Pete Hoekstra

Mr. HOEKSTRA

Mr. HOEKSTRA. Mr. Speaker, I thank the gentleman from California for yielding me this time. Mr. Speaker, I want to take this opportunity to congratulate the chairman of the committee, the gentleman from Washington [Mr. Tate], and the gentleman from California [Mr. Riggs], for moving this piece of legislation. It is kind of interesting as we are here at the end of the year to take a look at all the legislation that the committee has passed, that Members like Mr. Tate have passed, and to take a look at the problems of the past, to remember the House bank scandal, remember the hundreds of bounced checks, the post office scandal, the stamps for cash, unauditable House books, a Congress that exempted itself from the laws that it passed on the rest of the country, days of subsidized haircuts, days of free gifts and meals from lobbyists. The gentleman from California, Chairman Thomas, has worked hard for 2 years to change much of that, if not all of it. Taking a look at our booklet, which is called ``The Index of Congressional Reform,'' it outlines the changes that this Congress has made over the last 2 years. On opening day we applied a whole series of private sector laws to this Congress. Remember, these were the laws that did not even apply to us before but were applied to the rest of the country: Age Discrimination and Employment Act, Americans With Disabilities Act, the Civil Rights Act, Worker Adjustment and Retraining Notification Act, Veterans Reemployment Act, Federal Labor-Management Relations Act. We limited congressional terms. We held the first vote ever on congressional term limits. This Congress gave the next President the line-item veto. We cut congressional budgets. We reduced committee staff size. We slashed committee budgets. We limited the terms of chairmen and the Speaker of the House. We cut taxpayer-financed mass mailings. We eliminated free personalized calendars. We passed zero tolerance for gift ban. And today we add one more to this long, impressive list, where we are saying here is another law that only makes common sense; that for somebody who abuses their office, they will lose their Government- funded pension. It makes sense. It is a commonsense reform. I congratulate the chairman of the committee and the authors of this bill for bringing this bill to the floor today. It makes common sense. They have worked hard at taking this through the committee and building this bipartisan support. This goes on, the other items that we passed during Reform Week, where we denied floor privileges to former Members who are registered lobbyists. We prohibited the handing out of campaign checks on the floor of the House. We worked on campaign finance reform. We had a great bill. We did not get it passed, but we are going to revisit the issue of campaign finance reform. Also, in the rules package for the 105th Congress, we are going to include the Enumerated Powers Act. What does that mean? It means that in any piece of legislation that is brought before the House, the authors will have to outline the constitutional justification. What this brings is a complete and impressive package of reforms that inherently change the way business is done in Washington. It says that if Members abuse their role, their special role in this country, they will lose the benefits of serving, of having served in this institution. We have changed the way that Washington works. We have got a lot more work to do. This country is still $5 trillion in debt. But this Congress, this Congress, led by Republicans, has made significant progress in moving toward a balanced budget and moving toward the fundamental and systemic changes that will ensure that we will balance the budget. I congratulate the gentleman.

Mr. HOEKSTRA

Mr. HOEKSTRA. Mr. Speaker, I submit for the Record the following: Second Trimester Abortion: From Every Angle--Fall Risk Management Seminar introduction The surgical method described in this paper differs from classic D&E in that it does not rely upon dismemberment to remove the fetus. Nor are inductions or infusions used to expel the intact fetus. Rather, the surgeon grasps and removes a nearly intact fetus through an adequately dilated cervix. The author has coined the term Dilation and Extraction or D&X to distinguish it from dismemberment-type D&E's. This procedure can be performed in a properly equipped physician's office under local anesthesia. It can be used successfully in patients 20-26 weeks in pregnancy. The author has performed over 700 of these procedures with a low rate of complications. background D&E evolved as an alternative to induction or instillation methods for second trimester abortion in the mid 1970's. This happened in part because of lack of hospital facilities allowing second trimester abortions in some geographic areas, in part because surgeons needed a ``right now'' solution to complete suction abortions inadvertently started in the second trimester and in part to provide a means of early second trimester abortion to avoid necessary delays for instillation methods.\1\ The North Carolina Conference in 1978 established D&E as the preferred method for early second trimester abortions in the U.S.2, 3, 4 --------------------------------------------------------------------------- \1\ Footnotes at end of article. --------------------------------------------------------------------------- Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix.\5\ However, most surgeons find dismemberment at twenty weeks and beyond to be difficult due to the toughness of fetal tissues at this stage of development. Consequently, most late second trimester abortions are performed by an induction method.6, 7, 8 Two techniques of late second trimester D&E's have been described at previous NAF meetings. The first relies on sterile urea intra-amniotic infusion to cause fetal demise and lysis (or softening) of fetal tissues prior to surgery.\9\ The second technique is to rupture the membranes 24 hours prior to surgery and cut the umbilical cord. Fetal death and ensuing autolysis soften the tissues. There are attendant risks of infection with this method. In summary, approaches to late second trimester D&E's rely upon some means to induce early fetal demise to soften the fetal tissues making dismemberment easier. patient selection The author routinely performs this procedure on all patients 20 through 24 weeks LMP with certain exceptions. The author performs the procedure on selected patients 25 through 26 weeks LMP. The author refers for induction patients falling into the following categories: Previous C-section over 22 weeks; obese patients (more than 20 pounds over large frame ideal weight); twin pregnancy over 21 weeks; and patients 26 weeks and over. description of dilation and extraction method Dilation and extraction takes place over three days. In a nutshell, D&X can be described as follows: Dilation; more dilation; real-time ultrasound visualization; version (as needed); intact extraction; fetal skull decompression; removal; clean-up; and recovery. Day 1--Dilation: The patient is evaluated with an ultrasound, hemoglobin and Rh. Hadlock scales are used to interpret all ultrasound measurements. In the operating room, the cervix is prepped, anesthetized and dilated to 9.11 mm. Five, six of seven large Dilapan hydroscopic dilators are placed in the cervix. The patient goes home or to a motel overnight. Day 2--More Dilation: The patient returns to the operating room where the previous day's Dilapan are removed. The cervix is scrubbed and anesthetized. Between 15 and 25 Dilapan are placed in the cervical canal. The patient returns home or to a motel overnight. Day 3--The Operation: The patient returns to the operating room where the previous day's Dilapan are removed. The surgical assistant administers 10 IU Pitocin intramuscularly. The cervix is scrubbed, anesthetized and grasped with a tenaculum. The membranes are ruptured, if they are not already. The surgical assistant places an ultrasound probe on the patient's abdomen and scans the fetus, locating the lower extremities. This scan provides the surgeon information about the orientation of the fetus and approximate location of the lower extremities. The tranducer is then held in position over the lower extremities. The surgeon introduces a large grasping forcep, such as Bierer or Hern, through the vaginal and cervical canals into the corpus of the uterus. Based upon his knowledge of fetal orientation, he moves the tip of the instrument carefully towards the fetal lower extremities. When the instrument appears on the sonogram screen, the surgeon is able to open and close its jaws to firmly and reliably grasp a lower extremity. The surgeon then applies firm traction to the instrument causing a version of the fetus (if necessary) and pulls the extremity into the vagina. By observing the movement of the lower extremity and version of the fetus on the ultrasound screen, the surgeon is assured that his instrument has not inappropriately grasped a maternal structure. With a lower extremity in the vagina, the surgeon uses his fingers to deliver the opposite lower extremity, then the torso, the shoulders and the upper extremities. The skull lodges at the internal cervical os. Usually there is not enough dilation for it to pass through. The fetus is oriented dorsum or spine up. At this point, the right-handed surgeon slides the fingers of the left hand along the back of the fetus and ``hooks'' the shoulders of the fetus wit the index and ring fingers (palm down). Next he slides the tip of the middle finger along the spine towards the skull while applying traction to the shoulders and lower extremities. The middle finger lifts and pushes the anterior cervical lip out of the way. While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger. Reassessing proper placement of the closed scissors tip and safe elevation of the cervix, the surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening. The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient. The surgeon finally removes the placenta with forceps and scrapes the uterine walls with a large Evans and a 14 mm suction curette. The procedure ends. Recovery: Patients are observed a minimum of 2 hours following surgery. A pad check and vital signs are performed every 30 minutes. Patients with minimal bleeding after 30 minutes are encouraged to walk about the building or outside between checks. Intravenous fluids, pitocin and antibiotics are available for the exceptional times they are needed. anesthesia Lidocaine 1% with epinephrine administered intra-cervically is the standard anesthesia. Nitrous-oxide/oxygen analgesia is administered nasally as an adjunct. For the Dilapan insert and Dilapan change. 12cc's is used in 3 equidistant locations around the cervix. For the surgery, 24cc's is used at 6 equidistant spots. Carbocaine 1% is substituted for lidocaine for patients who expressed lidocaine sensitivity. medications All patients not allergic to tetracycline analogues receive doxycycline 200 mgm by mouth daily for 3 days beginning Day 1. Patients with any history of gonorrhea, chlamydia or pelvic inflammatory disease receive additional doxycycline, 100 mgm by mouth twice daily for six additional days. Patients allergic to tetracyclines are not given proplylactic antibiotics. Ergotrate 0.2 mgm by mouth four times daily for three days is dispensed to each patient. Pitocin 10 IU intramuscularly is administered upon removal of the Dilapan on Day 3. Rhogam intramuscularly is provided to all Rh negative patients on Day 3. Ibuprofen orally is provided liberally at a rate of 100 mgm per hour from Day 1 onward. Patients with severe cramps with Dilapan dilation are provided Phenergan 25 mgm suppositories rectally every 4 hours as needed. Rare patients require Synalogos DC in order to sleep during Dilapan dilation. Patients with a hemoglobin less than 10 g/dl prior to surgery receive packed red blood cell transfusions. followup All patient are given a 24 hour physician's number to call in case of a problem or concern. At least three attempts to contact each patient by phone one week after surgery are made by the office staff. All patients are asked to return for check-up three weeks following their surgery. third trimester The author is aware of one other surgeon who uses a conceptually similar technique. He adds additional changes of Dilapan and/or lamineria in the 48 hour dilation period. Coupled with other refinements and a slower operating time, he performs these procedures up to 32 weeks or more.\10\ summary In conclusion, Dilation and Extraction is an alternative method for achieving late second trimester abortions to 26 weeks. It can be used in the third trimester. Among its advantages are that it is a quick, surgical outpatient method that can be performed on a scheduled basis under local anesthesia. Among its disadvantages are that it requires a high degree of surgical skill, and may not be appropriate for a few patients. references \1\ Cates, W. Jr., Schulz, K.F., Grimes D.A., et al: The Effects of Delay and Method of Choice on the Risk of Abortion Morbidity, Family Planning Perspectives, 9:266, 1977. \2\ Borell, U., Emberey, M.P. Bygdeman, M., et al: Midtrimester Abortion by Dilation and Evacuation (Letter), American Journal of Obstetrics and Gynecology, 131:232, 1978. \3\ Centers for Disease Control: Abortion Surveillance 1978, p. 30, November, 1980. \4\ Grimes, D.A., Cates, W. Jr., (Berger, G.S. et al, ed): Dilation and Evacuation, Second Trimester Abortion-- Perspectives After a Decade of Experience, Boston, John Wright--PSG, 1981, p. 132. \5\ Ibid, p. 121-128. \6\ Ibid, p. 121. \7\ Kerenyi, T.D. (Bergen, G.S., et al, ed): Hypertonic Saline Installation, Second Trimester Abortion--Perspectives After a Decade of Experience, Boston, John Wright-PSG, 1981, p. 79. \8\ Hanson, M.S. (Zatuchni, G. I., et al, ed): Midtrimester Abortion: Dilation and Extraction Preceded by Laminaria, Pregnancy Termination Procedures, Safety and New Developments, Hagerstown, Harper and Row, 1979, p. 192. \9\ Hem, W.M., Abortion Practice, Philadelphia, J.B. Lippincott, 1990, p. 127, 144-6. \10\ McMahon, J., personal communications, 1992.

Mr. HOEKSTRA

Mr. HOEKSTRA. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I join my colleagues to honor former President George Bush, but I choose to do so in a very different way, by limiting the Federal Government and working toward a balanced budget, not by creating a new fellowship program. Supporters of H.R. 3803 have good intentions, but the goal of honoring former President George Bush can better be accomplished by resisting the urge to create yet another program and spending more Federal dollars. The new Bush School at Texas A&M is certainly a fitting tribute to former President Bush. President and Mrs. Bush are committed to teach and live in the area. I applaud his dedication to students and to working with this school and this Texas community to make a difference in the education of our young people. The enthusiasm for launching this new fellowship has caused very generous Members of Congress, I believe, to live outside of their means. Let us have a check on the Federal Government. Do we believe government is too small? Do we believe we have too few Federal education programs? By our count and by the count of the executive branch we already have over 760. Do we need 761? The most honorable thing that Congress can do for George Bush is to review our current programs, figure out what works, what does not work, and pursue creative ways to improve education. Creativity will not lead us to enacting yet another Federal education program and spending additional funds. Until we have gained an adequate understanding of the effectiveness of these 760 programs, we should not add another program to that list. President Bush was an advocate of 1,000 Points of Light. That philosophy still lives in the hearts of all Americans, that we can do so much more privately than with Federal funds. We do not need this legislation to accomplish its goal. This bill, though well-intentioned, perpetuates the myth that Washington can and should create effective education programs in the place of the private sector or State and local organizations. We are masters of buying constituencies with other people's money, a program here, a program there. It sounds good, it makes us feel important; it is what we do. We spend money. This is one time where we should resist that urge. It is a myth that this money we are spending today will help America. It does not honor George Bush. It honors the Washington spending myth. Citizens Against Government Waste, the National Taxpayers Union, and Taxpayers for Common Sense all agree that this is unnecessary new Federal spending. Mr. Speaker, I reserve the balance of my time.

Mr. HOEKSTRA. Mr. Speaker, I yield 2 minutes to my colleague, the gentleman from Minnesota [Mr. Minge].

Mr. HOEKSTRA

Mr. HOEKSTRA. If the gentleman will continue to yield, Madam Speaker, think of the arrogance that is used to describe this tax, the arrogance toward the American taxpayer, because they say the user fee must not act as a barrier to a product sale. Do these people never get outside of the beltway? Who thinks that the average American family, the parents that pack their kids off to school in the morning, that they have an extra 5 percent to pay for backpacks, for compasses, for dry bags, sleeping bags, hiking boots? No big deal, it is only 5 percent. They have that. They talk about the pressure on the family, and the financial pressure, but then it is kind of like where are they coming from? Five percent, of course they can; hey, they have 5 percent more to send to Washington. And they do it on a whole range of things. It is an arrogant way of taking a look at the American family and saying, we in Washington need 5 percent more, and you, at the family level, you have it. You can afford to easily give us 5 percent, because if we ask you for 5 percent more, that will not be a barrier to you being able to buy this product. Where have they been? And maybe it is time for the Clinton-Babbitt team to get outside of the beltway and talk to some real Americans, and find out how much 5 percent means to them.

Mr. HOEKSTRA. We are going to hear a lot more about this issue and others like it. We on our side of the aisle, we have pushed for family tax relief. We believe that Washington already collects enough of our money and we do not want any more money in Washington. We want to return it back to families. We want to return it back to small businesses, because we believe the best engine for growth in this country are small businesses and Americans deciding the priorities for where they spend their money. This I believe is just the beginning of a whole new series of taxes that a Clinton administration would love to put on the American people. You and I were both here in 1993 when we in this Congress, you and I both voted against it, but when we in this Congress came forward and it passed the Clinton tax increase, where again it became very clear, government is not big enough, we do not have enough money, we want more. This is just what I believe is the first scheme to get more money from the American people. I think it goes after it exactly the wrong way. It taxes the very things that are important to families, that are important to children. It hides the tax, because it would be a tax at the manufacturer's level, not at the sales tax level, so once again people will be paying taxes and they will not know that it is actually going to the Federal Government. At the same time, it does it in such a way that much of the tax dollars that will be raised will be used to fund bureaucrats here in Washington. The gentleman and I, we are talking about tax simplification, we are talking about going to a flat tax, we are talking about going to a consumption tax, or anything that takes the huge array of IRS tax booklets, so we could actually go fill our taxes out on a postcard or whatever. All this represents is a whole new series of taxes, complicated taxes describing what camping utensils will and will not be taxed, which flotation vest, which hiking boots. It is absolutely the wrong way to go at this time, or almost at any time. I cannot see any time where this kind of a tax in this kind of a direction would be appropriate. But it is an important lesson I think for the American people to understand that this is what the Clinton administration is talking about. This is the direction they are going.

Mr. HOEKSTRA. Madam Speaker, we thank the gentleman for staying.

Mr. HOEKSTRA. But we all know once a tax is in place, we do not raise it. Well, maybe that is not right. Usually when we have a tax in place it provides a floor from which to raise it, but you go out and buy an RV, or you go out and buy a sport utility vehicle--you know, a camper, a motor home a travel trailer or any of this. We are now talking about a quarter to a half a percent tax on these items. You know we have been joking about this, about what the Clinton- Babbitt tax looks like, because I mean it is, it is taking more money out of the system, it is moving decision-making to Washington. But this is a serious proposal, and this is indicative of what this administration believes. They believe Washington does not have enough money, that the American people are not even intelligent enough to make basic decisions about wildlife in these types of things, and they want more, they want more rules and regulations, and they want to grow the IRS, and they want more of our money, and they are blatantly going out and talking about increasing taxes and not talking about tax simplification. This is complicating the tax code, and it provides another avenue for Washington to suck a little bit more money out of our pockets and feed it to the bureaucrats here in Washington. Mr. de la GARZA. Madam Speaker, if the gentleman will yield?

Mr. HOEKSTRA. If the gentleman will yield, it goes on. We have talked about outdoor recreation equipment, backyard wildlife products, books and videos. You talked about the binoculars or may be we have not covered that yet; binoculars, hand lenses, spotting scopes, tripods, window mounts. Sorry. Those all now also have a 5-percent tax. This now goes on, talks about recreational vehicles, RVs. Now the tax rate is much lower on this.

Mr. HOEKSTRA. A tax on fat.

Mr. HOEKSTRA. You got to pay taxes on the hummingbird feeder. If you go to the grocery store and you buy suet and you put it in this little mesh thing, I am sorry, that is now taxed. You have to pay.

Mr. HOEKSTRA. I beg to take exception because I take Mr. Babbitt at his word. He does believe that he is doing the best for wildlife because what he is doing is he is saying: ``You as American citizens don't know what to do for wildlife or the birds in your backyard. Send me the tax because when I collect the money, States would then apply for the money to fund specific projects and would be required to match 25 percent of the Federal grants.'' So this is not about protecting or preserving the environment; it is just about how we do it. You pay the tax, you send the money to Washington so that the bureaucrats here in Washington can figure out what projects are best to do, and you know you cannot do that at the State level. We have got to have people in the Interior Department who are going to get this money from the IRS, who will then review the grants, and this is, you know, goes back--you are aware of the myth project that we have been working on, the myth that says only Washington can do things right. This is going to create a new department on not Independence Avenue, on Dependence Avenue, because it is going to be once again bureaucrats making decisions. In this case they are taking your money that you are going to buy birdbaths, birdhouses, bat houses, birdseed and this even goes on. You got a hummingbird feeder in your backyard.

Mr. HOEKSTRA. Floatation vests. Select, and for those--you know, this is, I am glad that they have already got the bureaucrats involved because for most people, floatation vests are just kind of like life preservers. But are we going to tax all floatation vests, or are we going to go to the IRS and come up with a set of rules and regulations that say these vests are taxed, taxed as 5 percent, and these are not? We are only going to tax selected classes of life preservers, but of course we are not going to tax standard lifeboat vests. You know, there is stuff on here. You outline the skis, polls, boots. That includes cross-country and downhill. Make sure we do not forget snowboards; they are now on the list. I do not know what a stuff sack is, but they are going to be taxed. Now let us go on. So we have covered--if you are going to have any fun outside, you know you can figure you are going to pay 5 percent, and it is not on this list, but I bet it soon will be: rollerblades will be on there. I cannot imagine not having rollerblades.

Mr. HOEKSTRA. Do not go to the calls yet, but take a look at another one, the floatation vests.

Mr. HOEKSTRA. I do not know, but we would have a bureaucrat at the IRS who would make that call.

Mr. HOEKSTRA. If it only had knives, and if it had just the blades with no forks----

Mr. HOEKSTRA. Go to schools. It is the kids. I have got three kids, 14, 11 and 8. They all go to school every morning with backpacks. Those now next year, when we go out and buy them with a Clinton, new Clinton-Babbitt tax, those backpacks will cost 5 percent more. But you forgot a couple of interesting things in there because obviously it is clear that Mr. Babbitt believes that government is not taking enough money, and otherwise he would not be proposing it. But remember this is a big number. This is a 5-percent tax. In Michigan our sales tax is 6 percent. You now tack on a 5-percent on top of that so he obviously believes government is not big enough and is not spending too much and he wants a little bit more money. But he also believes that the IRS is not big enough because we are going to have to come up with rules and regulations to implement this. We are going to tax certain camping utensils, but only those that are connected or folding. So, if it does not connect or snap together or fold, you do not pay the tax.

Mr. HOEKSTRA. Yes, and I would guess that if you took your seed that was packaged for pet feed and you ran out of wild bird feed but you took your seeds for pet feed and you used it outside for a wild bird, you know, you would be breaking the law.

Mr. HOEKSTRA. I mean you are getting to the fun parts now. I mean we think about it, the list that you have just gone through. Backpacks? The majority of backpacks in this country--

Mr. HOEKSTRA. If the gentleman would yield?

Mr. HOEKSTRA. Gentleman give an example?

Mr. HOEKSTRA. Madam Speaker, I believe that we ought to be fair to Mr. Babbitt, and I have misspoken myself. We are not talking about a new tax. The fee or the--excuse me, the term that the Secretary uses is, U.S. Interior Secretary Bruce Babbitt would put a, not a tax--a surcharge on outdoor-related equipment, and so it is not a tax. Later on now the AP goes on to take the liberty of describing a surcharge as a tax, but Mr. Babbitt has not called it a tax. He is working with, teaming with a wildlife group. And they also do not use the term ``surcharge'' or ``tax.'' They call it a ``user fee.'' This is what I think is interesting. We will talk a little bit about the amount. We will talk about the amount. But listen what they say about a user fee, which Mr. Babbitt calls a surcharge, which the Associated Press calls a tax, and which you and I would probably call a tax because what it means is that an American citizen is taking some money and sending it to government, and that is typically a tax. But they go on to say, make sure that the user fee must not act as a barrier to a product's sale. The user fee must not act as a barrier to a product's sale. So obviously, again, this is a case of companies and small businesses, because we will go through the list, these things are sold by small businesses. These small business people in America just must be making excess obscene products. I know that the distinguished chairwoman in the Speaker's chair this evening is chairing the Small Business Administration and cannot participate in this dialog. But I am sure if she had the liberty to participate in this dialog, the meetings and the hearings that we have had with her, she would clearly indicate that small businesses are under tremendous pressure and that any attempt to go back to small businesses or the American people probably would be hindrance to the sale of a new product. This is naive people in Washington saying we can charge people more, but of course it will not be a barrier to sale of more product. I gladly yield.

Mr. HOEKSTRA. What is that?

Mr. HOEKSTRA. What is that?

Mr. HOEKSTRA. Madam Speaker, what in the world does vacation have to do with new taxes?