[Congressional Record Volume 155, Number 105 (Tuesday, July 14, 2009)]
[House]
[Pages H8078-H8085]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  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. Well, good evening, Mr. Speaker and my friends. We have 
just heard from the Democrats talking about their new foray into 
solving all the problems with health care, and boy, did it sound good 
to me. I have to say it really sounded good.
  The promises, essentially what I was hearing talk about, first of 
all, the costs are coming down and you're going to get free medical 
care and the quality of the care is going to go up. And gosh, if you 
were given a proposal like that, I don't see why anybody wouldn't say, 
Yeah, let's just march right ahead with socialized medicine. Let's let 
the government run it because they're going to bring the costs down, 
they're going to give you free medical care, and you're going to get 
even better coverage than you get now.
  I also was hearing the fact that they talked about the muck of our 
health care system and how bad the health care system is, and how, if 
we don't immediately pass this legislation, that things are going to 
get even worse. But what we have in front of us is this absolutely 
euphoric view of a great health care system.
  Well, first thing off that strikes me is a little bit of a problem 
with common sense, the first is, if our health care system were so bad, 
then it would seem like, to me, that Americans would be going to some 
foreign country to get their health care. But what I'm observing is 
that if I got sick--and I have been sick--the place that I'd like to be 
treated is in good old U.S.A. I don't want to go to Canada. I don't 
want to go to Great Britain. I don't want to go to France or Sweden. I 
don't want to go to Russia. No, I'd like to be sick right here in this 
country.
  So it strikes me that a health care system that most people even 
around the world recognize as probably the most sophisticated and the 
best quality health care system in the world, we're saying that it is 
full of muck and that the system has to be completely changed around.
  And so it's okay if you want to believe these promises, that what's 
going to happen when the government takes over the health care system 
is that it's going to cost less money. The trouble is the Congressional 
Budget Office doesn't say that and the estimates of the costs don't say 
that. And the States that have tried using the same approach that's 
being proposed here nationally, they don't say that either, because 
those States are almost bankrupt for trying to do this kind of a 
system, and yet, we're going to try to copy those bad examples.
  We are just actually a few weeks, a couple, 3 weeks away from dealing 
with the other big problem that the administration has identified, 
which is the fact that the climate and the Earth is going to get worse 
and worse, hotter and hotter, and we are going to melt down. So we've 
got to deal with the problem of global warming by, what would you 
expect, a very, very large tax increase, the largest tax increase in 
the history of our country. I guess it was about $787 billion. That was 
the largest tax increase that we've done. We did that.
  It was an 1,100-page bill that was brought to the floor, and then at 
3 o'clock in the morning, in a special committee hearing, another 300 
pages of extra text were added to the 1,100 pages, and the 300 pages 
being in the form of amendments to had to be collated and put into the 
1,100 pages. So, as we were debating this wonderful bill on the floor, 
they were busy trying to collate this amendment that had been passed, 
300-page amendment, at 3 o'clock in the morning. They're busy trying to 
collate that. So, as we're debating it here on the floor about to take 
a vote on it, there isn't even a copy of the bill that we're going to 
vote on.
  So here we go again. Perhaps we did learn from our last experience 
that it's easier to pass something that people don't know what it is. 
And so here we go now with about 1,000 pages of bill in terms of what 
we're going to do to have the government take over 20 percent of the 
U.S. economy. The health care business is about 20 percent of the money 
that's spent in America. It's about 20 percent, or close to it, of our 
economy, and now we're going to have the government take--well, if you 
take a look at it, about half of it the government's already running 
with Medicare and Medicaid. So we've had some experience with the 
government running these programs.
  The Medicaid program, of course, is noted for the tremendous amount 
of fraud and abuse that it has, but if you add the Medicaid and 
Medicare money, if you take a look at the total money we spent in 
health care, government's doing about half of it right now, but we're 
talking about having the government do the rest of it. And so that's 
where we're going, and I think we need to take a look at that.
  When the government does take over various things, what tends to 
happen?

[[Page H8079]]

Is it noted for its efficiency? Well, usually what happens when the 
government takes over programs is you get tremendous excess in amount 
of spending. You get a lot of bureaucratic rationing. These are typical 
things in government programs. There's an inefficiency and a degraded 
quality. Those are the kinds of things that history would tell us 
happens when the government takes something over. That's what's being 
proposed here. Make no doubt about it, what's being proposed is the 
government is going to take over the health care system. And that has 
left people with this particular quip that, if you think health care is 
expensive now, just wait until it gets to be free. Then you will see 
what real expense means.
  Well, let's take a look at how well this has worked in the past. One 
way you can tell whether it's a good idea to make a move or to do 
something particularly is to take a look at other people who have tried 
the same thing.
  The State of Massachusetts decided in 2006 that they were going to 
require universal health care coverage that's very much like the 
current Democrat plan where people are required to purchase specific 
levels of health insurance.

                              {time}  1915

  Well, here's what happened. Health care costs have risen 42 percent 
since 2006--42 percent increase. Now we were just hearing from the 
Democrats that this thing isn't going to hardly cost anything. This is 
going to be a break-even because there's so much efficiency.
  Well, what sort of efficiency is a 42 percent increase? And yet, 
health care access is down and the patients have to wait more than 2 
months to try to get to see a doctor. So, is this the kind of thing 
that we think is going to improve what most people think is the best 
health care system in the world?
  Health care costs now up in Massachusetts, they're 133 percent of the 
national average. Well, that doesn't seem to me to be producing these 
glorious results that I hear the Democrats talk about.
  I just don't think that these people may have gotten over their 
euphoria from just managing to put 1,100 pages, with 300 pages that 
nobody could read or know what it was, and pass that within a day of 
the three o'clock in the morning when they made the amendments.
  So here we go again. We're going to see if we can't pass another 
1,000 or 2,000-page bill this week or next week--and it's a lot easier 
to pass them when people don't read them.
  I'm joined here this evening by some very, very good friends of mine 
and some people who've done a number of years of study on the health 
care issue. I think that we need to talk a little bit about this. 
Before we go racing off to make some snap decisions, I think that we 
need to do that.
  I'm joined by a number of my colleagues. I would yield to the 
gentleman. If you want some charts, help yourself.
  This is Congressman Shadegg. He's from Arizona.
  Mr. SHADEGG. I just want to put up some charts, if I could. We have 
got boring charts here.
  I want to thank the gentleman for yielding. And hopefully we can do 
this where we are all in a conversation and no one of us talks in a 
monologue. That makes it more interesting.
  I want to thank the gentleman for standing up. I, like he, watched 
the Democrats in their Special Order that preceded this. And I thought 
some things were very interesting. On the one hand, there are things 
that I think we agree on. Our Democrat colleagues said that it is 
tragic when someone has a preexisting condition or a chronic illness 
and because of that preexisting condition or illness they can't get 
care.
  That's one of the reasons why we Republicans believe that the health 
care system in America desperately needs to be reformed. And the health 
care bill put forward by every Republican that I know of says we need 
to make sure that every American with a preexisting condition or a 
chronic illness can get health care costs at roughly the same price as 
Americans who are healthy.
  Indeed, I introduced and the Congress passed a number of years ago a 
bill called the State High Risk Insurance Pool bill that encouraged all 
50 States in America to create high-risk pools so that for someone for 
whom they have an illness and that illness or that chronic condition 
has caused their health care cost to rise and they either can't get 
health care at all or they can only get health care at an extraordinary 
high price, they have the option of going into a State high risk pool 
and getting health care at the same cost. That's not an issue that 
divides us. That's an issue we agree on.
  In addition, they expressed concern about those who are uninsured in 
America. The bill that I've cosponsored, and I see several of the 
gentlemen and ladies who have cosponsored it with me today, the 
Ensuring Health Care for All Americans Act, that bill provides health 
insurance for every single American. It says we are going to provide 
care to everyone.
  And our Democrat colleagues say, Yeah, we think every American should 
be able to get care. There's another issue where we agree with our 
Democrat colleagues. But where we don't agree is how they propose to do 
it, because they want a top-down, government-controlled, one-plan-fits-
all, you're-just-one-little-cog-in-a-very-large-wheel plan. And that's 
what the bill they introduced today will do.
  I have to ask a question. I think that the biggest issue in the 
health care debate is cost. Most Americans are pretty satisfied with 
their health insurance. Eighty-three percent say they're happy. But 
every American is concerned about cost.
  And I listened when the Democrats introduced their bill today. And 
the chairman of my committee, Mr. Waxman, said the big issue here is 
cost. And so the Democrats are going to fix that cost.
  Now I don't quite understand how they're going to fix that cost by 
raising taxes $1.5 trillion to create a massive new government, one-
size-fits-all health care plan.
  But I really, really have this burning question. Anybody in America 
can answer it, anybody in the room can answer it, any of my Democrats 
colleagues out there watching tonight can answer it. Please show me the 
last time when we got government involved and took over a private 
sector activity, that the cost of something went down.
  Mr. AKIN. Just reclaiming my time, gentleman, I think you have asked 
an absolutely great question, because we just heard an hour from the 
Democrats. That was their whole point.
  Their whole point is: We're going to somehow make the costs go down, 
which is a little hard to reconcile with a $1.5 trillion estimate. We 
saw 3 weeks ago that we jammed through the biggest tax increase in the 
history of this country. What was it--a $787 billion tax on energy? 
Anybody who flips the light switch is going to get taxed. And that's 
just a drop in the bucket compared to what we want to spend. And 
somehow this is supposed to be efficiency. That really stretches long 
on the conscience.
  We have a number of medical doctors here today, and what I was just 
thinking about, Dr. Roe is from Tennessee. Did you put a program 
similar to this into Tennessee, and did you find that it really helped 
the economy of your State? I'd like to yield a little bit of time, then 
go to the doctor from Georgia as well in just a moment.
  Mr. ROE of Tennessee. I certainly don't want to take credit for 
putting that in.
  Mr. AKIN. I wasn't going to blame you for that, gentleman.
  Mr. ROE of Tennessee. What happened in Tennessee was we had a lot of 
uninsured in Tennessee, and it was a very noble goal of trying to cover 
as many people as we could. And we had a standard Medicare plan like 
most States do now. We got a Medicare waiver from HHS, the Department 
of Health and Human Services, to form a managed care plan for the 
State.
  And what happened was, it was a plan that was very rich in benefits, 
much like you're seeing in this plan and that we heard discussed last 
hour. Provided a lot of benefits but not much access, we found out.
  And what happened was, this plan, this public plan paid only about 60 
percent. Now it pays less than, I found out the other day, less than 60 
percent of the costs of actually providing the care. Medicare pays 
about 90 percent.
  So businesses and individuals made a perfectly logical decision. They 
dropped their private coverage, and about 45 percent of the people who 
are

[[Page H8080]]

on TennCare had private health insurance coverage, but chose to drop 
it.

  Well, that was fine until we got the bill in the State. What happened 
was the bills kept piling up until they consumed more of the State 
budget than education did.
  Mr. AKIN. Reclaiming my time for a minute. One of the troubles with 
doctors is you guys are so smart, you go pretty fast. You're going to 
have to slow this down.
  What happened was the State government said, We're going to give you 
medical insurance. And so a bunch of people signed up for that. Then 
the companies that had the private insurance, they dropped theirs 
because you could go get the freebie stuff from the government. Then, 
guess what happened? The government stuff got really expensive and now 
the State's in trouble.
  We have a Congresswoman that I greatly respect, Congresswoman 
Blackburn from Tennessee also. Do you have some more facts? I mean, you 
lived with it. I yield.
  Mrs. BLACKBURN. Well, I thank the gentleman for yielding. Dr. Roe is 
exactly right. He was a physician practicing medicine or trying to 
practice medicine under the impact of TennCare. I was a legislator 
trying to figure out how to pay for this as a member of the Tennessee 
State Senate.
  Mr. AKIN. Wait a minute. The Democrats just said this is going to be 
really cheap. It's not going to be hard to pay for.
  Mrs. BLACKBURN. That's one of the interesting things. You know, 
Tennessee's TennCare program was put in place in 1994 as the test case 
for public option, government-funded, government-delivered health care. 
The interesting thing now is the White House doesn't want to talk about 
it because it is an experiment that was not successful. It failed. Even 
our Democrat Governor has said it has been a disaster.
  Mr. AKIN. Reclaiming my time, the Governor of the State said it was a 
disaster in Tennessee?
  Mrs. BLACKBURN. Yes. And one of the things we need to realize is 
this. TennCare was put in place as an executive order program of the 
Office of the Governor. It was an 1115 waiver from CMS. The Statehouse 
and the State Senate got the bill of paying for it.
  What happened after about 5 years of this program being in place, and 
you had consent decrees and court orders, you had companies that were 
dropping insurance, 55 percent of the enrollees on the program were 
people that were not supposed to be there. They had previously had 
insurance.
  And you had a program that was ensuring or covering--gold-plated 
program covering 25 percent of the State's residents. Then the cost 
starts to balloon. You see cost shifting taking place onto those who 
have private insurance. You see restricted access by doctors and 
hospitals because they're not being paid by the program, because 
there's not enough money to go around, and the cost of the program goes 
to the point that they are actually absorbing every single new revenue 
dollar that is coming into the State of Tennessee, and ends up being 36 
percent of the State's budget.
  Mr. SHADEGG. Would the gentlelady yield?
  Mrs. BLACKBURN. I'll gladly yield.
  Mr. SHADEGG. I just want to make sure I understand this. So, our 
Democrats colleagues say the big issue here is cost. Costs are going up 
too fast. The President said it's unsustainable.
  In Tennessee they put in a government-run plan, got the government 
involved, substituted the private market, and costs did not go down?
  Mrs. BLACKBURN. Costs skyrocketed. And we saw the costs go up every 
single year. As Dr. Roe can tell you, having been a physician trying to 
handle this issue, every single year the costs went up on the public 
option, the access was restricted, the quality of care was diminished, 
and those with private insurance saw their rates go up 10 percent, 15 
percent.
  Mr. AKIN. Reclaiming my time, what you're depicting sounds like to me 
is one of those things they used to do, they charge people money. They 
get a railroad track with two huge steam locomotives, they charge them 
money, and they'd run them. It was a classic train wreck.
  It sounds like basically what happened was the government engineered 
a train wreck in health insurance.
  Dr. Roe, you were the doctor--you're a medical doctor. I assume you 
got into the doctoring business because you wanted to take care of 
people. What was it like to be there?
  I yield.
  Mr. ROE of Tennessee. Well, one of the things when I got to Congress 
here and I began to hear the plan, I said, Well, we tried that already 
in the State of Tennessee. This is nothing new. It failed. And can you 
say failed? It was a disaster.
  And the Governor ran in 2002--our Democratic Governor--his platform 
was fixing TennCare. Fixing what 6, 8 years later was a mess in the 
State of Tennessee.
  Now there are good parts of this plan, as we pointed out. Things we 
will agree on. And I do want to show the public one thing. I almost 
broke my printer in the office this afternoon. But this is the bill 
that came out this afternoon, just to give you an idea what we're going 
to talk about in the next couple of days.
  Mr. SHADEGG. I believe it's 1,100 pages long.
  Mr. ROE of Tennessee. It's 1,100 pages.
  Mr. SHADEGG. The discussion draft was 600 pages. This is 1,100 pages. 
And if they do what they did on cap-and-trade, it will explode on the 
day of the vote to what, 1,400 pages with the last-minute 300-page 
amendment.
  Mr. ROE of Tennessee. This is where the devil is in the details, 
right here.
  Mr. BROUN of Georgia. Will the gentleman yield?
  Mr. ROE of Tennessee. Yes.
  Mr. BROUN of GEORGIA. It's interesting. After our last series of 
votes I was walking into my office. As I went into the Cannon House 
Office Building, there was a Democrat engaged in this process.
  Mr. AKIN. Just reclaiming my time for a minute, I'd like to introduce 
the gentleman, because you're a medical doctor also. You got in the 
business to practice medicine. You're not from Tennessee. You're from 
Georgia. But Dr. Broun is a respected expert on the subject of health 
care because you have been doing it all your life. And I'm just 
thankful that we have you here. I'd like to you to continue commenting 
where we are because this is a very important discussion.
  Mr. BROUN of Georgia. Thank you, Mr. Akin. It was humorous to me--
actually, sad to me--because this Democrat, she said to me that all 
they're going to do is cover those who are not insured with this public 
option and give them the opportunity to buy into this public option if 
they don't have insurance. And I told her, How are you going to keep 
companies from canceling their insurance and from people being shifted 
over? That's going to increase the cost of insurance for everybody 
else, and so you're going to see just a continual shifting.
  Isn't that, Dr. Roe or Mrs. Blackburn, isn't that what you all saw in 
Tennessee?
  Mrs. BLACKBURN. I thank you. I will give a brief answer to that and 
then I know Dr. Roe will also want to comment on it. It's so wonderful 
that we can talk from the perspective of a State senator who was 
charged with holding that program accountable, even though it was set 
up without the permission, without the permission of either the 
Statehouse or the State senate in the State of Tennessee. And Dr. Roe 
was charged with keeping his oath and making certain that he was 
providing care to those that were in his care.

                              {time}  1930

  But what we saw, again, was the cost shifting that was taking place, 
the cost of the insurance to those in the private markets going through 
the roof.
  I have employers in my State senate district and now in my 
congressional district who have seen, over a 3-year period of time, 
their health insurance cost go up 100 percent. We also saw delayed 
care. And as the gentleman from Arizona knows, delayed care might as 
well be denied care.
  Mr. SHADEGG. Would the gentlelady yield just on that point?
  Mrs. BLACKBURN. I do yield.
  Mr. SHADEGG. By the way, our colleagues are saying, let's go to a 
Canadian-style system, something that gets the government more 
involved. Well, we all know Canada has a single-payer system. Some of 
us believe that those

[[Page H8081]]

on the other side of the aisle want to create exactly that, a single-
payer system, but they just want to transition to it.
  I think it is very important, you said that the right to access to 
care is not the right to care. Actually that is exactly what the 
Supreme Court of Canada ruled about their single-payer system. The 
chief justice, and this is on this chart next to me which I thank the 
gentlelady for allowing me to put up, Chief Justice Beverly McLaughlin 
of the Canadian Supreme Court said in an opinion, which was issued in 
2005, access to a waiting list is not access to health care, an opinion 
in which the Supreme Court of Canada ruled that you couldn't be forced 
to stay in their system, you had to be given the right to get outside 
of the government program and get the care you need. So to the point 
the gentlelady was making, access to a waiting list is not access to 
health care.
  Mr. AKIN. Reclaiming my time a second, now this supreme court 
justice, she was no right-wing conservative?
  Mr. SHADEGG. She was no right-wing conservative.
  Mr. AKIN. By politic standards of America, she would be considered 
liberal. Yet she is saying that this socialized system doesn't work. 
And access, just because you have insurance, doesn't do you any good. 
You can have a free C-section, but if you have to wait 12 months, it 
doesn't do you much good.
  Mr. SHADEGG. If you have to wait 12 months, it doesn't do you much 
good at all. I believe our colleague could comment on that more 
credibly than we could.
  I just want to make the point: we don't want this. We Republicans 
want a system that responds to patients. We want patient-centered care. 
We don't want to give Americans access to a government waiting list. We 
want to give them access to actual health care.
  Mr. AKIN. I yield back to Congressman Broun from Georgia. I think you 
had the floor for a moment there, and then I'm going to go to 
Congressman Gingrey, another medical doctor we have joining us. We have 
a lot of doctors here tonight, and I'm very thankful for your 
expertise, my friends.
  Mr. BROUN of Georgia. I thank Mr. Akin for yielding again to me.
  I want to come back to something that my dear friend John Shadegg 
said where he is talking about cost. I just wanted to inject here 
something that happened in my medical practice when I was practicing 
down in southwest Georgia. And what I'm fixing to say is going to point 
out that government intrusion in the health care system is what has 
driven up the cost for everybody, whether they are private insurers or 
public insurers on Medicare, SCHIP or Medicaid.
  Back a number of years ago, I was in private practice. I had a one-
man office with several employees. And I had a fully automated lab in 
my office. A patient would come in to see me with a red sore throat, 
running a fever, aching all over, coughing, runny nose and white 
patches on their throat. In my fully automated lab, I would do a CBC, a 
complete blood count. I could do that in 5 minutes and charge $12.
  Well, Congress passed a bill and signed into law what is called the 
Clinical Laboratory Improvement Act, or CLIA. It shut down my lab. It 
shut down every doctor's lab in this country. All the hospital labs had 
to get a waiver----
  Mr. AKIN. Reclaiming my time, the laws passed here in Congress shut 
down a lab that you had to be able to treat people that had an upper 
respiratory type of infection?
  Mr. BROUN of Georgia. Anything, to do blood sugars and blood counts 
and those sort of things.
  Mr. AKIN. They shut it down?
  Mr. BROUN of Georgia. They shut it down. CLIA shut every doctor's lab 
in the country. Patients would come in with aching all over, a red sore 
throat, and so I would do a CBC to see if they had a bacterial 
infection and thus needed antibiotics, if there was a strep throat that 
might need a penicillin shot, or if they had a viral infection that 
could look exactly the same. And a viral infection is not helped by 
antibiotics. The teaching in the Medical College of Georgia and all of 
my training postgraduate has encouraged doctors not to overprescribe 
medications. It is costly. It increases the cost to everybody. Also, if 
people have viral infections, they don't need antibiotics. Actually, it 
is harmful to some patients.
  So, I do a CBC, 12 bucks, 5 minutes. CLIA shut my lab down. I had to 
send patients across the way to the hospital. They got a waiver. It 
cost $75 and took 2 to 3 hours for one test. Now do you see what that 
does across the whole health care system? It markedly increased the 
cost.
  Congress not just a few years ago passed HIPPA, the Health Insurance 
Portability and Privacy Act. That has cost the health care industry, 
thus insurance and all of us, billions of dollars. It has not paid for 
the first aspirin to treat the headaches it has created. It was totally 
unneeded legislation. It was totally unneeded because we could have 
done something to make insurance portable without going that route.
  So, government intrusion into the health care system and Medicare 
policy is what has driven up the cost for everybody. And it comes back 
to what Mr. Shadegg was saying about asking a question, could any of us 
answer the question about has government's being involved in any area 
decreased the cost. And the answer is ``no.'' It has increased the cost 
markedly for the health insurance of everybody else. And it is going to 
in this too.
  Mr. AKIN. Reclaiming my time, I think you have really given us 
several very concrete examples in the health care business where the 
government involvement has basically run the cost of health care up. 
That is not a big surprise, is it? Because as we look at the regular 
marketplace, I think one of the examples would be the idea of Lasic 
surgery for eyes. That is one thing the government didn't get its big 
fingers into meddling, right? And laser technology has come along, and 
what used to cost thousands of dollars for a procedure now is done for 
hundreds of dollars. And so we have seen a dramatic decrease in the 
cost of good quality care just because the government wasn't tampering 
in it. Yet every time we see the government gets it fingers into 
things, the costs invariably go up.
  I would like to get over to Congressman Gingrey from Georgia, another 
medical doctor joining us with many years of medical practice, also a 
former senator from Georgia and a great colleague. I yield time.

  Mr. GINGREY of Georgia. I thank my colleague for yielding.
  It is a pleasure to be on the floor with my colleagues talking about 
this bill that was finally, as we all know, introduced by Speaker 
Pelosi at a press conference this afternoon. And hearing our colleagues 
from Tennessee talk about really the ultimate pilot project, we are 
always in Medicare, anytime they are trying to do something to improve 
a situation, we start with a pilot project, which makes sense.
  Well, this was the ultimate pilot project, I think, this TennCare 
that Congresswoman Blackburn and Dr. Roe, Congressman Roe, have 
described to us; and as their Democratic Governor said, it was a 
complete abysmal failure.
  Mr. AKIN. We are going to repeat this? Please continue.
  Mr. GINGREY of Georgia. If the gentleman will continue to yield, and 
yet we are going to repeat this now on a grand national scale.
  I want to just take a few minutes to talk about what the Blue Dog 
Democrats said to their leadership just last week in a letter that was 
sent to the Honorable Nancy Pelosi, Speaker of the House, Madam 
Speaker, and the Honorable Steny Hoyer, the majority leader of the 
Democrats. And 40--I think there are 52 Members of the Blue Dog 
Coalition of Democrats, those Members who are a little more 
conservative than the typical moderate to liberal Democrats, and 
basically these 40 Members, 40 out of 52, and there are a number of 
things in their letter, but I just want to go over a couple. One of the 
provisions that they say that absolutely needed fixing in this bill 
before they could support it is small business protections.
  Here is what it says: Any additional requirements for employers must 
be carefully considered and done so within the context of what is 
currently offered. Small business owners and their employees lack 
coverage because of high and unstable costs, not because of

[[Page H8082]]

any unwillingness to provide or purchase it. We cannot support a bill 
that further exacerbates the challenges faced by small businesses.
  Now, look, my colleagues, what this bill says that just came out 
today, this is the burden, the additional burden that will be put on 
small businesses. If the payroll of a business does not exceed 
$250,000, then there is no surtax. But if the payroll exceeds $250,000 
to $300,000, there is a 2 percent surtax. If the payroll exceeds 
$350,000 but does not exceed $400,000, there is a 6 percent tax on 
small business, and if the payroll exceeds only $400,000, there is an 8 
percent surtax on these small businesses.
  What I want to make sure everybody in this Chamber understands is 
that these small businesses are not subchapter; they are not C 
corporations. They are Subchapter S or they are sole proprietors. And 
they pay as an individual. And this is on top of the fact that 
President Obama is going to let the tax cuts expire that President Bush 
put in place in 2001 and 2003.
  Mr. AKIN. Just reclaiming my time for a minute, what you brought up 
is an absolutely critical point. It is part of how they are going to 
try and pay for this humdinger bill. And what you are saying is they 
are going after small business.
  Now a lot of us know small businesses have 500 employees or less, and 
they create 80 percent of the new jobs that are created typically in 
the economy. So if you target small business, now you are going to 
drive down employment. And that is significant.
  I yield the gentleman from Arizona time.
  Mr. SHADEGG. I am shocked. As I stand here, I have to tell you I'm 
absolutely shocked. I understand that the gentleman from Georgia was 
reading from the bill just now?
  You're reading provisions of the bill that was released today?
  Mr. GINGREY of Georgia. I am reading directly from that provision, 
taxes on employers and individuals.
  Mr. SHADEGG. So you have read a portion of this bill?
  Mr. GINGREY of Georgia. I have read a portion of this bill.
  Mr. SHADEGG. And I suggest that you also read from a letter written 
by Blue Dog Democrats, conservative Democrats, to their leadership 
expressing concerns about provisions of the bill before it was released 
today, the so-called ``Tri-Committee Discussion Draft.'' So are you 
telling me that Blue Dog Democrats have read portions of the bill?
  Mr. GINGREY of Georgia. The gentleman from Arizona is absolutely 
right. One of the provisions that they stated in the letter is this, 
finally, any health care reform legislation that comes to the floor 
must be available to all Members and to the public for a sufficient 
amount of time before we are asked to vote for it.
  Mr. SHADEGG. I'm just stunned. I have here beside me a quote from the 
House majority leader which suggests that it is not appropriate in 
America for us to expect Members of Congress to read bills. As a matter 
of fact, the majority leader said, if every Member pledged not to vote 
for it--``it'' being this health care bill--if they hadn't read it in 
its entirety, I think we would have very few votes.
  He said last week, he laughed out loud--laughed out loud at the 
notion that Members might actually read a bill. I suppose if you had 
done what he did, which is on the cap-and-trade bill, introduced at 
3:04 in the morning a 309-page amendment which made it impossible for a 
single Member to read the bill before it was voted on at 4 p.m. that 
afternoon or 5 p.m. that afternoon, then I guess you would have to say, 
gosh, we don't want Members to read bills. But as I understand it, 
you're reading this bill, and so are these Blue Dogs, reading the bill?
  Mr. GINGREY of Georgia. Well, if the gentleman will yield.
  Mr. AKIN. I do yield.
  Mr. GINGREY of Georgia. I can respond to the gentleman from Arizona, 
absolutely, and again in this letter, and I'm quoting directly from the 
letter: too short of a review period is unacceptable and only 
undermines Congress' ability to pass responsible health care reform 
that works for all Americans.
  And our colleague from Tennessee, Dr. Roe, just held up that 1,100-
page bill. I wonder when they are going to get around to reading it. 
And I yield back.
  Mr. AKIN. I would like to yield time to Congresswoman Blackburn from 
Tennessee. I think you had a point.
  And also the stack of that, that is just the beginning of the bill, 
and it has already given my eyes a headache from looking. What do you 
have, close to 9 or 10 inches of paper stacked up there, Doctor? That 
is just where we are now. We haven't done the amendments at 3 o'clock 
in the morning yet.
  I do yield to the gentlelady from Tennessee.
  Mrs. BLACKBURN. I thank you. What we see in this stack of the bill, 
the 1,100 pages that are there in that bill, 1,683 times it gives you 
the directive of you ``shall do,'' individuals ``shall do'' this. Now 
let me explain what this means. When you are a mother, many times you 
will tell your children, well, you can go out and play if you want to 
or you can do this if you want to. But when you really want to make a 
point, you say, ``you are going to go to time out'' or ``you are going 
to go to this corner'' or ``you are going to do your homework, no 
question, no options.''

                              {time}  1945

  In legislative parlance, that is what ``shall'' means. You have to do 
this.
  Now, 47 times it uses the word ``must.'' You must do this and that. 
And 495 times it uses the word ``require.'' All of these are new 
mandates on the American people.
  To make it worse, 172 times it talks about taxes, taxpayer, taxable 
activity, 172 times, and 99 times it uses ``penalties.''
  The Democrats have become the party of punishment, and they are going 
to punish Americans severely in this health care bill.
  And to the gentleman from Georgia, I loved the fact that he talked 
about the taxes. That portion that he so beautifully articulated, would 
create $300 billion in new revenue for the government, which means 
taxes out of your pocket that you're taking out of your pocket and 
handing to the tax man; $300 billion. Even the prices----
  Mr. AKIN. Reclaiming my time, I just heard promise this thing doesn't 
cost that much, and yet the Congressional Budget Office, the original 
version was 3.5 trillion, and they've whittled it down to only 1.5 
trillion is what we understand. And you're only talking $300 billion. 
And we did that huge, the biggest tax increase in the history of our 
country on energy taxes which is going to hurt our productivity, and 
that's only not even 800 billion. We're not there yet.
  Mrs. BLACKBURN. You're exactly right. And what the gentleman has is 
one small portion of that bill.
  And also, I would add, before I yield back, that his own economic 
advisor from--the President's economic advisor estimates that that 
amount of taxes and this legislation would cost us 4.7 million new 
jobs.
  And I yield back.
  Mr. SHADEGG. If the gentlelady will yield briefly, I just point out 
that for you to know all of those numbers shows that you are very much 
involved in the process of reading this bill. Your staff is involved in 
the process of reading the bill. I said facetiously to our colleague 
from Georgia yesterday that I was stunned that people were reading the 
bill. I just want to make the point I am really stunned that the 
majority leader made the comment that Members shouldn't be expected to 
read the bill. I know I won't vote for this bill until I have read it 
and been over it.
  I compliment the gentlelady's staff for poring through the bill, 
finding those statistics. I compliment the gentleman from Georgia for 
obviously reading portions of the bill and for his dedication. And 
everyone here, I think the American people expect us to read the bill. 
And I just wanted to make it clear that I was only being facetious when 
I expressed stun and shock that we might read a bill. I think it's my 
job to know what's in these bills.
  I would be happy to yield.
  Mr. BROUN of Georgia. I just signed a pledge this afternoon to the 
American people that I will not vote for this bill until I read it, and 
I meant that. I don't sign pledges----
  Mr. SHADEGG. I hope our colleagues on the other side will do the 
same.
  Mr. BROUN of Georgia. I hope they will, too.
  I applaud the Blue Dogs for asking from the leadership. I hope they 
don't

[[Page H8083]]

hold their breath because I think they'll turn blue and die from 
hypoxia.
  But I want to point out something that Dr. Gingrey was talking about 
that, and that Ms. Blackburn brought up very clearly. This tax increase 
on small business is going to cost jobs, not 1 or 2, not 10 or 20, not 
100, but thousands of jobs, because small businesses all across this 
country are not going to be able to pay for the increased taxes that 
the Democrats are going to put on the back of small business men and 
women around this country. So many people are going to be out of work, 
and it's going to shift them over to the public plan. They're going to 
get free health care.
  We have heard several of our colleagues say, if you think health care 
is expensive now, wait till you get it when it's free. It's going to be 
extremely expensive.
  Mr. AKIN. Reclaiming my time just a second, I'd like to go back over 
to Dr. Roe.
  You were there. You're in Tennessee. You saw this experiment. Even 
the Democrat Governor said it was a failure. I'd like you to just 
finish fleshing--we have just a few minutes left. If you could finish, 
and then I'll close.
  Mr. ROE of Tennessee. Let me go over why it's important for the 
public and my patients and, as physicians, our patients to understand 
this. What we're concerned about is if this plan becomes a public 
option and that's the only option. And the way that occurs is, I've 
explained, when the cost of the public plan does not pay for the cost 
of the care, more costs are shifted to your private health insurers, 
meaning that they'll eventually drop the plan.
  Now, having a single-payer system like Canada or England, is that 
necessarily bad? Well, I would argue that it is in America, and the 
reason is because it's going to limit choices.
  And I know it was brought up just a moment ago by the gentleman from 
Arizona about costs, and I'm going to share with you--just a family 
practitioner in my own district the other day called me up and said, 
Bill, he said, I have had one lawsuit in my career. A very young woman 
had a serious problem, probably not preventable. He had a grade by the 
insurance companies of what a good doctor he was, in the top third, 
always. After this one lawsuit, and nowhere is medical malpractice 
mentioned here, his referral to specialists in 1 year went up 350 
percent. His lab ordering went up 550 percent. This is not him saying 
this. This is a grade he got from the insurance companies. So there is 
the cost side that we were talking about earlier, and who knows, when 
you extrapolate that across the country, how much that must be.
  Now, I got this letter right here this afternoon from CBO to Chairman 
Rangel, 14th of July, today. And in this, it says, Another significant 
feature of the insurance exchanges is that they will include a public 
plan that largely pays Medicare-based rates for medical goods and 
services. CBO estimates that the premiums for that plan would generally 
be lower than the premiums for private insurance. But on average, the 
public plan would be about 10 percent cheaper than the typical private 
plan offered in the exchanges, and therefore, they're saying right here 
in this document that that's what's going to happen.
  The other thing about this I found interesting was this plan doesn't 
start until 2013. And what you're seeing here is only in the last 6 
years, this $1.1 trillion plan. It actually is 150 billion per year is 
what it amounts to. It's not what they're currently saying it's going 
to be, a trillion over 10 years. It's really a trillion-plus over 6 
years.
  I yield back.
  Mr. AKIN. Let me just, I told Congressman Shadegg from Arizona I'm 
going to get him in. He had a couple of points, and we're going to jump 
over to you, Doctor. We'll get right over to you. I yield to the 
gentleman from Arizona.
  Mr. SHADEGG. I thank the gentleman for yielding, and I'll try to be 
as brief as I can.
  I want to point out that the Democrats' bill was not the only bill 
introduced today. As many of my colleagues here note, we introduced the 
Improving Health Care for All Americans Act today. It's a bill that 
reforms health care, not top down government edict, government mandate. 
It reforms American health care bottom up. It controls costs by 
empowering Americans, and it has some key points.

  It says, if you like it, you can keep it. It provides coverage for 
every single American and choice for every single American. It provides 
new pooling mechanisms so that you could be in an insurance pool other 
than your employer's pool. It says that the Kiwanis International or 
the Rotary International or the Daughters of the American Revolution or 
your alumni association of your college or university could sponsor a 
plan. So you could pick many pools to get into.
  It also says we're going to cover preexisting conditions or people 
with chronic conditions at the same rates as everyone else, by cross-
subsidization and high-risk pools.
  But I wanted to make, because I have some charts here, two quick 
points very quickly, and I'd invite anybody else who speaks in the 
limited time we have left to comment on these because I think they're 
so important.
  The President has said over and over and over again, if you like it, 
you can keep it. I think that's so important, because polls show 
roughly 83 percent of Americans, 83 percent of Americans, like the 
health care they have. So if the President stands forth and says, if 
you like it, you can keep it, ladies and gentlemen, I wish it were 
true.
  This is the language of the bill which was introduced today. It's 
been revised and renumbered. This came from the working draft, but the 
same language is in the bill. It says, by the end of the 5-year period 
following the introduction of the bill, group health insurance plans, 
every group health insurance plan must meet the minimum benefit 
requirements under section 121. Section 121 creates a new Federal 
entity called the Health Care Advisory Committee, which will rewrite 
the minimum benefits for every health care plan in America. That means 
every health care plan in America, under their bill, will change within 
5 years. Some will change immediately. Everyone will change within 5 
years.
  Mr. AKIN. Reclaiming my time, so what you're saying is, if you like 
it, you won't be able to keep it. That isn't true.
  Mr. SHADEGG. If you like it, like the headline says right here, if 
you like it, if you like your care, if you're one of those 83 percent 
of Americans, be prepared to lose it, because you're going to lose it 
under their bill, not just by competition from the public plan. Their 
bill says you'll lose it. In 5 years, every plan has to change.
  I will conclude very briefly on an issue that I know is near and dear 
to the gentleman who sponsored this special hour tonight, Special Order 
tonight, our friend Mr. Akin, who's a cancer survivor.
  The American people, I hope, will slow down this process. I hope 
they'll say, We want to see what's in this bill. But I hope they'll ask 
this question and understand this information. We are being told to 
switch to a system similar to what exists in Canada, Europe and 
England. Those are the parallels.
  But I would suggest to my colleagues and to every American, there are 
two things that scare every American. Those two things are cancers. For 
men, it's prostate cancer. For women, it's breast cancer. And these are 
hard facts.
  This chart shows you that the 5-year survival rate in the United 
States for prostate cancer is dramatically better than Canada. It is 
stunningly better than Europe, and it is shockingly better than in 
England. So, if you have prostate cancer in America, your chance of 
surviving after 5 years are dramatically better in the United States 
than in the system the Democrats are telling us we ought to adopt.
  But that's not enough, because every woman in America goes to bed 
each night worrying about breast cancer, and I would suggest every 
husband in America goes to bed worrying about breast cancer. And here 
are the facts.
  If you look at 5-year survival rates for breast cancer, once again, 
the United States, the system they want to throw out, you have a 
dramatically better, significantly better chance of surviving than 
Canada, even more dramatically better chance of surviving 5 years than 
if you lived in Europe, and even better than that, of surviving 5 
years, than if you lived in England. Before we adopt a Canadian, a 
European,

[[Page H8084]]

or a British system of health care, we better know that the survival 
rates for these cancers, the cancers that scare most Americans more 
than any other, are significantly worse in those countries than in the 
United States of America.
  Mr. AKIN. I promised I was going to yield over to the gentleman from 
Michigan, my good friend Mr. Hoekstra, and I will come back over to 
you, Doctor, in just a minute. Congressman Hoekstra.
  Mr. BROUN of Georgia. Okay. I'd like to speak to Mr. Shadegg's point 
there before he leaves if he could stick around a second.
  Mr. HOEKSTRA. I thank the gentleman for yielding. I thank my 
colleagues for allowing me to just be a part of this discussion for a 
few minutes.
  You know, it's interesting. As my colleague from Arizona is pointing 
out the differences between the U.S. system, the Canadian system, and 
the British system, and I think one of the things that you see there is 
in America you've got competition, so the hospitals are all working to 
improve their survival rates. If you get a certain type of disease or 
illness, you know, people will check the various performance rates by 
hospitals, by clinics, as to where it's working.
  You know, I just--this bill now is 1,000 pages. It's over 1,000. We 
just went through a massive cap-and-trade and tax bill. But, you know, 
I just opened it up, and one of the things that people say, Don't 
worry. There's still going to be improvement and competition to get 
excellence.
  You know what job I want? Start on page 84. I want to be the 
commissioner. The commissioner shall specify the benefits. The next 
page, The commissioner shall establish the following standards. You go 
to page 87, The commissioner shall establish a permissible range. If 
the State has entered into an arrangement satisfactory to the 
commissioner, page 88, the commissioner shall, the commissioner shall. 
I mean, it's like--and this is in 2 minutes of looking at this bill. 
And it's like, well, it looks like the commissioner knows what to do. 
And if the commissioner's going to do all of this, what's there left 
for me? It looks like the commissioner's going to take over my health 
care.
  Mr. AKIN. Are you sure you're spelling that word right? It doesn't 
say ``czar''?
  Mr. HOEKSTRA. I was thinking it sounds like czar. Coming from 
Michigan, we've had enough of czars. We've had enough of car czars, you 
know, who are running our automobile industry, who are making decisions 
about which car company will survive, how they will survive, who will 
manage the companies, who will be on the board of directors, what 
dealers will survive. I mean, you know----
  Mr. AKIN. Reclaiming my time, gentleman, we're talking about the 
President of the United States firing the President of General Motors. 
We got ourselves into the insurance business, into the banking 
business, and now health care. What is it, 20 percent of all of 
American business? And we're going to have this commissioner, we're 
going to take another 20 percent the government's going to run?

                              {time}  2000

  Mr. HOEKSTRA. If the gentleman would yield for just a moment.
  Mr. AKIN. I would yield.
  Mr. HOEKSTRA. You know, think about it. If the President believes 
that he can decide who should run General Motors, which is a decision 
that he made in which he forced the replacement of the president of 
General Motors, then taking the next step and telling each of us what 
kind of health care we're going to have, what treatments we can have, 
what procedures we can have, and how much the government is going to 
pay for each one of those is fully within the realm of possibility, 
which is exactly where this bill goes.
  Mr. SHADEGG. I guess what the gentleman is saying is that, if the 
bill passes, we'd better hope the commissioner is as smart as Peter 
Orszag.
  Mr. ROE of Tennessee. Will the gentleman yield for a second?
  Mr. AKIN. I promised Dr. Broun that we would give him a chance here. 
We're getting close to closing.
  Mr. BROUN of Georgia. I appreciate it.
  In noting what Mr. Hoekstra is talking about and in going back to 
what Mr. Shadegg was talking about, I want to point out the reason 
there is such a difference in the survival rates for these two cancers. 
The American people need to look at it. It's not just because we're 
Americans. It's because, in those systems, people are put on waiting 
lists, as your prior chart noted, Mr. Shadegg. It is also because the 
government system won't pay for the new procedures, for the new 
medications. So it's because of delayed treatments, of delayed 
evaluations of lumps in a breast, because of delayed or denied 
services. That's going to come under this plan that the Democrats have 
proposed today. It's coming to every single American. That's the reason 
the survival rates are so much lower for prostate cancer and breast 
cancer. The thing is, and what's going to happen is, our survival rates 
are going to actually go down and match some of those others. The 
American people need to understand that. If I can speak to them, that's 
one thing that I would say. The delayed treatment and denied treatment 
is going to wind up killing people. That's what this plan is going to 
do. It's literally going to kill people.
  Mr. SHADEGG. The man is dead right.
  Mr. AKIN. Reclaiming my time, I would like to introduce another 
gentleman here who has been joining us at a number of key points and 
junctures, Congressman Scalise from Louisiana. I would appreciate your 
jumping into the conversation here for just a minute or two.
  Mr. SCALISE. Well, I want to thank the gentleman from Missouri and 
all of my colleagues who have been talking tonight.
  As we start to see the plan unveiled and, literally, some of the 
secrecy removed on this plan, I think what most American people are 
going to see over the next few weeks is the fact that this is nothing 
short of a government takeover of our health care system, a system that 
right now provides some of the best medical care in the world because 
some of those people come from those countries--from those very 
countries that do have government-run health care and the rationing 
that exists in those countries--to this country, if they have the 
means, because we have the best medical care even though it's a system 
with flaws and even though it's a system that needs some reforms. 
Though, the reforms that need to be made need to be made while working 
with all of us, with all of us here--with the doctors who have been 
presenting these ideas and these good solutions that have been 
presented--not by a government takeover that literally would ration 
care for American families and that would add hundreds of billions of 
dollars in new taxes on the backs of small business owners and families 
across this country. That's what their bill does. That's why we've got 
a big difference between how we here, who have been talking tonight, 
would approach this solution versus this government-run takeover of our 
health care system.
  I yield back.
  Mr. AKIN. I thank the gentleman.
  That's a great summary, and I appreciate your perspective from 
Louisiana. I think a lot of other people are seeing it this way, 
particularly the gentleman from Michigan, Congressman Hoekstra, with 
all of those--and he kept reading that word ``shall,'' ``shall,'' 
``shall,'' ``shall.'' This doesn't look like any kind of free 
enterprise to me.
  I would like to recognize the doctor from Georgia, Dr. Gingrey. I 
thought you said you wanted to do about a minute or so before we call 
it here.
  Mr. GINGREY of Georgia. Mr. Speaker, I thank this gentleman from 
Missouri for yielding. I know time is running short.
  I just wanted to point out, in regard to the government plan, the 
Blue Dogs, who sent this letter last Friday to Ms. Pelosi and to the 
majority leader, Mr. Hoyer. It reads: Providers in the government plan 
must be fairly reimbursed at negotiated rates, and their participation 
must be voluntary.
  The bill that was introduced today by Ms. Pelosi, in regard to 
providers forced to participate, reads: Establishment of a provider 
network for the government plan. Health care providers participating 
under Medicare are automatically participating providers in

[[Page H8085]]

the public health insurance option unless they opt out in a process 
established by the Secretary.
  So, in talking about the powers of the commissioner, I also worry 
about the powers of the Secretary, and every doctor in America should 
worry about that.
  I yield back.
  Mr. AKIN. I think that, perhaps, may be the Democrats' biggest 
nightmare--the fact, if we have time to read the bill, that the people 
will see that what is promised and what the bill says are two different 
things. That is certainly what we're dealing with here. You have the 
Blue Dogs. These are Democrats. They're asking their leadership to have 
this flexibility, and the bill goes the exact opposite of what they're 
saying.
  I would yield to the gentleman from Michigan, Congressman Hoekstra.
  Mr. HOEKSTRA. What we're really seeing here is a continued erosion of 
the rights of individuals and the rights of States. Michigan is a donor 
State in terms of transportation. What does that mean? It means, since 
the inception of the national highway or the national gas tax, for 
every dollar that Michigan has sent to Washington, we've received 83 
cents back. That hardly seems fair to me, especially when we're now 
number one in unemployment. Think of it. When we get that money back, 
the Federal Government tells us how to spend it. The same thing 
happened with education. We sent money here.
  Think about what's going to happen with health care. It's going to 
come here to Washington, and we're going to apportion it back to the 
States. Some States are going to do better than others, and it's not 
going to be based on population or those types of things. It's going to 
be based on the power of the people in this Chamber and in the Chamber 
down the hall as to who has got the most influence. There are going to 
be donor States and--what are they?--donees or beneficiaries, the ones 
who get more than the rest of us.
  Mr. GINGREY of Georgia. Recipients.
  Mr. HOEKSTRA. Recipients.
  That's no way to run a health care system. We will lose freedom, and 
this place will become the center of distributing money and of 
distributing power back to groups around the country. This is what 
we're fighting for. We're fighting for freedom for individuals and for 
sovereignty back to the States.
  Mr. AKIN. You know, I really appreciate your summary, and we're 
getting close in time. A number of you have come to this same basic 
position. What we're really talking about here is freedom, isn't it? 
It's a subject of freedom.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. AKIN. Okay. I'll finish up and reclaim some time. Go ahead.

                          ____________________