Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. Now, on the other hand--let's be fair to this bill--it does attempt to pay for its exploding costs. Before you walked in, I mentioned the Centers for Medicare and Medicaid Services found that the bill that was passed--although 39 Democrats joined Republicans in opposing it, it still passed on basically a party-line vote--that because of that bill, health care spending will increase to 21.3 percent of our GDP compared to current law; 20.8 percent would be under current law. And bending the cost curve the wrong way, if you will, or bending the cost curve up, we are yanking on that thing. But on the other hand, they do attempt to pay for it. If the gentleman will allow me to go forward. They are creating $730 billion in tax hikes. Some people have called this a tax bill disguised as a health care bill: $460 billion tax on small businesses and high earners; $135 billion employer-mandate tax; $33 billion individual mandate tax. You mentioned how you are a small businessman as well as a physician. I am going to yield to you and ask you if you can comment on how these taxes would affect you as a small business person.

Mr. CASSIDY. If I can contrast your patient-centered approach where you put the patient responsible, the person most responsible--the patient, your employee--in charge of the dollars she would spend for her health care and in so doing she responded in rational economic way. She didn't want to spend money on inhalers so she stopped smoking, so therefore she stopped needing inhalers and the whole system saved money. Contrast that with the bill that we passed a week ago in which now there is going to be a tax on health savings accounts. So the example I gave, if I may continue, is where the patient asked for an over-the-counter generic instead of the prescription medicine knowing that the one was as good as the other, and one costs $20, one cost $39, and yet now by the bill that was passed by our colleagues on the Democratic side of the aisle, we are now going to tax the purchase of over-the-counter medicines when that purchase is made with a health savings account. It seems like we're going backwards in terms of incentivizing people to use less costly drugs. I yield to the gentleman.

Mr. CASSIDY. So what you've told me is that families have been incentivized to be wise with their health care dollars, and at the end of every year, instead of losing that dollar, it rolls over and it accumulates. Now they put that much less money for the following year. For those particular families, their cost of insurance, if you will, is decreasing annually, I would assume.

Mr. CASSIDY. We sometimes hear that health savings accounts are only for the wealthy, yet you've heard me quote that study that found that 27 percent of people with HSAs and catastrophic policies were previously uninsured. And so as I know--and I'll yield back now--your business is a service business so I assume that people are of moderate income, and yet this is the policy that they have all chosen. So unless you tell me that all of these folks are wealthy, I will assume indeed this is something that works for middle America.

Mr. CASSIDY. If the gentleman will yield. You said that all of your employees in your group are on health savings accounts now?

Mr. CASSIDY. If the gentleman will yield.

Mr. CASSIDY. By connecting her with costs, if you will, you are incentivizing a healthy lifestyle.

Mr. CASSIDY. Thank you, Mr. Speaker. Although you called me ``mister,'' I am actually a physician; and so in my other life--I actually saw patients just yesterday at a public hospital in Louisiana, a safety net hospital where I have worked for the last 20 years. So caring for the uninsured has been my life's work since completing my residency and returning home. I've learned that if you don't pay attention to costs that it doesn't matter how passionate you are for the uninsured; the fact is that you are unable to achieve your goals. There are three goals of health reform, and they're commonly said to be controlling cost to provide access to high-quality care. In the hospital where I work, a safety net hospital, they are committed, they are so passionate for the underserved folks who are med techs, physical therapists, ward clerks, physicians and nurses. But the problem is, if there is a budget shortfall, then inevitably, services suffer. So it doesn't matter how passionate we are in our service. The fact is that if there are insufficient resources in the State at the end of the budget year, then services suffer. It may be that the nurse staffing has decreased and hospital beds are closed so that if somebody comes to the emergency room, they have to wait in the emergency room before they're admitted. And inevitably when that happens, the hospital goes into what is called divert, whereas instead of coming to our hospital, they will be diverted to another hospital. That's because if you don't control cost, inevitably, access and quality suffer. Now, I was struck that President Obama agrees with this. President Obama continually speaks about the need to bend the cost curve down, the need to control costs because if we do not control costs, then our economy suffers and the ability to provide care suffers. Now, it's one thing to say that we're going to control cost in order to expand access to quality care, but you've got to have a plan on how to get there. There is a company called McKinsey & Company, and on their Web site, they have a great article that you can download called ``The Three Imperatives of Health Care Reform.'' Without achieving these three imperatives, then, we cannot control cost in a way which expands access to quality care. Now the three imperatives that they list are decreasing administrative costs, how much money we put into the bureaucracy as opposed to patient care, incentivizing healthy lifestyle. Put differently, if people insist on smoking and drinking and if they're too heavy, it doesn't matter how much we throw at health care; we will never control cost because we are always try to catch up with the disease as opposed to preventing it. And, lastly, cost transparency. Someone going in for knee surgery needs to know how much her bill will be before she goes in as opposed to learning about it 2 months later when she gets the bill. It is important for us, therefore, to achieve our goals of cost containment to provide access to quality care to work through these three imperatives. Now, the bill we just passed, H.R. 3962, on the face of it does not achieve these three imperatives. As an example, if you are going to decrease administrative costs, you don't achieve a decrease in administrative costs by creating 111 new bureaucracies, boards, and commissions. It is just laughable to think that we are going to put that much more money into administration, build that many more buildings, hire that many more people and at the same time say we're decreasing administrative costs. There is very little in the bill that incentivizes a healthy lifestyle. You can argue that those provisions in the bill that address this weaken the current provisions that we're finding effective. And, lastly, there is not a whole lot that provides cost transparency. Indeed, one of the things that has been used to encourage cost transparency is the use of health savings accounts, and now health savings accounts are being taxed, as they have not been before. So it's not surprising if these three imperatives are not addressed that we can say that cost is not being controlled. Now, by the way, it's not just me who says that costs are not being controlled. We have here a quote from The Washington Post, and we also have a quote from The Washington Times. The Post article says, speaking of this bill: ``It does not do enough to control costs, and it is not funded in a sustainable way.'' The headline from The New York Times--I think this was November 10--``Democrats raise alarms over health bill costs.'' Democrats are raising alarms over the cost of this health bill. That's so important because if you can look in any health care system, if you don't effectively control costs, eventually access to quality care suffers. I have been living this for 20 years. In my life, I know this to be true. So here we see from a couple different sources, The Post and The Times, that this bill does not do enough to control costs. Now, it turns out it isn't just The Post and The Times that have such concerns. There is an article in Reuters, and Reuters says that China is now questioning the cost of our U.S. health care reform. Since China buys so much of our debt, it turns out they have a vested interest in making sure that we have our financial house in order. So to read the article from Reuters: ``Guess what? It turns out the Chinese are kind of curious about how President Barack Obama's health care reform plans would impact America's huge fiscal deficit. Government officials are using his Asian trip as an opportunity to ask the White House questions. Detailed questions. Boilerplate assurances that America won't default on its debt or inflate the shortfall away are apparently not cutting it.'' I think it's important for us as an American people and our country to look at the bill that was just passed that is going over to the Senate and to analyze how well does it control costs. Are the Chinese correct? The Washington Post, The New York Times, are their articles correct? Or does it, indeed, actually control costs and everyone else is a little bit confused about it? Well, let's go into that. First, remember our three imperatives: you have to decrease administrative costs, you have to incentivize healthy lifestyles, and you have to put in cost transparency. Let's talk about incentivizing healthy lifestyles and how you do so. Now, as it turns out, when the President talks about preventive medicine, one of the kinds of dirty little secrets of this--and as a physician, I can say this--if you are talking about things such as colonoscopy, actually, if we did a colonoscope on everybody over 50, as per the current recommendation, it actually costs the system a little bit more. Now, it's a good cost. If you find a polyp, remove it, and prevent cancer, that is actually a very good thing; but it doesn't save money. But there are some things you can do that will save money. If you can get someone to stop smoking, it actually saves the system money. It also helps them in terms of their health. If you can get someone to lose weight, it actually saves the system money. General Motors did a study--they have got so many employees, they can do this sort of thing--and they found that for every 10 pounds that an employee lost, that their health care costs went down significantly. If the person had high blood pressure, and they lost 10 pounds, their blood pressure got better. They required less medicine. If they had diabetes, the diabetes became easier to control or in some cases the diabetes would go completely away. Now, there are ways that you can incentivize a healthy lifestyle. Under current law, companies are allowed to decrease by up to 20 percent the premiums they charge their employees if the employee participates in a wellness program. So, for example, Safeway, which is a large grocery store chain across the United States, had a program where they will decrease their premiums by 20 percent for those employees who participate and attend a smoking cessation program. When they do so, they find that people--surprise, surprise--stop smoking. Similarly, if someone joins an exercise program or a dietary program if they are overweight and they lose weight--now, frankly, as I recall the way it's structured, is that the person just has to join the smoking cessation program. They don't actually have to stop smoking. But just as it turns out, people, if exposed to information, act on that information, and they adjust their lifestyles. So either by an exercise program, a dietitian or by smoking cessation programs, by participating in these, they will lose weight. And Safeway has kept their costs for their health insurance constant, whereas there has been about a 7 to 10 percent inflation rate over the United States. I just met with a company based in my hometown of Baton Rouge, Edelmayer, and Edelmayer has been having about a 10 percent inflation rate. But 2 years ago, they instituted a program where they first had all their employees come in for a health assessment. Last year they had all their employees come in for a health assessment--for example, do you smoke, are you overweight, but also a physical exam. Next year they are putting in, as a covered benefit, a smoking cessation program. Then 2 years from now--this is a 4-year process--they are going to decrease premiums for those that participate in these smoking cessation programs. Their premium costs, which have been increasing 7 percent to 10 percent per year, are projected to only rise 3 percent per year when they institute the full program. So by putting in or incentivizing healthy lifestyles, they're going to lower their inflation rate to 3 percent per year. Now, H.R. 3962 actually weakens these provisions. Republican amendments offered in committee would have increased the amount an employee could save if she participated in a wellness program, but these were defeated basically on party-line votes. Similarly, there is a disassociation in H.R. 3962 from what a company can do to incentivize healthy lifestyles and how this provision works. As an example, H.R. 3962 requires that a company pay at least 72.5 percent of an employee's insurance premium. Well, if you've got to pay at least 72.5 percent, that limits the amount you can decrease in order to incentivize somebody to participate in a wellness program. Now, the way you could say it is, if someone participates in a wellness program, you would pay 72.5 percent, but if they do not, you are allowed to decrease your contribution to 68 percent. Now, remember, I'm not saying they have to stop smoking; I'm just saying they have to participate in the wellness program to stop smoking. So there's a key difference. Some people will not be able to, but most people, if given the facts, will be able to do so. So if one of our three imperatives of lowering health care cost is to incentivize healthy lifestyles, we actually see some of the programs which are now working well are gutted or made less able to work effectively under the bill that we just passed. Now, we're never going to control cost if we do not incentivize a healthy lifestyle. As a physician, I will tell you that part of what is driving the cost of health care in the United States is the cost associated with diabetes, high blood pressure, heart attack and stroke. The prevalence of these diseases is so much more in our country relative to Europe that there's at least one article out there that suggests that the entirety of the cost differential between the United States and Europe is because the increased expense of treating these diseases such as diabetes, hypertension, high cholesterol, stroke, heart disease; they all kind of go under the term of a metabolic syndrome, if I'm allowed to speak like a physician. And so if we're not going to get a handle on these, if we're not going to incentivize a healthy lifestyle so that we're not treating the disease on the back end, as opposed to preventing it on the front end, then we will never achieve one of our principle three goals, which is to control cost, because, again, working in a public hospital for 20 years, I've learned, if you do not control cost, you do not have the adequate resources to expand access to quality care. And according to the independent sources, The Washington Post, The New York Times, China, this cost, this bill before us has significant issues as regards its ability to control costs. Indeed, Centers for Medicare and Medicaid Services, called CMS, the Federal government's already paying for Medicare, which is the health care program for folks 65 and above, and a large amount of money for Medicaid, which is the State Federal program for the poor in each State. And there is a new study, the Centers For Medicare and Medicaid Services, that finds that the health care reform bill recently passed in the House of Representatives will increase health care spending to 21.3 percent of our Gross Domestic Product, compared to 20.8 percent under current law, bending the curve the wrong way. If the President says that if we do nothing the status quo is such that costs will double, as it turns out, under the reform package passed a week ago in this Chamber, costs more than double. As crazy as it sounds, the reform bill we passed, according to the independent Centers For Medicare and Medicaid Services, the reform bill costs more than the status quo. And I keep saying that because the President said we've got to have reform to control costs. And according to the Federal Government, our reform costs more than the status quo. At a minimum, reform should not cost more than the status quo. We shouldn't bend the curve the wrong way. We should bend the curve the right way. In addition, the CMS study gives a clearer cost estimate than the one previously given by the Congressional Budget Office. According to the CBO, the 10-year cost of the plan was $894 billion. But the analysis included earlier years of very little government spending. According to the Center for Medicaid and Medicare Services, the House approach will cost $1 trillion from 2013 to 2019, or some $140 billion a year when put into effect. So, in 7 years, it will cost $1 trillion. Clearly, if the goals of health care reform are to control costs so that we can expand access to quality care, according to our government, the Chinese government, two prestigious newspapers, this bill did not do so. What does it do? Well, one thing it does is it takes power away from patients and it turns it over to the Federal Government. Now, it's going to sound like rhetoric, so let me elaborate. Again, as a physician who's worked for 20 years with the uninsured, I've learned that when you put the patient in the middle of process, if you say the most important person here is the patient, then actually, you tend to lower costs and have healthier patients. If you think about it, that program which lowers someone's premiums 20 percent if she participates in a wellness program, it puts the responsibility for someone's health on the person with the greatest ability to make a change--that is the patient. If she is financially rewarded for having a healthier lifestyle, as it turns out she'll have a healthier lifestyle. We, as a society--not only will she be healthier, she will have lower costs and, frankly, those lower costs, among millions of patients, if you will, lowers the cost for the system. There's one way to explain this. There's something in the Republican proposals called health savings accounts. Now, in a health savings account, you put the patient in the middle of the process in the following fashion: A health savings account takes the money that a family would normally spend for a health care premium. It sluices off a portion of it and puts it into a bank account. So if with a traditional insurance policy, at the beginning of the year, a family of four puts up $12,000, if at the end of the year they've not seen a doctor, well, they've put up another $12,000 for the next year. At the end of the year they put up another 12,000, and every year they put up another 12,000. In a health savings account you sluice off a portion, and you put it into an account. Now, that money comes from the money you'd ordinarily be spending for a premium. But instead of spending it for a premium, you put it in this bank account. And instead of asking the insurance company to pay for a flu shot, you pay for it out of your bank account. Instead of asking for the insurance company to pay for your arthritis medicine, you'd pay for it out of your bank account. The advantage is, at the end of the year, if you have money left over, instead of losing it, it rolls over until the next year. Or, if you have a family member whose costs are excessive, you can donate portions of your health savings account to your family member. And so, with that money, it is money that you are incentivized to spend wisely. I'll give you an example. Two patients come to mind, or three patients. There's one patient who's got a traditional insurance policy, and a very nice woman. And she's got an expensive policy but she's a woman of means and she can afford it. And she says, I never look at the bill. If the doctor writes me a generic or a name brand drug I don't care. My insurance pays for it. When I get a bill from the hospital, I don't look at it. The insurance pays for it. And so, because the insurance pays for everything, she likes her insurance policy, but she's got the money to pay for it. Contrast that with someone like the gentleman I'm about to describe. We're talking about health savings accounts. He goes, I have a health savings account. I went to my doctor and my doctor wrote me a prescription for a medicine that I knew by experience would cost $159. Now, notice, he didn't say $160. He said $159, because he's paying for this out of his account. And he said, my doctor wrote me for this medicine for $159. I said, Doc, I have a health savings account. Do you mind writing me for something cheaper? And the physician said, I'm sorry. You have an HSA, and he tore up that prescription and he wrote him for a generic. Now, you can say, why didn't the doctor write for the generic in the first place? He probably should have. On the other hand, who is most responsible for an individual's health? The person most responsible for an individual's health is that individual. And so, just like if I were to go to Target or Wal-Mart and say, okay, I'm going to buy school uniforms for my children, it's really not Target's responsibility to prove to me that they are cheaper than Wal-Mart. It's my responsibility to see who's cheaper and then to go to the place that gives me the best value for my money. So it puts the responsibility where probably it most rightfully should be. And frankly, with that responsibility, the man responded. Instead of getting a medicine that costs $159, he got a medicine that cost $20. The system saved $139. If you multiply that across the millions of transactions, then this system saves millions and even billions of dollars. Now, we have just gone from the anecdote of an individual patient. Let's talk about a study. Kaiser Family Foundation, a little bit of a left of center group, but a good group, did a study where they compared the cost for a family of four which had a health savings account with a catastrophic policy on top, so if they have a terrible illness like a liver transplant that exceeded the amount of money in their account, the catastrophic policy picks it up on the top end. They compared it with the cost of a traditional insurance policy for a family of four. They found that the family of four, with the HSA, the health savings account, and the catastrophic policy on top, they found that that family's cost of that HSA and catastrophic policy was 30 percent cheaper than the cost of the traditional insurance policy for a family of four. And they found that both families used preventive services as frequently. So what we have here, if our goals of health care reform are to control cost, to expand access to quality care by lowering premiums, the Kaiser Family Foundation found that the family with the HSA and catastrophic policy, their policy costs were 30 percent cheaper compared to traditional insurance. They also found that 27 percent of those people who had an HSA and a catastrophic policy were previously uninsured; that 50 percent of people with these sorts of policies had family incomes of $50,000 or less, and that about 60 percent of such families had family incomes of $70,000 or less. So, by controlling cost, the HSA catastrophic policy, 30 percent cheaper, by controlling cost, those people who were previously uninsured, 27 percent of the folks with these HSAs were previously uninsured, were able to now purchase insurance, and with this insurance they access preventive services as frequently as those with traditional policies. So the goals of reform were achieved. Lowered cost, expanded access to quality care. I've been joined by a colleague of mine who is also a physician, a family physician, also a small businessman. And Dr. Fleming, we're discussing costs and how control of cost is so essential to expanding access to quality care. Do you mind sharing the anecdote of that employee, when your group went to HSAs, because I want to show how the two things I've discussed so far have been how you can incentivize healthy lifestyles and control costs by decreasing premiums, if you will, and also how health savings accounts, by directly connecting people with costs, can also be cost savings. Your anecdote combines those two. Can I ask you to share that?

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, as a practicing physician, I know that this bill has tremendous consequences for patients and for the economy. It is estimated that the $730 billion in new taxes in this bill will kill 5.5 million jobs. The CBO estimates that this will have an annual inflation rate of 8 percent, an annual inflation rate that more than doubles costs in 10 years. The Republican bill expands access by lowering premiums 10 percent. This bill expands access by forcing businesses and individuals to purchase, and if they do not, the long arm of the State reaches out and grabs them and shakes out fees and penalties. Now, it was said this morning by a Democratic colleague that we need to redefine freedom. We are going to need all kinds of new definitions. We are going to redefine freedom as the ability to do what the government tells you to do. We are going to redefine helping the economy as higher taxes and destroying jobs. We are going to redefine bending the cost curve as more than doubling costs in 10 years. Consider not the rhetoric, but the facts. Please reject this bill.

Mr. CASSIDY. Mr. Speaker, I have spent 20 years caring for the uninsured in Louisiana's public hospital system. Skyrocketing costs put quality care out of reach for too many Americans, and I appreciate that everyone agrees the status quo is unacceptable. All agree on the goals of reform: lower costs and expand access to quality care. Unfortunately, this bill does not achieve our goals. The Congressional Budget Office says it raises costs. Without lowering costs, access or quality will suffer. Its effects will be radical, but this is not a radical bill. It turns insurance bureaucrats into federal bureaucrats. There's no innovation, just nationalization. Real reform would revolutionize health care. Real reform would give patients, not bureaucrats, the power. Unless patients are empowered with control over health care dollars and decisions, costs will not be lowered and access will not be expanded without sacrificing quality. The road to real health reform begins with stopping this bill today. I urge my colleagues to join me in this effort.

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, when they have events such as they had in China, one thing that happens is that as the buildings fall upon folks, they crush their muscles, and they end up having kidney failure. This comes to mind because after Katrina, one of the disasters that happened was that there were many people on dialysis that had to be evacuated from New Orleans to Baton Rouge, and there had to be an emergency dialysis center situation established. I thought about it: one of the great things about our current system of care is that there is this elasticity that exists in our country that often does not exist elsewhere. Yet when I toured recently those dialysis centers in my city, as it turns out, they're kept afloat by the few patients they see who have private insurance. Many of those patients are on Medicaid or Medicare. As it turns out, Medicaid pays about 60 percent of costs and Medicare pays about 90 percent of cost. So were it not for the private insurers paying over cost, we would not have the ability to treat the dialysis patients here or in the emergency situations, those that are evacuated up. It brings to mind immediately, of course, the health care bill that is before us. It attempts to expand the system of Medicaid and Medicare that is actually depriving our system of the resources it needs to care more carefully for those who are in times of natural disaster. That said, it is admirable to control costs in this bill, but paradoxically, the CBO says that this bill, which supposedly controls costs, actually will have an inflation rate of 8 percent per year. So 8 percent per year more than doubles costs over the next 10 years, Mr. Speaker. It's ironic when the President says that if we do nothing, costs will double in 10 years, if we do this bill, according to the Congressional Budget Office, costs will more than double in the next 10 years. So I guess, Mr. Speaker, in closing I would say that there are three imperatives to health care reform: it is controlling costs so we can expand access to quality care. We've seen in other countries where there is inadequate resources placed or inadequate attention to cost that, indeed, these are not addressed. I would ask that we reject this reform for its deleterious effects on our system.

Mr. CASSIDY

Mr. CASSIDY. Madam Speaker, I yield myself such time as I may consume. I rise today in support of House Resolution 752, recognizing the tragic loss of life that occurred at the Cherry Mine in Cherry, Illinois, on its 100th anniversary and the contributions to worker and mine safety that resulted from this and other disasters. On November 13, 1909, 400 miners went to work at the Cherry Mine in Cherry, Illinois. This mine was one of the first to have electric lighting, but on the day of the disaster, the system was not working. Instead, miners were using torches to light their way. Mules were being used to bring coal to the mine elevator, and the hay to feed those mules provided the fuel that started the fire that ultimately killed 263 miners. Miraculously, 200 miners working that day escaped. Even more amazing, though, 21 miners survived for 8 days underground with no food and little water. In order to suppress the fire, those above ground sealed the mine. Conditions below ground deteriorated rapidly. Led by mine manager George Eddy, the 21 miners who survived went into the recesses of the mine to escape the fire and seek good air. Ultimately, the miners barricaded themselves deep in the mine, attempting to block out the bad air. They were able to pool water from seepage in their shelter. The tragedy of the Cherry Mine has sadly been repeated in one form or another throughout the history of mining. With this resolution, we honor those lost in the mine. We also honor those who demonstrated their courage and resolve in the face of the tragedy. Just as we see in today's miners, those trapped in the mine fought hard to stay alive. The men above ground did everything they could to put out the fire with the hope of saving their fellow workers. I rise today to recognize the loss at the Cherry Mine and to honor those who work in our mines today. I ask my colleagues to support this resolution. Madam Speaker, I reserve the balance of my time.

Mr. CASSIDY. Madam Speaker, I yield back the balance of my time.

Mr. CASSIDY

Mr. CASSIDY. I yield back the balance of my time.

Mr. CASSIDY. Madam Speaker, I yield myself such time as I may consume. I rise today in support of House Resolution 878, expressing support for the goals and ideals of National Family Literacy Day. Literacy is an issue that is important to people of all ages, from kindergarteners just learning to read to adults whose everyday lives require reading skills. Problems with literacy also affect people of all ages. Children with literacy problems are far more likely to drop out of school before they graduate than those without literacy problems. In addition, approximately 85 percent of all juvenile offenders have problems reading. Approximately one in seven American adults have difficulty reading, according to the most recent literacy report. Difficulty reading spans generations and affects people of all ages. Family literacy encourages parents and children to learn together and encourages parents to become involved in their children's education. Multigenerational learning enables every willing family member to engage in learning and improve their ability to read. Children specifically can benefit from family literacy in a number of ways. Children spend a large majority of their time outside of school. Engaging children in reading in their family environment allows children to extend their learning time beyond the time they spend in school. Additionally, research has shown that children whose parents are involved in their education perform better in school. Family literacy encourages families to learn together and support each other in improving their literacy skills. National Family Literacy Day took place November 1 this year. On this day, schools, libraries and community centers were encouraged to hold book drives, family reading events, workshops and other events that encourage families to read together. Approximately 8,000 literacy programs and schools held events to honor National Family Literacy Day this year. By recognizing National Family Literacy Day, we honor the importance of families learning and reading together. I am honored to support this resolution, and I ask my colleagues to join me.

Mr. CASSIDY

Mr. CASSIDY. Madam Speaker, I yield myself such time as I may consume. Madam Speaker, I rise today in support of House Resolution 880, recognizing the efforts of post-secondary institutions offering career and technical education to educate and train workers for positions in high-demand industries. Post-secondary institutions that offer career and technical education are an incredibly valuable resource to our communities. These institutions enable adults in the community to improve their lives by furthering their education in order to improve their employability and working life. Career and technical education enables students to learn specific skills or earn a certificate or a degree that employers require or prefer. Many institutions that offer career and technical education also have valuable connections with employers in the community. These connections allow these institutions to better serve their students. Employers in high-demand industries are able to communicate with post-secondary institutions what skills, certificates and degrees they expect potential employees to exhibit. The close relationship between post- secondary institutions that offer career and technical education and employers provide students, and potential employees, with a valuable advantage. The Bureau of Labor Statistics estimated that 15.6 million new jobs will be added to the labor force between 2006 and 2016. These industries and employers also benefit from the unique relationship between post-secondary institutions that offer career and technical education and local business leaders. The relationship enables industries and businesses to communicate where there are experience and employment gaps and what skills they require for such positions. Post-secondary institutions that offer career and technical education provide students and the business community with an invaluable connection. I am honored to support this resolution, and I ask my colleagues to join me. Madam Speaker, I yield back the balance of my time.

Mr. CASSIDY

Mr. CASSIDY. Madam Speaker, I rise today in honor of the West Baton Rouge Museum, located in the City of Port Allen in Louisiana's Sixth Congressional District. It gives me great pleasure to announce that as of August 7th, 2009, the museum has achieved national accreditation by the American Association of Museums, becoming only the 11th museum in Louisiana and the 777th out of the more than 17,000 museums throughout the nation to achieve this distinguished accreditation. The West Baton Rouge Museum has successfully demonstrated that it meets the high standards established by the accreditation program and the museum field. It has done this through its completion of a rigorous process of self-study and reviews by a visiting committee of its peers and the Accreditation Commission. The accreditation process certifies a museum's commitment to excellence and professional standards of operation. The West Baton Rouge Museum is a regional history museum that was established in 1968. Through the hard work and persistent efforts of its curators, benefactors, and other supporters, it has grown to include a four-acre campus that offers six historic buildings and an 11,000-square-foot main museum building. It has become a staple of the local community and an invaluable resource to showcase the culture, art, and history of the region. With this accreditation, I can only hope that the Museum's next forty years will be even more successful than it's first.

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, health reform is a moral and national imperative. As a physician, my experience in treating uninsured patients at public hospitals teaches me that empowering patients is the best way to lower costs and improve patients' health. Patients are the best guardians of health care dollars. Real reform empowers patients to make wise decisions for their wallets and their health. Unfortunately, this bill introduced last week empowers government, not patients. And this 2,000-page bill, and this is half of it, a trillion dollars, is concentrating power in Washington, taking it away from States and citizens. For example, it creates 111 boards, bureaucracies, and commissions and has $730 billion in taxes. This government-centered plan won't work. In fact, the Congressional Budget Office says that it increases the cost to patients and taxpayers. The patient-centered alternative offered by Republicans will save patients money, save taxpayers money, and expand access to quality care.

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, what strikes me about this process is there actually is common ground here. We can agree on the goals we want. We want to lower cost and increase access and have quality care; but I think the problem we are addressing is there is a philosophical divide as to how we approach that. I liked what Dr. Fleming said when he spoke about if we can empower patients, we can lower cost. One example of empowering patients and lowering cost is health savings accounts, which the Republican alternatives all strengthen and the Democratic alternative weakens. A health savings account, imagine what is currently the case where a family of four puts up $12,000 a year. At the end of the year, if they haven't used any resources, they put up another $12,000, and the year after they put up another $12,000, but in a sense it is starting over every year. In a health savings account, you sluice off some of that money and put it into a banking account and the family controls that account. The patient is empowered to make wise financial decisions. If at the end of the year they have money left over in that account, it rolls over to the next year. They actually can hang onto it. Two examples of how this works, a friend of mine back home, a woman with some wealth, has a policy that pays for everything. As it turns out, she doesn't care what it costs because her insurance policy pays for everything. She said she doesn't look to see if her doctor gives her a generic or a name brand drug or what the bill is. She knows insurance will pay for it. She doesn't go through her itemized list to see if all expenses are appropriate. Contrast that with another fellow. I mentioned to him about the power of health savings account. He says, I have a health savings account. My doctor writes me a prescription and I know from experience, I tell him that it costs me $159. Notice he didn't say $160; he said $159. Because it is his own money, he is looking at the itemized deductions. He said, I have a health savings account. Do you mind writing me something less expensive? The doctor says, I'm sorry, tears it up, and writes him a generic that costs $20. The system just saved $139, not because a bureaucrat in Washington, DC said thou shalt, but rather because someone looking after his own financial interest made the best decision for his health care. We know this works on a systemic basis. The Kaiser Family Foundation did a study. They compared a family of four, their expenses with a health savings account and a wraparound catastrophic policy, with a family of four which had a traditional insurance policy. The family of four with the HSA catastrophic, they paid 30 percent less for their coverage than the family of four with the traditional insurance policy, and both families, if you will, were equally likely to access preventive services. So we see by controlling costs, we increased access to quality care, and we did it by bending the cost curve. What concerns me about the bill advanced by Ms. Pelosi is, according to the Congressional Budget Office, the inflation rate for these bills is 8 percent per year. Now, President Obama says we have to have reform because costs will double in 10 years if we do not. As it turns out, with the reform we have been presented, costs more than double in 10 years. At a minimum, reform should not cost more than status quo, but actually it does. And if we don't control costs, we know that if we don't control costs, access is denied. Now, we can always make that up by increasing taxes, but when you start off with a bill that increases taxes by $730 billion, it doesn't leave a whole lot of room, Mr. Speaker, for increasing taxes any more. At some point your increased taxes drive up costs, which decreases access, which means you have to spend more and you increase taxes even yet more. It is not wise public policy. So in closing, I will yield back after saying that I think our Republican alternatives concentrate the power with the patient. It is patient centered, empowering patients. Contrast that with the bills that are before us which, frankly, concentrate power in Washington, D.C., by collecting taxes, 111 bureaucracies, boards and panels, which will again take power away from the woman with her doctor in the exam room in her hometown and transfers it to Washington, D.C., where someone will attempt to dictate how that interaction takes place.

Mr. CASSIDY

Mr. CASSIDY. You know, I agree with almost everything Congressman Burgess said, except for one thing, in that I do think it is important to discuss our Republican alternatives, because, frankly, part of the rationale, the steamroll we are on, is there is no other option. We have, as the President has said, the cost of doing nothing, the costs will double over the next 10 years, and that is an inflation rate of about 7 percent if it compounds. Well, as it turns out, since the cost according to the Congressional Budget Office of the reforms before us--the inflation rate is 8 percent per year--under the reform proposals before us, costs more than double in 10 years. At a minimum, reform should not be more costly than the status quo. That said, I think it is important for us to discuss alternatives. I think we can all agree on the goals. We need to control costs. I am with the President on this. If we cannot control costs, we cannot expand access to quality care. Now, as it turns out, we three are physicians. We know that if the patient is in the middle of the process, then costs are controlled. There is a report by McKinsey & Company and it talks about the three imperatives for health care reform, and they are to decrease the administrative costs--so much money goes to administration; to have transparency, so that when a patient goes in for her knee surgery, she knows before the surgery how much it will cost her, not find out a month later; and, lastly, incentivize healthy lifestyles. So in a patient-centered plan we should lower administrative costs, increase transparency, and incentivize healthy lifestyles. So I would like to compare it to the 2,000-page, $1 trillion, 20- pound bill. Now, does it lower administrative costs? You almost have to laugh, because it creates 111 new bureaucracies, boards, commissions. You name it, it clearly expands administrative costs. Does it incentivize healthy lifestyles? I actually read that provision today, and it gives grants to small businesses that come up with innovative ways in which you can make employees healthier. But it is very vague and very gauzy. And I kept thinking of that small businesswoman who is really struggling to make ends meet, trying not to lay people off. What is the likelihood that she is going to take 2 hours a day to write a grant application to submit to the Federal Government on the hope they will give her $150 per employee, which is the maximum allowed, in order for her to come up with a wellness program? That is something written by a Washington bureaucrat, not by someone who knows the travails of a small business person. Lastly, transparency. Frankly, I just find it unbelievable that a bill that creates 111 boards and commissions will be transparent. That said, what are the alternatives? I think we would all agree from our own experience, patient-centered care can work. For example, you have got great anecdotes about health savings accounts. Congressman Fleming, who just left, I love his story about a health savings account. For those who don't know what they are, with traditional insurance policies, a family of four, you put up $12,000 a year. If you use the insurance, you may get some of your money back, but at the end of the year it is gone, and you put up another $12,000 for the next year. With a health savings account, you sluice off some of that money and you put it into a banking account, and that banking account is yours and you can spend it on the things which you choose. But at the end of the year, if you haven't spent it, you keep it. With the traditional policy, you start over. With the health savings account, you conserve that money and it is there for you the next year. It rolls over, and it is that much less you have to put forward. It changes the psychology. We know that. But just to explain it, in a patient-centered account, a patient was telling me, he goes to a doctor. The doctor writes him a prescription, $159. He says, doctor, you have given this to me before. It is $159. Listen, I have got a health savings account. Can you write me something cheaper? He goes, oh, I am sorry. He writes him a $20 generic, so the system just saved $139. I actually think the power of millions of individuals making decisions at $139 a decision has more ability to control costs than 111 boards and commissions in Washington, D.C., that are attempting to control health care in all the small towns across the United States.

Mr. CASSIDY. If the gentleman would yield, I was a little late coming over here because we were having a telephone town hall. For the folks who are watching, that is where we from Washington have a phone call that goes out to thousands of people in our district, and we have a telephone town hall. There was a woman that got on and she just nailed it. You pointed out, we have a 2,000-page, $1 trillion bill that was introduced last Thursday that we are going to vote on this coming Friday that is going to remake 17 percent of our gross domestic product, drastically affecting the health care for us all. If it seems kinds of crazy that we would do that, this woman calls in, Rebecca, and I happen to know the family, I didn't realize it was from her family, and they are very bright people, very hardworking, good people. So here is kind of her quote. She went to the Kaiser Family Foundation site to determine what her costs would be under the bills before Congress, and she figured out that her family's costs would double. She says a small business is going to do a cost-benefit analysis, and they are just going to dump patients upon the public option because, why shouldn't they? Now, she says, I am quoting her, it seems like the people writing this are obtuse. They are not writing this for the middle class of the Nation. It is not centered on the patient. It feels rushed. It doesn't make sense; 2,000 pages, one week to digest it. It feels rushed. She finishes up by saying, for all the possible plans, our premiums will double. It is very expensive. You can't get ahead. The more productive a citizen you try to become, it is like you take one step forward and go two steps back. This is a bill which is two steps back.

Mr. CASSIDY. If the gentleman will yield for just a second, this bill specifically excludes small businesses from doing what you described as a wellness program. That effective program is specifically excluded. So the patient-centered program which was so successful in Johnson City is not allowed in that 2,000-page bill.

Mr. CASSIDY

Mr. CASSIDY. Mr. Speaker, on rollcall No. 833, I was unavoidably detained. Had I been present, I would have voted ``yea.''

Mr. CASSIDY

Mr. CASSIDY. Madam Speaker, I rise today in honor of Staff Sergeant Ory Marioneaux, Sr., U.S. Army, on the occasion of his 90th birthday. Born in Baton Rouge, Louisiana on October 28, 1919, Ory Marioneaux has lived in Baton Rouge nearly all his 90 years. He graduated from McKinley High School in 1940 and rose to the rank of Staff Sergeant in the U.S. Army, fighting for our country in the European Theatre of World War II in 1942. After his honorable discharge from military service, Ory returned to Baton Rouge and was reunited with his wife, Mary Agnes Honore', with whom he raised eight children, twenty-two grandchildren, and several great-grandchildren. Ory worked in service to the people of Baton Rouge throughout his career, both as a private contractor and public employee. Ory worked as a maintenance supervisor for the Housing Authority, a construction supervisor for the city of Baton Rouge, and a teacher of the World War II defense program at Southern University. Ory Marioneaux has led a life of service to his country and devotion to his family that should serve as an example to us all. I join his family in wishing him, on behalf of a grateful country, a happy 90th birthday.

Mr. CASSIDY

Mr. CASSIDY. I am actually going to disagree with my colleague from Shreveport--and by the way, he is from north Louisiana, not south. The point being is that these gimmicks only pay for on paper. So the Congressional Budget Office, which makes an assessment, Does this achieve the goal of controlling cost? Because as President Obama points out, controlling cost is important. These gimmicks only control it on paper. Ultimately, this would be paid for not by gimmicks, but it will be paid for by taxpayers or by debt. Ultimately, that debt will come from taxpayers again. That's why I think Speaker Pelosi says of the savings--this is a public statement--The savings in the bills before the Senate side, the Democratic bills before the Senate, will come off the backs of the middle class, and these taxes will continue to be paid for by the middle class. I have learned in my practice--because, again, I have worked in a public hospital. I have worked in a government-run hospital where the nurses, doctors, med techs, therapists do their absolute best to bring health care to those who otherwise would not have it, a true safety net hospital. But when there is no money, the lines lengthen. When there is no money, something has to give. Now as it turns out, either we're going to raise taxes, we're going to borrow money, or their lines are going to grow; and our reform goals of controlling cost and, thereby, increasing access to quality care will not be achieved. On the other hand, let me just kind of amplify on your health savings account. The Kaiser Family Foundation has a study--I believe the Web site is kff.org--and they looked at a family of four with a health savings account and a wraparound catastrophic policy versus a family of four with a traditional insurance policy. They found that the cost of the patient-empowering health savings account with a wraparound catastrophic policy was 30 percent cheaper than the traditional insurance policy, that 27 percent of folks who had the health savings account with the wraparound catastrophic policy were previously uninsured, and that these folks who now have insurance access preventive services as frequently as a family with a traditional policy. We achieve the goals. By empowering patients, we, the folks buying those policies, lower their cost. By lowering their cost, folks who were previously uninsured now have access to insurance and, once having access to the insurance, are accessing the primary and preventive services as frequently as those who are paying 30 percent more for their insurance. The goals of insurance have got to be that. Now, again, I'll go back to the analogy I used earlier. We can either put the new financing, the new tax dollars in the old wineskin of a top-down, government-controlled, bureaucratic health care delivery system or we can use new wineskins, and I think the new wineskins that the Republican Party wants to use are patient-empowering. How do we empower patients to make a decision that's good not only for their health but also for their pocketbook? And by so doing, you lower cost. People previously uninsured can now afford it, and once they have their insurance, they're able to access those primary and preventive services. As practicing physicians, as a guy that's been working in a safety net hospital for some time, that seems the wineskin for us.