Steve Kagen

Mr. KAGEN

Mr. KAGEN. I thank you for yielding and thank you for putting on this opportunity, making it possible for some of us to express not just our views but the views of the people back home that we represent.

Mr. KAGEN. One of the things that I learned by listening to people on the campaign trail, perhaps the greatest lesson, came from a Native American, an outspoken woman, Gwenn Carr, who said, Dr. Kagen, it is not doctors that determine who lives and who dies, it is politicians. It is politicians that take us to war based on lies and deception. It is politicians that prevent people from having access to affordable health care that they require. I will share with you a story of Jerry Gajeske. Jerry Gajeske I discovered by knocking on his door. It was not even on his door. It was in Waupaca, Wisconsin, with a college student who 2 days earlier in a dialysis center fainted because of the blood that was available for the eye to see. We were at the door, and I knocked, a gentleman came and said, ha, are you a real doctor? I said, yes, sir, I am, but I am running for Congress now. He said, well, if you are a real doctor, would you take a look at my cousin? I said, sure. Because there were barking dogs, I asked him to come out on the porch. While he went out to retrieve his cousin, I turned to my assistant, I said, Katie, are you going to be okay with this because you don't know what this is going to be. ``Doc, what could it be''? Well, his cousin came to the door and stepped out into the sunlight and had an obvious tumor protruding like a softball at the side of his sinus pushing his eye into the orbit. I said, sir, I can tell you it is not an allergy because I am an allergist, but what did your doctor say? He said, well, I saw my doctor several months ago. I could afford him, but I couldn't afford the tests. The tests were going to cost thousands of dollars. But I had lost my job. I had no coverage. I didn't get the tests. I have been hanging out here. I have 75 bucks to my name hanging out here with my cousin. Well, I said, that ends right now. I took him to the local hospital and asked one of my colleagues to see him. We referred him to a tertiary care center. Several weeks ago, he died of a cancer of the sinus. It is not bad enough that you have to find these people knocking on doors, trying to get elected to office to change things. It is not bad enough that he died without any money or by getting care delayed. To me, the bad thing was he died of the same cancer that my golden retriever did. But my golden retriever got better health care than Jerry in this country at this time. Jerry didn't make it. We will never know if by being seen early and diagnosed early, having the availability of the tests, the radiation, the chemotherapy, if he would not be here today. Don't think that it was opportunistic for me to tell this story, he didn't even live in my district. Jerry is like many, many other people today, who have just fallen off the edge into the crack of the sidewalk; is not being forgotten. Our party, this time, will change health care, not State by State, but across the country and guarantee access to care for everyone. I will share with you this story that I tell often about Jenny, a single mother of two asthmatic children, who came to see me, and I wrote some prescriptions for the children to get medicine for their asthma. They were missing school. When she returned a month later, the children were still sick. I said, Jenny, you know, this is good medicine but it only works if you put it in their mouth. She took the same prescriptions out of her purse and said, here they are. I went to the pharmacy, I stood at the counter, and I could see the medicine, but I couldn't afford to put it in their mouth. What are you going to do? I said, well, I am going to run for Congress because I couldn't help her in the office. I think, by working together, we can build a better future and a better Nation for everyone by changing our health care system now, not later.

Mr. KAGEN. Well, the question then comes up, it is not just about values; it is about choices. So, if we are not going to be spending our hard-earned tax dollars for the good health of children, children who are in need, where are we going to spend that money? Where does the budget choose to spend it? Not here in our country, but in the sands of Iraq. And I would suggest to you and everyone listening that we really cannot solve our health care problems, we really cannot solve many of the problems we are facing until we begin to bring an end to that involvement in that civil war in Iraq. I do not think any day should go by that we do not all stand up and ask the question where do you want to spend your hard-earned money, here at home or in the sands of Iraq? You are quite correct; the budget the President has proposed is deficient, is neglectful to those who are most at risk, the children in poverty, and if you are not healthy, if you are not well fed, you cannot go to school and learn anything. If you do not get your education, you are not going to build a better future that we all require.

Mr. KAGEN. Would my colleague agree with me that we will never cut and run from our veterans?

Mr. KAGEN. It does not have to be that way. With the money we have already spent in Iraq, we could immunize every human on Earth with every vaccine that we know about for the next 95 years. We could have sent 14 million children, our children, to a college education. We could have built over 100, maybe 150, hospitals in each and every State in the Union. There is a lot we could be doing with the money we are spending overseas in Iraq, and it is all about values, and it is all about choices, and we are really getting to a tipping point, I believe, not just in our economy, but people feel it in their gut that we are headed in the wrong direction still, even though the difference makers, the three of us that just got the opportunity to serve here in Congress, have arrived.

Mr. KAGEN. Yes, they do. We go into medicine, most of us, because we care about people. We seek to solve problems for people. The model at our clinic was how can we help you today. So we take people, and we take all people, but the real question is this: Is Medicare able to pay for the cost of producing the service at an institution? They do not. So that cost is shifted to others who can afford to pay, and those prices are sky high. So many of the problems that we face, government has not really had its feet put to the fire saying, you know, you should pay for the cost of producing the service, at least for the overhead plus a margin of profit; you should pay for the entire cost of producing a medication or a vaccine, or it will not be there. There are two ways to get rid of anything. Let us take cigarettes as the example. If you want to get rid of cigarettes, tax the heck out of it or do not pay for it. It will be gone. The same is true in health care. If you do not pay for the service, the institution at the hospital, it cannot stand. It cannot balance its budgets. Most hospitals that I am familiar with in Wisconsin are running margins of profit anywhere from 3 to 5 percent, if they are profitable. So it is very difficult to make it. But to summarize Medicare, it is over 40,000 pages of rules and regulations. I do not know that there is anyone that fully understands it, and just think of it as a mess, and it does need to be repaired. But I think the more important point is institutions, hospitals, research centers, educational facilities are not being compensated, and the people that will suffer are those yet to become aged, because we are not really adequately funding higher education for the physicians' training and their fellowships and the nurses' positions. So there are a lot of problem to go after. I will not put you to sleep with the data.

Mr. KAGEN. Would my colleague agree that we will support the troops, but not this failed policy?

Mr. KAGEN. Thank you very much, Congressman Pallone. And what Congressman Perlmutter says is true. Really, let's ask the right question. A lot of times in your career, being an attorney, you have to ask the right question to get the truth out of somebody. So what kind of Nation are we, and in which direction shall we move? Are we a Nation that values and treasures those who have served in harm's way in our military? I think we are. Are we a Nation that values the health and education of our children and the mothers that care for them? I think that we are. And that is really where Democrats differ from our opposition party. I really believe that our core values resonate with everyone, not just in Wisconsin where I come from but everywhere, in Florida as well. I yield to Congresswoman Castor.

Mr. KAGEN. But I don't want you to hold it against me. And I won't hold it against Mrs. Christensen that you have ``M.D.'' behind your name. But if you ask around the Chamber and ask around back home, everyone that I know understands that how you spend your money and where you spend your money is a reflection of your values. And the current administration has shown us where their values are, and they are not with people. They are not really helping us to provide care to millions of people, 48 million, who don't have access to affordable health care, in this country. His State of the Union was very uplifting. He should be commended for bringing up the subject of providing access to health care for everyone. But his policy, as we talked about last week, raises taxes and offers no hope of lowering the cost of health care for insurance costs or prescription drug costs. And, more recently, with his 2,500 page budget, which I haven't finished all the fine print yet, he has shown us his values once again. The first thing he did was to cut benefits to veterans and make it much more difficult for veterans to get the well-deserved benefits that they have earned and that they deserve. What did he do? He is asking for $3.4 billion to come from veterans who have already earned their benefits, but now they have to kick it in. They are going to have to pay for their benefits that they have already earned. There are increasing copayments for veterans in their budget. I don't know where he is coming from on this, but he can't be coming from Wisconsin.

Mr. KAGEN

Mr. KAGEN. I want to make it perfectly clear to everyone in this room and beyond that we Democrats are very much in favor of profits. We believe in capitalism, and the problem that your hospitals have in Florida or Pennsylvania or New Jersey or Wisconsin, the problem we have in large part is this thing called ``cost shifting.'' The cost of providing a service to a Medicare enrollee does not cover the overhead, does not cover the operating expense to provide that service. So someone has to make up that difference. It takes so much money to run a business, to run a hospital or a clinic or a drug company, but we want people to be profitable. So we are not against profits, but we are against the idea of privatization of what is an essential service, one of the greatest social programs ever rolled out by this Nation being Medicare. Now, I would be the first to admit that Medicare is a mess. I do not know of any doctor or administrator that really understands all the 44,000 pages of the rules, but it does not mean that it cannot be fixed. It does not mean that we cannot take a positive attitude toward it and address it and fix it. Now, I am also a small businessman. I want everyone in this room and beyond to understand, the Democrats are pro-small business. Every small business in this country is facing a crisis because they cannot afford their health insurance premiums. Whether you are a farmer, a photographer or an employer of 50 or fewer people, health care is out of reach. The cost is out of reach, and this Congress needs to step up, not with the President's idea of tax benefits, but we should take part of the good from his policy and bring it to the floor with a new idea.

Mr. KAGEN. It is a tremendous concept, and it will work. It is an old saying, an ounce of prevention is worth a pound of cure. It works in health care. It works across the country, works on your automobile and will work on your body as well. Here is another sentinel idea. Right now the insurance companies write their own policies that benefit them. I think it is time for Congress to consider writing a Federal standard, a basic health insurance policy. It becomes a Federal standard. We have Federal standards in automobile manufacturing. We have Federal standards in construction, in health care, in every industry that you can name. But we don't have a basic health care policy that each and every insurance company should have to sell. You see, if every insurance company was selling the same piece of paper, then we could compare them based on the quality of their services and their price. I think it is time to take that step. It is time for us in Congress to decide what should be covered. If it is in your body, head to toe, I think it should be covered. I think it is time to start writing a basic, standard health insurance policy, not mandating prices, but allow the insurance industry to set their own prices and compete for us. Right now, back home in Wisconsin, my patients are on their hands and knees crawling to the insurance companies hoping to get in. Farmers will have their wife or themselves working on the farm during the daytime, working a nighttime job, just to get the health care benefits.

Mr. KAGEN. I agree with you that many people get very confused when you start talking about bean counting and you get into the numbers. It gets very confusing. We might be better off for everyone to understand health care and simplify it if we talk about trying to identify the essential elements that should be in any successful universal health care initiative. Those essential elements that I don't think anyone would disagree with would be that if you are a citizen, you should be in the risk pool. Because in every State, what they are trying to do now as they seek to find a solution to this urgent problem, every State is trying to form a larger buying group, a larger insurance pool. That is really their only game plan to leverage down the costs. But if we have 300 million in an insurance risk pool with regional modifiers, we can really begin to leverage down insurance costs. I would ask this question, what is the purpose of having health insurance? Health insurance is a form of delayed income. You put your hard-earned money into the insurance company's hands so that when you or a member of your family becomes ill, you get it back. But unfortunately today, when the money goes into the insurance company, you have to fight like heck to get it back, and it may not come back in total. Health insurance should be available to everyone at an openly disclosed price, so everyone has an opportunity to buy something that is affordable. Let us look at the numbers. In 1989, 83 percent of Americans had health insurance coverage from work; in 2004, 56 percent. It was because employers couldn't afford to pay the price. The cost was impossible to pay. If we had numbers today, it might be below 50 percent. More and more people that are watching tonight are falling into this category, going to bed at night knowing that if anyone in the family is ill, they are going to lose their house. What insurance ought to be all about is guaranteeing, if you do become ill or anyone in your family becomes ill, you are still in your house and not the poorhouse. If we identify the essential elements that need to be in any solution that is universal, I think there are several. First, openly disclose the prices. Second, every citizen should be allowed to pay the lowest price. Third, I think we need that insurance risk pool to be nationwide. If you are a citizen, you are in with no cherry-picking. Fourth, we need to have a deductible that is 3 percent of a household's Federal taxable income. If Mr. Altmire were to make $100,000 a year, he and his family could afford $3,000 on health care. But then give it to him as a tax deduction at the end of the year, up to that 3 percent limit. Fifth, most importantly, I believe the measure of any nation is in how we treat those who are in need. So I would say it this way, that local, State and national governments must provide for those in need. I think it is up to us here as Democrats and Republicans to come together and decide who is in need and what is it we should provide for them? If we can agree on the essential elements that should be in any national solution, the next step will be much more easy to take.

Mr. KAGEN. I have a lot to say about this subject, a lot of feelings. I would say it this way: Medicare part D has already been privatized because no longer is the benefit money going to go to a constituent, to a Medicare enrollee. It goes to the insurance company. In fact, all of us taxpayers paid money to private insurance companies for the marketing of this most fiscally irresponsible program ever to be rolled out by the Federal Government to help them to be successful to privatize the Medicare patients.

Mr. KAGEN. You are quite right, and I would look at it and phrase it a little bit differently. I believe our President must be kind to seniors and kind to all Americans, and he would be kind in signing the opportunity to negotiate for a lower price for medications. I believe it is discriminatory, as I said. I look at the world and say, okay, what I am about to do, is it kind or unkind. I think it would be terribly unkind to all senior citizens, to anyone certainly in AARP, if President Bush were to veto that bill.

Mr. KAGEN. If you are buying a car or truck or new suit, don't you ask the price? And when you ask the price, you find out the price. I challenge all of us in this room tonight and everyone listening at home, call up your local hospital and ask: Excuse me, what does it cost for a mammogram, and 99.9 percent of the time you are going to get this answer: ``Well, what insurance do you have?'' I think we need to have transparency, and this is one of the ideas that President Bush is in favor of, and I am sure our Republican colleagues would be as well. I believe we need to openly disclose all prices in health care. I believe every citizen should get the same discount. I don't believe in discrimination. Today, on average, if you are covered by Medicare part D, if you go to the pharmacy and you are in line behind somebody from the VA, you are going to pay 46 percent more for that prescription, the identical prescription being sold to a veteran patient, and yet you are paying more. I feel that is a form of discrimination. So if we have an open and transparent marketplace where everyone gets the same discount, where prices are openly disclosed, we form one nation again, not State by State solutions which are very difficult and challenging and unique to the region. I believe if you are a citizen, you should be in the risk pool across the country. Everyone has a health care story tonight, and what they need to understand is that the Democrats are really listening. This health care crisis is something that I see and feel every day as a physician. It is something all of us in Congress hear about here in Washington and when we are back home listening to our constituents. I think we need to spread the word that this Congress, the 110th Congress, and especially if I can say the word, our freshmen class, will address this issue and take it on straight away.

Mr. KAGEN. Thank you very much. I appreciate the opportunity to be here with you this evening. Everyone in this room, everyone in this country has a health care story to tell. But if you want to talk first about the President's proposal, I think it falls not in terms of a Trojan horse, but a smoke screen, much like the Social Security crisis was a smoke screen to distract people from what was really going on. I have a chart here that demonstrates that the number of uninsured Americans exceeds the cumulative population of 24 States in our country. Really what we are talking about is the uninsured and even those that have insurance coverage, just having insurance coverage doesn't guarantee that you are going to get coverage. After all, in my medical practice every day, when I would write a prescription, maybe one chance in two, one chance in three, it wasn't covered, it wasn't on the plan, or in Medicare part D on the 44 different lists we had in Wisconsin. I would start off on a positive note and say that the President should be commended for raising this important crisis. It is, in my view, the most important crisis facing our economy. The impossible costs of health care are holding back employment. Employers are unable to employ new employees because of the high cost of insuring them. In my hometown of Appleton, a new teacher this year will be paid $30,000, but his or her insurance coverage will be $12,000 to $13,000, in another neighboring city, $17,000. For anyone earning less than $48,000, the cost of health insurance coverage is simply out of reach. Medically speaking, I would say thank you to the President, but your idea is DOA, dead on arrival. It simply won't work, and it will not solve the crisis we are all facing. He had some other interesting and positive ideas. The idea of the health savings account, I think it is a great idea that people are saving money, but no matter how much money you are saving, it doesn't affect the cost of health insurance, it doesn't affect the cost of your physician's charges, the hospital expenses, or the prescription drugs that many people need. Everyone has a health care story to tell, and it is for those people and everyone in the country that this 110th Congress must address this crisis. Now let me ask all of you, Mr. Altmire, don't you want to know the price of a pill before you swallow it?

Mr. KAGEN

Mr. KAGEN. Madam Speaker, impossible costs for health care are a major concern for everyone, and the President should be commended for addressing this difficult crisis. But his proposal is really a tax hike for people who cannot afford it: businesses and working families. We must establish an open and transparent medical marketplace, and it is really not that difficult to do. We need to, one, openly disclose all prices in health care everywhere; two, give every citizen the same discount; and three, establish a single risk pool, 300 million strong, across the country to leverage down prices and costs for all of us. In other words, if you are a citizen, you are in. It is past time that the Congress should establish a single basic Federal standard health insurance policy that every insurance company must offer to each and every one of us. In doing so, we will be able to compare insurance companies based on the quality of their service and their price. The President means well, but you cannot use tax hikes to lower health care costs.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, today, in a bipartisan embrace, both Republicans and Democrats will continue to work together for positive change and a new direction for America by promoting a truly bipartisan first-100-hour agenda. People in Appleton and Green Bay, Wisconsin, and all across America, wanted us to come together and begin to solve these problems that we are facing, and we have done just that. Two weeks ago we passed a rules package and a comprehensive ethics reform package supported by margins of 426-0 and 430-1, respectively. I believe we are really beginning to come together. Fiscally responsible, pay-as-you-go, and real budget reforms were supported by many, many Republicans. Sixty-eight joined in implementing the 9/11 Commission recommendations. Eighty-two Republicans helped to increase the minimum wage, and 36 joined in lowering prescription drug costs for seniors. Let's continue to work together to help reduce the costs of higher education as well. By working together we really will build a better future for everyone.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, health care costs in this country are impossible for everyone. For small businesses, for local, State and Federal governments, the uninsured, for working families, and most especially for our senior citizens. As a physician, I see and feel this crisis every single day. Today in America the real price of a pill is whatever they can get. My patients and my constituents want to know the price of a pill before they swallow it, and they would prefer to pay less rather than more. H.R. 4 will allow our government, ``We, the People,'' to negotiate more affordable prices for the necessary prescription drugs our seniors require. Our health care crisis that we all are facing blurs the lines between Republicans and Democrats. Allow me, please, to share with you the comments of one of my constituents, a Republican, Dorey Hoffman from Appleton, when she says: ``When I went to receive cancer treatment, I saw this at the reception's desk at the cancer center. I thought of you being the voice for all of us and of course all the cancer patients. We all need someone to help us in our everyday lives.'' Please join with me in support of H.R. 4 and help Dorey and millions of other senior citizens.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, as a physician for 30 years, I know something about human diseases and the personal suffering of my patients and their families. I support stem cell progress, which is what H.R. 3 represents, because it will fulfill the promise of finding a cure to the many life-altering and painful disorders such as Alzheimer's, juvenile diabetes, heart disease and spinal injuries and more. Saying ``no'' to stem cell progress is extremely unkind to patients, patients who will benefit from these potential cures yet to come. If one truly cares about life and believes in improving the quality of life of all of our people that we represent, then one should say ``yes'' to stem cell progress. To all my colleagues, be not afraid. Be not afraid to take this important step forward. This Congress should be proud to be in favor of progress and should become pro-cure.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, we must begin to think differently in America, because the path we are on now is morally unacceptable. More than 3,000 brave Americans have perished in Iraq and more than 650,000 Iraqi civilians are dead. President Bush's newest war proposal is not a complete and comprehensive plan, and more importantly, it is not based on realities on the ground and in the region. The President believes that 20,000 additional U.S. troops will change the outcome in Iraq. He was wrong to invade Iraq, and he is wrong now. Instead of decreasing the violence, last night's proposal will increase the risks to everyone in Iraq and the surrounding region, and it will not bring an end to the Iraqi civil war. Clearly it was bad judgment to have invaded Iraq. It will be even worse judgment to remain. Simply put, we do not belong in Iraq, and we are still headed in the wrong direction. We all support our troops, but we must not support the administration's policy of more of the same poor judgment. We must begin to withdraw our forces and allow the Iraqis to take control of their own future.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, I rise today to recognize that it was on this day, as pointed out earlier by my freshman colleague, Bruce Bailey from Iowa, January 10, 1918, that the House of Representatives first voted to give women the right to vote by approving the 19th amendment to the Constitution of these United States. The State of Wisconsin became the first State to ratify the amendment. And following Wisconsin's lead, two-thirds of the States approved the amendment which became the law of the land. The 19th amendment gave women their full rights as citizens. It says, simply, citizens of the United States shall not be denied the right to vote on account of sex. The 19th amendment brought this Nation one step closer to fulfilling the promises enunciated by our Founders. As the first Chamber of Congress to approve the amendment, we showed the way, and the Senate followed. This Chamber took another historic step recently in fulfilling the promise of America's freedoms by electing Speaker Nancy Pelosi as the first woman to hold the position of Speaker of the House.

Mr. KAGEN

Mr. KAGEN. Mr. Speaker, we must begin to think differently in America and join hands across the aisle. Our Nation must become secure now, not next week; and that is why I rise in support of H.R. 1. As other Members have, I ask the current administration to present this Congress with a comprehensive plan for Iraq, a plan that makes sense, a plan based on the realities on the ground in Iraq and in the region, for all of us have the same goal: to build a better and more secure Nation. By working together, we will accomplish our shared mission, first, by implementing the recommendations of the 9/11 Commission; secondly, by securing our borders; and, finally, by protecting our Nation from threats from nuclear warfare. Please join me in supporting H.R. 1 as we begin to work together to build a better Nation and a more secure Nation for everyone.

Mr. KAGEN

Mr. KAGEN. Madam Speaker, my good friend Mr. Ryan from Wisconsin, I was elected to send a message to Congress to balance its budgets and to be fiscally responsible. As Paul Ryan notes, in Wisconsin thousands of hardworking people have lost their jobs; and when they lost their manufacturing jobs offshore, much of the wealth of this Nation was sent offshore along with those jobs. We need a positive change in America, and it needs to start now, right here and right now in the people's House. Let's begin to build a better future for everyone by dedicating ourselves to becoming fiscally responsible today, not next week. And then when we do, let's ship our values overseas and not our jobs. I rise before you today to urge you to support pay-as-you-go as a means to become fiscally responsible. We cannot realistically begin to solve the many problems we face until we completely reverse the misguided fiscal policy of borrow and spend, and borrow and spend, and borrow and spend, which has driven our country into more debt than our children can possibly repay. Let us agree to live within our means here in the House as we do in our own homes back in Wisconsin.