Floor Statements

Madam Speaker, I rise in support of this resolution to designate tomorrow as National Day of Recognition for Long-Term Care Physicians. And ironically the same weekend we're honoring these physicians, House Democrats are simultaneously destroying their ability to practice medicine by enacting a Washington takeover of the patient's decision-making power.

Let me just give you the short and sweet of it. We started health care reform in Tennessee 17 years, and I know what I am talking about here because we've experienced this. We wanted to control cost and increase access, and we began a plan called TennCare. What's happened during that plan is that it has decreased our access because of the payment to physicians and to providers. This year our plan has begun to ration the care. And how it's done that is, it's limited the number of patient visits and the amount of money that TennCare will pay for a hospitalization, no matter how much money the bill is. So those costs are shifted over to the private sector. I've seen this with my own eyes, as I have paid $10,000 for a visit to the hospital, no matter what the bill is.

I would like to associate my remarks with Dr. Snyder, the gentlelady from California, and the gentleman from Ohio. Madam Speaker, I, myself, have been in exactly the same position that the gentlelady from California spoke of when I ran for Congress and I left my medical practice with $1,800 a month for my health insurance. I was fortunate I could pay that, as the ER physician was able to do that.

You can do a couple of things to make those rates go down immediately. One is letting an individual deduct their health insurance premiums just like huge corporations do. That would make it 30 to 35 percent cheaper tomorrow for every person out there trying to buy affordable health insurance. Number two, it speaks volumes for allowing you to buy insurance across the State line because that one single ER physician could group in an association health plan with numerous other physicians--perhaps hundreds or thousands of other physicians--and bring those costs down.

How do I know that? Because I started my medical practice with four physicians. We now have 70 physicians with 350 employees, and our costs came down. One of the ways we help keep our costs down was a health savings account which was about 30 percent cheaper than the regular insurance.

I am going to finish by reading a letter from Governor Bredesen, a Democrat from Tennessee, who wrote Senator Corker and Bart Gordon: ``The problem that we're facing is simple: by 2013, we expect to have returned to our 2008 levels of revenue and will have already cut programs dramatically--over $1 billion. At that point, we have to start digging out--we will have not given raises to State employees or teachers for 5 years, our pension plans will need shoring up, our cash reserves (`rainy day fund') will have been considerably depleted and in need of restoration, and we will not have made any substantial new investments in years. There will have been major cuts to areas such as children's services that we really need to restore. On top of these, there are all the unusual obligations to be met--Medicaid, for example, will continue to grow at rates in excess of the economy and our tax revenues. It's going to take at least a full decade to dig our way out and back to where we were prior to the recession.''

``In this environment, for the Congress to also send also along a mandatory bill for $750 million for the health reform they've designed is very difficult. These are hard dollars--we can't borrow them--and make the management of our finances post-recession even more daunting.'' This is our Democratic Governor who's asking us not to pass this legislation.

I yield 2 minutes to the gentleman from Illinois (Mr. Roskam).

Madam Speaker, I would like to yield 2 minutes to the gentleman from Minnesota (Mr. Paulsen).

I yield the gentleman an additional 30 seconds.

Madam Speaker, I yield 2 minutes to the gentleman from New Jersey (Mr. Lance).

I yield myself as much time as I may consume.

Madam Speaker, I have spent the last 31 years before I came to Congress in the real world practicing medicine. So I know from where I speak. I have seen it, seen patients. I am probably one of the only people in this Chamber right now that has actually gone to an emergency room at 3 o'clock in the morning and seen someone without health insurance coverage and treated them, and treated numerous patients over the years without coverage. So I know that from a personal basis as a physician and just as a citizen.

Obviously what we are dealing with now is we are dealing with a very complex issue, health care. It is not easy. There is no question about that. I think the difference that we have, the gentlelady from California just pointed out some similarities, and that is where I think the American people would like us to start instead of this incredibly complex bill that the gentleman from Alaska read just a minute ago, only a portion of, that is incomprehensible.

There are two things you can do that would cover 20 million people, and we can do it on one sheet of paper and not have however many new bureaucracies and czars and agencies and IRS agents and all of that. And that is, which I wholeheartedly agree with, is allow young adults, I have had three in my only family do this, who graduated from college and didn't have insurance right after they got out, let those folks stay on, pick your number, 26, 27 years of age, on their family's health insurance policy. Simply sign up and adequately fund SCHIP, the State Children's Health Insurance Plan, and Medicaid. By doing those two things, you can cover 20 million people. This bill, as complex as it is, covers presumably 31 million people.

My concern with the cost is that one of the things that this bill does not do, it does not address costs. And let me just give you an example. When Medicare was established in 1965, the government estimates at that time was that in 25 years that bill would cost $15 billion. The actual cost of that bill, $90 billion. That was in 1990. The actual cost today, Madam Speaker, is over $500 billion. And we know that this bill is going to remove $500 billion, or approximately $500 billion from this plan.

Let me just tell you what begins to happen, and I have watched it in my own practice, in 2011. The baby boomers hit. Seventy-eight million baby boomers in the next 20 years, 35 million or more in the next 10 years, and you're going to provide the care they need with 500 billion less dollars. I don't think you get that math. The way I read that is that three things happen: Number one, you decrease access. Number two, if you don't get the access, you get decreased quality. And number three, you are going to increase costs because people are going to pay, if they can afford to, for the care that they are receiving.

As my friend Mr. Lance brought out, malpractice reform is desperately needed. I am an obstetrician. I know that all too well, about how many of my colleagues have left the practice of delivering babies, one of the most fulfilling things. I have delivered almost 5,000 babies. And when I left my practice to come to Washington, I never felt like I had a job. It was a privilege to take care of patients and bring those young people in and watch them grow up and flourish in the community I lived.

Young doctors are not able to do that now because of the cost. And it is not in here at all. In our own State, where we have a mutual company, an insurance company, State Volunteer Mutual Insurance Company, which insures the doctors of Tennessee, since the inception of that company, over half the malpractice premium dollars have gone to attorneys, not to the injured party. Less than 40 cents on the dollar. Many of my good attorney friends have said, we need to do something about this. I agree.

So we don't disagree about what needs to be done; it's the method to get there. We are going to have a large government bureaucracy that is expanding a plan that is not working, which is Medicaid. And I have some very good ideas about what we should do for that. We shouldn't treat our Medicaid patients different than we treat other patients. I absolutely agree with that. Therefore, I would argue also we have the insurance industry--I am not going to sit up here and be a shill for them. I have argued with them for 20 years, 30 years about care. But I will point out one thing.

You can take all the profits, that is what I have heard for the last 3 weeks up here is the evil insurance companies, you can take every nickel that they make and it will run our health plan in America, our health, for 2 days. So what are you going to do the next 363 days? Only 2 days. Take them all and put them out, you only cover people for 2 days. So that is not the solution. It is just demonizing them. They need to shape up, there is no question about that. And competition will help that happen.

I know this is a great vote. I think it is one of the biggest votes that we have had in the last 45 years in America. The people in my district overwhelmingly oppose this bill by about 8-to-1. I am going to vote against this bill for the reasons that I have stated, and certainly would be willing to work with the other side, and asked to do that.

One of my great frustrations in coming to Washington, D.C., was to have spent over 30 years in the practice of medicine and not be included in the decision. The physicians caucus on our side, 10 doctors, 14--we have other folks other than M.D.s in that caucus--and the two Senators who are M.D.s, none were included in this discussion about health care. I think that was wrong. I think it was a mistake on the other side, and would have certainly liked to have brought over 300 years of experience to the table and discuss with them real solutions, positive solutions for health care.

I yield back the balance of my time.

Madam Speaker, this week Speaker Pelosi and the House Democrats are trying to ram through one of the most ill-conceived pieces of legislation of all time, and they are considering not allowing Members an up-or-down vote on the bill.

One House Democrat recently said, ``I don't need to see my colleagues vote for the Senate bill in the House. We don't like the Senate bill. Why should we be forced to do that?'' Good question.

This attitude perfectly sums up the Democrats' push to have Washington bureaucrats take over our health care system. President Obama and the Democratic leadership don't think the rules apply to them.

First, the House Democrats had to twist arms enough to get Members to vote for their bill despite a 40-vote majority. Then, Senate Democrats had to give a sweetheart deal to Senators from Louisiana, Nebraska, Florida, Vermont, Massachusetts, Connecticut, and so on. Now the House Democrats are preparing to pass this legislation without even having an up-or-down vote.

It is no wonder the American people oppose this bill by such a wide margin. They feel like they are being duped by the Democratic leadership.

It is time to reject this Democratic health care and start over.

Thank you very much for holding this Special Order on health care and the life issue. As I was walking over here, I thought back to my medical school years and how this issue of abortion ever came up. I followed it from the time I was a medical student, when abortion was illegal in this country, until it was legalized. At that time, pregnancy was basically a mystery. It was described as tissue. I've heard of a human being described in a lot of different ways.

But as ultrasound came along and we were able to view noninvasively inside the woman's uterus to see what was actually going on, an astonishing thing happened. I will tell you, after 30-plus years of practicing medicine, it will make your adrenaline flow to look at a baby and watch it grow from the time you see a flicker of a heart beat. We can see that around 28 days post-conception. I can remember the first time to this day. It's been over 30 years since I saw that. And to see that within weeks develop into a little person at around 12 weeks. And certainly now with the new 3D ultrasounds, it is amazing what you can see.

This is a person there. You watch them move, you watch them breathe, you watch their eyes blink, and so on. They're people. If you have any question about what's in the uterus, simply look at an ultrasound and there will be no doubt in your mind that it is a person there. I know that in our area certainly a higher percentage than even 70 percent oppose abortion funding using their tax dollars to end life. That's exactly what it is. It's certainly illegal in this country now. But I think the pendulum is swinging. We have a very limited amount of resources for health care in this country. I think we will talk about certainly the need for reform. But abortion is not health care. It is not. And we should not be using our tax dollars, as precious as they are, to provide care.

Let me just give you an example of what we're trying to do in our State of Tennessee right now. This year, because of the budget crunch, we're limiting our State health insurance plan; and Medicaid, or TennCare in our case, is limiting doctor visits to eight per year. So you as a patient, if you were a patient of mine in Tennessee and you had Tennessee Medicaid, you can only come see me, and that's all the State will pay for, no matter what your condition is. Also, we will only pay $10,000 per year, no matter how many hospitalizations. That's all you're going to get paid. So those costs are shifted.

Right now, in Tennessee, with our Medicaid system, we're rationing care. What we should be doing before we massively expand the system is to adequately fund what we currently have. Certainly, funding abortion, not only is it just the public doesn't want it, it's the wrong policy. So I think the current bill that currently has this language in there should not be passed certainly in this body.

I yield back.

Oh, certainly, there are. Again, thank you for having this conversation, because what you're doing today is that you and Michele are speaking for the unborn. They cannot speak for themselves, so you're here on the floor of the House speaking for them.

Yes. I mean, throughout my career, I remember a case that I had--and I won't obviously disclose anything other than just a case I had in over a 30-year career--of a patient that I had known for years. She came in one day and had tears in her eyes. This was a woman in her fifties now. And she told me, she said, I have to tell you something. I had known her for a long time very well, even as a friend I had known her. And she told me, I had an abortion years ago, and I have got to share this.

Many of the problems I traced back through the 20 years, 25 years I cared for her were directly related to that abortion and the psychological impact that it had on her and her life. And we had a long talk that day, just as a friend to a friend. I hope she left there that day and could go on and continue her life.

So many women won't share things that are very negative--or people, not just women, but men and women both--a very negative part of their life that they're not very happy about and later realize it was a very bad decision. What we're trying to do here today is to prevent women from suffering that psychological damage.

And the other thing that Congresswoman Bachmann just brought up a minute ago was adoption. As an OB/GYN doctor--that's what I do. I have delivered almost 5,000 babies. I can assure you, I can find hundreds of babies a home right now in one town. I can't tell you how many friends of mine that have gone to Eastern Europe, to Russia, and to China to adopt babies. And those are very lucky children who get to come and live with these families.

But why are we doing that when we have babies right here in America that you can adopt? And I will assure you that it would be no cost to the families. Those medical costs will be cared for by these families who desperately need and want children. And what you brought out about a life that is lost, you never have the opportunity to find out what that person could and would be, boy or girl. Maybe they will be a Congressman or a President or a doctor or someone who discovers a cure for----

Exactly. Or a Heisman Trophy winner. And even though he is from the University of Florida, and I am from Tennessee, I have to brag about that young man, that great young person. But those are the things that I think we have to talk about.

And the other thing that you hear discussed a lot, Congresswoman Schmidt, is that you will hear about third trimester abortions. It's about the life of the mother. And I have to say this right now, there are no medical indications whatsoever for that procedure, a third trimester termination of life. There are none. I will be willing to sit and debate with over 30 years of experience to tell you there's only one reason for that procedure, and that is to kill the baby. That's the only reason. And if anyone wants to debate that, I will be glad to do it here on this House floor or in a medical setting. But I want to make that a part of the Record today. We, again, are here today to advocate not only for the unborn but for the mother who bears the problem, the brunt of what happens to her.

I agree with both of you. I'm not sure why I had kids first. I just need to go to grandkids. They are so much better. But I think that you can't imagine life--I know I have heard this right here--without our children and without our grandchildren. When you see a child out there--anybody that would abuse a child, I have no tolerance for them whatsoever. But to have a hug from a child, it doesn't matter whether that child is challenged or not, it's love. And I can't imagine life without mine and my grandchildren.

I thank you for the opportunity to be here today.

Thank you very much, Mr. Shadegg. I appreciate the opportunity to be here on the House floor, Mr. Speaker.

When I was elected to Congress, I had a 31-year medical career, and was coming to the tail end of that. I had been an obstetrician/ gynecologist and surgeon. And I had seen various changes from the late 1960s, when I was in medical school, until now. I had seen absolutely incredible changes in the way we deliver health care and what we can do for our patients.

Just a brief example. When I graduated from medical school in 1970, there were about five high blood pressure medicines, five antihypertensives. And three of them made you sicker almost than high blood pressure. Today, 40 years later, there are probably 50 or more, and with relatively minor side effects. And patients now have the opportunity with high blood pressure, with diabetes, with heart disease--we have just seen recently former Vice President Dick Cheney and former President Clinton get state-of-the-art health care.

The question is, how can we get this health care to the majority of our people and not bankrupt the country? Because it is not the quality of care we are talking about, whether it is heart disease or cancer or any other cadre of diseases that we are talking about.

In the mid eighties we started seeing a shift in the way we discussed and delivered health care. What fee-for-service health care is, is that you as a patient come to me, and I see you, and I give you a bill when you leave, and you pay the bill. That is fee-for-service health care. We saw that that was creating a situation where there was overconsumption of the services, we didn't have enough money in the system to provide that, so a new system of, quotes, ``managed care'' came along where insurance companies said, look, we can manage this care and we can do this by limiting the number of visits and very specifically saying what we are going to pay for in this particular health care contract that you have. That is your insurance plan. And there were various methods out there to do this.

In Tennessee, we saw costs rising ever so slowly, but rising faster than our inflation was. We tried to control these in our State Medicaid program called TennCare. We got a waiver from HHS, the Health and Human Services here in Washington, to try an experiment with managed care. We had about seven or eight different plans that were going to compete for your health insurance business.

What happened to us was that it was a very generous plan, as this plan is as we will discuss later, John, in this hour. When you mandate what is in a particular plan and you provide more health care in it than someone needs to consume, it costs a lot of money. What our plan did in Tennessee, it was first dollar coverage, all prescription drugs paid for, so the patient had no cost in this. They had no so-called ``skin in the game.''

In 1993 when we instituted this plan, the State spent about $2.6 billion on health care for the entire State. Ten years later we were spending $8 billion. Every new dollar that the State brought in, we spent on health care. There was no money in our State for schools, for new construction in colleges, and so on, new capital, other things that the State does; roads. We had to rein those in. And our Democratic Governor did that. The way we did that wasn't a very good way. It was basically we rationed care by cutting people off the rolls.

Today in the State of Tennessee, and the other unknown about these Federal plans, is they never pay for the cost of the care. In Tennessee, the State TennCare plan paid about 60 percent of the cost of actually providing the care. So the more people you got on that plan, the more costs that were shifted to private insurers, forcing those plans to charge higher premium benefits. So we shifted the costs with a hidden tax over from the government plan to the private sector, forcing costs to be passed onto businesses, and businesses much like I had.

Today what we are doing in Tennessee is that in this particular year right now, our State legislature is in the process of looking at our State health insurance plan. They have cut the cost down to about $7 billion. And how did they do that? Well, they simply just disenroll people. And what the plan is paying for this year are only eight doctor visits. In the State of Tennessee, if you have that type plan, you can only come to a physician eight times that the State will pay for. And they will only pay for a total of $10,000, no matter what your hospital bill is. That means that cost is being shifted.

John, in our State this year, the hospitals are going to have a bed tax. They will pass a tax on again to other paying patients to be able to make the Medicaid match that they have right here in the State. So an expansion that the Senate bill currently has of Medicaid will be disastrous for the State of Tennessee. We cannot pay for the plan we have.

Our State Governor, who is a Democrat, has said that this is the mother of all unfunded mandates. And let me give you an example of what has happened in our State. We are now being asked, if this bill were to pass as is, to have a massive expansion of government-run health care. It would cost the State $1.5 billion. In our State, we have 50 less State troopers than we had 30 years ago, and we have 2 million more people. We are not doing a single new capital project on the campus of a university this year in our State because we cannot afford it. So it is a matter of not do you do health care reform, it is a matter of can you afford this.

And when I have heard the President say that premiums will go down, well, I beg to differ. If you look at the Tennessee experience, I can assure you if you extrapolate our experience with what they are proposing nationwide, I did the math this morning on the way into the office, it will be exactly twice what they are saying. And if you look at the estimates that the government has done on health care plans, let me just run through a couple of those for you. When Medicare came on board in 1965, it was a $3 billion program. The government estimated, the CBO didn't occur until 1974, but the government estimate in 1965 was that by 1990, Medicare would be a $15 billion program. It was a $90 billion program. And today it is a $500 billion program in 2010. That particular plan, Medicare, will go upside down, there will be less revenue coming in than going out in 6 or 7 years depending on current estimates.

What we are proposing in this, and our senior citizens get this, is that one of the proposals in this plan is to take out $500 billion. Here is a news flash. Next year the baby boomers, which are a large number of people, hit Medicare age. That is 2011. They will begin at the rate of several million, tens of millions in the next 10 years, to be in a plan that is now underfunded by $500 billion.

One of the things that the Senate plan does have, which I totally agree with, is that we should have been doing this instead of, are the fraud and abuse. There is no question that anywhere there is fraud and abuse in the Medicare plan, we should be going after it. I couldn't agree more.

Also, in this plan, the new taxes that are in the plan over the next 10 years which equal about $500 billion, this is the absolute worst time on the planet Earth to have new taxes when the economy is still reeling from the worst recession since the 1930s. To increase taxes on business, whether it is device makers, or whatever it may be, is absolutely the wrong time.

Let me just point out that when you pointed out Louisiana, Nebraska, Massachusetts, Vermont, and Connecticut, all of these special deals, what that is saying is that those Representatives and Senators from there realize that this is a bad idea if it is going to cost the State money.

It is shocking. And the people from the outside who look at it, the people from Nebraska and Louisiana are fair people. I have heard the governors say this. They will pay their own way. They didn't ask to be cut into a special deal, and that is exactly what this is.

What we are looking at in Tennessee is that what this special deal will cost us in Tennessee is a billion and a half more dollars, in addition to what we are doing now, of dollars we do not have. Neither does the State of Arizona, and most of the other states.

It doesn't mean that we can't do something for health care, but this is not the right way to do it.

Another thing, in Tennessee we have a law called the sunshine law. I as a mayor--that was my last political job before I got here--could not discuss with other members outside a public meeting, totally transparent, any city business. So the camera was on or it was an open meeting. Every single thing we did. Was it cumbersome and hard to do? Yes. But guess what didn't happen? This kind of nonsense didn't happen.

I woke up on December 24 when the Senate voted on this, and I knew what was in there, and I told my wife, I said I worked very hard to gain my reputation throughout the years as physician, and I was very proud to be a Member of the U.S. Congress. It made me ashamed to be part of an organization that would cut a backroom deal like this.

You are describing me. When I worked for myself in a group of physicians, we had 70 physicians and 350 employees. I retired to run for Congress, and I am on my own. So that year that I ran, whatever my tax bracket was, my health insurance cost me that much more money, because as an individual I couldn't deduct my health insurance premiums. But a large company could do that. And my business could do that. I have experienced that very thing.

You can't change. If you dot an ``i'' or cross a ``t,'' that is not the same bill, so they can't strip it out.

I would think so.

I think the thing that bothers the American people, the fairest people in the world, as long as we are all treated the same--we have fought for that equality. And we expect equality in health care. We are trying to provide the same high quality health care for all of our citizens, but this is not the way to do it. I am telling you, this is a prescription for rationed care over time. I have seen it happen in my own State. The people understand it. They get it.

A couple of things that I would like to talk about. The financing of this bill, it is really a shell game. You've got 10 years of taxes to pay for about six-plus years of care which, when you stretch out over $1 trillion dollars, $100 billion a year, really you are putting that $1 trillion in 6 years worth of spending.

The other thing that this bill doesn't do, there is a little thing called the sustainable growth rate for physicians.

Right now, doctors are expected to have, in the next month, if we don't

kick the can down the road again, a 21-percent cut in their Medicare payments. If that happens, and I have talked to my own doctor, colleagues around the country, three things are going to happen.

Number one, you are going to decrease access because the physicians can't afford to see those patients. Remember another government program, Medicare, doesn't pay for the total cost of the care; it pays about 80 to 90 percent of the cost.

Number two, when you do that, you will decrease access and quality.

And, number three, you're going to increase the cost to our seniors, who cannot afford it.

So I think that's a thing that people get. This doctor fix, which is left out, is about a $250 billion or $260 billion additional cost to health care. And how you can take physician payments of Medicare out of the health care bill and say you're reforming it is beyond me.

I yield back.

We do have a high-risk pool, and that is how they work.

And just so people understand, a preexisting condition is a problem in the individual. If you're an individual like I was 2 years ago out trying to buy insurance, or, number two, in the small business pool, if you have 10 employees or 12 employees, it's very difficult. If one person has an illness, it just runs your cost up so high you can't afford it. So how do you make small groups or individuals large groups?

One of the things that Congressman Shadegg has brought up makes absolute sense to me--I cannot understand why anybody but an insurance company wouldn't want you to do it--to remove the State line. What you do, you can buy car, your life, your home, everything else across the State line except health insurance. Well, if I'm Blue Cross Blue Shield in Alabama and I've got 84 percent of the market there, I don't want that to happen, but I bet the consumers in Alabama or Tennessee, or wherever it may be, would like that. Allow us, as consumers, to go on the Internet, look and purchase across the State line and form pools which make small groups large groups and preexisting conditions go away.

I yield back.

We absolutely could. As we say, you don't eat an elephant in one bite; you take a bite at a time.

I tried last night.

The other thing that I would like to bring up while we're talking about it is how you affect cost, because we started this hour talking about health care cost. And without meaningful tort reform, liability reform, you will never bend the cost curve.

Let me give you an example. Years ago, when I was a resident in my training and after I got out of the Army and came back, we didn't make a lot of money as a resident so we would moonlight, work in emergency rooms. If you came into the emergency room and let's say you had some right-side, right-lower quadrant pain, I would examine you, get your vital signs, get a very simple, inexpensive blood test, a CBC. Let's say it was 10,000, a little bit elevated, your temperature is 99.2, a little bit elevated. I don't think you have appendicitis. And I say, well, why don't you come back in 8 or 12 hours and we'll reevaluate you. That was a very inexpensive visit.

Today, if that person comes into an emergency room, you're not going to leave until you glow in the dark, I can tell you, because you're going to get a CT scan, ultrasounds, and every other thing in the world. It's going to be a $1,500 or $2,000 visit. And, John, I will guarantee you most of those are negative.

The reason that the doctor orders them is that there is no reason I shouldn't do that because if that appendicitis patient does happen to get out there, you can just write the check with the zeros and the commas. I can tell you when you get sued, the cost of that is enormous in this country. And who pays for that? We all do. Every consumer of health care pays for that.

Exactly. And you hear us being compared to Canada and England and so forth. They have tort reform. They don't practice defensive medicine there. As a matter of fact, there is a lot of medicine that doesn't get practiced there at all because of cost, but they don't because you can't sue the government. The VA has that system; you can't sue a doctor in the VA. That's another area where tort reform has worked.

The reason that it needs to be done is that no one has argued not to compensate an injured person. Someone who has actually sustained an injury with actual damages, absolutely that should be done. In our State of Tennessee, since 1975, when we formed the State Volunteer Mutual Insurance Company, over half the premiums paid in by physicians into that company have gone to attorneys, not to the injured party. Less than 40 cents on the dollar have actually gone to people who have been hurt and about 10 to 12 cents on the dollar has gone to run the company and put back reserves.

We need a system where we can actually help people who have been damaged. And the cost of this, I can tell you right now, I have a friend of mine in my local community, a great family practitioner, 25 years, got his first lawsuit on a 19-year-old woman who had a very rare situation that occurred. There was no malpractice involved, just a very rare condition. His first year after that, his referrals to doctors, to specialists went up 500 percent and his ordering tests went up 300 percent. And that happens all over the country.

I think one of the things I have fought against for many, many years is that of the abuse of insurance companies. They don't get off free here. In one of the last cases I did in practice before I came to Congress, I spent as much time on the telephone getting a case approved as I did doing the case, which was a major surgical case. So there needs to be some meaningful insurance reform.

How do you do that?

Well, what also isn't in this bill works extremely well because I have used one myself, and 80-something percent of my 300 employees who get health care through our practice use this. It's called a health savings account. What it does is it puts me, the consumer, in charge of first dollar. The insurance company is not in charge of it; I am in charge of it. The argument is that only the wealthy will use a health savings account. That is not true. This is how my health savings account works and how it works for my employees:

The business puts $3,000 away, tax deductible, into a plan that is yours. You have a debit card--and I have one right here in my pocket-- so, when I go and purchase health care, I buy it on the first dollar. The people I'm buying it from don't have to wait 2 seconds to get paid, so I want the lowest price. The one I used had a $5,000 deductible. I take good care of myself, and I've been fortunate. After 2 years, I had almost $8,000 left of my money. The insurance company didn't keep it as profit--I kept it--so I am incentivized to spend my health care dollars wisely.

This is a very good way to bend down that cost curve when you put me, the consumer, in charge of my own health decisions.

That sounds like a southern comment.

They're in bed with them.

Well, let's talk about a couple of solutions. We've talked about a lot of problems. If you did two things, you could cover almost two-thirds of what the Senate bill does and would not have one new program. Actually, one new bill would do it.

Number one: Allow your adult-aged children when they're above 18 years of age or when they've graduated from college--and I've had three who have had this problem. For their first jobs, they didn't have health insurance. Just let them stay on their parents' plans. That's in the House bill. Pick your number--26, 27, 28 years old. You would cover 7 million young people by doing that.

Number two: Adequately fund and simply sign up the people who are eligible for SCHIP, the State Children's Health Insurance plan, in Medicaid right now. You would cover 10 to 12 million people.

In this way, you'd cover almost 20 million people without this massive, incomprehensible, 2,700-page bill with all the special deals in it.

You can talk about one page, and you're talking about 18, 19, or 20 million people.

So what could you do very briefly and very simply?

Number one: Increase competition. You have to do away with State lines and allow competition to occur across State lines.

Yes.

I know you were.

Well, the three things we have mentioned right there would cover this bill.

Anyway, one, you've got State lines. Two, you've got association health plans, or groups, which would allow individuals or groups to form. Three, you've got the tax deduction allowing an individual to deduct it from his tax. Four, you've got tort reform. Five, which we've just mentioned, will allow adult-aged children to stay on their parents' plans.

These are five simple things you can do without having all of the special interest groups and everything else. Then guess what? One of the things would be to expand the health savings account. You would be putting individuals in charge of their health care and of their health care decisions. Who should make them? A health care decision should be made between a physician, the family, and the patient. That's who should be making the decisions--not insurance companies, not the government.

That's absolutely right.

No.

You're stuck.

Yes.

I had a very successful medical practice, and I understood who I worked for--not the insurance company, not the hospital. I worked for the patient. We are losing that because we are putting insurance companies and we are putting the government in between those decisionmakers.

I thank the gentlewoman for yielding, and I rise in strong opposition to this resolution.

If passed, this would send a terrible message to our troops in harm's way and only serve to boost morale among our enemies who now have to face the reality that they are being tracked night and day.

I served in the Army in 1973 and 1974 in the infantry in Korea. I felt abandoned at that time by my country. I never want a soldier to feel like I felt at that time. I saw what happened in Vietnam when Washington bureaucrats and lawmakers micromanaged the war and prevented commanders from having the resources available which they thought would win. I will never support a plan for this or any other war in which I think we are tying the hands of our brave servicemembers.

In my judgment, the strategy devised by our military leaders and being implemented by our Armed Forces is the correct one. I have always said I will support this military plan so long as we do not set arbitrary dates for withdrawal from the country, which will only set a target date for those who would try to kill our young men and women.

It is important that we do not forget why we are in Afghanistan. We are fighting this war because a previous Afghan regime allowed al Qaeda, the terrorist group responsible for countless attacks around the globe, including the September 11 attacks against the United States, to operate freely within its borders. If the coalition forces leave, the Taliban could regain control of the country and once again provide safe harbors for those who hate America and want to destroy our country.

Winning the war in Afghanistan will also help deter a radical Islamic government from taking over Pakistan, a country with over 15 nuclear weapons. It seems that in recent months, since our surge in force has begun, we have seen Pakistan become more willing to confront the radical elements within its own borders. And while there is much work left to be done, there is no question that our more aggressive strategy against the enemy is having many positive results.

In April of 2009 I participated in a congressional delegation to visit Afghanistan to observe our operations firsthand. I can tell you without hesitation that we have every reason to be proud of our men and women serving in Afghanistan; they're doing a great job. What they need now is support and a clear signal from Washington that the job they are accomplishing is appreciated and in our national interests. By soundly defeating this resolution today, hopefully we will send such a message. And it is my hope and prayer that we never have to enter another war.

Madam Speaker, Democrats are once again rushing to meet an artificial deadline to pass their government takeover of our Nation's health care system, and it is clear that the majority of the American people don't want this bill.

Republicans have been clear about why reforms being proposed should be scrapped. This proposal will increase costs, decrease quality, and decrease access to care for the vast majority of Americans. I can say this unequivocally as a physician and as a Tennessee resident who has experienced TennCare, our State Medicaid program, firsthand. Small businesses that are dealing with the worst recession in decades will have to lay off workers and cut back on wages to deal with the new mandates.

The end result is what we are dealing with in Tennessee right now: rationed care. To meet its budget, the State is limiting TennCare patients to eight visits per year to a physician and $10,000 paid to providers, no matter what the costs.

While we can't make our State Medicaid program work as is, Democrats in Congress want to expand it. In the end, what is happening in Tennessee will happen to everyone in America, and that is the wrong solution.

I yield myself such time as I may consume.

I rise today in support of House Resolution 1117, commending and congratulating the California State University system on the occasion of its 50th anniversary. The Weekly Normal School, today San Jose State University, became the first institution of higher education established by the State of California in 1862. The California State University system was established in 1960 as the California State College system.

Today, the system is comprised of 23 campuses, with almost 433,000 students and 44,000 faculty and staff. Cal State's campuses stretch from Humboldt in northern California to San Diego. It is the Nation's largest and one of the most affordable university systems. The California State University system offers more than 1,800 degree programs in 357 different subjects. CSU draws its students from the top two-thirds of California's high school students and graduates 91,000 students annually.

The CSU system prepares approximately 60 percent of the teachers in the State, 40 percent of the engineering graduates, and more graduates in business, agriculture, communications, health education, and public administration than any other college or university in California. The California State University system undoubtedly makes an invaluable contribution to the education of the people of California and the Nation.

California State University also makes significant outreach efforts to inform and promote college attendance to middle and high school students, minority populations, and veterans. CSU's outreach to growing and underserved communities also provides a pathway for students from diverse backgrounds to pursue an education.

I am pleased to congratulate CSU on the 50th anniversary of the University system's founding. I extend my congratulations to the California State University system, all the alumni, students, faculty, and staff at each of the 23 campuses, and to the people of California. I urge my colleagues to support this resolution.

I reserve the balance of my time.

Mr. Speaker, just one comment.

There are a lot of things about our education system in America that is not right. And we deal with it every day. We had the Secretary in front of our committee this afternoon. But one of the things that is right is the higher education system in America. And I will tell you that without a system like California's, I wouldn't be standing here today. I was given an opportunity to succeed. And I know so many students in California that don't have the opportunity because of cost to attend a private university, get a great education in that system. And not only is the State of California better, America is better because of this. I would urge my colleagues to support this. I once again congratulate the CSU system.

I yield back the balance of my time.

Thank you, Dr. Gingrey, for yielding. As I was sitting here, I think what we should do is go back a year. Obviously, last year when we first began this session we knew that health care reform was going to be on the front burner. The arguments that I heard for the need of it being on the front burner were the same as I heard over 20 years ago, which were rising costs of care, decreased access to care. And we have viewed those things, I think, over a period of time and understand that we have the best quality health care in the world in the United States, but it is expensive. So the cost is a huge issue. And that's one of the things that I think in this current bill is not being addressed adequately, or has not been.

One of the great disappointments I had during the debate on this health care bill was the fact that in our Doctors Caucus on the Republican side we have 14 Members, now 10 physicians.

We have an optometrist, dentist, psychologist. And not any of us were consulted in any meaningful way in putting together, on the House side, an over-2,000-page bill.

Let's summarize that bill a little bit. The House bill that was passed has a public option in there. That is not the case in the Senate bill. In the Senate bill and the House bill there are both individual and business mandates to purchase insurance. We have never in the history of this country on a Federal level--and you hear it compared to a State issue of car insurance. It's not the same thing. We've never done that before. So there are some distinct differences in these two bills. And they are now coming to the House. It passed in the House by 220-215; and in the Senate, 60-40.

Now the President, and Dr. Gingrey mentioned this, several of us have attempted on numerous occasions to go to the White House and sit down in a bipartisan manner and lay out literally hundreds of years of experience and go over with him what we saw work and what didn't work.

And what I saw in my State in Tennessee back 16 years ago was we looked at access, we look at rising costs, and people's inability-- losing their insurance. The same issues as today. We asked for a waiver from the Health and Human Services to start a new managed care plan called TennCare. I've discussed it here on the House floor, and I'm not going to go into the details, but just to say that bill, that project, when it first started, was a $2.6 billion project in the State of Tennessee to cover people. We had a lot of uninsured people. We wanted to get as many people covered as we could.

In doing that, in 10 budget years in the State of Tennessee that had gone to an $8 billion program. It had tripled in costs. And so we found out unless people had some skin in the game, unless they had some different incentives than we had, the costs would escalate. As a matter of fact, it escalated so much that it took up one-third of the State budget, and every new State dollar we took in went to the health care. So the Governor, who's a Democrat, and the legislature, which was Democrat and Republican, split, had to do something about it because the State simply couldn't afford it.

What I see in this current Senate bill is a massive expansion of the same program that failed in the State of Tennessee. And to show you how bad it is right now in our State, we're having to limit doctors visits. That's right now, currently, I'm talking about. Not with this added part. Remember, in the Medicaid program, the State has a match. That's why the Nebraska carve-out was such a problem for other States, because there is a match that's required in Medicaid: the Federal Government provides so much money, the State provides so much. Well, our State can't provide any more. So we've cut the rolls of over 200,000 simply because the State of Tennessee doesn't have the money for the current plan, not the very expansive plan that we've talked about.

I think last week--I agree with you, Dr. Gingrey, it was a year overdue. It should have happened a year ago. It was good going to show that there are philosophical differences between how you approach health care. Basically, do you want a larger--I won't say nanny State-- but ever-expanding government to make those decisions, or individuals to make those decisions? Certainly, I believe that individuals should.

When you look at this plan that's there now, I can tell you it says it's budget neutral. There's some gimmicks that have been played. Paul Ryan very clearly pointed those out in the $500 billion that is being carved out of an already underfunded, failed Medicare plan; 2016, that goes upside down. In other words, more money is going out than coming in. If you take $500 billion out of that, you've just created another liability for the Medicare program.

I will tell you, if you take that much money out, three things will occur. One, there will be decreased access to care because doctors are not going to be able to take the patients. They won't pay. Number two, the quality will go down if you can't go in. And, thirdly, the seniors will pay more for the care they're going to get because they'll have to. There won't be any other choice.

We talked about some simple things that I think we could do. As you pointed out already, there's a 2,700-page Senate bill out there. We can cover two-thirds of the people in that Senate bill with two paragraphs. Number one--and it's in the House bill--it's simply to allow young people who don't have health insurance after they get out of high school or college to stay on their parents' plan until they're 26 or 27 years old. Just pick your number. That will cover 7 million young people. Number two, sign up the people who are already eligible for SCHIP, the State Children's Health Insurance Plan, or Medicaid. Already you have got those plans in place. Have adequate funding. That will cover, Dr. Gingrey, almost 20 million people. This complicated Senate plan covers 31 million people.

You hear people talk about bending the cost curve, keeping costs down. Dr. Gingrey talked about it a little bit on medical liability reform. Without liability reform you will never be able to completely reverse this cost escalation. Why? Because doctors will order tests to protect them in case there's no disincentive for them not to. Again, an experience we've had in our State: 35 years ago we formed a mutual company, State Volunteer Mutual Insurance Company, to protect physicians. When I first went into practice, my premiums were about $4,000 a year, probably much like yours were. When we left, a physician who took my place was $74,000. It's gone up almost 18 times, over that period of 30 years, the increase in premiums.

And what have we gotten for that? Well, over half the premium dollars that I paid in for 35 years, gone for attorneys, both defense and plaintiff attorneys, not to the injured party. Less than forty cents on the dollar actually went to the injured party. So we've got a bad system to basically compensate people who have been legitimately injured. So until you get that fixed, you're not going to ever completely bend the cost curve. You've got that to deal with.

I think the waste and fraud, everyone agrees with that. There's waste, fraud, and abuse in the Medicare program, absolutely. I do have the President's letter. And the four things that he agreed to discuss were waste, fraud, and abuse. I think we all agree on that. Both sides. I don't think you'll get any disagreement there. The liability reform is just more study. The study that he was talking about was to not limit attorneys' contingency fees and caps on damages. Well, that's the two problems that are causing the problem right now. And in Texas, which we've already done the experiment, in 2003 they passed liability reform. And what's happened in Texas? Well, premiums have gone down 30 percent and physicians have streamed into Texas. Almost 15,000 new doctors have applied for practice in Texas.

Mr. Speaker, the third thing that the President has in his letter is the inadequate payment for Medicaid patients. In our State, they pay less than 60 percent of the cost of actually providing the care. So physicians are not able to take as many of those patients, and many of them limit or don't see Medicaid patients. He said he would be willing to look at that if it's fiscally responsible. The other is to encourage health savings accounts, which has been one of the centerpieces of personal responsibility.

One of the things that has bothered me in this bill, that supposedly the President said in this chair here not long ago, that he wouldn't sign any legislation that wasn't budget neutral. Well, the sustainable growth rate, as you and I both know, are how doctors are paid by Medicare. As a matter of fact, right now there is no--we have had no ``doc fix,'' we call it. There's a 21 percent cut in the budget right now for that that will occur this week if we don't do something this week. If there's a 21 percent cut in those payments to our physicians, then you're going to see a lot less Medicare patients have access to their doctors. And that is a very bad thing.

So I think there are some good things about what the President said here. I agree with that. Then there's some things that just don't mesh with the current legislation.

I want to talk about one other thing, and then I'll yield back. One of the things that when you see CBO and you see all these estimates, you have to go

back and just look at history. When Medicare was first debated on this very floor right here, and passed, it was a $3 billion program. 1965. The estimates then were it would be a $15 billion program in 1990. Flash forward to 1990. It was over a $90 billion program. Today, it's over a $400 billion program.

So if you look at those estimates and look at the history of our estimate in Tennessee that we were going to actually save money, keep premiums down. And, Dr. Gingrey, what's happened when the bigger--these programs that come along that don't pay the cost of the care. Medicare pays about 80, 90 percent of the cost of providing the care, and TennCare or Medicaid pays about 60 percent of the cost. Those costs get shifted. And they get shifted to business and individuals. We think, in Tennessee, it might add as much as $1,800 per family who have private health insurance. So it's a hidden tax. We can't continue to do that, or you'll drive the insurance companies out of business.

Certainly, the insurance companies, we have every right, I think, to look at them very seriously. I know when I left practice, I had a case, and one of the last cases I did, I spent as much time getting the case approved as I did actually doing the case, almost. So there's some insurance reforms that need to be out there. You've experienced the same exact thing. A lot of frustration on my part there, also.

I yield back to the gentleman.

Will the gentleman yield?

You make a great point. We are not here defending them. But to put this in perspective, if you took all the profits that the health insurance industry made, it would be 2 days of the health care of this country. That is how much it is: 2 days out of 365.

I would like to go on record tonight with you as naming this ramming this bill through this month March Madness. And I am not talking about basketball. It would be madness to do that now. And I will just tell you why I believe that.

Six o'clock the night after that summit last week, I just happened to have a telephone town hall and had 1,100 people vote in a poll. There were four questions: Number one, do you want to pass this bill as it is? Number two, do you want to take a clean sheet of paper and start over? Number three, do you want to just scrap it and work on jobs? Or number four, do you not have an opinion on this? Five percent of those 1,100 people who voted said to pass the bill as is. Thirty-eight percent said get a clean piece of paper and start over. Fifty-two percent said just stop altogether and let's get to working on getting people back to work in this country; start on jobs. And then 5 percent were undecided.

As you can see, that CNN poll right there showed 73 percent of Americans think we should start all over or do nothing. So it is not that much different than the very poll I did of 1,100 people voting. Mine was not a scientific poll. I want to point that out. It was just a telephone town hall poll. I don't want to pass it off as anything it is not.

Thank you for yielding.

One of the things that is not mentioned in the President's letter that I am looking at here is that certainly people who are either pro- choice or pro-life do not want, a vast majority do not want taxpayer dollars spent on federally funding abortions. The way the Senate bill is written, the way the House bill without the Stupak amendment, it does do that. The Stupak amendment in the House bill forbids that. The Senate bill does not. And nowhere in this language--why can't we just come out and say a vast majority of the people do not want that? And we should be able to come out and say that no Federal dollars will be used to fund abortions in this health care takeover. I think that is fairly simple.

We saw how the Stupak amendment passed with an overwhelming majority in the House. It did not do so in the Senate. But I think that is fairly simple. We ought to be able to say that. The President ought to be able to say that right now, tomorrow. He should be able to come out and say just that.

The second thing you brought up a moment ago were preexisting conditions. That is for you and I, where I would see it as a physician would be in a patient I diagnosed and would have a breast cancer and maybe lost her job or retired from teaching or whatever it may be, and then she is uninsurable. Well, that is unacceptable. That is absolutely unacceptable. I fought with that for 30 years in practice. Preexisting conditions are a problem in the individual market. The year I ran for Congress, I was in the individual market. It was tough to find insurance. It is expensive, and most people can't afford it. And small businesses. Seventy percent of our jobs are from small businesses. So how do you create a situation where small businesses can afford this and become larger groups?

Well, I know it doesn't make sense, and I have never been able to understand why anybody would care if you sell insurance across the State line. I use the example of Bristol, Tennessee and Virginia. There is a city in my district where State Street has a line right down the middle of the street. On one side, you are in Virginia, and on one side, you are in Tennessee. One side you've got a different insurance policy than the other side of the street. That makes absolutely no sense. You don't get your homeowners that way, your life insurance. Car insurance you can buy across State lines. It makes no sense.

I can see why the insurance industry wouldn't want you to do that because it creates competition. And then what you allow people to do once they can shop across State lines, because there are vast differences, you can get on the Internet and find out what a life insurance policy costs you anyplace in the country. You can evaluate whether the company is solid or not, and you know what you're buying. You can find out. It is transparent.

We need transparency in insurance rates, and we need to allow small businesses to form groups. You can call them association health plans, group plans or whatever. But if you can spread those risks over thousands of people, then the preexisting condition

goes away. And I can't imagine why anybody would object to that. That's not here in the President's plan. He's got this exchange that's government regulated instead of the free market regulation. I think that's a huge difference in the way we look at this. Do we want government regulating it? Yeah, you want some. We have antitrust laws. Absolutely you do. But we want the free market to work because it works much more efficiently, and that's two of the basic differences in these two----

I can't imagine why anybody would mind if you bought your health insurance exactly like you buy any other insurance policy you want to. I don't know how you could possibly object to that. Let's take Realtors, for instance. Almost all realty shops are small businesses. In our community, 10 or 15 people would be a large realty store. There are over 500,000 Realtors in America. If they could come together as an association and buy their insurance through that exchange or through that association, I should say, preexisting conditions would go away. It's just not an issue if you've got 100,000, 200,000 people.

People talk about the FEHBP, the plan that the Federal Government has. That is the same thing. You have 9 million people in that plan. You share those risks, and you can then negotiate lower rates.

Another thing I think that we need to talk about tonight are health savings accounts. I want to talk about that for just a minute because most people don't really understand it. You hear it's just for rich people and so on. That's a big argument you hear. Let me explain to people what a health savings account really is.

You are given money, whatever the number is. The way we've done since World War II is that we've gotten our insurance and we pay a small copay or deductible, and it is 80 percent up to a certain point and then it's 100 percent after that. Well, that means at the end of the year, if you have been totally well, the insurance company keeps all your money. That's your money you are paying in, and you are getting some of that in lieu of a salary. What that HSA does is, let's say you put $3,000 or $5,000 in. I have had a health savings account, and we put $5,000 in that health savings account. If you got sick and used the $5,000, you would pay 100 percent after that. So that is my money I am dealing with. At the end of the year, if I have been healthy, I have had a healthy lifestyle, I don't smoke, I exercise, I eat well, take care of myself, I get to keep the money. I roll it over, and then next year I can use it. And after a number of years, you may have many thousands of dollars that you can use for long-term care.

Now, again, the argument I hear is that only rich people do that. Well, let's look at my own office. We have 300 or so people that get insurance through our medical practice, and 84 percent use a health savings account. They manage their own health care dollars. They like it a lot because they then become negotiators for their health care costs. They come to my office, and they may negotiate a price for a visit. They may go to whatever procedure they may have. They may go to the hospital and say, I want your lowest price, and they can get that by negotiations, and that will bend the cost curve down. What continually makes the cost curve go up is that we're shielded from all the costs of the health care.

I thank the gentleman for yielding. I will just point out the California experiment. They did caps on pain and suffering in 1976, and premiums across the country for malpractice have gone up over 1,000 percent during that time. In California, it was about 300 percent. So it's been a huge decrease. Texas was similar. They have had a 30 to 50 percent reduction in malpractice premiums. And doctors--especially high-risk doctors like yourself and myself--many counties in Texas now have an obstetrician which before they did not have. Over half the counties in the State of Tennessee do not have an OB/GYN doctor in the county. So it is an access inequality problem when you can't get to a doctor. And many of our physicians are leaving the practice, which is very worrisome, because you want your most experienced people staying with it.

We have another problem, I think, with this plan. I do believe that from what I have heard in my own district, there is no question. I came out of church the week before Christmas, and one of my friends there said, Doc, he said to me, What's the Senate going to do with this health care bill? This is after the House had passed it, and it was about Christmas Eve when they were getting ready to vote. And I said, Well, I think that they're going to try to fix it. He grabbed me by my shirt, by my coat lapels, and he said, You fix your cat. You kill this bill. What he was saying was that this comprehensive, almost incomprehensible bill needed to be shelved, and we needed to start from scratch and go all over.

I think last week was a start, but it was a year too late. You had so many people that had put their neck out and said this absolutely has to be in a bill when it didn't have to be. I can think of four or five things we ought to be able to agree on in a minute, and those would be selling across State lines. I think certainly forming association health plans, doing away with preexisting conditions. I think we all can agree on that. I think meaningful malpractice reform we can agree on. I think letting young people stay on their parents' health plan until age 27. I think just signing up people who currently are eligible for the current programs we already have. Those are five things right there that we ought to be able to agree on in a minute and we can do.

Would the gentleman yield?

One of the things that this plan does, it mandates a certain level of coverage. You have to purchase a certain level of coverage, and it is a fairly expensive piece of coverage. An example would be for fertility. I can assure you that in my family, we don't need that coverage. I should be able to purchase the coverage that I need. There are issues in there that I just don't need any more. For example, pregnancy coverage is something I don't need. I should be able to go buy, or a person should be able to go buy, just like when they buy the homeowner's policy that they need, that is what they purchase. You should be able to do the same thing for health insurance.

That is one of the problems with mandates. Some States have as many as 60 State mandates that you have to have in an insurance policy to sell insurance in that State. One of the problems with it is if you are allowed to buy across State lines, you can go buy a policy that fits your needs and your family's needs. You make that decision; the government doesn't make it for you.

Just a very short comment. This weekend, Dr. Gingrey, Mr. Speaker, I had three friends, people I know, diagnosed with some very serious illnesses. It just happened. These three men that I know extremely well, all of them, are getting the highest quality care anywhere in the world, and they don't have to go far from home to get it. I think one of the things that the American health care system has brought to us are new innovations, lengthening of our life span, and the procedures that are done today to extend and improve the quality of life. I am glad to hear no longer, and I heard it for a year, and it was very bothersome and troublesome to me, to hear the other side talk about how bad health care was in America. We certainly have a problem getting health care at an affordable price to all of our citizens, there is no question that is true, but the care that everyone gets is good care.

I can tell you that I have done it myself for people who couldn't pay. And I would stand here and hear people talk, and I am one of the few people on this House floor who had to get up and go to the emergency room at 3 in the morning and see a patient who doesn't have health insurance and try to work him through a system and get them care. It isn't easy. We can do better, and we sure can do better than this bill right here.

Mr. Speaker, today I rise to commend Coach Dave Loos, the head basketball coach at my alma mater, Austin Peay University. He has dedicated the majority of his life to coaching basketball.

The year 2009 marked Coach Loos' 20th season as head coach at Austin Pea, where he is also athletic director. During this time, he welcomed his 400th overall head-coaching victory on December 3, 2009. Austin Peay is a member of the Ohio Valley Conference, and this year, Coach Loos became the winningest coach in OVC history.

It has been a privilege to watch Coach Loos interact with his young athletes, recruiting and encouraging them, both as a mentor and as a coach. As Rick Pitino once said, ``The key to coaching is not what you do, but the way you do it. The intangibles, the motivational parts of the game are the most important facets of it.'' A successful coach not only prepares his team for victory but motivates them along the way. Coach Loos accomplishes this each time he sets a foot on the court and has great concern and

appreciation for each of his players, and that is an invaluable trait as a successful coach.

However, his proudest accomplishment is being a dedicated husband to Phyllis, a father, and grandfather. I encourage my colleagues to join me in commending Coach Loos for his service to Austin Peay University.

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

Life is a precious miracle from God that begins at conception. It's 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.

Tomorrow, we will mark one of the most tragic, misguided Supreme Court cases in our nation's history, Roe versus 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 full legal protections to all who are waiting to be born. If government has any legitimate function at all, it is to protect the most innocent among us.

Congress has prevented taxpayer funded abortions for over 30 years, and the healthcare reform bill has reopened the door to change this effort. As we debate the proposed healthcare legislation, we must fight to prevent it from becoming the largest expansion since the pivotal Roe versus Wade decision, and work to ensure that the door to taxpayer funded abortions remains closed.

I am glad to be fighting for the rights of the unborn.

General Leave

I thank the gentleman for yielding.

I will point out also, just to continue your point, when you take this $500 billion out, what is going to happen in 2011 is the first wave of our baby boomers hit at 3 million to 3.5 million people per year. Which means in the next 10 years when you take half a trillion dollars out, you are going to add 30 million to 35 million people. Three things happen when that occurs.

Number one, you decrease access. Seniors get it. Number two, if you can't get in to see your doctor, the quality of your care goes down. And, number three, to get the care you need, you are going to have to pay more money. You are going to have to pay a higher supplemental to get in.

So those three things are absolutely guaranteed. Our seniors understand it very well.

Back to the point that you were making a moment ago and I think is very important for comparative effectiveness research: I practiced medicine for over 30 years, and there is nothing wrong with finding out what the best treatment for something is. We do that and we do research on that.

The problem comes when you make the next move and say: okay, this person is 80 years old. Their life expectancy is three, four years. Am I going to do an expensive knee replacement? People will say that won't happen. It is already happening.

In England right now, they have an acronym called NICE, which is really an ugly word for that. I have a good friend, a physician in my hometown, whose sister-in-law is English. She was recently treated for chronic lymphocytic anemia and her treatment in England was a blood transfusion. People in this country don't die of that disease. Whatever your age is, you are offered treatment and you are treated.

So this is being used already around in England. Many medications are not allowed because it ``costs too much.'' You will get to take the red pill or the blue pill, and it may not be the best pill.

So what you said is absolutely true. If people don't think it will happen in this country, it will. And I could not agree more. I agree with the President. I think the President would have served himself and the country well to sit down with both sides and find the common denominator on the 80 percent of the things that we agree on and then fix them. It is not that hard to do.

An example I will give you: the Senate bill is going to cover 30 million people, I think, at a cost of $1 trillion. You can do two things, one of which is in this bill which I like. Two things:

One is if your adult-age children graduate from high school or college and don't have insurance, which three of mine didn't when they got their first job, you simply allow them to stay on their parents' health care plan. You can cover 7 million young people by doing that.

Number two, we already have a State Children's Health Insurance Plan and Medicaid. It is already out there, and so that doesn't require another bureaucracy. If you sign the people up who currently are eligible, you will cover another 10 million to 12 million people.

You get to almost two-thirds of what the Senate bill wants to do in one page, not 2,500 pages of incomprehensible gibberish. So I would suggest that we do that now.

We have a great opportunity to get this right. As I have said as a physician for years, first of all, patients and their families and their doctors ought to be making the health care decisions, not insurance companies, not the government. And after looking at this bill--and I have read, as probably you have, this entire 2,032-page bill. And some of it is almost incomprehensible. It takes two or three other manuals, the HHS manual and the IRS manual and so on, to even read it to fully understand what you are getting.

So we need to go back and do something that is simple and fixable so that the American people can understand and a doctor can understand. My physician friends are asking me, Phil, what does all this stuff mean? That is basically what we are dealing with. If the doctors don't understand it, I doubt if the general public does.

I will just continue with that thought for a moment. When I began my practice--and, yes, we practiced like it takes us a while to get it all right, and I am still working on it after 30 years trying to get it right--but when I began my practice in medicine, the survival rate of breast cancer in this Nation was about 50 percent for 5 years. If a patient came to me and said, Dr. Roe, I have breast cancer. What are my chances of living? About 50 percent had 5 years.

Fast forward to now. We get a stage I breast cancer now, which we are finding almost all of them at early detection because of early mammograms; it is over 95 percent. It is one of the great stories. You can tell a patient, no matter how ill you get, no matter how sick you are, you are going to make it. You are going to be fine.

In England what they did was they were doing mammograms, and they discovered and there will be a false positive where the test says you have something and you don't. Well, let me tell you, one of the best days you will ever have is calling a patient up and tell them, You don't have cancer. I have never had a problem with that. But what they found out was that the biopsies, it is a fairly sophisticated biopsy. It requires a radiologist and an X-ray and so forth. That was costing more than providing the mammograms. So what they have done is now they don't do routine screening mammograms. They just wait until you get a cancer, until you can feel a lump, and then biopsy it.

The highest survival rate I have been able to find in English literature is 78 percent. I can promise you, if you follow that pathway, it is going to go right back down to 50 because you will find them too late after the disease has already spread.

So this stuff is occurring. This is not fairytale stuff. It is occurring right now.

I will give--and back to your first point a moment ago, I will give Senator Nelson from Nebraska kudos. I have to say, because in our State, in Tennessee, we have a budget shortfall. As a matter of fact, we can't even fund--we have no capital projects at the university this year. We're not building a library, a dormitory, nothing. We have 50 less highway patrolmen than we had 30 years ago and we've got 2 million more people. That's how dire our budget is.

So what happens with this new bill we're talking about, adding Medicaid, is that you're going to add almost a billion dollars to Tennessee's budget that we don't have, and it's a tax on States. In other words, what you're doing when you add all these people, as you pointed out, is somebody's got to pay for it. And there's a State match. Senator Nelson understood that and he just exempted his State from that match.

So that's why it's important for the viewers to understand that you at home will get not only a tax, an individual mandate tax, you're also going to get a tax. And what the government has done is an unfunded mandate. We see that all the time around here, where bills are passed and local municipalities or States are left to pay the bills. So I think it's important that the folks understand that.

I yield back.

I thank the gentleman for yielding.

The point was made twice that the American people are the fairest people on this Earth, and we live in a place where we have fought a Revolutionary War, established a Constitution that stated that everyone had that right--has a right to be treated equally and under the U.S. Constitution. This does not do that. It absolutely voids those rights for people in certain States and gives more rights to people in other States.

I can tell you, the American people will do a lot of hard things if you're honest with them and you're fair and they feel like the people in California and the people in Ohio and Tennessee and Michigan and Nebraska are all being treated the same. I might add that the people in Nebraska feel the same way. I have seen them and I've seen the people in Florida speak and I've seen the people in other States who got these sweetheart deals. And Louisiana, they're not happy about that either. They're fair people. I want to point that out. It's not the people of those States. They're very fair people.

I yield back.

Will the gentleman yield?

We have a Democratic Governor in the State of Tennessee, and he and the legislature are right now in session beginning on this very difficult process of balancing the budget. Our Governor in the State of Tennessee said this was the mother of all unfunded mandates. He wants no part of it. He feels like it's bad, just as the Governor of Nebraska and other Governors are realizing; that it's just another huge government entitlement that's going to cost the States and local taxpayers.

Like I said a minute ago, what are we supposed to do? Do away with our highway patrol if the Federal Government passes this? Are we supposed to not do anything for education in the State of Tennessee? I don't know what the Federal Government expects us to do, but I guess they expect us not to build colleges, not to add to our schools. I don't know. Right now, the legislature is working very hard not to cut money from education.

We hear and I've heard all the time about how our side, the Republican side, doesn't have any ideas about health care. Well, it would have been nice to share that with somebody. We have 10 physicians in our caucus on the Republican side. Not one of us was asked about this 2,000-page health care bill. I found that astonishing when I've spent my career in health care and not one person asked my opinion about

what I thought of this bill. I found that amazing to me. And so when I go home and tell people in Tennessee--as a matter of fact, all over the State of Tennessee--when I go, they can't believe it. It is sort of hard to believe.

I yield back.

I would like to add to that. I agree with you 100 percent. If you haven't figured out that eating out of a vending machine is not healthy for you, you are not smart enough to be here in the U.S. Congress.

The other little thing that I thought was fascinating about this health care bill was a mention for carbon credits for black liquor. And most people don't know what black liquor is, but I happen to have a paper factory in my district. It's a paper byproduct. Why in the world was that in there? Why was a sewer system on Indian reservations? Why was the calorie content of a doughnut--I don't even eat doughnuts. I started eating a dozen of them because it's not government's business to be telling you that. I want to mention something about--you talked about how they took the money and then provided the service 3 years later. Well, typically you see those furniture store ads on Saturday morning, what they typically give you is zero interest; you don't pay anything, and you get the product. This is just the opposite. I find it fascinating. Let someone try to sell you a couch doing that.

The cost is another thing I wanted to bring up, the government estimates of cost--I think this, to me, was the most amazing thing in the world. Medicare came online in 1965. It was a $3 billion program. The estimate from the government was that 25 years later, that program would be a $15 billion program. In 1990, 25 years later, it was a $90 billion program. Today it's over $400 billion. In Tennessee, we started in 1993 a program called TennCare to save money, to manage care and save money. It was a $2.6 billion program. Ten budget years later, it had tripled to an $8 billion program. It took up every new--almost every new dollar the State took in. So when you see these cost estimates of $1 trillion or $1.2 trillion, it's a fairy tale. I mean, every single government program that I have ever heard of, with the exception of Medicare Part D, went over budget.

Well, I think it brings the point. It is getting harder and harder to pass legislation that people don't want, for sure. And I think, just very quickly, to let people know of a few basic ideas that we have that will help solve this problem. I mentioned to you a moment ago cost and affordability are what people worry about, and preexisting conditions. How do you deal with those things?

One of the things you can do is allow health insurance companies to go across State lines like any other insurance companies. Form association health plans. Preexisting conditions are only a problem for individual markets, if I'm going out to try to buy it, or small businesses, like I ran. But if you are spreading those risks among hundreds of thousands or millions of people, it's not a problem. Number three is tort reform. We haven't touched on that. Certainly malpractice reform is a major cost bender in this.

I could not agree more. And I certainly agree with my colleague from Michigan, Congressman McCotter, about the high plans, the so-called wealthy plans. We don't need to be increasing taxes on--Americans can't stand another tax right now.

The other thing you can do in the State is subsidize at a nominal amount of money high-risk pools so that people who do have preexisting conditions--that's another way you can deal with that very simply. And those four or five things we talked about we could all agree on. We could get this done this 90 days or less, right here in the House in a bipartisan fashion. If the President is ready to work with us, I know our side is. I am. I yield back.

I thank you for yielding.

As Congressman Akin has said, I've spent the last 31 years, until a year ago, practicing medicine in Johnson City, Tennessee, and really in a rural area in Appalachia. I've also practiced medicine in Memphis, in the inner-city, while I was in training and in school.

We have to back up, I think, and look at what the problem was, what problem are we trying to solve.

In this country, I just saw a poll recently that showed among likely voters that approximately 90, 91 percent of the folks had some form of health insurance. What we're getting confused with is there are people out there who don't have access to care. There is no question about that, and we need to address that problem.

What we've been hearing in this particular H.R. 3962, aka H.R. 3200 that we began to deal with, is that this is the only solution, which is this very complex health care bill, which I've read--I've read all 2,000 pages of it--and you have very adequately stated some of the problems. What are we trying to fix?

Well, we have 40-plus million people in America who do not have--not access to care, because a law was passed in 1986 called EMTALA, and that afforded every American, whether you're legal or not--you could be an illegal citizen in this country--or whether you could pay or not. If you go to a hospital with an emergency room, you have to be cared for. We have no choice. When I was on call in the emergency room--and believe me--I'm the one who had to get up at 3 a.m. in the morning and go see these patients and care for them. So the care was there. It's just not the most efficient way to provide the care. There is no question about that.

We have a system in this country now where costs are out of control, and I think that's what this bill doesn't do. It doesn't address the fear that most of

us have and that I know I had as a doctor and that I have as a consumer of health care, which is the ever-rising cost of the care.

We can do several things. Let me just point out, in the 2,600- or 2,700-page Senate bill, I can cover 20 million people on one page. This is just to show you how simple you can make it. Number one, if you have signed up the people currently who are eligible for the State Children's Health Insurance plan and they've just not signed up for a current plan that's already there in Medicaid, you would cover 10 to 12 million people.

There's one thing in this bill that I do like a lot, and that's to allow adult children, when they graduate from high school or college who don't have health insurance, to stay on their parents' plans, their parents' health care plans. You could cover 7 million young people. You could cover almost 20 million people in this country. I don't think either side, the Democrats or the Republicans, would mind doing that. You've covered two-thirds of what the Senate bill is going to do by doing that one thing, and you can do that on one page.

Yes.

On one page.

Another issue that we deal with all the time-- and as a physician, I would deal with this--are patients who would develop, let's say, breast cancer and lose their jobs. Then they would lose their insurance coverage. Now they have chronic conditions, and they don't have insurance coverage. How do you help those patients? How do you help those folks?

Well, this is a very simple problem. Preexisting conditions are a problem but not in the large group market. In other words, if you've worked for a large corporation or let's say--like we get our insurance here through the Federal Employees Health Benefit Plan, the so-called FEHBP. You've got 9 million people who get their insurance through that. If one person has a chronic condition like breast cancer or diabetes, it really doesn't affect our rates because you spread those risks over millions of people. If you would simply get rid of State lines and if you would allow small groups to become big groups, you then solve the preexisting condition problem.

The second thing you can do is to subsidize----

Reclaiming my time, absolutely.

Look, you can buy any other kind of insurance in the world but health insurance across a State line. Why in the world should it make any difference? If I'm living near the State line--and we're surrounded by multiple States in Tennessee--I should be able to buy that insurance across a State line.

For instance, let's take Realtors. Almost every Realtor's business is a small business. They have six, eight, ten. Twenty would be a lot in our area. Let them all group together across this Nation, and then you'll have 500,000 or 1 million Realtors who could spread their risks, and you wouldn't have any government involvement. You wouldn't have any subsidies involved. You wouldn't have any complications. You'd simply let the free market system work.

I thank the gentleman for yielding. You're absolutely right, because what you allow it to do is you allow a small business to become a large business.

Like I said, the problem with preexisting conditions is, if you have a small shop of 5, 10, 20 employees, which many businesses have--and 70 percent of our employees in this country work for small businesses. If you have one very expensive condition that hits, it breaks them. They can't afford insurance. That's why it's not affordable.

Some other things we could easily do are preventative care, and you could do that where you have different incentives to keep yourself well.

As a physician, I can tell you all day long how to stay well, but it is up to you as a patient to carry that out. I can give you all the great ideas in the world, but if you don't carry them out, then it doesn't do any good.

That is correct. So you want to have the incentives built into our health care system.

For instance, a health savings account. I have one, a health savings account. Let me explain this to our audience today, the people who are watching this.

Before, when you pay a premium in, if you don't use it, who keeps the money? The insurance company does. In my case right here, with a health savings account, you put in X dollars. In our office, it is $3,000. It can be $5,000 that your employer puts in that account for you. You pay everything first dollar, so I am highly motivated to take care of myself, because at the end of the year, if I don't spend that money, I get to keep that money, not the insurance company. And you can roll that money over and use it the following year and the following year.

In our group, we have 350 employees in our medical group at home, and for those who get insurance, over 80 percent of them choose a health savings account. They manage their own care, so they are motivated not to smoke and to exercise and to lose weight because they save their own money. You can use that money later in your life if you accumulate many thousands of dollars for long-term care or whatever you want. You are the insurance company.

That is correct. And if something were to happen catastrophically, let's say you have an accident or a heart attack and you spend more than that predetermined amount, you buy catastrophic coverage that covers every bit of it.

For instance, in my particular case, anything over $5,000 is paid for 100 percent. And you had the $5,000 to begin with, it was your money, so you got to keep it. I think that is a very simple thing that we are currently doing and we should be encouraging people to do, not discouraging.

It is not, and it should be.

I think probably we haven't educated our public as much as we should have. I was surprised in my own practice about how many chose to do that once they understood it.

When you are faced with paying $3,000, that is kind of scary to do that when you normally have a small copay or deductible. But once you understand how it works, that you get to keep the money, not the insurance company--and while we are on insurance companies, I have got a problem.

I know one of the things that I did in practice that really frustrated me to no end was to have insurance companies deny needed care for patients, and I think certainly they are culpable. I know I have spent as much time on the phone sometimes getting a case approved for a patient to get needed care as I did actually doing the procedure I was trying to get approved. That is very frustrating. So the insurance company is culpable out there, and we do need some reform.

No, we don't.

If the gentleman will yield, let me just mention a couple of things that my friend from Pennsylvania is talking about.

In 1975, all the malpractice companies left the State of Tennessee. We had nothing. So the physicians there brought together and formed what is called the State Volunteer Mutual Insurance Company. It was a mutual company that anything that wasn't paid out in premiums came back to us. Since the inception of that company in 1975, over half the premium dollars have gone to attorneys. Less than 40 cents on the dollar went to the injured parties, the injured patients, and about 10 cents to run the company.

We have a system that is broken terribly when you can't even compensate injured people. That is the system we have in America now, and that is wrong, because there are events that do occur that need to be compensated. We don't have a system that can even do that.

I would say, when you look at this--I am just a country doctor from east Tennessee, but if you look at the health care problem in America, it is this: One is we have had escalating costs. There is no question of the costs. And we have got people who don't have health insurance coverage. Those are the two problems. How do you solve those problems?

Let me explain to you why having more government will never work and will end up costing more money. And my good friend from Pennsylvania, Congressman Thompson, has hit the nail right on the head.

When you take $500 billion--and I have dealt with Medicare patients for my entire medical practice. When you take $500 billion out of a plan that is already underfunded, that goes upside down in premiums by 2017--and beginning next year the baby boomers hit 3 million to 3.5 million new recipients every year. You take a half trillion dollars out and you add 30 to 35 million people, three things happen: One, you have decreased access; two, because you are not going to get in to see the doctor, number two, you are going to have decreased quality; and three, and seniors get this, their costs are going to go up to get the care that they need.

No, sir.

That is correct. Unless you are in Florida, of course.

That's correct. What you're going to do is, you're going to create waits. There's no other way around it. And that's my biggest fear as a physician, is that at the bottom line, the end of the day, when you budget so much money for health care and you have more demand for services than you have money to pay for it, you create waits. It happens in England France, and Germany, unless you are wealthy and can buy your way around the system, which is what happens. But I'm talking about for the bulk of the American people.

Over 90 percent of the people who have insurance in this country like it. And they like what they have. They understand we pass all of this right here. When a patient comes to me, am I going to be able to provide better care for that patient? The answer is, No, I can't. And let's look at some numbers.

Mine, too.

We had the 17-year experiment called TennCare. And to back up to the beginning of Medicare, in 1965 that great program that was passed started as a $3 billion program. The congressional estimates were at that time that by 1990, 25 years later, it would be a $15 billion program. The actual number, a $90 billion program. It's gone from $90 billion in 1990 to over a $400 billion program. And we're going to cut this much money out. As our population ages, there's going to be more spending involved. Now that's one plan.

In Tennessee, we started with a managed care plan in 1993 to control costs, because costs were going up and there wasn't enough access for our citizens. It was a $2.6 billion program in 1993. In 10 budget years it was an $8 billion program. It took up almost every new dollar that the State of Tennessee brought. And let me go on and fast forward to this Senate bill for a moment, because this is very important for States.

This bill calls for a massive expansion, the Senate bill, a massive expansion of Medicaid. In the State of Tennessee we're looking at three-quarters of a billion dollars of unfunded--unfunded--liability. That's what Nebraska got off the hook for. What you're asking us to do in Tennessee is we, this year, Mr. Speaker, this year we have 50 less highway patrolmen in the State of Tennessee than we had in 1978. And we have 2 million more people. That's the kind of shape that the States are getting in. And we're getting now another unfunded mandate through this health care bill that I don't know where the money is going to come from.

We have no capital projects for our colleges this year in the State of Tennessee. We're not building a new dormitory, a new library, or anything. And yet we're going to get crammed down this massive expansion of government with an unfunded mandate. That's why people are angry.

That's what he said.

He is a very good Governor.

I think one of the problems that you've seen with this plan is the complexity of it. I think the bottom line, what you saw in Massachusetts yesterday is that the people there do appreciate their own personal freedom. They want their freedom to choose. Also, Massachusetts was being asked, since they've already been mandated to pay for their own policy, which I might add has added tremendous cost, and I will also tell you that half of the primary care doctors in that State are not accepting patients.

This is one of the things that isn't understood about a lot of the government-run plans: They don't pay the cost of the care. We haven't discussed that much here, but in our own State, Medicaid pays less than 60 percent of the cost to the providers; the hospitals and the doctors. Medicare pays somewhere between 80 and 90 percent of the costs. The rest of those costs are shifted to private health insurers, meaning that people out in private businesses are actually getting taxed again.

What Congressman Thompson was talking about, another thing that's left out of this particular plan that's really unfair is that you're not even putting in the so-called ``doctor fix.'' Let me explain that to the viewing public out there. In 1997, there was a bill passed here called ``The Sustainable Growth Rate: How Medicare Pays the Physicians.'' And what happened was, is there was supposed to be cuts every year. This year, there was supposed to be a 21 percent cut to physicians, which if that happens, nobody is going to able to see a Medicare patient. And that's not even here. It's over a $200 billion pricetag that's not even listed in this current trillion-dollar pricetag.

Yes.

That's correct. That's on top of the 80 to 90 percent. So for patients and what they're concerned with now, I believe what's happened, and just to simplify in my own terms, is what happened in Massachusetts, where people saw they were already paying very high taxes, they were already paying for coverage, and then they were going to have to pay for States like Nebraska, who were opted out of this deal.

Congressmen, I was very proud to be sworn in to the U.S. Congress on the 6th of January, 2009. I woke up on the 23rd----

It has been a whale of a ride. I woke up on the 23rd

of December and told my wife that I was actually embarrassed to be in this House because of the deals that were cut. And who ultimately paid for them are the patients and taxpayers. And that's wrong. It really embarrassed me when you saw this deal in Louisiana and the different deal in Florida.

Health care should not be a partisan issue. In 30-plus years, I never saw a Republican or Democrat heart attack. I never operated on a Republican or Democrat cancer, just a people problem. We need to get together in this body and not have a partisan solution. There needs to be a bipartisan solution that is simple and addresses problems that we have laid out here today so that patients, their families and doctors can make health care decisions.

I thank the gentleman for yielding. Mr. Speaker, I think last night, watching what happened in Massachusetts, was really, in the many years I have watched politics, was really astounding. The people there I think--it was more than just health care. We have a country now that's not in trouble. We're America, and we know how to avoid trouble in this country. But we have a lot of our citizens who are hurting now. They need jobs, and they need employment. Certainly in our district and around our area where unemployment is over 10 percent, that's the talk in the barber shops and the restaurants: What's the economy doing? What business are we going to lose overseas next? What manufacturing job is going to be gone?

I think the people there looked at more than just health care. I think they looked at a stimulus package of almost $800 billion that I don't believe has worked. It certainly has provided some one-time jobs. But you know and I know as a former mayor that you don't take one-time money and turn that into a long-time job.

How you do that is you incentivize the people who are creating jobs in this country. That is small business. In this country, 70 percent of the businesses are small business that create the jobs. And how do you help them? You make the cost of capital, the cost of money, the cost of creating a job less. How do you do that? Well, you cut capital gains taxes. You can cut individual income tax rates. You can accelerate depreciation for plant equipment that they buy. So we have a country now that has put itself in debt that my great grandchildren will not be able to pay off.

We looked last year, and it is staggering to me how much a trillion dollars is. I get almost overwhelmed, and I made it through calculus in college, and I have a tough time getting my arms around how much money that really is.

We have a budget that went up 8 percent last year. We added 8 percent. In the State of Tennessee where I live, we had to live on less money than the year before. That is what we had to do in our State. That is what California is having to do. That is what every State in this Union is having to do.

I don't know if the people here in Washington get out, as I have, and talk to our Governors and our State legislators, but our States are in trouble. We need our economy to pick up. If our economy was doing well, I don't think that our health care issue would be as big of an issue as it is. As people lose their jobs, they lose their health benefits.

The people of Massachusetts got their arms around the bigger problem, and I think they looked at this entire country and the direction it is going and said, Whoa, wait a minute, we don't like the direction that the country is going. They put the brakes on this. They said let's stop and take a slow, measured look at what we are doing.

If the gentleman would yield, let me give a practical example of what you are saying there.

Let's say years ago if I were working in the emergency room and a patient came in with right-sided pain, I might be concerned about whether they had an appendicitis. I would get a blood count. It was at that time probably a $15, $20 test. It is probably a $50 test now. You do a physical examination, take their vital signs, their blood pressure, their pulse and temperature and do a physical exam, and you would say, I don't think there is a chance that you have an appendicitis, but let's let you go home and if you get worse, start to have more pain, come right back and we will reevaluate you.

That is not going to happen anymore because part of the legal system now, you know if you do that and you don't get a CT scan, a very expensive test on that patient and you go out and you happen to have an appendicitis, the one in 500 times that might happen, you will be held liable. So all 499 people are going to come out of the emergency room glowing in the dark, just about, because of all the X-rays that they have had to protect the doctor from a potential lawsuit of the one in 500. That is the problem that you get into with the tests that are not needed basically to protect the physician. And why wouldn't the doctor order those tests? You don't want to put up everything you have earned in your entire life for the risk of that one in a thousand, that jackpot that somebody might have.

The thing you also brought up is people are genuinely injured in the system. We don't have any way to adequately compensate the injured parties without the attorneys getting their hands on a significant amount of the settlements.

If the gentleman would yield, let's just talk about, for a minute, we have this very complex, over 2,000-page bill which I have read. The Senate bill is over 2,500 pages, which I will admit I have not read. I have seen the synopsis of it. We have 118 new agencies in this very complex schematic that you have down there in front of you. We should, on both sides of the aisle, be able to agree on a few things. One is that we agree that the cost of care is rising too fast and we have the uninsured out there that we need to cover. Those are the two basic premises that spurred this entire debate. How can you best solve those problems? It is not that complicated. You can do several things.

One, as you point out, let's just look at five things that we can do on 25 pages, not a complicated 2,000 pages. You can let people buy insurance just like you do your auto insurance or your life insurance. We see advertisements every night on television with a little gecko running around, those cute ads they have. Let people buy health insurance across State lines.

Let young people who don't have health insurance stay on their parents' plan, if they don't have a job that provides it, until they are 26 or 27 years old. Pick your number. You can cover 7 million people by doing that at zero cost to the Federal Government.

You pointed out very eloquently liability reform. You save billions of dollars doing that.

You simply sign up the people right now who are eligible for government programs without creating another new one. You cover 19 million people by doing that. You are not creating another agency and 118 new bureaucracies.

Expand the health savings account. I will give you personal experience. I have had one for 2 years. I put $5,000 a year in. Instead of the insurance company keeping my $10,000, I have spent about $2,000. My wife and I are both healthy, fortunately. We have $8,000 in our health savings account that we can use how we choose, not the insurance company.

I think for someone who owned an individual policy, you can treat them like a big corporation. Let them deduct their premiums just like General Motors gets to do, like the big unions do, and so forth.

And then I think the last thing you have to do is you have to put some individual responsibility for each of us, so that everybody, no matter what care they get, needs to pay something for the care. It shouldn't be totally free. We saw that in Tennessee, when our costs just skyrocketed because of the very generous plan we had there where there were no costs to the patients and it was overutilized.

So those are five or six things that every one of us in this room, in this auditorium, ought to be able to agree on and take care of. And it wouldn't be hard to do. It is an easy solution. We

should be able to pass that in no time at all. And the President ought to listen to that. He really should. These are simple, real-world solutions.

If the gentleman would yield for just a second, there is a great book out by Milton Friedman, Free to Choose. And he makes a statement in that book, if you want more of something, you subsidize it. If you want less, you tax it. And it is a very simple principle you can apply to health care or anything else. If you have government programs that are subsidized by the taxpayers, you will create more people who use those programs. We have seen it over and over and over again.

I will give you a brief example before I yield to my colleague from Georgia. In this country we talk about, and I heard many times about how--and we do have failings in our health care system. It is not perfect. But when President Clinton had a heart attack, he was taken to an emergency room to the hospital, where he had a heart cath and discovered that he had blockages in his arteries and needed a bypass operation for it to save his heart. He got a bypass operation. It was delayed a couple, 3 days I am sure because of a blood thinner they gave him. I don't know that, but I am pretty sure that is what happened or they would have done it immediately.

Let's say you are in small town Johnson City, Tennessee, and you don't have any insurance or anything at all, and you have a heart attack and you come to the emergency room, what is going to happen to you is you are going to get a heart cath and you are going to get a bypass operation, and then we will figure out how to pay for it.

In Canada if you have that heart attack, what they will tell you is there is a list that you get on that you can get a catheterization, where they put the dye in your heart and see if you have a blockage. You will get on a list. And when your name comes up, you will get the cath. And then you will get put on the list to see if you get a bypass operation. That is the difference and the delay in the care. And I have seen it happen. I know people that that has happened to in Canada.

They have wonderful physicians in Canada, I want to point out also. I know many of them, have worked with some that have moved to our community. Well trained, excellent doctors. So when you get the care, I think, in Canada, it is good care. I really believe that. When it is available, I think it is excellent care because of the experience I have had with Canadian-trained physicians. Some of my colleagues I worked with every day were well-trained physicians.

That is the rationing of care that we speak of that we don't want to have happen in our country. And we have enough of that as it is. People will tell you that insurance companies ration care. And they do. And I think certainly they are to be held culpable also.

Will the gentleman yield?

You can call a polecat a skunk, but it is still a polecat or a skunk, whatever you name it. I yield back.

Would the gentleman yield?

What the gentlelady from Minnesota has said is absolutely true. Just in our area, at Vanderbilt University in Nashville, Tennessee, the largest employer in the county, 14,000 people--these are jobs that don't go overseas, they're not exported, these people are doing great work--new innovations, new treatments that may go away with this system--they're afraid to hire anybody. In my local town, our medical center, 9,000 employees in their system. The adjoining city has a medical system of 6,000. That's 15,000 people that work in health care in two cities with a little over 100,000 combined population bringing quality care to the people of Appalachia.

What I am worried about is if that's going to go away. Those jobs will dry up--and those are great jobs that are not exported anywhere, they are jobs for Americans with health insurance, with retirement plans, great benefits, and we may be tanking that also.

I want to just reminisce for a moment when I graduated from medical school and think back as the gentlelady from Minnesota, Congresswoman Bachmann, was talking about. When I graduated from medical school there were five high blood pressure medications, three of them made you sicker than the high blood pressure did. Now we have over 50 wonderful medications to provide for people. Antibiotics, a plethora of antibiotics; we had one or two at the time I graduated. Ultrasounds, MRIs, PET scans, survival rates of cancer. The research is just astonishing that's going on in America. We are the leader in the world; the world looks to us for medical innovation. With this right here I'm afraid it will stymie that innovation.

I think back--and we were talking about this a moment ago--one of my good friends and a colleague, a medical colleague whose wife is English, his sister-in-law lived in England. She died of chronic lymphocytic leukemia. That's a disease that Americans just don't die of any longer. We live with that disease. It's treatable. She was treated with a blood transfusion. We could have done that 50 years ago. That's all the treatment. And she got that treatment because she was too old to be treated. We don't do that in this country. And I'm afraid we're heading down that path.

I yield back.

I think you're absolutely right. I mean, it's the ``do unto others, except don't do it to me.''

There is not one of us standing here now that wouldn't agree with that 100 percent.

And Congressman Gohmert makes a good point about the mandate. Let's give some practical experience about what's happening to the mandate. Mandate means you have to purchase something, and in Massachusetts it's health insurance. It also says that you cannot be denied because of a preexisting condition. So the Harvard Pilgrim health care plan, beginning in March of 2008 until this year, 2009, 1 year, they found this, that almost half the people who got their health insurance through the Harvard Pilgrim plan kept it for an average of 5 months.

You couldn't turn them down, so they waited until they got sick, and when they got well, they dropped it. If you were in that 5-month period of time, that plan spent over $2,000 a month on those folks. For the other folks, like me, who just bought it for the year, they averaged then about $300 a month. So people scammed the system. They paid the tax until they got sick because it was cheaper than buying the health insurance. Then they bought the health insurance and kept it until they got well.

It's the same thing as using Congressman Gohmert's example of a car wreck. Well, you have your car wreck, and then you buy the best car insurance policy you can, and when your car is fixed, you drop it.

Thank you, Dr. Gingrey.

A little over a year ago, I stood on this House floor and was sworn in for the first time in the 111th Congress, one of the proudest days of my life. It goes up there with my marriage, the birth of my grandchildren and children. It was a very proud day to be here.

I came from a background of local government, and in Tennessee, where we're from, I was the mayor of Johnson City, Tennessee, and was a city commissioner and local official. In that

State, we have a sunshine law. Everything that is discussed is discussed in the open. It cannot be discussed in our local city government. We have five officials. We cannot discuss anything between ourselves unless we are in the open. That means an open, scheduled meeting that has been published or with a TV camera on.

Let me tell you what happens, Mr. Speaker. When that happens, you get a better government and you get a better product when the sun shines on it.

I will tell you that one of the great disappointments I have had is when I woke up near Christmas Eve and found that one of the Senators had voted for a health care bill to exempt a State that other States are going to have to obey on. I was absolutely nauseated with that. It is the most unbelievable thing. It made me ashamed to be a Member of this great body, and I shouldn't be. I should be proud. Every Member should be proud and honored to belong here. We lecture Hamid Karzai in Afghanistan about corruption. Let him turn around and look at our government and say, Wait a minute. For enough money, you can get your vote bought off to do something. If that health care bill had had legs, it should have stood on its own. Let me explain to you what that means for other States, and let me explain to the American people what that means for the State of Tennessee.

Right now, we have 50 fewer State troopers than we had in 1977, and we have 2 million more people. For the safety of our State, we can't afford Medicaid, which this bill in the Senate does. If it is accepted without going back to the Senate and goes straight to the President, we will have 15 million more people who will have Medicaid. With that comes an obligation from the State to pay for that. We don't have any money to pay for it in Tennessee. Right now, our colleges do not have one capital improvement project on a single college campus--the University of Tennessee and all of the 26 board of regents colleges-- not one dormitory, not a library, not a chemistry department, not anything. Right now, we can't add any more people to our local Medicaid and Medicare plans.

I will.

Where do we go? Do we cut K through 12? We're already in the 40s in education.

Here is another unfunded mandate that comes to the State of Nebraska, and the people in Nebraska don't have to pay for that. The people of Texas do. The people of Ohio do. The people of California do. The people of Maine do. This is something that should not be there. When the sun shines on this, this will not happen. That is why it is extremely important for the sun to shine on this process.

You mentioned a moment ago, when you peel this onion back and when you begin to read this bill--and I've read every page of the House bill. I have not read the 2,700 pages of the Senate bill--we look at the AARP. When you sell, there will be an insurance exchange, and on this insurance exchange, if a company trades on there--and this is a private company--their CEO will be limited to a $500,000 salary, which is tax deductible. That's fine. That company ought to be able to decide what it pays its CEO. If you pay more than that, you have to pay corporate taxes of 35 percent plus ordinary income taxes of 39 percent. So, for anything over $500,000, the government will get three-fourths of it--except if you are the CEO of AARP. If you are the CEO of AARP, you make $1.55 million a year. The average Social Security recipient receives about $12,000 a year. That's their business, but they are exempted from this bill. They are not included in this bill. So guess what happened? AARP endorsed this bill. I can go on and on.

I will yield.

Thank you, Dr. Gingrey. Thank you, Mr. Speaker.

As you go through this bill, the people who do get it are our seniors. I saw a lot of senior patients, as did you, and as I went home and spent these last couple of weeks over the break meeting with hundreds, if not thousands, of people during that time and talking to them one on one, let me tell you what they do get:

They do get the fact that you're going to take in the next 10 years almost $500 billion out of a Medicare plan that does not pay its premiums in 2017. Seven short years from now, it will not pay for the obligation that we have now, and we are going to add 3 to 3.5 million seniors beginning in 2011 when the baby boomers hit. So that's 30 to 35 million more people with $500 billion less money. Let me explain to you three things that will happen.

One is you will decrease access. And when you decrease access, you will decrease quality. Third, you are going to increase the cost for our seniors. They get it. They do understand that, and they understand they're going to pay more for needed care that they may not be able to get. That's the other reason. As people begin to understand what is in this bill, they push back.

Just today, Dr. Gingrey, as I was leaving home--and this has been consistent throughout my district--a poll was published in the local newspaper that showed in our district, the First District of Tennessee, that 79 percent of the people did not want this current bill, this current legislation. This is 8 out of 10. We'd better start listening to the people of this Nation. They have been screaming as loudly as they can. They want to be heard. I am afraid, right now, we are not listening to them. They want meaningful health care reform; 435 Members of this body want meaningful health care reform. We don't want to interfere with the doctor-patient relationship, and we can do that. We should be able to discuss that openly, and the cameras and the lights should shine upon those decisions.

I yield back, Mr. Speaker.

Very quickly, Mr. Speaker, I think what the American people want for us to trust is transparency. The people have to trust us for us to govern, and they can't trust us if they don't know what is going on.

I know, Mr. Speaker, you went home, I went home for the holidays; and they said, What is going on with the health care bill? And I told them, You know as much as I do. Because we are in the dark just as you are. And that is not the way it ought to be.