Floor Statements

Mr. Speaker, I am a physician. I still see uninsured patients at the public hospital where I've worked for 20 years. Now, to give uninsured patients access to private health care, we've got to lower costs. But lowering health costs is more than just access; it's also about a stronger economy.

According to the White House Council on Economic Advisers, they had a study that explained that lowering health care costs lowers unemployment, raises the standard of living, and prevents disastrous budgetary consequences. Unfortunately, neither the House nor Senate bill lowers costs. The Congressional Budget Office says that each will more than double costs over the next decade.

Yesterday, the President released a new proposal combining the House and the Senate bill. But combining two bills that don't lower costs results in a third bill which certainly doesn't lower costs. If you don't lower costs, access and quality suffer, our economy suffers, people lose their jobs.

The American people--Republicans, Democrats, and Independents--want health care reform but they want reform which controls costs in reality, not just in rhetoric. They know that their health care, economy, and jobs depend upon it.

Dr. Boustany will be at the summit meeting.

Clearly, I think we can all agree on what are the goals of health care reform. We want access to quality care at an affordable price. And it kind of gives us a nice way to judge each of these.

I am struck. Medicare is going bankrupt in 7 years. Medicaid is bankrupting States, and we're about to create a third entitlement to rescue the first two. And a third entitlement that is going to be based upon the House bill and the Senate bill. The Congressional Budget Office has said of both the House bill and Senate bill that they more than double costs within 10 years.

So we're going to go from a status quo which may double costs in 10 years, to a reform which more than doubles costs in 10 years.

Folks ask me how do I like my first year in Washington, D.C. I say, it's a crazy place. We pass a reform to control costs which is more expensive than the status quo--and that is important because the American people since August have been saying, Mr. Speaker, that we need to control costs. They understand that you can give everyone access, but soon our costs are out of control and access is gone. You can give everybody the highest quality, but unless you control costs, again you break the bank.

So the American people since August, and with the Senate election in Massachusetts putting an exclamation mark behind the sentence, are saying, Control costs.

Now as it turns out, the proposals before the President, the Senate bill, again, according to Congressional Budget Office, more than doubles costs in 10 years, and the President's proposal will be a hundred billion dollars more expensive than that.

Now, the President is billing this as a tax cut to the American people, but really it's a shell game. Some folks will have their taxes simultaneously raised and their subsidies increased. Now, that's a crazy thing, but on the other hand, if you're going to subsidize here, you must tax there. And because some of the things being taxed are insurance policies--insurance policies owned by union folks, for example, who negotiated this through their wages--there will be a tax on folks who most consider middle income.

What are the alternatives? You mentioned something earlier, Dr. Broun. I said, man, you can tell the guy's a family physician. You talked about empowering patients. I think the fundamental difference between the Republican proposal and the Democratic proposal is that the Democratic proposal

is a top-down, control costs from Washington, D.C., type approach.

Dr. Boozman just pointed out that the price controls upon insurance policies is the ultimate in a top-down, bureaucratic, doesn't matter what the market says, we're going to control your costs from Washington. It never has worked.

On the other hand, the Republican approach is patient-centered. You and I know as physicians--and I am still seeing patients. I see them about once every 2 weeks in my practice. I work in a public hospital treating the uninsured. If you involve the patient in her care, she typically is healthier, she saves money, and the system saves money.

Health savings accounts, Dr. Broun, I know you know this, but for the audience, a patient will put, with pretax dollars, before you are taxed on it, will fund a bank account, and that bank account is used to pay for medical care.

As it turns out, with traditional insurance, say a family of four puts up $12,000, and then a year later they put up another $12,000, and then a year later they put up another $12,000. With a health savings account, if you don't use the money, it rolls over to the next year. And some families will continue to accumulate until the amount they have to put in is zero because they have been so wise with how they spend their money.

A good example of this, I am sorry Dr. Fleming left, because he talks about how his medical practice went to HSAs for all the employees. And he has an employee who was smoking. And she complained, because before the insurance paid for inhalers--the smoking had given her asthma--and now she had to pay for it out of her own pocket. So before she was cost-insensitive, and now, because it is out of her bank account so to speak, she is aware of it.

And Dr. Fleming said to her, Well, you know, if you stopped smoking, you wouldn't need that inhaler.

And she goes, Really?

He goes, Yes.

She stopped smoking, her health is better, she no longer pays for inhalers, and we are controlling costs overall. So by involving somebody in her care, her health is better, the system saves money, and she has more money in her pocket.

And, by the way, one last thing before I yield back, the Kaiser Family Foundation has a study. They found that a family of four with a health savings account, that that policy is 30 percent less expensive than a traditional insurance policy for a family of four; that the family with the health savings account and the catastrophic policy on top, not only is that policy 30 percent cheaper, but they use preventive services as frequently as a family with a traditional insurance policy.

Now, if our goal is to give high quality care to all at an affordable cost, well, what we just found out is with the HSA you lower the cost by 30 percent. Okay. That is one of your goals. And they are using preventive services as frequently. So they have access to quality care. As it turns out, because it is lower cost, 27 percent of people in this study who had a health savings account with a catastrophic policy were previously uninsured. About 50 percent had a family income of $50,000 or less, and about 60 percent had a family income of $70,000 or less.

So again, by lowering costs 30 percent, people who were formerly uninsured now have access to quality care. That is a patient-centered approach, far different from the bureaucratic approach that is being offered by the Senate and House bills. But from our experience as practicing health care providers, I think we can say it is the right approach.

I yield back.

You know, it is interesting because we can see from the Republican administration of Richard Nixon, the Democratic administration of Jimmy Carter on oil and gas, that when you try to artificially control price with regulation, it doesn't work. You have to address the fundamentals.

So let me give an alternative between this top-down bureaucratic means of control and a patient-centered approach. I was speaking about HSAs and patient-centered approaches with a constituent, and he says, you know, doc, I take a pill for my ulcer. Now, I have an HSA. My physician wrote a prescription and I said, physician, I know from experience that this pill is going to cost me $159--he didn't say $160, he said $159. He said, I have an HSA, I pay for this out of pocket, can you do me something different? And the physician said, oh, you have an HSA? Tore it up and wrote a prescription for generic and it cost him $20. The system just saved $139.

I have another patient who called me--I am a liver specialist--called me up, and she says, Dr. Cassidy, I have a bad heart. My doctor over here said I needed this test because of my bad liver, not my heart, but rather my liver. And I said, from a liver perspective, you don't need it. She said, well, I will pay for it if I need it, I have an HSA, but I will pay for it if I need it. I said, no, ma'am, you do not need it. The system saved $1,000. Because she had an HSA, she was motivated, she was motivated to find out how much it cost and then to see if she really needed it.

I will.

That is correct. It is kind of a crazy thing where if an HSA is used for a generic price on an over-the-counter drug, which is what we are describing here----

Which lowers cost, it's not available for an over-the- counter medicine. And so that $20 prescription is actually over-the- counter medicine, and we're talking about ulcer medicine. So in this way, the patient reacts so as to take care of her health and to lower her cost. And in millions of those interactions across the Nation, not from Washington, D.C., but rather from the exam rooms themselves is how the system saves costs.

You recall, Dr. Broun and Mr. Speaker, how we spoke of the HSAs being 30 percent cheaper. Well, that's why they're 30 percent cheaper because patients are incentivized to control their cost.

One last thing I will say. When you ask a crowded room who is most responsible for each person's health, we all know that it is that person in particular. So what the Health Savings Account does, the patient-centered approach does, it says that the patient is most responsible for his or her care, and in so doing, we trust that the patient, with her physician, will make the right decisions. And the story of Health Savings Accounts is that that is true, that is a well placed trust.

Mr. Speaker, on rollcall No. 48, I was unavoidably detained. Had I been present, I would have voted ``nay.''

Mr. Speaker, this may be the last address given on the floor of the House of Representatives this year. It is fitting that it is a tribute to Michael Cote, a specialist who gave his life while fighting to defend us in Iraq.

Specialist Cote was from Denham Springs, Louisiana. After graduating from Denham Springs High School, he met his wife, Ashlee, when the two were in basic training. They passed notes back and forth during their training and snuck off to church services to be together on weekends. Just days after basic training ended, the two soldiers were married.

Michael was serving in Iraq when their daughter, Brooke, was born in March, but he found a way to be on the phone with Ashlee during the delivery. She delivered in Baton Rouge.

Ashlee tells me that Michael liked to fish and hunt. She says he was an all-around country boy who liked to goof around but always knew when it was time to be a soldier.

Michael was serving as a crew chief when his Black Hawk helicopter went down in Balad, Iraq, in September.

On the day of his memorial service, the people of Denham Springs lined the streets to wave American flags as the procession went by. Families brought their children and grandchildren out to honor Specialist Cote, a tribute to a man friends and family in Denham Springs say they knew would grow up to be a soldier.

His mother, Carol Bass, tells me that she visits the grave daily.

Mr. Speaker, we mourn with Ashlee, Brooke, and Mrs. Bass the loss of Specialist Cote, but let us celebrate his patriotism, his dedication to country, his sacrifice on behalf of our security.

We are forever indebted to the men and women of our armed services, soldiers like Michael Cote, who put themselves in harm's way so that we may live freely and in peace.

Mr. Speaker, on rollcall No. 973, I was unavoidably detained. Had I been present, I would have voted ``aye.''

Madam Speaker, I rise today in honor of Sergeant Benton Thames from the Town of Springfield in Louisiana's Sixth's Congressional District. It gives me great pleasure to extend to Sergeant Thames immense gratitude and appreciation for his exemplary service to our country as Commander of the Relief at the Tomb of the Unknown Soldier at Arlington National Cemetery.

Sergeant Thames has dutifully guarded the Tomb of the Unknown Soldier for over two years. His responsibilities include changing of the guard and laying of the wreath at the Tomb. Sergeant Thames strives to make this ceremony special for the thousands of veterans and Americans who visit this sacred landmark annually. Sergeant Thames' dedicated service and commitment to our brave and courageous veterans and fallen heroes is truly admirable.

Sergeant Thames is a graduate of Springfield High School, and a former resident of Louisiana's Sixth Congressional District. In his spare time, Sergeant Thames volunteers with the Louisiana Honor Air program which aides World War II veterans in a variety of ways. I am honored by Sergeant Thames' service to our country and wish him continued success as Commander of the Relief at the Tomb of the Unknown Soldier.

Madam Speaker, I rise today in honor of St. James Episcopal Day School, located in the City of Baton Rouge in Louisiana's Sixth Congressional District. It gives me great pleasure to announce that St. James Episcopal Day School has been designated as a ``Blue Ribbon School of Excellence'' by the United States Department of Education.

The administration, faculty, staff, students, and parents of St. James Episcopal Day School have successfully demonstrated academic excellence in standardized test scores, curriculum, technology, instructional methods, professional development, and school leadership.

St. James Episcopal Day School is a Pre-Kindergarten through Fifth grade elementary school that was founded in 1948. At St. James, students are challenged to reach their full potential; to be active in faith; to be responsible for their learning; and to be accountable for their actions, thus preparing these students to be leaders in facing the demands of their future. With this honor, I can only hope that the school's next sixty years will be even more successful than its first.

Thank you, Mr. Speaker. Although you called me ``mister,'' I am actually a physician; and so in my other life--I actually saw patients just yesterday at a public hospital in Louisiana, a safety net hospital where I have worked for the last 20 years. So caring for the uninsured has been my life's work since completing my residency and returning home. I've learned that if you don't pay attention to costs that it doesn't matter how passionate you are for the uninsured; the fact is that you are unable to achieve your goals.

There are three goals of health reform, and they're commonly said to be controlling cost to provide access to high-quality care. In the hospital where I work, a safety net hospital, they are committed, they are so passionate for the underserved folks who are med techs, physical therapists, ward clerks, physicians and nurses. But the problem is, if there is a budget shortfall, then inevitably, services suffer.

So it doesn't matter how passionate we are in our service. The fact is that if there are insufficient resources in the State at the end of the budget year, then services suffer. It may be that the nurse staffing has decreased and hospital beds are closed so that if somebody comes to the emergency room, they have to wait in the emergency room before they're admitted. And inevitably when that happens, the hospital goes into what is called divert, whereas instead of coming to our hospital, they will be diverted to another hospital. That's because if you don't control cost, inevitably, access and quality suffer.

Now, I was struck that President Obama agrees with this. President Obama continually speaks about the need to bend the cost curve down, the need to control costs because if we do not control costs, then our economy suffers and the ability to provide care suffers. Now, it's one thing to say that we're going to control cost in order to expand access to quality care, but you've got to have a plan on how to get there.

There is a company called McKinsey & Company, and on their Web site, they have a great article that you can download called ``The Three Imperatives of Health Care Reform.'' Without achieving these three imperatives, then, we cannot control cost in a way which expands access to quality care. Now the three imperatives that they list are decreasing administrative costs, how much money we put into the

bureaucracy as opposed to patient care, incentivizing healthy lifestyle. Put differently, if people insist on smoking and drinking and if they're too heavy, it doesn't matter how much we throw at health care; we will never control cost because we are always try to catch up with the disease as opposed to preventing it. And, lastly, cost transparency. Someone going in for knee surgery needs to know how much her bill will be before she goes in as opposed to learning about it 2 months later when she gets the bill.

It is important for us, therefore, to achieve our goals of cost containment to provide access to quality care to work through these three imperatives. Now, the bill we just passed, H.R. 3962, on the face of it does not achieve these three imperatives. As an example, if you are going to decrease administrative costs, you don't achieve a decrease in administrative costs by creating 111 new bureaucracies, boards, and commissions. It is just laughable to think that we are going to put that much more money into administration, build that many more buildings, hire that many more people and at the same time say we're decreasing administrative costs.

There is very little in the bill that incentivizes a healthy lifestyle. You can argue that those provisions in the bill that address this weaken the current provisions that we're finding effective. And, lastly, there is not a whole lot that provides cost transparency. Indeed, one of the things that has been used to encourage cost transparency is the use of health savings accounts, and now health savings accounts are being taxed, as they have not been before.

So it's not surprising if these three imperatives are not addressed that we can say that cost is not being controlled. Now, by the way, it's not just me who says that costs are not being controlled. We have here a quote from The Washington Post, and we also have a quote from The Washington Times. The Post article says, speaking of this bill: ``It does not do enough to control costs, and it is not funded in a sustainable way.'' The headline from The New York Times--I think this was November 10--``Democrats raise alarms over health bill costs.'' Democrats are raising alarms over the cost of this health bill. That's so important because if you can look in any health care system, if you don't effectively control costs, eventually access to quality care suffers.

I have been living this for 20 years. In my life, I know this to be true. So here we see from a couple different sources, The Post and The Times, that this bill does not do enough to control costs.

Now, it turns out it isn't just The Post and The Times that have such concerns. There is an article in Reuters, and Reuters says that China is now questioning the cost of our U.S. health care reform. Since China buys so much of our debt, it turns out they have a vested interest in making sure that we have our financial house in order. So to read the article from Reuters: ``Guess what? It turns out the Chinese are kind of curious about how President Barack Obama's health care reform plans would impact America's huge fiscal deficit. Government officials are using his Asian trip as an opportunity to ask the White House questions. Detailed questions. Boilerplate assurances that America won't default on its debt or inflate the shortfall away are apparently not cutting it.''

I think it's important for us as an American people and our country to look at the bill that was just passed that is going over to the Senate and to analyze how well does it control costs. Are the Chinese correct? The Washington Post, The New York Times, are their articles correct? Or does it, indeed, actually control costs and everyone else is a little bit confused about it?

Well, let's go into that. First, remember our three imperatives: you have to decrease administrative costs, you have to incentivize healthy lifestyles, and you have to put in cost transparency. Let's talk about incentivizing healthy lifestyles and how you do so. Now, as it turns out, when the President talks about preventive medicine, one of the kinds of dirty little secrets of this--and as a physician, I can say this--if you are talking about things such as colonoscopy, actually, if we did a colonoscope on everybody over 50, as per the current recommendation, it actually costs the system a little bit more. Now, it's a good cost. If you find a polyp, remove it, and prevent cancer, that is actually a very good thing; but it doesn't save money.

But there are some things you can do that will save money. If you can get someone to stop smoking, it actually saves the system money. It also helps them in terms of their health. If you can get someone to lose weight, it actually saves the system money. General Motors did a study--they have got so many employees, they can do this sort of thing--and they found that for every 10 pounds that an employee lost, that their health care costs went down significantly. If the person had high blood pressure, and they lost 10 pounds, their blood pressure got better. They required less medicine. If they had diabetes, the diabetes became easier to control or in some cases the diabetes would go completely away.

Now, there are ways that you can incentivize a healthy lifestyle. Under current law, companies are allowed to decrease by up to 20 percent the premiums they charge their employees if the employee participates in a wellness program. So, for example, Safeway, which is a large grocery store chain across the United States, had a program where they will decrease their premiums by 20 percent for those employees who participate and attend a smoking cessation program. When they do so, they find that people--surprise, surprise--stop smoking.

Similarly, if someone joins an exercise program or a dietary program if they are overweight and they lose weight--now, frankly, as I recall the way it's structured, is that the person just has to join the smoking cessation program. They don't actually have to stop smoking. But just as it turns out, people, if exposed to information, act on that information, and they adjust their lifestyles. So either by an exercise program, a dietitian or by smoking cessation programs, by participating in these, they will lose weight. And Safeway has kept their costs for their health insurance constant, whereas there has been about a 7 to 10 percent inflation rate over the United States.

I just met with a company based in my hometown of Baton Rouge, Edelmayer, and Edelmayer has been having about a 10 percent inflation rate. But 2 years ago, they instituted a program where they first had all their employees come in for a health assessment. Last year they had all their employees come in for a health assessment--for example, do you smoke, are you overweight, but also a physical exam. Next year they are putting in, as a covered benefit, a smoking cessation program.

Then 2 years from now--this is a 4-year process--they are going to decrease premiums for those that participate in these smoking cessation programs. Their premium costs, which have been increasing 7 percent to 10 percent per year, are projected to only rise 3 percent per year when they institute the full program. So by putting in or incentivizing healthy lifestyles, they're going to lower their inflation rate to 3 percent per year.

Now, H.R. 3962 actually weakens these provisions. Republican amendments offered in committee would have increased the amount an employee could save if she participated in a wellness program, but these were defeated basically on party-line votes. Similarly, there is a disassociation in H.R. 3962 from what a company can do to incentivize healthy lifestyles and how this provision works.

As an example, H.R. 3962 requires that a company pay at least 72.5 percent of an employee's insurance premium. Well, if you've got to pay at least 72.5 percent, that limits the amount you can decrease in order to incentivize somebody to participate in a wellness program. Now, the way you could say it is, if someone participates in a wellness program, you would pay 72.5 percent, but if they do not, you are allowed to decrease your contribution to 68 percent.

Now, remember, I'm not saying they have to stop smoking; I'm just saying they have to participate in the wellness program to stop smoking. So there's a key difference. Some people will not be able to, but most people, if given the facts, will be able to do so. So if one of our three imperatives of lowering health care cost is to incentivize

healthy lifestyles, we actually see some of the programs which are now working well are gutted or made less able to work effectively under the bill that we just passed.

Now, we're never going to control cost if we do not incentivize a healthy lifestyle. As a physician, I will tell you that part of what is driving the cost of health care in the United States is the cost associated with diabetes, high blood pressure, heart attack and stroke. The prevalence of these diseases is so much more in our country relative to Europe that there's at least one article out there that suggests that the entirety of the cost differential between the United States and Europe is because the increased expense of treating these diseases such as diabetes, hypertension, high cholesterol, stroke, heart disease; they all kind of go under the term of a metabolic syndrome, if I'm allowed to speak like a physician.

And so if we're not going to get a handle on these, if we're not going to incentivize a healthy lifestyle so that we're not treating the disease on the back end, as opposed to preventing it on the front end, then we will never achieve one of our principle three goals, which is to control cost, because, again, working in a public hospital for 20 years, I've learned, if you do not control cost, you do not have the adequate resources to expand access to quality care. And according to the independent sources, The Washington Post, The New York Times, China, this cost, this bill before us has significant issues as regards its ability to control costs.

Indeed, Centers for Medicare and Medicaid Services, called CMS, the Federal government's already paying for Medicare, which is the health care program for folks 65 and above, and a large amount of money for Medicaid, which is the State Federal program for the poor in each State. And there is a new study, the Centers For Medicare and Medicaid Services, that finds that the health care reform bill recently passed in the House of Representatives will increase health care spending to 21.3 percent of our Gross Domestic Product, compared to 20.8 percent under current law, bending the curve the wrong way.

If the President says that if we do nothing the status quo is such that costs will double, as it turns out, under the reform package passed a week ago in this Chamber, costs more than double. As crazy as it sounds, the reform bill we passed, according to the independent Centers For Medicare and Medicaid Services, the reform bill costs more than the status quo. And I keep saying that because the President said we've got to have reform to control costs. And according to the Federal Government, our reform costs more than the status quo. At a minimum, reform should not cost more than the status quo. We shouldn't bend the curve the wrong way. We should bend the curve the right way.

In addition, the CMS study gives a clearer cost estimate than the one previously given by the Congressional Budget Office. According to the CBO, the 10-year cost of the plan was $894 billion. But the analysis included earlier years of very little government spending. According to the Center for Medicaid and Medicare Services, the House approach will cost $1 trillion from 2013 to 2019, or some $140 billion a year when put into effect.

So, in 7 years, it will cost $1 trillion. Clearly, if the goals of health care reform are to control costs so that we can expand access to quality care, according to our government, the Chinese government, two prestigious newspapers, this bill did not do so. What does it do? Well, one thing it does is it takes power away from patients and it turns it over to the Federal Government. Now, it's going to sound like rhetoric, so let me elaborate. Again, as a physician who's worked for 20 years with the uninsured, I've learned that when you put the patient in the middle of process, if you say the most important person here is the patient, then actually, you tend to lower costs and have healthier patients.

If you think about it, that program which lowers someone's premiums 20 percent if she participates in a wellness program, it puts the responsibility for someone's health on the person with the greatest ability to make a change--that is the patient. If she is financially rewarded for having a healthier lifestyle, as it turns out she'll have a healthier lifestyle. We, as a society--not only will she be healthier, she will have lower costs and, frankly, those lower costs, among millions of patients, if you will, lowers the cost for the system.

There's one way to explain this. There's something in the Republican proposals called health savings accounts. Now, in a health savings account, you put the patient in the middle of the process in the following fashion: A health savings account takes the money that a family would normally spend for a health care premium. It sluices off a portion of it and puts it into a bank account. So if with a traditional insurance policy, at the beginning of the year, a family of four puts up $12,000, if at the end of the year they've not seen a doctor, well, they've put up another $12,000 for the next year. At the end of the year they put up another 12,000, and every year they put up another 12,000. In a health savings account you sluice off a portion, and you put it into an account.

Now, that money comes from the money you'd ordinarily be spending for a premium. But instead of spending it for a premium, you put it in this bank account. And instead of asking the insurance company to pay for a flu shot, you pay for it out of your bank account. Instead of asking for the insurance company to pay for your arthritis medicine, you'd pay for it out of your bank account. The advantage is, at the end of the year, if you have money left over, instead of losing it, it rolls over until the next year. Or, if you have a family member whose costs are excessive, you can donate portions of your health savings account to your family member.

And so, with that money, it is money that you are incentivized to spend wisely. I'll give you an example. Two patients come to mind, or three patients. There's one patient who's got a traditional insurance policy, and a very nice woman. And she's got an expensive policy but she's a woman of means and she can afford it. And she says, I never look at the bill. If the doctor writes me a generic or a name brand drug I don't care. My insurance pays for it. When I get a bill from the hospital, I don't look at it. The insurance pays for it.

And so, because the insurance pays for everything, she likes her insurance policy, but she's got the money to pay for it. Contrast that with someone like the gentleman I'm about to describe. We're talking about health savings accounts. He goes, I have a health savings account. I went to my doctor and my doctor wrote me a prescription for a medicine that I knew by experience would cost $159. Now, notice, he didn't say $160. He said $159, because he's paying for this out of his account. And he said, my doctor wrote me for this medicine for $159. I said, Doc, I have a health savings account. Do you mind writing me for something cheaper? And the physician said, I'm sorry. You have an HSA, and he tore up that prescription and he wrote him for a generic.

Now, you can say, why didn't the doctor write for the generic in the first place? He probably should have. On the other hand, who is most responsible for an individual's health? The person most responsible for an individual's health is that individual. And so, just like if I were to go to Target or Wal-Mart and say, okay, I'm going to buy school uniforms for my children, it's really not Target's responsibility to prove to me that they are cheaper than Wal-Mart. It's my responsibility to see who's cheaper and then to go to the place that gives me the best value for my money.

So it puts the responsibility where probably it most rightfully should be. And frankly, with that responsibility, the man responded. Instead of getting a medicine that costs $159, he got a medicine that cost $20. The system saved $139. If you multiply that across the millions of transactions, then this system saves millions and even billions of dollars.

Now, we have just gone from the anecdote of an individual patient. Let's talk about a study. Kaiser Family Foundation, a little bit of a left of center group, but a good group, did a study where they compared the cost for a family of four which had a health savings account with a catastrophic policy on top, so if they have a terrible illness like a liver transplant that exceeded

the amount of money in their account, the catastrophic policy picks it up on the top end. They compared it with the cost of a traditional insurance policy for a family of four. They found that the family of four, with the HSA, the health savings account, and the catastrophic policy on top, they found that that family's cost of that HSA and catastrophic policy was 30 percent cheaper than the cost of the traditional insurance policy for a family of four. And they found that both families used preventive services as frequently.

So what we have here, if our goals of health care reform are to control cost, to expand access to quality care by lowering premiums, the Kaiser Family Foundation found that the family with the HSA and catastrophic policy, their policy costs were 30 percent cheaper compared to traditional insurance.

They also found that 27 percent of those people who had an HSA and a catastrophic policy were previously uninsured; that 50 percent of people with these sorts of policies had family incomes of $50,000 or less, and that about 60 percent of such families had family incomes of $70,000 or less.

So, by controlling cost, the HSA catastrophic policy, 30 percent cheaper, by controlling cost, those people who were previously uninsured, 27 percent of the folks with these HSAs were previously uninsured, were able to now purchase insurance, and with this insurance they access preventive services as frequently as those with traditional policies. So the goals of reform were achieved. Lowered cost, expanded access to quality care.

I've been joined by a colleague of mine who is also a physician, a family physician, also a small businessman. And Dr. Fleming, we're discussing costs and how control of cost is so essential to expanding access to quality care. Do you mind sharing the anecdote of that employee, when your group went to HSAs, because I want to show how the two things I've discussed so far have been how you can incentivize healthy lifestyles and control costs by decreasing premiums, if you will, and also how health savings accounts, by directly connecting people with costs, can also be cost savings. Your anecdote combines those two. Can I ask you to share that?

If the gentleman will yield.

By connecting her with costs, if you will, you are incentivizing a healthy lifestyle.

If the gentleman will yield.

You said that all of your employees in your group are on health savings accounts now?

We sometimes hear that health savings accounts are only for the wealthy, yet you've heard me quote that study that found that 27 percent of people with HSAs and catastrophic policies were previously uninsured.

And so as I know--and I'll yield back now--your business is a service business so I assume that people are of moderate income, and yet this is the policy that they have all chosen. So unless you tell me that all of these folks are wealthy, I will assume indeed this is something that works for middle America.

So what you've told me is that families have been incentivized to be wise with their health care dollars, and at the end of every year, instead of losing that dollar, it rolls over and it accumulates. Now they put that much less money for the following year. For those particular families, their cost of insurance, if you will, is decreasing annually, I would assume.

If I can contrast your patient-centered approach where you put the patient responsible, the person most responsible--the patient, your employee--in charge of the dollars she would spend for her health care and in so doing she responded in rational economic way. She didn't want to spend money on inhalers so she stopped smoking, so therefore she stopped needing inhalers and the whole system saved money.

Contrast that with the bill that we passed a week ago in which now there is going to be a tax on health savings accounts.

So the example I gave, if I may continue, is where the patient asked for an

over-the-counter generic instead of the prescription medicine knowing that the one was as good as the other, and one costs $20, one cost $39, and yet now by the bill that was passed by our colleagues on the Democratic side of the aisle, we are now going to tax the purchase of over-the-counter medicines when that purchase is made with a health savings account. It seems like we're going backwards in terms of incentivizing people to use less costly drugs.

I yield to the gentleman.

Now, on the other hand--let's be fair to this bill--it does attempt to pay for its exploding costs.

Before you walked in, I mentioned the Centers for Medicare and Medicaid Services found that the bill that was passed--although 39 Democrats joined Republicans in opposing it, it still passed on basically a party-line vote--that because of that bill, health care spending will increase to 21.3 percent of our GDP compared to current law; 20.8 percent would be under current law. And bending the cost curve the wrong way, if you will, or bending the cost curve up, we are yanking on that thing. But on the other hand, they do attempt to pay for it.

If the gentleman will allow me to go forward. They are creating $730 billion in tax hikes. Some people have called this a tax bill disguised as a health care bill: $460 billion tax on small businesses and high earners; $135 billion employer-mandate tax; $33 billion individual mandate tax. You mentioned how you are a small businessman as well as a physician.

I am going to yield to you and ask you if you can comment on how these taxes would affect you as a small business person.

So lay people off. It is projected, I see, using the methodology of the White House Council on Economic Advisors, that the tax hike, $730 billion in tax hikes to address this cost--which, by the way, inadequately addresses it--would kill 5.5 million American jobs.

So there's mandates on businesses and individuals, there is a loss of freedom; there's $730 billion in new taxes, and there's 5.5 million American jobs lost.

That is a trifecta of disaster.

I see we've been joined by Congressman Scalise. I will yield to the gentleman from Louisiana.

Before doing so, I'll say we have been discussing costs; how the Washington Post, New York Times, the Chinese Government, Centers for Medicare & Medicaid Services have all expressed doubts that this bill will control costs. And frankly in fairness there were 39 Democrats that voted against this bill. Some of them also expressed concerns regarding this cost.

I'd like to yield to you for your thoughts, please.

There are a couple of ironies here. One irony is that we were told we had to do this to control costs, yet we see it does not do enough to control costs. The GDP amount going to health care will be more under this bill.

The other irony, we were told we had to do this to preserve jobs, yet it is estimated that we will lose 5.5 million jobs related to the $730 billion in taxes in this bill.

I think that was the message from the town hall meetings in August. In August, the people spoke. They came out in droves to say we want reform, but we want reform that doesn't concentrate power in Washington, DC, doesn't raise taxes by $737 billion and still does not do enough to control costs, doesn't kill 5.5 million jobs. No, we want something which you and I would call patient centered, something which recognizes there is a heck of a lot of money in the system now. If we just create the economic model in which people are incentivized, as your employee was, to live a healthier lifestyle, thereby saving her and the system money, thereby saving small businesses money, we can accomplish something.

So I think the American people spoke loudly and clearly in August. The only question is will they be heard.

I will compliment my Democratic colleagues. Thirty-nine of them heard and joined with Republicans voting against this bill which sacrifices personal freedom, which increases taxes by $737 billion, which is estimated to cost 5.5 million jobs and still does not control costs. So I think the American people are, frankly, where you and I are.

Reclaiming my time, just for those watching who are not familiar with Medicaid, Medicaid is the program where States put up some money and the Federal Government puts up other money and it covers the poor. Right now in many States they are either having to raise taxes to cover the cost of it or cut back services to the poor. And yet what this bill does is says that you shall, the States shall increase the percent of their population that they are paying for medical services with Medicaid. The Federal Government will pay for a portion of that, but not all, and the State taxpayer has to pay the rest.

In our State, Louisiana, it is estimated that will cost $610 million extra State dollars that will come out of roads and highways and schools. I think Schwarzenegger in California said $6 billion for California.

I think people back home are concerned that in this Chamber we are too partisan. That is why I am trying to make it a point to not speak from a Republican viewpoint, but to quote The Washington Post and The New York Times, which says that this bill does not do enough to control costs. To quote the Centers for Medicare & Medicaid Services, which is a Federal agency: In aggregate, we estimate that for the calendar years 2010 through 2019, national health expenditures will increase by almost $290 billion.

Most of the provisions in H.R. 3962 that were designed in part to reduce the rate of growth and health care costs would have relatively small savings.

Again, some of my colleagues, Democrats, said: I fear this bill will not reduce long-term costs and our debt and deficits will suffer and balloon in the years ahead.

Another Democrat colleague: My primary concerns have been that the legislation does little to bring down out-of-control health care costs, which is what burdens families and small businesses and also leads to our skyrocketing budget deficits.

The Congressional Budget Office, an independent agency, says that the cost has grown at about 8 percent per year, which more than doubles cost. If you compound 8 percent per year, when the President says the cost of doing nothing is that the cost will double, in this case the cost of doing this something, costs will more than double, according to the Congressional Budget Office.

On balance, during the decade following the 10-year period, the bill would increase Federal outlays for health care and the Federal budgetary commitment to health care relative to the current amount. That does not include the State dollars that we have been referring to.

We have spoken about the irony, about how the bill we have to pass in order to control costs is more expensive than status quo. We spoke about the irony about the bill we had to pass to rescue jobs will cost 5.5 million American jobs.

There is another irony here. Medicare, a great program but going bankrupt in 7 years, according to the folks that run it; Medicaid, another Federal program which is bankrupting States, is now going to be rescued by a third public program which is based upon the one and expands the other. So two going bankrupt or bankrupting will be saved by a third which builds upon those first two.

To go back to Scripture, you are building a house upon a foundation of sand. In this case, it is a fiscal foundation of sand which should concern us, as it concerns newspapers like the Post and the Times which wonder if it does enough to control costs.

I think the point just hit upon, we all want reform and we know the goals of reform are to control cost and to expand access to quality care.

Now, there are some who think that to do that you have to sacrifice freedoms, you have to raise taxes, kill jobs and still not control costs.

But you and I know from our practice and our life experience that you can do it differently. You can actually increase freedom by giving that person the ability to control her account that she can use to spend or not spend, to seek value. In so doing, you lower the administrative costs. You kind of cut the insurance company out of the deal because now she has her own account, and she doesn't have to submit a payment claim. She just pays for it with a debit card.

You can control costs in a patient-centered way, one that incentivizes a healthy lifestyle. And in so doing, the patient becomes healthier; and by becoming healthier, you control costs, not by 111 different bureaucracies, boards, and commissions. It stays with conservative values of individual responsibility, limited government, and free enterprise. It actually works in this segment of our economy as it does in every other segment.

I yield.

I think that people are waking up. Again, if we're going to achieve our goals of reform for all, health care accessible and at affordable costs, you can't have it with a program which drives up costs and drives up costs despite the high taxes and the loss of jobs. So we're not through yet. The American people still have time to weigh in on this, to weigh in as the bill goes through the Senate side and then comes back to conference.

But what I challenge the American people to do is to do as they did in August, to contact those Representatives that voted for this bill and express their concern regarding the cost, the taxes, the loss of jobs, but also to contact their Senators and to say that they want reform, but they want reform that doesn't kill jobs, raise taxes, or deprive us of personal freedom. I think in that way we can have a bill which serves the American people without sacrificing our values.

Mr. Speaker, as a practicing physician, I know that this bill has tremendous consequences for patients and for the economy. It is estimated that the $730 billion in new taxes in this bill will kill 5.5 million jobs. The CBO estimates that this will have an annual inflation rate of 8 percent, an annual inflation rate that more than doubles costs in 10 years.

The Republican bill expands access by lowering premiums 10 percent. This bill expands access by forcing businesses and individuals to purchase, and if they do not, the long arm of the State reaches out and grabs them and shakes out fees and penalties.

Now, it was said this morning by a Democratic colleague that we need to redefine freedom. We are going to need all kinds of new definitions. We are going to redefine freedom as the ability to do what the government tells you to do. We are going to redefine helping the economy as higher taxes and destroying jobs. We are going to redefine bending the cost curve as more than doubling costs in 10 years.

Consider not the rhetoric, but the facts. Please reject this bill.

Mr. Speaker, I have spent 20 years caring for the uninsured in Louisiana's public hospital system.

Skyrocketing costs put quality care out of reach for too many Americans, and I appreciate that everyone agrees the status quo is unacceptable.

All agree on the goals of reform: lower costs and expand access to quality care.

Unfortunately, this bill does not achieve our goals.

The Congressional Budget Office says it raises costs.

Without lowering costs, access or quality will suffer.

Its effects will be radical, but this is not a radical bill.

It turns insurance bureaucrats into federal bureaucrats.

There's no innovation, just nationalization.

Real reform would revolutionize health care.

Real reform would give patients, not bureaucrats, the power.

Unless patients are empowered with control over health care dollars and decisions, costs will not be lowered and access will not be expanded without sacrificing quality.

The road to real health reform begins with stopping this bill today.

I urge my colleagues to join me in this effort.

Mr. Speaker, when they have events such as they had in China, one thing that happens is that as the buildings fall upon folks, they crush their muscles, and they end up having kidney failure. This comes to mind because after Katrina, one of the disasters that happened was that there were many people on dialysis that had to be evacuated from New Orleans to Baton Rouge, and there had to be an emergency dialysis center situation established.

I thought about it: one of the great things about our current system of care is that there is this elasticity that exists in our country that often does not exist elsewhere. Yet when I toured recently those dialysis centers in my city, as it turns out, they're kept afloat by the few patients they see who have private insurance. Many of those patients are on Medicaid or Medicare. As it turns out, Medicaid pays about 60 percent of costs and Medicare pays about 90 percent of cost. So were it not for the private insurers paying over cost, we would not have the ability to treat the dialysis patients here or in the emergency situations, those that are evacuated up.

It brings to mind immediately, of course, the health care bill that is before us. It attempts to expand the system of Medicaid and Medicare that is actually depriving our system of the resources it needs to care more carefully for those who are in times of natural disaster.

That said, it is admirable to control costs in this bill, but paradoxically, the CBO says that this bill, which supposedly controls costs, actually will have an inflation rate of 8 percent per year. So 8 percent per year more than doubles costs over the next 10 years, Mr. Speaker. It's ironic when the President says that if we do nothing, costs will double in 10 years, if we do this bill, according to the Congressional Budget Office, costs will more than double in the next 10 years.

So I guess, Mr. Speaker, in closing I would say that there are three imperatives to health care reform: it is controlling costs so we can expand access to quality care. We've seen in other countries where there is inadequate resources placed or inadequate attention to cost that, indeed, these are not addressed. I would ask that we reject this reform for its deleterious effects on our system.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, I rise today in support of House Resolution 880, recognizing the efforts of post-secondary institutions offering career and technical education to educate and train workers for positions in high-demand industries.

Post-secondary institutions that offer career and technical education are an incredibly valuable resource to our communities. These institutions enable adults in the community to improve their lives by furthering their education in order to improve their employability and working life. Career and technical education enables students to learn specific skills or earn a certificate or a degree that employers require or prefer.

Many institutions that offer career and technical education also have valuable connections with employers in the community. These connections allow these institutions to better serve their students. Employers in high-demand industries are able to communicate with post-secondary institutions what skills, certificates and degrees they expect potential employees to exhibit. The close relationship between post- secondary institutions that offer career and technical education and employers provide students, and potential employees, with a valuable advantage.

The Bureau of Labor Statistics estimated that 15.6 million new jobs will be added to the labor force between 2006 and 2016. These industries and employers also benefit from the unique relationship between post-secondary institutions that offer career and technical education and local business leaders. The relationship enables industries and businesses to communicate where there are experience and employment gaps and what skills they require for such positions.

Post-secondary institutions that offer career and technical education provide students and the business community with an invaluable connection.

I am honored to support this resolution, and I ask my colleagues to join me.

Madam Speaker, I yield back the balance of my time.

Madam Speaker, I yield myself such time as I may consume.

I rise today in support of House Resolution 752, recognizing the tragic loss of life that occurred at the Cherry Mine in Cherry, Illinois, on its 100th anniversary and the contributions to worker and mine safety that resulted from this and other disasters.

On November 13, 1909, 400 miners went to work at the Cherry Mine in Cherry, Illinois. This mine was one of the first to have electric lighting, but on the day of the disaster, the system was not working. Instead, miners were using torches to light their way. Mules were being used to bring coal to the mine elevator, and the hay to feed those mules provided the fuel that started the fire that ultimately killed 263 miners. Miraculously, 200 miners working that day escaped. Even more amazing, though, 21 miners survived for 8 days underground with no food and little water.

In order to suppress the fire, those above ground sealed the mine. Conditions below ground deteriorated rapidly. Led by mine manager George Eddy, the 21 miners who survived went into the recesses of the mine to escape the fire and seek good air. Ultimately, the miners barricaded themselves deep in the mine, attempting to block out the bad air. They were able to pool water from seepage in their shelter.

The tragedy of the Cherry Mine has sadly been repeated in one form or another throughout the history of mining. With this resolution, we honor those lost in the mine. We also honor those who demonstrated their courage and resolve in the face of the tragedy. Just as we see in today's miners, those trapped in the mine fought hard to stay alive. The men above ground did everything they could to put out the fire with the hope of saving their fellow workers.

I rise today to recognize the loss at the Cherry Mine and to honor those who work in our mines today. I ask my colleagues to support this resolution.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield back the balance of my time.

Madam Speaker, I yield myself such time as I may consume.

I rise today in support of House Resolution 878, expressing support for the goals and ideals of National Family Literacy Day. Literacy is an issue that is important to people of all ages, from kindergarteners just learning to read to adults whose everyday lives require reading skills. Problems with literacy also affect people of all ages. Children with literacy problems are far more likely to drop out of school before they graduate than those without literacy problems. In addition, approximately 85 percent of all juvenile offenders have problems reading.

Approximately one in seven American adults have difficulty reading, according to the most recent literacy report. Difficulty reading spans generations and affects people of all ages. Family literacy encourages parents and children to learn together and encourages parents to become involved in their children's education. Multigenerational learning enables every willing family member to engage in learning and improve their ability to read.

Children specifically can benefit from family literacy in a number of ways. Children spend a large majority of their time outside of school. Engaging children in reading in their family environment allows children to extend their learning time beyond the time they spend in school. Additionally, research has shown that children whose parents are involved in their education perform better in school. Family literacy encourages families to learn together and support each other in improving their literacy skills.

National Family Literacy Day took place November 1 this year. On this day, schools, libraries and community centers were encouraged to hold book drives, family reading events, workshops and other events that encourage families to read together. Approximately 8,000 literacy programs and schools held events to honor National Family Literacy Day this year. By recognizing National Family Literacy Day, we honor the importance of families learning and reading together.

I am honored to support this resolution, and I ask my colleagues to join me.

I yield back the balance of my time.

Madam Speaker, I rise today in honor of the West Baton Rouge Museum, located in the City of Port Allen in Louisiana's Sixth Congressional District. It gives me great pleasure to announce that as of August 7th, 2009, the museum has achieved national accreditation by the American Association of Museums, becoming only the 11th museum in Louisiana and the 777th out of the more than 17,000 museums throughout the nation to achieve this distinguished accreditation.

The West Baton Rouge Museum has successfully demonstrated that it meets the high standards established by the accreditation program and the museum field. It has done this through its completion of a rigorous process of self-study and reviews by a visiting committee of its peers and the Accreditation Commission. The accreditation process certifies a museum's commitment to excellence and professional standards of operation.

The West Baton Rouge Museum is a regional history museum that was established in 1968. Through the hard work and persistent efforts of its curators, benefactors, and other supporters, it has grown to include a four-acre campus that offers six historic buildings and an 11,000-square-foot main museum building. It has become a staple of the local community and an invaluable resource to showcase the culture, art, and history of the region. With this accreditation, I can only hope that the Museum's next forty years will be even more successful than it's first.

Mr. Speaker, health reform is a moral and national imperative.

As a physician, my experience in treating uninsured patients at public hospitals teaches me that empowering patients is the best way to lower costs and improve patients' health. Patients are the best guardians of health care dollars. Real reform empowers patients to make wise decisions for their wallets and their health.

Unfortunately, this bill introduced last week empowers government, not patients. And this 2,000-page bill, and this is half of it, a trillion dollars, is concentrating power in Washington,

taking it away from States and citizens. For example, it creates 111 boards, bureaucracies, and commissions and has $730 billion in taxes.

This government-centered plan won't work. In fact, the Congressional Budget Office says that it increases the cost to patients and taxpayers.

The patient-centered alternative offered by Republicans will save patients money, save taxpayers money, and expand access to quality care.