Michael Burgess

Mr. BURGESS

Mr. BURGESS. Certainly that is my understanding. And we both have to pass the same bill.

Mr. BURGESS. Well, they may not be constitutional at our level. And the other thing to remember about a mandate, for a mandate to work, you have to know that it's in existence, and you have to know what the penalty is, and the penalty has to be pretty stiff. You alluded to the IRS already. The IRS has a mandate on every one of us that we'll pay Federal income taxes. Every single one of us knows, we may not know exactly what bad thing happens, but we know it's bad, and most of us know we don't want it to happen to us. So what is the compliance rate with the IRS in filing tax returns? Well, it's about 85 percent. What do we have as uninsured in this country right now? About 15 percent. How much more are we going to get coverage if we give up that much freedom by allowing us, us, Congress, to set a mandate as a condition for living in the United States of America? How much more coverage are we going to get? I mean, the point is arguable, but just at first glance, it might not be that much. Now, on the issue of the preexisting conditions bill, I know when Nathan Deal and I looked into this and the Congressional Budget Office scored and said what would it require in the additional Federal subsidy to make these things really work for people, the Congressional Budget Office came back with a score of $20 billion over 10 years. Real money to be sure, but at the same time it is nowhere near the $1 or $2 trillion that is on the table today if the House takes up and passes this Senate bill that they passed on Christmas Eve. I do have to make one point about the public option. The Senate bill does not have a public option per se, but there is language in the Senate bill that allows the Office of Personnel Management to oversee the exchanges and guarantee that there is one for-profit and one not- for-profit insurance company available in every exchange. If an exchange does not have an insurance product available, OPM will set up either a for-profit or a not-for-profit in that exchange. Well, suddenly you are going down the road of a public option because what is the Office of Personnel Management? Well, it is a Federal agency. It is not used to doing that much work, because they oversee what goes on in the Federal Employee Health Benefit Plan, but now they are going to be tasked with this vast new set of powers, and it's anyone's guess how that will actually work out.

Mr. BURGESS. That's correct. Thirty-four States do have the high-risk pools. Nathan Deal, the ranking member on our Health Subcommittee, and I tried to put some further refinements out there this year during the health care debate. I don't like mandates. I know we had that discussion in committee today. I don't like mandates. So what if we allowed States either a high-risk pool or an option for reinsurance, provided some Federal subsidy to the State. They don't have to take it, but if they do take it, then whatever they decide they want to do, they need to then set up that high-risk pool or that reinsurance for that set of business that is otherwise likely to go without insurance coverage. Because we all know, folks our age, employer-sponsored insurance, we're in a recession. You lose your job, you have the heart attack, you didn't keep up with the COBRA payments, boom, you're in that category and now there's nothing you can do to extract yourself. And the only option we were given was an individual mandate, or let the government take everything under their control.

Mr. BURGESS. Not, not fixing in this bill, that that will continue to exist. There are sites you can go to. You can go to Google and type in ``health savings account'' and get a variety of plans that will come up. And I encourage people who are looking for individual insurance, that is a reasonable thing to do. Yes, you have to pay with after-tax dollars. Some of those policies can be quite affordable if you're willing to accept the fact that it will be a high deductible type of policy. But, realistically, when you look at health care expenses--and I'm a physician. I've watched people spend their money in health care for years. Some expenses are so small that they're actually financed out of cash flow: aspirin and Band-Aids. Some expenses are predictable but larger: braces, having a baby, maybe arthroscopy on that knee injury. Those could be saved for or borrowed for if we allowed the correct flexibility within the health savings account, for example. And then there are the ``Boy, I hope that never happens to me'' events: the leukemia, the heart attack. Those are the ones where this catastrophic insurance really is a godsend when people have that. But, again, we did nothing. We had--we both sit in the committee that deals with this. Did we have a hearing on how to provide more flexibility, more competition with the insurance market? No. It was, if you want everyone covered, it is an individual mandate. That really was the only offering. We never had a hearing to ask the question: Is there a way to cover people with preexisting conditions without an individual mandate? We never asked that question, so it's not surprising that we don't know the answer to that.

Mr. BURGESS. Yes. And the power of the Internet could apply to health insurance as well. But, as you know, there is some difficulty selling in the individual market across State lines, and therein is where the regulatory part of what we--the regulatory environment that we set here in Congress that we're not fixing in this bill, as you point out.

Mr. BURGESS. Well, of course, the life insurance business, the premiums for life insurance plummeted with the introduction of the Internet with these companies that would advertise and then sell their policies on the Internet.

Mr. BURGESS. Great point. And another point that is so often missed in this discussion, let's take the example of the National Football League. You've got the Arizona Cardinals; I've got the Dallas Cowboys. A player who is lucky enough to be traded from Arizona to Dallas--I'm thinking it's an upgrade--their health insurance goes with them. If they had a knee injury in Arizona, they're covered for that knee injury day one in Dallas on the new team. But if the fan who wants to follow their favorite player moves from Arizona to Dallas, they cannot take that insurance policy with them, necessarily, across State lines. And, oh, by the way, that new policy you're buying in Texas, that knee injury may be excluded because, after all, it was a preexisting condition. We will not apply the same degree of portability for the little guy that we do for the person who's covered under the large multi-State plans, the ERISA plans that the multi-State corporations can provide for their employees. Make no mistake. I think that is wonderful that the large employers do that, and I don't think there is anyone among us who would want to see that system changed. But you are correct. We should provide the same breaks across the board.

Mr. BURGESS. Or a doctor's office.

Mr. BURGESS. Not entirely. And what they found was, since you have to buy the insurance, the cost may have gone up a little bit.

Mr. BURGESS. Up. Because you've got to buy it, or you get a fine.

Mr. BURGESS. That's my understanding from the reports that have been done by Heritage and other groups. But interestingly, if Massachusetts wants to enact a mandate, they are a State. And if their residents say, Okay, we are happy with you, Governor. We are happy with you, State legislator or State senator, for enacting this mandate and they reelect them to office, that's all well and good. But here we're talking about the 50 States and various territories, a mandate applied across the board. This has never been done in this country before because there's a document called the Constitution that says we shouldn't be doing this.

Mr. BURGESS. Just as a coincident fact for being born and living in the United States, no.

Mr. BURGESS. Correct. And still, that is a State mandate.

Mr. BURGESS. Correct. And there are some States who don't have the mandate.

Mr. BURGESS. That's my understanding. It is such a good idea, as you correctly pointed out in your very graphic demonstration. The strong arm of enforcement here is the already existing Federal agency that collects our income taxes every year.

Mr. BURGESS. Yes.

Mr. BURGESS. If the gentleman will recall in May and June of this year, six groups met down at the White House. It was a great photo-op. My AMA was there. The Hospital Association was there; PhRMA showed up; AdvaMed, the people who make medical devices; AHIP, America's Health Insurance Plans; and the Service Employees International Union all gathered at the White House. The President came out after this meeting and said that these groups have offered up $2 trillion in savings to the American people in order to get this health care bill done. So I don't know. I wasn't there. I can't get information on these meetings.

Mr. BURGESS. Well, we don't know because the White House refuses to provide us with any information, even though they've been asked nicely. They were asked more forcefully with the resolution of inquiry in our committee. Chairman Waxman and Ranking Member Barton did send a correspondence down to the White House asking for that information to be supplied to our committee. To date, what we've gotten back is a series of press releases and reprints of pages off of Web sites, but no real information. It would be fascinating to know if it's part of that $2 trillion deal: okay, you're going to get a mandate. Maybe we'll leave out the public option. But, oh, by the way, we're going to trash you every day during this process, so get ready for the next year and a half. We will vilify your industry six ways to Sunday because they certainly have done a good job of doing that. The gentleman points out an excellent point: if an individual is able to buy a policy with the same breaks that a company gets, and that individual is able to keep that insurance over time, a longitudinal relationship with a health insurance company, what a novel concept. I've had the same car insurance since I was 18 years old. I can't tell you how many different health plans I've had because when I was in business for myself, I was always trying to find a better deal because that was one of the number one line-item expenses on my budget every year, providing insurance for my employees. So you were always looking to see if there wasn't a better deal somewhere. And as a consequence, I frequently changed health insurances until I discovered what was then the medical savings account and now is the health savings account. So kind of through the back door, I have now developed a longitudinal relationship with an insurance company. They send me emails, and they ask me to do certain things to keep myself healthy, and it works well between us. Why we didn't embrace that sort of model going into this, I just, frankly, don't understand.

Mr. BURGESS. I thank the Speaker for the recognition. Well, here we are, Tuesday night, Washington, D.C., 20 minutes until eight o'clock in the evening. What a day we have had here in the Capitol. Mr. Speaker, many of your constituents and my constituents probably tried to call our offices today to register how they felt about this health care bill. I know I have been encouraging people, whether they agree with me or not, whether they think I'm spot on or all wet, I have been encouraging people to call and let Congress know what you think about this massive government takeover of one-seventh of our Nation's economy. And people have responded. They have been calling. But today they were met with either busy signals or interminable rings, because apparently the House switchboard was overwhelmed with the calls that were coming in. I will tell you I was concerned because I called my number for my office and got a busy signal, and yet walking around in the office, certainly not all of the phones were in use. So apparently this problem that Americans have encountered all afternoon has been one that has at its root and its cause in the antiquated House switchboard. I do hope the Speaker, I hope the Architect of the Capitol, and the Capitol business manager, will take that into account, because clearly, clearly we need to be able to hear from our constituents when we have such important legislation coming up to the floor. So where are we as we work through this? Are we in the last throes? Are we still in for a long, hard slog? We have heard terms like the final push, the final stretch, the 5-yard line. President Obama, Speaker Pelosi, and Majority Leader Reid have ignored calls by certainly every Republican, by many Democrats, many independent Americans, and just the American people in general, to really put the breaks on this current bill and to look at some of those things that people really want to see done, and do those. We don't have a lot of credibility right now in the United States Congress. Recent polls I think today put it around 17 percent. No one trusts us with a 1,000-page bill that we passed out of committee last July 31. They darn sure didn't trust us with a 2,000-page bill that the Speaker's office came up with in October and that we passed in this House in early November. They darn sure didn't trust the 2,700-page bill that passed in the Senate on Christmas Eve. And they sure don't trust what they see as a very difficult, tortured process that is now working its way through the House. And the reason they're having to resort to such legislative hijinks is because fundamentally this is a flawed bill. This is a bad bill. And it didn't have to be this way. Look, most of us went home during August. We did our summer town halls, as we always do. We were all, I think, somewhat astonished at the outpouring of the American people just showing up on a hot Saturday morning in Texas to stand in a parking lot and listen to their Representative and question their Representative about what they saw happening up on Capitol Hill. To be sure, cap-and-trade was in the news those days; to be sure, the stimulus bill was in the news those days. But they were most concerned about this massive takeover of health care. Most of the questions dealt with that. And it wasn't like they didn't want to see anything done. But they didn't trust us to overhaul the entire system with one massive bill. Sure, they want some help with preexisting conditions. Yeah, they'd like to see people be able to buy across State lines and bring some cost down. Maybe some liability reform would be nice. Boy, wouldn't it be great if COBRA was a little more flexible. These were the things we heard. When we came back in September, I thought, okay, rewind, pause, slow this thing down, and let's look at it. Maybe let's work together. Maybe Republicans and Democrats can kind of come to some common ground because every Democrat was hearing the same stuff I was hearing. And I know that because I saw it on the evening news. I saw the YouTube clips. Their town halls in Florida, their town halls in Arkansas, their town halls in Michigan were exactly the same as the town halls that were going on in north Texas. There was no difference. But instead in September, we come to a joint session of the House and the Senate. The President came and addressed us, and it was nothing of the sort that we're going to rework this process. We weren't going to check the weather. We're going to fly anyway, full speed ahead. Let's get this thing done. I think I heard it said again tonight in the discussion that just preceded us, A crisis is a terrible thing to waste; so let's take this economic crisis that we're in and force this health care bill on the American people. They don't know what's good for them, but we do; and this is what they're going to get. It is a terrible bill. It's a flawed bill. It's a very tortured process. I'm going to do everything in my power to stop it, but it may become law. And if it does, we need to know what's in it, and we need to know then what our next steps are to deal with those bad provisions that are contained within the bill. I've been joined tonight on the floor by a gentleman that I've come to admire during my time in Congress. He has been a leader on this issue and on the committee in which we jointly serve, Energy and Commerce, and here on the House floor. John, did you have some thoughts you wanted to share with us tonight?

Mr. BURGESS

Mr. BURGESS. I thank the gentleman for yielding. I actually came down to talk about some polling data that was in the Wall Street Journal today. You know, you talk about the Slaughter rule. And one of the talking pundits on television tonight, Hardball, at the end of that program, the moderator, the host said, it is only right that Congress allow an up-or-down vote on this health care bill. And he called on Republicans to stop obstructing. Let me remind everyone: Republicans are opposed to this bill, but Republicans lack the numbers to obstruct much of anything right now. So it is an internal fight in the Democratic Caucus that is obstructing this bill; it is not House Republicans. True, it is a bad bill. We all oppose it, as we should. But it is that internal fight on the Democratic side. Now, an up-or-down vote to me would mean that there'd be an up-or- down vote on some bill, not an up-or-down vote on a rule that deems passage of a bill that was passed by the Senate on Christmas Eve. Up- or-down vote means an up-or-down vote on an actual piece of legislation that has been filed with one of the clerks of either of the bodies. And I know I need to address my remarks to the Speaker. Mr. Speaker, if I would just ask, if you haven't thrown away your Wall Street Journal from today, you might want to take a look at it. There is some very interesting information in here, some polling data by Heather Higgins and Kellyanne Conway. Kellyanne Conway has spoken to many groups up here on the Hill many times. Their group is the polling company on behalf of the Independent Women's Voice. Twelve hundred people were polled in 35 Congressional districts; 20 previously had voted ``yes'' for the health care bill, 15 had voted ``no.'' But the survey shows astonishing intensity and sharp opposition, far more than the national polls reflect. For 82 percent of those surveyed, the health care bill is either the top or one of the top issues for deciding who to support for Congress next November. Seven in 10 would vote against a House Member who votes for the Senate health care bill with its special interest provisions. That includes 45 percent of self- identified Democrats, 75 percent of independents, 88 percent of Republicans, which you would expect. Almost half of the Democrats would not reelect a Democratic Member who voted for the Senate bill. Reconciliation poses its own set of problems. People see through that. That is a parliamentary trick. Yeah, if you can have an up-or-down vote, let's have an up-or-down vote on a bill, not on a procedural motion. But here was the part that really struck me. When they looked at various demographic groups, men and women, young and old, people who had voted for John McCain, people who had voted for Barack Obama, across all demographic groups, they described dramatic pluralities that say that if the legislation doesn't pass, they will be relieved. Well, I would submit that with what's left of this week and what's left of this bill, whether it's a long hard slog or what, we have a chance to provide the relief to millions of Americans by killing this bill and stopping it in its tracks. We can talk a good story about repealing the bill if it passes. The time for action is now. The action is to kill the bill. And I yield back to the gentleman.

Mr. BURGESS. I think it is important for people to remember that what we are doing right now has nothing to do with health care, has nothing to do with health care policy. This is all about pure political power and solidifying a hold on political power for the next 2 or 3 generations. This bill will be impossible to undo once it is passed. We need to step up and do our duty, stop this bill, then fix the things the American people want us to fix.

Mr. BURGESS

Mr. BURGESS. Madam Speaker, we are in the final throes of the government takeover of America's health care system. We have a shell bill that was posted on the Budget Committee site last night. This shell bill will give rise to a phantom bill. The phantom bill goes over to the Rules Committee, and that is where we get real reconciliation. We probably have one day or two to look at the shell bill, one day or two to look at the phantom bill, and virtually no time to see what is in the real reconciliation bill. My committee, the Committee on Energy and Commerce, is completely bypassed in this process. No respect for the oldest standing committee in the United States House of Representatives. And speaking of no respect for the oldest standing committee in the House of Representatives, our committee sent a request to the White House weeks ago for information regarding the secret deals that were cut in May and June of last year. This letter was signed by Chairman Waxman and Ranking Member Barton, and as of today, no response. Heather Higgins and Kelly Anne Conway, writing in today's Wall Street Journal, talked about, no matter the demographic group that you look at, men, women, old, young, independents, dramatic pluralities say that if this legislation doesn't pass, they will be relieved. We ought to listen to the American people on this one.

Mr. BURGESS

Mr. BURGESS. Reclaiming my time, let me just run through a little bit. We heard right at the end of the 6-hour discussion down at Blair House today, the President and I believe the Speaker of the House said that the time for incrementalism has passed. I felt like I had stepped back in time. I heard that very same argument in 1993 and 1994 when the then-Clinton health care plan was before the House of Representatives. I never will forget the day that Mike Synar, a Representative from Oklahoma, a Member of this House of Representatives, was down in Dallas. He was talking to a group of us who were American Medical Association members, and he was going to talk to us about this bill. Many people had questions at the time--believe it or not, I was so shy I was scared to say anything--but toward the end, someone asked Mr. Synar, wouldn't it be better to tackle some of these problems on an individual basis and not try to do all of this all at once because it did appear to be frightening people. And Mr. Synar made a very emphatic statement that the time for incrementalism is over, we must have this bill and we must have it this year. Sounds familiar. That was over 15 years ago. Of course they didn't get the bill passed, life went on, the health care system in this country improved. We developed the State Children's Health Insurance Program under a Republican Congress with a Democratic President. We established medical savings accounts. We then, several years later, improved them with health savings accounts. We provided a prescription drug benefit in Medicare. For better or for worse, we passed the HIPAA law in 1996. But there was a lot of work that went on in health care. Health care is an evolutionary process. Medicine is an evolutionary process because the knowledge base changes. The science changes over time. It is not a static event like law, or physics perhaps. But medicine is constantly evolving. In fact, many times we say that's why we refer to it as both an art and a science. Well, what do the people think about doing this all at once or perhaps taking off some smaller pieces that might be actually doable? Americans agree with Republicans and want a fresh start on health care reform. A CNN poll--now, CNN is not always friendly to conservative principles--in a CNN poll, 73 percent of Americans say lawmakers should work on an entirely new bill or stop working on health care altogether. This was from February 24, 2010. Another poll, 79 percent of independents want Congress to start work on a new bill or stop all work, again from the same time frame. So maybe it is reasonable that we start over with these small, incremental changes and solve some of the problems that bedevil Americans right now, but not turn the entire system on its head in order to help that smaller percentage that is having difficulty right now. Starting over does not mean that we have no bill to pass. It doesn't mean that we start into another year-long debate. As I began this hour, I outlined to you, Mr. Speaker, several bills that are already out there, already written, could be called up, could go to committee, could be worked on, marked up, amended, and come to this House to be voted on up or down. We could pass a bill on preexisting conditions before we go home for the Easter recess. It would really be that simple. Instead, what we may get is the Senate bill being passed by the House of Representatives--under great duress for some Members of the House of Representatives--and then when that bill is passed by the House, it goes down to the President for his signature, and then good luck undoing all of the problems that are contained within that bill. It would be far better, since no help is coming for 4 years anyway, to take a little time and do this correctly. The gentleman from Pennsylvania brought up the problems in Pennsylvania with medical liability. Texas, of course, in 2003 did change their medical liability laws and passed a bill that would allow a cap on noneconomic damages. It is a more generous cap than was passed in California in 1975 under the Medical Injury Compensation Reform Act of 1975, but nevertheless, it has worked well over the last several years and has now solved a lot of the problems that we were encountering in the earlier part of this decade. Just some statistics to share with you; before the reform, one in seven obstetricians no longer delivered babies, 49 percent of counties didn't have an OB/GYN, 75 percent of neurosurgeons would no longer operate on children. Since passing that reform in Texas, it has really dramatically changed things. We had, in the 2 years before the reform passed, 99 Texas counties--Texas has 254 counties, and 99 counties lost at least one high-risk specialist. With the passage of what was then called Proposition 12, which was a constitutional amendment to provide caps on noneconomic damages and lawsuits, 125 counties added at least one high-risk specialist, including the counties I represent, Denton, Tarrant and Cooke Counties. And you can see of course there are some areas that are still needing to add specialists. One of the remarkable things about the passage of this law is the number of counties that did not have an obstetrician previously but now do, and the number of counties that did not have an emergency room doctor but now do. Twenty-six counties that previously had no emergency room doctor, 10 that had no obstetrician, and seven that had no orthopedic surgeon, now at least have at least one of those specialists. Charity care rendered by Texas hospitals has increased 24 percent, nearly $600 million since the passage of this legislation. And Texas physicians have saved well over $500 million in liability insurance premiums. Now, people will argue that passing tort reform does not immediately result in lower cost. Defensive medicine is learned behavior. Defensive medicine is oftentimes learned over a lifetime of practicing medicine. And it does take a while to begin to walk back from that. But as anyone will tell you, the journey of a thousand miles starts with the first step, and Texas has taken that first step. In fact, in Texas, one of our bigger problems now is licensing all of the doctors who want to move to the State. The State Board of Medical Examiners cannot keep up with the demand. It is a good problem to have because we had many counties that were underserved. And now, with the passage of this legislation at the State level, almost 100 percent of Texans live within 20 miles of a physician. That is a remarkable change from even just a decade ago. One of the last things I want to bring up tonight before we leave, we've talked a lot about cost, and during the course of the discussion down at the Blair House the debate on cost was lengthy and sometimes it became contentious, but just a few points that Representative Paul Ryan from Wisconsin made today. He pointed out correctly that Medicare has an unfunded liability of $38 trillion over the next 75 years. This is a huge, huge budget pitfall that is facing not just Members of Congress, but every citizen of the United States over the next 75 years. While Federal Medicaid spending grows at 23 percent this year, the program continues to suffocate State budgets. And this bill does not control costs. Mr. Biden talked about if we don't bend the cost curve, we're in trouble. I will submit that we are in trouble because we have bent the cost curve, but we are bending it in the wrong direction.

Mr. BURGESS

Mr. BURGESS. It just shows you the type of tension that we are going to set up between the State and Federal Governments if we were to pick up and pass either the House or the Senate bill and send it down to the President for his signature.

Mr. BURGESS. It's interesting, perhaps the one thing that would provide the right impetus in the competition to hold down those costs we are not going to do, and that's the ability to buy across State lines. In the individual market, buying a policy for a family of four in New Jersey is $10,000 a year. Your State of Pennsylvania, $6,000 a year, my State of Texas, $5,000 a year. As long as people know what they are purchasing, I don't see why it is reasonable to restrict someone from having a policy that may be more affordable. My insurance premiums have decreased by about 50 percent over the last 2 years. Not because I am a Member of Congress and I get a special deal, but I said, you know what, I can no longer afford this high option PPO insurance that is available to us in Congress, so I have elected to go into what's called a high deductible health plan with a health savings account. I actually had one several years ago when I was in private practice. I liked it. I liked the fact that I was the one who got to choose which doctors and facilities I got to use. I didn't have to call 1-800-California to get an X-ray preapproved. I wrote the check and I controlled the money, and I made the decision about who I saw and when. So I have gone back to that type of policy, and I will tell you I am very satisfied. We have improved from the old medical savings account in 1986 to the Health Savings Account improvements that started in 2003 and continue to this day. Preventive care is now included as part of the benefit in a high deductible health plan because the insurance company has an interest in making sure if you have a problem that it is diagnosed early, while it is less expensive to treat, and I think ultimately that's a good thing. I have chosen a plan that does not have prescription drug coverage because after we passed the prescription drug benefit in Medicare in 2003, one of the unintended consequences was we changed the market so that now many generic medicines are available at Wal-Mart for $4 a month. I try to find those bargains for those medicines if I should need one. I try to find those bargains at Wal-Mart or go to an over- the-counter variety, which is much cheaper than the name brand that is bought at the pharmacy, and you can actually achieve significant savings. I am motivated to do that because it's my money that I am spending for those compounds. Yes, I could have paid more for PPO insurance and then, yes, I could have had a nice mail order, even gone down to my pharmacy and gotten brand names, but I have found that, hey Prevacid is over the counter now. It costs a fraction of what it used to cost a few years ago. Even before that, Prilosec was a similar medicine, not quite the same thing, but that was available in a generic form over the counter at that time at a fraction of the cost of the 30-pill bottle of Prevacid that I was taking before. So it makes the consumer more informed and motivated. Here is how you hold down health care costs: Let me be the decisionmaker about that. Don't tell me from a comparative effectiveness board that, hey, this medicine is just as good as this medicine, and so this is all you get because this is what we are buying for you this month. Let me have some of that money back to spend myself, the premium that I pay every month, a portion of that goes into the medical savings account. Every year that it accrues and grows larger it's tax deferred until--if I don't spend it on health expenses I would obviously have to pay taxes on it when I took it out. As long as I spend it for legitimate medical purposes, hey, that's pretax dollars. That's probably the best deal you could do in the individual market. So these are changes that we actually ought to encourage. I was stunned today to hear the Democrats admit, you know, we agree on a lot of this stuff that we have got here on these sheets, but, well, we don't do the health savings account thing. My goodness, that is the one way to really start to bring--you talk about bending the cost curve, that's one way. Get a motivated patient, educate them about some of the options that they have, and, oftentimes, not oftentimes, almost always they will make the right decision. I cannot tell you how many times in my medical practice if I recommend a test, a CT or MRI scan, a CAT scan or an MRI scan, and the next question from the patient back to me was not, Doctor, is it really necessary, or, Doctor, is this safe to do this, the next question was, well, does insurance cover it? If it did, there were no more questions. Go ahead and have the test. I, on the other hand, with the type of policy that I have, yes, I may have hurt my knee or shoulder bad enough to go get a CAT scan, or I may make the decision that, Doctor, with a little ice and tincture of time would this not perhaps resolve on its own? Yes, it could, and if it doesn't get better in a week we could still do the CAT scan and we won't have delayed beyond the therapeutic interval, so it is okay to do that. I am happy to take that advice and not have the test. If I don't feel better in a week or 10 days or whatever the prescribed time limit is, fine. Go get the test, and I will still be able to write the check and have that done. Here is how you bend the cost curve down. You get the patient involved, put the power back in the hands of the patient. Let the patient and the doctor make those decisions. Don't make them buy the insurance at 1-800-California, but don't make them buy across the street at Health and Human Services. Let the patient and the doctor make those decisions. Every doctor has had the unpleasant experience of having called a preapproval number and have their patient denied a test or a procedure or a surgery, and then you have got to go to bat for them and prove all of these things. It is an enormous nuisance, and I hated it every time it happened. On the other hand, in the Medicare and Medicaid system, they go ahead and cover that, but maybe 3 or months from now, maybe a year from now, they call you back and say, you know, we don't think that hospitalization was actually necessary, and we are going to deduct what we pay to you from the next round of payments that we give you for your next round of Medicare and Medicaid patients. That is beyond frustrating because at that point you may not have at your immediate disposal the documentation that you at least would have had with a preapproval process. Neither is a good occurrence in a doctor's office. We need to come to some sort of consensus. But, as much as I hated the preapproval process, I see now, dealing with these large, large Medicare and Medicaid outlays, why it is necessary sometimes to assess medical necessity and why it is necessary sometimes to seek that preapproval, perhaps in our Medicare system. If we really were serious about bending the cost curve, instead of just cutting doctors' payments--and that's what we do, we say, well, we will pay 20 percent less this year than we did last year--what's the practical effect of that? Well, the doctors' costs are fixed. He is not paying less for electricity to light his office this year than he was last year. His office help certainly didn't come in this year and say, hey, you know what, we can all take a pay cut because we love working for you. That doesn't happen. His costs go up every year. The reimbursement rate goes down because Congress says, hey, we are spending too much money. What is the practical effect of that? The practical effect of that is, you know, I was able to pay my bills and take something home last year seeing 18 patients a day. But you know what, this year I have got to see 25 patients a day. And maybe if I can squeeze an extra procedure or two out, maybe I should do that because I have got to make up that difference somewhere. So we have gone about this the wrong way. We are ratcheting down costs at the provider, and yet the doctor, he or she is the one who picks up the pen and writes the prescription, orders the hospitalization. The most expensive item in the doctor's office is their ballpoint pen most of the times because the doctor is the one making the decisions about that medical care. Wouldn't a different way to look at this might be to say, Doctor, we are not going to cut your pay this year. We are, in fact, going to pay you a little bit more. We hope you will see fewer patients and maybe take a little bit more care and a little bit more preventive medicine and education with those patients along the way. It would be a phenomenal thing to look at but we never tried. We just cut the doctor's pay and said, whew, we got through it this year, the doctors are all mad but maybe they won't remember come November, and we will cut them again at the end of the year. We are probably going to bump up against the clock. I do want to make this point from what we talked about the cost of insurance at the hearing we had yesterday. It is important to understand, I think, that Speaker Pelosi, Harry Reid, President Obama, their health proposals would not make health insurance significantly cheaper for America's families. Under the bill passed by the House in November, H.R. 3962, a family of three making just under $55,000 a year and buying now a plan in this new exchange that's going to be set up and created by the bill, they would have to personally contribute after a tax credit about $5,500 a year in premiums. Additionally, this family would also pay $4,000 of out-of- pocket costs exclusive of the premium--copays and drugs that weren't covered--so this family would pay about $9,500 for a family of three that earns $55,000 a year in the Health Insurance Exchange. I think it's important for people to understand that when we pass these bills and it's all settled and done, it doesn't mean free insurance. It doesn't mean free health care. It means, yes, you have got a government option here for buying insurance, but it's still going to cost something. It is still going to be an expensive item in that family's budget every year, and we are misleading people by telling them that, hey, we need to pass this bill because too many people don't have health care. True enough, the person who has no income and no job will now have access to Medicaid, which they may not have had before, but the average person earning a reasonable salary is still going to find that the cost, the expense they paid for health insurance, is going to be significant. Here is the rub: If we pass this bill, this won't be an optional expense in their budget. They will be required to buy this, and the enforcer is going to be the Internal Revenue Service. Now, Mr. Thompson, you brought up the online purchase of insurance for automobiles that has the cute little lizards and cave men on the logos. People will sometimes bring up to me, well, why, why not have a mandate. After all, there is a mandate to buy car insurance in your State, so, what would be the matter with having a health insurance mandate? Here is the key. In my State, this is a State decision that in the State of Texas, people have to carry insurance if they are going to exercise the privilege of driving on the roads of the State of Texas. Health insurance is a different animal, and for the Federal Government to require, not a State government, but the Federal Government to require the purchase of health insurance is taking us in the direction of loss of liberty that none of us have really ever encountered before. It is a new concept. So if a State wishes to exercise a mandate, which they have done in Massachusetts, then that's a State decision and that decision will either be supported or rejected by the voters in that State, but for the Federal Government to create for the first time a mandate, a requirement that a person purchase a product just for the privilege of living in this country, again, we are going down the road of loss of freedom that, again, I don't think people really want to go there. Now, you will also hear, and it's so strange to hear the comparison of we have got to have a mandate as you do with automobile insurance, and you know what, you can buy that consumable insurance online. What if, instead of, if we had our thinking right, we would let the health insurance be available online, let the plan finders be available online and, if people think it's necessary to have a mandate, let that be a State decision. Let that be a State decision if the exchange is--right now you have, and I don't know the precise number, 30 or 34 States whose attorney generals are drawing up legislation to prevent their States from or prevent their citizens and their States from being required to follow an illegal Federal mandate.