W. Akin

Mr. AKIN

Mr. AKIN. Maybe that's what he meant, it wasn't a dime, it would be trillions of dollars. But this doesn't give us any record to be comfortable with. This assertion doesn't square with what our history is. Now, there have been a number of other assertions. This is what makes people confused. First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare or Medicaid or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. The President is saying this. You get to keep what you have got. If you like what you've got, you can keep it. Yet here you have an MIT health economist, with or without reform, that won't be true. His point is that the government is not going to force you to give up what you have, but that is not to say that other circumstances won't make that happen. Essentially, what happens is the government gets into the insurance business, the other privates all close down, and you only have one choice: you have got to go to the government. So one thing you are hearing, you can keep what you have. In fact, here is a guy from outside that doesn't have a dog in the fight, he says that is not how it's going to work. Here, this is a section, the doctor-patient relationship. If there is anything important in medicine, it is the doctor-patient relationship. This is an amendment that was offered by Dr. Gingrey from Georgia, one of our friends and colleagues. Here is his amendment: ``Nothing in this section shall be construed to allow any Federal employee or political appointee,'' that is bureaucrat or whatever, ``to dictate how a medical provider practices medicine.'' In other words, we are going to enshrine the doctor-patient relationship. We are going to make it clear that when a doctor and patient decide on a particular procedure, we are going to proceed. Nobody is going to get in the way. Not only do we not want the insurance company getting in the way; we don't want any bureaucrats. So he puts this amendment up and it goes to a vote in committee. Most people don't know this amendment went to a vote in committee and here is the result: 23 Republicans say, yeah, we want to leave that doctor- patient relationship sacred. And where were the Democrats? Thirty-two of them voted against this, only one voting for it. So what confidence does that give you that we're not going to get a rationed health care system? And yet we're saying whatever you have, you can keep it. We've had these claims and counterclaims, and I think it's important for us to let the American public shed some light on this. This is what people are saying. I've got some other charts, but I want to go to my good friend from Pennsylvania. I yield.

Mr. AKIN. What strikes me, gentleman, and your points are very, very, well taken, currently full of waste and abuse. It's almost like you have a line item on a budget that says waste and abuse and so many million dollars. I mean, if you had that, you take that line item off the budget. Well, what exactly does waste and abuse mean? We were just talking to cardiologists today that came in. They explained the kinds of equipment they have in their office. From a practical point of view, if you are a cardiologist, it's like what used to be a stethoscope. A doctor hung it around his neck. He might not have used it all the time, but he needed it on a fairly regular basis. Their stethoscopes now are far more sophisticated, but they use them all the time. Not all time, but they have to have them immediately available to do their job. As you say, that allows them to provide service reasonably close where people live, and it allows them to do it right in the office. Particularly, it provides the fact you don't have to wait weeks and weeks to get some particular checkup. That is the weak underbelly of the socialized medical systems in England and Canada, because you take a look at things like cancer, you don't want to wait weeks and weeks. If you have got melanoma, you want to get it and you want to get it now. If you have got heart disease, you want to get it now. I just went through this with my father. He got a new heart doctor. His old heart doctor wasn't paying too much attention. His new heart doctor took a look at him, took a look at his meds and said you need to get a chemical stress test. When he got that, he said you need to get an angioplasty thing. So they go in and look around with that. They said when you get that, you need to get a heart bypass, which turned out was a seven-way heart bypass. When he got done with that, 4 days later he is home. Total period of time, less than 3 weeks from the time he went in to see the doctor until he had a seven-way heart bypass and was home from the hospital. That is the American medical system, because it can react quickly and rapidly to something that if you let it go is going to be life threatening. That is what you are talking about. So this waste and abuse, we have seen where some of this supposed waste and abuse is coming from; $500 billion out of Medicare. I know Republicans have been accused for years of being people who want to cut Medicare. Here we have got the Obama plan, we are going to get the money out of Medicare. In fact, you made the point, gentleman, that we hear these conflicting claims and people say, Well, what's the truth? Here's what you need to know: ``First, I'll not sign a plan that adds one dime to our deficits, either now or in the future.'' This is our President. He says he is not going to add a dime to our deficits. Guaranteed, first thing. Well, let's take a look at the track record since the beginning of the year. Deficits. We are talking trillions of dollars worth of deficits here. Here is the Wall Street bailout, the second half of that. Economic stimulus. If you don't vote for this, you might have over 8 percent unemployment. So all these liberals voted for this thing, $787 billion, mostly in handouts and welfare types of things; and now we have got, whatever it is, 9 percent unemployment.

Mr. AKIN. As you talk, what comes to my mind, as I am hearing you talk, is basically a form of rationing that's really diabolical, a sort of rationing that says, well, you can take a bottle of aspirin or what. I am getting to be an old codger at 62, but if I were older, I would be even more paranoid, I think, from what I am hearing you say was in the bill.

Mr. AKIN. This is death care?

Mr. AKIN. This is not really a particularly subtle point, yet the American public understands this. They would like us to read the bill. It's really hard to read the bill when the bill we are debating and voting on is still being collated up here, like the cap-and-tax bill that we had with 300 amendments passed at 3 o'clock in the morning. Your point is well taken. First of all, it would be a good idea to see what the bill is before we vote on it. It seems like a straightforward point.

Mr. AKIN. Here, this is a chart of these three big entitlements. People talk sometimes about earmarks and other stuff about Federal spending. But the real story about the Federal budget being broken is really within these three big entitlements. All of them, you can see, are growing out of control over time: Medicare, Medicaid, Social Security. Now, as these things grow, what you are saying is, in spite of the fact it's costing a ton, there is still not enough money in those programs to really pay for what the medical costs are. We are now taking money out of the private sector or from other sources to help subsidize these things that don't work. Now, you are a commonsense guy. It seems to me that if we have Medicare and Medicaid that are financially broken, the solution to say, well, we are going have the government take over all of that and a lot more, that almost defies common sense. You know, we are joined by a gentleman whose sagacity and also years of service on the floor are about legendary. Congressman Souder, I would appreciate you joining. I think of these as kind of a dinner conversation. Let's just talk about what we have got going on. This is something that Americans care about all across our country, and I think we need to have enough time to talk about it, take a look at it, and to say just say rationally what's the right thing for us to be doing.

Mr. AKIN. Yet the Democrat proposal we were talking about 2 weeks ago was raiding $500 billion out of Medicare. Now, that has been scored in the Senate. It's about 400-and-something billion being taken out of Medicare to try and pay for this thing. That wasn't something you were proposing?

Mr. AKIN. Let me ask you this. Did any of your proposals--because we have been accused of this as well, did any of your proposals raid money out of Medicare?

Mr. AKIN. That doesn't sound like a very good idea. Just probing a little bit, though, you made a comment. You said that you came here with 20-plus years of health care experience. You came here with ideas that could improve the system, and we have been accused for months, both by the President and others, as saying the Republicans don't have any ideas, yet you had quite a few ideas.

Mr. AKIN. Doctor-patient, yes.

Mr. AKIN. Slow down just a minute now. The four basic principles of health care, do that again.

Mr. AKIN. Mr. Speaker, this evening we're going to be continuing on a familiar theme for many, probably the single issue that rivets the attention of Americans perhaps more than any single debate and discussion and, that is the change to American health care. This is not, of course, a small debate. It is a debate that involves a question of, to a large degree, whether the government is going to take over 18 percent of our economy. That's not a small section of our economy, 18 percent, nor is it a small question. Not only economically is it a big question, every one of us has to live inside our own bodies. So it is a very personal question. We have to live inside our bodies, and we're dependent on health care, and we hope that we can continue to enjoy the high quality of health care that we have had in America. But people recognize that there are problems with American health care. Those problems largely are not so much in the delivery of the health care but rather in how the health care is being paid for. So there are stresses in the system as to who's going to pick up the tab on it. We've seen a lot of examples of different departments of the Federal Government. It does amaze me just in a commonsense point of view why people would really want to trust their own personal health care with any department in the Federal Government when I think of the profound inefficiencies within many departments of government. We don't think of the post office as being a model of efficiency, the IRS as being any particular model of compassion or precision. If you think about the Energy Department, the Energy Department was founded on the idea that we had to make sure that America never had to rely on foreign sources of energy. Since that time, the Energy Department has grown in employees, and we have also grown on our dependence on foreign oil. Then you've got, of course, the Education Department. That is a model of something that I wouldn't put my trust in. In fact, there was a study done on the Education Department some years ago that concluded that if a foreign nation had done to America what the Education Department had done, it would be viewed as an act of war. Yet there are people in spite of this--and we've seen the Federal emergency management in response to Katrina and other departments of the Federal Government. In spite of that, people want to turn over 18 percent of our economy to the government. Well, when the government does too much, there are some things that we tend to see as becoming problematic. One of them is that you get some inefficiencies. You could get excessive expenses, degraded quality, or bureaucratic rationing. Is this something we need to worry about when we are talking about health care? Somebody quipped that if you think health care is too expensive now, just wait until it's free. We will take a look. Here is what was proposed in the House plan, right here. It's a 1,000 page bill, but you can summarize it in this nifty flowchart. All of the colored boxes are new parts, new moving pieces. You could see that it certainly doesn't meet the test of simplicity, that's for sure. People who have looked at this and studied it long enough say, I want to be the health care czar. He's the guy who makes all the decisions and determines who gets care and who doesn't. Tonight, we are going to be talking on the subject of health care. A lot of new information is breaking, new estimates from the Senate as to how much their plan is going to cost and how much is going to be taken out of Medicare on that plan. I am joined by some good friends of mine here, and I am thinking my friend GT is here. I am just going to recognize and yield to you, my friend, a Congressman who has not been here that many years and yet who has already earned a reputation far in disproportion to the amount of time he has served, and long on the common sense department, which I think we need a whole lot more of that common sense.

Mr. AKIN

Mr. AKIN. Mr. Speaker, the bill that's before us today is a product of hundreds and hundreds of hours of hearings, all kinds of work by Members and staff, and by and large it's a good product. It's a political product. It has trade-offs here and there to try to balance one requirement against the other; and it is, once again, a reflection of a committee that I have been honored to be able to serve on for 9 years, a committee that has been largely bipartisan, a committee that has focused on solving problems, defending our Nation, and supporting our troops. And in all of those regards, this bill is fine, except for there is an elephant the room. The elephant in the room was an invention of the Senate. They decided to put onto a bill that is focused on supporting our troops their own liberal social agenda of hate crimes legislation. Now, they claim they have the votes to pass that so why don't they pass it somewhere else? Instead, they put it on the backs of our service men and women and expect to use a blackmail kind of approach to have us, to dare us to vote against adding something that's totally extraneous to defense of this Nation on the backs of our service people. A number of us are saying, as much as we support our troops, as much as we support the hard work of this committee, we believe that this is a poison pill, poisonous enough in fact that we refuse to be blackmailed into voting for a piece of social agenda that has no place in this bill. This is the kind of shenanigans that makes the American public irate. This is the kind of thing, like passing 300 pages of amendments at 3 in the morning, that makes the public nauseous. And I, for one, as much as I support our troops, indeed, I even have a son going to Afghanistan in 3 weeks, as much as I support him and the rest of our troops, I will not allow us to be blackmailed into voting for something totally extraneous on this bill; and that's the reason why I will not support the bill.

Mr. AKIN

Mr. AKIN. I would like to thank my good friend, Congressman Burgess and also Congressman Fortenberry. Thank you very much.

Mr. AKIN. Except instead what we've had is apparently our Speaker has pulled together various people, ignored the recommendations that we had and decided, well, we just know what's best, that is the government is going to run it all, we want this public option, and we're charging down this aisle. Basically people are wondering, well, why is this health care thing stalled? Well, the reason it's stalled is you don't just take over 18 percent of the economy, take $500 billion out of Medicare, basically allow a program which is going to allow public funding for abortion and illegal immigrants getting access to this money and all that stuff without people having something to say about it.

Mr. AKIN. So what you're talking about now, just to kind of summarize what we have talked about, what you're talking about is what people call in this business associated health plans, the idea that people can create these pools and buy, on a discount rate, their health care. That's a pretty straightforward idea. That's something that Republicans have voted for dozens of times. So we have got associated health plans. We're saying people should have their tax treatment and when they buy health insurance should be the same. We're going to deal with the issue of portability so that when you own a policy you get to keep it and the insurance company can't just dump you. The other thing we haven't, of course, talked about is tort reform which we have good support for that. That drives health care costs tremendously. And yet we are unwilling to really be serious about it. All of these ideas Republicans are supportive of. So the charge that we're not willing to deal with this debate is not true. Go ahead, my friend.

Mr. AKIN. Which, again, gets to another Republican proposal for portability. I mean, you know something isn't right with the way insurance is written when somebody does all the right things. They run for a number of years, they buy insurance, and all of a sudden their kid gets sick with juvenile diabetes or something very expensive. Then they changes jobs or something and now they're uninsurable. They fall through the cracks. That's not the way the system should work. That would be a very admirable thing if the House were to just focus on fixing that problem. That would be very good work. No, we have to scrap everything. We've got a hundred million Americans with insurance policies and doctors and doctor-patient relationships, a hundred million of them, and we're going to scrap the whole thing and have the government take it over. That's irrational.

Mr. AKIN. Fleshing that idea out a little bit, in the case of Missouri, where I'm from, you've got Kansas City; half of it's in Missouri and half of it's in Kansas. So if somebody in Missouri kind of goes over the line into Kansas and finds out, Hey, I can get a couple hundred bucks less a month on the same health policy, why can't I buy that policy from an insurance company in Kansas? So what you're saying is, Yeah, that's okay. Allow people to shop for insurance across lines, which then reduces the monopoly problem in the insurance industry. That's something that don't you think most Republicans would support that idea?

Mr. AKIN. Which therefore, Doctor, suggests?

Mr. AKIN. I'm not speaking for the whole House because they want the government to take things over, apparently. That's just one idea. I toss out another one.

Mr. AKIN. Gentleman, I really appreciate your approach of trying to solve problems. We have focused for some of our discussion this evening on the things that are wrong with basically having the government take the whole thing over and socialize it. But we have also been criticized by the President and others that the Republicans don't have any kind of solutions to health care, which you just showed was a tremendous amount of innovative and very kind of strategic thinking in terms of how do you approach this. I think maybe it would be worthwhile. Doctor, I ask you to join us, please. Let's just kind of tick off some things that--just think about our Republican colleagues and friends. I'm going to just toss out a few things that I would figure get at least 90 percent, probably 95 percent from our colleagues. One of them is that the big companies and employees of big companies get to pay for health care with pretax dollars, but the small business guy and the individual has to pay with after-tax dollars. I think most of us would say justice means that people are treated equally before the law, and that if we're going to allow people to buy their medical insurance with pretax dollars, that should be made available to everybody. Don't you think that we'd get a 95 percent on that, probably?

Mr. AKIN. Only 1.7, gentleman? That's not very much increase. Most people's insurance jumps 20 percent a year.

Mr. AKIN. I yield. We're basically enjoying having a conversation here. A little bit like going to dinner with your Congressman, except the food, you have to provide that for yourself. Proceed, please

Mr. AKIN. The sad thing is that, to a large degree, we're doing it to ourselves with this kind of overkill legislation. This almost looks like somebody has got a solution looking for a problem to justify it. I notice that we're joined by my good friend, Congressman Fortenberry. I'd like to yield some time to you so you can be part of our discussion. I have to say that Congressman Fortenberry is highly respected. He is one of these level-headed kind of decent guys. Everybody likes him. You've got to have some people in your district talking to you about this. What are you hearing, Congressman?

Mr. AKIN. We've got unemployment that's just running away. The statistic almost everybody knows is that I think it's pretty close to 79 percent of the jobs in America are with companies with 500 or fewer employees. So small business employs almost 80 percent of Americans. And what are we going to do? We're going to slam them with an 8 percent tax on top of things right now with unemployment already at 8 or 9 percent.