Floor Statements

Mr. Speaker, on Tuesday of this week I was here in this Chamber with my freshmen Republican colleagues, and we were preparing to do Special Orders about all the concerns we have with the 1,990-page Pelosi health care bill, and I had this bill with me, and it was in this bag. I was sitting in a chair and I was standing in the row next to it.

I was approached by one of the fine, dedicated public servants we have, employees here in this Chamber that are dedicated to our safety and security. They came up to me because somebody had observed this rather large unidentified object from the gallery and wanted to make sure that it wasn't something left there intentionally, a hazard. I assured him this was not a hazard to the Members here, that this was a 1,990-page Pelosi health care bill. Though, on second thought, it was a hazard, a hazard to anyone carrying it around, being as heavy as it is but a hazard to our health care system here in the country.

Mr. Speaker, my background is health care. Twenty-eight years I worked on rehabilitation services serving older adults, mostly, licensed as a nursing home administrator, dedicated to make a difference in the lives of individuals facing life-changing disease and disability. I am here with tremendous concerns on behalf of our seniors tonight on what this bill does to them.

Let me talk a little bit about Medicare. My Democratic colleagues must consider that Medicare is overfunded. I can tell you that it is not. Medicare today pays on the average of only 80 to 90 cents for every dollar of costs that a hospital or a doctor has, 80 to 90 cents. From the time that entitlement program was created, it was systematically underfunded.

This is a primary reason, actually, that commercial insurance is so expensive because of the underfunding of Medicare. Yet my Democratic colleagues consider Medicare overfunded. Well, how do I know this? Because the bill, this bill in front of me, has over a half a trillion dollars in Medicare cuts.

It must be overfunded in their minds if they can make half a trillion dollars in Medicare cuts. Where do those cuts fall at and where will they impact seniors? Well, it is going to impact seniors that go into hospitals, Medicare part A, significant cuts there, $175 billion, a minimum of that. That's cuts to those hospitals, and I know hospitals in my district are lucky to make a 1 to 3 percent margin annually. Out of that, they hopefully give cost-of-living increases and invest in new life-saving technology.

But they don't stop there. The Democrats go on to cut Medicare in terms of skilled nursing facilities. Now that's an area where I was licensed as a nursing home administrator. People who go into nursing homes today are the sickest of sick. That's the only alternative they have when they need that high level of skilled care. To cut services there, that's just unacceptable.

Let's move on to Medicare part B. Those are physician services. They are also outpatient services like rehabilitation. When an older adult, a senior citizen, has a disease or disability and they need rehabilitation, well, that's funded by Medicare part B. But Medicare part B, also, under the Democratic plan is scheduled and slated for significant cuts.

Another one that is under Medicare part B is hospice services. Mr. Speaker, hospice services, that's a service that reaches out and provides services to people that are in their end days, people who are in the process of dying. Hospice service allows people to die with compassion and surrounded by friends and pain management. Yet the Democrats feel that Medicare is so overfunded that we can actually make cuts to hospice services.

Medicare part D. Pharmaceuticals. Well, I never heard anybody say that our seniors actually have more than enough resources coming into pharmaceuticals, but that's one of the lines within this.

Then there are wheelchair taxes, medical devices, medical devices that are innovations that help people live with dignity, help people live with independence, to live outside of institutional settings, which are certainly more cost-effective places. Medical devices allow people an opportunity to be able to age in place for seniors.

Now, I assume my Democratic colleagues will assume that the people they tax, that will just come out of their pockets, but we know how that works. Taxes get passed on. And this will be passed on to the people on fixed incomes in this country, and that's unacceptable.

I want to talk briefly about the flawed math that went into this. One of my Democratic freshman colleagues, a Democrat that's on the Rules Committee, I heard him make a statement about how this bill is so much less expensive than the previous version we saw back in July. I have to tell you that's flawed math.

This bill was based on the fact that the Medicare growth rate would be at 4 percent. The average growth rate is 7 to 8 percent. In 2008, Medicare grew at 9 percent.

Mr. Speaker, on rollcall No. 858, I was unintentionally late upon return to the House Chamber and consequently missed this vote due to a meeting with my constituents who traveled to Washington, DC, to voice their opposition of pending health care legislation. I most certainly share overwhelming sense of the House in honoring and recognizing the service and achievements of current and former female members of the Armed Forces. Had I been present, I would have voted ``yea.''

Mr. Speaker, in South America there is a tenacious parasitic plant that attaches itself to trees. As it climbs to the top of the tree canopy seeking the light, the plant thrives. But eventually, in the end, it kills the tree.

That is what an unfunded mandate by the Federal Government does to States. Putting more people onto Medicaid arguably is a good thing that takes people off the roles of the uninsured. But the Pelosi health care bill will cost all of the States an added $34 billion in new burdens.

My Pennsylvania colleagues and I warned our Governor back when we thought people at 133 percent of the poverty level would be eligible for Medicaid. That would have cost the State $2.2 billion over 10 years. Now we are looking at those at 150 percent of poverty level. That will add 15 million to the Medicaid program nationwide.

Tennessee Democratic Governor Phil Bredesen called it ``the mother of all unfunded mandates.''

We may soon be saying our prayers for many of our States, when a program intended to help poor women,

children, and the disabled turns out to be the death knell for a number of State budgets.

This is a health risk, a serious health risk, for those of us who are carrying it around and, frankly, for the country. This is the Nancy Pelosi health care bill, 1,990 pages, and that's just part one.

Part two, I am sure we will see within the next 24 to 48 hours; that will be the manager's amendment. That will be all the buyouts, the bribes, the deals that are being made right now by the Speaker and my Democratic colleagues to buy their votes to support this.

I don't know what to expect. I don't know if my colleagues have a guess. We do a guess here in terms of the number of pages, this manager's amendment, which, frankly, will be all of the deals that are made. How many pages do you think the manager's amendment might be when we see this in the next 24, 48 hours?

Six hundred. Do I have another bid?

The gentlewoman from Wyoming says 800 pages. How about my good friend from Minnesota?

Now, that was a rather safe guess; a rather safe guess.

Yes, that manager's amendment is coming. And there are lots of just flawed approaches to health care here. Speaking as someone who worked in that field for almost 30 years as a manager in rural hospitals and a skilled nursing facility and many different settings, I want to talk just briefly about some of those, because it has to do with one of the charts you had up there about the promise to not add a dime to the debt, not a dime to the deficit.

This bill was based on the premise of Medicare growth being held at 4 percent. Now, why is that important? Well, Medicare is a significant amount of money, so 4 percent of Medicare is a lot of money. But let's talk about reality here, and that is what this bill lacks is a good dose of reality.

Medicare growth rates have been steady at 7 to 8 percent a year. That is just the reality of it. If you think about it, those in the baby boomer generation who are now retiring, becoming qualified beneficiaries under Medicare, that is a significant number of people adding to the Medicare rolls from this point forward. So, 7 to 8 percent.

If we just look back a year to 2008, the Medicare growth last calendar year alone was 9 percent, 9 percent, and yet this bill was based on holding Medicare at 4 percent. I think that is pretty flawed math. That is not even fuzzy math. That is just wrong.

We know that this is built on half a trillion dollars in new taxes, and you talked about some of those. Small businesses. Taxes on individuals who choose not to buy in, to buy insurance, are penalized. Medical devices will be taxed as an excise tax.

The other part of the funding mechanism is a half a trillion dollars in Medicare cuts. We have talked about that during other forums here, when already Medicare systematically has been underfunded from almost the day it was created. Medicare only pays today about 80 to 90 cents on every dollar of health care costs that a hospital or doctor has. And to do another half a trillion dollars in Medicare cuts, that is just wrong. The people that are going to suffer from that are the providers and older adults. This will bankrupt hospitals.

Well, I thank the gentlelady from Wyoming.

I think innovation is one of the things that our health care system fosters in this country. When you look at the advancements that we have had, whether it be in medical devices or lifesaving technology, diagnostic, invasive, noninvasive, lifesaving interventions, that comes out of the type of health care system that we have today. It is the way it has been designed and the way it works. It provides those encouragements.

I have a number of similar small businesses that started very small, I don't know if they started in somebody's garage, but started as small operations, and they developed tremendous innovations, innovations in terms of prostheses for individuals who have lost limbs.

Actually, one of them is an incredible small company developing a limb that is not just a powered limb, which is the cutting edge for a prosthesis, an artificial leg, but this one actually self-charges. In the use of it, that friction builds up the power.

The application of it is just tremendous, starting with our wounded warriors who rehabilitate and return to the field. This is an artificial limb and you don't have to plug it in at the end of the day. It recharges while you use it. We wouldn't get that innovation.

Any time we tax something, we repress it. We hold it back. We destroy it. This tax on medical devices is just, well, I agree, it would be a nail in the coffin of innovation for health care in this country.

If the gentlelady will yield, you are going down a tremendously important road here in terms of what this legacy of costs that we are passing along to our children and our grandchildren and great-grandchildren at this point is, on top of all the other deficits that have been accumulated by this Democrat-led Congress since January.

I had the opportunity to spend some time this morning with a former Congressional Budget Office director. And going back to the point of the flawed math here, of saying that growth in Medicare will be held at 4 percent, when we know that it is an average of 7 to 8, 9 percent last year, his estimates are this cost will actually be at somewhere around $1.8 trillion in terms of math.

To give us some idea, I just want to point to a project that actually is literally under our noses. It was a project that did not occur on our watch. This was years past, and it is a beautiful place to visit and we take our constituents there, the Capitol Visitor Center.

I certainly encourage people to come to Washington to visit that, but there is a prime example of estimates that were made, and in the end it was 300 percent more expensive than what the original cost estimates were. So even if we're at a trillion or $1.2 trillion or $1.8 trillion, and we know that we cannot afford that, where could these costs go once this legislation passes? Just based on the example of a project that we should have pretty good oversight on because it was being constructed right under our noses.

I thank the gentlewoman for yielding.

I just want to build quickly on affordability. And our Democratic colleagues have recognized this with this bill, and I just call attention to page 25, section 101, which is the national high-risk pool. These are the folks we should be doing something for. They're high risk, preexisting conditions. They have a difficult time accessing health insurance. And the language that's built into this, our Democratic colleagues recognize this isn't going to be sustainable. We're not going to be able to fund this. Within the legislative language it says, given once the money is spent and goes beyond the premiums checked, it allows the Secretary of Health and Human Services, if all are exhausted, to do three things: cut benefits, increase premiums, and create waiting lists. Page 25, section 101.

I think that's a general acknowledgment early in this bill. And if we can do that type of rationing for folks who are most at risk, who we should be doing health insurance reform for, what does it mean for the rest of us?

I thank the gentlewoman for coordinating tonight.

I thank my good friend for the opportunity to join you tonight to recognize Congressman John McHugh.

Unlike my colleague from New York, I didn't know Congressman McHugh when he served in the State legislature, nor previously prior to January, at my arrival here in Congress.

I got a chance to know Congressman McHugh since January--and his leadership record. And I stand today not just as a Member of Congress to mark all of his contributions, but, frankly, as a father of a United States soldier in the U.S. Army. I am so appreciative of what Congressman McHugh's service has been as now he has been sworn in as the 21st Secretary of the Army, that swearing-in occurring on September 21.

Today, in his new role, being responsible for the Army's annual budget, more than $200 billion, what a tremendous responsibility that is, a workforce of more than 1.1 million active duty Army, National Guard, and Reserve, that includes 221,000 Army civilian employees and 213,000 contracted service personnel.

Additionally, in his new role, Secretary McHugh will be a steward for more than 14 million acres of land under the jurisdiction of the U.S. Army.

He served more than 16 years as a Member of Congress representing northern and central New York. Over those last 8 years, McHugh had made 10 official visits to Iraq and four visits to Afghanistan and other deployed locations to visit U.S. forces. And quoting at his confirmation hearing about wounded warriors, ``I've been so struck how these heroes, facing pain and loss and uncertainty, ask one question, `What else can I do to serve?' ''

He served as the ranking member of the House Armed Services Committee and previously was chairman of the House Armed Services Committee's Military Personnel Subcommittee. As chairman of the Military Personnel Subcommittee, Congressman McHugh exercised leadership on overseeing our military forces, personnel policies, compensation, health care, morale, welfare, recreational activities, dependent schools, and other benefits. He advocated for the military's people and programs.

When Congress passed the fiscal year 2006 National Defense Authorization

Act, H.R. 1815, Congressman McHugh had a role in developing a bill that does so much for the members of our Armed Forces. The measure provided the basis for our Nation's defense policies and programs. This legislation relieved the tremendous pressures placed upon our military services, active Guard and Reserve alike.

The military personnel provisions aim to improve quality of life for active duty and Reserve troops through pay and bonus increases, improvements in living and working conditions, and enhancements in health care coverage. This legislation reflects Congressman McHugh's commitment and dedication to serving not just his constituents in New York, but the men and women serving as our heroes in the Armed Forces.

During his nine terms in the United States House of Representatives, Representative McHugh has been a champion of fiscal responsibility and lower taxes, protecting Social Security and Medicare, providing stronger and better schools, and protecting America's farmers. We wish him well in his newfound role as the 21st Secretary of the Army.

I thank my good friend for yielding.

Mr. Speaker, if you like your current plan, it had better not be Medicare Advantage because the Democrat health plan proposal cuts $162 billion from that program for our seniors. The reason is twofold; they need cuts to pay

for their new government-run health care program and they think insurers in the program are overpaid by 14 percent. Tell that to the 25 percent of seniors who are enrolled in the program nationwide. I guess they weren't included in the folks who can ``keep their plan if they like it.''

Perhaps the Democrats didn't look at the plus side of Medicare Advantage. Studies show that those in the program spend fewer days in the hospital and experience fewer readmissions. A study in California showed that those enrolled in Advantage plans spent 30 percent fewer days in the hospital and were 15 percent less likely to be readmitted to the hospital. I would say that accounts for a huge savings.

The Congressional Budget Office also says the Democrats' health care plan would increase seniors' Medicare prescription drug premiums by 20 percent over the next decade. I thought reform was supposed to be improvements, not a plan to soak our seniors.

Well, it certainly will have.

First of all, I thank my good friends--both of my colleagues from Colorado--and I thank Mr. Coffman for hosting this very important session tonight because what we're talking about is truly the economic engine of this country, and that's small business. Small business is so important. It has been and always has been our economic engine. You know, small businesses employ half of the workforce, and they create 72 percent of all new jobs.

Old fables would refer to small businesses as the geese that laid the golden eggs, and last month, unfortunately, we lost 263,000 jobs in this country.

Now, we normally would encourage small business, with incentives, to help the economy and to grow those jobs and to maintain those good family-sustaining jobs--jobs that provide health care benefits in most of those positions. Well, unfortunately, instead, the Democrats are going to tax the few golden eggs that are left and will probably kill the goose.

According to data from the IRS, more than half of those targeted under the Democrats' health care surtax are small business owners. When you look at those businesses that are organized as S corporations or as limited liability corporations, they constitute over 60 percent of individuals who file their taxes as individuals who are making over $200,000. These are small businesses. Out of those moneys, they pay a payroll every week. Then there will be the $208 billion in new taxes on businesses that can't afford to pay now for their employees' health care.

I was in the little town of Emporium, which is in Cameron County. It's a great county. It's in the middle of my district. Unfortunately, unemployment there is significant. Cameron County unemployment is among the highest in the Commonwealth of Pennsylvania.

I was there. I was with a young lady who was an entrepreneur. She was somebody who had that American dream, that drive to strive for something better. She had created this small business, and she had a payroll she was maintaining. In fact, it was early in the first couple years of this small business where she was at the point she was willing to sacrifice, and she wasn't taking a salary because she was dedicated to seeing this business be successful and because she was faithful to her employees and to the jobs that she had created. She chooses not to take a salary, and she doesn't offer health care. She would like to, but she can't.

Well, I thank my good friend from Utah. I feel like I am in the wild, wild west between Utah and Colorado. It is very good to be with you here.

This is a very important topic. It comes down to that very bold sign you have there, Mr. Coffman, 5.5 million jobs. That's what we are at the risk of doing, going down the direction we are going, which is not necessary. We have other alternatives. We have other bills, just like the idea that you outlined just a few minutes ago.

We have, as we look, you know, the National Federation of Independent Businesses, just one of the voices for small businesses, have been very clear about what it would like to see in health reform. It would like the ability to pool with other businesses to enjoy the economies of scale in purchasing health insurance. That's a fundamental part of what you just outlined. They want tax credits to be able to help them to be able to afford the insurance. I guess to come back to my opening analysis, but what we have here is an unhappy fable under the Democrats' health care plan in which no small business will live happily ever after.

I come out of a small business. I grew up in a small family sporting goods business. It was my job as a teenager to get up at 6 a.m. on Saturday morning to open the store that was down in the front yard in front of my parents' home where I grew up.

I have to tell you, 6 o'clock in the morning felt like the middle of the night then. I got up because of people coming in for either picking up their supplies for hunting or for fishing, and small business is what we did. I mean, we worked hard at it. My mom and dad had that.

They were looking for the American Dream, and they were willing to put whatever it took into it, the hours and the days. They created jobs and they created prosperity for other people, and they provided benefits for folks that worked for that family business.

I saw the toll that one of the biggest obstacles that ran up against being successful--and I am sad to say that the business does not exist today because those barriers eventually overtook it--it was government. It was government that did that business in, and it's government that's a barrier that impedes many, many of our small businesses. It was the taxes. It was the regulations. It was the mandates. Today we are talking about health care is one more mandate that is put on our small businesses.

Health care costs for small businesses across the country continue to outpace the rate of inflation. We know that we could do a better job of bringing the costs of health care down. But it's the path that we choose that is so important.

The path that the Democrats' plans are on will make matters worse. They will drive many small businesses out of existence, and we will lose jobs, many jobs. We have 5.5 million jobs at risk in this debate. But there are other paths that we can take, such as the ideas outlined by my good friend from Utah that we can take.

There is another bill that we have out there, Putting Patients First Act, H.R. 3400. That's a good plan. It's been introduced. We have been talking about it for some time.

I think the American people really need to know and get to know more about this, because it does so many different things. It allows being able to access across State lines for health insurance. It provides that competition, which is healthy, and which is important. It addresses tort reform.

When we talk about fraud, abuse, and waste of health care, I came out of working in health care for 28 years. We tried, as health care professionals, professionally and ethically, we worked very hard to make sure that we used every health care dollar wisely to treat the patients that are there, to help make them better where we can. One of the largest wastes, I feel, is the cost of medical liability.

Nationwide, we spend $26 billion annually in medical liability premiums, and in addition to that, the practice of defensive medicine. I understand defensive medicine. If you're practicing as a physician, when you come out of medical school, you may have $250,000 in loans as a part of that education. If you're a specialist, it may be a half a million dollars.

And because of a lawsuit, and frequently a frivolous lawsuit, you're at risk of losing not just your practice, but your family's home. And because of that, you may order these tests to be able to treat specifically this patient at this time, but these other tests are ordered and put in the medical record to be able to establish that you followed a standard of care. It's to protect you in the event that you are sued.

Well, that probably is, at a minimum, $100 billion a year annually in this country. So in terms of wasteful costs in health care that we could bring down, there is $126 billion annually just by good tort reform.

H.R. 3400 does that. H.R. 3400 provides some commonsense approaches to medical liability and brings down that cost for everybody, which would bring down the cost of health care for our small businesses and individuals all across the Nation.

Absolutely, and I really appreciate that question. It's been one of the biggest disappointments. I came to this body out of health. I thought I would actually retire from nonprofit community health care, which meant my hospital would have provided me a discount on my nursing home bed. But instead, I have the privilege of coming here to work on behalf of the citizens of Pennsylvania's Fifth District.

And I came here knowing that we've got a pretty good health care system. And we can do better, and we can improve it, and improve on all four principles: access, affordability, quality and patient choice.

So I was excited when the President said we were going to work on health care. And I get here, and do you know what we're working on? We're working on access to health insurance; we're not working on access to quality health care. That's what we should be working on. That's what the American people deserve: we work on things like we've been talking about, H.R. 3400 and the different bills that are presented here that would improve health care in all four dimensions. But instead, we're talking about health care insurance. And I guess I should have had some indication of that when I looked at the individual that was selected.

Absolutely.

Sure. Medicare actually is the central component of this debate for many different ways. And let me start with the question that you raised. The Democrats' health care bill, the accounting of it, cuts essentially $128 billion from Medicare part A. Medicare part A pays for end-patient services. That pays for hospital services. It pays for up to 100 days if an individual, an older adult, is qualified in a skilled nursing facility, $128 billion.

I have to tell you that most hospitals I know, and I have probably about 20 hospitals in my congressional district, I would say that my hospitals are like most, many in America, either in rural settings, certainly underserved urban areas. They are lucky to be making a margin of 3 to 4 percent annually. And to cut $128 billion from part A will certainly impact--I think what it will do actually, it could very easily move towards bankrupting many of these facilities. Certainly Medicare part B, which is the Medicare coverage that individuals choose to purchase. It helps to pay for physician services. It helps to pay for therapy services, if you're an outpatient. And that's scheduled for $130 billion in cuts for Medicare in order to fund this Democratic health care plan.

The Advantage plan you talked about is Medicare part C. Medicare Advantage is managed care Medicare, and it's essentially a plan where individuals choose to enroll. It gives them a little more flexibility. It provides them a little more coverage. It's a choice that they make. And the Medicare Advantage plan has really been targeted by my Democratic colleagues. And that's scheduled for, within this, $133 billion in cuts.

Finally, the pharmaceutical program, one of the newest parts of Medicare, Medicare part D, that's the drug benefit that President Bush put in place here a few years ago. Under the Democrat's proposed health care plan, Medicare part D, the pharmaceuticals, the drugs, is scheduled for a cut of $20 billion, totaling $411 billion in Medicare cuts. Now, that impacts people. It impacts individual lives. It impacts jobs.

In my district, in a very rural district with rural counties, my hospitals are actually important economic engines. It's a place with some really good jobs. They're economic engines. They buy a lot of resources to operate the hospital. They try to buy them locally to support the local economy. And when you start to make these types of Medicare cuts on facilities, health care facilities that are at best in a banner year making a 4 percent margin, we're talking about closing those. We're talking about losing jobs. And that's not good for anyone.

You never want to see a hospital close. But in a city, you can make, I guess, an argument that if you close one hospital, somewhere in the city, probably within blocks, you'll find another one. In rural America, rural Pennsylvania, if you close a hospital and what you wind up with is a commute, that makes a difference between life and death.

Absolutely. I see three reasons, three primary reasons why commercial health insurance is so expensive. One is we need more competition, and that is allowing a broader pool. I am really interested in learning more about the model in Utah. It is intriguing. It sounds like a great model to look at. But more competition is important.

Secondly, it is the need for tort reform. I talked about those numbers, $126 billion a year. It drives costs up. It drives the cost of providing care up. Therefore, commercial insurance goes up.

Finally, there is the necessary cost-shifting that occurs. Now, some of my colleagues in this body, particularly across the aisle, when you hear the term ``cost shifting,'' they see that as an evil thing. When you come out of health care, you begin to understand what happens in health care.

I would say the primary reason that health insurance is so expensive is because government creates an entitlement, Medicare, medical assistance, and then from day one, after they created it, discovers they can't afford it and they systematically underfund it.

Let me talk about the numbers specifically. Medicare: For every dollar of cost that a hospital or a physician has, Medicare pays 80 to 90 cents, 80 to 90 percent. If it is medical assistance, that is 40 to 60 cents for every dollar of cost. If you are just operating on Medicare or medical assistance, a hospital and doctor, you could see, they have these costs and this reimbursement, they are not going to keep their doors open very long because they can't cover their costs.

So what they do is negotiate with commercial insurance, and commercial insurance average, average across the Nation, pays at least 140 percent; 140 percent of cost. Now, why do they do that? Well, they do that because in the negotiation process, doctors and hospitals need to achieve that 140 percent from commercial insurance to offset what medical assistance and Medicare, what the government doesn't pay.

So that is where the cost shifting occurs, because if you don't get that higher rate for commercial insurance, you are not going to be able to make payroll. You are not going to be able to invest in lifesaving technology. You are not going to be able to keep the lights on in the facility.

So, the fact is the government creates these new programs, with the best intentions, I am sure, but quickly finds that the costs are just so tremendous that they begin to systematically underfund those costs.

One of the biggest concerns I have with the public option, as I read H.R. 3200 in the Education and Labor Committee when we marked that bill up, is that the public option would pay Medicare rates. Medicare rates are 80 to 90 percent of costs, 80 to 90 cents for every dollar of cost.

I do believe that the public option will be cheaper than commercial insurance because the public option will also underfund the cost of health care. And if the public option replaces the commercial insurance of today, that really today funds and keeps the lights on and our hospitals operating and our doctors in practice, we are going to lose health care providers.

Well, thank you. And actually, the commission is a body of individuals. But even more frightening to me is just the one lone bureaucrat, the Health Insurance Commissioner, as defined within House Resolution 3200.

And as we worked our way through this thousand-plus bill in the Education and Labor Committee over a course of 20 hours back in the very end of July, I found that many times there was so much left undefined, and everything was referred to according to the Health Insurance Commissioner, the Health Insurance Commissioner, the Health Insurance Commissioner.

Well, you know, our health care is, there's probably few things that we could debate on this floor that's more intimate than our health care, and certainly few things that are as large a part of our economy. And our colleagues who were here just the previous hour from the Progressive Caucus talked about how those of us who oppose, those of us who oppose their health care plan, those of us who would support more smart government solutions, more free-market solutions to health care, that we have these scare tactics, and one of them is rationing. Rationing could never occur. Rationing just won't happen. Well, I've got news for them. Rationing happens today. And where does it happen? It happens, first and foremost, under the government plans.

Let me tell you about Medicare part B. You know, part of my background is I've had the privilege of working with older adults for my entire career, in rehabilitation services. The last number of many years of my career, 15 years I worked in skilled nursing as well, and I became licensed as a nursing home administrator. And I've talked briefly about the cuts to Medicare part B.

Medicare part B is slated for additional cuts of $130 billion. And Medicare part B--think about the individuals who come into a nursing home. They come there because they're the sickest of the sick. They're there because they don't have any other alternatives in terms of the care, the health care that they require. They have intense needs. These are folks who have just a lot of very intense needs. And today, the government, under Medicare part B, if you need therapy services, it arbitrarily puts a number. There's a maximum amount of dollars.

And now I've been out of that for about 10 months, but it was somewhere around $1,800 a year, $1,800 to $1,900 a year of therapy services. Arbitrary number. Now, that's rationing, in my line. You know, it doesn't matter the fact that you have maybe suffered a stroke or you have fallen or you have a debilitating weakness that you develop. Once you max out on that Medicare part B benefit, that's it. That's the upper limit of what you receive. So we have rationing today, and rationing occurs under the current, one of the current government programs for Medicare part B.

So I don't know where you--when you look at--you know, I've worked in the inpatient hospital side for almost 30 years as a part of my practice. As I said, a 2 to 4 percent margin is a banner year, okay? And out of that, you want to be able to, out of that 4 percent, give cost of living adjustments so you continue to retain the best and the brightest.

Personally, if somebody's going to use a scalpel on me, I want them to be the smartest person in the county, and we want to be able to retain, recruit, and retain those individuals. So 4 percent margin. Most of my hospitals, I would say, are probably not doing that well, and most hospitals across the Nation are probably challenged and not doing that well. And then you have skilled nursing facilities where, honestly, nobody's getting rich operating skilled nursing facilities. They're providing good, compassionate care. They're treating people with intense needs, and yet, those are slated for significant cuts.

Specifically, in skilled nursing, $14.6 billion in designated cuts. Now, this is out of the Senate Finance bill, the Baucus bill, Senator Baucus' bill, and so those cuts have to come somewhere, and they're going to come out of services. They're going to come out of--it won't come out of the compassion, because the people that work in those areas, they're truly dedicated to serving the needs of older adults and people with needs. But they will come out of the care. Those dollars have to impact access to services.

Mr. Speaker, we must improve health care affordability, access, quality and choice. We must not, however, pass a sweeping government takeover of health care.

We should just fix what is broken. Medical liability and defensive medicine costs are broken.

Mr. Speaker, we need tort reform. The economic and professional consequences of medical liability lawsuits are driving the practice of defensive medicine.

Here are the facts: medical liability premiums in the United States have reached $26 billion a year. The average award is $4.7 million. More than 93 percent of Pennsylvania physicians reported engaging in defensive medicine.

I have cosponsored H.R. 3400, the Empowering Patients First Act, that provides tort reform. There will be no limit to actual economic damages to the patient. There would be a limitation on punitive damages, and they would be determined by a special health care panel that would have judges with health care expertise.

I urge my colleagues to support H.R. 3400 for a first step towards real health care reform.

Well, I thank the gentleman for coordinating this very important discussion this evening, and I thank the gentlelady from Wyoming for referencing the Keystone State.

Yes, Pennsylvania would be impacted tremendously by this. Certainly, expanding health care is a laudable goal, but this Federal mandate would require the increase of State Medicaid funding, an unfunded mandate. With this legislation, Pennsylvania would be required to increase State Medicaid funding by $2.2 billion over the next 10 years. Additionally, Federal subsidies for Medicaid would end in 2019, leaving States to pay the full costs of the Medicaid expansion. In Pennsylvania, the costs would be approximately $930 million in the year 2020 alone.

Now, Pennsylvania, my State legislative colleagues, they have had a challenging time. They just, finally, after months and months, came to a budget agreement. There was a budget crisis. It really illustrates how difficult it is for the State to maintain a balanced budget with rapidly increasing costs of government programs.

It's going to come out of the pockets of the taxpayers. Here's the rub with that: there are actually, as you read the Baucus bill from the Senate, there are exemptions, interestingly enough. One of those is for the State of Nevada. Nevada is on that chart, but I think Democrats and Republicans alike are aware of the damages that this bill will inflict on their States.

In the States, in the Senate version, for example, Senator Reid negotiated a deal to exempt the State of Nevada from any additional mandates in the health care legislation. Now, if this proposed legislation is too much of a burden for Nevada, what about the rest of the country?

Well, they are not only protected, but the taxpayers in our States will be paying their bill.

A total of four States were exempted. Nevada is the one I know of.

Well, I thank my good friend for that question. Actually I go back to the position I left 2 days before I was sworn into Congress, and actually at that point I will take it to be my responsibility in two areas specifically designated in here: Skilled nursing and hospice. I actually was a licensed nursing home administrator up to that point, working with individuals that really are the most vulnerable.

The people today that are in skilled nursing are the sick of the sick. They are individuals who have no other alternatives. We work real hard to have people stay in their homes and to age with dignity, but there are certain ones, and it is a small part of the population, they need facilities like good, caring, compassionate skilled-nursing facilities.

At the same time, for those folks who are at the final days of their lives and find themselves with a terminal disease, they need services such as hospice, where they are able to die with dignity and with compassion, surrounded by family, whether it is in their homes or in a facility much like the one I worked in.

So it just, I would say, grieves me, but angers me actually that this Senate health care bill, among the Medicare cuts that we see today, are slated for skilled-nursing facilities, which I can tell you nobody is getting rich in the skilled-nursing industry. It is challenging to make the day-to-day financial payments and requirements there. But the skilled-nursing facilities under this Democrat proposed bill are slated for cuts of $14.6 billion.

I think it is people's lives. You are right. This goes beyond an impact on industry. This is in fact an impact on people's lives, and the lives of people who really are some of the most vulnerable folks that are in our country.

And then you turn to hospice services. There are people that are in their final days of life and they're looking for that opportunity to die with dignity surrounded by family and loved ones in a setting that is just very compassionate, and this bill is anything but compassionate. This Democratic bill that is scheduled for $11 billion in Medicare cuts to hospice.

Certainly.

Will the gentleman yield?

We have a bill that we've made reference to that Republicans put forward, H.R. 3400, which specifically addresses tort reform, among many other things. That bill essentially would remove the burden on health care today, which I consider part of the waste, and that is the medical liability premiums; $26 billion annually in medical liability premiums. That's not a price tag that considers the cost of defensive practice, and I understand that. I mean, you invest anywhere from $200,000 to $500,000 coming out of school in loans, and because of lawsuits, and many times frivolous lawsuits, you can lose your practice and lose your home over the ordering of additional tests. That has to be in the neighborhood of somewhere over $100 billion annually.

H.R. 3400, which we have put forward, if that would come to the floor and our colleagues on that side of the aisle would join with us, we could eliminate over $125 billion in unnecessary costs from health care today.

Mr. Speaker, I thank my good friend, my colleague from Pennsylvania.

Mr. Speaker, I, too, rise today in support of House Resolution 754, a resolution commending the members of the 56th Stryker Brigade Combat Team of the Pennsylvania Army National Guard on the completion of their most recent deployment to Iraq. And I thank all of my Pennsylvania colleagues for their support of this resolution.

The Stryker is a combat vehicle similar to a tank but operates on wheels rather than on tracks. And the vehicle is essential to protecting our soldiers' lives and is vital to the Army's Interim Brigade Combat Teams. The 56th Stryker is a special unit not just to my home State, but my home. My son, Logan, served with the 56th Stryker Brigade before changing to Active Duty, and a number of my former Eagle Scouts from my scout troop serve currently with the 56th Brigade and serve proudly in Iraq.

The 56th Stryker Brigade was deployed in February of this year to Iraq and returned home this past summer. And while in Iraq, they captured some 80 hidden supply dumps, which caused severe shortages and disrupted enemy operations. Their service in Iraq and Afghanistan has not gone unnoticed and has saved many lives.

Upon arriving home last month, these heroes were finally embraced by their families, their friends and their loved ones. From Venango County to Lycoming County, many constituents from my district bravely and honorably served on this brigade. We say

``thank you, welcome home,'' and ``God bless you'' for your selfless service. Your actions will never be forgotten.

I urge my colleagues to support our troops and vote in the affirmative for the underlying resolution.

Well, I thank my good friend and, actually, 10 months, just about 10 months is what I have been here. The world I came from, actually, was the health care world. I mean, I had spent 28 years working in health care services as a therapist, health care manager in rural hospitals, licensed nursing home administrator.

I came here knowing with a commitment that we could do better with the health care system we had, that we can improve all four principles of health care: access, affordability, quality, and choice.

Access, affordability, quality, and choice.

By choice, I mean strengthening that vital decisionmaking relationship between the physician and the patient, and not having the government or a bureaucrat being wedged between those two.

Doctor-patient relationship, yes. I happen to think we have a pretty good system. Not that we couldn't improve on it. I came with ideas on how to do that. Unfortunately, the ideas I brought with my almost 30 years of experience have been largely ignored by the majority side, by the Democratic Party.

I find that the proposals put out there, specifically House Resolution 3200, in many ways I can find where that proposal, that the Democratic health care proposal, would make all four of those principles worse.

Absolutely. I am proud that, as Republicans, we have over 30 bills that we have introduced that would specifically address the different issues and the concerns that I came with, and many others, the visions of my colleagues, that I think would be good to address the health--

Absolutely not.

No. Especially when you are looking at proposals to raid Medicare specifically, the hospice services, people that are preparing their lives to die with dignity, to die in their own homes and places surrounded by their family and can be comforted in a way that provides that dignity to those final days. And to cut Medicare in that area is just wrong.

I think that what I find most interesting about that proposal to cut Medicare to fund this new large government-run program, sweeping government-run program, is that it's, in my experience, as I look at the issues surrounding--and this is some of the things I came with--the issues surrounding a wide commercial health insurance is so expensive, and it is in many places.

The average health insurance pays, nationwide, 140 percent of cost to hospitals and to physicians. The reason for that is--there are many reasons, and we will talk about them this evening, like tort reform, but the other reason is Medicare. It's medical assistance.

Medicare pays, on the average, 90 percent of the costs. For every dollar of costs a hospital has or a physician has, Medicare pays 90 cents. For every dollar of cost that a hospital or a physician has, medical assistance pays, varies State by State, but 40 to 60 cents. Within our health care system, because the government set up these entitlements and soon found that it couldn't sustain them, couldn't afford them and begins to systematically underpay them, we look to commercial insurance to make up the difference.

It's interesting that Medicare is the reason, I think, one of the primary reasons why commercial insurance is as expensive as it is, yet the proposal is to make more Medicare cuts.

I appreciate that, and I thank my good friend.

I want to come back to the waste and abuse claim, that in addition to obviously significant taxes, that there's all these savings under waste and abuse. It's being presented and proposed by the Democratic Party like this is something new that we're looking at.

I have to tell you that I was working in health care in 1983 when diagnostic-related groups and the first prospective payment system came into health care. Soon after that, we began to hear about and work on eliminating fraud and abuse. Professionally and ethically, that's a responsibility that health care professionals have to do. The fact is that is something that has been ongoing. So now this claim that we're going to find these massive amounts of money as a result of waste and abuse that we can use and save and help to fund this government-run health care program is just false, absolutely false.

Now I do think there's waste in health care, and I can point to annually $26 billion. We can take $26 billion annually, and we can find that like this if we had the courage of my colleagues on that side of the aisle to address medical malpractice.

There are line items in physician budgets, in hospital budgets; and we could eliminate that cost to health care today by passing medical malpractice tort reform.

Tort reform. Premiums annually in this country are paid in the amount of $26 billion. The average award under malpractice is $4.1 million in this country. And so there's a line item that actually is in health care budgets and all the providers across this Nation that we could take that money--and we've got great proposals. The Republicans have H.R. 3400 that's out there that would address tort reform, that would do it in a way that would limit punitive damages. It would set up panels to be able to deal with those situations using judges that have health care experience.

So we have bills out there that if we could get our colleagues' support tomorrow or today, we could actually eliminate what I consider $26 billion of waste from health care.

Will the gentleman yield for one quick point?

There was a recent study done just in Pennsylvania that showed that 93 percent of physicians in Pennsylvania practice some form of defensive medicine. Ninety-three percent, for that very reason. You invest $200,000 to a half a million dollars in a medical education career and then because of these lawsuits and because of medical malpractice and the lack of tort reform, you're at risk of losing not just your practice but your family's home. I understand why defensive medicine occurs. We've got the solution. H.R. 3400 would address that.

Will the gentleman yield?

I'm not sure which committee this is representative of, but I serve on the Education and Labor Committee. And in that approximate period of time of around July 16th, the next to the last week in July, we were also presented with H.R. 3200, and we were presented with it and went into within 48 hours of when we were given the first copy, which was 500 pages of the bill, and then that was on a Wednesday. The very next day, on Thursday, we started bill markup, which is an important event around this place. It's where we make substantive changes to bills. And at that point, the bill had grown, with a manager's amendment, to over 1,000 pages. And we started a marathon markup that started at 10 a.m. on a Thursday and was driven by the leadership of the Democratic party until 5 a.m. on Friday, 20 hours. I can't tell you the--

5 'o clock in the morning. I can't tell you--you can imagine what the quality of work was after about 11 p.m. But some time during those wee hours of the early morning, probably between 1 and 3 a.m. I specifically remember that amendment coming up and being debated, and debated passionately, that we have a responsibility to the American citizens to be able to be good stewards of the resources that are here that we have as a country, and that we have the responsibility of overseeing. And I remember that amendment, and specifically how it was defeated, along a party line, with all the Republicans voting for that amendment and the Democrats opposing it.

That is correct.

Well, what you're talking about is actually an amendment that I offered in

the Education and Labor Committee to bar the exchange, the health insurance exchange, which essentially allows this new health insurance commissioner to dictate the terms for your private insurance policies. Exactly what my good friend from Indiana was talking about. Specifically, what would be required, as opposed to a consumer in a free market, where I choose what's best for me and my family, a government bureaucrat would dictate if my insurance policy qualifies or not within this exchange. And again, that's an amendment we offered up to eliminate the exchange from H.R. 3200 within the Education and Labor Committee. And that was defeated along party lines.

I think that you are just going down a line, a road that is so important in this debate. It really comes back to where we started talking about rationing. And the ultimate form of rationing, to me, is where you have to close hospitals, especially in a congressional district like mine, and probably a number of my colleagues here are very rural; to get to another hospital when one closes is a commute that makes a difference between life and death. Hospitals, rural hospitals, and I'm sure underserved urban hospitals in particular, they have a banner year when they make a margin of 1 to 3 percent--1 to 3 percent.

No. Because out of that 1 to 3 percent, hopefully they're able to give some type of cost-of-living adjustments to keep the best and the brightest in terms of physicians and therapists and nurses and health care professionals.

They also need to be investing in new lifesaving technology that is being developed all the time. And so we see these Medicare cuts in particular.

I also put out there the public option, because the public option will pay by statute, what I saw in the Education and Labor Committee, pays Medicare rates 80 to 90 cents on the dollar of costs, essentially what you will do is bankrupt hospitals and physicians. And I project that that will hit first in rural America and underserved urban areas.

That's rationing. When you close facilities, when physicians no longer are in practice because they can't balance their books, that is the purest form of rationing services.

Madam Speaker, I rise today in support of House Resolution 754. It was an emotional time in Pennsylvania as members of the 56th Stryker Brigade Combat Team came home from Iraq to a tribute of yellow ribbons and flying flags. The homecoming elation belies the fear that always accompanies soldiers at war.

NBC correspondent Richard Engel described one of the uses of a Stryker vehicle now in Afghanistan: ``We're warned about IEDs, improvised explosive devices, a somewhat desensitized way of saying bombs that can blow you to pieces and throw your body 75 feet in the air.

``Some of the Strykers, the soldier's armored vehicles, are fitted with giant rollers. They stick out in front of the big armored trucks, making the Strykers look like the machines that pick up golf balls at a driving range. The Strykers push the heavy wheels of the rollers over the sand. If the wheels hit an IED, the device will blow up; if not, the ground is safe.

``We walk in a double-file line in the tracks left by the rollers. I try to walk in the footsteps of the soldier in front of me.''

This is a stark reality of the job the Stryker Brigade performs in both Iraq and Afghanistan. It is just one of the reasons we honor their service today.

Madam Speaker, this is National Fire Prevention Week. Last weekend, the National Fallen Firefighters Foundation held their memorial service out in Emmitsburg, Maryland. They added the names of 103 firefighters who died this year in the line of duty. That brings the total to 3,330 names on the memorial to fallen firefighters since it was established in 1981.

As a volunteer firefighter and EMT, I've seen the bravery and dedication of the men and women who face infernos to save lives and property. They walk into hell, and they do so knowingly. Many never walk out again. That was the case on September 11, 2001, when 343 firefighters lost their lives.

There are more than a million firefighters across this country who respond to more than 2 million calls per year. We owe them a debt of gratitude that cannot be repaid.

But there is something we can do. This week I cosponsored H. Res. 729, a measure to request that the President designate a day as National Firefighters Memorial Day to commemorate Federal, State, and local firefighters killed or disabled in the line of duty. It's the least we can do for these heroes.

Mr. Speaker, I rise today to praise the ``Buddy Walk'' being held this Saturday in State College, Pennsylvania. It is sponsored by the Centre County Down Syndrome Society. The society exists to be a resource for families with a child with Down syndrome and for those who are expecting a child with Down syndrome. Their goal is to educate friends, relatives and even communities that individuals with Down syndrome are energetic, capable and loving people who play, work and go to school just like the rest of us.

The statistics on their Web site change some of the preconceived stereotypes many people have. For example, half of all Down syndrome children go to mainstream school classes, one out of every five plays a musical instrument, and three out of five know how to operate a computer.

I am a member of the Congressional Down Syndrome Caucus who supports legislative activities that would improve Down syndrome research, education, treatment and promote public policies that would enhance the quality of life for those with Down syndrome.

The Centre County Down Syndrome Society does a great deal to educate people that those with Down syndrome do lead productive lives, and they deserve to be commended.