Floor Statements

Mr. Speaker, H.R. 515 is a worthy attempt to deal with an issue that deserves a long-term solution: our ability to store processed nuclear waste. I think all Members want to ensure we have adequate storage space, and I commend the gentleman from Tennessee for trying to deal with this complicated issue. I fundamentally support the gentleman's goal, which is to stop the long-term storage of foreign waste in our country. The problem, however, is the bill will stop any operation that safely imports, processes, or exports low-level nuclear material in this country.

A company in my district processes the waste and returns it to its country of origin, which does not impact the long-term domestic storage. This legislation would prohibit them from doing this and impact jobs at a time when jobs are scarce.

I certainly would like to work with my esteemed colleague from Tennessee to make changes in this legislation that would achieve this goal of halting the permanent storage of foreign waste while allowing companies that safely process and export this material to continue to do so.

Thank you for yielding.

Is it a problem to have the waste brought into this country and then shipped out back to the country of origin or wherever it is disposed of? We have a company in our district that does that.

Mr. Speaker, I thank the gentleman for yielding.

I rise in opposition to this bill before us. I came to Congress to enact health care reform. As a physician, I have seen firsthand the problems insurance companies created for my patients. I have seen firsthand how the government programs have made beneficiaries worse consumers of health care, and I have seen how the cost of health care has exploded and made insurance unaffordable. I want to fix these problems. But this bill will not fix these problems; it will make them worse.

The Democrats have ignored evidence that this program won't work. I asked President Obama three separate times since July to sit down and talk about the health care bill and what I know its effects will be, and I have yet to receive a call from the White House. It is one thing to disagree with the evidence that undermines the premise of reform you are pushing, but to not even consider it is unbelievable.

So here we are today with a health care bill that is over 2,000 pages. It is a Christmas tree of special interests. Sewer systems for Indian tribes, biofuel tax credits, nutrition standards for chain restaurants, and references to pizza and donuts all made it into this bill. But somehow the Democrats could not come up with a real solution for medical malpractice reform.

This bill taxes everyone and everything. It taxes medical devices, it taxes individuals, it taxes employers. It taxes small business owners who could be creating jobs and getting us out of this recession, instead forcing them to cut wages for jobs. It taxes medical savings accounts. It cuts Medicare. Home health care, skilled nursing facilities and Medicare Advantage would all be cut. And seniors with prescription drug coverage will have their premiums increased. Seniors oppose this bill because they get it. Their care is going to decrease and their costs are going up.

The bill spends all that money even faster. The bill dramatically expands Medicaid, despite the fact that I haven't heard anyone who had an option say they want to be on Medicaid. It creates a huge new Federal bureaucracy to navigate through. And it funds a government competitor to private insurance companies that will siphon people off the private insurance market onto a Medicaid-like program, just like Tennessee did with Tenncare.

Mr. Speaker, I came to Congress to enact health care reform. As a physician, I've seen firsthand the problems insurance companies created for patients. I've seen firsthand how government programs have made beneficiaries worse consumers of health care. I've seen how the cost of health care has exploded, so much so that many can't afford insurance. I've seen all these problems and I want to fix them.

When I first heard that the Democrats were proposing to insert a government competitor in the insurance marketplace, I thought, surely they can't be serious. When I realized they were, I thought I could change their opinions by telling them about the real-life failures I've seen under our state's program known as TennCare and how H.R. 3200 and now 3962 is simply a bad extension of these mistakes.

For months I've gone to the House floor with many of my physician colleagues to talk about the problems with this plan. The TennCare plan tried to provide universal coverage and make health insurance affordable, and in the end it nearly bankrupted the state as the program tripled in cost. It created an incentive for beneficiaries to seek unnecessary care because it cost them nothing. It shifted costs to the private plans, who were forced to make up the underpayments of the government program, increasing everyone's premiums. In the end, 45 percent of those on the public plan previously had private insurance and either dropped their coverage or were dropped by their employer.

Our Democratic Governor, Phil Bredesen, saved our state's budget by doing something hard--he cut the rolls. He controlled costs and he introduced an alternative plan called Cover Tennessee, which requires an equal contribution from employers, individuals and the government, which is a model for shared responsibility. Incidentally, Governor Bredesen has called this bill on the floor the mother of all unfunded mandates.

Democrats continued to ignore this evidence. I asked President Obama three separate times since July to sit down and talk about the health care bill and what I know its effects will be, and I have yet to receive a call from the White House. It's one thing to disagree with evidence that undermines the premise of the reform you're pushing, but to not even consider it is unbelievable.

So here we are today with a health care bill that is over two thousand pages. It's loaded up like a Christmas tree of special interest provisions. Sanitation facilities for Indian tribes, biofuel tax credits, nutrition standards for chain restaurants, and references to pizza and doughnuts all made it into this bill, but

somehow, Democrats could not come up with a real solution for medical malpractice reform except to try to protect trial lawyers' share of jury awards. Malpractice is proven to cost the health care system billions of dollars every year, but the reforms being proposed make the current system worse.

This bill taxes everyone and everything. It taxes medical devices. It taxes individuals who choose not to purchase insurance, and drives up premiums for individuals who do purchase insurance. It taxes employers who fail to offer health insurance, then taxes them further if they try to increase their employees' wages. It taxes small business owners, who could be creating jobs and getting us out of the recession, and instead forces them to cut jobs or wages. It taxes health savings accounts, which reduces the use of catastrophic health insurance coverage.

It cuts Medicare. Home health care, skilled nursing facilities and Medicare Advantage would all be cut, and seniors with prescription drug coverage will have their premiums increased. Seniors oppose this bill because they get it--their care is going to be decreased and costs are going up.

After the bill finishes up taxing everything and everyone, it spends all that money even faster. The bill dramatically expands Medicaid, despite the fact that I've never heard of anyone saying they want access to the program. It creates a huge new federal bureaucracy to navigate through. And it funds a government competitor to private insurance companies that will siphon people off of private insurance onto a Medicaid-like program, just like Tennessee did with TennCare.

After the Democrats finish spending $1.5 trillion, they say the bill is quote unquote deficit neutral. But they ignore that every major government health care expansion before it--Medicare, Medicaid, SCHIP to name a few--have cost more than originally estimated. And they completely ignore the fact that they use 10 years of revenue to pay for 7 years of new spending. In the second decade, this program will become an enormous unfunded mandate on state governments, on individuals and on the federal government. Despite the largest deficit in our nation's history, the Democrats are irresponsibly going to make it harder to ever balance the budget.

Here's the bottom line: this bill costs too much. It taxes too much. It does nothing to improve health care, and will result in the majority of Americans left with decreased access, decreased quality and increased costs. It is, as the Wall Street Journal called it, the worst bill ever and deserves to be rejected.

Mr. Speaker, this week, Democrats released 42 additional pages of the health care bill in their manager's amendment, meaning the total package now stands at 2,032 pages.

As I see it, the manager's amendment makes it more likely that we will see everyone in the exchange on a government-run plan within a few years of its creation. The amendment calls for insurers to report annual premium increases to the government and gives the administrator the power to kick insurers out of the exchange for increases that he or she deem to be excessive, a term that is left entirely up to the discretion of the administrator.

What we have been saying all year is that a plan that doesn't pay the cost of care will shift higher costs to private insurers, as hospitals and providers have to make up their losses on payments from the government. As costs are shifted, private insurers are left with no choice but to increase premiums.

Independent studies have shown that millions of people will be dropped from their current coverage and put on the public plan. Now, with the manager's amendment, Democrats are simply quickening this transition by kicking insurers off their plan. It is a bad amendment, a bad bill, and it should be rejected.

Mr. Speaker, I came to Congress to help enact health care reform. As a physician, I've seen firsthand the problems insurance companies have created for patients. I've seen firsthand how government programs have made beneficiaries worse consumers of health care. I've seen how the cost of health care has exploded so much so that many can't afford insurance. I've seen all of these problems, and I want to help fix them.

When I first heard that the Democrats were proposing to insert a government competitor into the insurance marketplace, I thought, surely, they can't be serious. When I realized they were, I thought I could change their opinions by telling them about the real-life failures I've seen under our State's program, known as TennCare, and how H.R. 3200--now H.R. 3962--is simply a bad extension of these mistakes.

For months, I've gone to the House floor with many of my physician colleagues to talk about the problems with this plan. The TennCare plan tried to provide universal coverage and to make health insurance affordable. In the end, it nearly bankrupted the State as the program's cost tripled. It created an incentive for beneficiaries to seek unnecessary care because it cost them nothing. It shifted costs to the private plans, which were forced to make up these underpayments of the government program by increasing everyone's premiums. In the end, 45 percent of those on the public plan previously had private insurance, and they either dropped their coverage or were dropped by their employers.

Our Democratic Governor, Phil Bredesen, saved our State's budget by doing something very hard. He cut the rolls. He controlled costs. He introduced an alternative plan called Cover Tennessee, which requires an equal contribution from employers, individuals, and the government. It is a model for shared responsibility. Incidentally, Governor Bredesen has called this bill on the floor the mother of all unfunded mandates.

Democrats continued to ignore this evidence. I have asked President Obama three separate times since July to sit down and talk about a health care bill and to talk about what I know the effects to be, yet I've received no call from the White House. It's one thing to disagree with evidence that undermines the premise of the reform you're pushing, but to not even consider it is unbelievable.

So here we are today with a health care bill that's over 2,000 pages. It's loaded up like a Christmas tree with special interest provisions. Sanitation facilities for Indian tribes, biofuel tax credits, nutrition standards for chain restaurants, and references to pizza and doughnuts all made it into this bill, but somehow Democrats could not come up with a real solution for medical malpractice reform except to try

to protect the trial lawyers' share of jury awards. Malpractice has proven to cost the health care system billions of dollars each year, but the reforms being proposed make the current system worse.

This bill taxes everyone and everything. It taxes medical devices. It taxes individuals who choose not to purchase insurance. It drives up premiums for individuals who do purchase insurance. It taxes employers who fail to offer health insurance. It then taxes them further if they try to increase their employees' wages. It taxes small business owners, who would be creating jobs and getting us out of this recession. Instead, it forces them to cut jobs or wages. It taxes health savings accounts, which reduces the use of catastrophic health insurance coverage.

It cuts Medicare. Home health care, skilled nursing facilities, and Medicare Advantage will all be cut. Seniors with prescription drug coverage will see their premiums increase. Seniors oppose this bill because they get it. Their care is going to be decreased, and costs are going up.

After the bill finishes up taxing everything and everyone, it spends all that money even faster. Despite the fact I've never heard anyone say they want access to this program, the bill dramatically expands Medicaid. It creates a huge, new Federal bureaucracy to navigate through, and it funds a government competitor to private insurance companies which will syphon people off of private insurance onto a Medicaid-like program, just like Tennessee did with TennCare.

After the Democrats finish spending $1.5 trillion, they say the bill is ``deficit neutral,'' but they ignore that every major government health care expansion before it--Medicare, Medicaid, SCHIP, which are just to name a few--have cost more than originally estimated. They completely ignore the fact that they use 10 years of revenue to pay for 7 years of new spending. In the second decade, this program will become an enormous unfunded mandate on State governments, on individuals, and on the Federal Government. Despite the largest deficit in our Nation's history, the Democrats are irresponsibly going forward to make it harder than ever to balance the budget.

Here is the bottom line: The bill costs too much. It taxes too much. It does little to improve health care. It will result in the majority of Americans being left with decreased access, decreased quality, and increased costs. It is, as The Wall Street Journal called it, the worst bill ever, and it deserves to be rejected.

Madam Speaker, I rise today to pay tribute to Danny Roy Price, who passed away in October at the age of 69. Danny was my most dedicated volunteer, a trusted staff member; but, most importantly, he was my friend. He dedicated his life to his Lord and to the service of others.

There are literally countless stories of Danny's sense of duty and commitment to service. He served our country in the U.S. Army; and because of that, he had a strong connection to every man and woman who served our country.

His wife, Carol, spoke of the day he helped a veteran and his wife receive benefits to which they were entitled but had never received. When Danny informed them their benefits had been approved, they began to tear up and weep. Carol said that when Danny returned home that evening, he told her the story and he too began to weep. I am incredibly proud to have had a person like him serving east Tennessee.

In 2007, Danny was named Tennessee's Statesman of the Year by the Tennessee House of Representatives. It was a fitting tribute to Danny, whose incredible attitude and passion I saw on display time and time again during my campaign during 2008 and as we traveled throughout the district this past year. Everywhere Danny went, he was a statesman, greeted and loved by everyone whose life he touched. He never wanted the credit. He only wanted a sense of satisfaction from knowing the job that he had done had been done right.

On the last day I shared with Danny, we had a full day of meetings in Bull's Gap, Gatlinburg, Morristown, Knoxville, and Greeneville, Tennessee, with a variety of doctors and local businessmen and businesswomen.

But it wasn't out of the ordinary for Danny and me. We finished up, and Danny told me, Phil, we had a great day. And it was a good day. To Danny, a good day wasn't getting the personal accolades. A good day was traveling up and down the district, getting to know the people, and learning about how he could help them.

At his eulogy, Danny's pastor of Hope Community Church in Rogersville, Tennessee, Rip Noble, talked of Danny's service to his Lord, Jesus Christ. Danny wanted others to experience the relationship he had with his Lord, so he constantly invited those he met to come worship with him. And then he would make sure that those people were welcomed into the service, first by himself, and then by the pastor.

When regular members hadn't attended in a while, Danny would call them and make sure that everything was all right and invite them back. Indeed, in large part due to Danny's efforts, the church has over 500 members, after starting just 5 years ago.

Danny is survived by his wife, Carol; his children, Jennifer and Brent Price; his granddaughter, Neyla Price; his brothers, Admiral Price and Keith Price; and his sister, Judy.

I extend our deepest condolences to the family for their loss, and hope they can find comfort in the knowledge that Danny was an extraordinary individual.

Madam Speaker, I thank the gentleman from New Jersey. I am going to go back many years ago in my life to a time when I was a young physician trying to decide what I was going to be in life. I decided I was going to be an internist, which is a noble thing to do. But I realized one day when I was in the hospital that what I really had a passion for were for babies and children and delivering babies, and it was fun. And of the almost 5,000 babies I delivered, they were fun. I had a wonderful time doing it, bringing life onto this planet. The group I belong to in a small town in Tennessee, Johnson City, Tennessee, has delivered almost 25,000 babies since I joined the group. We're a pro-life group.

I think back to the children I have delivered during the past 30 years, and these young people have become musicians and attorneys and physicians and teachers and carpenters and pastors. I was at my college homecoming last week, and one of them was a 6-foot 7-inch, 300-pound football player. They become all kinds of things. To me, the thought of them not being here is heartwrenching and heartbreaking because you've snuffed out a life that could have otherwise been a Congressman, a teacher, anything.

This bill that we're discussing should be a health care bill, and, distressingly, in my opinion, elective abortion is not health care. We should be doing, as the previous speaker said, everything we can to protect the unborn. Let me explain a little bit about that.

When I first began practice, of the babies born before 32 weeks, half of them died. And we have used extraordinary means and technology. Now a child born at 32 weeks is a term baby, and I recall a child that we delivered at 24 weeks over 20 years ago, which even then would have almost been considered a miscarriage. This child got down to 14 ounces, that's how big, and that was over 20 years ago. That child is a fully grown adult today. If we had used the idea that this was, hey, an abortion or a miscarriage, that child would not be there with a mother and a father who are loving it and a family and a chance to have a family.

We shouldn't disguise health care as abortion coverage. Madam Speaker, I think this is one of the most egregious things in this particular bill. There are a lot of things in this health care bill that are not related to health care, but this is one that should be done away with, and whether you are pro-life or you are pro-choice, the majority of people in this country don't want their tax dollars used for abortion. To me, it's a very emotional issue, a very personal issue, and I will continue to be a pro-life doctor until I'm not on this Earth.

I yield back my time.

Mr. Speaker, they say the definition of insanity is trying the same thing over and over again and expecting a different result, which perfectly describes the House Democrats' health care reform bill.

For months now, I have been trying to explain in every forum possible how this bill is taking the worst parts of the universal health programs in Tennessee and Massachusetts and combining them into one monstrosity of a program. Unfortunately, passing theory that sounds good but has failed is more important to our Democratic colleagues than actually getting reforms that work.

This is why it matters: the reforms being proposed will decrease access, decrease quality and increase cost of care for the vast majority of Americans. I can say this unequivocally as a physician and as a Tennessee resident who has experienced TennCare firsthand. Small businesses that are dealing with the worst recession in years will have to lay off workers and cut back on wages to deal with these new mandates. Individuals who are scrimping and saving to get by will see their taxes and costs increase.

Some good will come of this bill, but the bad results that we know from experience will happen should be reason enough to scrap this bill and try to agree on a bipartisan bill that will work.

Madam Speaker, I rise in strong support of House Resolution 867, which condemns the United Nations Human Rights Council's decision to endorse the views of the Goldstone Report. Among its conclusions was an assertion that the Israeli military campaign was aimed at civilians in Gaza rather than the terrorist group Hamas. The assertion itself is outrageous, but the fact that it was endorsed by an arm of the United Nations should be a cause for concern for anyone who's concerned about terrorism or human rights.

In criticizing Israel's behavior and not even mentioning Hamas in this resolution, the council essentially endorsed Hamas's decision to use Gazans as human shields to protect themselves from retaliation for their rocket attacks into Israel.

The fact is that the Human Rights Council is no better than its predecessor at the U.N., the Human Rights Commission, when it comes to anti-Israeli rhetoric. I think the resolution correctly urges the Obama administration and Secretary Clinton to strongly condemn this report, but I further urge them to reconsider their decision to participate in and fund the HRC. This body has proven time and again that they are incapable of acting without bias and simply gives a forum for anti- Israeli and anti-U.S. voices to be heard.

I appreciate the gentleman yielding.

I would like to start out by saying that I don't think there's a conflict at all either from the Republican side or the Democrat side that we have a need to reform health care in this country, because costs are not sustainable on the current path. I don't think anyone disagrees with that. And, secondly, it's a noble goal and an attainable goal, I believe, to cover our citizens with health care. I believe we can do that in this country. I don't think this bill is the one that does it, and I go back to an experience that I've had in Tennessee.

The gentleman from Pennsylvania was talking about the cost of the Visitors Center. Let's go over the costs of health care in this country and estimates by government people, by the CBO and others. Let's go back to 1965, and I do believe that this is the single biggest debate on a social issue since the civil rights movement in the 1960s and Medicare in 1965. In 1965 the estimate was Medicare would cost $3 billion to $4 billion a year, and that's what it cost. The estimate in 1990, 20 years later, it was going to be a $15 billion program. What was the actual cost? Over $90 billion. And today our Medicare program is over $400 billion.

Let's also dial back to Medicaid. The Medicaid program, the government insurance for low-income people and infants and children, has gone up 37 times since its inception.

In TennCare we had the argument that I hear and, again, I dealt with it as a physician and also as a mayor. In the early 1990s we had a lot of people in Tennessee who were uncovered. So we wanted to cover as many of our people as we could. So we got a waiver from Washington to experiment with a managed care plan called TennCare. And HHS, the Health and Human Services here in Washington, exempted us from the current Medicaid plan.

When we started this plan, we started with eight different companies that would go after your business on a competitive basis, and this was going to hold costs down. We would compete among these plans.

So what actually happened in Tennessee was this: in 1993 the State spent $2.6 billion on our TennCare program. Between there and 2004, 10, 11 budget years later, that had risen to almost $8.5 billion. It had over-tripled in price, where we thought the costs would be less than that. We thought it would hold costs down.

What actually happened with the public option? Well, what happened with the public option was this: 45 percent of the people who got on TennCare had private health insurance, and they made a perfectly logical decision. It was cheaper, it had first-dollar coverage, it was a very generous plan. So they dropped their own private health insurance coverage and got on TennCare.

Now, I just got the numbers this afternoon, and they are what I thought they were. In our State our TennCare plan pays about 58 percent of the cost of actually providing the care. Medicare pays 91 percent in Tennessee of the cost of providing the care, and the uninsured pay somewhere in between. And what happened in our State was those costs got shifted to private insurers.

Well, the State was then left with--almost every new budget dollar that came to the State of Tennessee was used for health care, not for K-12, not for roads, not for other things, colleges and so forth. So what did the Governor, who is a Democrat, and the legislature, which is now Republican, what did they do? Well, they rationed care. And how did they ration care? They cut the rolls. And every year that we had a raise, it was almost double digit. The year that broke the bank was a 19 percent increase in costs in 1 year.

So we have seen the public option. We have seen the competition. And the problem with any public plan is it doesn't pay the cost of the care. And when you do that, three things happen for somebody: one is you decrease access because you don't have someone who will take those patients on that don't pay the cost of the care. Number two, when you decrease access, you decrease quality of care because the patients can't get to a physician other than through an emergency room. And, three, somebody else, that's the private insurers in our State, pay more money. So we had decreased access, decreased quality, and increased costs. So that's what I'm fearful of here that will happen with this.

There is a better way. I mean, I can sit down with the expertise in this room right now and we can write a plan with our Democratic colleagues in 30 minutes. A quick example of that is the current Baucus plan calls for increasing access to 91 percent of our population. Now 85 percent of our population is covered. You can do two things that will get you to 91 percent on one page, and that is, number one, allow young people, like I've had children in my own home that have had to do this, that don't have health insurance when they graduate from high school or college, to stay on their parents' plan until they're 26 years old. This current bill, the Democrats have had that in there, and I agree with that 100 percent. And, number two, simply sign up the people who already qualify for Medicaid or SCHIP, and you will get to 91 percent. So it's a fairly simple thing to do without a lot of government bureaucracy, new plans, czars, commissioners, and so on that's so complicated right now. I'm sure some of you have tried to wade through this bill, and some of it's almost incomprehensible.

I thank you for yielding.

I thank the gentlewoman from Wyoming for yielding.

Just to make your point, something that I promised I would do when I came here as a local mayor, I had dealt with unfunded mandates until I had had them up to here on the local level. The State has to deal with these. And I made a decision I'm not going to vote for an unfunded mandate that the Federal Government puts on local government or State government.

And our Governor right here that you mentioned, Governor Bredesen, who is a Democrat, by the way, and is very knowledgeable in health care, I have great respect for him and the knowledge that he has. He's had to make some tough decisions. He has looked at this current plan and evaluated it from the viewpoint of the State of Tennessee. I think it's September of next year, 2010, the money that the States get from stimulus is gone. It's over with. So he's looking at this unfunded mandate to us.

And let me just tell you how critical it is in our State right now because of jobs. We are losing jobs in the State. The unemployment rate is above 10 percent, and we're a sales tax-based State. We don't have a State income tax. And he has estimated that this particular plan, H.R. 3200, now 3962, that's out there will conservatively cost our State $735 million in the first 5 years. And if it has the same benefit package, which remember the commissioner will decide what an adequate benefit package is, it will cost the State as much as $3 billion to $4 billion.

Let me tell you the dire straits we're in. The SCHIP program right now, the State Children's Health Insurance Plan, known in Tennessee as CoverKids, we can't enroll any other kids in there because we can't afford the current plan. So if we come down with another unfunded mandate, we don't know what we're going to do in the State.

I thank the gentlelady from Wyoming. Just a couple of brief things that we hadn't touched on maybe as much. Certainly I am one of the few people in this Congress who have had to go down to the emergency room at 3 or 4 o'clock in the morning and see someone who doesn't have health insurance coverage or has a malignancy that needs care. I have seen it and have dealt with it. Certainly what we would like to do is make sure that we can find a way to help those folks that don't have coverage right now. We have got 85 percent of the people in this Nation who have coverage, and what are they worried about? The cost. I will tell you now that we will never get the costs under control in this country without liability reform. Unless you have medical malpractice reform in some reasonable way--and one of the problems that we have in malpractice reform is that we don't have a way to adequately compensate someone who's been injured.

Right now in this system, in Tennessee, the system that we had doesn't do that. Since the inception of our malpractice company, owned by the physicians in Tennessee, since 1975, over half the dollars that have been paid out have been paid to attorneys and not to the injured party. Less than 40 cents of every dollar that we pay has been paid to someone who's been injured. There is something wrong with that. So we have to look into this as a Nation and decide how we're going to proceed. Certainly people are injured and do need compensation for their injuries. But the system we have now is broken. It needs to be fixed. This particular bill does nothing for that.

I will yield back the remainder of my time so that others can speak. I appreciate you having me on with you tonight.

Madam Speaker, we are here tonight to continue the discussion of health care.

Before I get started, I am a freshman here in Congress, and I am going to tell you a little about myself and why I'm here to discuss this.

I grew up in the rural south in a small, rural community. My father was a factory worker. I went to college, I went to medical school in Memphis, Tennessee, at the University of Tennessee--the real UT, I might add, for my Texas friends--and I spent 2 years in the military. I trained in an inner-city hospital, an urban hospital. I spent time in an infantry division in a medical battalion in Korea near the DMZ. I served in a military hospital, in a VA hospital. I practiced in Johnson City, Tennessee, an area in Appalachia in northeast Tennessee, and taught medical school with residents and interns. I really have had a varied experience, 31 years in private practice. My specialty was obstetrics and gynecology, where I delivered almost 5,000 babies. So I bring a rather unique experience to the House floor, and I am very privileged to be part of this debate.

I think before, as a physician, what I would try to do in any case that I saw was try to identify the problem. In America, we are trying to identify a problem with health care. And certainly, I think we have heard it on both sides of the aisle that we do need health care reform. I think the main reasons for that are two: One is costs--health care costs are escalating beyond the average person's ability to pay for the care--and access to adequate care for all of our citizens.

In this country, about 170 million of our citizens are covered by their job. Their health insurance is provided by their job. And this started where your employer provided health insurance after World War II as an incentive to get workers to come work for a particular company. And it has, of course, grown since that time, and I think it has been a good thing for most people. We have been able to provide a level of care in this country that has been unequaled anywhere in the world.

What I have been able to see since 1970, when I graduated from medical school, were advances that I didn't even dream of. The one advance that we haven't seen come to fruition that I thought would is the cure for cancer. We haven't done that, but we have made tremendous strides in cancer and heart disease, diabetes, and so on.

So we have a cost issue, and we have an access issue. We have approximately 47 million of our citizens in this country that are not covered currently by health insurance. Who are they? Well, the Census Bureau believes that approximately 10 million of these folks are illegally in the country. We also believe that probably 9 million or so have incomes above $75,000 a year and choose not to buy health insurance--their own choice. About 8 million people make between $50,000 and $75,000, and they may be families where this does stretch them, where they're a small business, and health insurance premiums-- again, the cost factor has gotten so expensive that these folks can't afford it. So we really are looking at about 20 million people in this country who are working poor who don't have access to care.

How are we providing the care in this country now? Well, we're using private health insurance. Many people use their own employer, a small business, their health savings account. There are variations that people use to buy their health insurance.

We have the government now which provides about 46 cents of every dollar spent on health care with Medicare and Medicaid and the VA. So we have government taxpayers approaching 50 percent of the care, and then we have the rest, the 15 percent, who don't have coverage at this time.

So how do we go about keeping the cost down, quality high, and the access? We are joined here this evening--and I am going to stop, having framed the debate--with my good friend from Louisiana, Dr. John Fleming. And John, I am going to turn this over to you to sort of continue this thought that I put forward.

We have also been joined this evening by our colleague from Wyoming, Cynthia Lummis. We appreciate you being here, and I would like to now yield time to you.

Thank you, the gentlewoman from Wyoming. Excellent comments.

Health care decisions should always be made between patients, their families and their physicians, not the insurance companies and not the Federal Government. I believe that, and I have used that in my practice for many years. It's one of the reasons I was a very successful practitioner. I knew who I worked for--my patients--and I looked after their benefit.

Now, one of the things I want you to think about in this bill--and this is the bill here. It's H.R. 3962. They've changed the number because H.R. 3200

has become so tainted now. It's two parts. As the gentlewoman pointed out, it's 1,990-pages long. I've only been through the first 1,000 or so pages, and it's going to take me a few more wakeful nights to go through it, but I will. In the Senate's Baucus plan, for instance, it's an alleged 1,500-page bill. It gets you to 91 percent coverage.

You can do two things on one page and get to 91 percent coverage, which is to allow young people who have graduated from high school or from college and who are not yet covered by insurance plans at their work or who can't afford it to stay on their parents' plans until they're 26 years old. You can cover 7 million young people by doing that.

Number two, you can sign up the people who are currently eligible for government programs, which would be SCHIP and Medicaid, and you would then be at 91 percent without all the other bureaucratic morass that this bill goes through.

I want to make this point tonight: this bill right here is almost incomprehensible when you read it, because, when you do read it, you have to refer to the IRS code, to HHS, to Medicare, and so on. It's just almost incomprehensible. So I'm going to go over about four or five things which, I think, could be done very simply--and I want the gentleman from Louisiana to step in--which will allow those health care decisions to be made by families.

Number one, one of the big arguments we hear today, or issues which we deal with, is preexisting conditions, and they're real. I've dealt with patients who've had breast cancer who then, as individuals, could not be insured. Well, in the group market, in large groups, that's not a problem because you just accept those increased risks and spread those risks among large groups of people.

When I was mayor of the city of Johnson City, we had 1,500 people, plus their families, with plans--teachers and employees of the city-- and we were able to spread risk and to buy reinsurance for high-risk patients, but an individual has a real problem. I, as an individual, going in with a problem am not insurable.

Well, how do you do that, how do you make that same group market available for an individual that you have for large businesses?

Well, you eliminate State lines. You take the State lines out, and you allow association health plans to be formed, and then the individual market becomes a very large group market. Costs go down, and the preexisting condition problem goes away.

Number two, I think that a person shouldn't be bankrupted if a person gets ill. I think, if you become ill through no fault of your own, you shouldn't go into bankruptcy. I think that's a fairly simple thing.

What are you going to do for low-income people who can't afford these things? Well, you can have subsidies or tax credits so that people in this income bracket can also join health plans and can share their risks.

I've never understood why the government treats our patients on Medicaid differently than they do from Medicare patients. They're not treated as well, I don't think, because of the payment differences, but they shouldn't be. They should be allowed to take those dollars as a credit that are spent on Medicaid, and they should be allowed to go into an association health plan and also spread those risks. So those are a few little things.

Lastly--and I think it's barely mentioned in this 2,000-page bill--we talked at the beginning of this hour about costs and about how we control costs. You will never ever control the costs of health care unless you begin to do something with tort reform, or with malpractice reform, because, as a physician, if I don't order a test--if I have a patient come to the emergency room and if I don't get a CT scan and if something by chance happens to that patient, then I'm going to be liable for that problem. If I order the test and if there is nothing wrong, there is no penalty to me. So we have to change that. Let me just explain a couple of things that helped me understand this.

We have a terrible tort system in this country. The reason it's terrible is we have no way to compensate injured people. When someone does have an injury due to malpractice, we have no way to compensate him.

In 1975 in the State of Tennessee, we started a malpractice company called the State Volunteer Mutual Insurance Company. Since the inception of that company, over half the premium dollars have gone to attorneys. Now, these are defense attorneys and plaintiff attorneys, but less than 40 cents on the dollar have actually gone to injured people. All the thousands and hundreds of thousands of dollars I have paid in over these years have not gone to compensate injured people. So that's something which, I think, is not in this bill. Until you address that, you're never going to address the ever-escalating costs.

What do you think about it, John?

Will the gentleman yield for a moment?

I just want to give a brief example.

I was home this past week, and I spoke to one of my partners, Dr. Lewis. Dr. Lewis had a patient who had a fertility problem, which he helped her with. She was able to become pregnant, but miscarried. She lost her baby. Her husband worked for the State Department and was sent to England. Apparently, when the American employees are sent to England, they get private insurance. Well, she wanted to move on with her fertility evaluation, so she first had to go through the public system before she could access the private system in England. She went there and she didn't see the doctor. She saw a nurse.

The nurse said, Well, you need to see the doctor for your fertility problem. That will be a year.

She was going to have to wait a year to see the fertility doctor. Well, she had a visit planned back home in a few weeks; and while she was home, she called her doctor, Dr. Lewis, who got her into the office in 1 week. He got her back on her treatment, and she is now back in England. Hopefully, it will be successful.

Those are the kinds of delays that you're going to see. This is just one example. I could spend the rest of the night giving these examples.

Dr. Fleming, I want to get into the cost because that's something that isn't talked about in this CBO report. Now, the CBO report we got said this is going to be deficit-neutral. Well, I want to go back through history a little bit. Let's look at the history of Medicare, of Medicaid, of the TennCare, and of the Massachusetts plan. I'll just briefly and quickly go through them.

In 1965, when Medicare was passed, it was passed as a plan that was going to be about a $3 billion to $4 billion plan. The CBO estimate was that, in 25 years, by 1990, this would be a $15 billion plan. Fast forward to 1990. This was a $90 billion plan. They missed it just a tad there. Today, it's over a $400 billion plan. It's about $428 billion.

The Medicaid program has gone up 37 times since its inception.

The Massachusetts plan had a noble goal, which was to try to cover as many of its citizens as possible. That's absolutely what we should try to do in an affordable way. In Massachusetts now, they're at around 97 percent coverage.

Government spending on health care is up 70 percent since 2006. Between then and 2009, that's just 36 short months. In TennCare--and we will go into that a little bit more. The reason it's important to go into TennCare and what's happening in Massachusetts is because that's basically what the basis of a lot of this plan is that we are debating tonight.

TennCare, which started in 1993 with a $2.6 billion Medicaid plan, by 2004, just 10 years later, 11 years later, it was at 7.5 billion and would go to 8.5 billion in 11 years, which almost bankrupted our State. Today our State is in such dire financial--and this is with the stimulus money that came in--that we can no longer add any further children to the State Children's Health Insurance Plan.

I got a letter from Governor Phil Bredesen, who is a Democrat, who is a health care expert, I might add, and has done a very fine job in Tennessee managing this along with the Republican legislature. They have worked together to try to control these costs. What the Governor said is that in the next 5 years this will add $735 million, which we do not have. If certain other stipulations are placed on this plan, it could be in the billions of dollars. We have seen every single government plan that's out there that didn't meet these cost expectations, and this one won't either.

For our seniors, I know they get it, but I want you to listen, and you can do the math. This plan, according to CBO, is going to be financed by taking $400 to $500 billion out of an underfunded Medicare plan that's going broke by 2017. That's the last number that I saw. That it would be upside down, more money going out than coming in.

We are going to take $400 to $500 billion out of that plan. We are then going to add between 3 and 3.5 million seniors, our baby boomers that are hitting Medicare age, beginning in 2011. That will be between 30 and 35 million new recipients in the next 10 years.

Then in 2 years, in 2011, we are going to cut provider pay by as much as 25 percent. We are going to now add 30 to 35 million more people. We are going to cut $400 to $500 billion and cut our providers. Let me tell what you that adds up to. They get it. I was home this weekend and spoke to many. Our seniors are genuinely worried.

They know, number one, when you do that, you are going to cut access, because when you cut that much money out, you are going to have a very difficult time getting to your doctor. If you can't get to your provider, you are going to cut quality. Number three, to get there, you are finally going to increase your own costs because you are going to have to pay more for the care you are getting; without a doubt, you are.

We have seen it in our State, as I said. We will go into it in more detail, but, Dr. Fleming, I would like to hear your comments about financing this.

Have you had any of your constituent businesspeople come to you and say, if this plan passes as they understand it, they are out? Their business is closed? I have.

I think one of the things I want to talk about now--and we have been joined here by Dr. Burgess, our good friend from Texas--I think, where is the money coming from to pay for this? I think at the end of the day, when a patient comes to me in my office and sees me, am I going to be able to deliver better care when we pass this in the House, if the House does pass this 2,000-page bill? The answer is no. Will access go down? I believe it will. Will costs go up? I believe they will.

You mentioned about the individual mandate. So people understand what that is, you are a person working out there as a painter or you work in a small business or whatever and you don't have health insurance. You choose not to buy it if it's offered at

your group, or you just choose not to. You will pay 2.5 percent of your total income into this exchange as a penalty.

Well, what's happened in Massachusetts? Let me sort of go over that for just a moment. They have a mandate. That experiment is being tried right now in the State of Massachusetts.

The Harvard Pilgrim Health Care plan found from April of 2008 until March of 2009, 1 year, they found that 40 percent of their new enrollees kept their insurance for only 5 months. During that 5-month period of time, the average payment was $2,400 a month; whereas, the average person who just had part of their plan was $350 a month. People were waiting because you don't have any--in Massachusetts, you cannot be denied coverage, and you get a community rating, meaning that everyone pays the same rate. What people are doing is they are waiting until they get sick, at least in this Harvard Pilgrim plan. Then when they get well, they drop their insurance and pay the 2.5 percent penalty.

The other is an 8 percent penalty on business, which is a payroll tax. Basically, a business will pay 8 percent of its payroll into this exchange or into the government. Well, if you are paying 10 or 12 percent now, then what you are going to do is you are going to drop that if you can and get into the public option.

Well, I started thinking about this the other night. It's the first time before, in my business, in my medical practice, I negotiated the health insurance policy every year as a separate cost than payroll. Now what's going to happen is your health care costs are tied directly to the payroll, meaning that if you give your employees a raise, you have also just raised your health care premiums. You put those linked together for the first time, and I think that's not good for the person out there working.

I am going to yield now to my good friend, Dr. Burgess from Texas. Thank you for joining us, and we have been joined also this evening by Dr. Cassidy from Louisiana.

Dr. Burgess.

Dr. Burgess, thank you for your comments. Also, just so people understand, it is not just an insulin pop. It is any medical device that we are talking about. It could be a wheelchair; it could be a prosthetic device, if you have a leg that is a prosthetic device; if you have stents in your heart or hip replacements. And who is going to pay that? The consumer is going to pay that, we know that, the person that is getting that device. What we don't want to see is this unbelievable amount of innovation that has occurred.

Dr. Burgess, what comes to mind for me is the equipment we use for a laparoscopically assisted hysterectomy. When we first started, those took us 5 to 6 hours because we didn't have the equipment to do it with. Now it is a 1-hour procedure because of the new equipment that is there. Patients have benefited tremendously from this. Did it cost money to do this? Yes, it did. But I look at the advantages for the patient. I don't want to see that innovation brought to a halt, and I fear it will be.

I thank the gentleman.

We have been joined by Dr. Cassidy from Louisiana. I yield to Dr. Cassidy. We thank you for being here this evening.

If the gentleman will yield for a moment, you are absolutely dead right on this. In my district, I visited four businesses, one is the City of Johnson City, Tennessee, where I was mayor. Another is Holston Munitions, or BAE Corporation.

They have instituted a wellness program that in the last 5 years they have not had a premium increase. What they have done is they have basically incentivized behavior, for instance, smoking.

If you smoke, and one of my good friends had a patient come to him the other day, and he said last spring, and this was in June, she said I have to quit smoking by the first of July. He thought, that is pretty good. I am glad to hear that. They've been trying to get you to quit for several years. But why are you going to quit? She says well, my insurance changes and they are going to penalize me if I smoke. It is going to cost me money.

So, if you don't smoke, or you get your hemoglobin A1C, which is the way we monitor your sugar and diabetes, to get your hemoglobin A1C down, you lose weight, they will pay you for that. So you can earn the money back. And they have done that with their wellness program and been wildly successful.

To tag-team into your health savings account, just me personally in 2 years, and people will say that, well, you can't use that in Medicaid or you can't use that, I absolutely disagree with that. In our own medical practice, of the 294 people that get insurance through our practice, 84 percent use a health savings account. These are the folks that check you in at the front and draw the blood and the nurses that assist us and so forth. So it works very well for everybody. We all respond.

Reclaiming my time, I would also say it takes away personal freedom to decide what is best for your family. For instance, in my family now we don't need fertility evaluations that maybe other families do need. They should be able to purchase those if they need to.

I want the viewing public tonight to take a peak at H.R. 3962, which is a new name for H.R. 3200. I would encourage you to begin to read this. It will take some time. But the American people did read H.R. 3200. They actually did. I had hundreds that came to me at town halls that printed it off the Internet and read it. It is probably just out on the Net.

It is amazingly complex, and the devil is in the details. When you start reading the details, and I did begin the details today, that is where you begin to see what you lose in this.

I think, in summary, in closing up this evening, what we have got this week is a discussion, I think the single biggest social discussion we have had in this Nation in 50 years, since Medicare. The challenge is how do we make health care affordable, and how do we provide it for the citizens now who don't have it?

I think, as Dr. Burgess stated just a moment ago, that right now, the bill before us, they are not our solutions. We keep hearing there are no Republican solutions. There absolutely are. They are not on the table. They are not being discussed. This bill right here, H.R. 3962, all 1,990 pages, that is what we are discussing this week, and, as Dr. Fleming said, we are probably going to vote on this week.

So I think that this needs to be looked at as quickly as we can by the American people to try to peel this onion back, so to say, and look at what's there. I appreciate my colleagues being here tonight, and we'll be here throughout this week to further discuss this bill and what is in this bill.

Madam Speaker, I move that the House do now adjourn.

The motion was agreed to; accordingly (at 9 o'clock and 46 minutes p.m.), under its previous order, the House adjourned until tomorrow, Tuesday, November 3, 2009, at 8 a.m., for morning-hour debate.

As a physician with over 30 years experience in treating patients, I came to Washington to participate in the great health care debate. Everyone in this Chamber agrees, we need health care reform. I will tell you, to be the first, I want to opt out of the public option. We've tried that in Tennessee, and it was a fiscal disaster. Costs tripled in less than 10 years, quality decreased, and access decreased.

What are we going to do? We're going to take $400 billion to $500 billion away from our senior citizens' health care while in 2011, we're going to add 3 million to 3.5 million baby boomers each year. That's 30 million more people. Guess what: They can do the math. Decreased access, decreased quality, and increased costs will be the result of this right here.

Americans should ask themselves one question at the end of the day: When this huge, 1,000-page, incomprehensible bill, which I've read every page of, comes to fruition, will the health care that I get and my family gets and that my doctor is able to provide for me, will it improve? The answer is ``no.''

Madam Speaker, I am so proud to recognize and commend the town of Jonesborough and Washington County for its 10th year anniversary of the Jonesborough Veterans Park. In 1999, Washington County celebrated this park at the groundbreaking ceremony, and on Memorial Day of 2000, the Jonesborough Veterans' Park construction was completed.

Memorial Day of 2000 was extra special for veterans all throughout Washington County because of the Jonesborough Veterans Park.

Mr. Speaker, I introduced a Resolution, congratulating the Jonesborough Veterans Park for their 10th anniversary and for a decade of successful management and preservation of the park land. This will be a reminder that we in the First District are committed to honoring our veterans.

I want to thank the volunteers in Washington County who worked on this park and who remain dedicated to honoring our veterans.

Mr. Speaker, this week The Washington Post published a poll supposedly showing that 57 percent of the American people support, and I quote, ``having the government create a new health insurance plan to compete with the private health insurance plans.'' Unfortunately, what The Post failed to ask and what poll after poll has consistently shown is that Americans who claim to support a government-run option switch their opinion when they find out that creating such a plan will decrease quality and access and increase costs.

How do I know this will happen? I practiced medicine in Tennessee under a plan very similar to what the Democrats are proposing here. We sought to increase access to health insurance by lowering provider payments and promising free medical care to our State's government-run Medicaid plan. Our plan was called TennCare, but it might as well have been called H.R. 3200. It resulted in costs tripling in 10 years and rationing of care when our State couldn't pay for the care that was promised.

Our businesses realized they could shift the cost to the public sector, and our State saw 45 percent of individuals on TennCare who had previously been on private health insurance. It was a disaster. And I'm trying to prevent that disaster from playing out on a national level.

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

Mr. Speaker, I ask unanimous consent to yield my time to the gentleman from Texas (Mr. Barton) to control.

Mr. Speaker, on that I demand the yeas and nays.