Floor Statements

Mr. Speaker, what strikes me about this process is there actually is common ground here. We can agree on the goals we want. We want to lower cost and increase access and have quality care; but I think the problem we are addressing is there is a philosophical divide as to how we approach that.

I liked what Dr. Fleming said when he spoke about if we can empower patients, we can lower cost. One example of empowering patients and lowering cost is health savings accounts, which the Republican alternatives all strengthen and the Democratic alternative weakens.

A health savings account, imagine what is currently the case where a family of four puts up $12,000 a year. At the end of the year, if they haven't used any resources, they put up another $12,000, and the year after they put up another $12,000, but in a sense it is starting over every year. In a health savings account, you sluice off some of that money and put it into a banking account and the family controls that account. The patient is empowered to make wise financial decisions. If at the end of the year they have money left over in that account, it rolls over to the next year. They actually can hang onto it.

Two examples of how this works, a friend of mine back home, a woman

with some wealth, has a policy that pays for everything. As it turns out, she doesn't care what it costs because her insurance policy pays for everything. She said she doesn't look to see if her doctor gives her a generic or a name brand drug or what the bill is. She knows insurance will pay for it. She doesn't go through her itemized list to see if all expenses are appropriate.

Contrast that with another fellow. I mentioned to him about the power of health savings account. He says, I have a health savings account. My doctor writes me a prescription and I know from experience, I tell him that it costs me $159. Notice he didn't say $160; he said $159. Because it is his own money, he is looking at the itemized deductions. He said, I have a health savings account. Do you mind writing me something less expensive?

The doctor says, I'm sorry, tears it up, and writes him a generic that costs $20. The system just saved $139, not because a bureaucrat in Washington, DC said thou shalt, but rather because someone looking after his own financial interest made the best decision for his health care.

We know this works on a systemic basis. The Kaiser Family Foundation did a study. They compared a family of four, their expenses with a health savings account and a wraparound catastrophic policy, with a family of four which had a traditional insurance policy. The family of four with the HSA catastrophic, they paid 30 percent less for their coverage than the family of four with the traditional insurance policy, and both families, if you will, were equally likely to access preventive services.

So we see by controlling costs, we increased access to quality care, and we did it by bending the cost curve.

What concerns me about the bill advanced by Ms. Pelosi is, according to the Congressional Budget Office, the inflation rate for these bills is 8 percent per year. Now, President Obama says we have to have reform because costs will double in 10 years if we do not. As it turns out, with the reform we have been presented, costs more than double in 10 years. At a minimum, reform should not cost more than status quo, but actually it does. And if we don't control costs, we know that if we don't control costs, access is denied.

Now, we can always make that up by increasing taxes, but when you start off with a bill that increases taxes by $730 billion, it doesn't leave a whole lot of room, Mr. Speaker, for increasing taxes any more. At some point your increased taxes drive up costs, which decreases access, which means you have to spend more and you increase taxes even yet more. It is not wise public policy.

So in closing, I will yield back after saying that I think our Republican alternatives concentrate the power with the patient. It is patient centered, empowering patients. Contrast that with the bills that are before us which, frankly, concentrate power in Washington, D.C., by collecting taxes, 111 bureaucracies, boards and panels, which will again take power away from the woman with her doctor in the exam room in her hometown and transfers it to Washington, D.C., where someone will attempt to dictate how that interaction takes place.

Mr. Speaker, on rollcall No. 833, I was unavoidably detained. Had I been present, I would have voted ``yea.''

You know, I agree with almost everything Congressman Burgess said, except for one thing, in that I do think it is important to discuss our Republican alternatives, because, frankly, part of the rationale, the steamroll we are on, is there is no other option. We have, as the President has said, the cost of doing nothing, the costs will double over the next 10 years, and that is an inflation rate of about 7 percent if it compounds.

Well, as it turns out, since the cost according to the Congressional Budget Office of the reforms before us--the inflation rate is 8 percent per year--under the reform proposals before us, costs more than double in 10 years. At a minimum, reform should not be more costly than the status quo.

That said, I think it is important for us to discuss alternatives. I think we can all agree on the goals. We need to control costs. I am with the President on this. If we cannot control costs, we cannot expand access to quality care.

Now, as it turns out, we three are physicians. We know that if the patient is in the middle of the process, then costs are controlled. There is a report by McKinsey & Company and it talks about the three imperatives for health care reform, and they are to decrease the administrative costs--so much money goes to administration; to have transparency, so that when a patient goes in for her knee surgery, she knows before the surgery how much it will cost her, not find out a month later; and, lastly, incentivize healthy lifestyles. So in a patient-centered plan we should lower administrative costs, increase transparency, and incentivize healthy lifestyles.

So I would like to compare it to the 2,000-page, $1 trillion, 20- pound bill.

Now, does it lower administrative costs? You almost have to laugh, because it creates 111 new bureaucracies, boards, commissions. You name it, it clearly expands administrative costs.

Does it incentivize healthy lifestyles? I actually read that provision today, and it gives grants to small businesses that come up with innovative ways in which you can make employees healthier. But it is very vague and very gauzy. And I kept thinking of that small businesswoman who is really struggling to make ends meet, trying not to lay people off. What is the likelihood that she is going to take 2 hours a day to write a grant application to submit to the Federal Government on the hope they will give her $150 per employee, which is the maximum allowed, in order for her to come up with a wellness program? That is something written by a Washington bureaucrat, not by someone who knows the travails of a small business person.

Lastly, transparency. Frankly, I just find it unbelievable that a bill that creates 111 boards and commissions will be transparent.

That said, what are the alternatives? I think we would all agree from our own experience, patient-centered care can work. For example, you have got great anecdotes about health savings accounts. Congressman Fleming, who just left, I love his story about a health savings account.

For those who don't know what they are, with traditional insurance policies, a family of four, you put up $12,000 a year. If you use the insurance, you may get some of your money back, but at the end of the year it is gone, and you put up another $12,000 for the next year.

With a health savings account, you sluice off some of that money and you put it into a banking account, and that banking account is yours and you can spend it on the things which you choose. But at the end of the year, if you haven't spent it, you keep it.

With the traditional policy, you start over. With the health savings account, you conserve that money and it is there for you the next year. It rolls over, and it is that much less you have to put forward. It changes the psychology. We know that.

But just to explain it, in a patient-centered account, a patient was telling me, he goes to a doctor. The doctor writes him a prescription, $159. He says, doctor, you have given this to me before. It is $159. Listen, I have got a health savings account. Can you write me something cheaper? He goes, oh, I am sorry. He writes him a $20 generic, so the system just saved $139.

I actually think the power of millions of individuals making decisions at $139 a decision has more ability to control costs than 111 boards and commissions in Washington, D.C., that are attempting to control health care in all the small towns across the United States.

If the gentleman will yield for just a second, this bill specifically excludes small businesses from doing what you described as a wellness program. That effective program is specifically excluded. So the patient-centered program which was so successful in Johnson City is not allowed in that 2,000-page bill.

If the gentleman would yield, I was a little late coming over here because we were having a telephone town hall. For the folks who are watching, that is where we from Washington have a phone call that goes out to thousands of people in our district, and we have a telephone town hall.

There was a woman that got on and she just nailed it. You pointed out, we have a 2,000-page, $1 trillion bill that was introduced last Thursday that we are going to vote on this coming Friday that is going to remake 17 percent of our gross domestic product, drastically affecting the health care for us all.

If it seems kinds of crazy that we would do that, this woman calls in, Rebecca, and I happen to know the family, I didn't realize it was from her family, and they are very bright people, very hardworking, good people.

So here is kind of her quote. She went to the Kaiser Family Foundation site to determine what her costs would be under the bills before Congress, and she figured out that her family's costs would double.

She says a small business is going to do a cost-benefit analysis, and they are just going to dump patients upon the public option because, why shouldn't they? Now, she says, I am quoting her, it seems like the people writing this are obtuse. They are not writing this for the middle class of the Nation. It is not centered on the patient. It feels rushed. It doesn't make sense; 2,000 pages, one week to digest it. It feels rushed.

She finishes up by saying, for all the possible plans, our premiums will double. It is very expensive. You can't get ahead. The more productive a citizen you try to become, it is like you take one step forward and go two steps back.

This is a bill which is two steps back.

Madam Speaker, I rise today in honor of Staff Sergeant Ory Marioneaux, Sr., U.S. Army, on the occasion of his 90th birthday.

Born in Baton Rouge, Louisiana on October 28, 1919, Ory Marioneaux has lived in Baton Rouge nearly all his 90 years. He graduated from McKinley High School in 1940 and rose to the rank of Staff Sergeant in the U.S. Army, fighting for our country in the European Theatre of World War II in 1942.

After his honorable discharge from military service, Ory returned to Baton Rouge and was reunited with his wife, Mary Agnes Honore', with whom he raised eight children, twenty-two grandchildren, and several great-grandchildren.

Ory worked in service to the people of Baton Rouge throughout his career, both as a private contractor and public employee. Ory worked as a maintenance supervisor for the Housing Authority, a construction supervisor for the city of Baton Rouge, and a teacher of the World War II defense program at Southern University.

Ory Marioneaux has led a life of service to his country and devotion to his family that should serve as an example to us all. I join his family in wishing him, on behalf of a grateful country, a happy 90th birthday.

Mr. Speaker, as a substitute for a plan that actually controls health care costs, the Senate majority leader has devised a gimmick. Under the plan announced yesterday, the Federal Government imposes billions of dollars of taxes on all 50 States, imposes billions in unfunded mandates via the Medicaid program, increasing the debt load of every citizen, creating a new government-run insurance program that, according to the CBO's official analysis, is more expensive than the status quo. Individual States can opt out, but their citizens cannot opt out of the taxes, and they can't opt out of the debt, and they can't opt out of the job losses that will result from these higher taxes and debt.

Real reform will not require gimmicks or job loss. States should not have to pass laws to save themselves. Real health reform lowers costs by empowering patients. If we give patients direct control over health care dollars and the information they need for value-conscious decisions, we will have reform.

Thank you, Dr. Gingrey.

I think Congressman Blunt made some great points. One of them is we want reform, but we want reform that works. Actually, I want to compliment President Obama, because of the three things we want in reform, one is to control costs so we can increase access to quality care. I think he has nailed it. My concern is the approach to achieving these will not work.

I am also concerned that the Democratic proposals before us attempt to achieve that through gimmickry. They are using gimmicks to try and convince the American people that they are achieving the appropriate goal that President Obama has laid out, that it will not add to our deficit.

I was struck today that on the Senate side they are saying that States can opt out of the public option. I am wondering, can you opt out of the taxes that will go into offsetting it? Can you opt out of the debt that the Congressional Budget Office says will accumulate? Can you opt out of losing the jobs that the increased taxes and the increased national debt will inevitably lead to? No. All you can opt out of is the benefit that is offered. You cannot opt out of the high cost that goes into providing this marginal benefit.

I am also struck that there is this tax that they are creating for the American people, and on some similar criticism, it is truly bipartisan. The bill before the Senate Finance Committee that Mr. Reid says that we can opt out of is funded by about $350 billion in taxes. If I may quote Speaker Pelosi, she says that these savings, these taxes, if you will, come off the backs of the middle class.

So I think we have a bipartisan criticism of the bill that is before the Senate right now. I think we would agree on the Republican side with Speaker Pelosi that the ``savings'' in those bills, that $350 billion, comes off the backs of the middle class. Indeed according to the Joint Committee on Taxation, families earning less than $200,000 pay 87 percent of these taxes.

This is remarkable. During the presidential campaign it was stated that if you earn less than $250,000, your taxes will not go up. Yet, now, through these various accounting gimmicks, we are seeing indeed 87 percent of these new taxes will come off of those who earn less than $200,000.

There are other gimmicks in this as well. It is pushing the cost of an expansion of Medicaid. And for those watching who don't worry about--I used to work in a hospital for the uninsured. For 20 years I have spent my life trying to bring health care to the people who don't have insurance. Medicaid is the safety net insurance program that is partly funded by the Federal Government and partly by the State government.

Now, in this plan before both the House and the Senate, both plans, they are going to expand Medicaid. In the Senate plan, they are going to make the State taxpayers pay for this expansion. That is really great. It looks like we are saving money on the Federal level, but all we are doing is shoving that cost upon a taxpayer, it is just through the State income tax or property tax or sales tax, not through the Federal tax.

That is a gimmick. If you want to say it is the taxpayer paying for it, absolutely she is paying for it. And so this expansion, this increased cost is going to lead to increased taxes, but it will be through the State tax code, not the Federal. There is the sleight of hand that is being passed off as fiscal responsibility.

Now, on the other hand, we agree on the goals. We want to have quality health care, accessible to all at an affordable price. But we can see that this kind of bargain being offered by the Democratic proposals is really not controlling costs at all. It is merely shifting it onto State taxpayers or it is using taxes upon the middle class to fund.

I like to say they are using new tax dollars in the old wineskin of an old health care delivery system. Just as we

know that new wine in old wineskins will not work, so we know that these new taxes, these savings off the back of the middle class, as Speaker Pelosi says, will not work in the old wineskin of an old delivery system.

Republicans, on the other hand, I think we truly want a transformation of how health care is delivered. The Republican proposal I have signed on to, and I think several of my colleagues have, H.R. 3400, is wonderful in the sense that it empowers patients to make cost- conscious decisions.

If I might yield to my friend from Shreveport, he has got this great anecdote of how Health Savings Accounts in his business worked not only to hold down costs, but how by empowering his employees, also improved our health, if I may yield.

I am actually going to disagree with my colleague from Shreveport--and by the way, he is from north Louisiana, not south. The point being is that these gimmicks only pay for on paper. So the Congressional Budget Office, which makes an assessment, Does this achieve the goal of controlling cost? Because as President Obama points out, controlling cost is important. These gimmicks only control it on paper. Ultimately, this would be paid for not by gimmicks, but it will be paid for by taxpayers or by debt. Ultimately, that debt will come from taxpayers again. That's why I think Speaker Pelosi says of the savings--this is a public statement--The savings in the bills before the Senate side, the Democratic bills before the Senate, will come off the backs of the middle class, and these taxes will continue to be paid for by the middle class.

I have learned in my practice--because, again, I have worked in a public hospital. I have worked in a government-run hospital where the nurses, doctors, med techs, therapists do their absolute best to bring health care to those who otherwise would not have it, a true safety net hospital. But when there is no money, the lines lengthen. When there is no money, something has to give. Now as it turns out, either we're going to raise taxes, we're going to borrow money, or their lines are going to grow; and our reform goals of controlling cost and, thereby, increasing access to quality care will not be achieved.

On the other hand, let me just kind of amplify on your health savings account. The Kaiser Family Foundation has a study--I believe the Web site is kff.org--and they looked at a family of four with a health savings account and a wraparound catastrophic policy versus a family of four with a traditional insurance policy. They found that the cost of the patient-empowering health savings account with a wraparound catastrophic policy was 30 percent cheaper than the traditional insurance policy, that 27 percent of folks who had the health savings account with the wraparound catastrophic policy were previously uninsured, and that these folks who now have insurance access preventive services as frequently as a family with a traditional policy. We achieve the goals. By empowering patients, we, the folks buying those policies, lower their cost. By lowering their cost, folks who were previously uninsured now have access to insurance and, once having access to the insurance, are accessing the primary and preventive services as frequently as those who are paying 30 percent more for their insurance. The goals of insurance have got to be that.

Now, again, I'll go back to the analogy I used earlier. We can either put the new financing, the new tax dollars in the old wineskin of a top-down, government-controlled, bureaucratic health care delivery system or we can use new wineskins, and I think the new wineskins that the Republican Party wants to use are patient-empowering. How do we empower patients to make a decision that's good not only for their health but also for their pocketbook? And by so doing, you lower cost. People previously uninsured can now afford it, and once they have their insurance, they're able to access those primary and preventive services. As practicing physicians, as a guy that's been working in a safety net hospital for some time, that seems the wineskin for us.

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.

Madam Speaker, I had several communications today that were just so appropriate for this time of discussing health care. I spoke to a physician in Ville Platte, Louisiana, who spoke just how the only people that can actually control costs in health care is the patient. Because if you think about it, if patients come in and want a test and they don't get the test, and there's going to be a dissatisfaction, sometimes patients will go elsewhere, and they will get the test from another provider.

Secondly, I spoke to a small businessman who said that his premiums are going up by 27 percent. And the third thing, I wrote a letter to a former patient of mine, the widow of a man who had died of cancer, and I was struck that in each of these, a common consideration was the cost of health care. Indeed, as we speak about health care, we can never get away from the fact that cost is a driver of our discussions.

As we approach reform, there are three things we need. We need to have quality health care accessible to all at an affordable cost. When we say ``cost,'' the President acknowledges this, as well, the President has said that he will not sign a health care bill that adds one dime to our Nation's deficit. Now, by that criteria, and he understands that we are, as a Nation, having a problem with the budget deficit, if we create a new entitlement and if that adds to our budget deficit, then we, as a Nation, will be worse off.

I work in a public hospital in Louisiana. And in that public hospital, whenever money is tight in the State, there tends to be a squeeze on the financing of the hospital. I can remember years in which we would wait to order a test until after the new fiscal year. And this happens when cost is an issue.

So as we look at our goals of health care reform, it is accessible, quality health care at an affordable cost. Now, if the President says that he will not sign a bill that adds one dime to our Nation's deficit, we can understand why four of the five bills before us are essentially eliminated. Four of the five bills include the public option, and the public option has been projected to increase our Nation's deficit.

Importantly, they are also projected to increase costs at 8 percent per year. Now, 8 percent per year more than doubles cost over 10 years. So when the President says that we know if we do nothing, we know if we persist with the

status quo that costs will double in 10 years, four of these five reforms, on the face of them, according to the Congressional Budget Office, will more than double cost.

That leaves us with the fifth option which has received a lot of attention. That is the bill that is coming out of the Senate Finance Committee and which has come to be known as the Baucus bill. Now the Baucus bill is gathering our attention because according to the initial estimate, it would save $81 billion. Wow. If we can actually control costs in that way, that's remarkable. It should be something that we all get behind. This is being seen as a vehicle where the Democratic leadership in Congress can achieve their goal of having health care reform in the way that they wish to achieve it.

Now, let me pause for a second. We all want reform. When I speak to that small businessman that says that his cost of insurance is going up 27 percent in 1 year, we know that that is not sustainable. At issue is, will he do better if it is merely the taxpayer or the ratepayer? If we come up with something which more than doubles cost in 10 years, that's really reform absent reform. It is merely changing a private insurance bureaucracy to a public insurance bureaucracy.

So we come back to the Baucus plan. Now the Baucus plan is significant because, again, it supposedly will save us $81 billion in 10 years. But clearly there is an issue with it.

I say that because where do those savings come from? Who pays? Well, according to Speaker Pelosi who is, by the way, a Democrat, she says who pays this particular plan from the Senate Finance Committee? The savings come off the backs of the middle class. If you have insurance, you get taxed. There are $201 billion in taxes on health insurance plans with a 40 percent excise tax on insurance plans worth more than $8,000 for individuals or $21,000 for family policies. Families making less than $200,000 a year shoulder 87 percent of this burden. As it turns out, many of these people are union workers. Over years, union workers have given up wage increases in order to have more generous insurance benefits. By this, it makes it a bad situation. So the Senate finance plan will tax those benefits. And that's why Ms. Pelosi says the savings come off the backs of the middle class.

So if you have insurance, you get taxed. But if you don't have insurance, you get taxed. There are $4 billion in fines on the uninsured and $23 billion in penalties and fines for businesses whose employees enter the government exchange. So if you don't have insurance or do not provide it, then you get $27 billion in taxes.

If you use medical devices, hearing aids or artificial hearts, you get taxed. There's going to be a $38 billion tax on medical device manufacturers. If you take prescription drugs, you get taxed. There are $22 billion in savings that are achieved by taxing prescription drug producers.

Total, there's $349 billion in new taxes on employers, individuals, medical device and drug manufacturers and insurance providers and families making $200,000 or less. Let's face it, $200,000 is a lot of money, but that's also ``or less'' will pay 87 percent of the taxes. If the math holds, then about $300 billion in these taxes will come from folks who are middle class or just lower upper income, if you will.

Despite that, there's still higher health care costs. According to the Congressional Budget Office, the independent arm of Congress, the premiums in this new insurance exchange which is created by this plan would tend to be higher than the average premiums in the current individual market. In fact, Mr. Elmendorf, who is the head of CBO, said that we note that piece of legislation would raise premiums on average.

There's also $200 billion in taxes on health insurance plans. So that tax, presumably, will be passed on to the person purchasing the policy, so that makes those policies more expensive. And ultimately, we know that taxes upon the pharmaceutical industry and manufacturers of durable medical equipment will be passed to the people that consume it.

So there are several other things that we will explore as we go through. I'm joined by my colleagues, so I will ask Congressman Gingrey, who is also a physician, as I am, if he would contribute to the conversation.

Thank you, Congressman Gingrey.

I think what you are talking about when you have the money, honey, let's go buy a new car, means that you actually have a way of financing within your own budget that's honest and that you know you can sustain, so that after a year of purchasing the car, you can continue the payments.

I would like to in a later point go back to Republican solutions, but just provide a little bit of a critique on the Senate Finance bill, because I don't think that they actually have their money, honey. One of the reasons I am

concerned is because this is, if you will, a schematic of where they have achieved their savings from.

One of these is an unfunded mandate on States to provide Medicaid coverage for folks for whom they do not do so now. That's important because it means that it is a State taxpayer that does it.

Even though they achieve savings and theoretically are not increasing the Federal deficit, they will be increasing State deficits. According to different Governors, Arnold Schwarzenegger says that in California this unfunded mandate will be $8 billion a year. That's in The Washington Post.

Now, they already have a $45 billion deficit in California. Governor Schwarzenegger is saying that it's going to add to that $8 billion a year; in Tennessee their Governor says $5 billion; Texas $20.4 billion increased cost over 10 years; Arizona, $4 billion cost over 5 years.

My State of Louisiana, which has a $1.8 billion shortfall in Medicaid over the next 2 years, this will increase the Medicaid deficit by $640 million over 5 years. I wish our State was as wealthy as California; but in our State, $640 million over 5 years is truly a tall mountain to climb.

We are joined tonight by Congresswoman Lummis, who is a former State treasurer from Wyoming. Congresswoman Lummis, will you please offer your thoughts.

What we see on this previous slide is there is $81 billion, these are in billions, so there is $81 billion in savings. That's how much it cuts the Federal deficit. The $33 billion you speak of is from the Congressional Budget Office estimate, the independent arm of Congress. We would have to at least subtract $33 billion from that $81 billion if we are talking about total health care spending by a government entity. Fair statement?

That's 10 percent now without the imposition of the unfunded Medicaid mandate; is that correct?

New revenue source means State tax.

I kind of like that, ``mother of unfunded mandates.''

Congressman Thompson, you are from Pennsylvania, and we are speaking of Pennsylvania. What thoughts would you offer, say, regarding, for example, I see that this is the Medicaid population increase per State under this bill. By this, in Pennsylvania, you will go up 20 percent. What would that mean to the State taxpayers of Pennsylvania?

Now, just so the folks understand this issue, in State government, State governments can't print money. They have got to balance the budget, I presume, in Pennsylvania as in my State.

If your population is going up, Medicaid population is going up by 20 percent, and you mentioned how much extra money will have to go into that, that will either come from higher taxes or lower services, for example, lower money spent for road construction, for secondary education, for colleges, et cetera; is that correct?

Governor Schwarzenegger says that this will add $8 billion in cost per year to California. In Texas they project over $4 billion per year. But these States will have to come up out of pocket. But because Nevada has been able to swing a separate deal, they are protected from this cost, although these States are not.

So the Californians and the Texans and the Louisianans will be paying for their own States, and they will be paying for Nevada too.

Well, this is where other States are, the growth in the Medicaid population.

I am going to ask Congressman Boozman to speak. Arkansas' Medicaid population will go up by 40 percent, and what will that do to your State finances?

Your point being that some of these savings that are achieved to give this nice Congressional Budget Office evaluation of the cost of the Senate Finance bill are, if you will, the savings coming from $240 billion cuts to providers.

Now, Dr. Roe, you have practiced medicine in Tennessee for many years. Two questions for you.

Is Medicare payments to hospitals and physicians so much above their cost that you can decrease them this amount and not impact the ability of those folks to continue to see Medicare patients? I will start with that question.

So, reclaiming my time, your experience is basically the kind of experience I have had. If costs are not controlled, ultimately patient care suffers.

Reclaiming my time, Congressman Gohmert, your State will have a 77 percent increase in your Medicaid population, so your governor predicts it will be $4 billion more a year in costs to the State of Texas. So as we score this Senate finance bill, which supposedly saves the Federal Government money, it apparently saves it by making Texans pay more on their State taxes, is that correct?

Reclaiming my time, it strikes me really in one way there is nothing radical about these plans, because all these plans do is take the current top-down, bureaucratic-controlled system and they nationalize it. Now, it is not the same sort of, if you will, patient- centered, where patients are involved in their care, patients are involved in saving costs. It doesn't involve that.

In a sense it is new wine in an old wineskin. All we are going to do is put the new wine of a nationalized, centralized, controlled type process, and without any of the things that you describe, which are, if you will, truly transformative, things that would help lower costs by empowering patients and empowering the physicians to work with those patients.

You are speaking of Medicare, if I may reclaim my time.

Reclaiming my time, as we come back to this, the conversation is that the bill which has been favorably reported as $81 billion in savings, actually the savings, as Ms. Pelosi says, comes on the back of the middle-class. If you will, part of the conversation is that it punishes the middle class. In fact, if you include the cost of the unfunded mandate to the States, if you recognize that some of these Medicare cuts just won't happen, it is reasonable to say that it is going to increase the deficit. If you will, I would like to say it is not so much fiscal responsibility as it is fiscal sleight of hand.

That said, Congressman Thompson, you have been a hospital administrator. What would be the impact of these savings upon the patients who were seen in hospitals where you worked?

Now, reclaiming my time, that is not an industry. That is a set of patients. Is that a fair statement?

Reclaiming my time, I was speaking to that small business man today back home whose premiums have just gone up 27 percent, and he was unaware of the Republican options. And there's a wall of sound that says the only thing we can discuss are the Democratic-controlled bills as opposed to the other options.

There is H.R. 3400, which really encapsulates many of the things that Congressman Murphy was speaking about earlier. Now, if we want to say that there are the essentials of health care reform, there's an article by McKinsey & Company which is very good. And it says the essentials are to reduce administrative costs, reduce the cost of chronic care, which is what Congressman Murphy was talking about, and incentivizing patients to make value-conscious decisions so that when the patient actually becomes aware of how much something costs, she will make a different decision than if she feels as if it costs nothing more at all.

I know, Congressman Roe, you have experience with the health savings accounts, if you wouldn't mind commenting on that.

So, as opposed to the Senate finance plan which, frankly, I think punishes the middle class--again,

Speaker Pelosi says that the savings in this plan will come off the backs of the middle class. Instead, we're offering a different sort of thing which costs are controlled by empowering patients. As Dr. Ardoin said, from Ville Platte, Louisiana, patients are the only one that can control costs. And so that would be our sense, empowering patients as opposed to putting the savings off the back of the middle class.

And reclaiming my time, to have some independent judgments, again, the Congressional Budget Office is the one that says that the Senate Finance plan will have a growth in cost of 8 percent per year, which more than doubles. Contrast that with the Kaiser Family Foundation study about health savings accounts, and they've found that a family of four with a health savings account and a catastrophic policy on top had a cost of insurance 30 percent cheaper than a family of four with a traditional insurance policy. So because the family is engaged, their costs are 30 percent cheaper, again, per Kaiser Family Foundation. That's bending the cost curve.

So Congressman Gohmert, have you ever driven across five lanes of traffic to get some gasoline at a penny cheaper?

Reclaiming my time, and that's because you're empowered, if you will. Now, what if someone else were filling up your gas tank? Do you think that if someone else were the responsible party as opposed to you, would it be the same dynamic?

If I may reclaim my time, again, going back to the McKinsey & Company report that spoke about the three imperatives for health reform, one was decreasing administrative costs. I read a statistic that 40 percent of the overhead of a primary practitioner is related to billing. With that debit card, you just lowered that 40 percent to a minimal percent.

Dr. Roe, as we try and come up with a plan which is patient centered, that controls costs, that expands care, OB-GYNs, which you are, have had more problems--except maybe neurosurgeons--with the cost of malpractice. Would you mind commenting?

Excuse me, Congressman. I'm sorry, $74,000 a year for malpractice insurance?

Reclaiming my time, we have about 1 minute left together.

We can say that we have really two contrasting visions: one is basically nationalizing the health insurance industry; and although scored as an $81 billion cost savings by the Congressional Budget Office, we have discussed that that's in part because of cuts to Medicare, which means cuts to health care for folks on Medicare, unfunded mandates on the States so that States will force their taxpayers to either pay higher taxes or cut the amount of money available for construction, education, and such like that, to achieve something which frankly seems illusory.

But if we contrast that with what the Republican Party is proposing, which is to put patients in the middle of the process, to say to patients, Listen, once you're there, you are empowered to not only direct your health care, but to control costs. And we have quoted data from Kaiser Family Foundation how that truly happens, as well as the experience of groups like yours with numerous employees.

So at the end we will say that Republicans' ideas, I think, will empower patients, whereas the Democratic ideas appear to empower government.

Thank you for joining us.

Mr. Speaker, instead of passing health care reform that lowers costs, Democrats are positioned to pass a bill that hides costs by passing them on to State taxpayers. A frightening footnote in the Congressional Budget Office report on the Senate Financial Committee bill reveals a $37 billion Medicaid mandate on State governments. Unlike the Federal Government, States can't just print money.

This $37 billion mandate will force States across the Nation to choose between deep cuts to programs or steep tax hikes. In Louisiana alone, it's $612 million over 5 years. That's $612 million less for roads, for higher education, for secondary education, for economic development.

In addition to driving States into bankruptcy, this unfunded mandate deliberately hides the bill's true cost. Whether from Federal taxes or State taxes, the American people will have to absorb this.

If the bill actually lowered costs, its author would not have to hide behind accounting gimmicks to sell the bill.

Madam Speaker, as we reflect upon the eighth anniversary of the September 11 attacks, the Americans who perished that day, the Americans who heard the call to arms and sacrificed themselves to defend our lives and liberty, the sacrifice of Americans who remain in the line of fire and their families, let us reaffirm our commitment to Never Forget.

Scott Rogers, a constituent from Baton Rouge, penned the following poem in 2001. It is a tribute to the searing legacy of that fateful day and the values that guarantee we will overcome it.

The Day Liberty Cried

(By Scott Rogers)

It was just another Tuesday morn

As people went their way

The cars, the trains were bustling by

Another working day

Although diverse with many faces

These people shared one hue

They lived together with Liberty

Under the colors Red, White, and Blue

Liberty was the one thing they all shared

They nurtured Her in their heart

But little that morn did they realize,

That their world would be torn apart

Liberty was strong She stood proud

But on this fateful morn She cried

In horror She watched as evil attacked

And so many innocent people died

Liberty bowed Her head that day

For She felt somehow that She

Had allowed these acts to come to Her shores

To the great land of the free

But the evil that attacked Her

Could not begin to understand

That Liberty could not be destroyed

Nor our great love for this land

Those who tried to hurt Her

Could not break Her soul

And proudly we fought to rebuild what was lost

Although heavy was our toll

Each brick that fell was carefully removed

Each victim we will always remember

And Liberty is there to remind us all

Each eleventh of September

We will never forget, we must not forget

Yes . . . Liberty did cry that day

But we will never stop pledging ``In God We Trust''

Because? . . . We love this U.S.A.

Mr. Speaker, we are pleased to be here. We call this the Doctors Hour because there is a fair number of us on the Republican side who are physicians or in some way health care providers, optometrists, a practicing psychologist, or in some other way connected with the health care field. So we give our own perspective.

Now, my own bio, if you will, aside from being a physician, I have worked with the uninsured in my State of Louisiana for the last 20 years.

That's almost 90 percent of my practice, working with the uninsured in a public hospital. And so, when I speak of what we need to do to help the uninsured, it is purely flowing out of my life experience. I think that as the others come up I'll give them a chance to speak as to it what they're about. I'll start off with a couple of comments. I've learned in my 20 years of, whether private practice or public practice, that the only thing that lowers costs is if you make things patient- centric. If the government is in charge, or the insurance company or a bureaucracy run by anybody is in charge, it becomes something that doesn't work for the patient. The patient's separated from costs. They have a harder time accessing benefits. It just doesn't work.

On the other hand, if you put the patient in the middle, if you tell that woman, listen, you can go see the physician you wish to see and when you go in there there's minimal administrative hassle. And if you don't like that physician, you can go see another physician. It really works. The patient's satisfied, and typically, the patient/physician relationship is stronger. And key to getting good health care is having a strong patient/physician relationship.

Now, frankly, I think the only thing innovative that we've heard from the other side, although their plan kind of is changing on a day-by-day basis, is in one sense, the only thing about that plan which is radical is that it nationalizes health insurance. I was a little amused by my Democratic colleagues earlier who were saying, Oh, my gosh, Republicans are defending insurance companies. No, actually I think they're defending insurance companies. They like insurance companies so much they want to nationalize it and have a national insurance company.

Now I'm thinking, now we have an insurance company run by the private sector that, if it doesn't work, constituents call Congresswomen, Congressmen, we pass a law that changes that, changes that so that the private insurance company plays by better rules. Now, though, it's going to be both the referee and the player. Now the government will make the rules, but also compete. And as it does that, in some way, we're supposed to expect that the government-run insurance company is going to be kinder and gentler, more cost-effective, higher value product than is the private insurance company.

I think it's the triumph of hope over experience. We hope it will be better. We know Medicaid and Medicare don't work as we wish; in fact, they're going bankrupt, and their bankruptcy is what's driving this plan. And so we're going to believe that the third try is going to be the charm and that this time we get it right. Well, without going further, I'll yield to my fellow physician from Louisiana, John Fleming.

Now, Congressman Fleming, how many Democratic cosponsors do you have?

Now, reclaiming my time, because we heard a presentation prior to this that, by golly, this is the best thing since sliced bread; this is the plan that's going to fix everything, and why wouldn't you be on it. So I'm kind of asking you, Dr. Fleming, why wouldn't they want to be on it.

Now, reclaiming my time, and I appreciate that because, again, what we've heard before is that this plan does not put government between the patient and their physician. And yet, I would have to think, if that weren't the case, why wouldn't anyone agree to your bill? I think your amendment was proposed in our committee, and it was defeated on party line votes. So I think Dr. Roe, from Tennessee, may have some thoughts as to what would come between the patient and the physician. I keep emphasizing that because if something's patient- centered, we know the closer it is to the patient, the more likely it works. So let's ask Dr. Roe, a physician from Tennessee, what might come between the patient and the physician. Dr. Roe.

Dr. Roe, can I reclaim my time?

Can you show me up there where there is a Washington bureaucrat on that chart? Where might there be a bureaucrat on that chart? Show me where the patient is and show me where a bureaucrat is.

So unlike the Republican plans, which are patient- centric, what you're telling me is this is kind of a top-down, let's figure it out from Washington and lay it on the rest of the country.

Dr. Roe, can I reclaim my time?

Of course we don't want this to be a partisan issue. Now frankly, as far as I know, Republicans have not been invited into the discussion. And there are actually some things in that Democratic plan, those thousand pages, that I think are very good. But there's other things, and I think they kind of general concept top-down. But it's not just us.

David Brooks is a columnist for The New York Times. You see him on TV, a very thoughtful man. I have a quote here. The health care system is as big as the entire British economy. There's no way something that big and complex and dynamic can be run out of Washington. We have to set up a dynamic system, not trying to establish a set of rules to be imposed by fiat. Now, I think what you're telling me is that this is a big, complex plan run out of Washington, and not the dynamic system, but rather a set of rules, and whoever that really powerful person is in that purple box, that person will be establishing the rules by fiat. Is that a fair statement?

Hang on. Hold that thought. Let me give one more David Brooks quote and call on our colleague, Dr. Fleming okay? Another David Brooks quote talking about the CBO report, speaking about how much it would cost. This is devastating. The plan was sold as a way to bend the cost curve to reduce the rate of health care cost growth. Instead, the cost of the plan to the Federal budget would rise by 8 percent a year, and there wouldn't be anything close to offsetting revenues to pay for it.

Now, Dr. Fleming, can you sustain a health care system which has out of control inflation, if you will?

Reclaiming my time, part of this plan is to increase Medicaid eligibility, i.e., put more people on to Medicaid. Yet what we've just heard is that Medicaid is bankrupting States, or causing them to raise taxes.

So going back to my question, if you cannot control costs, can you sustain a health care system?

I will yield.

Reclaiming my time, let me just praise the motivations of the people in Tennessee. They clearly cared about the uninsured, as our Democratic colleagues, are. But it was a flawed model and couldn't be sustained, and we know that those patients were now uninsured again, probably worse off than before the experiment.

Dr. Boozman, I would like your opinions on this. You're an optometrist from Arkansas.

Reclaiming my time, 10 percent in Medicare, a generally accepted figure, is in waste and fraud. So we hear from our colleagues across the aisle that Medicare has lower overhead costs. If you include in that the 10 percent, which is a common way to define ``overhead,'' actually, that 3 percent becomes at least 13 percent. A fair statement. I think an economist would say, if your overhead is so meager that you can't watch out for fraud and abuse, then you need to lump the cost of the fraud and abuse into your overhead.

Thank you.

Dr. Broun, you've joined us. May we have your thoughts on this, please?

If I can reclaim my time, let's give credit where credit is due, because the advocates for a public option plan--I'm not an advocate of one, though--will point out that there's a decrease in administrative costs.

So, Dr. Roe, will you look up at that chart once more--or maybe you will, Dr. Boozman--and give us a sense of what will be the administrative costs, do you imagine, with this publicly run health insurance plan.

I thank you for offering that.

Reclaiming my time, Dr. Boozman, John, when you look at that, some patients aren't as sophisticated as others. Let's face it, some folks don't have the same education. Maybe they've had to struggle a little bit to get through life. Imagine if a patient had a problem with that and didn't have a counselor coming to them, as Dr. Broun mentions, but, by golly, they just have a doctor they don't like, don't get along with, and they want to complain to someone. Where would they complain?

Reclaiming my time, I know there's supposed to be an ombudsman. In the 1,000-page bill, I've found one page that spoke of an ombudsman whom you would call up if you had a complaint.

I guess the point I'm making about administration--I read an article in the McKinsey Quarterly. They said there are three things you absolutely have to do if you're going to control costs. You've got to decrease administrative costs. I look at that and it just gives me a migraine.

If I can reclaim my time, Dr. Broun, as far as you know with the bill, how does the bill address tort reform?

I'm sorry?

We just heard from our colleague from Arkansas that that's a critical thing to do.

Now, Dr. Broun, if I could reclaim my time, earlier, Dr. Roe had suggested--we spent the first half in kind of a critique of what our folks, our colleagues across the aisle, have put forward; but we've set aside our second half to kind of talk about what works. This is kind of a nice segue because I think, one, we know that lowering administrative costs will help, and we know that malpractice reform can also address some of these issues.

I'll go back to the central theme, which has to be that any effective reform has to put the patient in the middle; and when you put the patient in the middle, you've got to give them transparent costs so they know what they're buying before they go in there, and you need to encourage them to make the lifestyle changes because, ultimately, a patient, she or he, is ultimately responsible for his own health.

I know that, Dr. Fleming, in your business--because you're not only a physician, a congressman, husband, and a father, but you're also a small business man--could you relate your experience with health savings accounts? Perhaps define them for us and say how it worked in your small business.

Will you define what that is, please?

Reclaiming my time, you put a portion of that health premium into a bank account of sorts that the patient/employee then controls?

Reclaiming my time, could she have used her HSA to buy the medication to help her get off of cigarettes?

Now, I like that because it puts the patient, the empowered patient in the middle so that she's making the best decisions not only for her wallet, but also for her health and, by the way, for her job because you are able to keep your costs down and keep her employed.

Fair statement?

Dr. Roe, I think also you've had experience with putting patients in the middle with these health insurance plans. Can you relate that, please.

Reclaiming my time, you had a savings account for the patient, $4,200, that you put in there to help pay that high deductible?

But now it's coming out of their pocket if they buy the expensive medicine as opposed to the insurance company.

Reclaiming my time, for a similar-size family, similar benefits, with a health savings account costs are 30 percent lower relative to traditional insurance.

Now, we've talked about and quoted David Brooks talking about the Congressional Budget Office comment that the plans being presented to us do not bend the curve; they elevate the cost curve. And yet here is something which has been proven--it's not a hope, but it's experience-- to lower costs by 30 percent.

Reclaiming my time, John, if I can ask you, those patients we talked about earlier, and maybe they haven't had the same educational opportunity, the same economic opportunity, but nonetheless, if gas were cheaper 3 cents a gallon on the other side of the interstate, do you think they would go over four lanes to get it?

May I add, that is part of some of the Republican alternatives that are being proposed. Allow those small business women and men to band together perhaps to purchase one of these empowering HSAs.

Reclaiming my time, you always give me these nice bridges to segue into. Some of the Republican alternatives--and you're actually addressing all of those very nicely. And if you're a member of Rotary, you can do that. Now, I like that.

So can I call on my good friend, Dr. Fleming, if he can initiate some of the discussion of just what the Republican Study Commission is putting forth, not necessarily what Mr. Ryan has put forth or others, but even this step plan.

Reclaiming my time, so if you will, what's being said by our colleagues across the aisle to misrepresent our positions, we absolutely favor insurance reform to allow folks with preexisting conditions to get coverage, correct? That's what you just said, correct?

So next time someone gets up to the podium and says we don't believe that, that is incorrect; am I correct?

The fact is that is misleading. And that is one thing I like in their plan and I like in our plan.

I yield back.

Reclaiming my time, the anecdotes that you gave and Dr. Roe gave regarding the empowered patients by giving them these health savings accounts or something such as that, we empower patients. That's in our plan. It's not the government bureaucracy between our friends up there; rather, it is empowering patients.

So, Dr. Roe, may I interrupt for a second?

A clear contrast between our plan, if you will, or one of our plans and their plan, aside from their increased administrative costs, aside from their top heavy, aside from ours being lower administrative costs and patient-centered, you're saying that one of the plans being presented to us has the mandates but the Republican plan does not.

If I may reclaim my time, it's important that the people watching realize that that is not just Republicans saying this. Again, I'm going to quote. The Congressional Budget Office, as we know, has spoken about how costly this bill would be.

From nytimes.com, I, again, quote David Brooks:

``The theory of the Democratic bills seems to be that 98 percent of Americans can party on, with the latest and costliest health care imaginable, no matter how ineffective, and the top 2 percent will pay for it all.'' He goes on to say, ``If you don't control the rate of health care inflation, even the rich won't be able to pay for the cost increases.''

So it's others, not in this Chamber, commenting on the cost of that program and, indeed, commenting on the Congressional Budget Office comments.

If I may reclaim my time, one, it's a tremendous testament to the faith of that family, their love for their son and to those fine physicians at Vanderbilt. I think all of us share the hope to have high-quality health care affordable, accessible to all Americans. Our concern is that the solutions being brought upon us are going to not only not achieve that but interfere with that relationship, and it's not just folks who are conservatives.

I have an editorial in my local paper by Susan Estrich. You will recall that Susan Estrich was chief of staff for Walter Mondale--I think I have this right--when he ran for President. I don't agree with her, but I respect her thoughts. She's a bright woman. She wrote Don't Risk Your Health Care.

She begins:

The President is ``not familiar'' with the bill. No one can explain how it will work yet, as Senator Ben Cardin told a contentious town meeting. There are various plans, and negotiations are still in the early stages. But whatever it is, we should be for it.

She goes on to say, ``Am I missing something?''

Then she describes the relationship that she and her family have with their physician. They are not sure. She wants to be reassured and has seen nothing that reassures her yet that that relationship will be preserved. So it isn't just folks in this arena. It's folks across the country.

Dr. Boozman, what are your thoughts?

Reclaiming my time, I would say that it works for 85 percent of the people; but we would favor the reforms that would ease the insecurity that if you get sick, you lose your insurance or it's priced out. So we favor the reform that deals with preexisting conditions. At the same time, we don't want to ruin it for the 85 percent.

I yield to my friend.

Reclaiming my time just for a second, CMS is the agency that governs Medicaid and Medicare, the Federal program.

If I may reclaim my time, we're almost out. I just want to wrap that in with a comment that Dr. Fleming said about how the best system is one in which the patient is involved. I think you said ``skin in the game.'' The McKinsey Quarterly talks about transparent pricing for value-conscious people. Again, quoting from David Brooks, the New York Times columnist, a very thoughtful man: ``I'd say that there have to be cost-conscious consumers within a closely regulated market. Unless you get proper incentives for both providers and consumers, I doubt you're going to go very far. In the current plans,'' meaning those across the aisle, ``all the emphasis is on the providers.''

If I may reclaim my time, I think you are involved in what is called as a concierge practice or a patient-centered practice where the patient will prepay you, say, $50 a month; and if you don't satisfy that patient, she goes to see another doctor.

Do I recall that correctly?

If you would yield back, because I just want to mention that one thing. There are some physicians, a lot of them on the west coast, that have a practice that is so patient-centered, it works beautifully. In that practice, the patient pays $50 to $100 a month and gets all the primary and preventive services cared for. If the patient doesn't like it, they find another doctor the next month. It's like Target or Wal-Mart. If my wife doesn't like the sale at Target, she goes over to Wal-Mart; and if she doesn't like the service at Wal-Mart, she will go back to Target. The fact is, is that the physician, knowing that those folks can go, is going to be more patient-sensitive.

Thank you all very much.

To achieve the three goals of patient-centered health care, we have to control costs to provide access to quality care. Now there are three imperatives to achieve this. We have to decrease the amount of money the patient is paying for administrative costs, increase the transparency so the patient knows what she's paying for, and lastly, address lifestyle issues so that a healthier patient has higher quality health care at lower cost. This is transformational.

The current plan, however, the CBO says, is not transformational and in fact is based upon things which are very old: Medicaid, which is a Federal program currently bankrupting the States; and Medicare, which is bankrupting the Federal Government. This new third entitlement program builds upon those models, which is supposed to rescue the two that are currently bankrupting us. At a minimum, the solution should not cost more than the problem.

Let's address the imperatives of lowering administrative costs, increasing transparency, and addressing lifestyle issues, and develop a patient-centered health care plan, not one built upon two programs going bankrupt. On a bipartisan basis, let's achieve quality, accessible health care at an affordable cost.

I thank my colleague from Arizona.

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

I rise today in support of House Resolution 616, congratulating the Louisiana State University baseball team for winning the 2009 National Collegiate Athletic Association Division I College World Series.

Louisiana State University, LSU, was founded in 1853. Its first academic session began in 1860. As of the spring of 2009, LSU's enrollment is more than 26,000 students, including more than 1,400 international students and over 4,000 graduate students. LSU includes 10 senior colleges and schools; and since its first commencement in 1869, the university has awarded nearly 200,000 degrees. LSU has more than 300 student organizations on campus and is widely known for its successful athletic program.

The Louisiana State University Tigers have won 45 national sports championships, including five in baseball, three in football, and 25 in women's track and field. Since 1986, LSU's baseball has been considered an elite program in college baseball, making 15 College World Series appearances and winning six national championships. The team was founded in 1895, and it played a total of four games that first season. The Tigers won their first national championship in 1991; and most recently, they were crowned national champions for the sixth time.

The 2009 LSU Tigers baseball team was led to national victory by Coach Paul Mainieri. The team traveled to Omaha, Nebraska, for the NCAA College World Series after sweeping Southern University, Baylor University, and the University of Minnesota in the regional championship and Rice University in the Super Regional Championship.

In the NCAA Division I College World Series, the LSU Tigers faced the Texas Longhorns in the finals after winning victories over the Virginia Cavaliers and the Arkansas Razorbacks. The LSU Tigers took the national title after a grueling three-game series against the Texas Longhorns. LSU finished their season 56-17. The team's athletic ability, determination, and Coach Paul Mainieri's leadership led the LSU Tigers baseball team to their first national championship victory since the year 2000.

As a graduate of both LSU and of the LSU Medical School, I am honored to stand before the House today to congratulate and to recognize the significant achievements of the players, coaches and students, whose dedication and hard work have led to the success of the LSU baseball program as the 2009 NCAA Division I College World Series national champions.

I ask my colleagues to support the resolution.

Geaux (go) Tigers.

I reserve the balance of my time.

I do.

I yield to the gentleman from Louisiana, my colleague, Dr. Boustany.

I reserve the balance of my time.

I yield 2 minutes to my colleague, the gentleman from Louisiana, Congressman Scalise.

I yield back the balance of my time.

Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. Speaker, I yield myself as much time as I may consume.

I rise today in support of H.R. 1035, a bill that amends the Morris K. Udall Scholarship and Excellence in National and Environmental Policy Act.

The Morris K. Udall Foundation was created by Congress in 1992 to honor Mr. Udall's 30 years in public service. The Foundation was created to help educate new generations to protect the environment. The Foundation works to increase the awareness of our Nation's natural resources, foster a greater recognition and understanding of the role of the environment in the development of our Nation, and through the U.S. Institute for Environmental Conflict Resolution provide mediation and other services to resolve environmental disputes involving Federal agencies.

The Foundation operates several educational programs. The Morris K. Udall scholarship program awards approximately 80 merit-based scholarships at about $5,000 each year. It also supports about 12 Native Americans or Alaskan Natives every summer for a 10-week, bipartisan congressional internship program. Finally, the Foundation supports two fellows every year in a doctoral program whose research focuses on environmental policy.

The bill before us today continues the work of the Foundation by making some administrative changes, and more importantly, adding another member of the Udall family to the name of the Foundation by changing the name of the Foundation to the Morris K. Udall and Stewart L. Udall Foundation.

Like his brother Morris, Stewart also spent his life serving the Nation. He was elected to Congress in 1954 and served from 1955 to 1961, when he left to serve as President John F. Kennedy's Secretary of the Interior. He continued in that post until 1969, when he returned to the private sector, always working to protect the environment and our Nation's heritage.

Mr. Stewart Udall is almost 90 years old, and adding his name to the Foundation is a fitting tribute to him and his family's services to the Nation. I urge my colleagues to support this bill.

I reserve the balance of my time.

I continue to reserve the balance of my time.

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

Mr. Speaker, I object to the vote on the ground that a quorum is not present and make the point of order that a quorum is not present.

Mr. Speaker, I actually applaud the goal of our Democratic colleagues in terms of the health bill they are putting out. Access, quality, and controlling costs are things that we should all aspire for. Absolutely.

And I agree with parts of the legislation. Guaranteed access, for example, is just wonderful. But, of course our concern is that CBO comment that it's not going to control cost, not achieve one of these goals, but rather, reset it to increase it. And we know as the cost of health care increases, that will be one more thing that inhibits growth and jobs.

So what can we do? One, we do need fundamental reform, which, as the CBO has pointed out, this bill does provide. We need to put the patient in charge of health care decisions and dollars. We need to empower patients to make value-conscious decisions, empower them with the information they need for reasonable decisions by increasing transparency on the pricing of health care.

Let's empower them by incentivizing wellness programs at lower costs and improved lives. Let's empower them with things such as HSAs, which have been shown to decrease costs by 30 percent and, indeed, give insurance to those previously uninsured. Empowering patients is the only way to lower cost and increase access.