Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. Well, this is where other States are, the growth in the Medicaid population. I am going to ask Congressman Boozman to speak. Arkansas' Medicaid population will go up by 40 percent, and what will that do to your State finances?

Mr. CASSIDY. So the Californians and the Texans and the Louisianans will be paying for their own States, and they will be paying for Nevada too.

Mr. CASSIDY. Governor Schwarzenegger says that this will add $8 billion in cost per year to California. In Texas they project over $4 billion per year. But these States will have to come up out of pocket. But because Nevada has been able to swing a separate deal, they are protected from this cost, although these States are not.

Mr. CASSIDY. Now, just so the folks understand this issue, in State government, State governments can't print money. They have got to balance the budget, I presume, in Pennsylvania as in my State. If your population is going up, Medicaid population is going up by 20 percent, and you mentioned how much extra money will have to go into that, that will either come from higher taxes or lower services, for example, lower money spent for road construction, for secondary education, for colleges, et cetera; is that correct?

Mr. CASSIDY. I kind of like that, ``mother of unfunded mandates.'' Congressman Thompson, you are from Pennsylvania, and we are speaking of Pennsylvania. What thoughts would you offer, say, regarding, for example, I see that this is the Medicaid population increase per State under this bill. By this, in Pennsylvania, you will go up 20 percent. What would that mean to the State taxpayers of Pennsylvania?

Mr. CASSIDY. New revenue source means State tax.

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, instead of passing health care reform that lowers costs, Democrats are positioned to pass a bill that hides costs by passing them on to State taxpayers. A frightening footnote in the Congressional Budget Office report on the Senate Financial Committee bill reveals a $37 billion Medicaid mandate on State governments. Unlike the Federal Government, States can't just print money. This $37 billion mandate will force States across the Nation to choose between deep cuts to programs or steep tax hikes. In Louisiana alone, it's $612 million over 5 years. That's $612 million less for roads, for higher education, for secondary education, for economic development. In addition to driving States into bankruptcy, this unfunded mandate deliberately hides the bill's true cost. Whether from Federal taxes or State taxes, the American people will have to absorb this. If the bill actually lowered costs, its author would not have to hide behind accounting gimmicks to sell the bill.

Mr. CASSIDY

Mr. CASSIDY. Madam Speaker, as we reflect upon the eighth anniversary of the September 11 attacks, the Americans who perished that day, the Americans who heard the call to arms and sacrificed themselves to defend our lives and liberty, the sacrifice of Americans who remain in the line of fire and their families, let us reaffirm our commitment to Never Forget. Scott Rogers, a constituent from Baton Rouge, penned the following poem in 2001. It is a tribute to the searing legacy of that fateful day and the values that guarantee we will overcome it. The Day Liberty Cried (By Scott Rogers) It was just another Tuesday morn As people went their way The cars, the trains were bustling by Another working day Although diverse with many faces These people shared one hue They lived together with Liberty Under the colors Red, White, and Blue Liberty was the one thing they all shared They nurtured Her in their heart But little that morn did they realize, That their world would be torn apart Liberty was strong She stood proud But on this fateful morn She cried In horror She watched as evil attacked And so many innocent people died Liberty bowed Her head that day For She felt somehow that She Had allowed these acts to come to Her shores To the great land of the free But the evil that attacked Her Could not begin to understand That Liberty could not be destroyed Nor our great love for this land Those who tried to hurt Her Could not break Her soul And proudly we fought to rebuild what was lost Although heavy was our toll Each brick that fell was carefully removed Each victim we will always remember And Liberty is there to remind us all Each eleventh of September We will never forget, we must not forget Yes . . . Liberty did cry that day But we will never stop pledging ``In God We Trust'' Because? . . . We love this U.S.A.

Mr. CASSIDY

Mr. CASSIDY. Now, Congressman Fleming, how many Democratic cosponsors do you have?

Mr. CASSIDY. Dr. Roe, can I reclaim my time?

Mr. CASSIDY. Can you show me up there where there is a Washington bureaucrat on that chart? Where might there be a bureaucrat on that chart? Show me where the patient is and show me where a bureaucrat is.

Mr. CASSIDY. So unlike the Republican plans, which are patient- centric, what you're telling me is this is kind of a top-down, let's figure it out from Washington and lay it on the rest of the country.

Mr. CASSIDY. Mr. Speaker, we are pleased to be here. We call this the Doctors Hour because there is a fair number of us on the Republican side who are physicians or in some way health care providers, optometrists, a practicing psychologist, or in some other way connected with the health care field. So we give our own perspective. Now, my own bio, if you will, aside from being a physician, I have worked with the uninsured in my State of Louisiana for the last 20 years. That's almost 90 percent of my practice, working with the uninsured in a public hospital. And so, when I speak of what we need to do to help the uninsured, it is purely flowing out of my life experience. I think that as the others come up I'll give them a chance to speak as to it what they're about. I'll start off with a couple of comments. I've learned in my 20 years of, whether private practice or public practice, that the only thing that lowers costs is if you make things patient- centric. If the government is in charge, or the insurance company or a bureaucracy run by anybody is in charge, it becomes something that doesn't work for the patient. The patient's separated from costs. They have a harder time accessing benefits. It just doesn't work. On the other hand, if you put the patient in the middle, if you tell that woman, listen, you can go see the physician you wish to see and when you go in there there's minimal administrative hassle. And if you don't like that physician, you can go see another physician. It really works. The patient's satisfied, and typically, the patient/physician relationship is stronger. And key to getting good health care is having a strong patient/physician relationship. Now, frankly, I think the only thing innovative that we've heard from the other side, although their plan kind of is changing on a day-by-day basis, is in one sense, the only thing about that plan which is radical is that it nationalizes health insurance. I was a little amused by my Democratic colleagues earlier who were saying, Oh, my gosh, Republicans are defending insurance companies. No, actually I think they're defending insurance companies. They like insurance companies so much they want to nationalize it and have a national insurance company. Now I'm thinking, now we have an insurance company run by the private sector that, if it doesn't work, constituents call Congresswomen, Congressmen, we pass a law that changes that, changes that so that the private insurance company plays by better rules. Now, though, it's going to be both the referee and the player. Now the government will make the rules, but also compete. And as it does that, in some way, we're supposed to expect that the government-run insurance company is going to be kinder and gentler, more cost-effective, higher value product than is the private insurance company. I think it's the triumph of hope over experience. We hope it will be better. We know Medicaid and Medicare don't work as we wish; in fact, they're going bankrupt, and their bankruptcy is what's driving this plan. And so we're going to believe that the third try is going to be the charm and that this time we get it right. Well, without going further, I'll yield to my fellow physician from Louisiana, John Fleming.

Mr. CASSIDY. Dr. Roe, can I reclaim my time?

Mr. CASSIDY. Of course we don't want this to be a partisan issue. Now frankly, as far as I know, Republicans have not been invited into the discussion. And there are actually some things in that Democratic plan, those thousand pages, that I think are very good. But there's other things, and I think they kind of general concept top-down. But it's not just us. David Brooks is a columnist for The New York Times. You see him on TV, a very thoughtful man. I have a quote here. The health care system is as big as the entire British economy. There's no way something that big and complex and dynamic can be run out of Washington. We have to set up a dynamic system, not trying to establish a set of rules to be imposed by fiat. Now, I think what you're telling me is that this is a big, complex plan run out of Washington, and not the dynamic system, but rather a set of rules, and whoever that really powerful person is in that purple box, that person will be establishing the rules by fiat. Is that a fair statement?

Mr. CASSIDY. Thank you all very much.

Mr. CASSIDY. If you would yield back, because I just want to mention that one thing. There are some physicians, a lot of them on the west coast, that have a practice that is so patient-centered, it works beautifully. In that practice, the patient pays $50 to $100 a month and gets all the primary and preventive services cared for. If the patient doesn't like it, they find another doctor the next month. It's like Target or Wal-Mart. If my wife doesn't like the sale at Target, she goes over to Wal-Mart; and if she doesn't like the service at Wal-Mart, she will go back to Target. The fact is, is that the physician, knowing that those folks can go, is going to be more patient-sensitive.

Mr. CASSIDY. If I may reclaim my time, I think you are involved in what is called as a concierge practice or a patient-centered practice where the patient will prepay you, say, $50 a month; and if you don't satisfy that patient, she goes to see another doctor. Do I recall that correctly?

Mr. CASSIDY. If I may reclaim my time, we're almost out. I just want to wrap that in with a comment that Dr. Fleming said about how the best system is one in which the patient is involved. I think you said ``skin in the game.'' The McKinsey Quarterly talks about transparent pricing for value-conscious people. Again, quoting from David Brooks, the New York Times columnist, a very thoughtful man: ``I'd say that there have to be cost-conscious consumers within a closely regulated market. Unless you get proper incentives for both providers and consumers, I doubt you're going to go very far. In the current plans,'' meaning those across the aisle, ``all the emphasis is on the providers.''

Mr. CASSIDY. Reclaiming my time just for a second, CMS is the agency that governs Medicaid and Medicare, the Federal program.

Mr. CASSIDY. Reclaiming my time, I would say that it works for 85 percent of the people; but we would favor the reforms that would ease the insecurity that if you get sick, you lose your insurance or it's priced out. So we favor the reform that deals with preexisting conditions. At the same time, we don't want to ruin it for the 85 percent. I yield to my friend.

Mr. CASSIDY. If I may reclaim my time, one, it's a tremendous testament to the faith of that family, their love for their son and to those fine physicians at Vanderbilt. I think all of us share the hope to have high-quality health care affordable, accessible to all Americans. Our concern is that the solutions being brought upon us are going to not only not achieve that but interfere with that relationship, and it's not just folks who are conservatives. I have an editorial in my local paper by Susan Estrich. You will recall that Susan Estrich was chief of staff for Walter Mondale--I think I have this right--when he ran for President. I don't agree with her, but I respect her thoughts. She's a bright woman. She wrote Don't Risk Your Health Care. She begins: The President is ``not familiar'' with the bill. No one can explain how it will work yet, as Senator Ben Cardin told a contentious town meeting. There are various plans, and negotiations are still in the early stages. But whatever it is, we should be for it. She goes on to say, ``Am I missing something?'' Then she describes the relationship that she and her family have with their physician. They are not sure. She wants to be reassured and has seen nothing that reassures her yet that that relationship will be preserved. So it isn't just folks in this arena. It's folks across the country. Dr. Boozman, what are your thoughts?

Mr. CASSIDY. If I may reclaim my time, it's important that the people watching realize that that is not just Republicans saying this. Again, I'm going to quote. The Congressional Budget Office, as we know, has spoken about how costly this bill would be. From nytimes.com, I, again, quote David Brooks: ``The theory of the Democratic bills seems to be that 98 percent of Americans can party on, with the latest and costliest health care imaginable, no matter how ineffective, and the top 2 percent will pay for it all.'' He goes on to say, ``If you don't control the rate of health care inflation, even the rich won't be able to pay for the cost increases.'' So it's others, not in this Chamber, commenting on the cost of that program and, indeed, commenting on the Congressional Budget Office comments.

Mr. CASSIDY. So, Dr. Roe, may I interrupt for a second? A clear contrast between our plan, if you will, or one of our plans and their plan, aside from their increased administrative costs, aside from their top heavy, aside from ours being lower administrative costs and patient-centered, you're saying that one of the plans being presented to us has the mandates but the Republican plan does not.

Mr. CASSIDY. Reclaiming my time, the anecdotes that you gave and Dr. Roe gave regarding the empowered patients by giving them these health savings accounts or something such as that, we empower patients. That's in our plan. It's not the government bureaucracy between our friends up there; rather, it is empowering patients.