[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[House]
[Pages 3169-3176]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Arizona (Mr. Shadegg) is recognized 
for 60 minutes.
  Mr. SHADEGG. I thank the Speaker.
  I would like to begin an hour where I hope to discuss with my 
colleagues and with the American people the extraordinary situation we 
face with respect to health care reform here in the United States 
House. I believe most people across America know that we have been 
debating health care reform for almost a year now--actually, quite 
frankly, a little over a year now. And I think most Americans agree 
with me and probably with almost everybody who comes to this floor that 
our health care system needs to be reformed.
  I have been a passionate advocate for health care reform since I was 
elected in 1994. I believe I have written more health care reform 
proposals and introduced them in this Congress than perhaps any other 
Member who began serving in 1995 or thereafter. I began working on 
patients' bill of rights legislation, and have moved onto comprehensive 
reform legislation because I think our system can be much better than 
it currently is.
  Indeed, if you look at it, the President is absolutely right that the 
cost of health care is going up dramatically faster than the cost of 
all of the other goods and services we buy in our society. And the 
President is right that that increase in cost is not sustainable over 
time. We have got to rein in this spiking cost of health care, the 
spike in the cost of health insurance premiums. Unfortunately, I don't 
believe the President is right about the manner in which he wants to go 
about it. I believe we are being confronted with an effort now to cram 
through this House, as early perhaps as next week, legislation which is 
proposed to reform health care in America, but will not do that. 
Certainly it will not rein in costs.
  I want to reiterate I am a supporter of health care reform. I not 
only think we need to take steps to rein in the cost of health care, I 
believe we need to address other problems, such as preexisting 
conditions. I happen to have an older sister who is a breast cancer 
survivor, thankfully. She is now almost a 20-year breast cancer 
survivor. And she at certain points in her career, because of her 
breast cancer, could have been placed into a situation where she would 
have been denied care or denied coverage by a health insurance company 
because she had a preexisting condition of breast cancer. But there are 
lots of ideas out there to deal with the problem of preexisting 
conditions rather than the heavy-handed edict or mandate which is in 
the President's legislation.
  I am joined right now by one of my colleagues, Dr. Roe from 
Tennessee, and I would like to conduct this particular hour in an 
informal fashion where each of us talk about issues within the health 
care bill that is going to be before us as early as next week and kind 
of banter those back and forth and try to make this interesting for the 
people of America to look at what we are being confronted with to 
confront the issue of is this a better bill to pass than so-called 
``doing nothing.'' And I think the answer to that is fairly clear. I 
believe this bill would be disastrous.
  Let me begin by yielding some time to my colleague, Mr. Roe, and let 
him give you some of his thoughts on what we confront at this point.
  Mr. ROE of Tennessee. Thank you very much, Mr. Shadegg. I appreciate 
the opportunity to be here on the House floor, Mr. Speaker.
  When I was elected to Congress, I had a 31-year medical career, and 
was coming to the tail end of that. I had been an obstetrician/
gynecologist and surgeon. And I had seen various changes from the late 
1960s, when I was in medical school, until now. I had seen absolutely 
incredible changes in the way we deliver health care and what we can do 
for our patients.
  Just a brief example. When I graduated from medical school in 1970, 
there were about five high blood pressure medicines, five 
antihypertensives. And three of them made you sicker almost than high 
blood pressure. Today, 40 years later, there are probably 50 or more, 
and with relatively minor side effects. And patients now have the 
opportunity with high blood pressure, with diabetes, with heart 
disease--we have just seen recently former Vice President Dick Cheney 
and former President Clinton get state-of-the-art health care.
  The question is, how can we get this health care to the majority of 
our people and not bankrupt the country? Because it is not the quality 
of care we are talking about, whether it is heart disease or cancer or 
any other cadre of diseases that we are talking about.
  In the mid eighties we started seeing a shift in the way we discussed 
and delivered health care. What fee-for-service health care is, is that 
you as a patient come to me, and I see you, and I give you a bill when 
you leave, and you pay the bill. That is fee-for-service health care. 
We saw that that was creating a situation where there was 
overconsumption of the services, we didn't have enough money in the 
system to provide that, so a new system of, quotes, ``managed care'' 
came along where insurance companies said, look, we can manage this 
care and we can do this by limiting the number of visits and very 
specifically saying what we are going to pay for in this particular 
health care contract that you have. That is your insurance plan. And 
there were various methods out there to do this.
  In Tennessee, we saw costs rising ever so slowly, but rising faster 
than our inflation was. We tried to control these in our State Medicaid 
program called TennCare. We got a waiver from HHS, the Health and Human 
Services here in Washington, to try an experiment with managed care. We 
had about seven or eight different plans that were going to compete for 
your health insurance business.
  What happened to us was that it was a very generous plan, as this 
plan is as we will discuss later, John, in this hour. When you mandate 
what is in a particular plan and you provide more health care in it 
than someone needs to

[[Page 3170]]

consume, it costs a lot of money. What our plan did in Tennessee, it 
was first dollar coverage, all prescription drugs paid for, so the 
patient had no cost in this. They had no so-called ``skin in the 
game.''
  In 1993 when we instituted this plan, the State spent about $2.6 
billion on health care for the entire State. Ten years later we were 
spending $8 billion. Every new dollar that the State brought in, we 
spent on health care. There was no money in our State for schools, for 
new construction in colleges, and so on, new capital, other things that 
the State does; roads. We had to rein those in. And our Democratic 
Governor did that. The way we did that wasn't a very good way. It was 
basically we rationed care by cutting people off the rolls.
  Today in the State of Tennessee, and the other unknown about these 
Federal plans, is they never pay for the cost of the care. In 
Tennessee, the State TennCare plan paid about 60 percent of the cost of 
actually providing the care. So the more people you got on that plan, 
the more costs that were shifted to private insurers, forcing those 
plans to charge higher premium benefits. So we shifted the costs with a 
hidden tax over from the government plan to the private sector, forcing 
costs to be passed onto businesses, and businesses much like I had.
  Today what we are doing in Tennessee is that in this particular year 
right now, our State legislature is in the process of looking at our 
State health insurance plan. They have cut the cost down to about $7 
billion. And how did they do that? Well, they simply just disenroll 
people. And what the plan is paying for this year are only eight doctor 
visits. In the State of Tennessee, if you have that type plan, you can 
only come to a physician eight times that the State will pay for. And 
they will only pay for a total of $10,000, no matter what your hospital 
bill is. That means that cost is being shifted.
  John, in our State this year, the hospitals are going to have a bed 
tax. They will pass a tax on again to other paying patients to be able 
to make the Medicaid match that they have right here in the State. So 
an expansion that the Senate bill currently has of Medicaid will be 
disastrous for the State of Tennessee. We cannot pay for the plan we 
have.
  Mr. SHADEGG. If I can jump in, let me just talk about an update with 
the experience of the State of Arizona. I happen to have here a letter 
dated yesterday from the Governor of Arizona. And she explains, 
Governor Janice Brewer of the State of Arizona, my Governor, explains 
that our State is already taking a deep financial hit as a result of 
the economy. We have had a loss of State revenues in excess of 30 
percent. This letter is from the Governor to the President of the 
United States. And I just think some of the points the letter makes 
reiterate what you have just said, Doctor, and I think they are 
important for the people of America to understand.
  She writes, ``As the Governor of a State that is bleeding red ink,'' 
this is a direct quote, ``I am imploring our congressional delegation 
to vote against your proposal to expand government health care and to 
help vote it down. The reason for my position is simple: we cannot 
afford it.'' She said, based on our own experience with government 
health care expansion, we doubt the rest of America can afford it. She 
then goes on to lay out the extra burdens that that legislation will 
place unfairly, in her view, on the State of Arizona.
  She says, ``Unfortunately, your proposal to further expand government 
health care does not fix the problem we face in Arizona. In fact, it 
makes our situation much worse, exacerbating our State's fiscal woes by 
billions of dollars.'' And she cites a series of points. One, it makes 
Arizonans pay twice to fund other States' expansions. She writes, 
``Your proposal continues the inequities established in the Senate 
health bill''--by the way, that is the very bill we are being asked to 
pass verbatim without changing so much as a comma, because we can't 
change a comma--``with regard to early expansion States. It is clear it 
will not fully cover the costs we,'' the State of Arizona, ``will 
experience as a result of the mandated expansion. Therefore, Arizona 
taxpayers will have the misfortune to pay twice: once for our program 
and once more for the higher match for other States.'' She then says, 
``It makes States responsible for financing national health care.''
  I won't read the entire paragraph, but she says, ``For 28 years, 
Arizona and the Federal Government have been partners in administering 
the Medicaid program. However,'' she writes, ``under your proposal, 
more power is centralized in Washington, D.C., and the States become 
just another financing mechanism.'' Now, that might not be bad, but she 
points out, ``Not only will States be forced to pay for this massive 
new entitlement program, but our ability,'' Arizona's ability, ``to 
control the costs of our existing program will be limited.'' She then 
says it creates a massive new entitlement program which our country 
cannot afford. And her letter says, Your proposal creates a program 
that does not have the resources and our country does not have the 
resources to support.
  I think the point is made that it is great to have good intentions, 
but it is important to be able to pay for these programs. And this is 
simply one Governor of I think many Governors who are deeply concerned 
that what we are doing is expanding the health care entitlement on the 
backs of States already in deep financial trouble.
  Mr. ROE of Tennessee. Our State Governor, who is a Democrat, has said 
that this is the mother of all unfunded mandates. And let me give you 
an example of what has happened in our State. We are now being asked, 
if this bill were to pass as is, to have a massive expansion of 
government-run health care. It would cost the State $1.5 billion. In 
our State, we have 50 less State troopers than we had 30 years ago, and 
we have 2 million more people. We are not doing a single new capital 
project on the campus of a university this year in our State because we 
cannot afford it. So it is a matter of not do you do health care 
reform, it is a matter of can you afford this.
  And when I have heard the President say that premiums will go down, 
well, I beg to differ. If you look at the Tennessee experience, I can 
assure you if you extrapolate our experience with what they are 
proposing nationwide, I did the math this morning on the way into the 
office, it will be exactly twice what they are saying. And if you look 
at the estimates that the government has done on health care plans, let 
me just run through a couple of those for you. When Medicare came on 
board in 1965, it was a $3 billion program. The government estimated, 
the CBO didn't occur until 1974, but the government estimate in 1965 
was that by 1990, Medicare would be a $15 billion program. It was a $90 
billion program. And today it is a $500 billion program in 2010. That 
particular plan, Medicare, will go upside down, there will be less 
revenue coming in than going out in 6 or 7 years depending on current 
estimates.

                              {time}  1515

  What we are proposing in this, and our senior citizens get this, is 
that one of the proposals in this plan is to take out $500 billion. 
Here is a news flash. Next year the baby boomers, which are a large 
number of people, hit Medicare age. That is 2011. They will begin at 
the rate of several million, tens of millions in the next 10 years, to 
be in a plan that is now underfunded by $500 billion.
  One of the things that the Senate plan does have, which I totally 
agree with, is that we should have been doing this instead of, are the 
fraud and abuse. There is no question that anywhere there is fraud and 
abuse in the Medicare plan, we should be going after it. I couldn't 
agree more.
  Also, in this plan, the new taxes that are in the plan over the next 
10 years which equal about $500 billion, this is the absolute worst 
time on the planet Earth to have new taxes when the economy is still 
reeling from the worst recession since the 1930s. To increase taxes on 
business, whether it is device makers, or whatever it may be, is 
absolutely the wrong time.
  Mr. SHADEGG. I think it is important to understand the burden that 
this legislation does place on our economy

[[Page 3171]]

at a time when we ought to be focused on jobs.
  I know when I go home on the weekends, I encounter many of my 
constituents. I get to see them at the Safeway or the Home Depot. I 
have to tell you, quite frankly, and I don't understand why the 
President and the majority don't get this message, but they do not come 
up to me and say: Congressman, when are you going to fix health care? 
I'm deeply worried about it.
  What they come up to me and say is: Congressman, what are you doing 
about this economy? I need a job. My son just graduated from college, 
and he can't get a job.
  That is where they are.
  But one of the issues I want to focus on in this hour goes to how we 
propose to pass this legislation because I think it shows that we are 
not a functioning institution and are not doing what the people want, 
and that they have reason to be, quite frankly, very upset with us.
  Speaker Pelosi, when she ran and captured the majority in 2006, said 
she was going to have the cleanest, most ethical Congress in history. 
You can debate that issue.
  I personally believe it has been the least procedurally open Congress 
I have ever seen. But I at least hoped that she would fulfill the 
promise Republicans had made of no special deals. And when President 
Obama campaigned and said he was going to bring America change we could 
believe in, and he was, for example, going to negotiate this bill on C-
SPAN, I had hoped that, well, maybe you might not attain that goal but 
that at least there would be fewer backroom deals. But it is absolutely 
stunning to me, and I think it ought to be stunning to every Member of 
this body, and stunning to every American, that not only have we not 
cleaned the process up, but we have seen in the year that we have 
debated this bill, the most outrageous examples of backroom deals in 
the composition or construction of this bill ever in at least the 
history that I have been here since 1995.
  It is important to understand that every one of those backroom deals, 
every one of those special deals cut with Members of the United States 
Senate and put into the Senate-passed bill, will have to be voted upon 
as a part in the bill that passes the U.S. House.
  We are now being asked to vote for, my colleagues on the Democrat 
side, are being asked to vote for a bill that contains the Corn Husker 
Kickback and that contains the Louisiana Purchase, that contains a 
special provision for a Connecticut hospital. Let me just document 
those because I think it is important to understand.
  The latest trick is somehow we are going to avoid that because the 
majority is going to simply pass a rule deeming the Senate bill passed. 
If that is not a charade to trick the American people, I don't know 
what is. But I will tell you this, these provisions are in that bill: 
number one, the Louisiana Purchase. According to The Washington Post on 
November 22, 2009, their headline, ``Sweeteners For the South.'' The 
bill in section 2006 provides a special adjustment of $300 million to 
aid or to provide for the State Medicaid program, and the only State 
that would qualify, the State of Louisiana. It sounds like a sweetheart 
deal to me. It sounds like a backroom deal that the American people 
thought wasn't going to happen any more.
  Second, according to Politico, December 20, 2009, ``Health bill money 
for hospitals sought by Dodd.'' Section 10502 of the bill, this is the 
bill we will vote upon or we will deem passed, so you can go on the 
Internet and look at it, go and look at section 10502, provides $100 
million for the University of Connecticut Hospital. I don't know about 
you, Dr. Roe, but I didn't get $100 million for a hospital in the State 
of Arizona in this bill.
  Item number 3, Politico, February 3, 2010, headline, ``Democrats 
protect backroom deals.'' This one is pretty interesting. It appears 
that Vermont, represented by Senator Bernie Sanders, John Kerry 
representing Massachusetts, were able to find in the bill, or put into 
the bill in section 10201, $1.1 billion for the States of Vermont and 
Massachusetts for their Medicaid program.
  Now I have had my staff go over the bill and I am looking for 
Arizona's $1.1 billion. Or, since those two States split it, it turns 
out to be $600 million for Vermont and $500 million for Massachusetts. 
I looked around to see if I could find $500 million or $600 million for 
Arizona, but it is not there. But every Member of this body, I think as 
early as next week, or maybe the week after, is going to get to vote on 
that special deal. They can't change a word of it. So if your 
congressman says oh, no, I'm not voting for that, that is wrong because 
it will be in the bill.
  I have many more of these to go over.
  Mr. ROE of Tennessee. Let me just point out that when you pointed out 
Louisiana, Nebraska, Massachusetts, Vermont, and Connecticut, all of 
these special deals, what that is saying is that those Representatives 
and Senators from there realize that this is a bad idea if it is going 
to cost the State money.
  Mr. SHADEGG. Wait, wait. So you are suggesting that they find the 
bill a bad idea, so they had to find a special deal, or a sweetener, to 
get their vote? Shocking.
  Mr. ROE of Tennessee. It is shocking. And the people from the outside 
who look at it, the people from Nebraska and Louisiana are fair people. 
I have heard the governors say this. They will pay their own way. They 
didn't ask to be cut into a special deal, and that is exactly what this 
is.
  What we are looking at in Tennessee is that what this special deal 
will cost us in Tennessee is a billion and a half more dollars, in 
addition to what we are doing now, of dollars we do not have. Neither 
does the State of Arizona, and most of the other states.
  It doesn't mean that we can't do something for health care, but this 
is not the right way to do it.
  Another thing, in Tennessee we have a law called the sunshine law. I 
as a mayor--that was my last political job before I got here--could not 
discuss with other members outside a public meeting, totally 
transparent, any city business. So the camera was on or it was an open 
meeting. Every single thing we did. Was it cumbersome and hard to do? 
Yes. But guess what didn't happen? This kind of nonsense didn't happen.
  I woke up on December 24 when the Senate voted on this, and I knew 
what was in there, and I told my wife, I said I worked very hard to 
gain my reputation throughout the years as physician, and I was very 
proud to be a Member of the U.S. Congress. It made me ashamed to be 
part of an organization that would cut a backroom deal like this.
  Mr. SHADEGG. I think you make a fascinating point. Clearly, the 
American people get it. They believe the health care system delivers 
quality care, but a lot of people are left out. Indeed, many of my 
friends in Arizona point out, way too many people are left out. The 
uninsured are left out. Many of the uninsured are people who are just 
not lucky enough to get employer-provided care.
  One of the moral outrages I find in America's political system is 
that we say if you work for a big employer, let's say you work for 
General Motors or you work for in my State Intel or Motorola. You get 
employer-provided health care. You know what that is? It is tax free. 
But if you own a lawn service or a small corner garage and you don't 
get employer-provided health care, and your employees don't get 
employer-provided health care, they have to go out and buy health care 
on their own. That might be okay. I actually think it is better when 
you buy your own policy, but here is what the Federal Government does 
to those people. They say we want you, the guy who works for the lawn 
service or the guy who works for the corner garage that can't provide 
employer-provided health care, we want you to go out and buy health 
care, and we want it so much that we are going to make you buy it with 
after-tax dollars. That is to say that we are going to charge you at 
least a third more.
  I want to make the point that we can fix that inequity and let every 
American buy health care tax free, just like their employers can, but 
this bill doesn't do it.

[[Page 3172]]


  Mr. ROE of Tennessee. You are describing me. When I worked for myself 
in a group of physicians, we had 70 physicians and 350 employees. I 
retired to run for Congress, and I am on my own. So that year that I 
ran, whatever my tax bracket was, my health insurance cost me that much 
more money, because as an individual I couldn't deduct my health 
insurance premiums. But a large company could do that. And my business 
could do that. I have experienced that very thing.
  Mr. SHADEGG. If that bill solved that one thing, if it just said to 
the average American who doesn't get employer-provided insurance, we 
will let you buy it tax free, like the people who get it from their 
employer, we would solve a huge amount of the problem of uninsured 
Americans who can't get care. But it doesn't do that. Let's talk about 
what it does do, because I only went through some of them. Let's talk 
about how this is the cleanest, most ethical Congress in history, and 
how we have change you can believe in.
  Well, here are some of the things you can believe in. The bill has $1 
billion, according to The Wall Street Journal in an article published 
on October 15, called ``States of Personal Privilege.'' This article 
says that there is $1 billion in the bill to assist New Jersey's 
biotech companies, and they get that subsidy, put in there, according 
to the article, by Senator Bob Menendez, Democrat from New Jersey. 
Apparently he didn't think it was a particularly good bill, not good 
enough until he got $1 billion in there for drug company research, at 
least according to The Wall Street Journal, one more special deal.
  But wait, there is more. Let's look at an article in The Wall Street 
Journal, same article, October 15, 2009, ``States Of Personal 
Privilege.'' It points out that Massachusetts--one of their United 
States Senators is John Kerry--or Michigan--one of their Senators is 
Debbie Stabenow--get, and these guys are not pikers, they get $5 
billion, with a ``b,'' $5 billion in a, I would suggest, a special 
deal, backroom deal, certainly a deal I didn't get, for union members 
that happen to live in Michigan and Massachusetts. You know, I guess it 
is a good deal if you can get it. You suggest maybe that persuaded them 
to support this bill that we now get to vote for, and I assume my 
Democrat colleagues are going to say, Look, we want all that stuff 
stripped out of the bill. The President says he is going to strip some 
out. But, quite frankly, I don't think that he is talking about 
stripping out many of these. They won't be stripped out from the bill 
we vote upon.
  Mr. ROE of Tennessee. You can't change. If you dot an ``i'' or cross 
a ``t,'' that is not the same bill, so they can't strip it out.
  Mr. SHADEGG. I presume that makes those Senators who got these deals 
into the bill that aren't going to be stripped very happy.
  Mr. ROE of Tennessee. I would think so.
  I think the thing that bothers the American people, the fairest 
people in the world, as long as we are all treated the same--we have 
fought for that equality. And we expect equality in health care. We are 
trying to provide the same high quality health care for all of our 
citizens, but this is not the way to do it. I am telling you, this is a 
prescription for rationed care over time. I have seen it happen in my 
own State. The people understand it. They get it.
  A couple of things that I would like to talk about. The financing of 
this bill, it is really a shell game. You've got 10 years of taxes to 
pay for about six-plus years of care which, when you stretch out over 
$1 trillion dollars, $100 billion a year, really you are putting that 
$1 trillion in 6 years worth of spending.
  The other thing that this bill doesn't do, there is a little thing 
called the sustainable growth rate for physicians.

                              {time}  1530

  Right now, doctors are expected to have, in the next month, if we 
don't kick the can down the road again, a 21-percent cut in their 
Medicare payments. If that happens, and I have talked to my own doctor, 
colleagues around the country, three things are going to happen.
  Number one, you are going to decrease access because the physicians 
can't afford to see those patients. Remember another government 
program, Medicare, doesn't pay for the total cost of the care; it pays 
about 80 to 90 percent of the cost.
  Number two, when you do that, you will decrease access and quality.
  And, number three, you're going to increase the cost to our seniors, 
who cannot afford it.
  So I think that's a thing that people get. This doctor fix, which is 
left out, is about a $250 billion or $260 billion additional cost to 
health care. And how you can take physician payments of Medicare out of 
the health care bill and say you're reforming it is beyond me.
  I yield back.
  Mr. SHADEGG. Pretty stunning when you discover that, for example, 
lots of people can't find a doctor that will take them as a Medicare 
patient. And even more so, unfortunately America's poorest, who do get 
Medicaid, a program that some would advocate expanding, cannot find a 
doctor who will treat them under Medicaid because the reimbursement 
rates are so low.
  You know, we're mixing a discussion here of kind of the things that 
are procedurally wrong with the bill because they must pass, here in 
the House, the Senate bill exactly as it passed the Senate. We're 
talking about the special deals that are in that bill.
  But I think we ought to also be talking about this whole notion about 
do Republicans have any ideas. What is it that we would do? I've 
already talked about one. I said, look, if you fix the Tax Code so that 
every single American could buy health insurance tax free, just like 
those who get it from their employer, you would go, instantaneously, 
just with that one fix, toward solving I think the single biggest 
inequity in American Society. We say to the lucky, who work for big 
employers, you get tax-free health care. We say to the unlucky, you 
don't; you've got to buy it with after-tax dollars. But that isn't 
fixed in this bill.
  But let's talk about another, since Republicans don't have any 
ideas--I'm saying that facetiously--let's talk about another Republican 
idea. I mentioned in my introductory remarks that I have an older 
sister who is a breast cancer survivor. Fortunately, she has now 
survived breast cancer for more than 20 years. That has focused my 
attention on the issue of preexisting conditions. I don't know a single 
Republican bill that does not solve the problem of preexisting 
conditions.
  Now, let me see if I understand this: the Democrats want to solve the 
problem of preexisting conditions; Republicans want to solve the 
problem of preexisting conditions. I know of nobody on that side of the 
aisle who says, yup, you ought to be able to be denied care because you 
once had and survived cancer or heart disease. I don't know anybody on 
this side of the aisle who says you ought to be able to be denied care 
because you once had cancer or heart disease. We all agree it's a 
problem that needs to be solved.
  Indeed, back in 2006, this Congress, when there was a Republican 
majority, passed legislation to deal with preexisting conditions and 
the Senate adopted it. It passed the House by a voice vote, it passed 
the Senate by unanimous consent, and it was signed into law by the 
President. Nobody remembers it. I happen to remember it because I wrote 
it. But let's talk about what it would do because, unfortunately, my 
colleagues on the other side of the aisle and President Obama and 
Secretary Sebelius apparently don't understand it. Let me explain how 
it works.
  This is legislation that would create high-risk pools. The bill 
offered money to every State in the Nation to create a State-based 
high-risk pool, do the administrative work of creating that pool, and 
then it offered additional money to help pay for the pool. Now, the 
average American out there listening might not know how a high-risk 
pool works. Well, here is how a high-risk pool works:
  If you live in the State of Tennessee and they created a State-based 
high-

[[Page 3173]]

risk pool, or the State of Arizona, my home State, and you are denied 
coverage like my older sister because you had breast cancer or denied 
coverage because you had, say, heart bypass surgery, you would have a 
right to go to the State-based high-risk pool, you would have the right 
to buy insurance, you could not be denied coverage, and you could not 
be charged more than, we'll say, 110 or 120 percent of what they would 
charge someone that didn't have that preexisting condition. Now, that 
would mean that everyone with a preexisting condition could join the 
high-risk pool.
  Now, here's how a high-risk pool works: the people in the high-risk 
pool do not pay the cost of its care because naturally if there is a 
cap on their premiums of 110 or 120 percent of the cost of a healthy 
person, they wouldn't have enough money to pay. So the extra cost for 
those people who are admittedly high risk, admittedly sick, is borne 
either by all of the taxpayers in the State through a tax subsidy, or 
by all the people in the State who purchase insurance because it is a 
levy on all the insurance companies in the State.
  There is also risk readjustment that's been proposed. But all of 
these are concepts whereby the healthy in a given State help pay for 
the care of the sick. Now, here's what I'm stunned by: at the White 
House summit on health care, the President described State high-risk 
pools, or high-risk pools, and he said, oh, those don't work very well 
because you just put all the sick people in them and over time their 
premiums go up. Secretary Sebelius said, no, high-risk pools don't work 
because you put the sick in them and you give them no help with their 
premiums.
  I've got news for the President and news for Secretary Sebelius: no 
high-risk pool in America works the way the President described it, 
one. No high-risk pool in America works the way Secretary Sebelius 
described it. In point of fact, they don't work by putting the sick 
people in and expecting the premiums paid by the sick people to take 
care of their care. They are put in the high-risk pool so that healthy 
people can be assessed a fee to help care for the extra care and 
services needed by the sick. And in point of fact, they work quite 
well.
  We could and should expand them dramatically, and the costs are 
spread amongst the healthy. Now, why do people agree to that? Well, 
it's very obvious. It's because you and I don't know that tomorrow we 
won't be the one with breast cancer or the one with heart disease and 
need to be in the high-risk pool ourselves.
  So we are supposedly having an educated debate where the Secretary of 
Health and Human Services and the President, who sponsored the summit, 
don't even understand how a high-risk pool works. That's an idea that 
Republicans have put on the table. I guess if Democrats are going to 
say we don't have ideas, it's because they don't understand our ideas.
  Does Tennessee have a high-risk pool, and is that how they work?
  Mr. ROE of Tennessee. We do have a high-risk pool, and that is how 
they work.
  And just so people understand, a preexisting condition is a problem 
in the individual. If you're an individual like I was 2 years ago out 
trying to buy insurance, or, number two, in the small business pool, if 
you have 10 employees or 12 employees, it's very difficult. If one 
person has an illness, it just runs your cost up so high you can't 
afford it. So how do you make small groups or individuals large groups?
  One of the things that Congressman Shadegg has brought up makes 
absolute sense to me--I cannot understand why anybody but an insurance 
company wouldn't want you to do it--to remove the State line. What you 
do, you can buy car, your life, your home, everything else across the 
State line except health insurance. Well, if I'm Blue Cross Blue Shield 
in Alabama and I've got 84 percent of the market there, I don't want 
that to happen, but I bet the consumers in Alabama or Tennessee, or 
wherever it may be, would like that. Allow us, as consumers, to go on 
the Internet, look and purchase across the State line and form pools 
which make small groups large groups and preexisting conditions go 
away.
  I yield back.
  Mr. SHADEGG. As I understand it, we first talked about a Republican 
idea of saying let everyone buy health insurance tax free. Republican 
idea. That would take care of the little guy who's paying an outrageous 
after-tax price for his health care. One Republican solution not in 
this bill.
  We've talked about high-risk pools so that people who have a 
preexisting condition--and they may have diabetes or something very 
expensive to treat--they can get help from those who are healthy in the 
State; they actually get a subsidy. Second Republican idea not in this 
bill. The President says it's in, but it's in as a temporary measure 
and taken right back out. Now you're talking about a third Republican 
idea, which is that we allow people in the individual market to buy 
health insurance across State lines, increase their competition.
  It sounds to me like there are ideas coming from our side of the 
aisle. I guess I would like to know, why don't we, rather than doing 
one big massive bill some 2,000 pages long that according to what I've 
read at least 56 percent of Americans don't want, that at least 78 
percent of Americans believe will cause the cost of government to go up 
and cause the cost of their premiums to go up, why don't we just pass 
individual bills, one, to allow people to buy health insurance tax 
free; two, one to allow people to join either a State or a national 
high-risk pool; three, a bill that will allow people to buy health 
insurance in the individual market across State lines and enjoy the 
competition of not having to pick from just Blue Cross Blue Shield of 
Alabama, but be able to pick from Blue Cross Blue Shield across the 
country or 20 other companies. Couldn't we do that on a piece-by-piece 
basis, do one bill and then the other bill and then the other bill?
  Mr. ROE of Tennessee. We absolutely could. As we say, you don't eat 
an elephant in one bite; you take a bite at a time.
  Mr. SHADEGG. I don't think I could eat an elephant in one bite.
  Mr. ROE of Tennessee. I tried last night.
  The other thing that I would like to bring up while we're talking 
about it is how you affect cost, because we started this hour talking 
about health care cost. And without meaningful tort reform, liability 
reform, you will never bend the cost curve.
  Let me give you an example. Years ago, when I was a resident in my 
training and after I got out of the Army and came back, we didn't make 
a lot of money as a resident so we would moonlight, work in emergency 
rooms. If you came into the emergency room and let's say you had some 
right-side, right-lower quadrant pain, I would examine you, get your 
vital signs, get a very simple, inexpensive blood test, a CBC. Let's 
say it was 10,000, a little bit elevated, your temperature is 99.2, a 
little bit elevated. I don't think you have appendicitis. And I say, 
well, why don't you come back in 8 or 12 hours and we'll reevaluate 
you. That was a very inexpensive visit.
  Today, if that person comes into an emergency room, you're not going 
to leave until you glow in the dark, I can tell you, because you're 
going to get a CT scan, ultrasounds, and every other thing in the 
world. It's going to be a $1,500 or $2,000 visit. And, John, I will 
guarantee you most of those are negative.
  The reason that the doctor orders them is that there is no reason I 
shouldn't do that because if that appendicitis patient does happen to 
get out there, you can just write the check with the zeros and the 
commas. I can tell you when you get sued, the cost of that is enormous 
in this country. And who pays for that? We all do. Every consumer of 
health care pays for that.
  Mr. SHADEGG. Just to interrupt for one quick second. That's what we 
call defensive medicine, which means a doctor defending himself in 
advance or practicing defensive medicine because he is afraid he's 
going to get sued and has to be able to respond to that suit.
  Mr. ROE of Tennessee. Exactly. And you hear us being compared to 
Canada

[[Page 3174]]

and England and so forth. They have tort reform. They don't practice 
defensive medicine there. As a matter of fact, there is a lot of 
medicine that doesn't get practiced there at all because of cost, but 
they don't because you can't sue the government. The VA has that 
system; you can't sue a doctor in the VA. That's another area where 
tort reform has worked.
  The reason that it needs to be done is that no one has argued not to 
compensate an injured person. Someone who has actually sustained an 
injury with actual damages, absolutely that should be done. In our 
State of Tennessee, since 1975, when we formed the State Volunteer 
Mutual Insurance Company, over half the premiums paid in by physicians 
into that company have gone to attorneys, not to the injured party. 
Less than 40 cents on the dollar have actually gone to people who have 
been hurt and about 10 to 12 cents on the dollar has gone to run the 
company and put back reserves.
  We need a system where we can actually help people who have been 
damaged. And the cost of this, I can tell you right now, I have a 
friend of mine in my local community, a great family practitioner, 25 
years, got his first lawsuit on a 19-year-old woman who had a very rare 
situation that occurred. There was no malpractice involved, just a very 
rare condition. His first year after that, his referrals to doctors, to 
specialists went up 500 percent and his ordering tests went up 300 
percent. And that happens all over the country.
  Mr. SHADEGG. It is clear that tort reform should be a part of this 
legislation, but of course it is not.
  I have tried to outline here, I told you that I had many, many kinds 
of special deals, backroom deals, behind the scenes deals--``change you 
can believe in'' if you will--that I wanted to go through during this 
hour. I think we've been through five of them so far.
  You just mentioned Blue Cross Blue Shield. It turns out that Blue 
Cross Blue Shield does pretty well in this legislation because section 
10905, if you want to look at it, of the Senate bill, the bill we will 
vote on here on the floor next week or the week after, without changing 
a comma has a special deal in it that exempts Blue Cross Blue Shield, 
but only Blue Cross Blue Shield of two States. It turns out it exempts 
Blue Cross Blue Shield of Nebraska and Blue Cross Blue Shield of 
Michigan from having to pay a particular fee that will be imposed on 
all other insurance companies.
  Interestingly, Senator Ben Nelson represents Nebraska; Senator Debbie 
Stabenow represents Michigan. And, again, the source of this story, 
another news story, Boston Globe, December 22, 2009, title of the 
article, ``Concessions Lawmakers Won in the Health Care Bill.'' These 
Senators won a lot of concessions. Blue Cross Blue Shield of, I guess, 
Nebraska and Michigan are happy.
  Let's talk about the next one. It turns out that, according to the 
New York Times--so we've got lots of sources, we've got the Wall Street 
Journal, we've got the Boston Globe, we've got Politico, we've got the 
New York Times--this one is the New York Times, December 20, 2009, 
``Deep in Health Bill,'' is the title of the article. Very specific 
beneficiaries. It turns out that coal miners in Libby, Montana, in 
section 10323, get several billion dollars' worth of free coverage as a 
result of, according to the article, Senator Max Baucus of Montana.

                              {time}  1545

  Yet I thought maybe that is a part of the change we can believe in 
when only powerful Senators are able to get the deals and not powerful 
House Members.
  The third one that I thought I'd bring up in this particular segment 
goes back to Florida. I think this has actually been called the ``Gator 
Aid.''
  Then this particular one appeared in an ABC News blog on February 22 
of this year, 2010, which reads, ``White House Cuts Special Help for 
Nebraska, but Other Deals Remain in Reform Bill.'' It points out the 
provision that Senator Bill Nelson was able to negotiate in not cutting 
Medicare Advantage in Florida.
  Now, mind you, Medicare Advantage is very important to the elderly. 
In Arizona, in my State, which is a big retirement State, I have lots 
of constituents on Medicare Advantage. If I could have cut this deal, 
you know, maybe I wouldn't have been complaining, but that's not the 
way the system works. I wasn't a Senator, and I didn't get to cut this 
deal, but Ben Nelson did. It says that the Medicare Advantage cuts that 
will occur in Tennessee or in Arizona won't occur in Florida, courtesy 
of Senator Ben Nelson.
  So I guess we have the most ethical and the change we can believe in 
except when we don't have the most ethical and the change we can 
believe in.
  Mr. ROE of Tennessee. I think one of the things I have fought against 
for many, many years is that of the abuse of insurance companies. They 
don't get off free here. In one of the last cases I did in practice 
before I came to Congress, I spent as much time on the telephone 
getting a case approved as I did doing the case, which was a major 
surgical case. So there needs to be some meaningful insurance reform.
  How do you do that?
  Well, what also isn't in this bill works extremely well because I 
have used one myself, and 80-something percent of my 300 employees who 
get health care through our practice use this. It's called a health 
savings account. What it does is it puts me, the consumer, in charge of 
first dollar. The insurance company is not in charge of it; I am in 
charge of it. The argument is that only the wealthy will use a health 
savings account. That is not true. This is how my health savings 
account works and how it works for my employees:
  The business puts $3,000 away, tax deductible, into a plan that is 
yours. You have a debit card--and I have one right here in my pocket--
so, when I go and purchase health care, I buy it on the first dollar. 
The people I'm buying it from don't have to wait 2 seconds to get paid, 
so I want the lowest price. The one I used had a $5,000 deductible. I 
take good care of myself, and I've been fortunate. After 2 years, I had 
almost $8,000 left of my money. The insurance company didn't keep it as 
profit--I kept it--so I am incentivized to spend my health care dollars 
wisely.
  This is a very good way to bend down that cost curve when you put me, 
the consumer, in charge of my own health decisions.
  Mr. SHADEGG. You've touched on a hot button for me.
  I think the health insurance industry in America has cut a fat hog. I 
think, quite frankly, they have failed the American people.
  Mr. ROE of Tennessee. That sounds like a southern comment.
  Mr. SHADEGG. It does. I think they have failed to provide economic 
coverage to the American people. I think they have failed to hold down 
costs. I think that the health insurance industry is largely to blame 
for a system that wastes a ton of money; yet it's the government that 
puts them in that position, because it's the government that says that 
you and I can't buy first-dollar coverage just for ourselves without 
paying for it with after-tax dollars.
  In this bill, I think we ought to be making the American health 
insurance companies compete with each other, and they don't right now. 
I can hear now the howls and screams of the health insurance executives 
across the country, saying, Of course we compete with each other. What 
are you talking about? Wrong. Wrong. Wrong. They compete to get your 
employer to buy their products. They don't compete to get you to buy 
their products.
  I've got to tell you, in my life, I've worked for a number of 
different employers. I've never had an employer say to me, Look. I'll 
buy your suits for you because I know better what kind of suits you 
need than you do; or, I'll buy your car for you because I know better 
what kind of car you need than you do; or, I'll buy your home for you 
because I know better what kind of home you should live in than you do. 
I've never had any of them say, I'll buy your auto insurance for you 
because I know better than you do.
  With all of those other products, we allow individuals to pick the 
products. I pick out my own suits. I pick out my

[[Page 3175]]

own home. I pick out my own auto. I pick out my own auto insurance, my 
own homeowners' insurance, and my own life insurance.
  Interestingly, in each of those businesses, costs aren't going up as 
fast as they are in health care. They're going up at a slower rate. 
Now, why is that? Ah, could it be that those companies, the people who 
sell me suits, are competing with other people? Could it be that the 
people who sell me a house are competing with other builders? Let's 
just talk about one clear comparison.
  When you go home tonight, turn on the TV, Doctor. I guarantee that 
you will see advertisements for auto insurance by GEICO, by 
Progressive, by Allstate, by State Farm, by Farmers. There will be a 
slew of TV commercials on your TV tonight, and every single commercial 
will say the same thing, which is, Buy our auto insurance, and we will 
charge you less and will give you more. They're pounding each other's 
heads in with competition.
  As a matter of fact, when I was a kid growing up, there was a song 
called ``Breaking Up is Hard to Do.'' You've probably heard it. 
Allstate has an ad out right now. It uses that song ``Breaking Up is 
Hard to Do.'' Allstate says, Guess what? If you'll fire your auto 
insurance company and buy ours, you'll get a better deal, but since you 
probably don't want to fire your auto insurance company, Allstate will 
do it for you.
  Now, it's interesting. Here are these auto insurance companies that 
are pounding each other's heads, saying they can give you a better 
product for a lower price. How many ads like that do you think you'll 
see tonight by UnitedHealthcare or Blue Cross Blue Shield or Aetna, 
saying, Buy our health care product, and we'll give you our health care 
plan, and we'll give you lower health insurance costs and better health 
insurance coverage?
  I know the answer. I think you know the answer.
  You will not see a single ad from a health insurance company, saying, 
Buy our health insurance plan, and we will charge you less and give you 
more. Do you know why? Because they don't have to compete for our 
business.
  That's just dead wrong. If this bill does one thing, it ought to make 
those guys compete for our business. Instead, look at what this bill 
does:
  Stunningly, the White House says that the answer to solving health 
care problems in America is to force us to buy a health insurance plan 
from the guys who already are selling us lousy, expensive health 
insurance. It has got an individual mandate. It has got an employer 
mandate. They're saying, We're going to fix health care in America. 
We're going to make you buy that crummy product that the current health 
insurance companies are selling you.
  How is that going to work? So let's talk about who has cut a fat hog 
in this deal.
  The health insurance industry came into this, and they said, Here is 
what we want out of health insurance reform. We want no public plan, 
because that would be competition, and we don't want to compete with a 
public plan. Well, maybe they've got a point. They said, Well, we do 
want an individual mandate.
  Guess what they're going to get?
  The bill that the Senate passed, the bill we're going to vote on in 
this House, says there will be no public plan, but they're going to 
compel, at almost gunpoint, every American to buy a health insurance 
plan, approved by the Federal Government, from one of those same health 
insurance companies that are overcharging us now.
  The White House says they're fighting the health insurance industry? 
Get a grip.
  Mr. ROE of Tennessee. They're in bed with them.
  Mr. SHADEGG. They're in bed with them.
  Mr. ROE of Tennessee. Well, let's talk about a couple of solutions. 
We've talked about a lot of problems. If you did two things, you could 
cover almost two-thirds of what the Senate bill does and would not have 
one new program. Actually, one new bill would do it.
  Number one: Allow your adult-aged children when they're above 18 
years of age or when they've graduated from college--and I've had three 
who have had this problem. For their first jobs, they didn't have 
health insurance. Just let them stay on their parents' plans. That's in 
the House bill. Pick your number--26, 27, 28 years old. You would cover 
7 million young people by doing that.
  Number two: Adequately fund and simply sign up the people who are 
eligible for SCHIP, the State Children's Health Insurance plan, in 
Medicaid right now. You would cover 10 to 12 million people.
  In this way, you'd cover almost 20 million people without this 
massive, incomprehensible, 2,700-page bill with all the special deals 
in it.
  Mr. SHADEGG. But wait. But wait.
  Without a 2,700-page bill, you couldn't hide the Cornhusker Kickback. 
You couldn't hide the Gator Aid. You couldn't hide the Louisiana 
Purchase. I haven't even gotten to all of them yet, but go ahead.
  Mr. ROE of Tennessee. You can talk about one page, and you're talking 
about 18, 19, or 20 million people.
  Mr. SHADEGG. There you go.
  Mr. ROE of Tennessee. So what could you do very briefly and very 
simply?
  Number one: Increase competition. You have to do away with State 
lines and allow competition to occur across State lines.
  Mr. SHADEGG. Wait. Can I stop you right there?
  Mr. ROE of Tennessee. Yes.
  Mr. SHADEGG. I was the first guy to introduce a bill to allow cross-
State-line purchase.
  Mr. ROE of Tennessee. I know you were.
  Mr. SHADEGG. You just used the number of 12 million. Two professors 
at the University of Minnesota, which is not exactly a conservative 
university, said, if you just enacted cross-State-line purchases, then 
that would enable 12 million additional Americans to afford health 
insurance with not one penny of cost to the American taxpayer.
  Mr. ROE of Tennessee. Well, the three things we have mentioned right 
there would cover this bill.
  Anyway, one, you've got State lines. Two, you've got association 
health plans, or groups, which would allow individuals or groups to 
form. Three, you've got the tax deduction allowing an individual to 
deduct it from his tax. Four, you've got tort reform. Five, which we've 
just mentioned, will allow adult-aged children to stay on their 
parents' plans.
  These are five simple things you can do without having all of the 
special interest groups and everything else. Then guess what? One of 
the things would be to expand the health savings account. You would be 
putting individuals in charge of their health care and of their health 
care decisions. Who should make them? A health care decision should be 
made between a physician, the family, and the patient. That's who 
should be making the decisions--not insurance companies, not the 
government.
  Mr. SHADEGG. I just want to reiterate what you said: A health care 
decision ought to be made by the patient, the family, and the 
physician.
  Mr. ROE of Tennessee. That's absolutely right.
  Mr. SHADEGG. Yet that's not how the system works today.
  Mr. ROE of Tennessee. No.
  Mr. SHADEGG. In the system today, your employer picks the plan, and 
the plan picks the doctor. You don't get to pick the plan, and you 
don't get to pick the doctor. If the plan or the doctor abuses you, you 
can't fire them.
  Mr. ROE of Tennessee. You're stuck.
  Mr. SHADEGG. Your idea is we should empower patients to be able to 
pick their plans and to be able to pick their doctors, which we could 
do by, number one, letting those Americans who can afford it but who 
don't get employer-provided care buy health care without paying a tax 
penalty; number two, letting those who get money from their employers 
either take their employers' plans or pick their own plans. I guess 
that's why we call it ``patient choice.''
  Instead of empowering patients, this bill that we're going to vote on 
of 2,000-and-some-odd pages, the Senate bill,

[[Page 3176]]

which has these 11 special backroom deals in it--and I still haven't 
gotten to all of them. That bill says, no, we shouldn't make it the 
patient, his or her family, and the doctor. We shouldn't leave it as 
the employer is overruling you. We should make it that the government 
is controlling the system.
  Mr. ROE of Tennessee. Yes.
  I had a very successful medical practice, and I understood who I 
worked for--not the insurance company, not the hospital. I worked for 
the patient. We are losing that because we are putting insurance 
companies and we are putting the government in between those 
decisionmakers.
  Mr. SHADEGG. It's a third-party pay system that exists right now. It 
does not work when your employer controls your health care plan. It 
will not work when the government controls your health care plan. It 
makes all the sense in the world to let people control their own health 
care plans. I've got a couple of myths and facts here I thought I'd 
conclude with.
  The White House says that your insurance premiums will decrease if 
this bill is enacted. Interestingly, the CBO and the Joint Committee on 
Taxation say that the average premium per person covered for new 
nongroup policies would be about 10 percent to 13 percent higher in 
2016 than the average premium for nongroup coverage in that same year 
under current law. So we're going to put the government in charge, and 
premiums will go up.
  The President said that you could keep your coverage if you like it. 
Interestingly, in Baltimore, when he came and talked to us, he admitted 
that was no longer the case. In fact, here are the numbers: Between 8 
and 9 million people who would be covered by an employment-based plan 
under current law would not have that offer of coverage if this bill 
passes.
  I think this is a critically important debate. I think we can reform 
health care in America. I think we can find ideas on the other side of 
the aisle and on this side of the aisle. I think we can get to reform, 
but I don't think the way to do that is with a system that moves power 
away from you and me and gives it to the government.
  I thank the gentleman for his assistance.
  Mr. Speaker, I yield back the balance of my time.

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