Floor Statements

Mr. Speaker, we're going to spend the next hour tonight discussing basically the health care debate and what has occurred in the past 2 years here in Congress. And we have asked our physician colleagues and Health Caucus to come down and spend this hour discussing this issue.

Now, I think before we start, what we need to do is talk about why we're having this debate. Obviously, we needed health care reform in America. And one of the frustrations at least I've had since I was here was during our last Congress, we had nine physicians in the Physicians Caucus, M.D.s and then 13 people total in that caucus, and none of us was consulted about the health care bill.

And when I came to Congress, I asked myself the question, just as I was seeing a patient, what's wrong with the American health care system? And the problem with the American health care system is today still, and getting worse, is that it costs too much money to go to the doctor and go to the hospital. So when I would see patients in my office, I could see the costs ever rising. Back in the eighties, we tried plans called managed care capitation. In our State, we tried to reform our Medicaid program. All failed to hold the costs down.

The second problem I saw with the American health care system is that there are a group of our citizens who didn't have access to affordable health insurance coverage. If it was affordable, we would all have it. As an example, let's say a sheetrock worker or a carpenter that puts up studs in a house or a homebuilder may not have a business big enough to afford health insurance coverage. And maybe this person's wife worked at a local diner, and together they make $40,000 a year. In our area you can get along just fine making that amount a year. They couldn't afford $12,000 premiums.

And the third problem I saw, which is a liability issue, is that we see ever-escalating health care costs, and I see Dr. Gingrey is here with us, a fellow OB/GYN as I am, and we saw costs from the time I began my practice from $4,000 in 1977, which is what the malpractice insurance was at that time, to over $70,000 today. Who bears those costs? Our patients.

Again, back to number one. We began this debate on what I think was a false premise. Basically, the health care bill was to cover those people who didn't have insurance. And this particular bill, the Affordable Care Act, so-called ObamaCare, did do a couple of things. One, it has done nothing so far--it is beginning to be initiated, as far as lowering the health care costs--it has done nothing. If you look at every business around, those rates are skyrocketing and making it less affordable for us.

Number two, it did increase access. And how did it increase access? At least it appears so far that it increased access by massively expanding Medicaid. And the one thing about the bill I do like is allowing young people to stay on their parents' health coverage until they are 26.

In a committee hearing we had the other day with HHS Director Sebelius, I asked her how many people would this bill cover, this 2,500-page bill? And she estimated a number, 30 million or 32 million more American citizens. The CMS's own actuary estimates, the Congressional Budget Office estimates it will add 15 million more people to Medicaid, a system that's already bankrupt in the States. The CMS actuary actually believes it will be 24 million more people on Medicaid, and you add 6 million more young people to that, and really without this incredibly complicated bill, in two paragraphs you could have done exactly what they did with this bill without all this complicated issue that we're going to talk about later tonight.

So we did nothing to lower costs. We did increase access by increasing Medicaid and potentially exchanges. And we can talk about that later. And then lastly, liability, which there is nothing in the Affordable Care Act for that.

The other thing that is not in the bill, glaringly not in this bill, which is incredibly important, is the so-called doc fix. And so our viewers can understand what that is, as a physician, when I see Medicare patients, the Federal Government pays a certain amount with Medicare part D and the person getting the care pays for those premiums also.

In 1997, to help hold health care costs down, there was a formula put in so that if the costs went above a certain amount, the doctors were, the providers were cut. Right now, if we hadn't passed a temporary fix of this, the doctors would have had a 26 percent decrease, and in 2 years that's going to be a 30 percent decrease in their payments. So what difference does that make if you're out there and you're a Medicare-age patient, as I became last summer? So I can speak from some experience. I signed up for Medicare last July.

The problem with it is there's a cost to the physician opening and practicing in their office. And we don't pay the cost of the care. And we are already seeing in our area where very fine physicians are no longer accepting Medicare patients. We believe this could get much, much worse under the Affordable Care Act.

And as the two past speakers brought out, what this bill also did, and what we're going to discuss tonight in more detail, is not just the entire health care bill, but it's going to be Medicare and one specific part of it called the

Independent Payment Advisory Board. But to get to that, we have to explain the problem and why we're having this discussion.

One of the charts I want to show you is this and why we're having the discussion right here is because right now we're looking at a budget that if we do nothing at all--and I'll use President Obama as an example. President Obama just turned 50 years of age. In 2025, he'll be Medicare age. And guess what? Four things will make up the entire budget of this country: Medicaid, Medicare, Social Security and interest on the national debt. And that could come even sooner where those things make up all, depending on certain economic factors. So this is the reason we're having this discussion.

And I had a person come up to me this weekend at a Memorial Day event and said, Dr. Roe, I'm concerned that my children and grandchildren will not have Medicare. And I said, that is exactly the reason we are having this discussion. I have that same concern. We want to save this program for future generations. And he said, well, why don't we just cut foreign aid? And I said that's fine. And last year we cut earmarks. That makes up only 2 percent of our budget. If we completely did away with all foreign aid, which some people I think would agree we need to do, but if we did that, it would only cover, it would take 15 years of no foreign aid to take care of Medicare for 1 year at today's dollar expenditures.

Let me give just a little bit of history on the Medicare program, which has been very successful and very popular in this country. In 1965 it came out. It was a $3 billion program, and the reason it was is because we had seniors that didn't have a way to put money back and to take care of their health care after they had retired from their work. So this program was started, Medicare part A, which is the hospitalization part, and Medicare part B, which is the physician part. It was a $3 billion program at that point. The government estimator said in 25 years, in 1990, this will be a $15 billion program. The real number was over $100 billion. And today, just 20 short years later, it's over $500 billion. So this is a totally unsustainable growth rate that we have to deal with.

Now, in passing, as our two previous speakers mentioned, we've cut, this bill cut $500 billion out of Medicare. This one little thing that was left out of those talks, though, this year, beginning in January 2011, our baby boomers hit retirement age, age 65, Medicare age at 3 million per year, approximately 10,000 a day. And guess what? In 10 years, we're going to have 500 billion less dollars to spend on Medicare and 35 million more people to take care of. And so you do the math. How are we going to control this? How are we going to control these costs?

Well, the President suggests a plan called the IPAB. Right now in Medicare we have MedPAC, a Medicare advisory board which gives advice to this body right here, the Congress, about how we are going to spend our Medicare dollars and suggestions. And the Congress has the right to make those decisions.

Well, this Medicare board, this IPAB board that's going to be in effect in 2014, starts this year with some funding; 2014, 15 bureaucratically appointed people will make decisions based on nothing but cost. Let's say we spend $500 billion on Medicare, and the actual cost of providing the care to our citizens is $550 billion. We've lost our ability in this body right here to say how those dollars are spent. That board will make a decision to cut the spending to $500 billion based on nothing but cost, not quality and not access.

And I can assure you, if you have 35 million more people or 36 million more people chasing 500 billion less dollars, three things happen. One is access to your doctor goes down, costs will go up, and essentially you will have, with this board, rationing of care.

I have several of my colleagues here. There are many more things we can talk about. We have the next hour. I want to recognize my colleague, Dr. Hayworth from New York, for some comments.

I thank the doctor for being here. And just for the viewers today, I want to thank all of my colleagues for being here, and all of you are health professionals, not career politicians. I want to point out that Dr. Hayworth just joined us in the Congress. I am a one-term congressman. I practiced medicine for 31 years. I know you did for a long time. We have OB-GYN doctors, ophthalmologists, family practice, cardiovascular surgeons, and nurses, in the well tonight. These are not long-term politicians. These are practicing health care providers who have been out there.

I think the question I always ask myself when I look at legislation, having just left the examining room, how does this legislation affect the care that I can give my patient. I think that is the one that we all worry about. We worried about it with insurance companies. All of us have fought with insurance companies about providing care. I believe at some point in time--we all do this--that care is going to be rationed. The question is: who is going to do it? Is it going to be a Federal bureaucrat and a Federal nameless, faceless panel here in Washington, D.C.? Or is that decision going to be made between a patient, a doctor, and their family? I believe that is who should be making health care decisions in America. It should be made in the examining room in the doctor's office with consultation, not by some nameless bureaucrat up here in Washington, D.C.

I thank you for being here, Dr. Hayworth, and I now yield to Dr. Gingrey, my good friend from Georgia, and a fellow OB-GYN.

I thank the gentleman.

I would like to point out to our viewing audience tonight that when the House version of this bill was discussed through three committees, when this was debated 2 years ago, this was not in the House version of the bill. This was not there. This independent payment advisory board did not exist. When this bill the House passed through three committees and then here as debated on the House floor went to the Senate, we knew that bill couldn't pass over there, so they brought one out that didn't go through a single committee hearing with this IPAB in it. We have right here the letter that many, many bipartisan Members--Dr. Fleming is here. Dr. Gingrey, myself, and others--signed along with many people. Barney Frank signed this, opposing this bill, as well as Bob Filner, Dr. McDermott, Jim McGovern, and on and on and on. They all think this is a bad idea.

Why do we think this is a bad idea?

We believe as the people's representatives--that would be us--that if there is going to be a cut in Medicare that some faceless, nameless board shouldn't have the right to do that and that the Congress would advocate its, I believe, constitutional right to control spending. So that's the reason we are having this debate now. This should never have been in the health care bill.

Before I yield to my friend from Louisiana, with regard to this right here, President Obama said on Medicare reform: Now, we believe the reforms we propose strengthen Medicare.

That would be taking $500 billion out. I have a hard time believing that's going to strengthen it when we've got 35 million more people going into it.

It will enable us to keep these commitments to our citizens.

If we are wrong and if Medicare costs rise faster than we expect, this approach--that's this IPAB--will give the independent commission, which is this 15 bunch of bureaucrats that are going to make $165,000 a year, I might add, the authority to make additional savings. ``Savings'' means we cut the money so you don't get care. Let me interpret this for you: by further improving Medicare. You tell me how that improves Medicare if you cut services to people and if they don't get the care they need.

I would now like to yield to my friend from Louisiana, Dr. John Fleming, a family practice doctor.

I thank the gentleman.

We are blessed to have not only physicians in our Health Caucus but registered nurses with years of experience in health care.

I would like to now yield to the gentlelady from North Carolina for her comments.

Before the gentlelady leaves, let me just point a couple of things out that concern me about this bill, and again, back to my premise that health care decisions should be made between patients and their doctor.

I have had patients in my practice who have been in their seventies or eighties who are much healthier than someone who may be 40 years of age. I have seen them. As a matter of fact, at home, one of the folks who helps cut wood and clean and take care of the Appalachian Trail, does trail maintenance, is 92 years old. And he's out hiking on the trail, a very healthy gentleman. And we see this over and over.

This Independent Payment Advisory Board--and I'm going to run down it real quickly just to let you know what authority this U.S. Congress right

here, and I think this is a bipartisan agreement that we're doing away with--it's created under ObamaCare. The Senate version. Not from the House of Representatives, remember. It creates targets, and it requires Medicare to make those cuts when those targets are reached not based on quality and access but just a specific number. And it targets only senior benefits and providers.

And here's the other little thing that's not known that we haven't even talked about tonight. This IPAB will start out for the first 5 years affecting prescription drugs and physician providers, but at the 5-year mark, your hospital is also included in that. That means that they can cut the payments to hospitals, and maybe many rural hospitals--we fear, where I live in a very rural area in America--may close because of this very provision right here. And it's targeted at high-growth areas.

Seniors are shut out when IPAB selects Medicare cuts. And there is no one they can go to to even complain about this. They can't go to their doctor, and they can't go to their Congressman because the Congress gave up its ability to control those decisions.

So one of my great frustrations is this Congress right here is giving up its constitutional authority. And we are beholden to the people who elect us to do what's right, not some nameless bureaucratic board.

I would now like to yield to the gentleman from Indiana, our new Member here, Dr. Larry Bucshon, who is a cardiovascular surgeon. He brings great expertise in cardiovascular surgery.

Welcome to the floor tonight, Dr. Bucshon.

Dr. Bucshon, let me throw this question at you a little bit.

When you are seeing patients in your practice and basically those health care decisions are made between you and them, when you look at their relevant clinical data and their symptoms and you can see that there is a lesion, maybe a heart surgery that you can do to help them, and it's based on what their needs are--and I have never understood since I have been in this Congress why health care has ever been a partisan issue--have you ever seen a Republican or a Democratic heart attack in your life? No. And I've never operated on a Republican or Democratic pelvic cancer in my life.

Why in the world--so this is one where there is bipartisan support because both sides of the aisle understand this is a very bad idea to get on this slippery slope where you allow Washington bureaucrats, and they can be called ``experts'' if they want to be, but they're going to be making clinical decisions for people they never have placed an eye on or a stethoscope on their chest.

And I, for one, am going to go down swinging on this because I believe this affects all the people in this country, and potentially in a very negative way, including the President, because he will be under this same plan.

And, unfortunately, many people will probably try to opt out. We're already seeing all of the opts out for the private health insurance plans. But I, as a 65-year-old, can't opt out. I'm in. I'm going to be part of this. And I know what my patients have wanted. And I just wondered if you feel the same way I do about that.

What I believe will happen in that situation is that the Federal Government will have overpromised, and what we, as physicians, will do is provide that care and shift that cost somewhere else until there is nowhere else to shift it; because I know how if I see a patient that needs care and they are 75 years old, let's say, and they have needed surgery and I can improve the quality of their life with that, we're going to do it in some kind of way. And you know; you've done it. We just figure out later how to pay for it. That's not the way to do this.

I thank the gentleman.

I'd now like to yield to the gentleman, my colleague and good friend from Tennessee, Dr. Scott DesJarlais, also a new Member of Congress. Welcome to the House floor tonight.

Will the gentleman yield?

Let's go back to what you were saying, Dr. DesJarlais, just a moment ago. We've discussed tonight this Independent Payment Advisory Board in some detail, about what it does. We've also discussed the Ryan plan, about what is in the future.

Well, why are we having that discussion? Well, we're having that discussion because we see Medicare as it is being unfundable in 2024, 13 years from now, and that could be a moving target and change. So we want to sustain this--I think both sides want to sustain Medicare as it is.

So we know that people are 55 and older--if you're 70 years old now, nothing changes. My mother is 88 years old and nothing will change for her. But if you're 54, what happens to you? And why do we think that will work?

Well, what happens to you at 54 is you're offered exactly the same health care plan that I have and you have right now. Maybe you have. I have Medicare part A. I would like to still have the plan I had. But you'll have exactly the same plan that Dr. DesJarlais has. And what plan is that?

Well, basically what the premium support is is that a person just looks--when you turn 65, you'll look at your health care plan as if-- say the Federal Government is your employer. They pay that part of your premium and you pay some other. Now, a higher-income senior like you or myself, we're going to get a bigger chunk of that. So it's going to be indexed based on what your income is. If you're 65 years of age and you're--let's say you have multiple health problems and you're going to have a more expensive plan, you'll pay less than that.

If you are a low income senior, you will pay less than that. Why do we think that will work? We've heard all these things about insurance companies. Why do we think that will work? Well, the one single plan that has ever come in under budget that the Federal Government runs that I know of in health care is Medicare part D.

Now, whether you believe in doughnut holes or not doughnut holes, but in the 10-year budget estimate, Medicare part D, which is the prescription drug plan, was estimated to cost about $630 billion or $640 billion over 10 years. It came in about $337 billion, a 41 percent decrease. So when patients have choices, and people can go and it is not one shoe fits all, one size fits all, people have choices to be able to go out and pick out what kind of health care plan is best for them--for me, I like a health savings account. Someone else may pick another plan with a 20 percent copay. But those patients, those Medicare recipients at age 65 will be able to make that choice, not some nameless board deciding what kind of care you get.

Now, I will say that we do need to help control the costs. That's why we're having this discussion. But again, I believe who should be making those decisions are patients and their families and their doctors.

I want you to stick around for a minute because I've got some more questions. But right now I would like to yield to Ann Marie Buerkle, a great new member of our Health Caucus, a nurse, and an attorney. I won't hold that against her. She is from New York, and welcome to the meeting tonight.

I thank the gentlelady.

Who more than anyone than the Health Caucus and the physicians caucus wouldn't want to maintain Medicare? And one of my frustrations that I have had in this body is, how can you solve a problem if you can't discuss it? And right now we're not even able to discuss in a logical way how we reform Medicare. And those Medicare changes, we've only mentioned a few of them I might add. There are many others in here. In 2012, that will be just next year, there will be Medicare cuts to dialysis treatment. Medicare cuts to hospice begin in 2012. And on and on.

And it's one thing to have a problem. It's quite another to not even be able to discuss the problem. So let's just summarize it briefly here, and then I will yield to you that are still here. We had a problem in this country with health care costing too much and a group of people that couldn't have access to care and a liability crisis. We did nothing with this ObamaCare bill to curb the costs.

How we helped pay for the Affordable Care Act is we took money out of Medicare. And to control spiraling Medicare costs, we set up a board, this bill set up--not we, but this bill set up a board called the Independent Payment Advisory Board. Most people, including many physician friends of mine, don't have any idea what this is. It is a very bad idea. It's not a good idea in England, where it's being used. That's where the group that wrote this bill got it.

And you know why they want this? Why the people that signed this, the Senate and others? Because they don't have to be accountable. They can blame somebody else when needed care isn't given. Oh, it isn't my fault. This board did it. Well, it is our fault. If we give up that right, it's our fault if those cuts occur to our seniors and we cannot provide the care that they need.

So why we are having this discussion is we have got a budget problem. We have got a $1.6 trillion budget deficit in this country we have to close. And how do we do that? We look forward and see where are the costs going forward? As I mentioned, when the President of the United States is 65 years of age, 15 years from now, four things will take up every tax dollar that we take in. So it's mandatory that we begin now solving this problem.

I think the plan is a great plan, the Ryan plan. It allows people to plan. It also, I believe, will allow you more choices. And I believe that that's exactly what the American people want in health care, is not someone up here in Washington making those choices for us and our patients, but the patients and the doctors making those choices.

I will yield to the gentleman, Dr. DesJarlais, if you would like to have some comment about that.

I thank the gentleman.

I yield now to Congresswoman Buerkle from New York for closing comments.

I thank the gentlelady.

I will finish by saying that I know that the Health Caucus and the physicians caucus are totally committed to this bipartisan bill, this repeal of this IPAB.

Again just to summarize what it is, it is 15 bureaucratically appointed people approved by the Senate, submitted by the administration. I don't want a Republican President or a Democrat President appointing these people. What they will do is make a decision based totally on cost. The Congress then requires a two-thirds override to change or they have to make the cuts, we have to make the cuts someplace else. CMS will be in charge of how those cuts are taken care of.

I think that responsibility, that fiduciary responsibility, is right here in the elected body that meets with the people.

I thank the gentleman for being here tonight, I thank the gentlelady for being here, and I yield back the balance of my time.

Mr. Speaker, I rise to commemorate the 100th anniversary earlier this month of the construction of the first hospital in Johnson City, Tennessee. Johnson City Memorial Hospital opened on May 10, 1911, as a 10-bed facility in a white, wooden-framed house. High demand for medical care would lead to larger facilities, culminating with Johnson City Medical Center.

Today, JCMC serves 29 counties and a population of more than 1.1 million people in four states with its Level 1 trauma program, the region's top heart program, a comprehensive cancer center, the region's state-designated perinatal center, and Wings Air Rescue.

This facility, and the evolution of health care in Northeast Tennessee, illustrates the effect of consumer demand on health care, and its power to improve it. It did not take a 2,000 page bill for this network to evolve. Instead, medical professionals and members of the local community did what was necessary to meet changing needs. I congratulate Johnson City Medical Center on its 100 year anniversary, and wish it further success in the years to come.

I thank the gentleman for yielding.

Madam Speaker, I rise today in support of H.R. 3, the No Taxpayer Funding for Abortion Act. I am a proud cosponsor of this legislation.

As an obstetrician and gynecologist, I have delivered nearly 5,000 babies, and I strongly support the sanctity of life. I believe life is a precious gift from God that begins at conception. I have seen human development occur from the earliest stages of a small fetus all the way through birth. The magic of the heartbeat at 26 to 28 days post- conception is indescribable in my field like this, which strengthens my conviction of the right to life.

Since 1976 until the passage of President Obama's health care reform law, Congress prevented taxpayer funding for abortions. Unless abortion is specifically excluded from Federal insurance plans, the courts and administrative agencies have historically mandated it. That's why the language in H.R. 3 is so important and necessary. It explicitly states that taxpayer dollars should not be used to fund abortion.

Abortion is not a business our government should be involved in. Because something is legal doesn't mean you should do it. Regardless of how people felt about the President's health care law, people shared the belief that the President's Executive order on this subject was simply insufficient. I agree with this concern and believe that further efforts need to be made to ensure that no taxpayer funds are ever used for this purpose.

Under H.R. 3, Federal funds are statutorily prohibited from being involved in any type of health care coverage or benefits that include abortion. This means future Presidents, or even our President, can't go back and insert abortion coverage on a whim.

As legislators, we carry the responsibility and privilege to protect those who do not have a voice. We must make our laws consistent with our science and restore full legal protections to all who are waiting to be born. This starts with legislation like H.R. 3.

One of government's core functions is to protect the most innocent among us, and I will do my best to ensure that government fulfills its duty. I will always fight for the right to life because it is my belief that we are unique creations of God who knows us and loves us even before we are conceived.

Madam Speaker, I rise today to pay tribute to all those affected by the devastating storms that ripped through Tennessee and 12 other States last week. My thoughts and prayers are with the families who lost loved ones and with those that must rebuild their lives after this terrible natural disaster.

Just as the people of Tennessee came together following last year's floods, we will do so again. With heavy hearts, we will overcome our great loss with greater strength and a renewed sense of community.

I would also like to extend my heartfelt thanks to all of the volunteers and rescue workers involved in the disaster relief efforts. Even in dark hours, the efforts of Americans like these should give all of us cause to hope.

In the days ahead, we will work together to ensure that our communities have the resources needed to rebuild. I have complete faith that we will emerge stronger and better than ever before.

Madam Speaker, my prayers go to those family members in our State and others who have lost loved ones. It's a terrible, terrible tragedy.

I thank the gentleman for yielding.

Mr. Speaker, I rise today in support of the rule and of the underlying bills. I would like to draw particular attention to H.R. 1213, which would repeal a provision in the health care law that gives the Secretary of Health and Human Services unlimited spending authority with regard to State-based exchanges.

Let me start by saying that two years ago, when I came to Congress, I looked at the American health care system, and I asked: What's the problem with it?

The problem with the American health care system is that it costs too much money. It's too expensive to go to the doctor or to go to the hospital to receive medical care. If it were affordable, we could all have it. Number two, we have a segment of our population that doesn't have access to affordable health care coverage. Let's say it's a drywall or a sheetrock worker or a carpenter who may be out, working. Maybe his spouse works in a diner, let's say, and they get along just fine, but they can't afford the high premiums. Number three, we have a liability crisis in this country that is forcing the cost of health care through the roof.

Well, what did the Affordable Health Care Act do? It did do number two. It

expanded coverage for some people in this 2,500-page bill--remember, it's this thick--but it did nothing to help curb the costs, and it did nothing for liability, which is forcing the costs of health insurance coverage higher for all of us. I've seen it in my own State of Tennessee. The enactment of this legislation we are talking about today will take $14 billion that we don't have.

Let me just say this: What worries me about Washington, D.C., is that we didn't get the memo. We're broke here. Number two, what is that $14 billion going to do? It's not going to put one more patient in my office who I can see and treat. It's going to the bureaucracy. I see it in education. I see it in commerce. I see the beast, the Federal Government beast, just getting larger and larger and larger. The money doesn't actually get down to a patient for whom I can write a prescription so he can then go to a pharmacy, get the prescription filled, and then get his health care.

So we talk about several simple things that the chairman spoke about just a moment ago very eloquently, and let me show you an example.

I have a Health Savings Account. This little card right here is a debit card. I don't have to fool with the insurance company. I don't have to fool with the Federal Government. I don't have to fool with anybody. I fool with me and my doctor; and who should be making health care decisions are patients and their physicians, not an exchange and not all of this. That's just going to complicate it. I go in with this, and I pay for it, and I usually get a significant discount when I do that.

There are a couple of other things that you can do. Just remember, as to this 2,500-page bill, Mr. Speaker, you could have done two-thirds of it with two paragraphs. One which I agree with, which is in the bill-- and it's one of the few things I do agree with--is to simply let children stay on their parents' plans. Pick your age--25, 26, 27. Number two, simply sign up people who are already eligible for government programs. That's SCHIP and Medicaid. If you do those two things, you can cover nearly 20 million people without this complex, almost incomprehensible bill. We have a Secretary who really has a fungible account from which she can spend billions of dollars that are really unaccounted for. Also, we are knee-deep in red ink. That's the major problem with granting the Secretary access to the Federal Treasury.

The exchanges mandated by this affordable health care law are the first step for Washington bureaucrats in really getting more control of our health care system. Don't get me wrong. I am absolutely for consumer choice because I believe consumer-driven health care is the only way to keep costs down. I think, if we don't do that, you will never get the costs going in the right direction. Instead, this creates a top-down mandate for the type of insurance that will be made available in these exchanges. Remember, when you're looking at this Affordable Health Care Act, the government--not you, the patient, as an individual, as a person, and not the doctor--decides what is an adequate health care plan. So these exchanges are basically just an excuse for unelected Washington bureaucrats to really make our health care decisions for us.

Mr. Speaker, this is not a free market system. It's basically central planning. Patients should be allowed to choose which benefits they want when buying their insurance plans. By passing H.R. 1213, Congress would send a message that we want health care reform that puts the patients first.

There are another couple of things that are very simple in lowering the costs of health care.

It is difficult to cover people in small businesses. There is no question about that. Association health plans allow you to do that, to group and become large groups. There is a second thing you can do that really is so simple I don't know why we haven't done it. I spent a year, when I was running for Congress and after I left my medical practice, and I had to buy an individual insurance policy. It was very expensive. Many people out there in small businesses or individuals who work on farms or in other places do the same thing. To make that insurance more affordable, not only could you have an association health plan, but number two, as an individual, you could have allowed me to deduct my health premiums just like a big business does, just like a huge corporation does, and you would have automatically lowered my cost by 35 percent and would have made insurance more affordable.

So there are many things we could do. This is not what we should be doing. I would urge a vote for the rule.

Mr. Speaker, I have read the bill, all pages of it. I won't say that says a whole lot about my intelligence, but I did read the entire health care bill. When you speak of HSAs only being for wealthy people, that is absolutely not correct.

In my own practice, we have offered the 300 people or so who get insurance through our practice, we allow them to get a traditional health insurance policy or an HSA, and over 3 out of 4 people choose an HSA. And why is that? Because they make the health care decisions, not an insurance company and not a bureaucrat.

I yield to the gentlelady from Texas.

I thank the gentleman for yielding.

Absolutely. What our goal is is to provide affordable health insurance coverage for all Americans. There is no question that I would like to see that in my tenure here in this House, in this body. The problem we have is, how do you get there?

I think the Democratic side is to expand the bureaucracy, more government control. IPAB is a perfect example, and the President spoke of that, and our Medicare patients. I think that is a terrible idea. As a matter of fact, it is a terrible idea. We want to do that. I know there is a way to do it. And, again, to hold the costs down. Remember, that is the problem.

The gentlelady from Texas made a point that insurance premiums would go up. Insurance premiums are going up in anticipation of this particular health plan because, why? The government decides what you must have. You don't get to make that decision yourself. That is done by a bureaucrat, it is done by Congress or whoever decides what is in the plan.

I will give you an example, Mr. Speaker. I don't need in my family fertility coverage at my age. I have three grown children that are raised, educated, have health insurance, good jobs. But I probably will have to have that, because that is a plan that someone else will decide I need--to have fertility coverage. There are things in those bills that I don't need to have personally that I should be able to pick out. And I am just one example. People across this country ought to be making those decisions, not the Federal Government and not a bureaucrat.

Ultimately, what is going to happen in our health care system is, because resources are finite, is that care is going to be rationed. Is the government going to ration it, or are a patient and a doctor going to make those health care decisions? I trust the patient and the doctor to make those health care decisions.

I thank the gentleman for yielding.

Mr. Speaker, in Tennessee, 17, 18 years ago now, we tried TennCare with sort of an exchange. We have had seven or eight different plans competing for your business, and in 10 years the costs tripled in our State because of the intervention of the government.

Medicare, I want to speak to that very quickly. If you're 65 years of age and you have Medicare, you keep it. If you're 55, if the Ryan plan goes through, you keep it. If you're younger and you're a more affluent senior, like I am, you're going to pay for your health insurance. Yes, you are. If you're someone like me with a higher income, you are. If you're lower income and you're sick, you're not. The Federal Government will act like your employer does if you have the employer-based insurance. That part of the premium is paid by them. You pay your part of the premium. Again, it will be means-tested for a higher-income senior.

Why do we think that will work? Because the only plan that I have seen this government ever pass that has come in under budget is Medicare part D. So I think there is a real chance for this to help hold costs down.

Mr. Speaker, I rise today to celebrate a great leader, minister, and educator, Dr. Donald Jeanes, who is retiring this year as president of Milligan College in my hometown of Johnson City, Tennessee.

President Jeanes is a 1968 magna cum laude graduate of Milligan College and has lived in Johnson City most of his life, first as a minister, and then as part of Milligan College. President Jeanes was inaugurated as the 14th president of Milligan College in October of 1997. Under Dr. Jeanes' leadership, Milligan College has consistently been named one of America's Best Colleges, and has experienced phenomenal growth both in terms of the physical campus as well as the courses offered.

I would like to personally thank and acknowledge Dr. Jeanes for his commitment to faith, education, and community development. I wish he and his wife, Clarinda, the very best as he prepares for his retirement from the presidency of Milligan College. I would like to say to my friend, a job well done.

I thank the gentleman for yielding.

When I came, as we all did, doctors, physicians tend to look at a problem. When a patient comes in, the first thing we ask them, Dr. Gingrey: Why are you here today? It is a fairly obvious question. It is called the chief complaint.

When I came to Washington, D.C., I asked the same thing about the American health care system. I said: What is the problem with the American health care system? I thought there were probably three.

Number one, it was too expensive. The cost of health care had skyrocketed way above inflation so it is way too expensive to come see a doctor or go to the hospital.

The second issue I saw you just brought up was that there was a segment of our population that didn't have access to affordable health insurance coverage. These are not the very poor who had access in my State to TennCare or in other States to Medicaid, but these are folks who are out working. Maybe they are a carpenter and their wife stays at home. Or maybe they have a job, a small business, where they can't afford it. So there was that segment that didn't have it.

Lastly, there is a liability crisis in America. Our friends on the other side, our trial lawyer friends can tend to say that is not the case, but let me give you a personal example. When I started my medical practice, probably about the same time you did, Dr. Gingrey, it cost $360. That was the first baby I delivered in 1977 that I got paid for. I was out of the Army and out of my training, $360. My first year's salary was $32,000. That is what I made my first year in practice. I delivered 260 babies that year; a lot of babies. The next year I was up to $60,000 a year. My malpractice was $4,000 a year. When I came to Congress 2 years ago, the malpractice in Tennessee for an obstetrician was $74,000. And there is no value that we get, that patients get from that. We will go into that when we have another hour.

But the thing about the ObamaCare plan that bothered me was it did nothing to bend the cost curve. If you looked at this and if you look at plans that have been out there in the past, Medicare, for instance, came on board in 1965 as a $3 billion program; $3 billion in 1965.

The estimators, there was no Congressional Budget Office then or folks who make these estimates, but the government estimators at that time said in 25 years this will be a $15 billion program. The actual number was over $100 billion. And today it is over $500 billion.

In Tennessee, we noticed we had the same problem 20 years ago. We have been through all of this before. Unfortunately, no one here chose to listen to us in our Doctors Caucus. We said we had lack of access and we had prices rising back in the 1990s, the early 1990s, exactly the same debate that we are having today except today it is more severe than it was.

We spent $2.6 billion on TennCare in 1993. In 2004, 2005, just 10 budget years later, it was up to $8.5 billion. The cost had tripled.

So when you see these cost estimates--and remember that the same CBO, and these are good folks. I'm not pointing the finger at them. It is very hard to do what they do. They are given a set of data. They crunch the numbers and they hand them to us. They only missed this year's budget deficit by $400 billion in 1 year. So I am to stand here and believe, looking at these other examples I have just given you, that this is going to be budget neutral in 10 years? There is no way it will be.

I know we have a lot to discuss. I'm sorry I was a little late. I had some folks from the great University of Tennessee in my office to see. I look forward to continuing this discussion.

Mr. Chairman, I move to strike the last word.

Mr. Chairman, I rise in support of this amendment.

Over the past year, a number of us have met with Education Secretary Duncan to express our serious concerns with any proposal that evaluates education programs based on the level of debt students are accumulating. Despite improvements that have been made to the rule, I remain concerned about the direction this rule is taking our education system.

I understand and agree with those who are concerned about the high cost of education, but shouldn't we let students and their family evaluate for themselves whether the risk of carrying a high debt load is one they want to take on? It seems to me to be a far better use of our resources to be encouraging informed decisions by putting out accurate information to students about graduation rates, placement rates, and even average student debt burdens.

The fact is career colleges are meeting a community need by educating and training people in specific professions like nursing. In six short years, we are a million nurses short in this country. If there are problems with a specific program, and there are many--in fact, there may be bad programs in this country. Let's come up with a criteria that actually evaluates the programs' effectiveness.

Either way, I think it makes sense to put a halt to this rule and use the additional time to urge the Department to go back and put out a rule that will ensure students continue to have access to educational choice.

I urge adoption of the rule.

I yield back the balance of my time.

I thank the gentleman for yielding.

Mr. Speaker, I rise today to support H.R. 2, the repeal of ObamaCare. For the past 30 years, I haven't been a politician but a physician treating patients and delivering babies in rural east Tennessee. And I can say without hesitation that we have the finest health care system in the world.

Health care should not be a partisan issue, and I personally have never operated on a Democrat or Republican cancer in my life. You can't spend $1 trillion and have a bill that's over 2,500 pages long and not have something good come out of it. This bill is not, however, good medicine for our country.

The repeal of ObamaCare doesn't mean that we aren't for health care reform. Quite the contrary. What I discovered in my own practice of 30 years was health care was becoming more and more unaffordable for our citizens. And we had a group of patients, a group of citizens, who didn't have affordable health insurance coverage. This we need to address.

This bill does increase the number of people having insurance, but does nothing to control the costs. The other side says that if we repeal ObamaCare, it will increase the costs and decrease access.

Let's take a look at three government-run plans. One is TennCare, my State's Medicaid program; the Massachusetts Care; and Medicare.

In TennCare, we had a plan that had competing interests. It would compete

for your business. It was supposed to hold costs down. We saw our costs in Tennessee from 1993 until 2004 and 2005 go from $2.6 billion to $8 billion. It tripled. And what we found was that half the people who went on the government plan had private health insurance and dropped it and got on the government plan. This plan took up almost every new dollar our State took in. We balanced this on the backs of college students. We have less highway patrolmen in our State than we had 30 years ago, and we have 2 million more people. What our Democratic Governor did was rationed care by cutting the rolls of TennCare patients and also limiting the access to physicians to eight visits per year.

Let's look at Massachusetts Care where there is a mandate right now. You are required to buy a good or service and the government decides what the right good or service is, not you as the consumer. So what happens is it hasn't held the costs down there either. They have the highest private insurance premiums in America in Massachusetts. Emergency room visits are not down. And why is that? The same as TennCare. These plans don't pay for the cost of the care, shifting more cost over to the private sector, making it more and more expensive.

The second thing this mandate does is it empowers lobbyists. How it does that is you will see the lobbyists come to us, the politicians, and say, Hey, we want this medicine or this device on our plan. And these are the people that write the checks to the politicians, so you are empowering them.

Let's finally look at Medicare, a program that started in 1965 as a $3 billion program. The government estimators at that time said in 25 years this will be a $15 billion program. It was over a $100 billion program. Today, it is over $400 billion.

So we have three examples where costs are out of control in the government-run plans.

The senior citizens understand this. When you take $500 billion out of a plan, and in the next 10 years we are going to add 36 million seniors, three things are going to happen when you have got more patients chasing fewer dollars: You will have decreased access, you will have decreased quality, and you will have increased costs. That is a given.

We had the President say last year, I will go over this bill line by line.

I have read this bill. I wanted to go over it. I wanted to have meaningful health care reform but was denied that privilege.

Without exception, our States are almost broke, every one of them. And we are adding another unfunded Federal mandate to require them to pay and implement a plan that is already breaking them, the expansion of Medicaid, which is an entitlement.

Businesses get it also. If this is such a great plan, why have, to date, 222 businesses opted out, including McDonald's and, of all people, the SEIU, the government's employee union who fought for this and then opted themselves out? I find that ridiculous when you see that.

The doctors get it. The doctor fix, the SGR fix is not in this bill. It is a cost that was hidden. As doctors are squeezed, they cannot see patients that cannot pay the cost of the care.

Malpractice is not in this bill. I can tell you as an OB-GYN doctor, it is over the top. It is almost unaffordable for us.

So the American people get it. The people of Tennessee get it. And we as elected representatives get it. We got that in the election of November 2.

I want to encourage my colleagues to vote to repeal ObamaCare.

Mr. Speaker, just to address my colleague from California, I would argue that Tennessee has thought this plan well out; and the problem with this plan is, when you have more services chasing fewer dollars, you are going to create waits in a situation where you shifted the cost.

You talked about the private health insurance costs going up. That is true. There is innovation, liability. There are a lot of reasons for that, Congressman, but one of the main reasons is an overpromise by government programs that shifts costs. We saw that in our State. We can do better.

I thank the gentleman for yielding.

Mr. Speaker, as an obstetrician-gynecologist, I have delivered close to 5,000 babies and strongly support the sanctity of life. Using technology like the 3-D ultrasound has given us windows to the womb that show the unborn child as living, breathing, a feeling human being. I have looked through that window with my own eyes numerous times, and I have seen human development occur from the earliest stages of the tiniest embryo all of the way through birth, which strengthens my conviction in the right to life.

Life is a precious miracle from God which begins at conception. It is our responsibility and privilege as legislators to protect those who do not have a voice. I will always fight for the right to life because it is my conviction that we are all unique creations of a God who knows us and loves us before we are even conceived.

Tonight we mark one of the most tragic, misguided Supreme Court cases in our Nation's history, Roe v. Wade. Since 1973, more than 50 million babies have been denied the right to life. We must make our laws consistent with our science and restore fully legal protections to all of those who are waiting to be born. If government has any legitimate function at all, it is to protect the most innocent among us.

For over 30 years, Congress has prevented taxpayer-funded abortions. Unfortunately, this door has been reopened with the passage of ObamaCare, the largest expansion since the pivotal Roe v. Wade decision. In response, House Republicans in the Pledge to America vowed to repeal and replace this legislation. I look forward to working with my new colleagues to ensure this promise is kept. It is only by making good on this oath that we can expect to restore the trust that the American people have in their own government and, in doing so, ensure that the door to taxpayer-funded abortions remains closed.

I want to congratulate the Hope Center in Greenville, Tennessee, which is sponsored by the First Free Will Baptist Ministries who support life. These people do a wonderful job in ministering young mothers who may be single or married to preserve life.

I am glad to be here on the House floor tonight with my friend and other legislators fighting for the rights of the unborn. And I want to thank the gentleman from New Jersey who literally is one of the leaders and heroes in the pro-life movement. I can't say enough about Congressman Smith and what he has done to promote this right to life across the country.

As I was walking over here toward the House floor tonight, I had some thoughts about children I have delivered. I have seen those children grow up in my hometown, Johnson City, Tennessee. The beauty of it is that you get to coach these young kids in Little League ball and you get to watch them grow up and come to your home and graduate. The people I have seen have been young doctors and nurses and teachers and college athletes and newspaper writers and news directors. All of these young people I have delivered and seen grow up, and the world would not be a better place if they were not here. The world would be a much worse place. Think about how many thousands and tens of thousands and millions of the same people I just delivered that I watched grow up in my community that are not here today because of this terrible law.

I do want to mention one thing medically that was brought up a moment ago about a third trimester abortion to save a mother's life. Let me make this as clear as any doctor can make anything: There is no medical indication whatsoever for a third trimester abortion, period. Let me say that one more time, and I will debate this anywhere with any doctor in the world: There is no medical indication on this Earth for a third trimester abortion.

I thank the gentleman. I am encouraged about the degree that the American people are changing their minds, and I think if we keep working and talking and explaining and changing hearts, we will change this terrible law.

Madam Speaker, I rise in support of this resolution, and I join my colleagues in denouncing the horrific attack that occurred against one of our own this past weekend, and took the lives of six innocent people, including a staff member, Gabe Zimmerman, and a beautiful 9-year-old child. We continue to pray for Congresswoman Giffords and all those injured, and the families of the deceased.

As Members of Congress we have two responsibilities after such an attack. First, we must vow that we will never let the work of a madman stop us from doing our work on behalf of the American people. Secondly, we will make it clear to all that while we have disagreements, we are all still Americans, and we respect each other. Words matter. When we show Americans that we can disagree substantively and respectfully, we bring our entire country closer together and show the world why America is the greatest force for good.

There is a song Sarah McLachlan sings, ``Angel''--we place them in the arms of angels. And may God bless this family and these people who endured this horrific event.

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

I rise today in support of House Resolution 1767, a resolution commending the Wisconsin Badger football team for an outstanding season in the 2011 Rose Bowl bid.

The 2010 Wisconsin Badgers finished the regular season with a sterling 11-1 record, were co-champions of the Big Ten conference, and earned a trip to the Rose Bowl. The path to the Rose Bowl started early, with a victory over the number one-ranked Ohio State Buckeyes in a nationally televised game, and the season just got better from there.

The Badgers were a prolific offensive machine, averaging 45.2 points per conference game. It was the second highest per game total in conference history. Numerous players earned spots on the All-American teams for their performances on the field this year, including Gabe Carimi, John Moffitt, Lance Kendricks, J.J. Watt, and Johen Clay. Carimi was named winner of the prestigious Outland Trophy, an award given every year to the Nation's best interior lineman.

Of course, all these accomplishments would not have been possible without their head coach, Bret Bielema. Bielema's achievements have also been recognized, as he was recently named a finalist for the Bear Bryant Award, the award given the top college football team in the country.

We wish the Badgers the best of luck on January 1, and I urge my colleagues to support this resolution.

I reserve the balance of my time.

Mr. Speaker, I have no further requests for time, but I would like to congratulate the Wisconsin football team. It's difficult for me to be here because they destroyed my small school this year, Austin Peay, but we do appreciate the large check you sent us.

I yield back the balance of my time.

I rise in support of this resolution, of which I am proud to be an original cosponsor.

I want to thank my good friend from New York, Representative Lowey, for her timely work in authoring this tribute.

The sudden and unexpected passing of Ambassador Richard Holbrooke earlier this week was a shock to all of us.

The depth of sadness that we felt at the news was a testament to his exemplary life of service to our country, in so many different capacities.

Ambassador Holbrooke was one of the most consequential world diplomats of the last half-century, and his tireless work in pursuit of United States national interests and international peace have put us all in his debt.

His advocacy for peace was of course most clearly shown during the conflict in Bosnia.

His tenacity and force of will brought the warring parties to the negotiation table in Dayton, Ohio, where he skillfully brokered the accord that ended the over 3 years of atrocities and bloody conflict.

Over 100,000 perished in the Bosnian war, and it is impossible to say how many thousands were saved by Ambassador Holbrooke's actions at Dayton.

And while that accomplishment would have been enough to mark any diplomatic career with high distinction, it was only one of the many facets of his service, which continued to the end of his life.

As Assistant Secretary of State for two regions of the world--East Asia and Europe, as United States ambassador to the United Nations, and as U.S. Special Representative for Afghanistan and Pakistan, he made his mark on many issues that remain urgent concerns today.

In New York at the U.N., he did much of the heavy lifting on Congressionally led efforts to rein in U.N. spending, to rationalize the dues paid by the United States, and to improve the standing of Israel in that multinational body.

Sadly, those concerns have returned with a renewed urgency--with the need for fundamental reform of U.N. budgets and the virulently anti- Israel U.N. Human Rights Council (so called)--and the Congress can only hope to have such a tenacious, principled partner in the future.

Ambassador Holbrooke made his final appearance before our Committee on Foreign Affairs in the spring of last year, as U.S. Special Representative for Afghanistan and Pakistan.

We lament the loss of his matchless skills in those critical regions.

But while we grieve at his passing, let us renew our own commitment to success in Afghanistan as a fitting way to honor his service toward that end.

At this time we extend our condolences, our thoughts, and our prayers to his wife Kati, and to his children.

While we mourn the loss of a dedicated public servant, they mourn the loss of a husband and a father.

I urge all of my colleagues to join me in this expression of gratitude for the service of Ambassador Richard Holbrooke.

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

Mr. Speaker, I rise in support of House Resolution 1746, as amended, a bill to recognize and support the efforts of the Welcome Back Veterans organization to augment the services provided by the Department of Defense and Veterans Affairs in providing timely and world-class care for veterans and members of the Armed Forces suffering from post-traumatic stress disorder and related psychiatric disorders.

Many of our veterans return from combat in need of assistance due to the symptoms related to PTSD. Welcome Back Veterans is engaged in a public-private partnership with the Department of Veterans Affairs, the Department of Defense, Major League Baseball, the McCormick Foundation and university hospitals of Weill Cornell, the University of Michigan, and Stanford University to help veterans by addressing the ongoing issue of PTSD.

Nearly 5,000 veterans and members of the Armed Forces are already receiving help through the Welcome Back Veterans program. To date, the program has raised over $10 million in funding to help improve the lives of our veterans and their families. Their Center of Excellence initiative looks to continue their commitment to veterans by creating a network of university hospitals that specialize in assisting veterans who suffer from PTSD.

House Resolution 1746 would resolve that the House of Representatives recognizes and supports the efforts of Welcome Back Veterans and encourages the Secretary of Veterans Affairs to establish innovative public-private partnerships for the treatment and research of posttraumatic stress disorder in teaching hospitals across this country.

Again, I urge my colleagues to support H. Res. 1746.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, in closing, I want to commend Congressman Israel for introducing this much needed resolution and also as a veteran myself and as a physician, we need to be looking for public-private partnerships. I couldn't be happier with this because the VA is not meeting the entire need that we have of our veterans right now in treating PTSD. We need to look at innovative ways to put these young men and women back into the workforce and to help them. And certainly not just with the Iraq and Afghanistan war but through the Vietnam War and World War II. Many of our troops out there are dealing with this very, very serious problem. I want to thank these organizations privately for stepping up.

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

Mr. Speaker, I demand a recorded vote.