together and make a resolution, if we were allowed to discuss real 
litigation reform. But, once again, that is not on the table. That is 
not discussable on the floor, if ``discussable'' is a word, which it 
probably isn't.
  Mr. AKIN. Well, but it is something that needs to be dealt with. If 
we just kind of run through that, I think people can understand. You 
are a doctor. You have somebody who is ill, and you think, well, I am 
pretty sure this is what is wrong with them, but it could be five other 
things, so I am going to run all these tests, some of them are very 
expensive tests, just in case, no matter what, so if anything goes 
wrong, anybody gets me in a courtroom, I can say I did absolutely 
everything that anybody could do, and a whole lot more besides.
  Well, of course, that costs a whole lot more money, and they are 
doing it strictly to cover their tails because they don't want to be 
sued and have millions and millions of dollars thrown against them and 
run their cost of insurance up.
  Now, if their insurance goes up and up and up, guess how they have to 
pay for that insurance? By charging the patients more money. So that is 
how this tort reform can save in various States. We don't have to study 
it. It saved a whole lot of money in a great number of States.
  So those are some things that I think are important. I talked a 
little bit about reconciliation, the misuse of that process. I had a 
good quotation here from a prominent Senator. A prominent Senator was 
looking at reconciliation. That is the process the Democrats are 
talking about doing. And this prominent Senator, you have got it, it is 
the President, says, ``Reconciliation is, therefore, the wrong place 
for policy changes.''
  I think the government taking over one-sixth of the U.S. economy 
would probably qualify as a policy change.
  He says, in short, the reconciliation process appears to have lost 
its proper meaning, a vehicle designed for deficit reduction and fiscal 
responsibility. This doesn't seem like deficit reduction and fiscal 
responsibility. It seems like it is a policy change.
  We have to agree with the President that this is not the place for 
reconciliation. And yet, guess what? In spite of the fact that 
Massachusetts has even voted on this, we are going to jam this bill 
through, whether you want it or not, using this process, the misuse of 
this process called reconciliation, which most people have never heard 
of before, but it is by hook and by crook and not by a legitimate 
method.
  Here it benefits trial attorneys, by failing to enact meaningful 
lawsuit reform. That is that tort reform. The old Democrat bill does 
not put it in; the new one does not. The Republican believes, yes, we 
should have tort reform.
  Here is another one. Protects backroom deals with Washington special 
interests. There have been a lot of special deals in these particular 
bills. I think the one that I find most offensive was an agreement made 
with insurance companies that said if an insurance company makes a 
decision that overrides the doctor-patient relationship--that is, they 
say, yeah, we recognize the doctor-patient relationship; we are just 
not going to pay for it--if they do that and something goes wrong, the 
insurance company cannot be sued. So the doctor gets sued for 
everything. But if the insurance company that is not a medical 
authority makes a decision, the decision turns out to be bad, yes, the 
doctor said your wife should go to the hospital but we said we are not 
going to cover it, she doesn't really need to go to the hospital, and 
then she gets really, really sick because she should have been in the 
hospital, guess what happens? The insurance company has no liability 
whatsoever. So that is one of the backroom deals that is particularly 
upsetting.
  The other one we talked about puts the government bureaucrats in 
charge of personal health care decisions. The Democrat bills are doing 
that. That is why Republicans--this isn't a matter of, hey, can't you 
just be a little open minded? No, I can't be open minded. I don't want 
the government involved in health care decisions with my body.

                              {time}  2000

  The Republican proposals don't do that. We're joined--I don't know 
whether he wants to join us yet or not--by a good friend of mine from 
Texas. No, he's not quite ready. Will you talk to us in a few minutes? 
We'd like to have you as part of our discussion. But you're going to do 
another hour.
  Here's one. This is: Breaks President Obama's pledge to not raise 
taxes on those who make less than $250,000. I recall in the campaign he 
said, I'm not going to tax anybody who makes less than $250,000. And I 
thought, Man, am I glad about that, because I don't make

[[Page 2393]]

$250,000. I'm going to skate free for 5 years. No taxes. It's not going 
to be a big deal.
  Well, the trouble was the House passed a bill not so long ago that 
was going to get you. If you flipped the light switch, you were going 
to get taxed. That doesn't have anything to do with $250,000. This bill 
is going to tax a whole lot of people making less than $250,000. Yes, 
it does. And the old Democrat bill, the President's new bill, yes, it 
is taxing people under $250,000 very heavily. In fact, it mandates that 
you have to buy a government product, which is unconstitutional. The 
Republican bill doesn't do that.
  My good friend from Utah.
  Mr. BISHOP of Utah. If I could add just one element to that concept 
of $250,000, because I agree with you, if $250,000 was a salaried 
employee, that's pretty good money. The only problem is, in all of 
these equations it applies to the business world as well, in which 
almost every small businessman is grossing at least $250,000. I know in 
my district--once again, I said Utah has more small businesses on 
average than most States do. And in my district, almost 98 percent of 
those, according to the IRS, will have a bottom line that's above 
$250,000. So it means the taxes that are imposed are also imposed to 
the business community. It's one of the reasons why the State of Utah, 
when they looked at a reform for health care in the State of Utah, 
tried to come up with a policy that would give a consistent number to 
small business so they knew how to plan for what the health care cost 
would be and can come up with a defined contribution level they could 
give their employees, who could then go to the exchange and buy 
something that fits into what they need. But that consistency is 
extremely important.
  It's very difficult for small business to provide health care for 
their employees when they don't know what the escalating and 
skyrocketing, almost roller coaster costs, will be to them. They cannot 
plan for that so they basically don't do it at all. And if indeed we 
add a tax to them at this stage of the game, that means we are making 
it even harder for the business community to recover, to provide jobs, 
to grow our economy, and to get people working again. That's why when 
we say this thing hurts job performance, that's why it hurts job 
performance. It can be devastating to job creation.
  Mr. AKIN. I really appreciate your highlighting this question of 
unemployment because I really think that a whole lot of Americans would 
think we were more effective and that they would have more respect for 
Congress if we were dealing with the fact that we've got a 10-plus 
percent unemployment rate out there. And in fact that number is 
probably conservative because of the fact that if you haven't had a job 
in a year, you're no longer part of the statistic. So as people get 
more and more discouraged, don't get a job, they fall off those 
numbers, and we still have a 10 percent unemployment rate.
  So I think a lot of the public would say, Hey, why don't you guys pay 
attention to unemployment. Well, here's a way to pay attention to 
unemployment. We've got a bill here that, on the face of it, economists 
have rated it's going to cost 5 million jobs. Why in the world would 
this proposal cost 5 million jobs? Well, you just hit it. But do it 
again, gentleman, so people can make that connection.
  You have got to understand, this is going to increase unemployment in 
America. Is that what the public wants, more unemployment? I don't 
think so. But please run through that again. You're a small businessman 
and this bill passes, and what does that mean?
  Mr. BISHOP of Utah. That means there will be an extended cost of 
doing business associated with this particular plan. Even though when 
we say anyone making over $250,000 will not be taxed, it will be taxed. 
Once again, if that was simply a salaried employee--a salaried 
employee--that sounds pretty good. But that covers almost all the 
businesses we have who are small in this country, and large as well.
  Once again, it does go to the point we tried to make a little bit 
earlier. The Shadegg bill, the Price bill, the other Republicans' bills 
that should have been allowed to be debated, they don't have any of 
those provisions. So that negative anti-job aspect that is definitely a 
part of this bill if it's pushed through does not necessarily have to 
be there if you simply allowed the other ideas to be debated, discussed 
openly here on the floor.
  Mr. AKIN. Right. So we don't have to create unemployment and deal 
with health care. It's just that this approach is going to create 
unemployment. Now let's take a look at how that works. There's a number 
of ways that unemployment is going to be driven. The first is you're 
going to tax the guy that owns the business. When you tax somebody that 
owns a business, it means he's got to give money to Washington, D.C. 
That means he can't take that same money and put it back in his 
business to add a wing to the business, to buy a new machine tool to 
create a new process to create more jobs, because instead of taking the 
money to build the small business, you're taking it to give to the 
government to run health care. So when you take money away from the 
owner of a small business, you're going to kill the job creation 
process.
  What else does it do? Well, it creates a lot of redtape for business 
owners. And when you create redtape, that also makes it so that it's 
harder for them to be efficient and competitive. And so that tends to 
hurt job creation. You also, because this bill has been sitting around 
and been hanging, scaring everybody to death for three quarters of a 
year, it creates a sense of tension and a restlessness, so that 
business owners are saying, I don't know what the business climate is 
going to look like in 6 months. I don't dare take a risk because I see 
threats on the horizon to the financial stability of my company.
  Mr. BISHOP of Utah. The gentleman from Missouri also has those last 
two points on your chart, which reemphasizes the very statements that 
you were just making.
  Mr. AKIN. It forces individuals to purchase government-approved 
health insurance. Let's talk about that for a minute. Yeah, the old 
Democrat plan forced you, it forces everybody in America to buy 
something. And the President's new version forces you to buy something. 
The Republican does not force you to. And aside from the fact that 
Americans don't like to be told that you have to buy something, there's 
a small detail: It's not constitutional. When can the government tell 
you that you have to go out and buy a gun or you have to go buy a 
watermelon or something? That's not constitutional for the government 
to tell you you have to buy something. Yet, that's what's going on 
here.
  Mr. BISHOP of Utah. At times we have talked in the past about this 
concept of constitutionality in two ways. One, that it violates the 
concepts of federalism. But the second one deals with specifically the 
commerce clause. I think that's been brought to our attention before. 
That even in court cases, and maybe somebody will correct me here when 
it's his turn, in court cases there are usually two principles that are 
involved on whether the commerce clause is justifiably used. One: Does 
it have an impact on interstate commerce? I think everybody admits this 
would have an impact on interstate commerce. But the second is: Is 
there a willing participant in this program? This is why this is 
different, because for the first time you are threatening to fine 
people, throw them in jail, for not doing anything. For doing nothing. 
I don't know how many negatives I put in those sentences. But for 
someone just living their life who does not want to participate, they 
will now be fined for doing that. The government has never done that. 
And that is what I think exacerbates and expands the commerce clause 
beyond recognition and beyond fairness to individuals at the same time.
  Mr. AKIN. Well, I think we have had a chance to take a look tonight 
at what I started out by saying that we are standing as Americans on 
the edge of an abyss. I recall standing on the rim of the Grand Canyon 
and seeing a thousand feet of open space in front of

[[Page 2394]]

me. And in a sense, that's where we stand today, with America perhaps 
politically poised to push forward using a misuse of a process to force 
this government takeover of health care down the throats of many, many 
Americans who do not want to see this take place.
  This is a very serious moment in American history. I can recall 
historically there's been other very, very serious moments in American 
history. The Pilgrims standing on the frozen shore of Plymouth with the 
dream of creating a new kind of civilization; our President-to-be, 
President George Washington, on his knees at Valley Forge, praying for 
his little army. And even old skeptic Ben Franklin at the 
Constitutional Convention asking for prayer each day.
  In all of these cases, Americans discovered that in their hour of 
need they turned to God for his help and his guidance. I believe as we 
stand on the abyss tonight, for those Americans who are wont to turn to 
God for answers, that this is a time to be doing that. To ask for his 
help supernaturally so that we don't make this fatal step pushing our 
Nation into socialized medicine, creating a precedent for our citizens 
to be continually handcuffed to a government health care in a system 
which no politician that's freely elected could ever reverse because 
the public would say, You're going to take my government health care 
away. I won't elect you. That's been the experience of other countries. 
It completely changes the nature of the freedom and the nature of the 
quality of health care in America if we'd fall off this abyss. And it's 
time for some prayers.
  God bless you all. Thank you. And good night.

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