W. Akin

Mr. AKIN

Mr. AKIN. I do yield.

Mr. AKIN. That is called free enterprise, I guess.

Mr. AKIN. Well, thank you. It's good to hear from Illinois. And I hope that you continue to join us in this discussion. We have my friend from Ohio, another State from the Midwest, a big manufacturing State, and a great young legislator, Congressman Jordan. I yield time.

Mr. AKIN. I notice that we're joined by another good friend of mine from the--

Mr. AKIN. I call that the wheelchair tax. Now, I've thought of taxing a lot of stuff, but would you ever think of taxing a wheelchair? I mean, that's imaginative. It really is.

Mr. AKIN. So it's not just wheelchairs. We're going to tax other medical devices.

Mr. AKIN. So it's really a nice promise. The trouble is there isn't any backup to the promise. It's just a piece of paper saying you've got free health care, but you got what you paid for. That isn't any health care at all. I see my good friend from Illinois, Congressman Manzullo, and somebody who really understands the Small Business Committee, understands small business in general and is a fierce, fierce defender of his section of Illinois, and a good friend of mine. And I'd like to yield some time to my good friend, Congressman Manzullo.

Mr. AKIN. Now, let me just ask you a question. My friend, you come from the Midwest. You're a commonsense kind of guy. Now here's why this bill is having trouble getting votes, because it's like trying to grab yourself by the boot straps and lift yourself up and fly around this Chamber, because think about it a little bit. We've got the U.S. economy in serious economic problem because of three entitlement programs. They're the main things that are the budget busters: Medicare, Medicaid, and Social Security. So the government has stuck its nose into what was previously a free market with Medicare and Medicaid. And how well has the government managed those programs? It's about to bankrupt our country. So we've got Medicare and Medicaid about to bankrupt the country, and the government says, trust me to take it all over. I mean, there's something counterintuitive here somehow.

Mr. AKIN. So if you know nothing else about the bill, this is saying, Well, this is something to pay attention to. Now we haven't talked about some of the other nifty features. This is what gets me worried. This is what I don't like the most. And I don't like this bill. I want to be completely clear. I'm a conservative Republican. I do not trust Big Government to do a lot of stuff. And particularly, I don't want them meddling in our health care. So I'm not, I guess, objective, or I am objective, but it's just because we talk about how bad it is to have an insurance agent between you and your doctor. The last thing I want is a government bureaucrat or thousands of government bureaucrats between me and my doctor. This is a picture we've seen and used on the floor sometimes. But this is a very much simplified version of thousands of pages of legislation with shall, shall, shall, which means the government's going to do all of this stuff. And somehow as a consumer of health care, you're supposed to find your way all the way across, over to the doctor over there. This is like some sort of a maze that you've got to go through. So this is a very complicated government takeover of what is otherwise the private system of health provision in this country. So that, to me, is something that really causes me to say ``no'' on this bill because as Republicans, we don't like anything that gets between the doctor and the patient. And insurance companies, we don't like it when they get in there. But at least if you have a bad insurance company, you have a chance of changing your insurance company. What happens if you've got all these bureaucrats in there? You will never change it. And so this thing is really a very, very dangerous piece of legislation in my opinion. But I know you've given your whole life to taking care of patients. What's your impression of this whole deal?

Mr. AKIN. So let's try and get up to 50,000 feet here and take a look at the sort of choices there are before Americans as to how we approach health care. It seems to me that in the beginning, you've got the sort of supply and demand situation. If everybody in America got absolutely the very, very best medical care that you could get, it would just bankrupt the country probably because the supply and demand law says that if you don't have to pay anything at all, people are just going to get the very most expensive thing they can do. So basically the whole country stops if you try to give everybody the very best thing possible. So the question then is how do you balance supply and demand? And we usually have a thing we call freedom, and we allow individuals to work hard, earn money, and then they spend their money to buy what they want to buy with it. They can choose whether they want health care, or a vacation, or food, or shoes, or a new car, and that's called freedom. So that's the free market, which allows people to decide how much money they can afford to pay on health care. So that's one way to balance that supply and demand. Another thing: The insurance companies then came along and said, Yeah, but we can get you some savings. We can reduce the amount of tests and do some other things and negotiate some special rates with a whole pool of doctors that we make a deal with so we get you a product that gives you pretty good health care, but it's a discount-priced product because we're doing some things to drop the cost down. So the insurance company then is one that is starting to take part in that management of the cost of health care. The free market, it's just a matter of you paying the barrelhead, and you go back and forth and figure out what the price is. That's the way we do most things. You have the insurance company which is kind of a hybrid. Then you can go to the socialistic model where the government does it all. But the government still can't make mathematics change. So the problem is that the governments in other countries that have tried it-- it's not like we're the only ones doing this. Canada and England do this kind of thing. And what they do is, in order to keep the cost down, they keep a big waiting line, so you have to wait a long time to get your health care. So it's basically a form of rationing. It's kind of a nice rationing because you're told, Get in line. We're used to getting in line. You get in line, and that's how it is that they keep their costs down. The only trouble is, if you are like me, I had cancer. If I have to get in line, that means I have to wait. If I have to wait, it reduces my life expectancy. And that's one of the reasons why England has really high cancer rates, because of that. But let's just talk about places where this kind of idea has been tried before. Dr. Fleming, as I recall, they tried something like this in Tennessee, didn't they?

Mr. AKIN. So in other words, what's going on is if you tell people with this system they can have anything they want, you're going to have a tremendous level of demand, which is what we see in the other countries after this gets going, and then you have all the waiting lines because you can't do that all.

Mr. AKIN. Let me see if I can just cut in and restate what you said, because I know that you have an expertise in small business. So you've got a small businessman who's showing a lot of creativity, the sort of innovative spirit that's in America, comes up with a medical device machined out of aluminum, which is a very specialized kind of device. And so what's going to happen is we're going to drop a tax on this thing, which makes it more expensive. And what you're saying is somebody overseas is going to say, I can make that device, and what's more, I don't have to pay the tax on it.

Mr. AKIN. Okay. Can you explain that?

Mr. AKIN. Okay. So let me just see if I get this right. You're a medical doctor. You went all through med school. You've been practicing a number of years. You enjoy what you're doing. Old people come to you that need medical attention. You don't mind treating them. And before you were treating them at 80 percent of what the cost is. But let's say you drop down how much Medicare is paying. Well, at a certain point, you're just saying, I just can't afford to do this at this price, because ultimately, you've got to run an office. You've got to hire people. You've got to pay the rent on the building and all of those kinds of things. You've got a lot of insurance you're paying for, and you're trying to provide for your family. At a certain point, Medicare is reimbursing so little that you basically say, Hey, the old people I've been seeing before, I'm going to keep them on because I'm a nice guy. But I'm not going to take any new people. And so some old person that's sick wants to go find a doctor, perhaps they moved or something like that. And everybody says sorry, I'm not seeing any new Medicare patients. So while they've got Medicare, it doesn't mean they've got health care. So they don't get any health care.

Mr. AKIN. So let's just say for instance that we wanted to cut more money out of Medicare. Let's say we're going to take $500 billion. But just theoretically, if you drop the money in Medicare so we're putting less money into it, what's the net effect of that going to be on the person that's counting on Medicare to pay for their medical care and to the usually older person that is counting on Medicare to cover their doctors' bills? What's going to happen then?

Mr. AKIN. Oh, wait. You are saying it will cut access for older people to Medicare?

Mr. AKIN. So that's the problem with it.

Mr. AKIN. So we're really charging them some amount more, whatever their bill was. If it was $100, we're going to add a little extra to that to compensate for the Medicare thing. So now you're driving the cost up for the guy that's really doing what we think is responsible. And that is, going out and making sure he has insurance, and he buys insurance in the private market. But he's paying a premium for that insurance because he's got to cover Medicare that's underfunded. So that's the first thing. Do I have that right?

Mr. AKIN. And you're already looking at, most people are looking in their district at a 10 percent unemployment rate. We're looking here at a bill that's going to cost trillions of dollars, 500 million jobs, a government takeover

Mr. AKIN. So this new bill is going to pull $500 billion out of Medicare?

Mr. AKIN. Thank you, Mr. Speaker. I'm just taking a moment here to arrange some charts and I will be right with you. Mr. Speaker, we once again are going to be on a subject that seems to be increasingly riveting the attention of Americans--and for good reason. What we are talking about here this evening is the proposition that the Congress will take over, over a period of time, one-sixth of the U.S. economy. That is the health care section of the economy. Obviously, this big a change, a remake of health care, which is not just changing a little portion here or there, but a complete remake of health care, is a question of significant proportion. It is a very costly proposition. It's one that involves a tremendous amount of change, and any change, of course, is controversial. This proposal, though, is more controversial than most and is resulting in a tremendous outpouring of phone calls. The switchboards are almost shut down here at the Capitol. But we, once again tonight, are going to be talking about it because there is talk we might even vote on the bill this week, and who knows what's going to happen. I'm joined in the Chamber by Dr. Fleming, a very fine physician but also a Member of Congress and someone who knows a considerable amount about the health care bill. Part of what the discussion has been lately has been a question of the procedure of how the bill would become law. That's, I think, where we should start, because that's where the news is right now and it's a big question. Dr. Fleming, I thought we might start there because a lot of people have heard about the bill, even some of the things in the bill, but the question is how this bill would become law. I'm going to start by just laying down the simple pattern that's in the U.S. Constitution. The way that a bill becomes law is that it's passed by the Senate. It's passed by the House. It's sent to the President, and he signs it. That's the plain, bare-bones facts of how it works. That's what the Constitution says. The Constitution gives the House and the Senate a lot of flexibility in how we design our rules, but ultimately the bill has to pass a straight-up vote in the Senate and a straight-up vote in the House and has to be signed by the President. If it doesn't do that, it doesn't meet the constitutional standard. Now, the process becomes a little more complicated as we go on because the Senate has a weird rule. In fact, the Senate does a lot of weird things, but it has a weird rule, at least to those of us who are Members of the House, and that is that before a bill can come up for a vote, it takes 60 votes to bring it up for a vote. So if you've got a bill and you say, Hey, we've got a hundred Senators; I've got 55 votes for the bill, you're in deep trouble, because you won't ever get the 60 votes to get it up for just a straight-up vote even though you've got enough votes to pass it. In other words, the Senate has a little bit of a higher bar to protect to make sure there's at least 60 out of 100 Senators that are willing to pass a particular piece of legislation or bring it up for a vote. So that makes things more complicated. The Senate took a House bill which we passed on health care. They gutted it. They took every single thing out of it and stuck their own language in it, a couple thousands pages of new ideas and text and all this, took it to the Senate floor and fought and fought and fought. Finally, on Christmas Eve, passed it by the 60 votes that were necessary, and so the bill was passed through the Senate. In order to do that, they put all kinds of special deals in there just to keep certain Senators to vote for it. There was what is called the second Louisiana purchase, a big benefit for Louisiana; the Cornhusker kickback; a special deal for people of Florida that they get to keep their Medicare Advantage money, but everybody else, the other 49 States, have to lose $500 billion out of Medicare. And so there were all of these special deals in there, as well as a whole lot of other legislation; for instance, the fact that the government would be paying for abortions for people, which is a big problem for many Americans, and other provisions such as there would be health care for illegal immigrants and things like that, which are very controversial. So all of that is then passed on Christmas Eve and comes to the House. Now, in order for that bill to become law, two things have to happen. Either the House has to pass it just the way the Senate did, in which case they can send the bill straight to the President for his signature--so, if the House--and, of course, they have 80 votes less over on the Republican side. So we can all vote ``no,'' but Nancy Pelosi could lose a whole lot of votes because she has 80 votes more than the Republicans do. So what they need is a majority of Democrats to vote for the bill just the way the Senate passed it, could go straight to the President and the bill could become law. That's a way to do it. The problem is, it has all this junk in it that nobody wants to vote for. And so they're kind of stuck with making a decision: Are we going to just vote on it and send it to the President or are we going to try to amend it, which then requires it to go back to the Senate where it has to face a 60-vote rule to get these things cleaned up? And so that's the tension. So what's being proposed is something that is neither. It's something that is rather unusual and completely unprecedented, to a degree, and that is what they call deeming the bill passed; that is, it was never really voted on to be passed. In the past, we have done this deeming thing many times, but it's usually after a bill has gone back and forth and we're working out the details of an amendment. But this is thousands of pages of legislation that's never had a vote, and they're just going to say, Well, we've just decided it's all approved, without a vote. Now, that is really pushing the limits on what is constitutional. So that's the beginning of the process. So I wanted to invite my good friend Dr. Fleming to join me. Let's just talk about this process. Most people are really bored to death by this stuff, but when it involves one-sixth of the U.S. economy and everybody's health care, it's like, I guess we have to pay attention. Please join me.

Mr. AKIN. Well, there are just so many things in this bill to talk about, and that's why you have such old and young, male and female--the public just doesn't like this bill. And the reason is because there's stuff for everybody to hate in this bill. I thought that this was an amazing quote Nancy Pelosi said. I just can't resist putting this up here. ``We have to pass the bill to find out what's in it.'' Now what it seems like is going on now is, not only are we supposed to not read the bill, but we're supposed to not vote for the bill. So we want to pass a bill that we haven't read and haven't voted for. This seems to be really twisting the long arm of conscience a little bit to say, not only are you not supposed to read it, but now you can't vote for it, and we still want to pass it. And we wonder why the American public is just a teensy bit skeptical. I think some of the shenanigans are amazing. One of the ideas is, you have to get an assessment as to how much the bill's going to cost. The Government Accounting Office, who is supposed to be impartial, they take a look at a bill, and they go all through it and figure out what they think it's going to cost. Well, one of the tricks that they're playing is that they're going to collect taxes for a bill over a 10- year period, but they're only going to count the bill being in effect for 6 years. Now that's kind of an amazing way to calculate what the bill's going to cost because the implication is that that's what it will be running along at. And the thing is is that every time the government's gotten into this taking over of the medical system, anytime we do a bill like Medicaid or Medicare, it always costs at least two times more than ever any accountant thought it was going to be, sometimes as much as 10 times more expensive than what some accounting office says. And yet we're going to start off with this, you know, smoke and mirrors deal where we're going to tax people 10 years but only run the bill six. And that's supposed to be how you figure out how it costs $1 trillion. I think that's what you're referring to. You're a doctor. Let me just ask you this question: What happens if you keep cutting the money to Medicare? What's going to happen to people?

Mr. AKIN. I mean 5 million jobs. Excuse me. That would really be something. And a government, a major government takeover, and yet what do we have for the quality of results to expect in that we've seen it done in other countries and in the State of Tennessee and Massachusetts? I think Massachusetts health care costs are up 20 or 30 percent over the average of other States. That's not a very good model. Tennessee, the Governor of that State, a Democrat Governor of Tennessee, said this thing is the mother of all unfunded mandates. The States are struggling with their budgets. And here you've got a guy who's a Democrat who's experienced with this thing and saying why are you going to impose this nationally, when it doesn't work on a State basis.

Mr. AKIN. Let me stop you. Because you know this stuff cold, but there may be some people, some of our other Members here that just don't know this as well. So you've got Medicare, which is reimbursing doctors at 80 cents on the dollar, which means that somebody's got to make up the 20 cents. So we do a cost shift and shift that 20 cents into Medicare and dump that cost onto people who have private insurance, right?

Mr. AKIN. You know what amazes me about that, gentleman, is I have heard various news outlets and various individuals, even people of political stripes saying that this bill is being held up by the Republicans. Now, somehow that just tickles my funny bone. You know, they've got 80 more people on this floor than we do, and if we all voted ``no'' and lit our hair on fire, there's no way we could slow this bill down. There's nothing we could do. The only thing slowing this bill down is there's a whole lot of Democrats that are going, ooh, is it ugly. So how in the world are they accusing us to be obstructionists or, you know--there's nothing we could do. I wish there were. But it's amazing. What you're saying, I just want to underline because what you're saying is it's the American people. The American people are the ones that are really driving what's going on here. And they're looking at this thing and they're saying, oh my goodness. What part of no don't you understand? Go ahead. I didn't mean to interrupt the gentleman.