Steve Kagen

Mr. KAGEN

Mr. KAGEN. The answer is, yes, we can, and yes, we will. By working together, we can close the doughnut hole; but it's going to take the opportunity and the power and the legality of leveraging down the price by using the government purchasing power. When we, the people, ban together in a purchasing pool to leverage down the prices for prescription drugs, we can get that price down. And I will give you one further hypothetical. If you are the owner of a drug company selling a pill in Mexico City for $1, thank you for openly disclosing that product and that price. That is the price it should be in New York State all the way through to California and the territories. Show me your price, and give every citizen and legal resident that same lowest price that you accept as payment in full. That's the power of the marketplace, and that is equality brought to the pharmacy.

Mr. KAGEN. So if I understand you correctly, you're saying if you're a citizen, you're going to be in. If it's in your body, you're going to be covered. And would you also agree that much like we had a systemic financial risk with our financial meltdown, isn't it also true with the crisis in health care, with the impossible costs for everyone, it presents a systemic risk to our economy and if we do not confront it, our economy may be in shambles?

Mr. KAGEN. I'm glad you brought this subject up because not every Medicare Advantage plan is identical, and not every community is identical as well. And there are some areas of the country where Medicare Advantage plans, like in some regions of New York State and some regions of Wisconsin, are very advantageous. They have a lot of prevention planned in them, and they're not really overcharging at all. They're really bringing about all of the evolution in our health care system that you'd like to see, squeezing out the waste and an emphasis on prevention and primary care. But no legislation is perfect. And nothing that we codify in law here that the President will sign will instill better judgment in every patient that is going to exist. It still comes down to personal responsibility. We can't possibly instill all of the good judgment into our children, don't you know. So we have to have an understanding of what our limitations are in terms of government. We have to set up the table and set up the rules of engagement wherein we can have an open and transparent medical marketplace, allow the marketplace to do what it does best, bring down prices for everybody and increase access. But it begins with this piece of legislation that we had submitted today, with no discrimination against anyone to preexisting conditions and a standard plan, a plan that guarantees if you get sick you will be in your house, not the poorhouse.

Mr. KAGEN. I thought it was my grandmother.

Mr. KAGEN. The other thing, the idea that was commonplace up until this point in time is to divide and conquer, and that's what the insurance industry did. They cherry-picked and they separated neighbor from neighbor based on preexisting condition. They went so far as to separate a husband and a wife based on medical conditions, in some cases a mother from her child. We're going to have to go back to community, the community-based ratings. We're going to have to go back to community here in Congress where we reach across the aisle and work together to solve these very complex problems. I'm so very glad that this class of 2006 and our recent adoptee from Ohio is taking on not just health care but energy and education. These are the three essential problems that the President has been leading us on.

Mr. KAGEN. I'd like to dovetail on both of these conversations and say that Mr. Ryan from Ohio pointed out the difference between health insurance and health care, and what we are talking about in this bill is health care, getting the care that you need. You have the choice, you've got the coverage, and you've got the costs coming down. That's exactly what this bill aims to do.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, it is with a deep sense of sadness that I express my sincere condolences to the family, friends, and community of Peshtigo, Wisconsin's native son Steven Drees, who was killed in action in Afghanistan on June 28 while serving his country in Operation Enduring Freedom. Private First Class Drees' enlistment began on July 25, 2008. He was assigned to D Company, 2nd Battalion, 12th Infantry Regiment, 4th Infantry Division out of Fort Carson, Colorado. Frequently decorated, he counted among his awards three Bronze Stars and a Purple Heart. When any soldier falls, we mourn collectively and we pray as one people. And when we lose one of our very youngest soldiers so close to home, we are especially aggrieved. Nothing can replace what Steve's family has lost, but if it's any consolation, let it be remembered that Private First Class Steven Drees remained dutiful and brave at all times and that he was a loyal United States soldier. That such a young man could serve so selflessly is a tribute to the nobility and fortitude of the people of Peshtigo, the people of Wisconsin, and the citizens of these United States. Steven will never be forgotten.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, we've come to a point in time in American history when it's past time for us to guarantee access to affordable health care for everyone. Last week, Thursday, President Obama came to Green Bay, Wisconsin, and he didn't have to travel very far to find a health care story. At the airport restaurant there's Jeff. And Jeff is working 65 hours a week, two different jobs, and he doesn't have the health care coverage that he needs. He can't get health care coverage because he has a preexisting medical condition. It's time for this House, on both sides of the aisle, to understand that Jeff isn't the only one who needs our help. We need to have choices. We need to have the care that we require just to get through the day, and we have to have health care at a price we can all afford to pay. And we must guarantee that no citizen shall suffer any discrimination due to any preexisting medical conditions. And I'll ask you this question: Isn't it time that we have a Federal standard, a standard health benefit plan, that's available to each and every American citizen and legal resident? I think it's time, and so do the people of northeast Wisconsin.

Mr. KAGEN

Mr. KAGEN. Thank you, Mr. Murphy. If you could raise up that sign one more time, it does say ``Health Care for America.'' It doesn't say ``health insurance.'' It says ``health care,'' which is our focus. We care about the people we're listening to--the people we have the honor of representing. It is about making certain that people can get to see their doctors when they need to at prices they can afford to pay. I'll share with you some of the stories that, perhaps, President Obama is going to hear when he comes to Green Bay, Wisconsin, on the 11th of June, just a few days from now. Here is someone from Green Bay who wrote to me. Her name is Stephanie: ``Insurance is number one on my list. My current employer can't afford to give us health insurance, and I can't get individual coverage. Help, please.'' President Obama might hear from Jim, who is also from Green Bay: ``Every human should have health care. Don't have insurance. 60 years old.'' He is between the cracks. He is not old enough for Medicare, and he is not poor enough for welfare or for Medicaid. In Sturgeon Bay, just outside of Green Bay, I got a card from Rhonda: ``Our middle class income cannot support the increase in medical premiums, copays and deductibles. What will be done for the middle class?'' She is Rhonda in Sturgeon Bay. People are writing to their legislators, not just in the Federal House here in Washington but across the State houses. Every government at every level understands the pressure and that the cost for health care has risen astronomically. It is 17 percent of our GDP. It is that investment that we make in ourselves to guarantee that we have health. If you don't have your health, you may not have anything. Now, recently, I received a mailing from an insurance company that is in my district. It's a great company. I just want to read this into the Record because, if you have certain preexisting conditions, all the marketing in the world won't allow you to purchase their product, because they don't insure people with preexisting conditions: ``Important information about preexisting conditions: Although we make every effort to extend coverage to all applicants, not everyone will qualify. If you have had treatment for any of the following conditions, you may not qualify for the coverage being offered.'' It reads: ``HIV/AIDS, alcohol, drug dependence, cancer, chronic obstructive pulmonary disease, connective tissue disease, Crohn's disease, diabetes, emphysema, heart attack, stroke, hepatitis, inpatient emotional and mental health care, organ or tissue transplant, ulcerative colitis.'' It goes on to conclude: ``You should also be aware that we may not be able to provide coverage to individuals who are severely obese, who are severely underweight or who are undergoing or who are awaiting results of diagnostic tests. We cannot offer coverage to expectant parents or to children less than 2 months old.'' Finally, it reads: ``This list is not all-inclusive. Other conditions may apply.'' I don't think it was a doctor who wrote this policy. I think it was someone who had his economic interests in mind and not the care of the people who are looking for the coverage they need in order to guarantee they get the care that they're going to require. We are prepared in this Congress, I believe on both sides of the aisle, to step up and to face and to confront this essential economic fiscal problem. It's not just about your money. It's about your life. This, after all, is the House of Representatives. Some people back home in Wisconsin think that we're trying to talk them out of their money and out of their lives. Tonight we're going to have a conversation with one another and with the American people about what is most important to you, and that is your health care. I'm hoping that, someday soon, we're going to come to a time when we'll have all prices openly disclosed everywhere in these United States for all of the products. Mr. Murphy, last week when I was home, I had a ``Congress on your Corner'' at a grocery store in Waupaca, Wisconsin. While there, I didn't get a headache, but if I had had a headache and had wanted to buy some aspirin--I took a picture of this. Now, some of my staff here in Washington think this is pretty cheap. You know, you can get Bayer's cherry- or orange-flavored aspirin for $2.55. Right there in the middle, you can buy a generic brand for $2.05, which is 20 percent less. What do you want to pay: more or less? It's the same medication. This price is openly disclosed. I think we have to have this type of health care available, not just at the grocery store for aspirin products but at the hospitals and at the doctors' offices and everywhere in health care across the country, most particularly for health insurance policies. If at the end of the day we're going to continue to allow companies to be in the marketplace, like the offering I just read to you, I believe very strongly they should be compelled to sell the same product to any willing customer with no discrimination due to preexisting medical conditions. If, after all, we have Federal standards in this country for almost everything, why don't we have the standard of a comprehensive health insurance coverage plan that each and every insurance company must offer to any citizen or legal resident anywhere in these United States? There is nothing wrong with having standards so long as we can meet those standards. So I think these are some of the issues that are important, one of which is transparency in health care purchases. We have to have no discrimination anywhere in health care. I think the President has accepted this as one of his most essential elements, as one of his eight principles for health care. One should not suffer in this country due to discrimination based on the color of one's skin. Well, what about the chemistry of one's skin? If we're not allowed to discriminate against anyone because of what they're thinking, what about how they're thinking? What about the chemistry of their minds? So I think it's time that we apply our civil rights that guarantee no discrimination to health care. When we do, we'll begin to guarantee access to affordable care for every single citizen and legal resident. I yield back.

Mr. KAGEN. You have got me all excited now. It has taken so long to get to this point. It is very frustrating. Back when we first got here, the class of '06, we got to initiate bills in '07 in the first few months. And as they say here, I dropped a bill called ``no discrimination'' to apply our constitutional rights to prevent us from being discriminated against, to prevent the insurance companies from cherry-picking people out. I don't know how it is in Pennsylvania, but in Wisconsin, in my neighborhood, I grew up in a neighborhood. But that neighborhood has been chopped apart by the insurance industry. The insurance industry was allowed to separate Mrs. Koss or Mr. Romer out of the risk pool because they had some condition they didn't want to touch or insure. And it has gotten to the point now where even some mothers may be split from their family because they have a condition, and their children can be insured but they can't. So I like the idea that we are going to get primary care and access to primary care. But as you know, we don't have enough doctors and nurses right now. So we have to invest in a possibility to make sure that our students can go to school and perhaps have their funding paid for through medical school and in return give us those years back in terms of service in primary care where that need most exists. My district is a rural district. I would point you to the rural district of northern Wisconsin. As Mr. Courtney has brought out so elegantly about the VA system, I would ask this question not only to him but to everybody in the country: Is there any reason why a soldier served only for himself or herself to get that benefit at the VA at the pharmacy? If a soldier has a VA benefit and has a discount, a medication available at a lower price, is there any reason not to provide his or her entire family with that same medication at that price? And what about his neighborhood? What about his community? In fact, what about the whole United States? No soldier today is serving in Iraq and Afghanistan for him or herself. They are there for our Nation. And if the VA was successful in negotiating a steep discount for a given medication, I think that price ought to be available to anyone who is willing and in need of that medication. And Mr. Klein from Florida mentioned that he might be taking a medication. Is there any reason that it continues to exist today that if I go into a pharmacy anywhere in the country, if all four of us are in line to get the same exact prescription, the same number of pills, we are going to pay four`` different prices for the same thing? I think not. I think we have to have complete transparency, and the price that one should pay for medication is the lowest price available within that community, and that price should be openly disclosed. And no one put it better than one of my constituents. Kaukauna is another city that Barack Obama has visited in my district. I tell you, this guy, Obama, is everywhere. Sally from Kaukauna said, ``Our prescriptions cost $1,000 a month. This is a very big issue for us.'' Well, heck, yeah. If you don't have the money, you're not going to get the medication you require just to survive. So I would submit to you that it is time to end discrimination in health care. And when we do, that form of discrimination that takes place at the pharmacy where Mr. Klein might get charged three times what the person in line next to him is charged for the same medication, to me that is a form of discrimination. I think it is time that that form of discrimination came to an end. We have to have openness and transparency for prescription drugs and be allowed to negotiate for a lower price.

Mr. KAGEN. Thank you for yielding. I'm just reassured, I'm more reassured tonight, I'm more optimistic tonight than ever before that by working together, not just as Democrats and Republicans or Libertarians or Independents, but as Americans we're going to come up with the solutions we need, as you say, to find this uniquely American solution to our health care crisis. It's going to happen. And, as we said tonight, in part it's going to be by leveraging the marketplace, using the marketplace to leverage down prices for everyone. After all, for those of you who are listening tonight, do you want to pay the higher price or the lowest price for the medical care that you need? Today the price is whatever they can get. So I look forward to working with all my colleagues on the floor in the House and working with the Senate to bring about the solutions that we need.

Mr. KAGEN

Mr. KAGEN. Madam Speaker, I would respectfully ask that all House Members rise and observe a moment of silence on the passing of our former colleague, Congressman Rev. Robert Cornell, who passed away on Sunday, May 10. Father Cornell represented the Eighth District of Wisconsin in this House from 1975 to 1979. He was a life-long advocate for the betterment of mankind, a deep-thinking educator, and a keeper of his faith.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, to put our Nation on the road to recovery, we have to do several things: First, we have to begin to clean up the economic mess that we have inherited after the past 8 years. Secondly, we have to rewrite our laws to guarantee that everyone has a fair shake and a fair opportunity to make it in today's economy. And together we will. Last week I was very proud to stand here and vote for the Credit Cardholder's Bill of Rights, and today I rise in favor of the Mortgage and Anti-Predatory Lending Act. This bill would help end the predatory lending that is a major factor in the many, far too many, home foreclosures now taking place. The bill would prohibit lenders from steering their customers into higher-cost loans, would ensure that borrowers actually have the ability to pay back the money that they are taking out, and would establish a simple standard for all home loans. I believe we have to work hard for people everywhere to guarantee that they can make it and keep their heads above water. Let's pass the Mortgage and Anti-Predatory Lending Act and build a better future for everyone.

Mr. KAGEN

Mr. KAGEN. Thank you, Congressman Perlmutter. I rise in strong support of the rule for supporting the Credit Cardholders' Bill of Rights. In these difficult economic times, all credit cardholders across the country should ask themselves, whose side are we on? Are we on the side of ordinary people? Are we on the side of consumers who are working hard to pay their bills every month? Or are we sitting in the boardroom of the big banks? Whose side are we on? We must protect the hardworking taxpayers everywhere in this country. I am working hard for the families of northeast Wisconsin, who I have the honor of representing. For too long, consumers everywhere, including Wisconsin, have been victimized by high fees, by increasing interest rates, and confusing credit card agreements that have allowed banks to jack up interest rates at their own pleasure and at consumers' expense. The Credit Cardholders' Bill of Rights will protect everyone from unfair and abusive practices. In short, it will prevent companies from constantly moving the goalpost and taking advantage of people who haven't done anything wrong. You know, when I grew up in northeast Wisconsin, on the playground we used to call this changing of the rules and interest rates, we used to call that ``party shop'' rules. If you work hard and play by the rules, you should be able to get ahead and receive credit at a price we can afford to pay. For these reasons, I urge my colleagues to support this rule and pass the Credit Cardholders' Bill of Rights. And someday soon, I hope we will also bring fairness to the merchants who suffer from excessive bank interchange fees, which is not yet part of this legislation.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, in these difficult economic times, we, as leaders, must ask ourselves the question, whose side are we on? Are we on the side of people--the consumers, the taxpayers, and hardworking families across the Nation? Well, I certainly am. Today, I rise in favor of the Credit Cardholders' Bill of Rights. For too long, hardworking Americans have been victimized by high fees, high interest rates, and confusing credit card agreements that these companies can change at will. The Credit Cardholders' Bill of Rights protects everyone from the unfair and often abusive practices that credit card companies put on everybody. It prevents credit card companies from unfairly increasing interest rates on existing balances. The Credit Cardholders' Bill of Rights will protect everyone. It ends unfair penalties for cardholders who pay on time, and it protects vulnerable consumers from high fees due to subprime credit cards. In short, it prevents these companies from constantly moving the goalposts and taking advantage of ordinary people who have done nothing wrong. Let's pass the Credit Cardholders' Bill of Rights and build a better Nation for everyone.

Mr. KAGEN

Mr. KAGEN. Thank you, Congressman Murphy. It's good to be with you again on the House floor where we can begin to discuss with the American people about progress we can make together. And only by working together are we going to bring about the changes that we need. Now, we did come here in 2006, November. We came for orientation. And we came with a message, and the message was about positive change. Now, I will just give you the good news. Just in case people haven't heard it across the country, there has been a change in Washington. We now have a President who can actually think things all the way through, someone who's really on our side for the changes that we need. And what have we done so far? Well, for the Meronek family that I have the honor of representing, this is a photo of Wendy and her 3-month-old child. And they didn't have access to a doctor at the doctor's office. She had access at the emergency room because she didn't have any health care at all. She was qualified for SCHIP but it wasn't fully funded. We passed SCHIP in our first term here in the 110th Congress. We passed it and the President signed it. And the very first thing that the President did for this country this year was to pass legislation that guaranteed that children who are most in need have access to the doctor in the doctor's office. It reduces taxes, reduces our costs, increases the health for our children, and prevents problems from getting worse. It's good for people's health and it's good for our budget. So we began to take that positive change by helping children. We also passed a bill that may not seem to be too related to health care, Lilly Ledbetter. This was a bill that guaranteed equal pay for women. Now, of all of you here in the gallery, a few of you that might be here tonight, raise your hand if you're against equal pay for women. Raise your hand if you're against providing health care to children who are most in need at the doctor's office. I don't think we see a hand going up. Women and children first, that is what this 111th Congress has done with the help of President Obama and his leadership. I have here a few postcards I have received from my constituents in northeast Wisconsin that pretty well tell it like it is. David and Dianne from Appleton: ``We have health insurance, but cannot afford to use it.'' Now, that is a problem, when you have health insurance coverage and the only thing it guarantees is that the insurance company is going to take the money, then you have to fight like heck to get the money back. They have high deductibles and can't afford to use the insurance they have. From Luxembourg, Wisconsin, Jim says, ``My wife and I have preexisting conditions with our health. Right now, we pay $3,000 a year after 80 percent is already paid.'' ``Preexisting conditions.'' It is time that we applied our constitutional rights that prevent us from suffering from discrimination by the health care industry. No discrimination. No citizen, no legal resident in this country anywhere should be discriminated against because of the color of their skin, and likewise they should not suffer from discrimination because of the chemistry of their skin. No discrimination based on the content of their heart. Well, what about the content of the arteries of their heart? We need to pass legislation that guarantees that no one will suffer from discrimination due to preexisting conditions. Here is a card from Albert from Crivitz, Wisconsin, who writes, ``Without a job that pays a fair wage, I won't have money to pay for health care, for gas, for a war, for Social Security or anything else.'' It is really tough to separate health care from our economy and our economic recession from the loss of the 6 million jobs during the last 12 months. We have to put this thing all together. One thing directly affects the other. Here is Kathleen from DePere, Wisconsin: ``It is time for all Americans to have the same health care benefits as their representatives in Washington.'' Well, that is not a bad start. I think people in our districts understand the situation just as well as we do here in Congress, and we are working very hard to bring about the changes that we need. I yield to my colleague from Florida, Ron Klein.

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

Mr. KAGEN. Let's not let the facts get in the way of a good argument or a good conversation, but the fact is that 72 million Americans are having great difficulty paying their medical bills as of November of last year. About 47 to 50 million Americans have no health care coverage at all. But let's not let the facts get in the way. And I certainly appreciate Chairman Olver reassuring the people in Japan, if they're looking in tonight, or this morning, for them, you know, they've got it pretty good in terms of health care coverage. And our friends in Europe understand that, you know, they don't have to worry about getting sick. My way of thinking is, as a physician, if you're sick, you should have the reassurance that when you're sick, you're going to have the coverage that means you're going to be in your house, not the poorhouse. If you're a citizen, you should be in the risk pool. It should be just that simple. If you're a citizen, you ought to be in. And if it's in your body, it ought to be covered. We have to find a way to make certain that that works out. And before I turn and yield to somebody else here in this discussion, not everyone agrees with all these ideas. That's why we have a debate. Here's a person from De Pere, Wisconsin who says, ``I do not want the government involved in health care. The government mismanages money and thinks funds are endless.'' So you see, we have to reassure our citizens, not just in De Pere, but that good government can make a positive difference in your life. Medicare was a tremendous program when it was first initiated; 16-1 was the ratio of people working versus retired. Now it's down to about 4-1, so there are some things we have to talk about. Is Medicare sustainable in its current model? It's a great challenge. And can we somehow tease apart and differentiate our economic recession from our ability to pay for our health care costs? I don't think so. People in my district are telling me, Kagen, health care costs are just impossible. Small businesses, what are their greater components of their overhead? Energy and health care. And that doesn't matter if you're on Main Street, on Wall Street, or if you're a family farmer in northeast Wisconsin. So we have to attack the greatest cause of bankruptcy today in the country, which is the high cost of medical care. I am confident that we're going to be able to work out some details to guarantee that if you're a citizen, you're in; that there will be no discrimination due to preexisting conditions; that the price for health care services, for hospital services, for your pills and prescription drugs will not be whatever they can get. It won't be whatever they can get. It'll be whatever they openly disclose, and give every citizen that same discount.

Mr. KAGEN. Well, Mr. Klein, I appreciate what it's like to be in Florida. I had a small medical practice there studying the fire ant allergy for a couple of years. I wanted to come up with a vaccine that would prevent people from having allergic reactions to those venomous creatures. We could talk an hour about the fire ants. But on that hot subject, wouldn't it be nice if Medicare actually covered the overhead expense, or if Medicaid covered the overhead expense? You see, there's a subject called cost shifting. One of the reasons that the prices are so high is that everybody else is paying for the unpaid for health care that occurs not just in the emergency room but in doctors' offices and hospitals all across the country. And that takes place when Medicare does not cover the overhead of essential medical services. And I guess it wouldn't shock too many people to understand that we don't have the data yet that actually determines and allows us to know here in Congress what the overhead expense is within a metropolitan statistical area. You know, I don't want to have to pay in Green Bay or Appleton, Wisconsin what they're paying for medical procedures in Florida or in New York City or in Los Angeles or other large metropolitan areas, certainly not Washington, D.C., where my first hamburger, fry and a Coke was $22.50. So the cost for health care has to be brought down, I think, in large part by creating a real vibrant, open and transparent medical marketplace. And, you know, I can go on my communication device--I'm not going to mention the brand. I don't want to promote a given product. I can go on the Web, the Internet, and search for the price of a car, the price of a book. How about the price of my prescription drugs that I might need, and map it out within the area in which I live? I want the pharmacies to openly disclose the price and give every citizen the same lowest price that they accept as full payment for that product. I think it's time that the hospitals showed us their prices and then charged everybody the same. Wouldn't that be wonderful?

Mr. KAGEN. Would the gentleman yield?

Mr. KAGEN. Some years ago I sponsored for citizenship a Ph.D. in my research laboratory. And when I was about to enter the political discussion in 2005, I asked my Ph.D., Dr. Muthiah, how did he look at our American health care system, because he grew up in Sri Lanka and then graduated from Southern India, Madras, and how did he look at the American system? And he said, well, Boss, American health care is upside down because if you go to the hospital and you have insurance, you get a discount. If you have no insurance at all, you get the big bill. So, you see, what we have to do is prevent the cost shifting, and by preventing cost shifting we can bring prices down. I think when we finally come to have an agreement that we should have a Federal standard. I mean, we have Federal standards in the United States for everything, making cars, we have OSHA, we have the environmental standards. We have standards for making clothing. But we don't have a standard basic insurance policy that guarantees that if you get sick you are going to be in your house, not the poor house. We don't have a basic insurance policy that all the insurance companies, if they are going to be in business, should be offered an opportunity to sell, to compete within the marketplace. I will give you, just an example, and I am not too good with examples. A few years ago I wanted to buy a Chevrolet Impala. At the time it was the highest percent American made car. I went out shopping for the Impala. I had five dealers with the same car. Now, they competed for me. I didn't get it for free. I got a skinny deal. The dealer made money, the manufacturer made money, and there was an economy, a real marketplace, a competitive and transparent marketplace. What consumers want in health care is transparency. They want an opportunity to be able to afford the medications that they need so that they don't have to skip a meal or skip a pill, or as you referred to some minutes ago, cutting your medication in half. There are a number of stories I could tell you that would make you cry. There is Jenny, who has two young children who came to see me. They were asthmatic. I made a wonderful diagnosis, I wrote the prescriptions for her and her children. I said come back in a month, they will be back in school, they will be fine. And she came back a month later, and I examined the children, and they were not fine. They were still wheezing. Being right to the point, I came down pretty hard on her. I said, you know, the funny thing about these medications, they only work if you put them in the kids' mouths. And she lifted up her sack, which contained her own personal property and also some diapers, unzipped it, held out the prescription. It was the same ones I had written. And she said, Dr. Kagen, I took these prescriptions to the pharmacy, and I could see the medications behind the counter, but I couldn't afford to put them in my kids' mouths. Now, what are you going to do to help me? I said, well, that's it, I'm going to have to go to Congress because I can't go to the State House to fix this. This is really a national crisis, one that can't be solved State by State. We can't have these incubators of democracy, as it has been referred to. We can't have one-State solutions like Massachusetts or another State, or Oregon. We need to find a national solution wherein there is going to be a real transparent medical marketplace to allow a drug company to produce a great medication, to openly disclose that price. And if it's $1 in Mexico City, hey, thanks. If it's $1 in New York City, Chicago, L.A., and everywhere else in between, we need to allow them to compete in an open, transparent medical marketplace. But, first, we here in this Congress have to make a commitment, to make sure we get it right, to think it all the way through, and above all else let's find out what the real overhead cost is, because if Medicare doesn't cover the overhead costs for something, it's going to cause cost shifting or that service or product is just going to disappear.

Mr. KAGEN. The consumers of America need to be able to compare apples to apples. And really the only way to get that done is to come up with at least a basic Federal standard, an insurance policy, one that will cover the basics and keep you in your house if you get sick, one that every insurance company has to offer to every willing purchaser, every citizen and legal resident within a metropolitan area where we can create the largest risk pool possible to leverage down prices for everyone. Here I have someone in rural America. This is really a telling story. She is from Waupaca, Wisconsin, and, quote, ``no health insurance for 4 years, one son in the Army on active duty, my son shipping out. He is guarding our home, but we are not taking care of our families here at home. We are taking care of people overseas. ``We know numerous people over 50 who have lost their jobs so companies can cut health care and payroll costs and then can't find any other work and no longer have health insurance.'' Now this is being multiplied all across the country as this recession rolls across not just the United States but across other nations as well. We have to establish a basic insurance policy so we can begin to have an open and transparent and very competitive marketplace for insurance process.

Mr. KAGEN. Well, be careful there, because you may just get what you want. There is nothing to say really that the health care that you have is the best available. I will bet you don't understand completely what you have got for insurance, because it's so hard to read and interpret that policy. We have got an idea here that's kind of a good idea, but like many things here in Congress, if it makes sense, it just may not happen. So what we really have to do is just clear away all the clutter and ask some very basic questions: Do you want to have an opportunity to go to the pharmacy and pay the lowest price available for that prescription? I think you do. Is there any reason why someone should be discriminated against? Now, let's say there is five of us standing in line to get the prescription, 30 pills of drug X at a pharmacy. Why should we pay five different prices? Why shouldn't they just put the sign up on the wall and say here is what it is. Put it on the Internet, here is what it is. And let's get some competitive forces to leverage down these prices. When insurance companies have to compete in an open marketplace, we are going to leverage down that price, my best guess is about 22 percent before they really begin to compete for the customer, just like the auto dealers competed for my precious dollars for that Chevrolet Impala. So I look forward to a competitive marketplace. As you know, I chose not to select health insurance when I got here. It was offered to me, and I was quite surprised. They said, ``Well, Congressman, before you leave to go back to Wisconsin, would you like to hear about the benefits?'' And I said, ``Lady, are you kidding me? What are you talking about?'' And she showed me a list of health care benefits, of cafeteria plans I could choose from. I had to go catch a plane. I said, ``Well, okay. What did you take?'' ``Oh, I took the Cadillac plan,'' she said, ``$250 deductible. They have got to take you because you are a government employee.'' I said, ``Well, I'll tell you what. As soon as you can make that same offer to everybody else that I have the honor of representing, I will be happy to make my choice.'' I agree with you that we have to have choices, but they've got to be openly disclosed, and we need to get a basic insurance policy that really says, if you're a citizen, you're in. Now, one of the things that I am really pleased about with this President is that President Barack Obama gets it. He doesn't just get it in his mind. He gets it in his heart. He actually feels what we feel and what my patients feel, and he has taken the single, most essential element in health care as his number 1 element, and that is no discrimination due to preexisting conditions. When we frame health care around our civil rights, we're not saying you have a constitutional right to this or that service. We're saying that you shall not suffer from discrimination, like we passed last year, based on your genetic potential. You will not suffer from discrimination at the pharmacy because you have less money in your pocket than somebody who is getting a discount and not you. You mentioned our veterans who served not for themselves but for their country. Isn't it appropriate that when a veteran comes home that his wife and his family get the same discount on that medication that they might need? What about their neighbors? What about their whole community? What about their entire country? Isn't it appropriate, if the pharmaceutical company is making a profit at the VA price, that we all benefit from his service or her service at that leveraged down discounted price? We have to begin to use the leverage of the marketplace. I'll finish up with my comments by saying that we have witnessed in the last year the collapse of the housing bubble. That repercussion, that ripple effect in the economy, has just taken down many millions of jobs. It has taken away businesses left and right, and it continues to do so. I believe we're also looking at another bubble, and that bubble is in the price of health care. It's simply out of reach for ordinary families, averaging $1,200 to $1,400 a month for insurance premiums, and it guarantees only one thing: that, every month, the insurance company is going to take your money and that you'll have to fight like hell to get it back. Having insurance today doesn't guarantee that you're going to get the services that you need. That's how Chairman Olver was able to show us all the data. We are spending a lot of money for health care. We are not getting the value. So I think it's time to begin to ask the question if we shouldn't begin to change the process of how we're going to reward the delivery of health care, to change the process and reward value, not just per head or per prescription. We have to begin to reward value and prevention. Look, you are exactly what you eat. As my father says, ``Steve, boy, pollution begins at your lips. If you don't put it in, it won't stay on you.'' ``Well, okay. I'm doing my best to lose weight, Dad,'' but the reality is we can do this by working together. It will take Democrats, Republicans, Libertarians, and Independents. The American people don't want any more argument about this. They want us to come up with a solution that works for their budgets, that works in their homes and that works within a framework that guarantees that, if you're a citizen, you're in. If it's in your body, it should be covered. I am more confident tonight than ever before that, this year, we're going to achieve that goal of guaranteeing access to affordable health care for everyone who is legally here.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, discrimination is alive and well all across America. You may not have heard about it on the radio or seen it on television, but it's still alive and well. You won't see it on television because discrimination today is beneath the skin, beneath the skin of our entire society, as insurance companies, omnipotent as they are, continue to discriminate based on the preexisting condition of a citizen. These insurance companies no longer discriminate on the basis of skin color. Rather, they discriminate against women because of the calcium, or the lack of it, in their bones. They discriminate against people who may have coronary artery disease or any of a number of medical conditions. The lessons of both my profession and my faith have made it clear: We are all really the same beneath our skin. We're all made of the same clay. And 40 years after the civil rights movement has established that all citizens of any color shall be able to drink from the same water fountain, sit on the same bus, and attend the same medical clinic, our Nation still remains divided, not by skin color but by skin chemistry. Mr. Speaker, it's time we bring an end to discrimination in health care.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, we're going to be listening this evening to President Obama, and one of his featured subjects will be health care. What we don't need in the United States is socialized medicine. We don't need more government control of our personal lives. What we do need is access to affordable health care for everyone. And to guarantee access to affordable care for every citizen, we need to enact the essential elements of health care, which are, first, that there shall be no discrimination against any citizen due to any pre- existing condition. Second, there should be open disclosure of all prices, so we know the price of a pill before we swallow it. And, third, we need to secure the same discounts for all citizens so we all pay the same price for the same service or product. We can also create the largest risk pools possible to leverage down prices for all of us. Imagine this: We are only one law away from guaranteeing access to affordable care for everyone everywhere in these United States.