John Fleming

Mr. FLEMING

Mr. FLEMING. I thank the gentleman. To conclude my comments, I was comparing and contrasting the Pelosi bill with the Republican bill. The bottom line, Mr. Speaker, is there are only two ways you can control costs. There is the Nancy Pelosi way where you have an extremely large governmental system that disconnects the patient and the doctor from the cost and it leaves it to the government, it leaves it to a very, very distant decisionmaker in the Federal Government to make decisions about our personal lives and put in force things that affect us that we have no control over. That is one way to do it, and that is ultimately leading to rationing and long lines, like Canada and the U.K. do it. The other way is a patient-centered perspective, which is the way the Republicans address it, and that is to leave the decisions between the doctor and the patient. If you stop there, you are not going to control costs. The way you control costs is to engage both the doctor and the patient into the cost. That is not to say that the patient pays all of the costs or even most of the cost. It is just to say through a health savings account and perhaps other methods, the patient is aware what is being spent and there is a certain reward for making good decisions as a consumer. And in order to do that, you have to connect the patient with the cost in some way, and that is where health savings come in, and you have to have transparency and clarity, which we do not have today. And if we do that, then we make very savvy consumers out of patients, and we have the doctors and patients do buy into it. All of the right decisions can be made in the exam room, and you don't need this giant bureaucracy to do that and create long lines. To sum it up, care delayed is care denied. With that, I thank you.

Mr. FLEMING. I thank the gentleman, Congressman Gingrey, again, a physician colleague as well as a congressional colleague; of course Dr. Broun as well and others. We have done this a number of times. It's always enjoyable and important for the American people to see the physician perspective. What I would actually like to do is to go over the fact that it's been said many times by Democrats here and everywhere that we are the party of ``no.'' We offer no solutions. And I have to remind people constantly that I ran on a pro-reform campaign to be elected to Congress last year. So it's very important to me as a physician to see true reform, not a government takeover of health care, but reform of what is really an excellent system. And we have had several plans that we are ready to offer, but now that we are getting to a point where there is actually going to be a Democrat plan on the floor perhaps this week or the next week that will be voted on, we're now ready to offer our substitute. And I wanted to contrast and compare for a moment how these two plans differ, and I will just hit the high points. Number one, the Pelosi plan cuts Medicare by $500 billion. That's a half trillion dollars. It cuts it out. No explanation. No plan. No strategy. We have had Medicare for 45 years. No one knows how to reduce fraud, waste, and abuse any more than it has. In fact, we know that the larger the entity, the higher the fraud, waste, and abuse is. Our plan does not cut a dime out of Medicare. The CBO estimates in PelosiCare that it will cut over $150 billion to Medicare Advantage, the private option of Medicare, which 25 percent of Americans, seniors, if you will, have chosen. It will take that program out completely. That will knock about 6 to 11 million seniors off of Medicare Advantage. And not only will they lose preventative health, the eyeware, and all the other benefits that go with it and the efficiencies and the preventative health, as I say, but they will be required to go out in the market and buy Medigap coverage; that's additional coverage. Our plan does not touch Medicare Advantage. It keeps it fully intact. Here's a very interesting one: the CBO says that under PelosiCare that part B premiums will increase by $25 billion, and part D, the medication part, will increase by 20 percent. Again, ours does not increase those costs one iota.

Mr. FLEMING. Thank you. Yes, you're quite correct, many things that go beyond the standard Medicare. And Americans have learned that that is a good bill. It's private insurance using Medicare dollars. In fact, many of us would like to see us, instead of having more government running of health care, to actually have current government programs run in the private sector, where things can be done far more efficiently. Also, there is a mandate, all employers, essentially all employers, will be imposed an 8 percent payroll tax under PelosiCare, absolutely. Under our plan, no mandate, no individual mandate, no employer mandate. As pointed out, as many as 5.5 million jobs will be lost as a result of increased taxes, which will add to, of course, the overhead for average businesses. Now, get this: currently businesses are at a marginal rate of 35 percent taxation. When the Bush tax cuts expire in the next year, that will jump to 39 percent. But added to it with the Pelosi health bill, there will be another surtax added of 5.4 percent, which will then take it up to 45 percent. So we're looking at a 10 percent increase in marginal tax rates. Now, tell me that that will not cause joblessness. There's no way around that. Also employers will be required to pay at least 72.5 percent of the premiums. There will not be the flexibility that they have today to pay less if they can't afford more. Will PelosiCare have medical malpractice reform? Not only will it not have it, but the so-called pilot studies that will be offered out there, a measly few million dollars to do that, the only States that can do that are States that do not have laws that restrict lawyer fees or awards or rewards--should I use the word ``rewards''--awards for damages. So that means that we can, of course, reform medical malpractice as long as we don't do anything to lawyers, which, of course, is the biggest interest group, I think, in this bill to begin with. There are many things, Mr. Speaker, that are going to just blow the budget out. And I would say in summary that everyone, middle class and above, is going to be affected by this in a negative way. And here's how they are going to be affected: they're either going to be paying higher insurance premiums, or they're going to be paying higher taxes or both. And the government will be deeply involved in every decision in life. Their lives will be managed by the Federal Government, micro-managed, if you will. And if you're a senior, you're going to have increasing difficulty in finding a provider, a hospital or a doctor. It's already true with Medicaid, the other government-run program, which, by the way, is going to increase to 25 percent of human beings in this country from where it is today. And most people who are on Medicaid cannot find doctors as it is. Where are these doctors going to come from? Because you see, Mr. Speaker, the problem is, and again look at Cuba, look at North Korea, look at Canada, look at the United Kingdom, they all have universal coverage, but universal coverage doesn't mean you're going to get treated. Only one out of six people in Canada has a family physician. So the answer is always in these countries that are government-run systems, yes, you're not going to have to pay that; yes, it's fully covered; but you're just going to have to wait a couple of years to get it. And some things that are common in the vernacular in Canada and the U.K. is, yes, you have cancer, but, no, we're not going to treat it, we're going to watch it. You will never hear a doctor say that in the U.S.

Mr. FLEMING

Mr. FLEMING. Well, I quite agree, with you, Dr. Roe. I would like at this moment--and I think it would be a fitting time for this--to quote an excerpt from The Wall Street Journal, today's edition, where there's an editorial, probably the best editorial I've ever read. For those of you who are watching tonight, I would strongly recommend that you read a copy of, again, today's Wall Street Journal editorial. I'm going to read just an excerpt. Here is what it says. Again, these are financial experts who are writing this. This is probably the widest read newspaper in the country, period, even more than USA Today, and they're certainly the most intelligent and best-trained financial people. It says: Speaker Pelosi has reportedly told fellow Democrats that she is prepared to lose seats in 2010 if that's what it takes to pass it. This is obviously suggesting that there are a lot of people out there who don't like this, and she's bound and determined to have this as her legacy. ObamaCare, as it says--I call it PelosiCare--and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a critical milestone, may well be the worst piece of post-New Deal legislation ever introduced. In a rational political world, this 1,990- page runaway train would have been derailed months ago. That's quite true. Not one single Republican at any point has supported this bill, and many Democrats have not supported it. With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle class entitlement that is designed to expand over time. Again, I emphasize ``unrepealable.'' Once this thing gets into law, like so many things, there is no way we can get rid of it. It will be with us forever. Taxes will need to rise precipitously. Even as ObamaCare so dramatically expands the government control of health care, eventually all medicine will be rationed via politics. So I think that's very critical. First of all, it's one party--and one party only--that wants to force this. Really, it's even less than that. Just the leadership of one party wants to force this takeover of one-sixth of the American economy forever and wants to put it under government control forever, controlling your life from day to day. For what gain? Dr. Roe just pointed out that we could easily cover the same number of additional people with much less cost and with much less effort. What it does is it leads to rationing. It leads to long lines. I think, certainly, what has been said about justice is true about health care: health care delayed is health care denied.

Mr. FLEMING. Yes, I would be happy to.

Mr. FLEMING. One thing that I think can be said about this bill that's pretty obvious, and that is by virtue of a lot that you have said tonight, Dr. Roe, is that everyone will see costs go up. There is individual mandates, so even individuals who don't sign up for insurance will pay 2.5 percent taxes, which they don't have to pay. That's middle class, even lower socioeconomic class taxation. There will be taxation on health savings accounts that does not exist today. Taxpayers will see their taxes increase. An employer will see their net tax go from 35 percent marginal rate today to 39 when the Bush tax cuts expire. Then another 5 percent above that, they will get to marginal rates of 45 percent, which most of those higher-income individuals in that range are small business owners, which means that they will have to reduce other benefits or reduce pay or reduce number of employees. That's all there flat is to it. There are only so many places you can cut.

Mr. FLEMING. I have. I have had a number of them say that. They have done the math. They cannot figure out where they are going to get the extra 5, 10, 15 percent. I mean, most businesses today operate on a margin of around 5 percent of gross income. Well, when you add overhead of another 15 percent, that means you are upside down by 10 percent. The bottom line is that everybody, not just the high-income people, everybody is going to be paying more in either taxes or premiums or both. Everybody is going to be getting less access to care. Yes, less access to care. Again, just quickly going back to Canada, remember in Canada, care is free for everybody. It's universal, 100 percent. Well, only one out of six people have a family doctor in Canada. They actually have a lottery system. Yes, it's 100 percent universal. Unfortunately, you can't get in the system. They close hospitals down. Even Cuba claims to have universal health care and medicine is free. The only problem is they've got no medicine. So what good is free when it isn't available? That is the direction that we are taking here if we go off this way. Just to kind of summarize my comments on this, that is that every health care model in the world looks at two possibilities, two options to save money. One is to bring it down to the unit between the doctor and the patient and give them both a stake in what the total cost is, not necessarily pay completely out of pocket but at least pay a portion of it, and that's where health savings accounts make savvy consumers out of patients. Either that, in which they have a stake in controlling costs, or you have a giant bureaucracy such as in Canada and the UK, in which case you have to have long lines and rationing. It's one way or the other. America, you are going to have to decide what you want. Today, we don't have the ideal thing. We need to improve the system we have. But if we go with the public option, which will lead to single payer, then we are going to go down the road of rationing and long lines. There is no doubt about that. And even Members of the other side of the aisle said that's where they want to be.

Mr. FLEMING. I thank the gentleman, my colleague and good friend, Dr. Roe from the great State of Tennessee. I have visited there many times, the Smoky Mountains. Also, speaking of smoky, everything there is smoked, and it smells so delicious you want to eat bark off trees when you go through Tennessee. So it's a lovely State, and I always enjoy visiting it. Like you, I grew up in a very middle class, working middle class environment. I had to work my way through college. My mother became disabled when I was five, and then my father died just as I graduated from high school. I suddenly had the burden of helping out with the family, but also working my way through college and then ultimately medical school, which, with the help of the U.S. Navy, I was able to do that. I served 6 honorable years--some of the best years of my life, and my wife--in the Navy practicing medicine in such duty stations as Guam; Charleston, South Carolina; Oceanside, California; Camp Pendleton Marine Base. It was, indeed, an honor to serve my country in that capacity as a physician. And then of course I've been in private practice since 1982, family medicine. I still see patients, I still provide care. I'm still dealing even day-to-day with some of the issues that all of us as physicians deal with. Like you, in your many years of practice, I have carried a burden about what a wonderful contrast we have here. We have tremendous quality of care and delivery of care and the best of care and the best of technology, but yet some people do have access problems. There is no question about it; that needs to be solved. I ran on a reform campaign, health care reform. I wanted reform, I came here to reform, but you know what I found when I got here is really anything but reform. What I'm seeing is a Congress that has taken a sudden left turn towards socialism to dismantle what is the best health care system in the world and remake it into the same image as Cuba, North Korea, Soviet Union, the U.K., Canada. Even some of the States like your own, Tennessee, who have experimented with socialized medicine and government takeover of medicine, have failed. I have actually asked, I have been to venues and asked, please, show me one example where government-run health care has ever been successful, and I have yet to find one single example of that. So, like you, I am very interested in health care reform that is true reform, that is common sense, that makes the cost go down--bend the cost curve down, that's the common theme today. And there are so many ways that I'm sure we will get into as we go forward that we can do that. And I thank the gentleman for recognizing me.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, this past weekend, my district in northwest Louisiana was hit with severe storms and tornadoes which left neighborhoods tattered, families without homes, and thousands threatened by levees that were threatening to break. On Friday night, Bossier Parish officials had exhausted all options to save this levee when many citizens and especially the airmen of Barksdale Air Force Base mobilized to protect this community. Colonel Steven Basham assembled 140 airmen; and through their efforts, the levees were saved that night. Over the days that followed, over 400 airmen worked around the clock to protect the levees, the homes and the families that surrounded it. Enlisteds, officers and even generals worked side by side in an effort to make sure that floodwaters did not destroy Bossier Parish. I want to extend my sincere gratitude for their dedication and work during this natural disaster; and I want to say that the efforts of these airmen prove, once again, why the United States military is the greatest assemblage of outstanding men and women in the world.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, as a doctor for over 30 years, I have become a pretty good judge of truth telling. We have heard Democratic leadership try to convince us that ObamaCare is going to pass, and with a ``robust'' public option. It has become obvious there are not enough votes in Congress, and suddenly, the terms are changing. Within a few days, a whole new vernacular has emerged to describe the public option. This includes the opt-in and the opt-out option; the trigger--no offense to Roy Rogers' horse; the competitive option; and finally, the consumer option. Mr. Speaker, this is not a marketing problem; it is an idea problem. To my Democrat colleagues, let me suggest a frequently spoken idiom: if you put lipstick on porcine, it is still porcine. Or if you prefer a Louisiana colloquialism: this dog won't hunt. This bill will add 750 billion real dollars to the deficit, not to mention taxes and higher premiums on the middle class, all while covering relatively few more Americans. Fortunately, there are enough Democrats in both Houses who see past this sham and fear their voters more than their leadership, as they well should.

Mr. FLEMING

Mr. FLEMING. I thank the gentleman. And thank you, Dr. Gingrey, for having this hour. You have shown tremendous leadership over the last few months and even before that, of course, but particularly the last few months in being willing to control time for us to have these discussions. Of course, Dr. Cassidy, my colleague from Louisiana, has been deeply involved in this issue, and we have all worked together, I think, as a great team, the GOP Doctors Caucus. I will get to that anecdote in just a moment. I think it is an important one. But let me stay with the subject just for a moment about the gimmickry, because I think that is essential to our discussion. I will develop it very carefully, but quickly, and also point out that this is an important part of the macroeconomics of health care that everyone must understand, and that is this: Currently Medicare and Medicaid, which are the current government-run health care systems, do not pay for the service that they are providing. Let me repeat that: These programs, Medicare and Medicaid, do not pay, at least completely, for all of the services that are provided, because the government requires and forces doctors, if you will, hospitals and other organizations, to provide care for less than the 100 percent reimbursement. Physicians, nurses, hospitals, home health agencies and so forth actually have to settle for less. So, how is it that we can stay in business, we in the health care industry, and get by on less? The answer is that the private insurance market, a much bigger market, subsidizes to the tune of about $1,700 to $2,400 per year per family. If it were not for that subsidy, it would collapse. Yet and still, Medicare is scheduled to run out of money by 2017. Now, how long is 2017? This is 2009. That is about 8 years that we are going to run completely out of money. Nobody in Washington is advancing any solutions to that. All right, where did the gimmickry begin? Remember that in the time period from about 1997 to 2003, Congress decided in its infinite wisdom that Medicare will be subject to a limitation on the budgetary increases from year-to-year. We call that the sustained growth rate, SGR for a lot of people. But because it was recognized even in the first year that such cuts would block access to health care by patients, it has never been enforced. So it has been a bookkeeping gimmickry that now has created an incremental difference of about $250 billion, and growing. And even the other day the Senate attempted to resolve this.

Mr. FLEMING. Would the gentleman yield for a moment?

Mr. FLEMING. That is a great point you make. What I would like to say is that something we have all observed as physicians is that while we all recognize collectively that, yeah, we should lose weight, we should exercise, and we shouldn't smoke, we, as human beings, tend to not address those issues until something comes up, until it affects us immediately in day-to-day life. The beauty of systems such as Safeway's is that they implement a financial impact, both positive and negative, that encourages healthy behavior before you ever get to a point where you go, You know what, I'm going to have to have heart stents or bypass surgery. Now I am going to make changes. Why not make the changes 5 years in advance? Then you don't have to go through that. Look at all the money you save and the health that you have as a result of that. I yield back.

Mr. FLEMING. That is correct. It is just physicians only. It is actually part B, which is mainly physicians. It simply says if you guys can't keep your billing and your costs and everything down in totality, we will just cut across-the-board. Well, that is an impractical solution. It is gimmickry. It would never work. Now we have a $250 billion gap that is not being paid for. The Senate the other day tried to address that and failed to, because they knew it would be dumped on to the budget. Let's advance, fast forward to this bill today. Right now this plan for approximately $500 billion that will be cut from Medicare, $160 billion or so of that would be a direct cut out of Medicare Advantage, which, as you know, is the more generous private system that is funded by Medicare dollars. If that happens, then those who are on Medicare Advantage, such as Humana Gold, will have to go back into the regular Medicare system and they will have to purchase Medigap insurance that they didn't have to purchase before. Again, seniors taking on the added burden. On top of that is another $300 billion to $350 billion coming directly out of Medicare on the basis of some future savings, some future efficiencies that no one has been able to figure out. So where are we today, Mr. Speaker? Basically $250 billion of doctor cuts, which have never been cut and will never be cut and are growing, that is going to end up in the budget at some point, another part of the deficit; another $350 billion which everybody in this room has known will never be paid for, but yet somehow it is being booked by the CBO as some savings. It is just continuous gimmickry. That is the only way this bill will ever be paid for, is gimmicks, which really means it is going to be taxpayers and premium holders. Then to go back and kind of summarize, my point here is that, as Dr. Cassidy points out, the only way that this is going to be an efficient health care system in terms of cost is the decisionmaking has to be in the exam room between the doctor and the patient, and one of the best methods to do that was a plan started in 2003 or so, Health Savings Accounts. All this does is allow the employer--and government could do this, too, for Medicare and Medicaid--to put money in the bank that can be used at the discretion of the patient to buy medications or whatever, and it's his money or her money to use efficiently. Just an example of how it works, we implemented this with my own private health plan with my companies a few years ago, and instead of our rates going up an average of 15 percent per year, they're going up an average of 3 percent per year. I was giving this discussion to my employees one day, and one of my employees piped up and said, Well, look, if we go to this health savings account idea, that's going to mean that I'm going to have to pay out of my health savings account $100, $150 a month for inhalers. I said, Well, let me suggest to you this: Why don't you stop smoking? You will save money from the tobacco. You will be able to stop your inhalers, and then you'll just be banking all this extra money, which will end up removing any deductible you're going to have in the future. She came back to me 3 months later and said, I stopped smoking. I no longer have to use inhalers, and I've got extra money every week. I wanted to pull together some of these salient points that have to go with the gimmickry and how we're going in the wrong direction. Expanding government control is going to expand cost. Instead, we should be looking inwardly and bringing it down to the doctor-patient level where the decisions can really be made efficiently. With that, I will yield back.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, as a family physician for over 30 years, I could have never imagined that the Democrats would come up with such a crazy idea as ObamaCare paid for on the backs of the American seniors. As it stands today, $162 billion will be cut from Medicare Advantage, forcing seniors to buy Medigap insurance like that sold by AARP, one of the many special interest groups the President cut a sweetheart deal with behind closed doors. There is also another $350 billion that will be cut from the regular Medicare, which will directly remove access to medical care for this, the Nation's Greatest Generation. In rural areas like much of my district in Louisiana, seniors will lose access to critical medical care as home health, doctors, and hospitals--they will all be closing their doors. I call on Speaker Pelosi to stop this horrible attack on the health and welfare of our senior citizens now.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, as a physician, I must say the news coming out of Washington is all bad when it comes to the government takeover of our health care. Just last night, Speaker Pelosi got the news that she does not have the votes to pass it. The Senate expects the debate to spill over into next year, and even Democrat candidates back home are turning against this crazy idea. Why is this happening? Simply put, they can't find a way to pay for it. There are not enough taxpayers and insurance policyholders to pay the exploding tab, and the polls show a continued decline in support. Also, they can't depend on the wealth of the Federal Government anymore as we are broke, broke. This is not a case of Republicans wanting sick people to die quickly. It is a case of wanting this sick, expensive, ineffective, and wasteful government takeover of health care to die quickly.

Mr. FLEMING

Mr. FLEMING. Mr. Speaker, as a physician, a family physician for over 30 years, I must speak out again on health care. The President promised, promised that if you like what you have you, you can keep it. But it appears, with the current Democrat health plan, this is not true, at least when it comes to seniors. Both the House and Senate proposals contain billions in cuts to Medicare Advantage, a very popular private insurance program that 25 percent of America's seniors have chosen for themselves. With ObamaCare this, the Greatest Generation, will lose benefits they currently enjoy, another broken promise by the President. Many seniors will be forced to pay for services such as supplemental vision or hearing coverage that was previously covered. Consequently, seniors will be dumped back into the regular Medicare that, according to this plan, will have $300 billion stripped from it. The net result of this broken promise for seniors, some of whom are my patients, will be to have substantial reduction in service, care, and benefits.

Mr. FLEMING

Mr. FLEMING. Again, to look at the fundamentals of economics, today doctors are paid on average 80 percent of the cost of the care they provide. The rest is made up on private insurance. And if you cut that further, then physicians will find not only can they not break even on providing care to Medicaid recipients, they are going to lose money. And they can't afford to do that. They can't make payroll. They can't pay their light bill, their rent and so forth if they can't make enough money from their patients. So the bottom line here is the basic dishonesty of this bill. It says that a half trillion dollars will be cut out of Medicare and it's going to come out of fraud, waste and abuse. After 40 years, no one has been able to figure out how to do that. No one advances a methodology for doing that today. And so if you add already the fact that physicians are paid less than their costs, an impending cut of 21 percent of their reimbursement and perhaps more in future years, and then another half trillion dollars, which is going to go against them and hospitals, what we're basically doing is telling seniors, Forget it; we're taking your health care, and we're giving it to other people.

Mr. FLEMING. Absolutely. It's only a fraction of the real cost.

Mr. FLEMING. No. Absolutely. What this bill will do is not only gut Medicare and reduce the reimbursements to physicians already, but it is going to deliberately push people from private insurance, because this so-called competition is going to be an artificial market, which is really a low-ball, and it is going to force employers to push their employees onto this. So you will see Medicare enlarging. And when I say that, I don't necessarily mean in a generic way. Just today, the Democratic Party released a trial balloon, saying, well, instead of calling it a public option, let's call it Medicare for everyone. Every physician will be paid at the Medicare rates for all these new patients. So what you have in the end, just to summarize, is a growing Medicare pool or universe and a shrinking private insurance, which will drive insurance costs up steeply, and you will be left with basically a collapsed private insurance market.

Mr. FLEMING. I just have 15 seconds of a thumbnail little summary I'd like to mention. If ObamaCare passes, there will be increased taxes for the middle class--which the President promised wouldn't happen--and significantly increased private premiums. It will decrease services to senior citizens. It will explode the budget. And the bottom line is we will pay more for less

Mr. FLEMING. On the subject of health savings account--and you heard me say our experience was less than 3 percent increase in costs per year. And you point out that it's the employer's dollars that are going into that account, not the employees. It's pre-tax or nontaxed, really; and it's used at the employee's discretion. Just a quick example: had a lady who, when we first implemented this, she said, Well, I'm a little concerned because this means that I'll have to pay out of pocket, meaning out of the health savings account for my medications for my respiratory problems. And I said, Well, what is it that you take and how much does it cost? And she says, Well, I use several inhalers. It costs me $100, $150 a month for medication. And I suggested, Well, why don't you stop smoking and you'll save money on the tobacco, and you can stop your inhalers, probably. And sure enough, she did: came back 3 months later and thanked me. She felt better. She had a lot more money in her pocket, and it all had to do with the health savings account.

Mr. FLEMING. I thank the gentleman, Dr. Broun from Georgia, whom I consider a mentor of mine, a family physician who has preceded me into Congress. And it's important that we physicians speak out on this important issue. We've come to a point now where the Democrat version of this, or versions I shall say, are about to be put together and put to a vote. And I think that we have an idea about what's going to come out on the other side of this, whether it's a hybrid or some sort of combination or one or the other, the Baucus bill, which mainly emphasizes increased premiums, taxes on health plans, on medical devices, if you will; and then on the House side, a plan with a so- called robust public option which we know to be a very robust takeover by the government of health care which will lead to a number of taxes. Every one of them finance this program basically in two ways: one, raising taxes or a cost on premiums or both; and the other is gutting Medicare to the tune of a half trillion dollars. On top of that, it gets a running start by taking in revenue for about 3 years before actually spending it on anything to, again, cook the books and make things look better. And then on top of that is an impending decline in reimbursements to physicians of 21 percent in their Medicare reimbursements, which, again, adds another $250 billion of cost on this, which can be hidden. They're trying to hide it, but it's not successful.

Mr. FLEMING. Will the gentleman yield on that?

Mr. FLEMING. I appreciate your yielding for a moment. Absolutely true. Apart from being a family physician for over 30 years, I have owned small nonmedical businesses for a number of years, over 20 years, and we ran into this same escalation problem, 9, 10, 12, 15 percent, really, per year. Finally we said, What can we do to resolve this? And the Health Savings Account had been enacted again by the Republicans just shortly before that, and I studied it. I used my background as a physician in the economics of medicine and I said, You know what? This, in effect, connects the patient, in this case me and my employees, back to the real cost of care. It should have a remarkable impact bending the cost curve down. We didn't use that term then because it hadn't been used. But to make a long story short, we implemented it. We are about 7 years down the road now, and our net increase in inflation cost has been less than 3 percent per year.