Steve Kagen

Mr. KAGEN

Mr. KAGEN. Thank you very much, Mr. Speaker. I feel very flattered that you have provided me with sufficient time to explain some of the problems and solutions that we're looking at in helping to solve our crisis in health care across America. By way of background, my name is Steve Kagen. For the first time in my life, I ran for public office in 2006, and I was elected and reelected in 2008. I grew up in Appleton, Wisconsin; went to public schools; went to the University of Wisconsin; studied molecular biology; went to medical school. I went back home to Appleton with my wife, Gayle, to raise a family in 1981, practicing allergy, asthma and immunology. Over the years, what has been happening to my patients is they've been having more and more difficulty paying for their prescription drugs. What has been happening to my friends I went to high school with is they've had more and more difficulty running their businesses and having access to affordable health care. The health care costs in this country have simply gone through the roof. It's becoming more and more impossible for people to pay for, not only their medically necessary and life-saving prescription drugs, but also their health care coverage that they so dearly need. It's not just difficult for families. It's difficult for small businesses. It's difficult for large businesses. Recently, I received an e-mail from a large employer in Green Bay, Wisconsin--home of the world champion a long time ago, the Green Bay Packers. This very large employer-CEO said: Kagen, keep the public option on the table. I just got my quote from Blue Cross, and they're jacking it up by 29 percent in 2010. People have to understand that, if we don't address this crisis and begin to solve it immediately in 2010, they'll either have a job with no health care coverage or no job at all, and good luck with the coverage you can get. Now I'd like to share with you some of the personal stories and comments from people in Northeast Wisconsin, and I trust that they're very much the same as they might be all across this great land. Ned writes from Dunbar, Wisconsin: The part D doughnut hole needs to be eliminated. Well, Ned, you're right, and we're working very hard on the Democratic side, and I'm sure the Republicans will go along with the idea of closing the doughnut hole in Medicare part D. Medicare part D, after all, was a prescription drug plan which was written by and for the insurance industry, which was nothing more than a windfall profit of billions and billions of dollars for Big Pharma. It wasn't intended to help my patients. It wasn't intended to help the senior citizens who live in Northeast Wisconsin. It was written by and for Big Pharma, and they're the ones that had the windfall profit. Ned needs help now because he needs to be able to go to the pharmacy and pay for his prescription drugs without having to go to the bank before doing so. Jack from Kaukauna writes: I need help. Prescription drugs are most important to very many seniors on limited incomes. In these economic times, those people who are most at risk are people who are living on fixed incomes, not only because they may not receive a cost-of-living adjustment but also because they have fixed incomes. They're not getting the interest payments they were before on their investments. So it is for Ned, for Jack and for everybody who is living on fixed incomes that we must write a bill here in the House that will guarantee access to affordable prescription drugs, and we have to do it soon. Eleanor from Green Bay, Wisconsin writes: Drug prices rise since part D. One of my husband's drugs in December 2005 was $144; in January of 2007, $189. A $45 rise in 14 months is too much. They need help now with prescription drugs, and we intend to provide it in the legislation that we're writing. Deb from Florence, Wisconsin writes: I have no health insurance. We cannot afford it. Well, we've got to make sure that the prices are driven down. Ordinary people, both seniors and hardworking families, students alike--everybody understands there is a crisis in affordable health care. Here is a note from Carl from Greenleaf, Wisconsin: I have a pacemaker, and feel better than I had a year ago. I don't know why I had to pay $1,725 every 3 months for insurance with a $3,500 deductible. You know, one of the games that's being played by the health insurance corporations, which are pretty much Wall Street-run, is to increase the premium and also to increase the deductible. What ends up happening is the patients are paying for their own health care with their deductibles, and then they're paying for the health insurance corporations' profits as well. Sheila from Weyauwega, Wisconsin: Family businesses need affordable insurance for health care. I think she's right. It goes on. Pat from Green Bay: Health care issues are critical. We need to develop a plan to help the elderly and the uninsurable. You know, one of the ideas on the Senate side is to create a high- risk pool, in other words, to allow for some discrimination where the insurance companies would be cherry-picking you out if you were an expensive date, if you had health care issues and cost a lot to care for. In my view, I think that's an act of discrimination, and one of the greatest ideas in the Democrat bill, which is moving through the House, is the idea that we're going to bring an end to discrimination in health care. No longer will a health insurance corporation be allowed to cherry-pick you or your children or your family out of the risk pool. No longer will they be allowed to say ``no'' to you because of a preexisting condition or because of the way you were born. And to families like the Wendel family here next to me, they need access to that affordable health care now. And like many, many families across the country who have preexisting conditions--heck, these days who doesn't?--we have to bring an end to discrimination. President Obama agrees, the Senate agrees, and so does the House. But to create a toxic risk pool, so to speak, of these patients with preexisting conditions I feel is a wrong direction, and I hope that the Senate turns this around. We cannot allow for any discrimination against any citizen due to preexisting conditions. Well, one of the problems in practicing medicine today is that Medicare may not cover all of the overhead costs of caring for patients even when you provide high-quality care. And I'm going to use my great State of Wisconsin as an example. A State where we have covered nearly 97 percent to 98 percent of every citizen within the State by one form of coverage or another. According to studies in quality care, Wisconsin ranks number 2 in the Nation, the 1st being the State of Minnesota, our neighbor. But when it comes to where we rank with the rates paid to health plans to provide coverage, the Medicare Advantage monthly payment rates in Wisconsin are number 44 in the country. In other words, we are paying on average $765. States like Florida, Louisiana, New York, and Texas are some of the highest in the country, where in Florida the Medicare Advantage programs are taking $1,013 as an average monthly payment. The Medicare Advantage plans that we have available in northeast Wisconsin are wonderful. They're affordable. They're great. They should be measured in terms of the quality of their service, and if they don't measure up, they should be eliminated. We have to seek out and root out and eliminate all wasteful practices in spending in health care, beginning with our hospitals and also within the Medicare system. I heard my colleagues on the other side of the aisle make the case that there was some cutting coming up in Medicare. Well, I'd say what we're trying to do is make your tax dollars go further. We want to be able to invest our tax dollars and get the highest quality care available anywhere at the lowest possible price. This is something that northeast Wisconsin knows a great deal about. We have a health care facility called ThedaCare, and the ThedaCare Center for Healthcare Value has been able to drive down the cost of caring for patients at a hospital by 25 percent. By lowering the cost, at the same time they have also improved the quality. Higher quality care at a lower price. This is something that should be replicated across the country, and if it were, we would be able to save in every year $40 billion of savings. Now, this is not a cut to Medicare; this is about making your tax dollars stretch and go further. Higher quality care at a lower price. This is exactly what you would want. Now, what happens when you talk about the total Medicare patient spending at hospitals and clinics? When you look at that, New York, per patient, is spending about $9,564; Wisconsin, $6,978. Wow, about a 30 percent increase. I was very proud to work with other Members in the Midwest from the State of Nebraska over to Ohio to bring about an agreement with the leadership of the House that we have to address a Medicare payment discrepancy, a disparity, an unfairness. Something you may not know, but if you retire from the State of Wisconsin, Minnesota, or anywhere in the upper Midwest, including the State of Washington in the Northwest, your Social Security check will follow you wherever you go and it will be the same amount in the State of Washington or the State of Wisconsin when you retire, let's say, for example, to Arizona, New Mexico, Texas, or even into Florida. But the same cannot be said about Medicare. Your Medicare tax dollars that you've been paying in for your entire working life may not follow you when you move out of the upper Midwest or the Northwest. So we have reached an agreement with the Speaker of the House to begin to address this payment disparity with Medicare, and at the same time we took up the conversation about how are we going to pay for medical services with your hard-earned tax dollars. Well, with Medicare and Medicaid, what we are seeking to do is to make certain that we reward physicians and hospitals for higher quality care and the value of that care that they're offering and delivering, and we intend to measure it. We intend to change the payment mechanism away from the volume of tests and care that you're receiving and more towards rewarding value. Not volume but, yes, to the value. And I think physicians and hospitals across the country will welcome this idea of moving up. Well, there's another topic that is very important. When I, as cochairman of the Congressional Business Owners Caucus, had a listening session with employers and the representatives here who came to Washington who represent them, groups such as the Small Business Majority and the Franchise Owners of America and others, they had some very simple requests. They asked us for immediate results where we would lower the cost of care. Lower costs have to be gotten immediately or as soon as possible. Why? Because the businesses can't survive with their current overhead. The single greatest component of their overhead is the cost for health care, and they want very much to see Congress help them to drive it down. And one way to do that is to provide transparency in health care pricing. Imagine this: You go to the grocery store. You put the food you're looking to buy for yourself and your family in the cart. You go to the checkout counter. They put it in the bag, and you take it home. You've never seen the price and they never billed you at the cash register. You simply take what you feel you need, go home, eat it, feed it to your family, and then later, a month or so later, they send you the bill. That would be unimaginable in this country. But that's what's happening in this health care, because you really don't know the price when you go to the hospital, to the doctor. You don't know the price, and the price really is whatever they can get. And I will get one picture here to take a look at. I will hold it in front of the Wendel family. This is a little picture I took at a grocery store. It's got Bayer Aspirin, generic aspirin, and then there's a flavored aspirin as well. And for 20 percent less, you can buy the generic aspirin. The price is openly disclosed, and if I take this off the counter and so do you, when we get to the cash register, we get to pay the same openly disclosed price. I think it's time, and I think you might agree, that we need to have open and transparent pricing throughout the health care industry. That way you will know the price of a pill before you swallow it. And I'm sure you would agree with that. We don't have that yet, but we're working hard to get it. Now, immediate results in 2010, it's a difficult challenge. And joining me here on the floor is Mr. Murphy. Thank you, Mr. Murphy. I yield to you in this fine hour to help reassure people across America that we have been studying this problem for a number of decades and we are beginning to take action on their behalf.

Mr. KAGEN. Thank you for your comments. Everybody who has a human heart has feelings about people who are in need. I went into health care, into medicine, became a physician because I wanted to help people out. But what good is it to be a doctor if you write a prescription that people can't afford to pay for? What good is it to be a doctor if people can't afford to come in and get the tests that they require? We have the right ideas. We have heard a lot from many people who reject change. No, no, no. No, you can't do this, you can't do that. They are trying to create a great deal of fear. It is easy to scare and frighten people when you hand them the wrong information and threaten their livelihood and lives. That is what this is. If people don't have access to the care they need, their lives and their livelihood are at risk. In northeast Wisconsin, the greatest cause of bankruptcy is health care costs, people who can't make their payments. We have the right idea of fixing things as quickly as we can. We intend to close the doughnut hole beginning in the first year by closing it by 50 percent. That is a step in a positive direction. We intend to do things for people rather than the Wall Street-run corporations who today are controlling our health care industry. I can tell you as a doctor, in the room with me was the patient and their family, and that invisible person in the room was also the health insurance corporation who would be telling my patients where to get their tests, what tests they could have, and how much they are going to be paying for it. I think it is time to move the insurance industry out of our examination rooms. And the focus of the Democrats here in the House is to make certain that that happens, to guarantee that you have control of your health care decisions. It is between the patient and the doctor and the patient's family. In the health care legislation that we are putting together, the winners, first of all, will be Medicare patients, because with our legislation, with the efforts we are about to make, there will be no deductibles and no out-of-pocket expenses for prevention services. The other winners, the biggest winners in this legislation in my view as a business owner, is small businesses, because small businesses can't afford to continue to pay 30 percent more per year. They will have it as a big win because we are going to pool small businesses together in large risk pools, large buying groups, to leverage down the prices for them. Just like the big businesses get discounts, today the numbers are almost unbelievable. If you are in small business, you are paying anywhere from 18 percent more than a large business, or 60 percent more, even though you live and work and recreate in the same location. Another big winner is people who have coverage now. You will be able to keep it and hopefully at a lower cost. We want these insurance companies to compete against one another. Today they are exempt from the antitrust laws. That allows them to talk about where they are going to sell and compete and where they are not, or to conspire about prices. We want to eliminate that. Whether or not that gets into the bill is yet to be determined. If you don't have coverage now, coverage will be available to you through some credits. We are going to help those, a helping hand up. It is not a handout; it is a helping hand up. In my State of Wisconsin, with the fix to the geographical disparities, where a doctor or hospital might get paid $40 for a service and the same service would be compensated by Medicare in Florida about $200, we are going to address that. So Wisconsin hospitals and Wisconsin physicians, you are going to get an increase in compensation for your services through Medicare very shortly. Overall the big winner will be our economy because when we drive down the cost of health care and improve the quality, you will have an opportunity as a small business owner to hire more people, to invest not in the Wall Street-run health insurance corporation, but to invest in your business and acquire the equipment you need to expand and hire more people so we can begin to work our way through this recession.

Mr. KAGEN. Do you mean capitalism?

Mr. KAGEN. I think what you are trying to say, it is hard to negotiate when you have a gun held at your head. How do you negotiate as a single purchaser against a large corporation? You can't negotiate; it is a take it or leave it. We did something in Wisconsin where we created a prescription-drug program for senior citizens in low-income situations. I think it is the best prescription-drug plan in America. We have got about 103,000 senior citizens in a buying group, and that buying group leveraged down their prescription drugs tremendously. It is life saving. It saves taxes because when you are healthy you don't end up in the emergency room where it is expensive on the government who cares for these elderly seniors and low income. So senior care saves lives and tax dollars, and it is exactly the same kind of concept that we did with the SCHIP, the State health insurance plan for low-income children. But let's not mix the metaphors, senior care and SCHIP are not government-run health care. It is private doctors, private hospitals, private drug companies who provide the care and get paid through a government system. It is very fair. It is a level playing field. So senior care is a wonderful model, a prescription-drug program that really works for senior citizens who are in lower-income situations. Now I think a buying group is a good idea. Who do you think would stand against having large risk pools and lowering the cost of insurance coverage? My guess is going to be the Wall Street insurance corporations, for one. I think they would be against that, don't you?

Mr. KAGEN. A buying group drives down the price in a competitive, openly disclosed price situation. When you have a very competitive medical marketplace where the power and the leverage and the purchasing power of people buying together, that is when you drive down the price. But I want to burn this point into the American people: We are not talking about government-run health care. The government, hey, if you get sick, don't call your congressman, call your doctor. Today, you are calling your insurance agent to make sure that you can go to the doctor or hospital of your choice. We want people to have choices when you call your doctor. Ask your doctor for help, don't call your congressman or your governor. Earlier today, I met with World War II veterans. They took the honor flight where they flew from Wisconsin this morning to see the World War II memorial that they hadn't visited before. There were over 80 of them. The youngest is about 85, and the oldest is about 92. What a great honor and pleasure it was for me to greet them and listen to some of their stories and to thank them for their service. One senior came up to me, a World War II veteran, and he's much like a lot of people in the country, and here's his quote: ``I don't want the government involved in deciding my health care choices, period.'' I said, Sir, I want to thank you, and I will share that quote on the House floor tonight with my colleagues so all of America will hear your voice. That's my job; I'm listening and transmitting their message. And then I asked him, How is the VA treating you? ``Good. That's different.'' Well, it's different in some senses because he has earned his benefit and he is receiving the benefit at the Veterans Administration clinic and hospital, and it's a benefit well deserved. We're fighting very hard to move those benefits up and to guarantee that it gets out to every veteran. But you see, it isn't that much different. It is government run, and he's happy with the service. Now I will be the first to admit, as a doctor practicing in the VA hospitals in the 1970s, beginning in 1973, it was terrible, it was disgusting, it was to the point of becoming inhumane. Our shelves were not bare, but close to it. We didn't have the newer drugs to help our veterans who came back from Vietnam, in particular, and many World War II veterans. It got to the point where at one time I had to kidnap a patient and take him several blocks away in Chicago to a real hospital to get him the surgery that he needed because our operating room wasn't open after hours. Things have changed. This Congress, the 110th and the 111th Congress have stepped up for our veterans, increasing by 77 percent--the biggest increase in the history of the VA--its funding. We're not at the top yet, but we're getting there, and we intend to invest in our veterans' care. The government isn't going to be your doctor. We're not talking about government-run health care. Two others things that some World War II veterans were concerned about: Kagen, now in that bill, are you putting in money for illegal abortions? Are you putting in money for people who are here outside the law, here illegally, who immigrated here but did it illegally? And the answer is no and the answer is no. You're going to hear, unfortunately, a great deal of misinformation, but it is our intention to work with Members of all parties to guarantee that your tax dollars are going to you, who earned it like our veterans, and to make sure those benefits go towards legal causes. I yield.

Mr. KAGEN. But isn't that elimination of wasteful spending?

Mr. KAGEN. There are three other ways we could help to save money to reduce the cost of health care. The first idea is not a new one, we did it in Wisconsin with Senior-Care; we negotiated for deeper, steeper cuts and discounts from prescription drug makers. We need to be able to negotiate with pharmaceutical companies for deeper discounts for all of Medicare, for all the VA, for all the Coast Guard, and for all of us. The men and women I saw today at the World War II monuments, they fought for this country, not only for themselves and their family, they fought for the entire country. So why can't we allow a veteran, who has a deep discount for a prescription drug, why can't we give that same discount to his wife and his family? What about his neighbors? What about his whole town? What about the whole country? If we have a steep discount that we're benefiting from as we invest our tax dollars in the health care of our veterans, that discount should be spread out to all Americans who are here legally. So let's begin to negotiate for deeper discounts for prescription drugs for all of us. The second thing we must do is to encourage hospitals to cut their overhead costs, to deliver care more efficiently, to make sure that our tax dollars are stretched to the very limit, not by cutting quality, but by cutting their cost of care. It has been done in a number of institutions, one of them in my district I mentioned earlier, which is the ThedaCare health care system. We have to take that model and replicate it across the country. In over 10 years, we will save $400 billion. That's called the elimination of wasteful spending. It's becoming more efficient. We have to do that not just in the corporate world and the business world, but in our hospitals. After all, we just proved in the sands of Iraq that we can deliver world-class health care in a tent in a desert. Then maybe we can do the same by getting skinny, getting leaner in our hospital system. So negotiating for steeper discounts from drug companies, driving down the cost of care in hospitals. And the third, the biggest savings yet to come, is prevention, which is why we want people to get to a primary care doctor and make sure we diagnose things early because you're a cheaper date; your illnesses are better managed through prevention. And that the government can't do for you. That's something that you have to do with your family in the personal choices you make, in consultation with your own family and personal physicians.

Mr. KAGEN. I was a little concerned that you were going to blame all the lawyers; I'm glad you didn't do that. But when we bring this subject up about reducing costs, many people on the other side have been screaming that if we just got tort reform, we could really drive down the cost. I wonder, Mr. Braley from Iowa, if you could address this issue and other issues that we haven't yet discussed?

Mr. KAGEN. But if I can interrupt for a minute, this internal conservation about the CBO, Congressional Budget Office--for those of you listening, the CBO, the Congressional Budget Office, only counts money that goes into and out of the United States Treasury. They don't measure those savings, do they?

Mr. KAGEN. Well, I will tell you about Brandon Rudie, who is a 2- year-old who, through no fault of his own, accidently fell below the lawnmower of the father cutting the lawn. They busted through the cap. They stand to lose not just their jobs but their home. We had a bake sale to try to come up with money for Brandon, who lost much of his face and some facial structure. He is going to have to go through a lot of surgery that this family cannot afford. The days of having bake sales to pay for a child's health care needs must come to an end. I yield to Mr. Klein from Florida. Thank you for joining us.

Mr. KAGEN. Thank you, Mr. Braley. I will summarize by saying that we are working hard to fix what's broken. We are going to improve what we already have and make sure that it's at a price we can all afford to pay. What kind of nation, what kind of nation would we be if we didn't take this positive step forward?

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, isn't it time we had transparency in all health care pricing? Wouldn't you like to know the price of a pill before you buy it? Wouldn't you like to know the price of the greatest discount a hospital offered at your location? Wouldn't you like to know the lowest price an insurance company accepted for payment in full for their health insurance policy? This is a picture of several pills you can buy at a grocery store, and the price is always openly disclosed. Isn't it time that Congress passed legislation to guarantee that, at all times, any business entity that offers medical products and services for sale to the public openly disclose all of their prices and then accept the lowest price from everybody that they have accepted from anybody else? Isn't it time we had transparency in health care pricing?

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I appreciate having the opportunity to review with the Members of the House, and also with other people watching, one of the most important ailments of the country, and that is there is today an asthma epidemic all across these United States. The rate of asthma in terms of its incidence of morbidity and mortality has been increasing each and every year. What we find here today is asthma in America has some numbers we all need to be aware of: 22 million people here in these United States suffer from symptoms of asthma. There are 4,000 deaths every year from people who have asthma that's totally out of control, undermedicated and undercared for. Too often today, patients will suffer from allergic reactions not just in the nose and the sinuses, which we call hay fever or allergic rhinitis, but also in the lungs, where we call it asthma, for asthma is nothing more than an allergic reaction within the lungs. $20 billion is what we spend every year treating and diagnosing this condition. We can and must do better. In terms of lost days of work, over 10 million days are lost because people are ill with their asthma symptoms, and 13 million school days are lost each and every year because children are underdiagnosed and undertreated with this important condition. We can and we must do better, and one way to do that is to guarantee that patients receive an accurate diagnosis. Recently, in the health care debate here in the House, much attention has been paid to primary care or to the medical home model where every citizen in the country would have a primary care physician to go to to receive their medical care, not just for themselves, but for members of their family as well. So how well are the primary care doctors doing when taking care of these asthma patients? In a number of double-blind crossover control studies, we find that asthma specialists have been delivering higher quality and lower costs to the care of these asthmatic patients. There has been a documented 95 percent reduction in hospitalization when taking patients once hospitalized with asthma and then following the patients, whether they are referred to primary care or to an asthma specialist. There has been a 95 percent reduction in hospitalization, a 77 percent reduction in visits to an emergency room, and a 77 percent reduction in days missed from work. Clearly, the evidence reveals that specialty care for the diagnosis, treatment and management of this chronic and often fatal disease is best handled by those who are specialists in the area. These facts have to be considered as we consider legislation that would compress people and, not force people, but guide them into primary care versus specialty care. Throughout the country, specialists and primary care physicians have been working hand in hand and need to collaborate and cooperate when caring for patients, not just with asthma, but with all sorts of medical ailments. And now that we are on the subject of health care reform, there are three essential elements that must be in a piece of legislation to pass this House and the Senate and to be signed by the President. They include not only no discrimination against any citizen due to preexisting conditions, but also transparency in the medical marketplace where every entity, every individual or business entity, that offers medical products or services for sale to the public should at all times openly disclose all of their prices and guarantee that everyone has an opportunity to know the price of a pill before they swallow it and to guarantee that everybody knows the price of a chest x ray or any other medical procedure before they actually have that procedure done. Transparency, that sunshine that's needed to help create a medical marketplace, is critically important. No discrimination against any citizen and complete transparency will help create that medical marketplace. But we also need to develop a standard health benefit plan, one that will guarantee that if you are sick and covered by that standard benefit plan, you'll be in your house, not the poorhouse, a standard plan that each and every insurance company must offer to every citizen within regional markets to guarantee that a marketplace creates that competition to drive down prices immediately, not in 2013, but in early 2010. Asthma is an important condition. It's a very common condition, best managed by specialists who cooperate collaboratively with primary care physicians. As we go forward to reform our health care system, I hope that the House leadership will understand how important it is to collaborate between primary care and specialty care and to guarantee that no discrimination, complete transparency in medical pricing, and the standard health benefit plan will exist in our legislation.

Mr. KAGEN

Mr. KAGEN. Madam Speaker, like everyone else in northeast Wisconsin, I am shocked and saddened by the passing of my friend, former Congressman Jay Johnson. Jay represented the Eighth District of Wisconsin in this body from January of 1997 to January 1999. Jay was a friend of mine. He was a gentle person, and everyone in northeast Wisconsin was considered his friend as well. He served the best interests of all of our families and will be greatly missed. For many years, Jay's trusted voice and kind countenance came into all of our homes as a news anchor on WFRV-TV and WLUK-TV in Green Bay. His colleagues in this room here all recall how kind he was. His colleagues in the newsroom in Green Bay recalled his kind heart, his unending patience, and his grand sense of humor. They will remember him as a gentleman in every sense of the world. It's clear from his life spent in front of the camera and here in public service that he truly loved people. In 2000, President Clinton appointed Jay to be director of the United States Mint; and more recently, he ran Jay Johnson Coins and Consulting. During my service here, Jay had been a mentor, an adviser, and a close friend. On behalf of the people of the Eighth District of Wisconsin, I want to thank Jay for his service and extend my deepest sympathies to his wife, JoLee, their family and friends.

Mr. KAGEN

Mr. KAGEN. Well, it's a great honor to join you here on the floor to talk about health care and about making progress, making progress where for nearly a century, since 1910 when Teddy Roosevelt first suggested the idea that we should have some kind of national solution for health care, we are finally taking up this conversation. As Mr. Polis mentioned, this is the most important conversation we are going to have this century. So we are taking our time. We are going to get it right. We are going to fix what's broken; we are going to improve on what we already have and make sure it's at a price we can all afford to pay. Where I come from, having practiced medicine for 33 years, I am always focused on the patient, much like we are all focused on our constituents. And you can imagine how I felt when my patients couldn't afford their prescription drugs. Now, what good is it to be a doctor if you are writing a prescription that the patient can't handle financially? What's wrong with a system where we continue to allow the Wall Street corporations that run health care today to discriminate against people because of the way they are born or because of a preexisting medical illness? I will submit to the jury, if you were a jury, this little piece of evidence: I won't mention the insurance company, blank has great news for people who buy their own health insurance. They have got something for you, all right. But then on the inside, I am going to read it into the Record: ``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: AIDS/HIV, alcohol or drug dependence, cancer, chronic obstructive pulmonary disease (COPD), connective tissue disorder, Crohn's disease, diabetes, emphysema, heart attacks or stroke, hepatitis (chronic) or liver disease, inpatient emotional or mental illness, organ or tissue transplant, ulcerative colitis.'' It goes on to say: ``You should also be aware that we may not be able to provide coverage to individuals who are severely obese, severely underweight or who are undergoing or awaiting results of diagnostic tests, treatments, surgeries, biopsies or lab work. We cannot offer coverage to expectant parents or children less than 2 months old.'' And here the closing sentence: ``This list is not all inclusive; other conditions may apply.'' I am so proud to be working with the President who understands that this form of discrimination has got to come to an end. That is why in the House bill and every version we have seen, that is why in every Senate bill, there is the language that will bring an end to this form of discrimination. What we are about to do is very historic. We are going to apply our civil rights that we fought so hard for in the 1960s to the health care industry. No longer will any kind of Wall Street corporation be allowed to discriminate against people, not because of the color of their skin, but because of the chemistry of their skin. Not because of what they are thinking, nor on the basis of how they think, the chemistry of their mind. In my mind, bringing about no discrimination in the health insurance industry, in health care throughout this country will transform our economy, because it will begin to lower prices for everybody, making it possible for small business, the real economic engines of America, to employ people to be more profitable and to move our economy out of this economic ditch we find ourselves in. But there are three things that must be in this bill, number one is no discrimination against any citizen due to preexisting medical conditions. If you are a citizen, you have to be in the risk pool. You have to be in your neighborhood. Secondly, there should be complete transparency of all prices in health care. Openly disclose all the prices at the hospital from the insurance coverage, openly disclose the prices at the doctor, the dentist, anything that's health care related, be it a product or a service. Show me the price. Please openly disclose your price and then accept from anybody at your store as payment in full the lowest price you charged and accepted as payment from anybody else. The lowest price should become everybody's price. The third thing that we need--and hopefully it will be in this next version that we are going to see shortly we have to establish a standard health care plan--a standard plan such that Humana, United, CIGNA, Aetna, Blue Cross, WellPoint, whatever point, whatever insurance company are you are, when you are selling the same basic standard plan within a very large risk pool, you have to show me your price, and we will begin to have competition where insurance companies are going to compete to the lowest price and the highest quality. We will finally be able to compare these corporations, apples to apples. That's the moment I think we will really see the benefits that we need. Improve the quality at a lower cost. No discrimination, complete, complete openness in transparency and pricing and a standard plan. I think we are making progress; I don't think we are there yet. I think we are going to make that progress and, in my limited experience as a Congressman, more so as a physician, this place doesn't work well when it happens very fast. I am very pleased that we are taking our time to get it right. I look forward to finding Republicans, Independents, Democrats, and, yes, the Libertarian people that are here in this House to vote for a bill that moves us down the road.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I rise in strong support of H.R. 3590. I wish to compliment Mr. Camp, Mr. Blumenauer, and everyone who's had a contribution to making this a very good bill. It's about teamwork. It's about making certain that our soldiers, our service men and women, have the support they need before, during, and after they've been deployed. And certainly everyone here would agree that our service men and women shouldn't be punished for going overseas to serve our Nation anyplace, let alone Iraq or Afghanistan. In April of this year I received a telephone call from the Kavanaugh family. Jerry in Kaukauna called up to say he was concerned his son might not be able to take advantage of the first-time homebuyer tax credit of nearly $8,000. He wouldn't be able to take advantage of this because he was being deployed once more overseas. Well, I think it's time to work together. We came up with a bill with Ron Kind to address this issue, and it has been improved upon by the Ways and Means Committee. Over 1.4 million people have already taken advantage of the First- Time HomeBuyer Act, and now it's a great opportunity for all service men and women to consider coming home and taking advantage of this opportunity to solidify not just their own home but the housing market here across the country. I wish to honor all service men and women who have served overseas. I wish to thank as well Chairman Rangel; Representatives Boustany and Johnson, who also worked with me on preparing legislation that has been morphed into this act. Again, I thank you for the hard work and teamwork to mend our Nation and make certain our service men and women are made whole when they return.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, let's all agree about three things when it comes to health care reform. The first message has to be we have to fix what is broken and improve on what we already have and make certain it's at a price we can all afford to pay. Secondly, and this is in every piece of legislation moving through Congress on health care, we have to guarantee that no citizen anywhere in this country shall be discriminated against because of preexisting medical conditions. Isn't it time to finally establish a transparent medical marketplace where all prices for health care service and products are openly disclosed to the public at all times on the Internet? Isn't it time that every customer, when they go to the doctor or hospital or purchase insurance policies, gets to pay the lowest price that's openly disclosed and accepted as payment in full from everyone else? It's time to have a transparent medical system and make sure that we can drive down prices for everyone.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I rise today to speak out in favor of my constituents, like Jim from Green Bay, who says that every citizen should have health care: I have no insurance. I'm 60 years old. It is time to fix that problem in a bipartisan way. I am speaking out today for Sally from Kaukauna, who says: Our prescriptions cost $1,000 a month. This is a very big issue for our family. Well, Sally, hope is on the way. We have to pass legislation that allows the people to negotiate for lower prescription drug costs, to guarantee that if you're a citizen you should be in the risk pool, and insurance companies, well, they ought to be processing paper, not practicing medicine. It is time to change our health care system and to move towards a market-based system that really works for everybody and that guarantees for every citizen that, if they have an opportunity, they should have it at the lowest price. Every business entity should show us their prices and then accept as payment in full the lowest price that is accepted from anybody else.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I ask unanimous consent to withdraw my co- sponsorship of H. Res. 648.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I rise today to remind everyone on both sides of the aisle, whether you're Republican, a Democrat, a Libertarian or an Independent, that hope is on the way. We have some things we can agree upon. Isn't it a fact that we all agree that it's time to end discrimination in health care where insurance companies are allowed to discriminate against you because of a preexisting condition? I think it's time. We secured equal treatment at the lunch counter 50-some years ago; and this year, we're going to come to some agreement here in the House to end the discrimination in health care and bring equality to the pharmacy counter as well. We can all agree it's time to end the discrimination in health care due to preexisting conditions, to pass a bill that has a standard plan, an insurance plan that includes all Americans, a standard plan that each and every insurance company must sell to any citizen throughout the land. In this House, at this time, we can agree on these things.

Mr. KAGEN

Mr. KAGEN. Madam Speaker, I have some excellent news for the people of northeast Wisconsin, people like Mike up in Marinette, Jenny in Appleton, and Jeff in Green Bay: access to affordable health care will be enacted this year by this Congress. After all, how can we continue the losing ways of the past, where discrimination against citizens due to preexisting conditions was allowed to take place. You're going to hear arguments from one side and the other. But we stand on the side of the American people who understand this: There shall be no discrimination to any citizen due to preexisting medical conditions. After all, we don't discriminate on the basis of the color of your skin. What about the chemistry of your skin? The bill that's moving forward in this House will guarantee other things as well. It will guarantee small businesses will be able to reduce their costs for health care and allow them to employ more people and stimulate our economy at the greatest time of need.

Mr. KAGEN

Mr. KAGEN. Madam Speaker, I rise this morning to strongly support the ideas contained within our health care reform legislation. The idea is very simple. It's about equality. It's about no discrimination against any citizen due to preexisting medical conditions. And isn't it about time? You know, it was a little over 50 years ago that this Congress in a bipartisan way guaranteed the equality at the lunch counter; and now working together we're going to guarantee that every citizen has equality at the pharmacy counter, at the physician's office, and at the hospitals that they need to go to to guarantee the health that they require just to survive. This is our time in Congress to work together to fashion a health care system that works for everybody, not just those who were chosen at the top of the feeding chain. I stand in support of health care reform that is meaningful, that guarantees no discrimination against any citizen anywhere in this land.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I ask unanimous consent to withdraw my cosponsorship of H. Res. 648.

Mr. KAGEN

Mr. KAGEN. Thank you, Congressman Yarmuth. I appreciate the opportunity to join with you and with other Members of the class of 2006, the difference-makers, the Majority Makers, who brought a message of positive change here to Washington in January of 2007. What happened is we had another election in 2008, and we returned because we haven't finished the job yet. There is an inheritance that our President, Barack Obama, has taken on. I can't think of another time in American history when a President inherited so much in crisis: the housing crisis, where housing construction and prices were falling through the floor, and a financial crisis where the credit markets completely froze up and went into a medical coma--money wasn't being transferred between banks. He inherited a lot. He also inherited 3.7 million people who had lost their jobs during the previous year. This economic recession that we've slipped into began under the watch of the previous President, and we have a lot of fixing to do. It's going to need a doctor in the House to get things going. But we do have hope now because we have a new way of looking at things. We're taking a positive approach, and we brought forward today a bill that begins the process of healing our fractured health care system. Now when I ran for Congress and when I got re-elected, I put together a health care advisory team in my district, in northeast Wisconsin, composed of physicians, of medical people involved in hospital administration, insurance people, nurses, everybody that's involved in health care, and we came up with 10 essential elements that should be included in a successful piece of Federal legislation. The first and most important element was no discrimination. We sought to apply our constitutional rights that protect us against discrimination to the health care industry to guarantee that no one would suffer from discrimination, not on the basis of the color of their skin but the chemistry of their skin or, in the case that you mentioned, the patient with epilepsy. We shall not discriminate against any citizen or legal resident based upon pre- existing medical conditions, and that's in this bill that was submitted today for our consideration. Now the bill may not be perfect. It certainly hasn't been read all the way through yet. It's only 1,018 pages. But it does have within it, ``No discrimination against any citizen or legal resident due to pre- existing medical conditions.'' The second most essential element of the Eighth Congressional District of Wisconsin's ideas was that we needed a standard plan, a health care benefit plan that was standardized such that each and every insurance company would offer in the marketplace, by openly disclosing the price, a standard plan. That's in this bill. The idea is to create competition, which doesn't exist today, create open and transparent markets that don't exist today because you can't call up an insurance company and ask for the price. They just don't know what to charge you until they find out how to cherry-pick you out or boost up your price. So no discrimination and a standard plan are in this bill. When we do that, when we have an open marketplace with a standard policy that's being sold in a very competitive fashion, I believe we can drive down the price of your insurance premiums by about 22 percent. That's a lot of money when the average cost today is $1,200 to $1,400 a month for a family of four. The third element, transparency. It's in the bill. The fourth element, incentives, financial incentives to begin to root out waste in the system. I believe, as many people here in Congress and across the country believe, that we're spending enough money across this country now on health care. It just needs to find a better home. Since 47 percent is the overall overhead of the private insurance industry for small business, that means that when a small business sends a dollar in to an insurance company, 47 cents, in my view, is wasted. It's wasted on the bureaucracy within that insurance industry. We can and must do better. We must drive that overhead down to 15 percent; and when we do, we'll save America $39 billion a year which will go right back into our economy. I am absolutely convinced, as are many Members here, that when we reduce the cost of health care for everyone by using the marketplace to leverage things down, leverage the price down, we're going to stimulate our economy because there are two big overheads right now for any small business. It's called health care and energy. If you're in farming, if you are a small business on Main Street or the side streets, you've got an overhead that's health care, number one, and energy, number two. So I'm very pleased to see that these essential elements are in this bill. It's a great day for America. It's a very hopeful day. I yield back.

Mr. KAGEN. Thank you, Mr. Cohen. I want to thank you for your kind words about what we're about to do together. But let's agree--we're not Canada. We're going to have a uniquely American health care solution. I don't think anybody in this body, I don't think any one legislator here, I don't think anyone watching tonight or across America would argue, we're getting a menu. Now my son works at a pizzeria, and he's a pretty darn good cook. This is Appleton's First & Finest Pizzeria, Frank's Pizza Place. Now if we all go there together and we order a sausage 12-inch medium pizza, it's $12.50. It says it right here. Now if you order that same pizza, what are you going to pay? $12.50. Health care shouldn't be much more complicated than that. The price is openly disclosed at the pizzeria, and they don't discriminate against anybody. They are happy to take any customer on. And just like in health care, they're only as good as their last performance. So they have to compete for business. They compete with the Italian place down the street or the Greek restaurant or the Chinese restaurant or just your home cooking. So what we're suggesting here is that we use the leverage of the marketplace, that we have an open, transparent and competitive medical marketplace and guarantee universal access as we will do. The power of no discrimination, the power of equality, it is, after all, the foundation of our country and our culture. It is equality that we seek, not of outcomes, but equality of opportunity. I think it's time to apply that ``no discrimination'' theme not just to the insurance world saying, No, you can't cherry-pick and discriminate against someone because of a pre-existing condition. It's time to take our equality, our desire for equality and no discrimination to the level of the pharmacy counter. As a doctor, I can tell you, that is where the rubber meets the road. If I write a prescription for a patient, and they can't fill it because they can't afford it, if it's not on their list, we haven't done a thing. We haven't improved that patient's health. So we have to make certain that when you go to the pharmacy counter, you're going to pay the openly disclosed lowest price that they accept as payment in full from anybody. I'll use just one other example, and then I will yield back. Our veterans. Everywhere I go in Wisconsin, we subscribe, we volunteer; but our veterans didn't go into combat and didn't serve our country for themselves. They serve for our entire Nation. They didn't serve just for themselves; and yet they're the ones that have the VA benefit of that discount for their prescription drug. I think it's time that the soldier's wife or husband had that same benefit of that low-cost prescription drug and their children. And while we're at it, what about their next-door neighbor? What about their community? What about the whole country? If we could use the power, the purchasing power of these United States together in leveraging down prices for everybody, we could have affordable prescription drugs once again. That would bring equality to the pharmacy counter. It's something that needs to be defined very clearly in this piece of legislation. It isn't there yet, but we're going to work together and hopefully get that done.