John Fleming

Mr. FLEMING

Mr. FLEMING. Madam Speaker, it's a pleasure to be on the floor once again to really talk about my favorite subject in Congress, and that is health care. I am a physician and have been a physician for 36 years. I am a family physician. I still have an active practice and practice when I get a chance, which lately has not been very often. We'll be talking about ObamaCare, the repeal of ObamaCare, and we'll be talking about Medicare. I say ``we.'' That is only if I'm joined by some of my colleagues who may be making their way here this evening. I want to in the way of introduction just let everyone understand, Madam Speaker, how we got here in the first place. Why are we here this evening talking about this? Why are we talking about the repeal of ObamaCare? I take you back to 1965 when there was a recognition that health care insurance was becoming something more than just insurance; that is to say, that insurance, of course, in theory is to protect against catastrophe. We see that, of course, in our homeowners insurance and our car insurance. So it seemed a good idea to have some form of insurance where you would not be bankrupted by a sudden and severe illness and have your lifesavings taken away. So the idea of insurance came up, and it was mostly a catastrophic policy. Then that sort of evolved over time into more and more comprehensive concepts, and it really has become today extremely comprehensive, perhaps even a health management type of system that you pay into and hopefully the system takes care of you. It was a recognition that a robust market did not exist for insurance for the elderly. From that sprang the idea of Medicare, health care insurance for the elderly, which is really not insurance, per se. It's really a 100 percent single-payer government program. Then also insurance--again, a single-payer program--for the poor, and that is Medicaid. That began around 1965. It began with a promise to the health care system and to the elderly that this would never usurp the relationship with the patient, that the decisions would be made by the providers and the patients, and that Medicare--of course, the government taxpayers, if you will--would be picking up the bill, no questions asked. There was also a recognition that even though patients would get help with their bills, they would still have to pay something into that. I will also interject that there was the belief, actuarial estimates, CBO, the Congressional Budget Office, that predicted that a program that would be maybe $3 billion annually would maybe top out at $12 billion. Of course we know now that it's in the hundreds of billions of dollars many times over what it was initially promised to be. In that evolution, we saw where government and insurance companies began to take a larger and larger role in covering for various things. For instance, beginning in the early eighties, Medicare began to see the physician charges becoming a problem, and from a budgetary standpoint they weren't really going up that fast, but because of the growth of the elderly out there it was running the cost up. That led to restrictions put on what doctors could charge. Then came EMTALA, which is an acronym, a long acronym, that basically says regardless of your ability to pay, if you show up to the emergency room, the doctors and hospital have to treat you. These are all things that began to add up over the years, and it's made Medicare, of course, balloon into an extremely expensive program, as is Medicaid as well. In fact, for most States that is the largest budgetary item that they have. Well, fast forward to 2008. As a physician, I became very concerned that we needed health care reform in this country. Why? Because government had become such a large part of the health care system and the so-called insurance thereof, and with the price fixing that went along with that, that it began to actually have a perverse effect on health care. That is to say that as reimbursement to hospitals, doctors, and other providers were going down, that costs were actually going up just as fast, which is just the opposite you would expect intuitively. Why was that happening, and why is it happening today? Well, the answer is this: a physician, a hospital, anybody, the first thing that they are going to do, the first thing a business or a factory is going to do is when the reimbursement per unit goes down, that is a reimbursement per patient goes down, you make it up on volume and you keep working harder and you keep seeing more patients, and you find more things to do to drive up that, and I'm saying this in a generic way. I do not ascribe to that, but many doctors have been put in that position to just stay solvent in their practices. They have run faster and faster, seen more and more patients, done anything they can. While they make an extra dime to keep up with their costs, they're running the system up by a factor of 10. They make a dime for themselves, but the system costs a dollar for that. As a result, we have had severe inflation. It was my belief that the way to solve this problem was to begin to move government out of health care and begin to move the private sector back in, put together robust and healthy markets, give consumers choices once again. Patients have skin in the game--that is to say, they have to pay a little something into it. Because, remember, back in the eighties, patients' out-of-pocket expense, for instance, in Medicare for laboratory and many other items went to zero, which meant that instead of having to negotiate with the patient, what is the best ideas in terms of a list of tests that must be performed to get to the answer, I can just simply make out a list as long as I want. Somebody is going to pay for it, but it won't be the patient, and therefore, again, health care inflation. I came to Washington after being elected to work on this with the other side of the aisle, because I saw that we had two major giant entitlement programs that are bankrupting this country, Medicaid and Medicare. I remind folks that Medicare runs out of money, according to whichever actuary you want to listen to, in 5 to 12 years. But they all agree that it runs out of money and the services will have to be sharply curtailed. What we found was that the other side of the aisle, our Democrat colleagues over there decided that instead of solving the problem by bringing the marketplace, they wanted to take government another step. It reminds me of a story that was told to me once about two farmers. They were on a wagon, a mule, and they are going down the road, it's an old farm road, and one of the wheels breaks and they come to a stop. Now, the mule can't pull that wagon, it's just too hard to pull it on one wheel. So the two farmers get off, one starts fixing the wheel and the other one starts going back home. The first farmer says to the second one, where are you going? He said, I'm going to get another mule, because that's the way we're going to go forward. We're just going to hitch a second mule and keep dragging this wagon down the road. You see, in my opinion, that's precisely what happened with ObamaCare. Instead of fixing our health care crisis and the inflation and costs, the inefficiencies in the system and the fraud, waste, and abuse, by bringing the marketplace back into sanity and back into balance once again, and letting patients be the decisionmakers, what we really did is double down on the government control of health care and, as a result of that, we're going to have an even more expensive, more burdensome and bureaucratic system that we won't be able to control. Anyway, this is the Doctors Caucus Special Order. We're going to be talking in the next 30 minutes, and we're going to be talking about the repeal of ObamaCare. We have voted on this, you probably already heard, several times already. Of course, we have never got it past the House of Representatives because the Senate won't take it up and, of course, it's doubtful that the President, our current President, would ever sign it. There are a lot of things that we hear about ObamaCare. Let's talk for a moment about taxes. We just had a Supreme Court decision handed down, and there has been this debate, this battle, within the Supreme Court and outside, on this individual mandate where government under this bill literally forces and requires you to purchase a product or service that is created by government, rather than making it more affordable and attractive and you opting in and you buying it on your own. The decision has been handed down that, yes, the decision is constitutional, but not by the way of the commerce clause. But government can, Congress can now, according to the justices, Congress can basically make you do anything Congress wants to do. It has to force you through taxes. While we could debate whether I agree or not agree with that, that is the law of the land now. This means that if we in Congress decide that we want to make citizens do things, we do have a pathway now to do that, and that is to tax you. Even if you're not in an activity or buying something we can still tax you. I prefer that we go the market route. I would much rather people buy insurance because they see a need, they see a desirability, and they see that it's cost-effective, rather than forcing Americans to do that. Our colleagues on the other side, would rather just simply force you to do that. But now we have to also admit that this is a tax, and our friends on the other side of the aisle I think would admit that had this been advertised as what it turns out to be, a big tax increase on the middle class, that it never would have gotten passed because they would have been voted out of office for having raised taxes on the middle class. That's a big political no-no these days. But there are many other taxes, and I'm just going to hit on a few here. One is a 156 percent increase on the Federal excise tax on tobacco. Another is the employer mandate. The Supreme Court says that you can, Congress, you can make employers buy insurance or you certainly can penalize them if they don't. But, interestingly enough, one part of the bill that was termed unconstitutional was coercing, or forcing States to expand Medicaid eligibility. That's a part of the Supreme Court's decision that actually is going to impact the cost of this bill. There is a surtax on investment. This is something that you're going to hear more and more about, and the way you're going to hear about it is that one day you're going to sell a home, you're going to sell a property or an investment or something like that, and the IRS is going to demand 3.8 percent of those profits. On the subject of the IRS, remember that it's estimated that 16,500 new IRS agents will need to be hired and are funded in order to require or force the taxation into ObamaCare. This will certainly bring the IRS much more intimately into your life, regardless of whether you own a business, or you're simply an employee, or really don't even have a job. There will be an excise tax on comprehensive health insurance plans that will go up over time, ObamaCare hike in the Medicare payroll tax. There will be a medicine cabinet tax, if you will. But what that really is removing is the tax deductibility for the pretax dollars from health savings accounts that you have been able to enjoy before, that if you go and buy cold medicine off the shelf, that you could buy it with your pretax dollars under your health savings account, that's gone. If you want to get cold medicine and use your pretax dollars, you have to get a prescription from a doctor. So one of two things are going to happen: Either you're going to have to see the doctor, which is going to cost you more, or the doctors are going to be spending a lot of their time, again, wasted in paperwork, writing prescriptions for nonprescription drugs. That really doesn't make much sense. There will be an ObamaCare HSA withdrawal tax hike, an ObamaCare flexible spending account cap, ObamaCare tax on medical device manufacturing. It's estimated that many of the domestic medical device factories will simply go out of business or go offshore. The cutting- edge innovation that we have today in health care devices, we're going to lose that has a result of ObamaCare. That will go to other countries. The itemized deductions, the exemption is going to go from 7.5 percent to 10 percent of adjusted gross income. There will be a tax on tanning. That's got to be a middle class tax. ObamaCare elimination of tax deduction for employer-provided retirement drug coverage in coordination with Medicare part D, ObamaCare Blue Cross Blue Shield tax hike, an excise tax on charitable hospitals, a tax on innovator drug companies, a tax on health insurers, a $500,000 annual executive compensation limit for health insurance executives, ObamaCare employer reporting of insurance on the W-2, the black liquor tax, the ObamaCare codification of the economic substance doctrine. Again, a long list of taxes. So, Madam Speaker, it seems to me that in a time that we have the worst recession since the Great Depression, we're now facing perhaps the largest tax increase that's occurred in our lifetimes, both through ObamaCare and through the expiration of the Bush tax rates, which are much lower than the Clinton tax rates. Of course, you have heard some about that as well in recent days. In fact, the President himself said in 2009 the last thing in the world we want to do is to raise taxes in a recession. And everybody knows we're in 41 months of a recession and no end in sight. Now, there's also been some discussion and debate on the impact on small businesses. And I'm segueing to small businesses because, let's face it, taxes have an impact on all of our pocketbooks, but taxes also have an impact on the ability for small businesses to hire people. If you take money off their bottom line, that's less money, less capital to invest, less money to hire more people. And that is precisely what is going on with ObamaCare. In fact, I would say, based on studies that I have read, one said that 70-plus percent of small businesses are saying that the main reason that they're not hiring people is because of their fear, the uncertainty of ObamaCare and its impacts on them, and the people I speak with throughout my district and throughout the country who say that ObamaCare is probably the worst threat to the survival of their businesses and, therefore, they're not going to expand their businesses. We know there's trillions of dollars sitting on the sideline right now, both small and large businesses, ready to be invested to grow jobs, and yet the job creators, the employers, are fearful. They don't want to put that money in. Why would somebody want to put, say, $10 million into a new factory not knowing whether they can make a profit and making the calculation that perhaps I should stand up that factory overseas someplace where, in fact, I can make a profit. I don't have to deal with ObamaCare and all that comes with it. Now, that's just part of. We also know the hyper-regulatory atmosphere that we've evolved into, where regulations are not being written by Congress but by people in the buildings that surround the Hill here, many of which we do not yet know. 106 new major rules being written out of this administration, the worst proliferation of regulations. So this, on top of other things--the direct hostility and attacks on energy and the job creators themselves--has just put a complete wet blanket over our economy and the creation of jobs. And I would say that ObamaCare is the lead in that entire process. Now, there's also something that I get asked about a lot, and that is, well, what about what you Republicans say about ObamaCare and what the Democrats say about ObamaCare? And it seems--at least it appears to them--that one of us is lying about some of these things. And, of course, one of the things that is important that we do when we come to Congress, what we understand and learn, is that we should never presume ill motives of the other side. And that's exactly what I will do tonight is not presume ill motives by the other side. So I will give you an example of what I'm talking about. We Republicans have contended all along that $500 billion will be ripped from Medicare. Again, I said earlier that Medicare runs out of money, becomes insolvent, in 5 to 12 years. Everybody agrees it's in that window someplace. And we have the Ryan budget plan, which would save Medicare. The other side of the aisle refuses to engage on that. But the question is: Does ObamaCare take $500 billion out of Medicare? I have a lot of Medicare recipients who are very worried about that, and they ask me because they hear and read things. They read something from PolitiFact or all these fact checkers, and they say, no, this isn't happening, or it's not happening the way you think it does and so forth. Well, we had a discussion with Douglas Holtz-Eakin, who is the prior CBO, about this 2 days ago, and he confirmed a lot of my beliefs about this, and here's the way it goes. Madam Speaker, the way laws are written, oftentimes what is in the four corners of that law says one thing, but when you add the omissions and the unintended consequences and sometimes intended consequences, the effect of that is completely different. And so, for instance, the idea that Medicare does not lose $500 billion that is dumped into ObamaCare, well, I think the nuance in there is that you have to understand that the cost of Medicare goes up progressively every year. Now, in some years it goes up higher than other years, but it always goes up. And so in Washington, oftentimes you can say that something is cut when, in fact, it's just the increase is reduced. And so that's really what happens here, is what Democrats did in crafting ObamaCare is they cut the increase in Medicare spending and they took those so-called savings and they spent it inside of ObamaCare. Well, where is it coming from? Is it going to have an impact? Well, of course it will. Because as things get more expensive, if you reduce the amount of increases that nominally occur, it's going to have an impact because there isn't an underlying inflationary rate that has to be recognized. So while one can make the legalistic case that, no, there isn't $500 billion removed, in reality, yes, it is removed because you have got to go from point A to point B. And if you don't allow that nominal increase, that inflationary rate in Medicare spending, if you don't allow that, it's a cut. It's going to be a cut in services. And where are the services? About half of it is going to be in Medicare Advantage, which is the private type of Medicare which people really love. It's very popular in a lot of States. And the other is going to come from providers. That would be doctors, hospitals, medical device providers, and so forth. Now, the Democrats were very careful not to take that money from beneficiaries. And, in fact, in the sequestration that occurred last year and that we're still debating, where money is taken out of defense and it's also taken out of Medicare, the money is taken out on the provider side but not the beneficiary side. That is, we're not taking away from patients, we're only taking away from the people who are providing the care. Well, that's all well and good. Well, not so fast. You have to understand that as you reduce reimbursement of services, the ability for providers to provide those services goes down. And it has been going down progressively. Certainly, a relatively small percentage of physicians today accept Medicaid for payment and reimbursement. So even if you have a Medicaid card, which, by the way, half of the so-called increase in coverage under ObamaCare will be on Medicaid. Well, that will be very good. You'll have a Medicaid card. But when you shop around and you go to various doctors' offices and you say, I'd like to see the doctor today, there will be a lot of the assistants at the desk that will say, I'm sorry, we don't accept Medicaid. Now, you might be critical of the doctor on that, but you have to understand, doctors have to make payrolls, and they have to pay rent like everybody else. And if it comes to a point where they can't do that, then they either have to stop seeing Medicaid patients, or they have to go out of business. Either way, you're not getting in to see him because the reimbursement is not there. Well, the same phenomenon is now happening across America in Medicare. If you're on Medicare, if you're 65 and over and are disabled and you're on Medicare, there's been such a flattening and ratcheting down in many cases of reimbursement that just because you have a Medicare card does not mean you're going to be seeing doctors when you want to see them. And, in fact, that is precisely what I was talking about in the beginning of the discussion--that if we just simply take the same entitlement programs that are making the cost problems worse, and through the price-fixing mechanism actually perversely incentivizing fraud, waste and abuse, if we're doing that now and then, we expand yet another entitlement system, we're only going to aggravate the same problem. So what's going to be the net result? We're going to have more people, more patients, searching out care from fewer and fewer providers. And what will that lead to? It will lead to long lines, and it will lead to rationing as a natural thing, not a planned kind of rationing. That just will be the imbalance that we're going to have in the system. Now, how do I know that's going to happen? Well, as I mentioned, it's already happening, but it's not showing up to the level you might expect just yet. But let's look at Massachusetts. Remember, Massachusetts and also Tennessee have comprehensive State programs, and since the comprehensive plan started in Massachusetts a few years ago, the waiting lines for doctors have grown now to an average of 6 weeks. Over 50 percent of primary care doctors are not accepting new patients. The reimbursements are going down, and so are the number of doctors. The waiting lines are getting longer. The same happens in other countries that have single-payer systems such as Canada and Great Britain. And as a result, how do these people get care? They go to the emergency room. And where is the most expensive care? In the emergency room. So you see, Madam Speaker, when you have a highly structured, bureaucratic, top-to-bottom system that micromanages behavior of individuals and providers, all you're going to get are higher costs. And ultimately, the only way you're going to control costs is through long lines and rationing. Now, in ObamaCare, Democrats did something very clever. They didn't want to depend on Congress to make those tough decisions to cut reimbursements. So they created something called IPAB, the Independent Payment Advisory Board, which will be 15 unelected bureaucrats, not necessarily health care providers, appointed by the President. Again, they are unelected, and they will not be answering your phone when you call to complain. They will literally have more power than Congress itself in order to cut the benefits that you'll receive. They'll do it by way of reducing the types of services, the quality of services, and the payment for those services. It will happen in a lot of different ways, and it will begin to show up in delays, in more paperwork, misdiagnoses, and ultimately some very unfortunate outcomes that I can see coming down the road. Now, Congress will have the responsibility of meeting certain targets of spending. But if they fail to meet those targets--and Congresses never reach those targets, that is, to cut spending by so much in Medicare--then it falls back to, it defaults back to IPAB, and IPABs will be the ones making those decisions. So call it what you will, there will be members of government, people who are on a governmental payroll, who will be making decisions about what services you will have. Now, a lot has been said today about all the free services that you're going to receive, free Pap smears, free breast exams, free preventive health services. Madam Speaker, I have never seen anything free in this society. Somebody is going to pay for that service. Somebody has got to pay somebody for doing it. Somebody has got to pay the secretary, somebody has to pay the provider, somebody has got to pay the rent. Nothing in this society is free. And I will tell you that any time somebody tells you something is free in ObamaCare or any other kind of health care insurance, they're just not being straight with you. Let's just be honest. Somebody is going to pay for it at one point or another. Let's talk about the social conscience part of ObamaCare, which has a lot of us who are in the pro-life community very concerned. Remember, the President said that he would preserve conscience rights; that is, providers would not be forced to provide abortions or abortifacients, that is, pills that will create abortions, or anything that is against our conscience. And, in fact, the first version of ObamaCare that passed the House passed only because the pro-life Members of the Democrats said those protections have to be in there, the so-called Hyde amendment that says that no taxpayer dollars will be spent on abortions or abortion-like activities. However, when it came back from the Senate, another trick was pulled and that was pulled out of the legislation. But the President said, well, look, I'll write an Executive order, which really has very little meaning, certainly in the long term. Any President can rescind that. There are many different ways to end-run an Executive order if it's not something that's in statute. So, as a result, there are plenty of holes in ObamaCare like Swiss cheese that allow taxpayer funding of abortions. Now for the first time in many years, a majority of Americans are pro-life. But I can tell you an overwhelming majority today and always has been against the taxpayer funding of abortions. But what we're dealing with today is not the taxpayer funding of abortions, that's already in law, and that's part of the reason to repeal it, but the fact that the President is now forcing religious institutions such as the Catholic Church to provide certain services that are against their conscience, such as abortifacients, abortions, and sterilizations. And so their choice is either to get out of health care entirely or to go along with the government and run into heavy fines. So, where are we today with ObamaCare? Is it going to be repealed? Tomorrow ObamaCare will be repealed in the House of Representatives. That you can bet on. However, we all understand that there is a problem with the Senate, which is controlled by the very people who voted it in to begin with, and a President who, though he supports it and would not sign a repeal, says very little in defense of ObamaCare. But why? Because there's very little that is desirable to defend in it. So I look forward to another opportunity to vote for the full repeal and look forward to next year when we'll have the ability to repeal it lock, stock, and barrel, pull it out by its roots and start over again with step-by-step reform in health care with patient choices, as it should be.

Mr. FLEMING

Mr. FLEMING. I want to thank the gentleman, Mr. Franks of Arizona, for authoring this fine bill. You know, I find that gender-oriented abortion is problematic for two reasons. Number one is very obvious. The taking of an innocent life merely because that child happens to be a boy or a girl certainly goes against all the values that we hold true in America. But, secondly, because of the technology requiring that you are well into the second trimester even to determine the gender of the fetus means that we're talking about a mid- to late-term abortion, something that is so brutal. Mr. Speaker, as a family physician and a father of four, two boys and two girls, I have delivered over 300 babies in my career. Each and every child, regardless of his or her gender, is a unique individual, deserving of equal protection under the law. The American people agree with me on this. In fact, polls show that over two-thirds of Americans are supportive of eliminating abortion practices tailored to destroy babies because of their gender. Gender aside, which is really what this is, the deliberate annihilation of a particular sex, often unborn female children, as we know, generally occurs midway through pregnancy. These late-term abortions are grisly procedures, where the condemned is often poisoned or dismembered before being extracted from the womb, sometimes in pieces. Medical evidence shows that, at a minimum, unborn babies can experience pain at 20 weeks. I ask my colleagues to support this bill, H.R. 3541.

Mr. FLEMING

Mr. FLEMING. I thank the gentleman for yielding. Delaying development of the new bomber for 10 years would put the average age of the bomber fleet over 50 years old by the time a new bomber was fielded, our oldest of which, the B 52, would be nearly 75 years old. It would create unacceptable levels of risk regarding power projection requirements and would affect our national security. The Air Force has only 19 B 2 stealth bombers in the inventory, but they are 1980s technology, very maintenance intensive and very expensive to own and operate. The aircraft availability rate of the B 2 bomber fleet today being ready at a moment's notice for a mission is currently less than 40 percent. A mainstay of the U.S. global military power is the ability to conduct long-range conventional or nuclear strike missions anywhere in the world and against any type of threat. Therefore, it is imperative to maintain a credible bomber fleet. The Air Force plans to affordably, cost-effectively develop off-the- shelf technology--stuff that exists today--instead of inventing new technologies which in the past have led to cost overruns. And I would say to the gentleman, don't just take my opinion. It's in the President's budget, so the administration obviously supports it. The Air Force says it's one of its top priorities. We're in a day when oftentimes Congress wants things for the Pentagon that the Pentagon doesn't want. In this case, the Pentagon and the Air Force wants it. But let me quote what the Air Force said: Delaying the long-range strike bomber program for 10 years would create unacceptable levels of risk in our ability to directly support future power projection requirements, significantly impacting national security. The long-range bomber will possess unique capabilities, including long- range, significant payload capacity, operational flexibility, and survivability in anti-access environments. It will replace existing bomber aircraft, some of which will be over six decades old when the long-range strike bomber reaches initial operational capability.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, the EPA is out to get you and crucify you. That's the message from one of President Obama's EPA appointees to our country's oil and natural gas companies. Yesterday, we learned that an official at the Environmental Protection Agency based in Dallas used the Roman Empire to illustrate the kind of philosophy that he's followed at the EPA. Here's what he said: The Romans used to conquer little villages in the Mediterranean. They'd go into a little Turkish town somewhere, they'd find the first five guys they saw, and they would crucify them. And then you know that town was really easy to manage for the next few years. That's exactly what he did as an EPA official, going after a company that was safely using hydraulic fracturing to drill for gas. He led the charge to crucify this company with no proof that the company had done anything wrong in a case that was finally dismissed last month by a Federal court. This is enviro-fascism at its worst; and if someone needs to be made an example of, it's this EPA official who disregarded science and facts to radically and negligently pursue the Obama administration's war on energy.

Mr. FLEMING

Mr. FLEMING. Mr. Chairman, I have an amendment that has been made in order.

Mr. FLEMING. Mr. Chairman, I yield myself such time as I may consume. My amendment today maintains the State of Louisiana's ability to regulate hunting within its borders. In a decision announced March 1, 2012, the Forest Service Regional Forester located way over in Atlanta, Georgia, went over the heads of the Louisiana Wildlife and Fisheries Commission to forever prohibit the use of dogs to hunt deer in Kisatchie National Forest. Deer hunting has a long and important cultural history within the State of Louisiana. When French settlers first came to Louisiana in the 18th century, Louisiana was covered by thickets and dense timber. Most of these settlers had companion dogs with them, but the most treasured were the deerhounds. The use of dogs would help the hunter drive the deer out of the forest because deer were so plentiful and provided exciting races that provided sound nourishment. Hunting in many forms has been for decades, and continues to be, a compatible activity on the 600,000-acre Kisatchie National Forest. Oddly enough, the Regional Forester does not prohibit the use of dogs for hunting raccoon, squirrel, rabbit, and game birds. In 2011, the Kisatchie dog deer season was only 9 days and only applies to certain ranger districts. According to communication with the Forest Service, seven southern States allow hunting on national forests within their borders. They include Alabama, Arkansas, Florida, Mississippi, North Carolina, South Carolina; but in this case, not Louisiana. However, this is the first time the Forest Service has issued a ban on dog deer hunting, or hunting deer with dogs, within a specific State. According to the Forest Service itself, they indicate that revenue generated on dog deer hunting, including expenses to care for dogs, contributes to approximately 18 to 29 direct jobs and results in roughly $890,000 to $1.4 million of income. By their own assessment, it is likely that some economic benefits will be lost depending on whether hunting with dogs for deer leave the area to pursue the sport elsewhere. Now this is about to kill even more jobs in Louisiana. I would also like to emphasize that the State of Louisiana, the NRA, and the Safari Club all support my amendment; and I urge support of this amendment.

Mr. FLEMING. I yield to the gentleman from Washington.

Mr. FLEMING. Mr. Chair, I reserve the balance of my time.

Mr. FLEMING. Thank you, Mr. Chairman. I would like to respond to some of the statements that were made. I received a petition of thousands of hunters from Louisiana and several States who wanted this to continue. The State, not the Federal Government, is in the best position to make this determination. By October 6, 2009, the Forest Service had received 1,237 responses to its 2009 request for comments. Of these, 320 agreed with the proposed prohibition, but 917 were against it. That's a 77 percent majority of these respondents who were actually from central Louisiana where this Kisatchie National Forest exists. During October 2011, the Forest Service received over 1,300 more comments on the original proposal and environmental analysis. All but five letters--all but five letters, Mr. Chairman--were opposed to the proposed prohibition. I reserve the balance of my time.

Mr. FLEMING. I just want to respond, again, the people of Louisiana, the State of Louisiana has full support of doing away with this prohibition. This was a decision made by somebody in Atlanta, a Federal person, that has to do with what is really a local issue. This is a tradition that goes back 300 years, and I think it's pretty obvious that the people of Louisiana support the continuance of hunting deer with dogs. I yield back the balance of my time.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, in this hour, I and my colleagues who will be joining me very shortly--other physicians who are from the GOP Doctors Caucus, perhaps nurses, and other health care workers as well-- in this next hour we're going to be talking about our favorite subject, and that is health care reform. We're going to be talking about specific aspects, things that have actually come to light to us that I think are important. We're going to have other things that in the coming days we're going to learn about how ObamaCare was passed, what things were done by the other side of the aisle to make that happen, things that maybe some would call sausage-making, others would say it's improper. But we'll certainly spend some time on that as the days come. I want to continue a theme that we've been discussing, and that is the broken promises of ObamaCare. Remember, to get ObamaCare passed, President Obama made a number of promises. I'll start with the first one that is relevant to our topic tonight, and that is: Under my plan, no family making less than $250,000 a year will see any form of tax increase. That was candidate Obama, Senator Obama at the time, who talked about all the number of things that were going to be good about ObamaCare; but in fact we see that virtually everything that's come up, with a few possible exceptions, has not been so favorable. I think that taxes is really a very relevant subject to speak about this evening because here we are and today is the tax deadline for the IRS, and we all have that on our minds. It's interesting, whenever I file my taxes, the first thing I think about doing is projecting into the next year what the issues are going to be for me and my taxes. And so I think it's only proper and the timing is excellent that we talk about that this evening. Remember, Candidate Obama pledged he would not raise any of your taxes and promised not to tax health benefits. His health care broke those promises at least 10 times. Here's just a lineup of some of the taxes that we're talking about. Fifty-two billion dollars in fines on employers who do not provide government-approved coverage. Remember that under ObamaCare not only is there a mandate date for individuals to buy health insurance. There's a mandate on the employers, the business owners to buy it as well. And upon both is the burden to buy not health insurance but government- conceived health insurance, that is, health insurance that the government in its wisdom--our Federal Government--decides and deems is proper for us. And so you have to make two fulfillments in that mandate. One is to buy health care insurance and, number two, health care insurance that's approved by the government. Thirty-two billion dollars in taxes on health insurance plans. The actual health plans are going to be taxed as well. Now, who is going to pay that tax? Do you think the insurance companies are going to pay it? No, it's going to be passed down to you, the subscriber, as taxes on business always make their way down to the consumer. Five billion dollars in taxes from limits on over-the-counter medication; $15 billion in taxes from limiting the deduction on itemized medical expenses; $13 billion in taxes from new limits on flexible-spending arrangements; $60 billion in taxes on health insurance plans; $27 billion in taxes on pharmaceutical companies; $20 billion in taxes on medical device companies; $3 billion in taxes on tanning services; $3 billion in taxes on self-insured health plans; and $1 billion in new penalties on health savings account distributions. The health care law also includes a high income tax. Because it's not indexed for inflation, it will eventually hit 80 percent of taxpayers. I draw my colleagues' attention to this slide: ``ObamaCare's Rising Tax Burden.'' You can see that the tax burden in 2012, the year we're in, is $190 for a family of four. That's $15 billion. You see that the burden goes up each year, and that in the out-years, 2022, it makes it above $150 billion. In 2032, the burden goes well above $250 billion. And it finally tops out at $320 billion total, and that's an average of $3,290 for a family of four. So what am I saying? Remember that when you hear the rhetoric from the other side of the aisle, it talks about how we should be having more sacrifice from the wealthy and more sacrifice from those who make more. Folks, we've been down this road before. Remember the luxury tax that came out some years ago? What did it do? It killed the companies that made boats and luxury items. It created a lot of job losses. The people who were hurt were the working class people, not the wealthy. They can still buy those things anyplace they want to. We also came up with this silly idea of an alternative minimum tax to make the wealthy do their fair share. Well, we have the AMT today, and where has it gotten us? Because that was never indexed for inflation, middle class people are being hit by the alternative minimum tax. So it's no longer a tax on wealthy. It is a tax on the middle class, the people that our colleagues on the other side of the aisle talk so fondly of. That's an important point, and that is that every time we come up with a tax on the wealthy, it always makes its way to the working class and the middle class. Now, why is this? Is this by accident or is it by grand design? Well, folks, we all know that inflation occurs every year at an average rate of about 3 percent, but it's been as high as 16 percent in our history. And so any time we have a tax law that affects people in a certain income, we know that automatically, over time, people with lower and lower incomes, because while their absolute dollars in value are going to go up, the truth is, the purchase power of those dollars goes down. So that pushes more and more people of lower and lower income levels into higher and higher tax brackets. So, again, our colleagues on the other side of the aisle love all of these taxes on the wealthy, but they can never make enough money. We've heard in recent days about the infamous Buffett tax, the Buffett rule that would require superwealthy people to pay some additional tax. And their own side agrees that would only add about $4 billion per year, not even a drop in the bucket, less than 1 percent of the annual deficit. So why is that important? It's important because if you're going to get more income from taxes--and I would argue that you never really get more income from taxes, but if you think you can, you can only do it when you spread it out among the middle class and the working class. And the way you do that, kind of the silent way, the camel nose under the tent, is to pass it on the wealthy first, and then, through inflation, it's passed down to albeit a lower income level but a much larger group, because you simply can't get enough tax revenue by putting a lot of tax on the wealthy. There just isn't enough wealthy people out there to do it. The way you have to do it is push it down where there's a lot of people, and that's the middle class and the working class. Another slide here, rhetoric versus reality on premium cost, the average annual cost of family health insurance premiums in the U.S. Here we are 2012. This is what President Obama in campaigning for ObamaCare said would happen, that you would follow this blue line down, and the costs would go down by 2,500. And what are we hearing from all the actuaries, the CBOs and others? Not only will it go up by $393, but we already have a differential of around $4,000 from where President Obama said we would be today and where we actually are. It hasn't gone down; it's actually gone up. Let's talk about a couple more taxes, and then I'm going to introduce a colleague here and give him some sharing time as well. The surtax on investment income, $123 billion, which begins this past January, the creation of a new 3.8 percent surtax on investment income earned in households making at least $250,000 for a couple or $200,000 single. Now this is the homeowner real estate tax that you've heard about. It was, again, passed in the dead of night. Folks, this is a terrible tax, 3.8 percent on investment income. Now, when you sell your home, it may or may not be classed as investment income, but it can be, it just depends on the situation. But it's not just that. If you own any type of other property, if you own stocks and bonds, mutual funds, whatever, they could be easily subject to this, and it is not indexed to inflation. Again, let me reemphasize this. Yes, it's a tax on people who make over $200,000 a year, but if you make $50,000 a year, over time, this will affect you, too, because inflation will bring those dollars up in real terms because of inflation, and your buying power will stay at the $50,000 level, but you will show on paper that you're making $200,000, and this tax will affect you. So the bottom line here is that ObamaCare has many taxes, and certainly they are Trojan horses by any explanation; and, yes, they don't raise a lot of revenue at first, but down the road they raise a lot of revenue, but not on the wealthy folks, on the middle class. That's who's getting hurt by ObamaCare. A medicine cabinet tax, $5 billion beginning this past January, Americans are no longer able to use their health savings accounts and flexible spending accounts and all those other types of accounts on over-the-counter drugs. So that means if you want to use your health savings account to pay for your cold medicine or medicine you're taking for a headache like Aleve or Motrin or something like that, if you want to pay for it through your health savings account, you're going to have to go get a prescription from your doctor. And the doctor is going to say, Look, I'm overwhelmed with all these people wanting me to do this. We're going to have to charge something for that, so that means more cost. Ultimately, more bureaucracy, more paperwork, more cost, and up until now, prior to ObamaCare, that was not the case. You could write that off or pay for that out of your health savings account. An HSA withdrawal tax hike, $1.4 billion, that began in January 2011. It increases additional tax on nonmedical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax advantage accounts. So, you see, if you have an early withdrawal from your IRA or some other type of retirement plan, you've had a 10 percent penalty, and that was true of HSAs. So that's been doubled. So ObamaCare has limited the use of health savings accounts, but at the same time has made the penalties even steeper for using it. And I can tell you, in my own case, in my own companies, apart from my own medical practice, we have used health savings accounts to tremendous benefit to our employees because it has lowered their cost and taken a lot of the anxiety and the fear away from their cost in being caught in some sort of illness that would bankrupt them otherwise. An excise tax on charitable hospitals, that's immediate, $50,000 per hospital if they fail to meet new community health assessment needs. Section 1411 increases the Medicare hospital insurance portion of the payroll tax, so this provision will increase the employees' portion from 1.45 percent to 2.35 percent for families making more than $250,000 a year or individuals making above 200. Combined with the employers' portion, the total rate will increase by 3.8 percent on every dollar of income over $250,000. And, again, I implore you, I realize, hey, I don't make $250,000, I don't make $200,000, but because of inflation--and trust me, with the monetary easing and the monetary policies that are coming out of this administration in half of the last 3\1/2\ years--when inflation gets going again, which it will quite soon, you will be driven up into those income levels, but your buying power will be the same as it is today. So, trust me, you're not getting by with anything. You're going to get hit with this tax just like everybody else. The reality is--and I'm going to be recognizing my good friend, Dr. Gingrey, here in a moment. The reality is ObamaCare includes tons of new taxes and tax hikes. Heritage has a list of them that shows an increase in revenue of more than $500 billion in 10 years. Two examples that clearly hit consumers are the 10 percent tax on indoor tanning services that will raise $2.7 billion between 2010 and 2019 and, beginning in 2013, the 2.3 percent excise tax on manufacturers and importers of certain medical devices that will raise $20 billion between 2010 and 2019. And I'm just going to just throw in a couple of more things. Remember, this discussion began with this being the April 15--April 17 deadline for your taxes and the Internal Revenue Service. Remember that under ObamaCare as many as 16,000 new IRS agents will be hired. Estimates vary, of course, and that many have not been hired yet. But there's no question about it that the IRS will be beefed up to the tune of billions of dollars in order to make that happen. So, with that, I've been joined by my colleague, my good friend, Dr. Phil Gingrey, an obstetrician/gynecologist from Georgia, someone that I look up to very much, who's been a great mentor to me and a role model; who was here as a physician in days past when there weren't many doctors in the House of Representatives, and has helped facilitate, in fact helped start, the GOP Doctors Caucus, which is speaking here tonight, and helped grow our numbers from just a handful of physicians and health care workers to now over 15 MDs and upwards of around 20 total health care workers that we have in the House of Representatives that I think are making big, big differences in particularly health care policy overall. I yield to the gentleman, Dr. Gingrey.

Mr. FLEMING. Well, I thank my friend and colleague. I'll certainly be returning back to you for some more information that's very valuable information. I want to get back to and sort of recap some of the things I talked about, and that is that the taxes are tremendously increased under ObamaCare. Well, let's talk about the financing of ObamaCare. I'm just going to stick with the basics. There are a lot of ways it is theoretically financed, but I'm going to tell you maybe the three major ways that it's supposedly paid for. Well, number one, you heard my friend, Dr. Gingrey, say that ObamaCare actually takes over $500 billion--that is, over a half- trillion dollars--from existing Medicare and uses that to subsidize the middle class health plans for people below a certain income level. We're going to get to that in just a moment--I'm going to draw your attention to this chart and talk about those subsidies. But not only does it do that, but as my good friend says, it's used to extend the life of Medicare. So this is basically how it works. The idea of the bill is it takes money out of Medicare and theoretically makes Medicare last longer-- because it's running out of money--by taking the same money out of the middle and putting it at the end. I don't understand how that can work, but that's the way it works. That would be sort of like taking money out of your paycheck in the middle of the year and somehow living on nothing for about 3 months, and then going back to what you took out and paying at the end. It makes no sense. Not only that, but it takes the same $500 billion--and we've really honed down on this in our committees, and Secretary Sebelius had to admit that this was true--it takes the same $500 billion that's used to prolong the life of Medicare to subsidize middle class health plans. I don't know--where I come from in Louisiana, we can't spend the same dollar twice. You can spend it place A and place B. If my kids want to go to the movies or they want to do some entertainment, or maybe they need money for their education, I can give it to them, and they can spend it one time. They don't get to use the same dollar twice. And folks, neither can your Federal Government. So that is really smoke- and-mirrors accounting. We've called them out on it, and they've really basically admitted that's true. But then another way that ObamaCare is paid for is by over $800 billion in taxes in 10 years, which I've gone over a number of these, and I'm going to get back to them. It really is not paid for. And we know, we're getting estimates now showing that as much as 300 to $500 billion is going to be added over the next 10 years in deficits, total debt in that period of time. So it is not paid for. All of these steep taxes, all of these smoke-and-mirror types of accounting are not going to work. Furthermore, half of the people who are going to get health care coverage cards that they wouldn't otherwise get are going to be on Medicaid. Today, Medicaid pays on average about 60 percent of what Medicare pays to health care providers, which is already too low. So what is the chance that 15 million Americans are going to come newly on the rolls, and they're going to carry a card around that pays less than what the doctor can afford to accept to even cover the cost of that care, or otherwise go out of business, what's the chance they're going to find doctors? So what we'll have is a drop in the number of physicians, a steep rise in the demand in health care. And so these people will all end up in emergency rooms. To my colleagues, it's one thing to have coverage in health care. It's another thing altogether to have access to health care. All you have to do is look at other countries that have socialized health care--Great Britain, Canada, and many others, and even go to the extreme steps of Cuba and North Korea--they all have coverage, and it's free. The problem is there's no access to it. There are shortages. There are waiting times, as much as 1 year, 2 years to get a CT scan. People are dying as a result of that, and they show up in their statistics. The death rates, for instance, from breast cancer and prostate cancer in the United States are much lower than they are in Canada and Great Britain. They have access to the same medications and the same quality physicians. The only difference is their health care systems themselves. So let's get back again. I want to really focus on this topic for a moment before I yield time to my friend. And again, back to this idea that many of the taxes are going to be placed upon wealthy Americans in order to pay for ObamaCare. And I'll just step back through them again. There is a 40 percent excise tax on so-called ``Cadillac'' health plans, which would be health plans valued in excess of $10,200 for individuals, $27,500 for families. Those thresholds will grow annually by an inflation rate of 1 percent, which is about a third or less of what it really is. So what that means is that, as ObamaCare unfolds, having an expensive gold-plated Cadillac health care plan, you're going to get taxed 40 percent more for having it. Well, maybe that's justified. But remember that after a few years, that will not be an expensive, gold-plated plan; that will be an average plan, and you will again have to pay the same 40 percent excise--bracket creep is what they called it back some years ago, and I think it applies here today. Now, again, increases in Medicare hospital insurance. That's a payroll tax on people who make $200,000 a year individually, $250,000 as a couple, again, only applying to people who are in that $200,000- plus range. And then, of course, I told you the 3.8 percent tax on your investments that are sold for those who, again, make $200,000 or more. Again, we go back to it. Remember the alternative minimum tax. Remember the luxury tax. Remember the tax that was placed on oil, the so-called ``windfall'' taxes. Ultimately, those taxes all fell to the middle class and below. Those are the ones who were burdened with them and why most of them have been repealed. We would repeal the alternative minimum tax if we could find a way to actually pay for it now because we're spending at a level that we can't afford to repeal it, unfortunately. So here is this chart, which is very important in this whole discussion. Under ObamaCare, there is an income threshold for receiving subsidy. So if your income is just below $100,000 for a family, a married couple--and I believe that is a family of four total--if you make less than $100,000, or about $95,000 here, you'll get some kind of subsidy beginning in 2012, 2013. However, that subsidy, that line continues out all the way indefinitely, well past 2062 and before. Now, if you make $90,000 or less than $90,000 today, with inflation in those out-years--5 years, 10 years, 20 years, 30 years--you will break through this threshold. So you will not get the support, the subsidy in your health plan in those out-years. You'll get it early so that you think you're getting something, but ultimately that's going to basically go away, and you will not get that subsidy. Now, also, if you make $200,000 or $250,000 a year, you will be the one paying in for those who need this subsidy. But you see this line comes down because people who make $200,000 today, in 2022 they will still get a check that will say $250,000, but it will be more like $180,000 in today's dollars. With each year, it ratchets it down until finally you get to about 2042, or 2050, in that range. So a check today that says $200,000 on it will buy equivalent to something like $90,000 in those years because inflation devalues the actual currency that you hold. So what you get is a crossover point where you see the subsidy threshold gets higher and higher. You've got to make more and more money to get that subsidy. But even though your income is the same, or going down, you actually drop out, and you get a crossover point. Where here, even though you're making $200,000 or $250,000, you're making too much for the subsidy, but you're not making too much to be taxed. And that is the problem. Ultimately, over time, ObamaCare begins to take the subsidies out for those who are middle class and lower, and it begins to add taxes on those who are middle class and above. That is very destructive, my friends. That's the way you end up with socialized health care and with the kind of system that is working so poorly in many other countries. We still have time to discuss some of these issues further, so I would ask my good friend from Georgia, Dr. Gingrey, to elaborate on some of his points tonight.

Mr. FLEMING. Would you touch a moment, Dr. Gingrey, on the fact that while we're trying to expand coverage and all of those things that there will actually be people who will be pushed off their coverage of the health care they have today, such as by their employers. Would you expound on that.

Mr. FLEMING. Yes. You say that the threshold is 50 employees and that they lose certain subsidies or certainly face more penalties or costs after 50. What is the chance that a small business that has 49 employees will dare hire another employee?

Mr. FLEMING. I thank the gentleman. Again, great points. Estimates are as high as 20 million Americans who are on insurance today through their employers, happy and satisfied with the coverage they have, that will be pushed off. Why? Because the employer, the business will find it at least financially reasonable and perhaps beneficial to just pay the fine, push the employees out into the marketplace, make them go into the exchanges and force them to have to deal with the realities of ObamaCare. I know that people hearing me say this would say, Well, that's coldhearted. If you really love your employees--and I have a small business and we employ considerably more than 50 employees, and I love my employees and I want them to have the best possible coverage. But look, if I have a competitor out there who can lower his cost by pushing his employees out and paying a penalty and then I go and do the right thing and pay that, then he's going to be able to sell his product at a lower price than me. That puts me out of business. Now not only do my employees not have health insurance, they don't have a job. Back to this 50 threshold. Any time you have a law in the United States that penalizes an employer for hiring above a certain level, that is a terrible law by itself. It is disincentivizing an employer who is going to say, Well, I'm not going to grow my business. If I can't grow it by leaps and bounds and take tremendous risk and in the process bring in so much money to cover that incremental cost of health care, I'm not even going to try it. In fact, I may just close my business down altogether. In the remaining moments we have--and I'll be happy to give Dr. Gingrey even further time to add some additional comments--I just wanted to go back again to this broken promise that was mentioned before both by Dr. Gingrey and myself, ``I will protect Medicare,'' President Barack Obama, September 2009. He promised he would protect Medicare. Where are we today? The Republicans, through the Ryan plan, a very good plan, a very good budget, have a solution that will make Medicare sustainable for an indefinite period of time. The Democrats in the House say, No, we're not in for that. We're not in for anything. We have no ideas. I'll remind folks in this body that the actuaries, the CBO, and all of the authorities tell us that Medicare runs out of money, becomes insolvent, becomes bankrupt in 4 to 8 years. So it's time that somebody comes up with a plan. We have a plan. We had one this year. We had one last year. We modified it a little bit to make it one that, I think, Democrats could accept, and they still have not signed on to it; although, we have one Democrat in the Senate who has, so it is bipartisan. But the President made the promise and the Republicans in the House are trying to keep it, and Democrats will not go along with that. Again, to recap: ObamaCare cuts as much as $575 billion from the Medicare program; $200 billion from Medicare Advantage, which is a private form of Medicare that many Americans enjoy and love. It forces over 7 million seniors out of their current Medicare plan. Fifteen percent of hospitals, nursing homes, and home health will close because of Medicare paying less under ObamaCare. Again, you can't cut out over $500 billion without cutting out reimbursements for something, and that's where it's going to be. It's going to be hospitals, nursing homes, home health agencies, and many other types of services that Medicare provides. The CBO estimates that Medicare prescription drug coverage premiums will increase by 9 percent as a result of ObamaCare. Mr. Speaker, this is not a tax. It's not an expense just on the wealthy. It hits the middle class and the poor as well. Finally, the CMS actuary projects the Medicare program could be bankrupt, as I mentioned before, as early as 2016. Medicare costs are projected to grow substantially from approximately 3.6 percent of the size of our economy, the GDP, in 2010, to 5.5 percent by 2035. That's the Medicare trustees. The physician payment formula in Medicare needs to be fixed or seniors may lose their doctors. It costs $316 billion. We're hearing all over America about physicians who are beginning to back away from seeing Medicare patients. Not because they don't want to, not because they are not willing to sacrifice, but because if they do, they go out of business and they can't make it. Already access is an issue because of money problems. Twelve percent of physicians stopped seeing Medicare patients due to the broken physician formula that we have and that cannot be resolved and our friends on the other side refuse to address. In our closing moments, I would be happy to yield to the gentleman, if he has any comments.

Mr. FLEMING. That's very important, because what I'm understanding you saying is that if the trust fund becomes insolvent and there are checks going out to physicians across America, we can't just connect a line over to the general budget and say we're going to cover the bills. No, they don't get paid. Checks will bounce. This is a problem that must be solved. So to recap in the final moments that we have--and I want to thank my good friend, Dr. Gingrey, for joining me this evening. We really have a strong group of physicians and nurses and other health care workers in the GOP Doctors Caucus. We hope to be joined by some more next year as a matter of fact. We feel like the physicians are a strong force in the U.S. Congress, not just because they know and understand the health care economy, which is very unique, but also because physicians are unique in a way that we want to make a diagnosis and we want to treat and we want to cure. We're not about kicking the can down the road. We want to cure the disease or solve the problem and move to the next one, and so the more physicians we have here, I think we will. But again, I want to just reiterate for my colleagues that just because you have a card that says you are entitled to care in the United States does not mean you have access to it. I want to reiterate that. Just because you have a card, just because you have coverage does not mean that the doors will open for you, and this is where our colleagues, I think, are misguided on the other side. ObamaCare is all about giving coverage, all about giving cards to people, but it does not protect their access to care. Because, in fact, under their system, which is basically based on a socialized model, the only way that the government will be able to afford it, and taxpayers in general, will be to create long lines, create shortages, and say ``no,'' to be traffic cops to people. And you know what? The parts of our health care system today that are government-run, already before ObamaCare, we are already seeing spot shortages; chemotherapeutic agents, injectable drugs, that are otherwise not expensive, but because of the quirks of this socialized, government-run, highly bureaucratic system, we're finding that the manufacturers can't make them because they don't get enough reimbursement to cover their cost. So what happens is they slow down, or stop making them altogether, and we have diseases and cancers out there today where physicians are scrounging around looking for the correct chemotherapeutic agent which would cure their disease, and it's very inexpensive and has been around for many years, and we have to even look to other countries to supply that. With that, I look forward to our next GOP Doctors Caucus. I always enjoy this. I hope that those in this Chamber who listen to this find it at least somewhat informative. Mr. Speaker, I yield back the balance of my time.

Mr. FLEMING

Mr. FLEMING. Thank you, Mr. Speaker. It is indeed a pleasure to come to the floor today to speak to this Chamber about a subject that I think is very important on the minds of the American people, and that is the 2-year anniversary of the Patient Protection and Affordable Care Act, also known as PPACA, and certainly more commonly known as ObamaCare. I want to give you a little context, Mr. Speaker, of where I come from. I'm a Congressman from Louisiana in the 4th District, centered in Shreveport Bossier. I have been a family physician for 36 years. I still see patients when I have the opportunity. I also have businesses on the side that are not related to health care. So in my world for many years, and in raising a family, the responsibilities of meeting payrolls have included not only running a small medical practice but also a growing business dealing with all of the regulations, the taxation, and the many different issues--personnel problems, human resource problems--that we must deal with. And certainly providing health care has been a great challenge over the years. And there's no question that the system has not been what it should be prior to this time. In fact, one of the reasons why I ran for Congress--and many other of my colleagues who were physicians--we have 15 just in the Republican section alone, and I think we'll have more next year--the reason why we've become so activated, if you will, when it comes to Federal policy on health care is because of all the failures that we've seen over the years and the problems with government trying to micromanage health care. So what I want to talk about today is broken promises with regard to ObamaCare. You may recall that Candidate Obama, Senator Obama, says you will not have to change your health care plan if his health care plan is brought into law. For those of you, he said, who have insurance now, nothing will change under the Obama plan except that you will simply pay less. Another quote from him is this. This is President Obama in June of 2009: And that means that no matter how we reform health care, we will keep this promise to the American people. If you like your doctor, you will be able to keep your doctor. If you like your health care plan, you will be able to keep your health care plan. Well, what is the truth of this? By the administration's own estimates, new health care regulations will force most firms and up to 80 percent of small businesses to give up their current plans by 2013. Grandfather plans would be subject to the costly new mandates and increased premiums under the President's health care plan. Again, my own business is back home. We still cover our employees, and we would fall under the grandfather. But here's what we're up against. If we change just one dotted ``i,'' one crossed ``t,'' that totally nullifies the grandfather rule that applies to our plan. So what that means is if we change anything--the cost structure, anything--then simply we will fall into the government-mandated plan in which we have to choose among the three specified, certified government plans that would be chosen for us. Now you could say, Well, we could keep exactly what we have without changing one scintilla of it. The problem is, what if the cost continues to go up--and it will--and we say maybe let's raise the deductible, raise copayments, cut some coverage someplace, change the way we cover pharmaceuticals, do something to lower that cost so we can afford it as a company and our patients can afford it. No. It then nullifies the grandfather clause and then it activates, of course, ObamaCare, and we will be required to be in it. Let's go to broken promise number two. I have many broken promises but I'm going to focus on six today. Broken promise number two. President Obama in September of 2009 says: First, I will not sign a plan that adds one dime to our deficits either now or in the future. I will not sign it if it adds one dime to the deficit now or in the future. Well, is that true? An honest accounting of the health care plan finds that it will increase the deficit by hundreds of billions in the first 10 years alone. For instance, the law double-counts the Medicare savings. It's interesting the way we have something in Washington, in Congress, called the CBO, the Congressional Budget Office. It uses a scoring mechanism. It works out of a 10-year budget window. So whatever we do, it either costs more or costs less, based on what happens for it in the next 10 years. And so this was a big challenge for the Obama administration to get this bill passed because they saw what we saw, and that is it will add billions of dollars to the deficit. So what did they do? They manipulated the budget window to make it look like it paid for itself. And how did they do that? Well, for one thing, the way the bill is set in motion and the way it's implemented is that for the first 4 years-- you've noticed that even though it passed in March of 2010, it hasn't been implemented. Why? A very good reason. Because the costs don't begin until it's implemented. However, the revenues already began soon after the bill passed. So the way it was scored is we have 10 years of revenue--that's income--and 6 years of costs. Well, Mr. Speaker, I could run any business profitably that way if I have 10 years of revenue and only 6 years of cost. That's precisely what happened here. However, the law has been rescored and in fact what was supposed to be a $900-some billion bill over 10 years is now rescored at $1.75 trillion. And next year, which will then stretch it out the full 10 years, it will be well over $2 trillion. Former CBO Director Douglas Holz-Eakin has written that: Under a realistic set of assumptions, the law will increase the deficit by at least $500 billion in the first 10 years and more than $1.5 trillion in the second decade. Mr. Speaker, let's go back to where we are with government health care pre-ObamaCare. Back in the nineties, the last time that we balanced a budget was under President Clinton and after, of course, a Republican-controlled House and Congress in general sent a balanced budget three times in a row. He vetoed it twice and finally signed it the third time. How did they do it and we can't do it today? Well, one reason is very important, and that is that at that time 30 percent of the budget was made up of mandatory spending, that's entitlement spending, which would be Medicare, Medicaid, Social Security, and other forms of mandatory spending such as welfare, section 8 and so forth. So that meant that 70 percent was discretionary spending, which means that you could cut budgets out of certain departments and agencies and you could begin to balance a budget once again. Well, today it is 60 percent of the budget that's mandatory or entitlement spending--and growing--which means that we have certainly much less to work with in order to balance the budget, and it continues to grow. The largest piece of that is Medicare itself. Mr. Speaker, I guarantee you that most Americans do not realize that today Medicare is very much a subsidized and entitlement program. Even though its recipients and those of us who are in the workforce paying into it, even though we pay premiums into it, the return on those premiums are threefold; that is to say, for every dollar you put into Medicare, you get $3 back in benefit. And that applies no matter what your income. Warren Buffett is old enough to be on Medicare, and as a result of that, Warren Buffett, with his $40 billion, gets the same subsidies as the little lady who barely gets by each month. So it's important for us to understand that we already have a government-run health care system--that is, Medicare--that actuaries, the CBO and everyone says becomes insolvent, runs out of money in 4 to 8 years; it just depends upon which estimate you believe in. And to be honest with you, with each year that estimate comes closer and closer rather than farther and farther away. So, I hate to say it, but promise number one was broken. The President promised that there would be nothing to change about your health care plan or your doctor. We know that not to be true. Broken promise number two is it would not add one dime to the deficit. And we know now that it's going to be at least $500 billion, perhaps as much as $1.5 trillion over the coming decade. So let's move to broken promise number three. President Barack Obama said in September 2009: And one more misunderstanding I want to clear up. Under our plan, no Federal dollars will be used to fund abortions, and Federal conscience laws will remain in place. Well, is that true? There was a whole lot of drama around here during the debate, the original ObamaCare bill--and, by the way, I want to point out something about the term ``ObamaCare.'' I'm often asked in my town halls, Why do you call it ObamaCare? Isn't that being derogatory or in some way denigrating to the bill itself or to the President? Of course the rhetorical response I have is, Well, if it's a law or a bill that you can be proud of, then why are you ashamed to name it after President Obama? If it were a bill I was proud of, a law I was proud of, I would love it if it were called FlemingCare. But, quite honestly, I don't think even the President is proud of this bill. And how do I know that? Because on the 2-year anniversary, where are the cakes and the candles? Where's the celebration? Remember that Speaker Pelosi, when she was Speaker right here in this Chamber, said that we have to pass it to know what's in it. Well, Mr. Speaker, we now know what's in it, and we're not happy about it. Fifty-seven percent of the American people say we want it repealed, and only 38 percent--and these are consistent numbers since the passage of the law. In fact, they've actually gotten a little worse over time. The vast majority of Americans do want it repealed. But back to this. What about the funding of abortions? When the bill first passed this House, we had protections and guarantees. We had a few pro-life Members from the Democrat side, we had a vast number of pro-life Members on the Republican side, and we came together and said, okay, they're not going to vote for this bill. No Republican voted for it. But the Democrats who were pro-life said, We're not going to support this bill unless it has protections not to prevent abortions but to prevent taxpayer funding of abortions. Today we're in a divided Nation when it comes to the question of abortions. About half of Americans, 51 percent, are pro-life. They do not believe that we should take innocent life. Something near that say, Well, we think it's a woman's right to choose. But by a margin of around 75 percent, Americans say we do not want to pay for--through our taxpayer money, we do not want to pay for abortions. And so we were given certain guarantees that that wouldn't happen. However, when the bill came back to us from the Senate, all the protections, conscience clause protections, protections against taxpayer funding of abortions, all of that was stripped away. Now, the President would say, even today, and many Democrats would say, there's not any taxpayer funding of abortions. Well, again, is that true? Just recently, the Department of Health and Human Services, under Secretary Sebelius, issued a final rule on the State health care exchanges providing for taxpayer funding of insurance coverage that includes elective abortion. The rule confirms that abortions on demand will be included in publicly funded insurance plans. This means that it is absolutely required that insurance companies provide abortion services. Now, even among the pro-choice Americans, they would suggest to you and admit to you that while they think a woman should have the right to choose, they also would agree we need to reduce the number of abortions whenever possible. But while making abortions more and more convenient, more and more available and cheaper and cheaper, that's not going to be the case. Even though abortions have been coming down year after year because young ladies have been deciding for life instead of against life, we're going to be seeing those numbers go back up again because of the wholesale subsidy of the industry. What do I mean by that? To comply with the accounting requirement of ObamaCare, plans will collect a $1 abortion surcharge for each premium payer. The enrollee will make two payments, $1 per month for abortion and another payment for the rest of the services. As described in the rule, the surcharge can only be disclosed to the enrollee at the time of enrollment. Furthermore, insurance plans may only advertise the total cost of the premiums without disclosing that enrollees will be charged a $1 per month fee to pay and directly subsidize abortions. Now, that's kind of technical jargon. What does it mean? It basically means that in the most technical sense, the premium dollars will not be used to fund abortions. What will happen is that you, as Americans, will be charged an extra fee, a surcharge, if you will. It will be booked separately, but it still flows directly to abortion services. You'll be required to do that. Under ObamaCare, all insurance plans must cover, at no charge--to the patient, that is; charged to the taxpayer, but not to the patient-- abortion-inducing drugs, contraceptives, sterilization, and patient education and counseling for women of reproductive age. Religious employers such as Catholic hospitals, Christian schools, and faith- based pregnancy care centers will have to provide and pay for such coverage for their employees regardless of their religious beliefs. Now, Mr. Speaker, that is a direct violation of the First Amendment to the Constitution. The First Amendment to the Constitution provides that government shall establish no religion and that you should have the freedom to practice religion in any way you see fit. And we've seen this played out over the many years of this country. For instance, the Amish are against war. It's against their conscience to fight in a war. And if, indeed, an Amish person is asked to join the military, to pick up a rifle and go fight, if he declares that it's against his religious conscience, then he is not forced to fight. And that is a well-respected and a well-observed tradition, and it's certainly right down to the very beginning of the core of the Constitution. But for some reason we're suspending that constitutional right. That is to say that a hospital owner, an insurance company owner, a physician, even, or nurse who may choose not to provide abortion- inducing pills, certainly provide abortions themselves, or perhaps for whatever fundamental religious reasons, such as in Catholicism it's against their religion to practice sterilization or even provide birth control pills, that they cannot refuse to provide those. Now the question, of course, comes from Democrats on this, well, that means that those services will be cut off from Americans. Well, today these institutions are not required to produce that. And does anybody have a problem finding these services and in an affordable way? Every State has a program--it's funded both by the State and federally--to get free services with regard to obstetrical, gynecological care and prevention of pregnancy. So it already exists today. It's completely available. There's no reason that we have to force health care providers to participate in something that is against their religious or moral convictions. Now, we recently had a mandate, a rule provided by the President that said, look, doesn't matter who you are or where you are or what kind of religion you practice, you're going to have to provide the abortion or abortion-related services that we dictate to you. Then, as a result of the pushback of the Catholic Church, they said, well, we'll make an accommodation. But, Mr. Speaker, that accommodation never occurred. That was only a statement made by the President. The actual rule that was propagated is still the rule today and, in fact, it's now been finalized. Nothing was changed. It was certainly just spin put on the entire discussion of the rule. Let's move along to broken promise number four. President Barack Obama, September 2009, in an address to a Joint Session of Congress--and I was here--says: ``I will protect Medicare.'' Now, did he protect Medicare? Well, the first thing that ObamaCare does is it cuts $500 billion--a half a trillion dollars--from Medicare itself. I repeat, ObamaCare, the first thing it does to finance the services that it provides, it cuts $500 billion from Medicare. Part of that is taken out of the so-called Medicare Advantage program, which is a private part of Medicare where private plans like Humana Gold are provided funds. But half or more of that is simply taken out of direct services, such as home health, hospice services, many other kinds of services. So I don't see how you can remove $500 billion from Medicare and begin to say that you're going to protect it. In fact, we Republicans have been criticized in the last year that for some reason we want to end Medicare. Nothing could be further from the truth. Republicans want to save Medicare. But because Medicare--you heard me say Medicare will become insolvent in 4 to 8 years, the experts tell us. Don't take my word for it. Go to the experts, the actuaries and the CBO. They tell us that the system runs out of money, the checks start bouncing in 4 to 8 years. So what have our Democratic colleagues done to save Medicare? Whenever you ask them, all you hear is crickets. What is the Republican's answer to that? Well, we submitted in 2011 a budget that would not only protect Medicare, but sustain it indefinitely by the use of premium support, means testing, and many other things, and opening up Medicare to market forces so it would drive costs down and increase services. So whether you like the Republican solution or not, we do have a solution. Our Democrat friends offer no solution. So their plan is no plan. Their plan is sticking your head in the sand. And, therefore, their plan is the one that would end Medicare. On to broken promise number five. Senator Barack Obama, Candidate Obama, said: ``Under my plan, no family making less than $250,000 a year will see any form of tax increase.'' Well, is that true? Well, let me go down the list and you decide for yourself, Mr. Speaker: $52 billion in fines on employers who do not provide government- approved coverage; $32 billion in taxes on health insurance plans--not a penalty, just, simply straightforward, an excise tax which adds up to $32 billion. Mr. Speaker, if you think that your premiums are going to go down when the taxes on those companies go up, then we need to sit down and talk about it; $5 billion in taxes from limits on over-the-counter medication; $15 billion in taxes from limiting the deduction on itemized medical expenses--and that's to everybody, not just people who make over $200,000, $250,000 a year; $13 billion in taxes from new limits on flexible spending accounts; $60 billion in taxes on health insurance plans; $27 billion in taxes on pharmaceutical companies; $20 billion in taxes on medical device companies. We already hear of medical device companies either going out of business or moving their business overseas; $3 billion in taxes on tanning services; $3 billion in taxes on self-insured health plans; and $1 billion in new penalties on health savings account distributions. Remember that one of the most useful tools in limiting cost that has been well received by beneficiaries of private insurance has been health savings accounts, which allows you to keep your own money and spend your own money and save the first dollar expenses to insurance companies, which ultimately lowers your premiums. I know that because we instituted that about 7 years ago in our companies; and instead of having 15 percent increase year over year in our premiums, they flattened out and have never been above 3 percent per year. That means more money we can pay our employees and more benefits that they can enjoy. But here's a couple of really important ones I think everyone needs to understand, Mr. Speaker. In 2013, the payroll tax will increase .9 percent going to Medicare for those making $200,000 to $250,000 a year--that is to say, single filers, $200,000; a couple, $250,000. Now, Mr. Speaker, most people hearing this might say, Well, that doesn't apply to me because I don't make $200,000 a year. But this is not indexed, which means that in a few years, through inflation, Mr. Speaker, everyone will be included in this, virtually; certainly the middle class would be. Already today we have a similar problem called AMT, alternative minimum tax. It was designed years ago to hit the wealthy, the high- income earners. Who is it hitting today? It's hitting the middle class because it hasn't been indexed. But that isn't the worst of it when it comes to taxes. There is a 3.8 percent tax on the sale of your assets--again, for people who make $200,000 for singles, $250,000 for a couple. Again, the question is, Well, what do I care? I sell my house, I make some money on it, but I don't make $200,000 a year. I sell my stocks, maybe I sell a business, I sell some other sort of asset. Should I worry about that? Well, maybe today you don't. The average American doesn't make $200,000, $250,000 a year. But in a few years, through inflation--and the way we're printing money these days, that should be very soon--average Americans will easily be making $200,000, $250,000. As a result, they will be captured in that. The middle class will be hurt the most by this tax. The law also forces people to buy insurance. Then the Federal Government taxes employer-provided plans at a 40 percent rate. This tax will hit middle-income families especially hard. So, you see, Mr. Speaker, we have a bevy of taxes, at least 10 or more that I've listed here. The vast majority of them hit the middle class and even lower than that. There's no way that this promise was ever kept, and, in my opinion, it was ever intended to be kept. Broken promise number six, Senator Barack Obama, February 2008-- again, Candidate Obama--said in Columbus, Ohio: ``If you've got health insurance, we're going to work with you to lower your premiums by $2,500 per family per year.'' I think this is perhaps the cruelest promise of all. What has actually happened? The annual Kaiser Family Foundation survey of employer-provided insurance found that average family premiums totaled $12,860 in 2008, $13,375 in 2009, $13,770 in 2010, and $15,073 in 2011. Premiums have already risen by $2,213 since President Obama took office, and much of that increase was as a direct result from ObamaCare. Why? Because the mandates create more cost. Oftentimes, Mr. Speaker, folks will say to me, Well, look, if you Republicans want to repeal ObamaCare, will you keep coverage for preexisting illness? Will you keep coverage for folks who are up to 26 years old and living in their household? My answer is this: We certainly can, and, in fact, we could have been doing that all along. But if, Mr. Speaker, we add more mandates, we take caps off, all that does is raise the premium. The marketplace has to deal with that one way or another. So you have to decide for yourselves, as consumers, do you want more benefits, less caps, or do you want less benefits, more caps? You're going to have to pay for it either way. So I would say, Mr. Speaker, yes, we would love to keep those. But what we'd rather do, more than that, is to make it a choice for the American citizens. They can choose whichever one they want. If you want a plan that, for instance, has no lifetime caps, fine. But you are going to have to pay incrementally more in your premiums in order to receive that benefit. The CBO projects that the law's new benefit mandates will raise premiums in the individual market by $2,100 per family. The increase is because people will be forced to buy richer coverage, which will encourage them to consume even more health care. So, you see, Mr. Speaker, the President, when he was a candidate, promised that the cost of premiums would go down by $2,500 per year per family. It has already gone up that much, so that's a spread of about $5,000 per year, and it's expected to go up even another $2,100 as ObamaCare fully kicks in. Mr. Speaker, these are the main six points that I wanted to bring out today. In closing, I would just like to say that we'll be posting, Mr. Speaker, on our Web site these promises and the others that have been broken. And I pledge, with many of my colleagues here in the House, that we will, hopefully, the beginning of next year fully repeal ObamaCare and replace it with something that's common sense, that's market-driven, that re-establishes the doctor-patient relationship and puts the choice back into the hands of the American citizen.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, we now have reached a landmark, 2 years since the passage of ObamaCare. More and more, the American people have been hearing about something called IPAB, the Independent Payment Advisory Board--the centerpiece to ObamaCare and its inevitable rationing of health care. This is a board of 15 unelected, unaccountable and not necessarily health care-experienced individuals who will have more power than even Congress, itself, when it comes to deciding what care every American will receive. The board members will not be under congressional oversight and will not answer the phone when you call to complain. Americans agree by 57 percent to 38 percent margins ObamaCare and IPAB should be fully repealed. So far, Democrats have been unwilling to listen to the outcry from the American people. They will have yet another chance to respond to ``we the people's'' unhappiness with ObamaCare by voting with Republicans this week to repeal IPAB. And, hopefully, they will be willing to vote to repeal ObamaCare, itself, in its entirety when it is brought up for a vote sometime in the future.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, President Obama's mandate on abortion- inducing drugs and contraceptive services has not gone away--I repeat-- has not gone away. It has not been settled. There is no compromise. The administration's assault on the First Amendment continues. The deeply held beliefs of people who oppose abortifacients are still under attack. Let's be clear. The President remains as determined as ever to force insurance companies and their customers to pay for services which defy the moral fiber of their beings and which are contrary to religious beliefs and sacred teachings. Let me be clear. Despite what you have heard, no rules have changed. There has been no accommodation. President Obama is simply hoping to cover this issue with a smokescreen to push it past Election Day so he can still get his way. That's why this Congress needs to act--and act right now--to put in place conscience protections that the administration cannot violate. We need to safeguard our religious liberties against these attacks by the Obama administration.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, for 50 years, the St. Jude Children's Research Hospital has been one of the leading facilities for researching and treating catastrophic diseases in children. Every year, nearly 8,000 children are treated at St. Jude. That's why I'm proud of a group of friends back in my hometown who, for 36 years, have been raising money for St. Jude through an annual auction. When the auction started, the first goal they set and reached was $10,000. Well, that has long since been eclipsed. This year was another record-breaking year. The Minden, Louisiana, St. Jude auction held earlier this month raised $1,065,235 to help the ongoing work of saving children's lives. So thank you to Melissa Brown and Christie Ruple, the cochairs of the Minden St. Jude auction. And thank you to Pete Treat who, after suffering the terrible loss of his 5-year-old daughter to leukemia, started the Minden St. Jude auction and now has had the privilege of watching that auction raise more than $1 million for the St. Jude Children's Research Hospital.

Mr. FLEMING

Mr. FLEMING. By Medicare Part D, you're referring to the drug program, which is the last piece that was added where there was a lot of debate about top-down, government commanded pricing or a market- based system. They ended with a market-based system, and that reduced the cost by 40 percent.

Mr. FLEMING. Mr. Speaker, once again the GOP Doctors Caucus comes together to discuss important matters regarding health care. Tonight we're going to focus on saving Medicare. This has been a very interesting discussion going back to the days of the ObamaCare debate where we talked about how we would finance ObamaCare. And lo and behold in the middle of the debate, we find out that the Members of the other side of the aisle decide that they're going to help finance ObamaCare by taking out over $500 billion--half a trillion--$500 billion from Medicare over the next 10 years in order to help finance ObamaCare. Now if you think about this, the CBO states that Medicare may become insolvent as early as 2016. So I think the focus right now with regard to Medicare, an important part of our entitlement program, has got to be how are we going to save Medicare. I have an array of colleagues here this evening that are going to help me develop that issue. Again, I'll go back to the financing of ObamaCare, and that is cutting out over half a trillion dollars from Medicare in order to help finance ObamaCare. And there are some other pieces of the financing as well--the individual mandate which is soon to go to the Supreme Court. And if that is struck down, that will be another piece of the financing that won't be available. Tax increases, increases of taxes, excise taxes, taxes on equipment, taxes on tanning beds, many different new taxes, as much as $800 billion over 10 years of new taxes in order to finance ObamaCare. Then there was the CLASS Act, which was long term health care, which the actuaries said from the beginning would not work. It would not finance anything. And then last, but not least, is the student loan program, which was nationalized in order to siphon off profits from that in order to help finance ObamaCare. And we hear talk now about forgiving those loans which means that it'll probably be another bailout, like the mortgage. So, Mr. Speaker, I have to speak out tonight on the fact that ObamaCare is going to bankrupt this country if it is actually fully implemented. But more importantly, Medicare will become insolvent as early as 2016. We're going to be talking about how that's happening, how we're seeing skyrocketing costs. And some of the things perhaps that will be discussed tonight will be how we can save Medicare. Again, in closing my initial comments here, I will have to emphasize to you that our colleagues from the other side, inasmuch as they somehow want to blame us for ending Medicare, which not a single Member on the Republican side wants to do, of course, but they accuse us of this, but in fact they have yet to submit a plan that will save Medicare, will prevent it from becoming insolvent by 2016 or 2022, depending on whom you believe. So with these opening remarks, I would like to open the floor to my good friend, Dr. Harris from Maryland, and would love to hear some of your comments about saving Medicare and other matters having to do with health care.

Mr. FLEMING. I thank the gentleman from Maryland, my good friend, who is an anesthesiologist, a practicing anesthesiologist for a number of years and very experienced. Before I recognize my friend from Georgia (Mr. Gingrey), I did want to point out a couple of things. Remember I said a moment ago the CMS actuary in this case projects the Medicare program could be bankrupt as early as 2016. This is 2012. That's 4 years, Mr. Speaker. Where is the Democrat plan to save Medicare? Republicans, on the other hand, we've already passed a budget last year. We're working on another one this year that would do that. We just could not get Harry Reid to even salute it, much less have a vote on it. Also, Medicare costs are projected to grow substantially from approximately 3.6 percent of GDP in 2010 to 5.5 percent by 2035. The physician payment formula in Medicare needs to be fixed or seniors may lose their doctor as it costs $316 billion. And that's what Dr. Harris was referring to, that it's already very difficult for doctors to make it on what they're paid, and they're looking at a cliff of a 30 percent reduction in their pay. If that goes into effect, Mr. Speaker, a lot of seniors out there will not have access to health care. So I want to show you, before I recognize my good friend, what this means in graphic form. And as you can see, the purple aspect of this is Social Security. The green is Medicaid and other health care. You see it rising very fairly steadily, but plateauing. But look at the red. That's Medicare. That is Medicare. And in out-years, going all the way out to 2080, it just goes straight up. Of course, that's largely due to an aging population, baby boomers like myself getting older. But everything about this program has way outdistanced any projections of what those costs are. So this really takes it up to a point where Medicare alone, if not dealt with, not reformed and saved, will eventually displace all of our budgetary spending, that alone. And of course that means no defense, no nothing else, no running government whatsoever. With that, I would like to recognize my good friend, Dr. Phil Gingrey, a gynecologist-obstetrician from the great State of Georgia.

Mr. FLEMING. I thank the gentleman from Georgia, my colleague and physician. Let me say parenthetically here that what are some of the things that we in this Chamber, we Republicans from the Doc Caucus--which, by the way, is 23 strong, which includes three nurses, two dentists, and one psychologist. So what are some of the things that we agree on moving forward that we really need in terms of saving Medicare? Well, I can tell you one thing that everybody agrees on, and that is that we need robust competition among providers--doctors, hospitals, insurance companies. There is no reason why they shouldn't have to deal with the competition of market forces. And why? Because everything in America that we see improves improves because of the marketplace; that is that when you compete, it makes you work harder; it makes you try harder; it raises the level of effort; and, ultimately, you end up with better quality service products and you end up with lower cost to the consumer. We also agree that we want choices for Americans. Today, there are a lot of choices even for Medicare recipients that just aren't there, and we want that to occur. We also want to move away from a top-down bureaucratic system where, again, a 15-member appointed board of bureaucrats--nameless, faceless, unelectable, unaccountable people who are selected and who will not be there to answer your call. We all agree that that is not a good thing. Instead, we want a program, a system in which you can change health care systems, you can change hospitals, doctor, insurance companies, whatever you want to do, and there's lots of transparency in order to do that. That's going to make the quality of care improve and the cost go down. I would now like to recognize another gentleman from Georgia. Georgia, like Louisiana, is flush with physician Members in Congress, but we'd like to have a few more, in fact. So I would like to recognize my good friend Dr. Broun, the gentleman from Georgia.

Mr. FLEMING. I thank the gentleman, my good friend from Georgia, a family physician of note, and also one who has actually reentered the U.S. Marine Corps as a reserve physician as well. I admire him for that. Before I recognize my friend from Tennessee, also another physician, I want to point out something about Medicare that is very important for everyone to think about. Medicare was started in 1965 with a lot of promises, and the promises have been fulfilled to those recipients who get the benefits of Medicare. However, this big, beautiful apple, if you will, of Medicare, unbeknownst to a lot of people, has been slowly rotting and decaying from the inside financially in ways that the public can't see, in a way that is very soon going to be evident. And why? The reason is because even though folks pay their premiums into Medicare, they do not nearly cover the cost of Medicare. In fact, they only cover about one-third. The other two-thirds come from the providers themselves, and also from the taxpayers. And that's all well and good. There's nobody we would rather do more for than those who are from the Greatest Generation, those who lived through the Great Depression, World War II. But the fact is, we cannot continue the same way. It will totally bankrupt the country. And therefore we have got to heal this patient and, that is, we've got to save Medicare. I want to recognize my good friend from Tennessee, also an OB GYN, one who came here in 2009, as I did. We've grown to be great friends. And certainly, the best doctors are from the South, mostly from Louisiana and Tennessee, I think you would agree. With that, I yield to my good friend, the gentleman from Tennessee, Dr. Roe.