Floor Statements

Mr. Speaker, this week the House Democrats on the Energy and Commerce Committee are marking up a more aggressive cap- and-tax bill than what even the President had proposed. On the campaign trail last year, the President said his plan would cause electric rates to skyrocket, and the bill being considered this week will cause electric utilities even more disruption than what the President proposed.

Individuals and businesses everywhere need to start paying attention to the threat this bill poses. The nonpartisan Congressional Budget Office estimated such a plan would increase the average household's electric bill by $1,600 per year.

Since the bill requires no concessions from developing countries, businesses like Eastman in Kingsport, Tennessee, who are engaged in a tooth-and-nail competition with China, can't pass increased energy costs on to consumers and maintain their market share, which means that employees could lose their jobs if this bill passes.

I urge those on the other side of the aisle not to sacrifice two good-paying American manufacturing jobs to create one ``green'' job.

Thank you, Mr. Speaker. We're here this evening to begin and continue a very important debate in American society. I think it's probably one of the most important social debates we've had in the last 40 years in this Nation since the debate on Medicare in 1965.

We're here tonight as a Physicians Caucus to discuss health care reform. My background, I spent 31 years practicing medicine in Johnson City, Tennessee, in the First Congressional District. As I've watched our health care system change over the past 30 years, it really spurred me to run for Congress, to come here and be part of this great debate that will affect every American citizen.

I recall when I made my decision to go to medical school, I wanted to be a family practitioner. Somewhere along the way, I discovered I had a great knack and a love of delivering babies. I have delivered almost 5,000 of them, many of whom are now grown. One of the great advantages you have as an obstetrician when you run for Congress is that you can deliver your own voters. There is some advantage to that.

We have a health care problem in America. Some call it a crisis. For some, it is. For others, it's cost. Certainly we know that there are great concerns about the cost of health care.

In the next hour we're going to discuss how we're going to address this health care crisis. We can ensure that every American can get the care they need, protect individuals from costs that can bankrupt them and make health insurance portable so that you don't lose your coverage just because you change jobs or move from one State to another.

We can also take the profits out of health care by reforming the health insurance industry to bring about a patient-centered approach to providing health care. Enacting a public plan will not bring about this type of change, and I'm going to go into that in some detail from the experiences we've had in the State of Tennessee with our Tennessee Medicaid system called TennCare.

If you think you won't be affected by a public plan, consider this: A recent analysis of this plan by the respected independent firm Lewin Group estimated that 70 percent of individuals who have health care coverage through their employer would lose those benefits in favor of a public plan. Now this plan could very easily become a Medicaid-type plan.

When supporters of a public plan say they want the public plan to compete with private plans, the facts show that what they're really saying is that they want Washington bureaucrats to take over the health care decision-making.

I want to talk for a while or speak to you a little while about the principles that House Republicans have put forward to start the debate over how to bring about patient-centered health care.

I want to mention a couple things before we start. Health care affects all of us, whether we're Democrats, Republicans, Independents, or whether we're totally apolitical. At some point in time in your life, you're going to have to make decisions about how I receive and get health care for myself or my family.

We're going to start this evening by giving another opinion or another view of the health care plan and how it is to be administered and obtained. The principles that we're going to talk about for health care reform are, number one, make quality health care coverage affordable and accessible for every American regardless of preexisting conditions. In a country that spends 16 percent of its GDP, over $2 trillion a year, on health care, I think there's no question that we can provide a basic health care plan for each American.

Now what I mean by basic health care, it's not a plan where you can get hair transplants or face-lifts or all this. But if you are out there injured in an automobile wreck or have a heart attack or have a gallbladder that goes bad, you can get basic health coverage and care.

I think this is something that all Americans believe in. I think we now have crossed that bridge and believe we can do that. I think the differences we're going to have in this great debate that we're going to have are, how are we going to accomplish this very noble task? In a few minutes I will go through how we tried this in Tennessee, and how it was not successful. But I think it can be.

Most Americans also fear, I think rightly so, that a basic health problem--it may be leukemia or a cancer of some type--can bankrupt the family. Certainly we don't want a situation where a family, through no fault of their own, develops a disease process, and then you use up all the family resources you've saved in a lifetime to provide care for your family.

The second principle we'll talk about is not a government-run health care plan. This eliminates coverage for more than 100 million people who receive insurance from an employer, and it restricts patient choice of doctors and treatments and results in the Federal Government takeover of health care.

Let me sort of explain how this worked in Tennessee. In the early nineties and mid-nineties, the big debate in this country came along about controlling health care costs or managed care. We were going to control costs through deciding who and what care was appropriate and so on. Well, that didn't work. Health care costs have continued to escalate in spite of managed care, and managed care basically has moved the pay to providers over to the third-party payers.

In Tennessee we had a very noble plan. We wanted to cover everyone in our State, and we're not a wealthy

State, so it was a noble goal. Right now in the State of Tennessee we have TennCare, which is our Medicaid plan. We have the uninsured, we have Medicare, and then we also have the private health insurance coverage. About 60-plus percent of Americans are covered by private health insurance coverage.

In Tennessee when we applied the TennCare solution, which was a managed care solution with multiple third-party payers at that time, the plan was not fully vetted and thought out well. One of the things I've said the entire time I've been here, Let's do this health care plan right. Let's not do it fast. I think one of the mistakes we made in Tennessee was going too rapidly with this plan.

So we instituted this plan, and what we found out was that 45 percent of the people who applied for TennCare and were granted it had private health insurance coverage. Well, I went to the providers recently, hospitals and other providers, and I said, What percent of your costs does Medicaid or TennCare pay in your particular facility? And the resounding answer was, about 60 percent. So you have a significant percentage of people now who have given up their private health insurance and have gotten on the public plan, which only pays about 60 percent of the provider costs. You also have the uninsured who pay some percentage of their own costs, and Medicare pays about 90 percent of the costs.

So as you shifted more people from the private plans to the TennCare plan, you forced the private health insurers to charge more for their plan. That's what happened. What I can see happening in the public plan is exactly this. It's going to be described, we're going to have a plan that's competitive. It will be very rich in benefits. And what happened was, in Tennessee the actual TennCare plan was richer in benefits than I could afford to provide my own office staff and myself because of the costs.

When you have politicians deciding what goes into a basic plan, it will become richer and richer and richer. What will happen in the public plan--and you'll hear the buzzwords. It will be competitive. If you like your own health insurance coverage, you can keep it. You don't have to give it up. Just keep what you have.

Well, what will happen is this: Businesses will make a perfectly logical decision. What they will do is--and this is small business because in businesses in this country with over 200 employees, 99 percent of those have health insurance coverage.

So this is what will happen. You have the public option plan, the government-run bureaucratic plan that will have a lot of benefits, except it won't pay the cost of care. And when that happens, the cost of private insurance once again will be forced up, causing more and more and more businesses to do away with their private health insurance plans and put it on the public plan. And really over time--and I think a very short period of time--you will see the public plan, along with Medicaid and Medicare, become the only options available.

Now why do we think that this is not a good idea? Well, we've looked at public plans, and I have studied these extensively in foreign countries. In England, Canada, Sweden, Norway, Germany, France, Italy, other major European industrialized nations.

And this is what you would find. The way costs are controlled are by rationing care. In other words, when you have used up all the public dollars that you have dedicated for health care, you have to create ways. An example is in Tennessee. What we did was we simply shrank the rolls. We realized if so many people got on the public plan, the TennCare plan, that the State no longer could afford to budget for it. Our health care costs were more than education in the State. So what the Governor did, along with the legislature, is just cut the number of people off the TennCare rolls.

Well, for instance, in Canada, if you have a heart attack, your average time to go to the operating room is 117 days. They simply ration their care in Canada. And they have great physicians there. As a matter of fact, in the last decade, 11 percent of the Canadian physicians have moved to the United States. I have several very close friends who are Canadian physicians and colleagues. And they do a wonderful job. The president of the Canadian Medical Association once stated that a dog in Canada could get a hip operation within 1 week, and a patient there, it took between 2 and 3 years, simply because of lack of government funds to provide all of the benefits that the government had promised.

So in this particular plan, the one thing that I want as a physician, that I have utilized for years, is that you want to maintain the patient-physician relationship. The one thing that is absolutely mandatory, in my mind, is that the decisionmaking between patient and physician is paramount. Doctors and patients should be making health care decisions. Some government bureaucrat should not be deciding whether you get your hip replaced or your aging parents get the care they need.

I'm going to stop at this point in the principles, and there are lots to talk about tonight. And I see my colleague, Dr. Fleming from Louisiana, is here. And I would like to yield him as much time as he feels is necessary.

Will the gentleman yield for a moment?

Here just a minute ago, we heard a debate on the floor about how we are going to have to redo Medicaid and Medicare. And we have a system already that has promised up to as much as a $70 trillion promise that we have unfunded, a government system that we don't have the money to pay for now, and we are thinking about starting another one, another government system. And you mentioned rationing of care. It brings to me the thought of breast cancer.

As a physician in our practice, we average seeing one newly diagnosed breast cancer per week. And when I began my practice over 30 years ago, half the women, approximately half the women, died in 5 years after being diagnosed with breast cancer. It was a terrible, and still is, a terrible diagnosis. And one of the great miracles of medicine is we haven't cured that disease, but we have improved the life expectancy for a woman diagnosed early to a 5-year survival rate of 98 percent. It is a wonderful story to tell. When a patient comes to my office, and she says, Dr. Roe, how am I going to do? I can say, look, you're going to have some tough times. It's going to be hard. This therapy is going to be difficult and tough. But you're going to make it. And you're going to live. And you're going to get through it. And I'm going to be through it with you.

What has happened in England is that the best results they had ever was a 78 percent 5-year survival rate. And they quit doing routine screening mammograms in England. And the reason they quit doing that is because there is a false positive rate. That means the test says you have something wrong, you go and have a more sophisticated biopsy. It is called a ``wire-guided biopsy.'' It requires a radiologist. It is a fairly sophisticated, as you all know, procedure. But what happens is that that costs more than the screening mammogram. So now they just wait until you develop a lump that you can feel. And as most physicians know, that is about 2 centimeters or three-quarters of an inch.

I don't think the American people are going to tolerate that for their families. I know I won't tolerate that for my family. I don't want a government decision based on the amount of money whether my wife or my daughter can have a mammogram. I yield back.

Thank you, Dr. Fleming, and thank you for those great comments.

For the public, we have had, for the last several weeks and months, a physician's caucus that has met now sometimes one and two times a week to discuss this ongoing health care debate. With us tonight here is one of the leaders in that caucus, Dr. Phil Gingrey, who happens to just have the same specialty as I do, and he has been very heavily involved in the health care debate over the past several years, so I will yield now to Dr. Phil Gingrey from Georgia.

We used to say, ``Smoke a long cigar.''

Thank you, Dr. Gingrey. Thank you for those comments.

I think one of the things that has concerned me the more I have watched this system and have watched this debate go on is, since I've been here, I've had one of the health care think tanks in my office about every week or so to discuss this issue, and it is incredibly complicated. That's why we cannot do it rapidly, because it is so complicated.

I'll now recognize my colleague from Georgia, Dr. Paul Broun.

Dr. Broun.

Dr. Broun, thank you for your comments.

And just to summarize and sum up. I think our time is just about gone.

This is just the beginning of this debate. It is a very important debate for the American people. We just got through a few of the principles tonight. We will continue those at another time.

But I thank Dr. Broun for being here, and I thank the Speaker.

I yield back the balance of my time.

I rise today in opposition to the legislation. School construction is being billed as something that can dramatically improve student performance and, while it will have an effect, I would guess it would impact the performance less than parental involvement, less than having a quality teacher, and less than having good textbooks and curricula.

Since arriving in Washington, all I've heard is that programs are dramatically underfunded, so I question why we would add a new program to fund that could divert more resources from these other programs.

I was personally educated in a two-room country school with no running water, no indoor plumbing. I think my parents placing a high value on education had far more to do with my success in the classroom than the condition of my school did.

In our debate yesterday before the Rules Committee, we were discussing the merits of Federal involvement in school construction. The point was made that State and local officials are being forced to cut back on school construction because they're required to balance their budgets, so we at the Federal level should start funding this construction to make up for their shortfalls.

At home, where I was a mayor, I had a very simple philosophy: Spend less than you take in. Here in Washington, we have a different philosophy: Borrow more than we take, then spend it.

At a time of record deficits, I believe the Federal Government should act more like our State and local officials, many of whom are setting priorities and trying to fund programs to get the most bang to their buck.

Some communities, like Johnson City, Tennessee, where I was mayor before coming to Washington, are investing their own resources in school construction. We were just able to fund $50 million worth of improvements because we acted in a fiscally responsible manner balancing budgets--and we now have a surplus. Other communities have chosen to put off these needs while they weather this economic crisis.

I think it speaks volumes when communities collectively decide that other programs are more of a priority to student achievement than school construction, yet we at the Federal level are making just the opposite determination. It seems to me that if we want to do something that will really help students, we'd be better off with funding the IDEA and No Child Left Behind programs, which are proven to boost student achievement.

I appreciate what both sides are doing--and everyone wants to improve the education level. I urge a ``no'' vote on this legislation.

Mr. Chairman, I have an amendment at the desk.

I yield myself as much time as I may consume.

Mr. Chairman, the amendment is simple, straightforward and hopefully noncontroversial. It adds a bit of accountability to this legislation by requiring the Institute of Education Sciences within the Department of Education to study the impact the Federal school construction dollars have on the institutions that are receiving the funds.

I know proponents of this legislation will say that school construction does impact performance, and they may be correct. I am skeptical of the claim. So I am asking for the opportunity to study the effects of school construction on student performance.

This amendment would require the institute to issue a report a year after the schools have issued construction funding and report the impact the funding has. I am hopeful that such a report could provide valuable insights into the best use of taxpayer dollars.

I know Mr. Cuellar wanted to be here today to speak in favor. It's nice to have bipartisan support for accountability.

I urge adoption of the amendment.

I reserve the balance of my time.

Mr. Chairman, I urge adoption of my amendment.

I yield back the balance of my time.

Thank you, Mr. Scalise or Dr. Scalise, whatever it is tonight.

I am going to share with you some of the experiences that--we've already done this experiment in the State of Tennessee. And as a physician from Tennessee and who has delivered babies in that State for over 30 years, we've seen our health care system change dramatically.

Remember back in the 1980s, early 1990s when managed care was going to be the be-all, save-all for us and obviously didn't slow the health care costs at all. And none of us here tonight, not a single person-- there is well over 100 years' experience in this room tonight discussing this--defend the status quo. Not any of us do. Many of us have a tremendous program, I think, and we're here tonight to share these experiences, what is positive and negative about the system.

Let me turn the clock back about 15 or 16 years to a very noble cause in the State of Tennessee--not a wealthy State--to cover all of our citizens, and we went into a managed care plan. We got a Medicaid waiver called TennCare, and what happened was this was a very rich plan that was offered by the State to compete with other plans. And businesses made a perfectly logical decision: 45 percent of the people who ended up on TennCare had private health insurance but dropped their private health insurance to go on the State plan.

And I went to several of the hospital administrators, the providers there locally, and I said what percent of your cost did TennCare pay in your hospital system? It was about 60 percent. And Medicare, at least in our area--it varies in different areas--pays about 90 percent of the costs. And then you have the costs of the uninsured which pays somewhere in between, leaving a cost shifting to the private payers.

Well, what is going to happen--and this is so predictable because we've already done this experiment--we're going to have a plan that's going to be set forward--again, a noble plan--to cover everyone. If we have time tonight, I will go over some principles that I feel are important in the health care debate. What will happen is there will be a plan brought forth to compete with the private sector that will be subsidized by the taxpayers, that when you go to provide the care, it will pay less than the cost of care. And once again, businesses will make a perfectly logical decision to drop that, and over time, you'll end up with a single-payer system. That's how exactly it's going to work.

And what happened in Tennessee was this: In the State of Tennessee, you had a choice. In Tennessee, we can't borrow money. It's against the State Constitution, so we have to balance the budget. When the TennCare rolls got so big, the legislature and our Governor--who is a Democrat, different party--made a decision. We had to pare the rolls. So they rationed care by basically cutting the number of people on the system.

What happens in a system like in Canada and in England, what happens when you've spent all the health care dollars? The only other option you have is to create waits, and that's exactly what happened.

Let me share with you another statistic that hits me right in my heart, because when I started my medical practice, as did Dr. Gingrey, the 5-year survival rate of breast cancer was approximately 50 percent for women in America. Today, it's 98 percent. One of the great stories.

So when a patient comes to me or the physicians in this room, they can tell that patient, You're going to have a 98 percent survival rate. In 2003, the 5-year survival rate of breast cancer in England was 78 percent.

Now, in England, which is a single-payer system--and in that system, they quit doing routine mammography, and the reason for that was cost. The mammogram comes along and says the woman has a problem in her breast. You do a biopsy, and it shows up that it's negative. She doesn't have cancer, and that is a wonderful thing to be able to tell a patient. But these wire-guided needle biopsies are more expensive than the routine mammogram is, so

they quit doing those, and they wait now until a patient develops a mass in her breast which is approximately 2 centimeters, about three- quarters of an inch, of which a certain percentage of those women will have spread to a lymph node. We're not going to do that in this country. I cannot believe we're going to do that.

The survival rates of colon cancer are less in England than in this country, and the reason is because the screening takes place at a much later time. I, myself, had a screening colonoscopy at age 50. I had a lesion discovered, clipped out. I've had absolutely no problem whatsoever. If I had waited later in my life, I most likely would have had colon cancer.

So just from a personal testimonial here, those health care decisions, Mr. Speaker, should be made between a patient and the doctor, mutual decision made between both of them. That's where the health care decisionmaking should be made.

And I will yield back my time. I have some other things to talk about, Mr. Scalise, and I appreciate the honorable gentleman for giving me this time to express my opinion.

Thank you very much for yielding.

I think, just to kind of emphasize what Dr. Broun said, if you like the way the government managed AIG, you are going to fall in love with a government-run health care system.

I think there are a few principles that we all ought to abide by, and I think we have, and we have discussed this tonight. One is, above all, do no harm. Eighty-five percent of people have health insurance now. We have to help control the cost.

Again, as Dr. Broun was talking, physicians and patients should be making decisions. And every American needs access to quality, affordable health care. I think we all agree on that, and we have brought up some ideas tonight about how to do this.

An illness should not bankrupt you; you shouldn't go bankrupt because you get cancer or another serious illness, and today it does. It should be portable. We have got several ways--and we can talk about this in the future. It shouldn't just be tied to your job. And the COBRA payments now, you have to be Bill Gates to pay for it. You would have to have an affordable way to do that.

And lastly, every single person ought to make an investment, ought to have some investment. Let me give you a very quick example. Let's say a patient on the Medicaid/TennCare system in Tennessee would come to my office to be treated for a cold, as he was talking about; a perfectly rational decision because it costs nothing to do that. If you go down to the local pharmacy to get some medicine, it might cost you $15 or $20 to be treated for the same cold.

With this system right here we are talking about, exactly what happened in that graph, Dr. Gingrey, is what is going to happen to the national system; you are going to push people out of a higher quality private system into the public system that we have seen.

I had patients who had to go to Knoxville--which is 100 miles from where I live--to see an orthopedist because no one would take the Medicaid-type insurance. And I can go on and on. And we will discuss this further, obviously, as this debate goes on.

I yield back my time, Mr. Scalise.

Madam Speaker, I rise today to congratulate Mr. and Mrs. James Ailshie, who are celebrating their 79th year of marriage. James Ailshie was born in 1912, and his lovely wife, Dussie, in 1914. The two are proud parents of six wonderful children, all of whom are residents of East Tennessee.

When asked how they have maintained such an incredible marriage, the couple always responds with, ``The secret of a long life together is a four letter word, love.'' In my opinion, the Ailshie marriage is a living testimony of what love truly is. Let theirs serve as an example to all of us, that love and dedication can truly last a lifetime.

However, their marriage is more than simply an affirmation of love. Across the years they have witnessed times of joy and times of hardship, yet their commitment has endured. The qualities of character that have enabled them to sustain their union and build their family are the same qualities that are fundamental to the strength of our Nation. May we continue to be blessed with Americans who cherish the values of our traditions.

Married in 1930, the Ailshies have shared many yesterdays together. It has been said that, ``An anniversary is a time to celebrate the joys of today, the memories of yesterday, and the hopes of tomorrow.'' It is my hope that they will go on and see many, many more tomorrows together.

Madam Speaker, I rise also today to congratulate Jessi, Jedediah, Josiah, and Josephine Smith, better known as ``J4,'' who were declared the winner of the CBS Early Show's Singing Family Face Off this week. The competition began months ago when roughly 700 videos of family bands performing were submitted by Early Show viewers.

The ``J4'' siblings performed the Mary Mary's song ``Shackles,'' on the Early Show, which advanced them to the finals. CBS said they were chosen as the winner based on votes through the network's Web site.

``J4'' is made up of four siblings, aged 7 to 15, all with names beginning with the letter ``J'' from the Smith family in Bluff City, Tennessee. The oldest two have played for a couple of years for services at the church across the street from their home where their dad, Mark, is pastor.

The Smith kids are the children of Mark and Lori Smith. They're home- schooled and very involved in music, including piano and violin.

Congratulations again to ``J4.'' They make East Tennessee proud.

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

I rise today in support of H.R. 1171, as amended, the Homeless Veterans Reintegration Program Reauthorization Act of 2009. This bill would extend the Homeless Veteran Reintegration Program, HVRP, through fiscal year 2014. This bill was introduced by Ranking Member Dr. John Boozman and the Subcommittee on Economic Opportunity, and I am proud to join him as an original cosponsor.

I would also like to thank Chairwoman Herseth Sandlin of the Subcommittee on Economic Opportunity and Chairman Filner and Ranking Member Buyer of the full Committee on Veterans' Affairs for moving this important measure with our first group of authorizing bills.

At the proper time, I will yield to Ranking Member Boozman to describe his bill.

I reserve the balance of my time.

I yield 3 minutes to the gentleman from Arkansas (Mr. Boozman).

I yield the gentleman as much time as he may consume.

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

Madam Speaker, H.R. 1171, as amended, includes an amendment offered by Ranking Member Buyer during our full committee markup session on March 25, 2009. This amendment is similar to language in H.R. 293, the Homeless Women Veterans and Homeless Veterans With Children Act of 2009, or what is also referred to as HVRP-W.

Mr. Buyer's amendment adds the provisions of H.R. 293 to H.R. 1171, as amended, to create a new grant program that complements the current HVRP program with a focus on homeless women veterans and homeless veterans with children.

As amended, H.R. 1171 authorizes a separate appropriation of $10 million to fund grants to community organizations that provide service to homeless women veterans and homeless veterans with children. Today, VA estimates there are about 154,000 veterans counted among the homeless, and this is indeed a tragedy. As many of you may be aware, women now comprise a larger percentage of our military, and in addition to sexual trauma, women are increasingly exposed to the same stressors and dangers as men, and we are now seeing more women in need of homeless services, including the training and employment services offered through HVRP.

This legislation is critically important to our Nation's veterans, and expanding the program to include additional grant services for homeless

women veterans and veterans with dependent children continues our mandate to care for those who fought so bravely for many freedoms which we, as a Nation, enjoy.

Madam Speaker, despite the headway this country has made in reducing the number of homeless veterans, we have much further to go in order to end homelessness among our Nation's heroes. I believe H.R. 1171, as amended, will go a long way towards this goal.

I urge my colleagues to support the bill.

Having no further requests at this time, I yield back the balance of my time.

General Leave

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

I rise in support of H.R. 1377, as amended, to amend title 38, United States Code, to expand VA's authority to reimburse veterans for the cost of emergency care provided in a nondepartment facility. I want to thank the chairman for introducing this bill, which would provide financial protections for veterans in need of emergency care.

Current law allows VA to reimburse a veteran for emergency treatment obtained in a non-VA facility only if the veteran does not have any other entitlement to pay from a private party. As a result, a veteran with a policy that covers only a small part of the emergency care costs could be personally liable for substantial out-of-pocket expenses.

H.R. 1377, as amended, would change current law to authorize VA to cover additional expenses in cases where a veteran receives only partial payment from a third party. However, the legislation does make it clear that VA would be the secondary payer and that payment would be limited to the difference between the amount paid by the private insurance and the VA authorized rate. It also ensures that VA payment fully absolves a veteran from any liability to that provider.

In addition to providing prospective protection for veterans, H.R. 1377 was amended to allow the Secretary of Veterans Affairs to retroactively apply this law on a discretionary basis for a veteran who may have incurred a medical debt for emergency treatment prior to the date of enactment.

Madam Speaker, the chairman has talked about the need for this discretionary authority. As such, Ranking Member Buyer requested during our markup last week that the bill report make it clear that it is the committee's intention for the Secretary to use this authority and take into consideration the facts and circumstances of each veteran's situation. A veteran should not be discouraged from seeking emergency care at the closest community hospital for fear of financial uncertainty.

I urge my colleagues to support this bill.

I reserve the balance of my time.

I yield 2 minutes to the gentlewoman from Florida, Congresswoman Brown-Waite.

Madam Speaker, I yield myself 1 minute.

Madam Speaker, I would like to thank the Subcommittee on Health chairman, Mike Michaud, and Ranking Member Henry Brown for their hard work on this legislation and Chairman Filner and Ranking Member Buyer for moving this bill so quickly through the committee process.

I urge my colleagues to support this legislation.

I yield back the balance of my time.

General Leave

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

Madam Speaker, I rise in strong support of H.R. 1513, the Veterans' Compensation Cost-of-Living Adjustment Act of 2009.

I would like to thank my colleagues, Mr. Hall of New York and chairman of the Disabilities Assistance and Memorial Affairs Subcommittee, and Mr. Lamborn of Colorado, the ranking member of the subcommittee, as well as the bill's sponsor, Mrs. Kirkpatrick of Arizona, for their leadership on this bill.

Madam Speaker, H.R. 1513 would increase, effective as of December 1, 2009, the rates of compensation for veterans with service-connected disabilities, and the rates of dependents and indemnity compensation for the survivors of certain disabled veterans. The COLA adjustments include veterans disability compensation, additional compensation for dependents, clothing allowance, and dependents and indemnity compensation for surviving spouses and children.

Madam Speaker, this is an important annual authorization which provides much-needed assistance to our Nation's veterans, and I encourage all of my colleagues to support this bill.

I reserve the balance of my time.

I recognize Congresswoman Brown-Waite for as much time as she may consume.

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

Again, I'd like to thank Chairman Filner, Ranking Member Buyer, Subcommittee Chairman Hall and ranking member of the subcommittee, Mr. Lamborn, for their leadership in bringing this much-needed legislation to the

floor. And I urge my colleagues to support it.

And I'd like to thank the gentlelady from Illinois (Mrs. Halvorson) for her help today. This is a great piece of legislation, and I urge tonight we vote unanimously for this bill.

I yield back the balance of my time.

General Leave

When I was home this weekend in Johnson City, Tennessee, I met a few small business owners who are really feeling the effects of this economy. These are real people I'm going to introduce you to, not just some abstraction.

One is a fourth-generation owner of Glenn Wynne Paint and Wallpaper Company. Like many responsible small businessmen and women, he is trying to figure out how to keep his company long enough to ride out this economic mess we are in.

He did have 25 full-time employees for whom he provided benefits, including health care. First, he had to cut back on health care, and then he had to eliminate it altogether. Then he cut 15 percent of the workforce, and he reduced it again to 15 employees.

Finally, he cut 10 percent of the pay for all his employees, including himself. He even went so far as to cut out the $90 a month he was paying for trash removal, choosing to haul the trash himself. He also cut out the cable TV in his business.

As he sees it, he's making tough economic decisions on how to keep his company financially stable during this rough economic time. But he is astounded that people in Washington can't do the same thing, especially because help isn't being targeted for businesses like his that really need it. He sees this cap-and-trade tax as one that will just finally put him completely out of business.

Another individual I met has been in business for 35 years and has very, very little debt, which makes it easier for him to survive this crisis. He had to cut his staff from 50 down to 18 employees and cut unnecessary expenses.

What he's mad about is that while he hears talk about wanting to help small business, he still has hundreds, if not thousands, of dollars of fees to pay to OSHA and Tennessee's Department of Labor and Workforce Development.

As he sees it, large employers can afford these fees and weather the storm, but he doesn't see help for small business. He would like to see the government make it easier for small businesses to stay in business by easing up on the regulations when they can least afford it.

Of course, what I had to tell these two gentlemen was that you make too much sense to get your ideas heard here in Washington. We haven't tightened our belts at all, and definitely haven't gotten our financial house in order. We certainly haven't curtailed the unnecessary regulations on small business or reduced their fees to help them weather this economic storm.

It's time we started acting more responsibly and passed legislation that will stimulate economic growth and prevent our children from bearing the burden of this crushing debt we're racking up to pay for irresponsible choices of the present.

On top of this economic stimulus bill comes the President's budget, which spends too much, taxes too much, and borrows too much. That, ladies and gentlemen, may be the understatement of the week.

With a worsening economic crisis in the forecast, you would think we'd be talking about how some of the President's ambitious proposals could be scaled back. In fact, new economic numbers show larger deficits than the President originally predicted--and these numbers are already very significant.

Instead, the administration and its Democratic colleagues are insisting they will press ahead with the agenda undeterred, as though we don't have an economic crisis.

The President is not at fault for the State of our economy, and I know he is sincere in his desire to get us back on track. But it's important he acknowledge the impact of our current economic crisis on his agenda. The recession does impact his ability to spend billions upon billions of dollars to meet his priorities.

I think many Americans would take it as a positive sign if the President told the people frankly that because we're in a recession, we have to scale back some on his agenda and focus all our efforts on restoring economic growth and creating jobs.

The American people will appreciate hearing this because it's what they're already doing. I think they would have much more confidence in our government if we acted just like them.

Thank you. I appreciate the gentleman yielding.

I have just a couple of comments. I was back in my district this weekend and talked to some of our local governments. My background is a physician and a local mayor. And the community that I was mayor in just before I came here is looking at making a 5 percent cut in their budget, worst case scenario. They are looking at what they have to do to balance their budget. I also talked to a town administrator of Morristown, Tennessee, this past week. They were looking at their MTPO funds. They got an extra $720,000 in stimulus money for a bus system. To show you how out of touch the Federal Government is, they had about $600,000 in MTPO funds, that is Metropolitan Transportation Planning Organization funds, and they can buy buses with these funds and they can build bus stations. There is just one small problem in that community. Their general fund budget has got a $1.6 million hole in it. They have 16 people they can't hire right now that they normally do. They can't afford to hire the bus drivers.

That is something that gets lost in this place up here is that we spend at these record deficits, and local communities are making these tough decisions. And they are tough decisions. Business leaders are doing exactly what they are doing with their budgets, tightening their belts. What do we do up here? In the omnibus spending bill, which I call the ``ominous spending bill,'' when everybody else is cutting it, what are we doing? Up 8 percent. Now, how can I go back to Tennessee and explain to people that we print money--or borrow it--and then go back and spend at that level while they are having to make these tough decisions? I yield back.

We have already had a perfect example of cap- and-trade. It was last year when oil prices went to $147 a barrel. Every American citizen knows that that went straight out of their hip pocket. And like you pointed out, everything you buy at the grocery store, every product that is transported by energy pays for that. And we have already seen that. We know what will happen with cap-and-trade.

A couple of things to historically go back over, and I might mention that if the public out there that is watching this tonight thinks that the government's management of AIG is good, then they are going to be thrilled to death with the government management of health care, I can tell you that.

I am going to go through a couple of historical things.

You and I went through the managed care in all of the 1990s and all of the promises that were going to occur, the cost savings and so forth, that didn't show up; and one of the things that concerned me about health care going forward is accessibility, not just in physicians but in other health care providers.

For instance, our nursing staff. By 2016--that is 7 years from now-- we're going to need one million more registered nurses in this country. And in the next 8-10 years, more physicians will be retiring and dying than we're producing in this country.

And let me go back a few years to read this to us just briefly. It is a 1994 report to both Congress and the Secretary of Health and Human Services, the National Council on Graduate Medical Education noted, ``In a managed care dominated health care system, the Bureau of Health Professions Commissions projects a year 2000 shortage of 35,000 generalist physicians and a surplus of 115,000 specialist physicians'' and recommended that the ``nation `produce 25 percent fewer physicians annually.' '' That was just 13 years ago.

``In 1995, the PEW Commission recommended medical schools `by 2005 reduce the size of entering medical school class in the U.S. by 20-25 percent,' arguing further that this reduction should come from the closure of existing medical schools.''

Have you ever heard of anything as ridiculous as that? And think of what a catastrophe that would have been had we followed this.

The Institute of Medicine committee ``recommended `no new schools of allopathic or osteopathic medicine be opened, that class sizes in existing schools not be increased, and that public funds not be made available to open new schools or expand class sizes.' ''

Now, to give you an example just to reiterate what you said, if physicians don't retire--and there are over a quarter of a million physicians over the age of 55; that is a third of the practicing doctors in America--do retire in the next 10 years, which they most certainly will, this number--and the reason that is so important for the folks listening is is the access to care. What happens will be that patients won't have access to their physicians, and I have seen that.

I have practiced and trained in Memphis, inner-city Memphis and a rural area where I am now, and you all know inner-cities and the rural areas are the two most underserved areas in America now.

Patients in those areas are now not only having a difficult time paying for care, just finding someone to give them the care. So this particular recommendation that was made, if it had been followed, would have been an utter disaster for the American health care system.

We need to encourage more and more young people. The community where I live has a Quillen College of Medicine, has 26 students. It hasn't increased the class size in 20 years. Why? They don't have funding to do it, and we have a tremendous shortage of primary care physicians.

At the end of my practice last year when I was still in the operating room, one of the most difficult things I had to do was find a primary care provider for a post-surgical patient. It is difficult to do now, and it is going to get much, much, much worse.

I will mention a couple of things about our TennCare system, and it was a system that was started with noble objectives, to provide care for all Tennesseans. It was rapidly put together, and I heard you say at the beginning of this, we don't need to do this fast; we need do this right. It's to important.

The health care that we provide affects every citizen in this country. Every one of us is going to have to abide by this system, and who should be in control of that system are the patients and the physicians. That's who should be making these health care decisions.

Now, in a survey that was done in the current budget crisis in the State, the State was about $1 billion short before the stimulus package came along. And what the stimulus package does is simply put off these hard decisions for about 2 years in our State. But that survey showed that nearly half the physicians in the State of Tennessee would end their participation or consider ending their participation in one or both of the MCOs in the State--that's the medical care organizations-- if those cuts were enacted to ease the State budget crisis, and another 31 percent said they would reduce the number of TennCare patients they're seeing. That's 80 percent either would stop or reduce the number that they're currently seeing.

I spoke to one of our large hospital administrators this past weekend, and right now, we have TennCare covering 60 percent of hospital costs. Medicare covers about 90 percent of hospital costs. The uninsured obviously cover none of the costs, and the private payers have to make up that difference to keep the hospital open.

You hear that your medical benefits are tax deductible and so forth. Well, I would argue they're not. If you go ahead, that's a hidden tax right there that a person who has private health insurance has to pay when they pay it. Now I know this year because in the past year, I bought my own policy. I've a health savings account, and to buy this health savings account, I was fortunate to be able to do that. It is about $1,000 a month, but I had to earn about $18,000 to pay that after taxes. So, for a person with a health savings account or a small business or whatever, they're on your own, you're in real trouble in this country now.

And I think the health care plan in this country should have about four principles. One is a basic health plan for all Americans, and we can define that a lot of ways, but I think one of the ways you could define it is the least expensive government plan.

And number two, illness should not bankrupt you. If you get sick, if you develop multiple myeloma or a malignancy or something or at no cause of your own, you should not be bankrupted by that illness.

And number three, it should be portable. You should be able to move. If your lose your job, as many people have done during this current recession, you should be able to carry your health benefits along and not have COBRA payments that people with expensive, who let's say Bill Gates would have a hard time paying.

So I look forward to continuing this discussion in the future.

Mr. Chairman, I have an amendment made in order under the rule.

Mr. Chairman, I ask unanimous consent that the amendment be modified by the text I placed at the desk.

Mr. Chairman, I yield myself 1\1/2\ minutes.

My amendment would cap the authorization level in this legislation for fiscal year 2010 at the fiscal year 2008 level of $405 million. This is 5 percent less than fiscal year 2009, which I think reflects what State and local governments are asking their programs to do all over the country.

The legislation we have before us today continues the process of turning the AmeriCorps program into a much more streamlined, cost- effective program that is leveraging a great deal of service for dollars we are spending. While I have some concerns that a few programs want additional scrutiny, the majority of the programs within the national service laws are performing well.

With that being said, the fact is we are in a recession and face record deficits. The legislation before us includes a sense of Congress that the AmeriCorps and several other programs should increase the number of volunteers to 250,000, up from its current level of just over 75,300, which, if achieved, would represent a 300 percent increase. While it seems to me this is a worthy goal for the future, I'm concerned about the temptation to try to get there all at once without some direction to the Appropriations Committee on how much funding to allocate the program.

Nothing in this amendment prevents the program from growing in future years. If our economy gets back on track and revenues increase, which we all are hoping will happen, I think it's perfectly reasonable in the future years to increase the funding for the program. At least for this year, however, when our focus should be on tightening our belts to lower our deficits, this amendment sets what I think is a reasonable boundary for the program.

I urge adoption of this amendment.

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

Mr. Chair, I yield such time as he may consume to the distinguished ranking member of the Education and Labor Committee, the gentleman from California (Mr. McKeon).

Mr. Chairman, I yield myself the balance of my time.

I know I am new here in Congress and probably don't understand the way things work, but I have a basic philosophy that I have applied throughout my public service. It's very simple: The government should spend less than it takes in. It's a concept that our State governments and local governments achieve every year, and I know there's pain, but they get it, and it's because that's what they have to do. States like California and Tennessee have to make major spending cuts this year to bring their budgets in balance. The city I was mayor of has a 5 percent cut in their budget this year.

Congress, unfortunately, seems to be best at completely ignoring this principle. I'm not blaming Republicans or Democrats, because it has occurred under the watch of Presidents of both parties. But now is our chance to do something about it. Our economy is in crisis, our deficits are soaring, and I think it's reasonable to ask good programs like AmeriCorps to join the rest of the country in tightening our belts and making do with what we have for 1 more year while we try to get out of this crisis.

With that I urge adoption of my amendment.

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

Mr. Chairman, I demand a recorded vote.

I thank the gentleman for yielding. I rise in support of conducting a GAO study of whether the NCCC and PART programs are accomplishing their mission in a cost-effective manner.

While reauthorizing the Corporation for National and Community Service in our committee, I learned that approximately up to $27,000 dollars is spent per volunteer in the NCCC. In Tennessee, where I am from, you can go to a university in our State for 3 years for that.

I understand that this is a residential program, so there are additional costs for this program that don't exist for other programs, but it still seems high to me. I think it would be helpful to have an independent evaluation of this program to prove its effectiveness, and I thank the gentleman for yielding.

Mr. Speaker, while I was running for Congress last year, I noticed that Democrats everywhere were campaigning on the notion that they were fiscally responsible and would make wise decisions for our country based on what we could afford.

Frankly, as the former mayor of Johnson City, Tennessee, who has grown accustomed to balanced budgets and living within our means, this sounded pretty good. It made me excited to come to Washington and get our financial house in order.

My excitement, however, was short lived when I realized how thoughtlessly we would spend a billion dollars. First we approved the second $350 billion of the Troubled Asset Relief Program, which is what people back home and I call a bailout of our banking institutions. Then we approved $787 billion for what was called economic stimulus, but what was in reality a laundry list of spending items the Democrats hadn't been able to get funded the past few years and won't produce sustainable economic growth.

Just when I thought things couldn't get worse, we went out and passed a fiscal year 2009 omnibus spending bill that included $410 billion and an 8 percent increase for our Federal agencies. I am going to pause for a second and let that sink in, an 8 percent increase at a time of record deficits where local county, city and State governments are cutting and balancing budgets.

I think the American people are so skeptical of what's happening in Washington because what they see people in

Washington do is disconnected completely from reality. The reality is in Johnson City, Tennessee, they are asking their agencies to fund a 5 percent cut over last year's budget.

All over America, families and State and local governments are tightening their belts and making do with what they have. Only in Washington do we respond to a huge drop in tax receipts by spending even more money.

Now the administration has proposed a $3.9 trillion budget, which will be 27 percent of gross domestic product of this country. This will create the largest Federal Government since World War II.

This budget is especially troubling because it's coupled with tax increases, and our job creators have to pay for it. The math of these policies seems to be more government spending, plus higher taxes, equals more jobs and economic growth.

If this equation seems questionable to you, I'm right there with you. This budget spends too much, taxes too much and borrows too much.

I think the American people are beginning to question everything they hear being done in the name of economic stimulus and recovery. They heard ``fiscally responsible'' during the campaign and assumed that meant we would be looking for savings from ineffective programs and keep income in families pockets where it's most needed. They are getting just the opposite.

My House Republican colleagues prefer a simpler strategy that has proven effective time and time again. First you want to leave the money in the hands of the families to decide how to spend their own money. We proposed lowering the lowest two tax brackets from 15 to 10 percent and 10 to 5 percent respectively.

We would like to create tax incentives for small businesses, the engines of our economy, to create these jobs. We believe it's important to eliminate taxes on unemployment insurance, which will help those who have lost their jobs stay afloat until they find a new job.

And I believe we should invest in our transportation, water, education, and infrastructure. As a fiscal conservative, I generally don't like deficit spending unless future generations will get to enjoy the benefit of the spending.

By leaving a lasting infrastructure in place, our children will be able to enjoy the benefits, even if they are asked to pay for some of the costs. While I am hopeful we can consider these commonsense solutions, the fact is Republicans are in the minority. We don't have the ability to stop these harmful policies from going forward, only President Obama, and Democrats and Congress can.

I urge the American people to ask President Obama and his Democratic colleagues to fulfill their campaign promises of fiscal responsibility and stop these tax increases and wasteful spending, and help restore our economy, which is still the strongest in the world.

Thank you. I went home this weekend and met with a number of constituents, and one of the things that they brought out is that they understand. And these are from police officers, sheriffs, builders, developers, grandmothers, grandparents. They are saying this is the craziest thing they have ever seen in their life. And the builders and developers believe that simply if we will get the financial situation straight, the banking straight in this country, they said: Look, we will go out and create the jobs if we will get where we can lend money. I will give an example.

A person came in my office in the local district, and he said, Doc, this is the deal I am trying to put together. He had 14 or 15 commercial lots on a river, beautiful river not too far from Knoxville, Tennessee. And they are not making any more Holston River, not making any more lots on the river. It was a $1.7 million project. It was appraised at $2.3 million. He put $500,000 of his own money down on this project.

The bank regulators said, okay, if you had to have a fire sale, what could you sell this property for, the bank, in one month? Well, nobody does a project like that where you have got to liquidate. When you develop homes, you do it over a period of years is how you do these developments.

The appraiser said, well, a fire sale would be probably $1.1 million. The bank then said that was a bad loan because it is $100,000 upside down and would go as a bad loan against that bank. Now, if you can't release capital when somebody puts down $500,000 on a $1.7 million project, then you can't do business. And that is one of the things that is clogging up right now, is this access to capital is being choked off. And until we open the capital market up, you are not going to see our businesses and jobs be created.

The single number one thing the President of the United States should be doing right now is making sure that our banks are solvent and that capital is available, and that we can go out and let these business people create jobs. And they cannot create the jobs if you increase tax on small business, because that is where most of the jobs are being created in America. Certainly in my district that is the case.

Now, we have been very fortunate in our area. The unemployment rate overall is not quite as high as it is Nationwide, but it is heading in that direction. And if you are a person who loses their job, basically it is a depression for you if you don't have a job.

Obviously one of my heroes, too, is Thomas Sowell whom Congresswoman Foxx quoted a minute ago who happened to be a student of Milton Friedman. And Dr. Friedman is a Nobel Prize-winning economist at the University of Chicago. And Dr. Friedman stated very clearly that if you want more of something, you subsidize it. If you want less of something, you tax it. So, if you want less wealth, you tax wealth, and you will have less wealth.

Thank you for yielding. So if you want more programs, you create programs that subsidize those, and you will get more of those government programs. If you want more wealth, you cut taxes. Like you said, every single time the appropriate tax cut is done, revenue to the government has gone up, not down. Every single time the price of capital goes down, revenue to the government goes up. Why is that? Well because it leaves more money to the people who have earned it. They can go out and invest it, save it and do whatever they want to with it. And guess what that does? That creates jobs.

One of the things I wanted to talk about was you had mentioned the word ``compassion'' a minute ago. And I had discussed this. I was on the phone with a local newspaper at home. And my previous job, besides practicing medicine when I had a real job before I came here, was being mayor of our city. And I had to look at my neighbors, especially the elderly. And the two ways we have to raise revenue locally was either raise your property taxes or sales taxes. Well, we can't raise sales tax. We can't make you go down and spend any more money. So I had one other option. Or I could limit the size of government. And I thought the most compassionate thing I could do for senior citizens who are on a fixed income was not overspend by government. Because then the only way locally I could do when these folks are on a fixed income, they are already making tough decisions about what to do with their money, was raise their property taxes, which they chose not to do. And we were rewarded by that.

Let me go over a couple of things in the government spending that we have just done. There was a huge amount of money in there for infrastructure. And let me just think out loud for a minute. You hear a lot about green jobs and that we are going to invest in all this. In our local community, we invested not one dollar and created an enormous number of jobs. Let me tell you how we did it. We partnered with a private company. We had an open landfill. One of the largest carbon polluters in America is a landfill. We went to a

private company and negotiated the deal. They put all the capital up. We captured all the methane gas at this landfill. We cleaned this landfill gas up where it was almost pipeline quality. We piped it 4 miles across town to one of our largest employers, which happens to be the Veterans Administration Hospital at Mountain Home. They operate, they heat and cool their facility, a 100-acre campus, at a 15 percent discount off their energy bills. We make money, and they save money. The local Federal taxpayers save money. And we as a local taxpayer made between 5 and $700,000. And it was the environmental equivalent of taking 34,000 cars off the road or not importing almost 20 millions of gasoline. And guess how many taxpayer dollars we spent? Zero.

The second thing we did before I came up here, and I looked at this stimulus bill, and I thought you could do a lot of this for nothing. We did an energy audit of every building the city owned. We owned 44 buildings. We got a guarantee from a private company that if you don't make the bond payments, we will make it for you. So what we did was we put in new HVAC systems and we put in new windows. We did all of that, $11 million worth of infrastructure improvements, to our building. And guess how much money the taxpayers paid? A big zero because energy savings paid for all of that redo.

Did we do that in this bill that we just sent up as a stimulus package? No, we did not. And guess where the windows were made? Right there locally. Guess where the glass was made? In a community next door at Kingsport, Tennessee. And we did those kind of things at no cost to the taxpayers. That is the innovative things that the Republican party brings.

One of the things that my good friend from Ohio is talking about on the cap and trade, so people understand and get this jargon out of the way, cap and tax is a better definition or description of it.

So people understand how it works, when you pump anything out of the ground, whether it is oil or you pump natural gas out of the ground or you dig coal out of the ground, there is a tax. It was first listed at $15 a ton. I saw the initial tax on coal was $15 a

ton, or I should say on the carbon dioxide per ton, and then it goes out $10 a year. So you are absolutely correct; everything you purchase is going to cost more. The exact opposite thing you should be doing in an economic downturn is even consider raising taxes because you have taken more capital out of the market.

Right now small businesses are having to compete with the government for capital. It is difficult to do. The banks, the regulators, are having more stringent rules on banks, so it is much more difficult for them to get this capital. In fact, there is no question in my mind that it is delaying our recovery.