Antifreeze Bittering Act of 2009

Mr. Speaker, it is a pleasure to come and talk about health care tonight. I expect other physicians to come and discuss this extremely important issue to the American people.

We keep hearing over and over again from our Democratic colleagues that Republicans have no alternatives. Well, we have got a bunch of binders here. Each one of those contains a Republican alternative to ObamaCare that the Democrats are proposing.

As the staff brings these forward, every single folder is a Republican plan. Every single folder is a different Republican plan. Every single folder offers suggestions and solutions to the cost of health care for all Americans.

Almost every one of those folders, if not every one of them, we could get bipartisan agreement on, if any of these

bills would ever see the light of the day. Let me repeat that. I believe that we could get bipartisan agreement on most, if not all, of these Republican bills that will affect health care costs for every single American and will offer some solutions to Americans' concern about the rising cost of health care.

It's untenable that health care costs are rising like they are today. It's unsustainable the way health care costs are rising like they are today. But we ask why. Well, there are many reasons why.

I have practiced medicine in Georgia for almost four decades now. I am a general practitioner, a family doctor. I have seen in my medical practice the marked amount of government intrusion and how it runs up the cost of health care.

I will give you a good example, Mr. Speaker. When I was practicing in rural south Georgia, I had a small automated lab with quality control to make sure that the results I got from my lab were accurate, because I wanted to give good quality care to my patients.

Well, Congress passed a bill called CLIA, the Clinical Laboratory Improvement Act, which outlawed mine as well as every doctor's lab in the country. Prior to CLIA, if a patient came in to see me with a fever, red sore throat, white patches on the throat, coughing, runny nose, headaches, aching all over, I would do a CBC, or a complete blood count, to see if they had a bacterial infection which needs an antibiotic treatment, or a viral infection, which is not helped by antibiotics. The patient doesn't need to expend the money on those antibiotics and doesn't need the exposure with the possible side effects and the consequences of being on the antibiotics.

I could do that test, CBC, in 5 minutes. It cost 12 bucks. CLIA shut my lab down. I had to send patients over to the hospital across the way. It took 2 to 3 hours and cost $75 for one test. The test goes from 5 minutes, 12 bucks, to 2 to 3 hours, $75, for one test.

Now, the American people, if they look at the math there and just extend it over the course of everything that comes into play in the health care financing in this country, would see that the health care insurance costs went up for everybody because of that one government intrusion into my office and my ability to give the kind of quality care that I am trained to do and that I want to do.

Another example, Congress not long ago passed HIPAA, the Health Insurance Affordability and Accessibility Act. The HIPAA bill has cost the health care industry billions and billions of dollars, billions of dollars. That's passed on down through the insurance companies and through pricing to the consumers.

It has to be, because people have to make a living. It has cost the health care industry billions of dollars and has not paid for the first aspirin to treat the headaches that it has created. It's government intrusion into health care. That's what's caused a marked rise in the cost of care.

Mr. Speaker, let me tell you something else where this bill that is being written in darkness or in secrecy now by the Speaker, we don't even have the bill that we are going to see here on floor, if we ever see one, because it's being written in secrecy.

Democrats nor Republicans can see the proceedings. We can't put any of our ideas into the writing of that bill. It's being hidden from all of us. It's being hidden from the public view, and that is not right.

We have been promised transparency by this Speaker, but we have had everything but transparency and fairness. Both of those things were promised, but we are not getting them.

The bill that Speaker Pelosi is going to present at some time, whenever she takes a notion to do so and gets it finished, that she is writing in secret currently, is going to have a tremendous amount of more intrusion into people's lives. Experts tell us that it's going to cost millions of people their jobs.

In fact, in my home district of Georgia, I have talked to small businessmen and women that tell me if the mandates that we already know in H.R. 3200 are put in place or the mandates that the Senate bills-- that are already being written in secrecy also on their side--but the mandates that we know that they want to include in those bills will cost millions of people their work and put people out of work. Why? Because they are mandates on small business that small business is going to have to either not hire people or they are going to have to let people go.

In fact, I have talked to small businessmen and women, and they tell me that with the 8 percent mandate that's in the House bill that's going to fall upon them if they don't supply health insurance for their employees, it's going to put that business out of business. Millions of people in this country are going to lose their job with ObamaCare. The American people need to understand that, Mr. Speaker.

Not only that, it's going to be extremely expensive. We don't know what the ultimate cost is because we haven't seen the bill. Nobody can see it except for the few handpicked minions of the Speaker and the majority leader of the Senate. We don't know how much it's going to cost, $1 trillion, $2 trillion, $3 trillion.

We know this, Mr. Speaker: When Medicare was brought into being, the cost estimates of Medicare missed the mark terribly. Medicare has cost many, many times over what it was projected to cost by the Congressional Budget Office. I think that's exactly what we are going to see with us today.

Congress, Mr. Speaker, is spending money that it doesn't have. We hear people over and over again say, well, government will provide free health care for me. There is nothing that's free, Mr. Speaker, and health care is not going to be free. Who is going to pay for it?

Mr. Speaker, our children and our grandchildren are going to pay for it. It's going to cost them their livelihood. It's going to cost them their standard of life, their standard of living, because they are going to live at a lower standard than we do today because of this outrageous spending that this Congress and this President have been doing since January.

It's got to stop, Mr. Speaker. The American people need to understand exactly what ObamaCare is going to mean to them. It's going to cost jobs. It's going to cost our children's future. And seniors need to know that it's going to cost them tremendously.

In the nonstimulus bill, and I call it a nonstimulus bill because where are the jobs? The President promised us that if we passed his stimulus package, we would not reach an 8 percent unemployment. Well, it's approaching 10 percent. In my district in Georgia, in many counties, it's nearing 14 percent. In many communities around this country, it's even higher than that. I have already said that ObamaCare is going to put more people out of work. We are going to have more joblessness throughout this Nation.

We cannot continue to spend. You cannot spend yourself into prosperity. It's impossible. And that's exactly what we seem to be doing. In fact, the President came to the Republican Conference when he wanted us to vote on his stimulus package, and he said he wanted bipartisanship, which is laudable. But then he went on to say he wanted bipartisanship but we needed it and must vote for his bill. He didn't want any input from us.

He's said that his door is open for Republican ideas on health care, but he won't listen to us. We've tried and tried, but he doesn't listen, because with the President, with the Speaker and the majority leader, it's their way or no way.

In the nonstimulus bill, there was funding for what is called comparative effectiveness research. And in medicine, as a doctor, what we'll do is look at comparative effectiveness of different treatment programs. We will decide, for instance, for prostate cancer if surgery alone is more effective than radiation therapy alone or chemotherapy alone. And we will compare the effectiveness of those treatment modalities, those treatment options, or maybe surgery plus radiation, surgery plus chemotherapy, surgery plus all three. This is what we do in health care. This is what we do in medicine today. We compare the effectiveness of treatments: one medicine for high cholesterol versus another medicine for high cholesterol; one medicine for diabetes versus another; one medicine for high blood pressure versus another. We do

this comparative effectiveness. But that's not what the Democrats put into the stimulus bill with their comparative effectiveness research. And in the new bureaucracy created by ObamaCare here in the House, there is a comparative effectiveness panel that is going to make decisions about seniors and what they can get in the way of treatments, medicines, surgeries, everything. And it's going to be age related. So they are going to use an age-related cost comparative effectiveness of looking at spending dollars, not treatment outcomes, not whether one treatment saves lives over another, but how to best spend the limited dollars that the Federal Government has.

We don't have unlimited dollars, Mr. Speaker, and we cannot continue to print dollars like we're doing today. It's got to stop. We've got to stop printing money. We've got to stop borrowing from our children's future. We've got to stop this outrageous spending, Mr. Speaker, and we've got to give people choices.

Republicans have offered many bills. Over 40 Republican bills, alternatives to ObamaCare, to H.R. 3200, have been introduced in the U.S. House of Representatives. Each folder contains a separate bill. Republicans are offering folks in this country options, options to lowering the cost of health care, options to make sure that patients have the ability to choose their own doctor, and that in that doctor- patient relationship, that's how health care decisions are made, not by some bureaucrat that H.R. 3200, ObamaCare, is going to put between the patient and their doctor.

In fact, just today, I introduced my own bill. It's in this stack, one of them. Mine is a little over 100 pages. By the way, I have read my own bill. I doubt Nancy Pelosi ever read her own bill. But I read my own bill. We call it the OPTION Act. The OPTION Act stands for ``Offering Patients True and Individualized Options Now Act.'' My bill will make the purchase of health care more affordable to more people because it drastically expands the individual markets available for all of us and gives us many options.

Right now, most people in this country only have one option, and that's the insurance that their employer provides to them. About 85 percent of America has that one option. Medicare and Medicaid patients only have those two government options, one each. Also my bill increases pooling options. What my bill will do is it will allow what we call associations to be formed, if they are not already there, to offer health insurance to their members. For instance, I'm a Rotarian. Rotary International could have one or more health insurance plans that they offer to all Rotarians and Rotarian families around the country. I'm also an alumnus of the University of Georgia. We can have a UGA health care option that people could buy into. I'm a hunter. I'm a fisherman. We could have a hunters' option and a fisherman's option. We could have a bricklayers' option and a carpet layers' option. This will increase the options and thus increase the marketplace for all Americans. And the more options you put on the marketplace, the lower the cost is going to be. Plus, it will help to drive down some of these outrageous salaries that the insurance companies are offering their executives.

Mine will lower the overreaching cost of health care for everyone through the tax system, because what my bill will do is give 100 percent tax deductibility--let me repeat that--100 percent tax deductibility for everybody for every health care expense. And this is above a standard deduction. So it will allow an income tax deduction on all health care premium costs for everybody. It will allow individuals to make tax deductions to any health care expense, including their expenses that are funded through a health savings account.

My bill markedly expands the health savings account and gives people the ownership of that where they can turn their health savings account into their estate so that their beneficiaries, their family, will receive the benefits. In fact, it even creates a Medicare health savings account and allows Medicare patients to buy health insurance, private health insurance, on top of the health savings account. It gives them ownership. It will be funded through Medicare. But it will be such that they will own that, and that will go into their estates, too, if they don't spend all the funds.

The AARP can, for instance, sell them supplemental insurance on top of their Medicare health savings accounts, and all the insurance companies will be able to continue to do business. But it creates a marked amount of market forces in the health care field.

My bill will also repeal and reform the barriers that currently exist for physicians to donate their services to people who don't have health insurance or can't afford to pay for their health care. And many others things are in my bill, H.R. 3889, the patient OPTION Act.

Republicans offered many alternatives. The American people, Mr. Speaker, need to know that what they hear from our Democratic colleagues, that Republicans don't have a plan, is absolutely false. It's trying to mislead the American people. And the American people should call them on that and say shame on you for making these outrageous statements because they know it's not factual.

We have many plans. I have been joined tonight by several other physician colleagues here in Congress. We are offering many alternatives. Another family doctor is a freshman who has been very vocal in this from Shreveport, Louisiana, Dr. John Fleming.

I welcome you, Dr. Fleming, to this discussion tonight. I know you have a lot to say, and I will yield to you.

I want to reclaim my time just 1 second because there's an extremely important point, Dr. Fleming, you just made, and I think the American people need to understand that. So I would like for you, if you would please, to repeat the statement that you just said, and then I want to ask you a question about that statement, if you would. Please repeat that statement.

The physician reimbursement rate is the point I wanted you to really focus upon, Dr. Fleming. I know you've talked to a lot of doctors in Louisiana, just like I've talked to a lot of our physician colleagues from Georgia, and really from all over the country. The doctors' reimbursement rate is what doctors are paid. That is now below what it costs them to deliver the care. I think most physicians would agree with that, wouldn't you?

Then if doctors are cut more, that's through Medicare and Medicaid today, if doctors' payments are cut even more, what's going to happen to a senior's doctor who is out there trying to take care of folks now and being underpaid by Medicare? What do you think is going to happen? What is the doctor's response going to be? What does it have to be?

That is right, and that is what the Cost Effectiveness Panel is going to tell seniors is you just can't get that surgery, you just can't get that test you need. But doctors are going to quit seeing Medicare patients is what is going to happen. I have talked to a lot of physicians. So seniors particularly are going to lose, because they are not going to get the medical services that they need to keep them healthy and keep them living, plus they are going to lose their doctor that they have trust in today.

In fact, in some communities, some patients have difficulty finding a doctor who will take Medicare, and a lot of communities, even in my own community, patients are having a hard time finding a doctor that will take Medicaid, or PeachCare, which is the Georgia SCHIP, State Child Health Insurance Program payment.

Doctors are going to be forced to abandon their acceptance of these patients. They want to see these patients, but they are not going to be able to do so because of the economic squeeze upon the doctors. Right now doctors are being paid less than what it costs them to actually give the service.

That is not fair either to the private side.

That is the reason we know that millions of people are going to lose their private health insurance, because they are going to be forced off of it and forced into this so-called public option, this government, bureaucrat-run, socialized health care system. And we already see we have several government, bureaucrat-run health care systems, Medicare being probably the most notable one, which is already rationing care.

It tells me as a doctor and you as a doctor when we can put a patient in the hospital or not and how long they can stay there or not, whether they can get a medication or other types of treatments or not. And they want to put everybody in that kind of system? I think not. That is not what is in the best interests of the American people. The American people need to understand this.

We have also been joined by another good friend of mine, also from Louisiana. We are blessed in the Republican Conference with three excellent physicians from the State of Louisiana. Dr. Bill Cassidy is a gastroenterologist, and he has been working in a public hospital for years and taking care of patients that have had problems with health insurance.

Dr. Bill Cassidy is one of the sages of the freshman class and an excellent physician from Louisiana. We are blessed to have him here tonight, and we are blessed to have you, Dr. Cassidy, in the Congress to help us discuss the issues about health care finance reform.

This whole discussion is not about health care reform. We have got the best health care system in the world. Some of the Democrats will refute that statement, but, factually, people come from all over the world for our health care because it is the best in the world.

Dr. Cassidy, thank you for joining us tonight. I will be glad to yield to you for a while.

Tell me it is not so. It is going to go up? The health care costs are going to go up?

That is outstanding.

Let's go back to something we said with both of you, Dr. Fleming as well as Dr. Cassidy. H.R. 3200, the Pelosi-ObamaCare bill, is going to raise overall costs of health care in this country. It is not going to lower the cost; it is going to raise the cost. Not only do we have this administration estimate that it is going to increase the cost, but even CBO said it is going to increase the cost. CBO said it is not going to cover everybody.

Absolutely. So it is going to cost more money for everybody, and it is going to cost jobs. Millions of people are going to be put out of work by the ObamaCare bill. And we have got all these bills. Every folder has a different bill that the Republicans have introduced, many, many alternatives, that will lower the cost, let me repeat that, lower the cost for everybody and get more people on insurance.

We have also been joined tonight by another good friend, a freshman from Tennessee who has been very eloquent in telling us about the Tennessee experiment that is exactly the same experiment, the same program that Nancy Pelosi and Barack Obama and Harry Reid are trying to force upon the American public called TennCare. It didn't work in Tennessee and it is not going to work here. In fact, one of the definitions of insanity is doing the same thing over and over again and expecting different results.

We have already done it, haven't we, Dr. Roe?

Let me interrupt you and just say that we hear that over and over again. We hear claims from the Democrats that the Republicans don't have a plan. Look at all these bills. Every folder has a Republican bill in it. I have my own there. Many other Members, all these are Republican plans, Republican bills to help rein in the costs and give people more options.

Yes, sir.

Reclaiming my time, as a family doctor, it's always been a problem for me to get patients to comply with these wellness suggestions that I make that Dr. Roe is taking about. I talked to a hospital administrator in my district Monday, and he told me that their health insurance plan for their employees has a $2,500 deductible. But what they put in place was, if a patient smoked, they would pay a $2,500 deductible. If they have high blood pressure, they pay a $2,500 deductible. Diabetes, if they didn't lose weight and control their sugar, they had a $2,500 deductible for everybody.

But if you don't smoke, they'd give you a $500 credit. If you controlled your blood pressure, they'd give you another $500 credit. If you controlled your blood sugar, another $500 credit. If you lose weight, another one. And people could actually, by doing these things that we all suggest to our patients to make them healthier, and make them less liable to expend health care dollars, people could actually get credits so they had no deductible. And if an employee didn't have those problems, then they didn't have the deductible because they were already under control, their blood pressure was controlled, their sugar was controlled, et cetera.

So going back to what Dr. Roe said, it was an excellent way of getting their employees to help take care of themselves and lower the cost for them as a company, plus it lowered the cost for all of their employees too. We've also been joined by my good friend, Roy Blunt from Missouri; and we welcome you, Mr. Blunt, anytime for, not only this Doctors Caucus Special Order, but you've got--you're very sage on these issues and I yield to you, sir.

Mr. Blunt, I want to point out here we have all these folders here on the desk. Each one contains a Republican bill to help reform the health care financing. Every single one of these, these are all Republican bills that have been introduced in this House of Representatives. Not one will see the light of day if Nancy Pelosi wants to bury them as she has thus far. Every single one of these is a plan that I think we could get a lot of Democrats, if they would ever have the ability to look at them and consider them.

But it's unfortunate that this leadership is saying it's either the Obama way or no way. And then they come and literally lie about us not having a bill. Just this morning during Special Orders, Democrats came in and said we don't have a bill. Here they are. The American people need to understand that.

Thank you, Mr. Blunt. I appreciate it and appreciate your chairing the task force to look at the health care from the Republican Conference side. We've also been joined by my dear friend and colleague, one of my mentors actually, Dr. Phil Gingrey, OB- GYN from Georgia. He grew up in Augusta, Georgia, that I represent. He was slightly ahead of me in medical school at the Medical College of Georgia, and we're just very honored to have you, Dr. Gingrey. I yield to you, sir.

I want to go back to Dr. Roe for a minute because we've got about 5 more minutes.

In Tennessee, you all put in a government-run health care program, just exactly the same kind of thing that Nancy Pelosi's offering us here in H.R. 3200, or whatever she's writing. We know those things.

Bottom line, very quickly in 30 seconds, did it work, or did it fail, and what was the outcome?

Thank you, Dr. Roe.

TennCare failed?

ObamaCare is going to fail. It's going to wreck our economy, it's going to put people out of work, and seniors are going to be hurt the most by ObamaCare.

We've got just a minute left.

I would like to go back to Dr. Fleming.

You're exactly right, Dr. Fleming. We'll pay more for less, we'll get poor quality care. It's going to destroy the quality of health care in this country.

CBO says it's not going to cover everybody, and we hear our Democratic colleagues say they want to cover everybody, but it's not going to. And it's going to hurt everybody. And it's really going to hurt the middle class.

When the President came and spoke to the joint session of Congress a couple of weeks ago, only one person told the truth, and that was Joe Wilson. Joe Wilson is the only person who told the truth.

The ObamaCare bill is going to give free health insurance to illegal aliens, it's going to pay for abortions, it's going to do a lot of things that people don't like. But the bottom line is people are going to be out of work that are working today. It's going to hurt our economy. It's going to hurt the elderly, because they're going to have their health care services cut, and they're not going to be able to get their services from the doctor or from the hospital that they need and deserve because of ObamaCare. And the American people need to understand these things. Millions of people are going to lose a job and be out on the street, and it's going to hurt our economy.

So the American people need to understand these things and rise up and say ``no'' to ObamaCare. Let us have a bipartisan debate on all of these Republican plans so that we can find commonsense market-based solutions for health care.

Madam Speaker, it is always an honor to be here on this floor where so much history has been made. I can't help but think of the quote from Thomas Jefferson: ``The natural course of things is for liberty to yield and government to gain.''

What we have been faced with and what is being negotiated behind closed doors, interesting negotiations, there are no Republicans that have been allowed anywhere near, despite all the promises of the most open government that we would have once President Obama was in the White House and Speaker Pelosi was Speaker and Harry Reid was the Majority Leader in the Senate. Those things just simply have not materialized.

I keep hearing people, and I have heard them on both sides of the aisle, say we want health insurance for everyone. What I want for everyone is health care; health care that is affordable, health care that is accessible.

Health insurance? I gave a speech to health insurance folks here last year and I pointed out, you think you are selling insurance, but this is not insurance. You are selling management by health insurance companies of health care. It is not insurance.

Look it up. Insurance is not paying a company to manage everything for you. Insurance is when you pay a little premium, a small premium, sometimes monthly, sometimes quarterly, sometimes for a whole year. You pay that to insure against some unforeseeable event out there in the future.

Now, when I was growing up in East Texas, there were precious few people that had any insurance, but the ones that did, they paid a tiny premium to insure against some catastrophic illness overtaking them or some terrible accident that left them in need of expensive health care, and that insurance would cover them.

For the rest of us, if you got sick, you knew exactly what the cost was at each doctor's clinic, at the hospital, and you also knew if you got sick and had to go to the doctor's office what it would cost. But if it was more than you could pay, then there was usually someone near the front counter who could work out a monthly payment for you to pay. But, as a patient, you had control of your health care.

I have been intrigued. It just leaves you with a broken heart to hear all the troubling stories from our colleagues across the aisle about the tragedies of sickness or accident. But I have heard the same thing except, many-fold more, about socialized medicine.

As an exchange student in the Soviet Union in 1973, I had a chance to see socialized medicine up close and personal, the way it gets after it has existed for a number of years. People rarely ever saw the same doctor when they went.

The doctors, it was not an honor to be a doctor there. College students with whom I came in contact and got to know, if they had a parent, a father or mother that was a doctor, they were not all that thrilled to tell you. They were tickled to death to tell you if they had a parent that was assistant to the assistant manager of a factory, but not so much of doctors.

Here in the United States, doctors traditionally have been paid well, and it has inspired the very best and brightest among us to aspire to go to medical school and become doctors to help people. And what seems to have been missing from heartrending story after heartrending story are any good stories.

So if someone is visiting the United States, and the only exposure that they have to hearing about our health care is from the stories from our friends across the aisle, they would certainly want to avoid U.S. hospitals, U.S. doctors and U.S. clinics because of all the terrible tragedies that seem to be the only thing that occur; when the fact is, this country provides a better level of care than anywhere not only in the world but in history.

I've had doctors who were historians indicate that before 1910--not even a full 100 years ago--before 1910, if you went to the doctor, the odds were about 50-50 that you would actually be helped by going to the doctor instead of being harmed by going to the doctor. Just down the road out here you can get to Mount Vernon, to George Washington's home. We have a beautiful painting over here similar to the one hanging in the White House of George Washington, all 6-foot-3\1/2\. Though some say he was not that tall, they knew he was that tall when they measured him on the slab after his death. But he died at an age that was unexpected for him because he seemed to be in such good health. He had been out marking trees that were going to be cut down. He didn't know that he might someday get a carbon credit for them, so he had marked them to be cut down. It was during the cold and during the rain, and he got a cold. He didn't get out of his wet clothing very quickly. He had dinner the night he came back. He didn't do much about the cold. But before long, it began to overtake him.

One of his closest friends in the world was his doctor, Dr. Craik. I think he was bled three times, and they just could not understand why they kept draining out the bad blood, as they thought, out of the great father of our country, and he just seemed to not be getting better. They didn't know the damage they were doing to this giant of a man.

But we get past 1910, and because of the free market system in this country, health care has been elevated to a level never before seen in the history of mankind. What is missing in some of the stories that have been told are some of the stories that I have personally heard and have become familiar with.

Sue Clark lives in Tyler. She told me that she emigrated from England. Her mother got cancer living in England and, as is normally the case with socialized medicine, there, in Canada and soon to be here if the health care bill either the House or the Senate is talking about makes its way and gets passed, signed into law, people will go on lists the same way here. So when the President says, We're cutting $500 billion or so in Medicare, but we're not going to deny coverage to anyone, not going to deny treatment, what we see in these other countries is that they're not technically denied treatment or care. They're put on lists. And as it goes with socialized medicine, in order for the socialized medicine health care system not to go broke, people end up dying on the list, waiting to get their health care coverage.

That's what Sue said happened with her mother. Because her mother got cancer in England, she died of the cancer, which would have been an unnecessary outcome, had she been living in the United States, as Sue said. Sue got cancer here in the United States. She didn't go on a list. She is a secretary,

as I recall, and she said she didn't go on a list. She knows she's alive today because she emigrated from England and got away from the socialized government, single-payer health care, whatever you want to call it, public option. Over there it's not a public option. It's a public requirement. But, anyway, her mother died of cancer because she was in a country that had the kind of health care that those across the aisle--many of them that is, not all of them--are aspiring to give us here.

By the same token, I know personally of incredible stories, of people who didn't have money for health care and doctors provided it, doctors who answered the call in the middle of the night and came rushing down to help, even though they knew there was a good chance they wouldn't get paid. Doctors, hospitals and clinics providing free care. I come back to my friends across the aisle who seem to indicate, like the one indicated earlier today that the guy was told because he was not from here in the United States and because he didn't have health insurance and because he didn't have $250 to pay cash, he could not demand and require that the doctor he wanted to see had to see him. My friend across the aisle was upset about that. He was told he'd have to go to the emergency room to get that treatment.

I've also talked to physicians who said that if there was any way to require even a $5 copay, it would root out so many of the people that just show up at the emergency room with colds, things like I get--maybe because of the stress or I'm not getting more than 2 or 3 hours sleep so often around here. We get colds. I don't go to the hospital. I don't go to the doctor. We have got great over-the-counter medical supplies. So you can go pick them up. I don't use insurance for those kinds of things. You just get what you need. I am familiar with what it costs. When I went out on my own as an attorney and left the big firm I started with, I was determined not to steal any clients, as I knew some lawyers had been accused of doing. So I started out with next to nothing. That first year that I was on my own, my adjusted gross income was $12,000. We had a daughter who was about 2, and the only thing we could afford to give her that Christmas was a free puppy dog that my late mother had found and thought my daughter would love, and she did.

I know something about having to scrape and scrimp and build a business. Within 3 years of going out on my own, I ended up paying more in income tax than I ever made at the big firm where I went to work after I got out of the Army service. So I know something about scrimping. I know something about not having the money to give your child everything you want. I understand. But the free market system, when allowed to work properly, can do amazing things.

But I'm telling you, Madam Speaker, and I would tell the world, I don't want health insurance companies or the government managing my health care. I want to make those decisions, and I want everybody else to have that same freedom. I want them to have coverage where they can afford it, and I want them to have the best health care that is available in this country, and that's doable. But not by socializing medicine.

You hear the stories over and over. We heard about a company in Canada which, in order to attract the best and brightest employees, was offering them the added perk that if you get sick and need surgery or need testing, we'll put you on a plane and fly you to the United States to get it done within 24 hours. That's what they were offering as part of their contract because you couldn't get that in Canada, working up there. But here if we emulate those systems, you go on lists.

The seniors, having lived on this Earth for so long, they understand what's going on. They understand when you talk about cutting Medicare $500 billion what that means, that they're expected to do as Robert Reich recently said, You know, they're not going to get the health care they need at the end of their lives; it's too expensive. Basically, we'll let them die within a couple of months.

If you remember the President's own town hall meeting at the White House, there was a lady there named Pam Sturm. She had said that her mother was 99, close to 100. Her own doctor said that he couldn't do any more unless she got a pacemaker, but that seemed awfully old to be getting a pacemaker. Everyone else said, Yeah, sure. Go for it, except, according to Ms. Sturm, the arrhythmia specialist. But he had never met her mother. Well, her doctor contacted the arrhythmia specialist and said, You really need to meet this lady before you make that medical call. Don't just do it off a list. You really need to meet her. He met her, and according to Pam, the specialist saw her and saw her joy of life, and he said that he, indeed, was going forward with the pacemaker. It's been 5 or 6 years since then. She's now 105 and doing well, according to Pam.

Now the question she asked the President, she wanted to know under President Obama's plan what treatment someone elderly could have, and asked this question: ``Outside the medical criteria for prolonging the life for somebody who is elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, a quality of life? Or is it just a medical cutoff at a certain age?''

I watched the video, and I typed this up so I could have every comment exactly right. President Obama said, ``We're suggesting--and we're not going to solve every difficult problem in terms of end-of- life care.'' My English teacher mother taught eighth grade English for most of her adult life, actually taught me English my whole life and got frustrated with me quite a bit. But I know that she would outline that sentence and say, The President needs to clean that up, just as she did with some of mine.

Anyway, he apparently is talking and thinking and trying to come up with an answer, kind of beating around the bush. But he goes on and says, ``A lot of that is going to have to be--we as a culture and as a society starting to make better decisions within our own families and-- and for ourselves.''

The President goes on and says, ``But what we can do is make sure that at least some of the waste that exists in the system that's not making anybody's mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what, maybe this isn't going to help; maybe you're better off not having the surgery but taking a painkiller.''

That is the President's answer. How ironic. She had just explained that her mother had lived 5 or 6 years, a very joyful life after the pacemaker, and here the President is saying, Maybe you're better off not having that pacemaker surgery but just take a painkiller.

The seniors get that. They understand what that means to them, and they don't need a death panel to read them the writing on the wall that comes from that kind of approach to health care.

I had one senior say that she's concerned that they're cutting health care costs for seniors because they know that's where all the wisdom-- not all of it but a great deal of most of the wisdom resides. The longer you are around, hopefully the greater your wisdom grows. I know from having been a judge that it is true. You live and you learn. Unfortunately, there are those who just live. Very unfortunate. Some never get to that learning part.

But we have seniors who have lived and learned. They've seen the threats of fascism. They've seen the threats of communism. The greatest generation that provided us the protection and afforded us the opportunity to enjoy the blessings we enjoy, and now we say, ``You know what, maybe you're better off taking a painkiller''? What have we come to? You know, are we so self-absorbed, and we look at the money that we're throwing around from this body. We're supposed to have the purse strings and have some self-restraint as an obligation to those who sent us here, and yet we pass a bill to spend $770 million on wild horse habitat to buy them another area the size of West Virginia so they can roam around more when we have 3 million or so people, I understand, who have lost their habitats? Why aren't we taking care of their needs by creating new jobs and creating the ability to afford health care?

My health care, my health insurance here in Congress, is part of the same

big thick booklet that all other Federal employees get to have, but it was costing over $1,000 a month. It was just too much. So I elected to go with a health savings account, and it went to $300--well, it's under $300 a month, but a majority of that goes into my own health savings account. I've had some disagreements with the insurance company. I hear lots of people say, Everybody in America ought to be able to have what our Congress has for health care insurance.

My answer to that is you don't want my insurance. I'm changing it at the end of the year. I don't like it. I'm changing it at the end of the year. But what you want is not the insurance I've got right now, I don't think. What you want are my choices, because I've got a big, thick book like everybody else in here, and all the clerks, all the support staff and personnel, all the Federal employees have the same opportunities. It's not exclusive to Members of Congress.

I do support I believe it's H.R. 615 that John Fleming came up with that a number of us have signed onto. I think it's a good bill, that Congress shouldn't pass any health care system created at least with legislation that we do not put ourselves on. It seems fair to me. But people should have choices, and that will bring about better health care options for people.

But you have health insurance companies right now managing health care. It's not insurance. They're just taking care of people's health care. And it reminded me that--and someone, Madam Speaker, may be interested in taking this idea and actually going public and trying to sell the public on the idea. Maybe it will work. It sure worked in health care. And that is to tell people, You know what? Gasoline goes up. Sometimes it goes down, but it seems like more often it's going up. So why don't we tell the American public, Look, we will provide you what we will call gasoline insurance. You pay us a truckload of money every month, and we'll give you a copay and a deductible, and then we will pay your gasoline bill above that every month. How does that sound? Well, that's what people are doing with health insurance, and they're paying an awful lot of money.

The same thing is true with Medicare and Medicaid. When you take the total expenditures for Medicare and Medicaid in the year 2007--we're still looking for 2008 full-year numbers, don't have them yet--we were approaching $10,000 average for every household in America to pay for Medicare and Medicaid. A small percentage of the population is on Medicare and Medicaid; yet the average is $10,000 for every household in America just to pay for Medicare and Medicaid. That just seems outrageous. There's an easier way. I filed a bill that has a solution. There are lots of other people that have suggested solutions.

I want health insurance companies to get back into the business of insurance, and the way to do that is to have a high deductible policy and to provide tax incentives for companies to pay into employees' own personal health savings accounts, not like the old kind where if you don't use it by the end of the year, you lose it. No. If you don't use it, it rolls over to the next year, and it will accumulate and grow. And statisticians tell us that young people in their twenties and thirties, the vast majority of them, if they do that, will have such tremendous accumulated amounts in their health savings account by the time they reach retirement age that they won't need nor want Federal assistance with their health care decisions or payments because they can address it themselves with their own health care savings account and with the money that they have stored up. We provide tax advantages for businesses to do that.

Now, I do agree with those on both sides of the aisle, and not everybody agrees but I think we do have some joint agreement, on the fact that we should have health insurance policies where the insurance company just can't up and cancel the insurance policy after you find out you have some dreaded disease. That seems grossly unfair. And I would agree that would be fair, and the Federal Government can do that. We can be about making sure there is a level playing field and there's fairness across the country. That's what we are supposed to do.

This body was never intended to run everyone's life in the United States. But you give control, you give the cost to the Federal Government of all health care in America, well, that can't be paid for by the Federal Government unless they get it from the people living in America; so they're forced to tax Americans more to pay for their health care, and then you have the Federal Government, whose role is supposed to be that of referee, not only being referee but being the player.

I mean, we are constantly, it seems, most every day having people come in who are having problems with the Veterans Administration or the Social Security Administration, and it is such a nightmare dealing with the Federal Government when they are the player and the referee. There's nobody else to go around. The Federal Government is it; whereas, if it took its role from our original Constitution, it would be the referee.

I heard someone call into my friend Sean Hannity's show and he was berating health insurance companies, and he said, One of your precious health insurance companies had to settle a lawsuit for $3 million dollars and that's why the Federal Government ought to be providing the health insurance for health care.

Well, he didn't know what he was talking about because what that shows is you don't want the Federal Government in the business of being both the player and the referee because they don't play fair when they're the only player and the referee. They treat you as some of our veterans have been treated or, should I say, mistreated. What you want is the Federal Government to be the referee.

To me, if the insurance company got tagged for $3 million for some heinous way they handled somebody's situation, that means the Federal Government is doing its job. It provided an arena in the judiciary system where people could have a right of redress. That's what we are supposed to do. And by having such a heavy hammer as the arena of redress, forcing the free market players out there to play by the rules, to be fair and don't mistreat people, we do a better job when that is what we concentrate on; not telling automakers how to make cars or taking control of all these other areas that we seem to have taken control of in the last year or so.

I want to go back to the comment of Thomas Jefferson: ``The natural course of things is for liberty to yield and the government to gain.''

Of course, it was John Adams that commented, ``In my many years I have come to the conclusion that one useless man is a shame, two is a law firm, and three is a Congress.'' What a wise man John Adams was.

With regard to health insurance, my bill that has been filed we have been trying to get CBO scoring on. But it may be recalled that earlier this year after CBO came out with a score on a Democratic bill that upset the White House, the head of CBO, the Congressional Budget Office that does all the scoring that people constantly refer to as this unbiased source, the head was called over to the White House, called to the woodshed at the White House. And lo and behold, after that trip to the White House, it's amazing how CBO seemed to try to reach out and help the majority party, the majority in the House, the majority in the Senate, and the White House.

So Senator Baucus can rush in a bill, rush in something that is not even a bill, just a plan, and get them to score it. Well, I was told back in June that they would not score my health care bill unless I could get it into the form of a bill that could be filed here in the House.

Well, I couldn't get my bill. I had the plan all drafted, what we wanted in it, and I could not get Legislative Counsel to put it into the form which is required in order to file it normally. And so we pushed and pushed. I told Newt Gingrich about my health care plan. He said you need to get that in bill form and get it scored. That should score. Well, I tried and tried. I was told, well, you are in the minority party and besides that, you are not on the Energy and Commerce Committee. So I got the highest-ranking Republican, Joe Barton, who was extremely helpful. He

made the request. He and his office started pushing to get my plan into a bill form so I could file it. That wasn't good enough. We got other Republicans. We kept pushing and pushing. It took about a month, but we finally got it into bill form so we could go about getting it scored by

I thank the gentleman, Dr. Broun from Georgia, whom I consider a mentor of mine, a family physician who has preceded me into Congress. And it's important that we physicians speak out on this important issue. We've come to a point now where the Democrat version of this, or versions I shall say, are about to be put together and put to a vote. And I think that we have an idea about what's going to come out on the other side of this, whether it's a hybrid or some sort of combination or one or the other, the Baucus bill, which mainly emphasizes increased premiums, taxes on health plans, on medical devices, if you will; and then on the House side, a plan with a so- called robust public option which we know to be a very robust takeover by the government of health care which will lead to a number of taxes.

Every one of them finance this program basically in two ways: one, raising taxes or a cost on premiums or both; and the other is gutting Medicare to the tune of a half trillion dollars. On top of that, it gets a running start by taking in revenue for about 3 years before actually spending it on anything to, again, cook the books and make things look better. And then on top of that is an impending decline in reimbursements to physicians of 21 percent in their Medicare reimbursements, which, again, adds another $250 billion of cost on this, which can be hidden. They're trying to hide it, but it's not successful.

That at the end of the day, this thing is going to be financed by a combination of increased premium costs--significantly increased premium costs--or taxes or both, and gutting Medicare to the tune of a half trillion dollars, and on top of that, another $250 billion of impending cuts to the tune of, at this point, of 21 percent, if not greater, to physician reimbursement, which if it ever goes into effect will basically collapse the Medicare market and accessibility of care to physicians.

Absolutely. It's only a fraction of the real cost.

Again, to look at the fundamentals of economics, today doctors are paid on average 80 percent of the cost of the care they provide. The rest is made up on private insurance. And if you cut that further, then physicians will find not only can they not break even on providing care to Medicaid recipients, they are going to lose money. And they can't afford to do that. They can't make payroll. They can't pay their light bill, their rent and so forth if they can't make enough money from their patients.

So the bottom line here is the basic dishonesty of this bill. It says that a half trillion dollars will be cut out of Medicare and it's going to come out of fraud, waste and abuse. After 40 years, no one has been able to figure out how to do that. No one advances a methodology for doing that today. And so if you add already the fact that physicians are paid less than their costs, an impending cut of 21 percent of their reimbursement and perhaps more in future years, and then another half trillion dollars, which is going to go against them and hospitals, what we're basically doing is telling seniors, Forget it; we're taking your health care, and we're giving it to other people.

If the gentleman would yield, I would like to extend that another step. Remember that I said earlier the only way doctors are making it now is that private insurance is making up the difference, it is making up the gap, on average $1,800 per family per year that is insured.

No. Absolutely. What this bill will do is not only gut Medicare and reduce the reimbursements to physicians already, but it is going to deliberately push people from private insurance, because this so-called competition is going to be an artificial market, which is really a low-ball, and it is going to force employers to push their employees onto this. So you will see Medicare enlarging. And when I say that, I don't necessarily mean in a generic way.

Just today, the Democratic Party released a trial balloon, saying, well, instead of calling it a public option, let's call it Medicare for everyone. Every physician will be paid at the Medicare rates for all these new patients.

So what you have in the end, just to summarize, is a growing Medicare pool or universe and a shrinking private insurance, which will drive insurance costs up steeply, and you will be left with basically a collapsed private insurance market.

I appreciate your yielding for a moment.

Absolutely true. Apart from being a family physician for over 30 years, I have owned small nonmedical businesses for a number of years, over 20 years, and we ran into this same escalation problem, 9, 10, 12, 15 percent, really, per year. Finally we said, What can we do to resolve this? And the Health Savings Account had been enacted again by the Republicans just shortly before that, and I studied it.

I used my background as a physician in the economics of medicine and I said, You know what? This, in effect, connects the patient, in this case me and my employees, back to the real cost of care. It should have a remarkable impact bending the cost curve down. We didn't use that term then because it hadn't been used. But to make a long story short, we implemented it. We are about 7 years down the road now, and our net increase in inflation cost has been less than 3 percent per year.

Will the gentleman yield on that?

On the subject of health savings account--and you heard me say our experience was less than 3 percent increase in costs per year. And you point out that it's the employer's dollars that are going into that account, not the employees. It's pre-tax or nontaxed, really; and it's used at the employee's discretion.

Just a quick example: had a lady who, when we first implemented this, she said, Well, I'm a little concerned because this means that I'll have to pay out of pocket, meaning out of the health savings account for my medications for my respiratory problems. And I said, Well, what is it that you take and how much does it cost? And she says, Well, I use several inhalers. It costs me $100, $150 a month for medication. And I suggested, Well, why don't you stop smoking and you'll save money on the tobacco, and you can stop your inhalers, probably. And sure enough, she did: came back 3 months later and thanked me. She felt better. She had a lot more money in her pocket, and it all had to do with the health savings account.

I just have 15 seconds of a thumbnail little summary I'd like to mention.

If ObamaCare passes, there will be increased taxes for the middle class--which the President promised wouldn't happen--and significantly increased private premiums. It will decrease services to senior citizens. It will explode the budget. And the bottom line is we will pay more for less

Thank you, Dr. Broun. I am pleased to be here.

Let me start off by saying I actually totally agree with our Democrat colleagues on the goals of health care reform. We have to control costs. By doing so, you can create access to high quality care.

As you mentioned, I have been working in a hospital for the uninsured for 20-something years, a public hospital in Louisiana, part of our safety net system, so it occurs to me that I know firsthand the need to control costs. In our budget, there is a fixed budget, if you will. If we exceed that, then we don't have the ability to provide more access. We do have to form those long lines. And I kind of applaud the President because he recognizes the need to control costs.

For example, he has more than once said that the price of failure is that costs will double over the next 10 years. In fact, I think the President has said that without his reforms or the reforms he agrees with, that we know that the costs will double over the next 10 years and they will be out of control. I think he recognizes that cost control is one of the three legs of the stool. Again, we must control costs in order to ensure access to high quality care.

But we on the Republican side, I think, have continually pointed out that his programs will lead to higher costs, not lower costs, and that is of concern to me, who has worked in a public hospital, that knows that once costs are out control, then you inevitably have a decrease in access.

I was struck today that there is an independent article that just came across the Associated Press that under the proposed overhauls, the U.S. health care tab would grow. That is the headline. And this is an analysis by the Health and Human Services Department looking at the impact of H.R. 3200 upon overall health care costs.

You know, in one sense, in one sense it is almost humorous, and in another sense, it is almost tragic. Because what we have been saying all along is that under these proposals, costs actually go up, and we know in our practice when that cost goes up, inevitably there is some sort of squeeze-down on people's access to high quality care.

By this, which is an independent government economist, this is the Medicare Office of the Actuary, it says that the report found that health care would account for 21.3 percent of the U.S. economy in 2019 under these reforms, slightly more than an estimated

share of 20.8 percent of the economy if no bill passes.

Additionally, it says that with the exception of the proposed reductions in Medicare, the legislation would not have a significant impact upon future health care gross costs. It adds, it is doubtful that the proposed Medicare cuts will stay in.

What we are seeing is that when the President says that reform must be done or costs will double, indeed, under their reform plan, costs more than double.

Another report by the Congressional Budget Office suggests that under the reform plans before us, including the Senate Finance Committee, that the rate of inflation will be 8 percent per year. That is compounded. That more than doubles costs. At a minimum, reform should not be more expensive than the status quo if cost is the issue.

So, Dr. Broun, I want to return, I think you are right on when you spoke earlier about your bill, and, of course, I am a cosponsor of H.R. 3400, which includes things such as Health Savings Accounts, that actually can bend the cost curve.

I was speaking to a woman back home who does small group insurance. I called her up and I said, If you have a family of four with an HSA and a wraparound catastrophic policy versus a family of four with the traditional insurance policy, what is the rate of inflation?

She said, Well, with the Health Savings Account and the wraparound catastrophic, about 6 percent per year. Now, that actually begins to bend the cost curve down. She said, though, for the traditional insurance policy, it is more along the lines of 9 to 11 percent per year.

So I think what we in this delegation, this conference, have found is that if we empower patients, if we do what a Health Savings Account does, which is take a portion of that health insurance premium, puts it into an account, and if the patient has money left over at the end of the year, it belongs to the patient, she can roll it over into the account the subsequent year, as opposed to a program which empowers government, which is a top-down, central planning Medicaid-Medicare type of program, which, as good as they are, nonetheless have inflation rates which are higher than the inflation rates for even traditional insurance policies. If we go with the patient-empowered process, we control costs. If we go with the same paradigm as this report states, we actually increase costs, the kind of government paradigm.

If I can defer to my colleague from Shreveport, Dr. Fleming actually has a very nice story about how they brought Health Savings Accounts into their small group and indeed lowered costs.

CBO, if I may, the Congressional Budget Office, because I find sometimes we get used to these terms, but the independent arm of Congress that evaluates the fiscal matters, if you will, whether or not something costs more or less or is just right, the Congressional Budget Office says the rate of growth will be 8 percent per year under the plans before us from the House Democratic leadership and the Senate Finance Committee, and that more than doubles costs in 10 years.

Well, Dr. Broun, we have. Let me say I was here this morning early, and I came to this Congress, I practiced medicine, OB-GYN, delivered almost 5,000 babies, and I came to this Congress with a nonpartisan background as the mayor of Johnson City, Tennessee. That was my political background. So I came here to try to help be part of this great health care debate.

How I started my time off was I brought every think tank that I could find--Brookings Institute, which is a left-leaning think tank, Heritage Foundation, Cato, AEI--into my office and sat down and listened to them and said, What is the problem? How do we define the problem of our country right now as far as health care is concerned?

One of them was escalating costs. How do we deal with that? How do we deal with the uninsured and how do we deal with preexisting conditions?

I think the thing that troubles most of us out there, and me as an individual, quite frankly, is if you lose your job, you lose your health care. That is something that everyone in this country fears, and certainly in a bad job market. So I thought about that at great length and brought some basic principles which we have, and I stood on the House floor this morning and heard three different individuals say that there were no other plans out there.

That is absolutely false.

Well, Dr. Broun, if you'll yield back.

And I heard my good friends, Dr. Fleming from Louisiana and Dr. Cassidy, both mention this. But I looked at it, and I thought How can we make insurance portable? How do you affect preexisting conditions? If you have a large group market, you don't have a problem with preexisting conditions.

For instance, in our city, where I was mayor, it didn't matter. How did we handle a preexisting condition? We took everyone in. Everyone paid the same rate, and we bought catastrophic coverage in case someone had a leukemia or a cancer or a severe heart problem and covered that issue.

We also used prevention and wellness. And I can tell you there are four organizations in my community, in my area, that have had minimal health care increases in the last 4 to 5 years. How do they do that? Well, they change the incentives from consumption to wellness. And let's say you

came in and you were hypertensive and you had diabetes and you smoked and you were overweight. Well, we would penalize you financially for that. These organizations--and there are businesses there that have been able to hold their costs down--but if you changed and modified your behavior, we rewarded you for that and you would actually earn money by changing your behavior.

And guess what that's done? That's empowered the patient to be in charge of their own health care. And we hear all the time about insurance companies. And I can tell you right now, I'm not sitting here defending an insurance company. And you and I--I'm a surgeon, and I've spent as much time on the phone trying to get an insurance company to approve care than I actually do in the cases. But in our own practice we have about close to 300 people who get their care from our group, 70 providers, 300 or so employees.

What we did, and what I've done, is use this as a health savings account card. And what Dr. Cassidy was talking about, so people understand how this empowers the individual, is this: so much money, whether it's $2,000 or $3,000 and you go buy first dollar. You're going to shop. I do. If I go get a scan, I want the best price. At the end of that year, if I don't spend that money, it goes into an account, as Doctor Fleming said. Now, how many people in our group chose to use this? Eighty-four percent, instead of traditional accounts, they used a health savings account.

Yes.

Dr. Broun, what happened was exactly as you point out. In 1993, we were spending $2.6 billion. We had a lot in the State of Tennessee on our Medicaid plan. We changed to a plan called TennCare. By the year 2004, it was a $7.5 to $8.5 billion plan. It tripled the cost. Forty-five percent of the people who got on the plan had private health insurance and dropped it--exactly what's going to happen in the public option. And how did the governor, a Democratic governor, rein in costs? He cut the rolls. He rationed care in that way. And that is exactly what will happen in a public option that we're talking about. We'll go into it in more detail.

Let me take 30 seconds and tell you if we could agree on this and pass a meaningful health care bill, this is all you have to do. Eliminate State lines so you can form association health plans; give tax credits for low-income people to buy affordable health care; have a tax deduction for individuals. Last year I was an individual when I ran for Congress, and I couldn't deduct my health care premiums. It made them 30 percent higher.

Number four, let young people who don't have a job when they get out of high school or college, let them stay on their parents' health care until they're 25, 26 years old. It costs the government a big fat zero. You can cover 7 million young people doing that.

Tort reform and SGR fix. Those are not terribly expensive things to do. I think we can all agree on them. And I believe we can get a meaningful health care plan that doesn't blow up a system that's working for 80 or 85 percent of the people right now.