Tom Price

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I am going to shift gears a little bit right now and just recount a bit of this past week. This has been a remarkable week, first week of a new majority. For the record, the first 100 hours of this new majority, and for the record, Mr. Speaker, you ought to know that the Speaker's Office officially states that we have been in session dealing with the issues of importance to the American people for 12 hours and 28 minutes. That is over 4 days. That turns out to be about 3 hours and 7 minutes a day. Now, if you count the actual time that we have been in session, which I think is important, because if you are going to promise that you are going to do things in 100 hours, then you doggone well better do it, and actually, we have been in session now at 6:18 p.m., 38 hours and 21 minutes, 38 hours and 21 minutes. We are keeping track of the right clock. So for all those folks out there, we want you to know that The Official Truth Squad is keeping an eye on the majority party and making certain that they live up to their promises. We have dealt with some remarkable issues during the first 38 hours that we have been in session. We have dealt with the minimum wage today in a way that left a lot to be desired in terms of bringing about that wonderful bipartisan spirit that has been promised but not seen yet by the majority party. We have dealt with the 9/11 recommendations. As you recall, Mr. Speaker, before the election, the new majority party, the leaders of that party, promised that they would enact every single recommendation of the 9/11 Commission. Well, that bill has come and gone without any input from the minority party. As you know, you know very, very well what happened was not the enactment of every single 9/11 recommendation, because promises made on the campaign trail don't appear to be promises that will be kept in the majority. These are important issues. We have got two more issues to go this week. They are extremely important issues to the American people. The issue of stem cell research, embryonic stem cell research, which is an incredibly important issue, a complex issue, a scientific issue and one, again, that I am very distressed and concerned is not being dealt with in an open and honest way that has been promised, nor is it being dealt with, certainly, in a bipartisan way. We also have this week the issue of Medicare part D prescription drug program that is in place for Medicare recipients, and that, too, is being dealt with in a way that doesn't allow for any input from the minority party, doesn't allow for any amendments, isn't being heard in committee. The gentleman before me mentioned that there were a number of freshmen Members of this body, and there are, there are 54 Members of this body who are now here for the very first time, freshmen Members. They haven't dealt with any of these issues. Mr. Speaker, a majority of this House is not being allowed to deal with the issues that are coming to the floor right now, because they are being done in secret. These bills are being written in secret without input from anybody on the minority side and certainly without any input from any of the new Members of Congress. So the Official Truth Squad is here to make certain that we hold accountable for the majority party, for the promises that they made and make certain that the American people understand and appreciate what is occurring in Washington under this new martial law rule that we have for bringing issues to the floor. The Official Truth Squad has one of our favorite quotes, we have a lot of favorite quotes. One of them is from the late Senator Daniel Patrick Moynihan, who had one of the most wonderful and appropriate quotes for this building that I know of, and that is that everyone is entitled to their own opinion but not their own facts. So what we would like to do this evening, Mr. Speaker, is to talk a little bit about some facts, some facts as they relate to the two issues, Medicare part D prescription drug program and stem cell research, embryonic stem cell research. Now decisions made regarding Medicare part D and the discussion that we are having, many people will think, well, it is just about a narrow prescription drug program for Medicare. In fact, Mr. Speaker, it is about a whole lot more than that. If you back up from the specific debate about prescription drugs and you look at what is really being done, what is happening is that we have a difference of opinion, a philosophical difference of opinion about who ought to be making very personal health care decisions for the American people. On the other side of the aisle, on the majority side of the aisle, we apparently have a majority of those individuals who believe that the government ought to be making those decisions, personal health care decisions. On the minority, on the Republican side of the aisle, we are proud to say that we support health care decisions, medical decisions being made between physicians and patients. That is where those decisions ought to be made. In fact, when you look at this whole issue right now, it is important to ask exactly what it is that the Democratic majority is attempting to solve. When you look at this program that has been in place now just a few short years, the costs are down. In fact, the costs are down for the last year, $13 billion, $13 billion. Actual costs of benefits in 2006 are 30 percent or $13 billion less than was projected. The projected costs over 10 years are down 21.3 percent, which is $197 billion. That is a fact. That is a fact. Premiums are down 40 percent over projections, again a fact. If we would listen to the Democrats on this issue, when the bill was enacted, they attempted to put into law that premiums ought to be for every Medicare recipient, $35 a month. They wanted to make certain that they were $35 a month. So what are the premiums now? They are about $22, $23 a month on average. If we had listened to them when this was enacted a couple of years ago, every single senior would be paying on average $12 a month more for their prescription medication. I would suggest that if the past is prologue, that we ought to be very careful about what is coming to the floor this week as it relates to Medicare part D. Beneficiaries, those who are using the plan and benefitting from the plan, over 80 percent of them, are supportive and satisfied with the program. That is with nearly 90 percent of those eligible being supportive. Again, people are entitled to their own opinion, but they are not entitled to their own facts. The costs are down. Access is expansive. Medications are being covered across the whole spectrum of disease. And seniors are happy. I ask, Mr. Speaker, what is it that the Democratic majority is attempting to fix? What problem are they trying to solve? I am pleased to be joined tonight by a number of colleagues to talk about both of these issues. As we talk about Medicare part D, I am pleased to welcome my good friend, Congressman Patrick McHenry, from the great state of North Carolina who has great experience in representing individuals and understanding and appreciating the importance of bringing truth to debate. I welcome you, Congressman McHenry.

Mr. PRICE of Georgia. I appreciate your earlier comment. And I want to get to what the Democrat plan is, but I want to make certain that people appreciate and, Mr. Speaker, it is important that the Members of Congress appreciate that what we are talking about here is who is making decisions. And I appreciate you mentioning that not even a physician in the House ought to be making the decisions, because the collective wisdom here isn't as great in the area of health care in all 435 Members of this body than the wisdom that is between a physician and a patient. That collective wisdom is greater than the 435 individuals here. And when you talk about plans offering programs to seniors to have certain medications and there is this big push to have the government negotiate, isn't it true that those plans are negotiating already with pharmaceutical companies and with pharmacists?

Mr. PRICE of Georgia. Choice is so very important. And when our colleagues on the other side of the aisle talk about negotiation and the government negotiating, I just almost chuckle. If it weren't that they were serious about doing this, it would be humorous. It really would. Because if you think about negotiating with the Federal Government, I don't know, Mr. Speaker, how many times you have had an opportunity to negotiate with the Federal Government, but when I think about negotiating with the Federal Government, whether it is the IRS or the Post Office, when you think about negotiating with the Post Office those aren't folks that one would think are going to be warm and fuzzy and interested in your best interests, Mr. Speaker, or the American people's best interests.

Mr. PRICE of Georgia. And when you mention the decrease in quality of care and the decrease in access to care, people say, well, that is just smoke and mirrors. That is just conjecture. But if you look at programs that have had the effect of price fixing, and we can look at programs in our own Nation. You can look at them around the world and give grand examples for how you decrease access and decrease quality of care to individuals in health care, again, those very personal decisions. But if you want to look at something in this Nation where the government has stepped in and said, okay, we are going to fix prices, all you have to do is look a few short years back to the Vaccine for Children's program, something incredibly important to the American people, something incredibly important to the health of our Nation. In the early 1990s, there were about 30 or so pharmaceutical companies that were making vaccines, and they were aggressive and active in their research and development. The vaccines had a varying price depending on the disease that they were attempting to cover or to prevent, and the government came in and said, oh, those prices are too high. Those prices are too high. In fact, in order to provide vaccines for every single child and individual in this Nation we are only going to allow you to charge this much. That was in 1993 or 1994. Well, 12, 13 years later, remember, Mr. Speaker, there were about 30 or so pharmaceutical companies making vaccines. Do you know how many there are now? Three. Three. Mr. Speaker, men and women and children all across this Nation know the difficulties that they have had oftentimes in getting their vaccines, and that is due to a lot of things but not the least of which is the intervention of the Federal Government and price fixing which always, always decreases the quality and decreases the access.

Mr. PRICE of Georgia. I appreciate that. And it is such an important question, because of the premise of all of this from a policy side. You take away the politics, but from a policy side the premise of all of this presumes that every single patient is just like every single other patient and they are just kind of little blocks that move along, and all you have to do is recognize what disease they have or what problem they have and you just determine exactly by algorithm what they need and so that a bureaucrat can determine that. In fact, that is not the way health care works. That is not the way medicine works. That is not the way patients work. Mr. Speaker, you know as well as anybody that patients are different. Each and every individual patient is different, and what may work in one patient doesn't necessarily work in another. I can give you a real-life example from working in the VA, which is touted as being a wonderful program, as an example for what the other side, what the majority party is trying to do to Medicare part D. When I worked in the VA, and I had an opportunity to do that for a number of years, we were given a list of medications that were available for use in patients. And if you as a treating physician determined that the patient wasn't responding to the medication that was on that list; I am an orthopedic surgeon and treated hundreds of patients if not thousands of patients through the VA, and whether it was a pain medication or whether it was an anti-inflammatory medication or an antibiotic, something that can truly be life and death, and it wasn't working and you needed to use something that wasn't on that list, it was virtually impossible to get the right medication. And that is how you decrease the quality of health care, decrease access to quality of health care for patients, and that is precisely what will happen for 43 million, at least, seniors; and the ripple effect will occur throughout the entire Nation.

Mr. PRICE of Georgia. I appreciate the gentleman bringing that up. Because if you ask the individuals who are objective experts in this area and you go either to CMS, the Center for Medicare and Medicaid Services, or in Congress we go to CBO, Congressional Budget Office, there are some very interesting findings. And these are folks that really don't have a dog in this hunt from a policy side. They are charged with giving us objective information. And the CMS actuary, the individuals who are charged with determining what a program is going to cost, said, regarding having the government ``negotiate'' on this, ``Price negotiations between plan sponsors and drug manufacturers would achieve comparable or better savings than direct price negotiation. This expectation reflects the strong incentives to obtain low prices and pass on savings to beneficiaries resulting from competition.'' And CBO, the Congressional Budget Office, which is charged with providing accurate information, Mr. Speaker, to both Democrats and Republicans, both sides of the aisle, they provide the same kind of information. They attempt to provide objective and accurate information, and what they said was, ``We expect that risk-bearing private plans will have strong incentives to negotiate price discounts for such drugs and that the Secretary would not be able to negotiate prices that further reduce Federal spending to a significant degree.'' So those are the two main folks that we look at to determine what the costs of this program will be that is being proposed by the other side of the aisle, and in fact what they say is that it will not be as inexpensive as that currently in place.

Mr. PRICE of Georgia. Mr. Speaker, I thank the gentleman. I know that you are very familiar with medical issues, being a physician in your former life, and I appreciate your comments as it relates to part D. And I just want to spend just a few more moments on the prescription drug plan and then move on to another issue and would be happy to yield to my good friend again from North Carolina, Congressman McHenry, for some closing remarks about part D that is going to come to the floor later this week.

Mr. PRICE of Georgia. I thank you for your participation. Let me just close with some final comments about a Medicare prescription drug plan that is on the agenda this week to be dealt with by the majority party. In the program, the costs are down. The access is expansive to medications. All medications in the panoply or the array of plans that are available are available to patients. Seniors are happy. We are negotiating now. There are negotiations going on now between plans and pharmaceutical companies and plans and pharmacists that have decreased costs much below what was projected. The big question in the end, Mr. Speaker, is who is going to be making health care decisions? Is it going to be government bureaucrats and majority parties, or is it going to be patients and doctors? That is the real question. And I am hopeful that my colleagues on the other side of the aisle will appreciate the gravity of this issue that they are bringing forward and the importance of making certain that there is input from all Members of Congress as it relates to this issue. And hopefully, hopefully, if we cannot get some sanity in this Chamber, we will get some sanity in the Senate and make sure that we don't do something that would truly harm the health of the American people. Mr. Speaker, we are going to continue now and talk about another issue that is of incredible importance and incredible gravity to the American people and certainly to some very specific individuals, and that is the issue of stem cell research. It is an extremely complex issue. It is a scientific issue. It is an issue, Mr. Speaker, that demands the highest quality debate and input here in the U.S. House of Representatives. And, once again, what we are seeing from the majority party is not that kind of involvement. Nobody, nobody on the minority side of the aisle has been involved specifically in bringing forward the legislation, with the exception of the few individuals who are supportive of what the majority party is doing. Nobody who has a contrary view has been involved in the process. There have been no committee hearings this session on this bill. The Republicans by and large have been shut out and certainly all of the freshmen have been shut out of this issue. An issue that truly, Mr. Speaker, you talk about a life-and-death issue. This is a life-and- death issue. I am so pleased to be joined by many of my colleagues this evening to talk specifically about the issue of embryonic stem cell research and stem cell research in general. I would remind folks again of kind of the hallmark quote of the Official Truth Squad, and that is that everyone is entitled to their own opinion but not their own facts. And if you look at the scientific facts on this issue, Mr. Speaker, you will arrive at the right conclusion. So I am pleased to ask to join us this evening my good colleague from North Carolina, Congresswoman Virginia Foxx, who has been passionate in her desire to make certain that we as a Nation have an appropriate and correct policy when it relates to embryonic stem cell research. So I yield to my good friend from North Carolina, Congresswoman Virginia Foxx.

Mr. PRICE of Georgia. I thank Congresswoman Foxx for participating and for bringing up the incredible importance of the ethical issues that are real. Regardless of where you come down on this issue, there is no doubt, it cannot be denied there are significant ethical challenges and questions surrounding this entire debate. If we ignore those as a Nation in our debate and discussion about it, it will result in a disservice to the entire Nation. I am pleased to call again on my physician colleague, the gentleman from Georgia (Mr. Gingrey), an obstetrician-gynecologist who practiced for almost 30 years and has incredible knowledge and passion and perspective on this most important issue of stem cell research.

Mr. PRICE of Georgia. I thank the gentleman for joining us this evening and truly the recognition that this is a life-and-death issue. As I mentioned, regardless where anybody is, Mr. Speaker, on this issue, whether or not you believe that an embryo is indeed life or not, nobody can deny that there are ethical questions and an ethical dilemma that surrounds all of this. As a physician, I was trained in what is called the scientific model which means you try to collect as much information as possible and determine from that information what course of action you ought to take, and then step back and evaluate what has occurred in treating a patient or in whatever course of action you might have taken, and then make decisions based upon that information. The information we have available to us now, the information, specific information, the facts, not opinions but facts, the facts of the situation right now are that, in the area of stem cell research, which all of us support, all of us support stem cell research, in the area of stem cell research, the work that is being done for patients right now is overwhelming in its benefit now from adult and cord stem cell research and stem cell treatments in the area of adult and cord stem cell as opposed to embryonic stem cell. Mr. Speaker, as you know, there has been no opportunity to amend or bring light in this Congress to that issue. I know that this won't show up very well, but this is a sheet that has 77 different diseases on it for which there are currently either clinical treatments or clinical trials for patients. Seventy-seven different diseases. I think it is important for you, Mr. Speaker, and anybody listening, to appreciate that there are individuals who are being cured of diseases right now from the use of adult and cord stem cells, stem cells that are not derived from situations where there is, indeed, this ethical question or challenge. In fact, there are at least nine patients who have been cured of their sickle cell disease. That is patients who no longer have sickle cell disease utilizing cord stem cells. Mr. Speaker, that is incredible. It is a wonderful thing that has occurred. It is something that all of us ought to embrace, and that is factual. That is factual. If you look, however, Mr. Speaker, at the number of diseases for which there are clinical trials or clinical treatments in the area of embryonic stem cells, and those are the ones where there is that ethical dilemma or challenge, this is the answer to that: None. None. Zero. So you have 77 different diseases that are being either treated in the clinical setting with actual patients, real patients, or there are trials that are going on or there is active study going; 77 with adult and cord stem cells. And then embryonic stem cells, none. Zero, Mr. Speaker. Now, it is wholly possible that something at some point in the future may result in the ability to use embryonic stem cells for the treatment of disease, but I would suggest to you, Mr. Speaker, and my colleagues here and to anybody who truly is interested in the factual nature of this scientific question, a very complex question, and that is that the scientists are way ahead of the politicians on this. Congresswoman Foxx mentioned one of the wonderful breakthroughs that was just announced from Wake Forest earlier this week, and that is the use of amniotic fluid to find and recover, capture, if you will, embryonic stem cells that have none of the ethical dilemma of whether or not life is being destroyed in order to advance science. None. None of that ethical dilemma. So, Mr. Speaker, I would ask my colleagues on both sides of the aisle to recognize that science ought to be listened to in this, and we ought to pay attention to facts. There is no reason to move forward with a bill that will not necessarily result in significant cures for diseases and that will only, only, result in the demagoguing of an issue and hold out a false hope for individuals for whom they believe that if we just pass this bill that their disease will be cured tomorrow. Mr. Speaker, that simply is not the case. The biggest bang for the buck in terms of utilizing taxpayer money, Federal taxpayer money, which is hard-earned taxpayer money, for appropriate research is in the area of adult and cord stem cells and possibly embryonic stem cells that are recovered in a way that has none of the ethical dilemma or challenge. Mr. Speaker, I was honored to be with you this evening.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, Annie Lee Boggs Latimer was born in Milton County, now a portion of Fulton County in north Georgia on January 10, 1907, to Elizabeth and Ben Boggs 100 years ago today. She grew up on a farm on Boggs Road with eight siblings, Glenn, Mary, Frank, Frances, Walter A., Nettie, Ruth and Dorothy, off what is now I- 85 in Gwinnett County, Georgia. She attended Duluth High School, Young Harris College and the University of Georgia and went on to become a beloved teacher in Gwinnett and Cobb counties for over 30 years. On June 12, 1937, she married William B. Latimer, and for over 50 years, they lived in what all knew as the ``Rock House'' in Duluth, Georgia. Anne and Bill were married for a wonderful 61 years until his passing in 1998. She is the proud mother of Ben W. Latimer and the mother-in-law of Rachel H. Latimer. She is an inspiration for her two grandsons and their wives, Bill and Lynn and Mike and Laura, and adored by her five great grandchildren Brian, Sara, Claire, Gabrielle and Andrew. She is known affectionately by her family as ``Mama Anne'' and by her friends at church as ``Miss Anne.'' She has imparted wisdom and positive values to all the many students who were in her classes and benefitted from her teaching. Mama Anne is a guiding light for all her family and always brings love, direction, caring and support. Mr. Speaker, I know the U.S. House of Representatives joins me in sending our very best on the occasion of her 100th birthday to Anne B. Latimer and recognizing her life as a role model to all for achieving independence, longevity and success, by living the American dream of spirituality, community, hard work, and accomplishment. I am very privileged, Mr. Speaker, to have had the opportunity to recognize one of America's greatest citizens.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. I appreciate those comments so much, because they really bring into focus and clarity exactly what happened today. As I mentioned before, the purpose of this is not to say to folks, well, it was better when we were in the majority. The purpose is to say the promises that were made to the American people and decisions that the American people made upon those promises are not being followed. They are not being followed. And when they are not being followed, what that means when it comes to rules, it means that the individuals who represent those 140 million people are not allowed a voice, which means in essence that those 140 million people have no voice in the House of Representatives as it relates to the rules that have been put in place. I also think it is important to talk about the fact that it never happened before. There is kind of this general sense by some that this is just business as usual. Well, it is not business as usual. And one of my colleagues who knows better than most, who understands and appreciates that, is my good friend from Georgia, fellow colleague from Georgia, Congressman Gingrey, who is a former member of the Rules Committee, who I think has a wonderful perspective on the rule that will enact bills in place on this floor of the House without any review by committee, any review by anybody other than potentially, I guess the Speaker, and that may be it. So, I am so pleased that you joined us this evening to talk about what is a closed rule within a closed rule and to talk about the bills and the consequences of that for the American people. I welcome my good friend, Congressman Gingrey.

Mr. PRICE of Georgia. Mr. Speaker, I appreciate once again the opportunity to come to the floor of the House, and I am pleased to do it on the first day of the 110th Congress. It is an exciting day, a historic day. I want to thank the leadership for allowing me the opportunity to host an hour of the Official Truth Squad. We started this 2 years ago, and did so because there were many of us who were concerned about the fact that on the floor of the House oftentimes the words that were spoken and the presentations made oftentimes bore little resemblance to the truth. So we began 2 years ago to institute the Official Truth Squad, to try to come to the floor like this every so often and try to do it at least once a week to bring light to issues of concern to the American people. Today is no different. This is a historic day, the first day of the 110th Congress. It was an exciting day. The first day is always exciting. It is full of families and celebration and children on the floor of the House sharing the remarkable experiences of Members being sworn in, oftentimes new Members, of which we have today, Mr. Speaker, as you know, over 50 new Members in the House of Representatives. So it is an important occasion. We heard a lot of discussion leading up to today, and that discussion was culminated in November by a vote by the American people, and the American people voted and changed the majorities in the House of Representatives. And in terms of the American people's decision, it was the right decision for them because it was the decision that they made at the polls. It was important for us, it is important for all of us to appreciate that, yes, they did, the American people spoke. I think one of the things that they said is that they want a different process here. They were tired of some of the things that had gone on here in the past, so they spoke and said a different process is needed. Many of my friends on the other side of the aisle, Mr. Speaker, as you well know, talked as we led up to the November elections about the need for civility in Congress, which we believe wholeheartedly, about the need for openness, which is imperative for us to have in our system of government, openness, and then fiscal responsibility, kind of three tenets that they brought to the American people. I would concur with each and every one of those. I would suggest, Mr. Speaker, that those principles by the now- majority party ought to last longer than one day of speeches. So we have some concerns about what has occurred and some disappointments already, and we would like to share some of those with the American people as we are presenting things to the House of Representatives this evening. Now, in pointing these out, the purpose is not to say how good it was when we were in the majority, because it can always be better. As many of us talked in the election process, the campaign process, we talked about the kinds of improvements that we would like to see. The purpose is to shed light on both word and deed, and it is important, because what folks say and what they do, it is important for the American people to know that those two things are the same. In our system of government, we have elections where people go to the polls and vote. They vote based on a lot of things, but probably most importantly they base their vote on the fact that they believe that the person that they voted for and what they said they were going to do was in fact what they were going to do. So when individuals say things that they are going to do once they get into office and then they break those promises, then it is important for people to be held accountable. The American people do that time and again. It is also important as a Member of now the minority party for us to hold the majority party accountable. One of the responsibilities we have in our dynamic form of government is to hold them accountable, and we do this as a matter of principle. It is a matter of principle, and we believe it is a matter of principle that elected officials ought to be held accountable for not just what they say, but also what they do. To that end, I would like to share, Mr. Speaker, some quotes. We are going to talk a fair amount tonight about what individuals have said in the past, oftentimes the recent past, and what we have some concerns with in terms of their action. This first quote is from the ``Declaration on Honest Leadership and Open Government,'' which was one of the Democrat Party's publications that they had prior to the election. The quote there is from the now- Speaker. It says: ``Our goal is to restore accountability, honesty and openness at all levels of government.'' It is a noble goal. It is a noble goal. We would agree with that. It is just important that when one says that that is your goal and that is your purpose that, in fact, you comply with that. The Washington Post on December 17, 2006, said Speaker Pelosi is determined to try to return the House to what it was in an earlier era ``where you debated ideas and listened to each other's arguments.'' Where you debated ideas and listened to each other's arguments. That is important as we go through the process of what is of concern to many of us here in the House of Representatives about how the process is already being implemented. This is a quote from July of 2005 from Representative Rahm Emanuel, now the chairman of the Democrat Caucus, and he voiced some frustration about the inability to have either an amendment or a vote on the floor. He said, ``Let us have an up and down vote. Don't be scared. Don't hide behind some little rule. Come on out here. Put it on the table and let us have a vote. So don't hide behind the rule. If this is what you want to do, let us have an up and down vote.'' It is important to remember that the purpose of that was to say that every Member of the House of Representatives ought to have the opportunity to in fact offer amendments and have their opportunity for people to say, yes, I agree with you and your amendment or your bill, or, no, I don't. Here is a quote from Representative Steny Hoyer, now the majority leader, in October of 2005. The one that I would like to highlight here is a quote where he said these provisions are an outrage, talking about the rules that were in place: ``These provisions are an outrage and this process is an outrage. As one Member of this body complained, once again the vast majority of Americans are having their representatives in Congress gagged by the closed rule committee.'' Now, we will talk a fair amount this evening about what a closed rule is and why Representative Hoyer in October 2005 would have made that comment, saying that the representatives were being in effect disenfranchised in the House of Representatives. This quote comes from our now Speaker, Speaker Pelosi, who, in a letter to then-Speaker Denny Hastert in October of 2006 said, and this is an important quote, because this is one of those promises that were made prior to the election and that I believe affected individuals all across this Nation and what they were going to do when they went to the polls in November. This, again, is from now-Speaker Pelosi to then-Speaker Hastert. And what this says is, ``More than two years ago, I first sent you Democratic proposals to restore civility to the Congress. I reiterate my support for these proposals today. We must restore bipartisanship to the administration of the House, reestablish regular order for considering legislation,'' and we will talk about what that means, ``and ensure the rights of the minority, whichever party is in the minority.'' Restore the rights of the minority, whichever party is in the minority. ``The voice of every American has a right to be heard.'' We would certainly concur with that. And, again, we will point out some of the concerns and disappointments that many of us have about the process that we have already seen in place today. This quote here, Mr. Speaker, is from a Washington Post article of January 2, 2007, 2 days ago. And it says, ``As they prepare to take control of Congress this week and face up to the campaign pledges to restore bipartisanship and openness, Democrats are planning to largely sideline Republicans from the first burst of lawmaking. Instead of allowing Republicans to fully participate in deliberations as promised after the Democrats victory in the November 7 midterm elections, Democrats now say they will use House rules to prevent the opposition from offering alternative measures.'' And so we think it is important for people to be held accountable for what they say and what they do. We also think it is important, Mr. Speaker, as a matter of principle for people to do what they say they are going to do, especially elected officials. So, Mr. Speaker, I place into the Record an article which appeared in The Washington Post on January 2 that included this quote, in addition to that an editorial which appeared in the Washington Post yesterday entitled, ``A Fairer House, But Not Quite Yet.'' [From the Washington Post, Jan. 2, 2007] Democrats To Start Without GOP Input: Quick Passage of First Bills Sought (By Lyndsey Layton and Juliet Eilperin) As they prepare to take control of Congress this week and face up to campaign pledges to restore bipartisanship and openness, Democrats are planning to largely sideline Republicans from the first burst of lawmaking. House Democrats intend to pass a raft of popular measures as part of their well-publicized plan for the first 100 hours. They include tightening ethics rules for lawmakers, raising the minimum wage, allowing more research on stem cells and cutting interest rates on student loans. But instead of allowing Republicans to fully participate in deliberations, as promised after the Democratic victory in the Nov. 7 midterm elections, Democrats now say they will use House rules to prevent the opposition from offering alternative measures, assuring speedy passage of the bills and allowing their party to trumpet early victories. Nancy Pelosi, the Californian who will become House speaker, and Steny H. Hoyer of Maryland, who will become majority leader, finalized the strategy over the holiday recess in a flurry of conference calls and meetings with other party leaders. A few Democrats, worried that the party would be criticized for reneging on an important pledge, argued unsuccessfully that they should grant the Republicans greater latitude when the Congress convenes on Thursday. The episode illustrates the dilemma facing the new party in power. The Democrats must demonstrate that they can break legislative gridlock and govern after 12 years in the minority, while honoring their pledge to make the 110th Congress a civil era in which Democrats and Republicans work together to solve the nation's problems. Yet in attempting to pass laws key to their prospects for winning reelection and expanding their majority, the Democrats may have to resort to some of the same tough tactics Republicans used the past several years. Democratic leaders say they are torn between giving Republicans a say in legislation and shutting them out to prevent them from derailing Democratic bills. ``There is a going to be a tension there,'' said Rep. Chris Van Hollen (Md.), the new chairman of the Democratic Congressional Campaign Committee. ``My sense is there's going to be a testing period to gauge to what extent the Republicans want to join us in a constructive effort or whether they intend to be disruptive. It's going to be a work in progress.'' House Republicans have begun to complain that Democrats are backing away from their promise to work cooperatively. They are working on their own strategy for the first 100 hours, and part of it is built on the idea that they might be able to break the Democrats' slender majority by wooing away some conservative Democrats. Democrats intend to introduce their first bills within hours of taking the oath of office on Thursday. The first legislation will focus on the behavior of lawmakers, banning travel on corporate jets and gifts from lobbyists and requiring lawmakers to attach their names to special spending directives and to certify that such earmarks would not financially benefit the lawmaker or the lawmaker's spouse. That bill is aimed at bringing legislative transparency that Democrats said was lacking under Republican rule. Democratic leaders said they are not going to allow Republican input into the ethics package and other early legislation, because several of the bills have already been debated and dissected, including the proposal to raise the minimum wage, which passed the House Appropriations Committee in the 109th Congress, said Brendan Daly, a spokesman for Pelosi. ``We've talked about these things for more than a year,'' he said. ``The members and the public know what we're voting on. So in the first 100 hours, we're going to pass these bills.'' But because the details of the Democratic proposals have not been released, some language could be new. Daly said Democrats are still committed to sharing power with the minority down the line. ``The test is not the first 100 hours,'' he said. ``The test is the first 6 months or the first year. We will do what we promised to do.'' For clues about how the Democrats will operate, the spotlight is on the House, where the new 16-seat majority will hold absolute power over the way the chamber operates. Most of the early legislative action is expected to stem from the House. ``It's in the nature of the House of Representatives for the majority party to be dominant and control the agenda and limit as much as possible the influence of the minority,'' said Ross K. Baker, a political scientist at Rutgers University. ``It's almost counter to the essence of the place for the majority and minority to share responsibility for legislation.'' In the Senate, by contrast, the Democrats will have less control over business because of their razor-thin 51-to-49- seat margin and because individual senators wield substantial power. Senate Democrats will allow Republicans to make amendments to all their initiatives, starting with the first measure--ethics and lobbying reform, said Jim Manley, spokesman for the incoming majority leader, Harry M. Reid (D- Nev.). Those same Democrats, who campaigned on a pledge of more openness in government, will kick off the new Congress with a closed meeting of all senators in the Capitol. Manley said the point of the meeting is to figure out ways both parties can work together. In the House, Louise M. Slaughter (D-N.Y.), who will chair the Rules Committee, said she intends to bring openness to a committee that used to meet in the middle of the night. In the new Congress, the panel--which sets the terms of debate on the House floor--will convene at 10 a.m. before a roomful of reporters. ``It's going to be open,'' Slaughter said of the process. ``Everybody will have an opportunity to participate.'' At the same time, she added, the majority would grant Republicans every possible chance to alter legislation once it reaches the floor. ``We intend to allow some of their amendments, not all of them,'' Slaughter said. For several reasons, House Democrats are assiduously trying to avoid some of the heavy-handed tactics they resented under GOP rule. They say they want to prove to voters they are setting a new tone on Capitol Hill. But they are also convinced that Republicans lost the midterms in part because they were perceived as arrogant and divisive. ``We're going to make an impression one way or the other,'' said one Democratic leadership aide. ``If it's not positive, we'll be out in 2 years.'' House Republicans say their strategy will be to offer alternative bills that would be attractive to the conservative ``Blue Dog'' Democrats, with an eye toward fracturing the Democratic coalition. They hope to force some tough votes for Democrats from conservative districts who will soon begin campaigning for 2008 reelection and will have to defend their records. ``We'll capitalize on every opportunity we have,'' said one GOP leadership aide, adding that Republicans were preparing alternatives to the Democrats' plans to raise the minimum wage, reduce the interest on student loans, and reduce the profits of big oil and energy companies. Several Blue Dog Democrats said they do not think Republicans can pick up much support from their group. ``If they've got ideas that will make our legislation better, we ought to consider that,'' said Rep. Allen Boyd Jr. (D-Fla.), leader of the Blue Dogs. ``But if their idea is to try to split a group off to gain power, that's what they've been doing for the past 6 years, and it's all wrong.'' To keep her sometimes-fractious coalition together, Pelosi has been distributing the spoils of victory across the ideological spectrum, trying to make sure that no group within the Democratic Party feels alienated. Blue Dogs picked up some plum committee assignments, with Jim Matheson (Utah) landing a spot on Energy and Commerce and A.B. ``Ben'' Chandler (Ky.) getting an Appropriations seat. At the same time, members of Black and Hispanic caucuses obtained spots on these panels, as Ciro Rodriguez (Tex.) was given a seat on Appropriations and Artur Davis (Ala.) took the place of Democrat William J. Jefferson (La.) on Ways and Means. Democrats acknowledge that if they appear too extreme in blocking the opposing party, their party is sure to come under fire from the Republicans, who are already charging they are being left out of the legislative process. ``If you're talking about 100 hours, you're talking about no obstruction whatsoever, no amendments offered other than those approved by the majority,'' said Rutgers's Baker. ``I would like to think after 100 hours are over, the Democrats will adhere to their promise to make the system a little more equitable. But experience tells me it's really going to be casting against type.'' ``The temptations to rule the roost with an iron hand are very, very strong,'' he added. ``It would take a majority party of uncommon sensitivity and a firm sense of its own agenda to open up the process in any significant degree to minority. But hope springs eternal.''

Mr. PRICE of Georgia. I thank the gentlewoman from North Carolina and the wonderful words and focus that you bring to the need for civility and appropriateness in terms of word and deed on the floor of the House and in actions throughout our careers as elected officials. I am so pleased to be joined by another good friend and colleague from Tennessee, Congresswoman Marsha Blackburn, who has participated actively in the Official Truth Squad. I guess I share the gentlewoman from North Carolina's lament in having to be here on the first day because there is some straightening out in terms of bringing truth to the issue that has occurred even on this first day. We welcome you and look forward to your comments as they relate to the issues that have already occurred in this 110th Congress.

Mr. PRICE of Georgia. I appreciate those comments, and I appreciate the comments of the gentleman from Georgia (Mr. Gingrey). I think it is appropriate now to ask my good friend, the gentlewoman from North Carolina (Ms. Foxx), to make some comments about civility. Congresswoman Foxx is a dear friend and has had great concern about the level of discourse in this House of Representatives, has participated actively in the Official Truth Squad. I know you had some comments that you wanted to make about the level of civility and the importance of that in this House.

Mr. PRICE of Georgia. I thank the gentlewoman and I thank my good friend from Georgia for his answer to my rhetorical question, because the answer was the only thing that can be possible as a reason to do it is politics. That is it. That is the only thing that can be possible. There can be no good reason, from a process standpoint, for this House of Representatives not to record those votes. So I appreciate so much your enlightening me and helping me understand why that would have been done. I do know that constituents at home are tired, are tired of decisions that are made up here in Washington based solely on politics. And, in fact, I would suggest to my friends on the other side of the aisle who now find themselves in the majority that decisions like that and being held accountable for those decisions make it so that lives in majorities can sometimes be very, very short. So I appreciate your comments and appreciate your input and would be happy to yield if either of you had anything else to comment regarding the rules. If not, I do want to comment a little bit about the process and about why discussion of the process is important. My good friends know and most Americans know we live in the longest surviving democracy ever in the history of man, ever in the history of man. And there is a reason for that. I think people can conjecture about why that is the case, but I think one of the reasons for that is that we as a Nation have respected the process by which we develop policy. And the reason it is important is because everybody that is an elected official, is a representative of the people, has an opportunity to have input into the process, and that process itself not only produces the best product because as you have more people involved who represent more diverse areas, I think you get a better product, but what it does do is it ensures that people trust the outcome. They trust the outcome of not just elections, but they trust the outcome of the process of legislation. And when that process gets truncated or gets cut down or is closed, we use that term ``closed rule'' here, when the American people hear about a closed rule, what that means is that it does not allow your representative at home to be able to offer amendments, be able to have input into what the ultimate work product is, what the ultimate bill, what the ultimate law is. So, Mr. Speaker, many individuals across this Nation who went to the polls and voted in November have elected people who because of changes in these rules today will not be able to have input into very, very important issues like 9/11 Commission recommendations and whether or not they are adopted; like stem cell research and whether that goes forward paid for with Federal taxpayer money; minimum wage, an important issue, but it ought to be debated, ought to have opportunity for amendment; and then something that is near and dear to my heart as a physician in my former life along with Dr. Gingrey and my other colleagues is the issue of prescription drugs and the Medicare part D prescription drug program. An extremely complex issue. Extremely complex issue. And today, what the majority party did was say that we will bring within the next week to the floor of this House a bill that has never been discussed in committee. It has never had a hearing. It has never had anybody in this body be able to offer an amendment officially and have folks vote on it and say ``yes'' or ``no,'' they believe that that is the case, that has never been through that process that results in the best work product that is available for a bill and for ultimately a law. And from the rumors that we hear, and we only hear rumors because we don't have the legislative language, because we do not know what is going to be in that bill, but from the rumors that we hear, the result of that bill will be a decrease in the kinds of medications that are available to the American people. That may go into effect, Mr. Speaker, if the majority party goes forward with the rule that they adopted today. That may go into effect without anybody in this House of Representatives ever having an opportunity to affect that outcome. Some on the majority side would say, well, it has been talked about for a long time. It was voted on, the Medicare prescription drug program was voted on in 2003, got a lot of hearings then. There were a lot of people that talked about it and voiced their opinion on it at that time. That is true, Mr. Speaker, but what hasn't happened is that every single freshman Member of this House was duly elected in their districts and has a right, a right, under our system of government to have input into a bill that comes out of the House of Representatives. Every single freshman will have no input into that bill or into the bill as it relates to minimum wage, as it relates to stem cell research or anything else that was included in the rules package today. Never. That has never been done, as my colleagues said before, never been done in the history, in the history of this Nation, to have that kind of substantive legislation dealt with in a way that does not allow that kind of input. Mr. Speaker, that kind of rule, that kind of process, which is difficult to get your arms around, but that kind of process, I would suggest to you, is an abuse of majority power. Our job, on the minority side, is to hold people accountable for their actions and for their decisions. It is important that the American people understand and appreciate that these decisions that were made on the very first day, which, by and large, are procedural issues, that are difficult to get folks interested in, but they not only set the tone for this Congress, but they set the rules under which we make major decisions that will affect the American people as it relates to their income, as it relates to their security, and as it relates to their health. Nothing, nothing could be more important. Mr. Speaker, this is indeed a historic day. But it is also a day of concern. It is a day of concern, because what goes on here is extremely important. Within these walls we can effect change that will benefit citizens all across our Nation. We can also effect change that will harm citizens all across our Nation. If we work together, we will do much more of the former and very little of the latter. Let me close by just saying, Mr. Speaker, as I have said before, the challenges that we face in this Nation are huge. They are immense. But they are not Republican challenges, and they are not Democrat challenges. They are American challenges. If we work together as a body of elected representatives from all across this wonderful and glorious Nation, we will come up with the best product, the best legislation, the best laws that will result in the most amount of benefit to our citizens all across this Nation. So I challenge, I challenge my Democrat colleagues to fulfill the promises that they made on the election, during the election campaign, to fulfill the promises that they made, to fulfill the promises that they made when they talked to citizens in their districts all across this Nation about openness and about civility and about fiscal responsibility. That challenge, that challenge making certain that you fulfill those promises is what will ring true to the American people. I appreciate once again, Mr. Speaker, the opportunity to come to the floor tonight.

Mr. PRICE of Georgia. Mr. Speaker, reclaiming my time, I wanted to highlight the new rule for the Rules Committee, which says that votes don't have to be recorded, and I appreciate so much your bringing that up because nobody at home, none of my constituents, believe that any Member of Congress ought to be able to come here and vote and not have their constituents be able to look and see what they have done. And, in fact, part of this rules package that I think breaks a number of promises that were made by our friends in the majority as they ran up to the election, part of this package says that those votes don't have to be recorded. And I would be happy to yield to you, but for the life of me, I can't think of a reason that one would want to do that.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I move that the House do now adjourn.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I thank my colleague for yielding, and I want to commend the ranking member of the Rules Committee and the former chairman for his comments because I think they bring some truth and veracity to this discussion. I am truly pleased to join my colleagues here who are interested in good government, responsive government, but accountable government. And as a matter of principle, as a matter of principle we believe it is imperative that elected officials be held accountable for what they say and what they do. Now, while on the campaign trail, Democrats made the promise over and over again that they wanted to have the most open and fair government in history. In fact, the new Speaker said herself, ``More than 2 years ago, I first sent Speaker Hastert proposals to restore civility in Congress. I reiterate my support for these proposals today. We must restore bipartisanship to the administration of the House, reestablish regular order for considering legislation, and ensure the rights of the minority, whichever party is in the minority. The voice of every American has the right to be heard.'' And she is right. But far from regular order is what we are dealing with here. There are a couple of items I want to present. We have heard that these issues to be dealt with over the next 100 hours of debate have already been vetted, already been through committee. In fact, the freshmen, who are at least 39-strong Democrats, have not had any opportunity. So there is no regular order there. We also note that in the rules package under Democrat control, the Rules Committee would become anything but transparent, being that the votes that are required or will take place in the Rules Committee will not be available to the public. I do not think that is what the American people voted on when they voted in November. A minority bill of rights is what we will propose in our previous question amendment motion, and it is that kind of common sense and that kind of accountability and fairness that Americans expect and that we are asking for. Hearings, amendments to bills, 24 hours' notice, it is that kind of thing we need because it is that process that ensures that the House will work for all Americans to decrease taxes and to make certain our security is maintained in solving the health care challenges that we have. Mr. Speaker, it appears that promises made on the campaign trail are going to be promises broken in the majority.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I appreciate the chairman yielding me time. Mr. Speaker, I rise in opposition to this bill. Having just seen this legislation within the last hour, this is a significant change to current law. It is one that has had no House hearings during this session. This is what we used to describe at the State level as the dangerous time for legislation, and this is clearly one of those instances. I don't think that anybody is opposed to decreasing the number of adverse events or of serious adverse events. But when you read through the bill, the level of problem that can occur that would result in an adverse event can be relatively minor; an adverse event occurring from the abuse of a drug, which would require companies to report to the FDA, adverse event occurring from the withdrawal from a drug, any failure of expected pharmacologic action of the drug itself. This is just a huge reach right at this point for the FDA and the Secretary. So I would encourage the House to not support this bill. I would encourage the House to go through regular order on this piece of legislation, which is a significant change, and would ask for the House to turn down this suspension bill.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I want to thank my colleagues. I want to thank Congressman Burgess, physician colleague and Congressman colleague, for yielding me time and allowing me to participate in this. In our lives we plan for all sorts of things. Some of them are trivial and some not. We plan for vacations. We plan for changes in our jobs. We plan for changes where we live, moving. We plan for changes in education. But most of us don't plan for the time when end-of-life decisions must be made. And what, Mr. Speaker, could be more personal than those decisions, when none of us, none of us, would want others making uninformed decisions on our behalf? So I rise and commend my colleague Dr. Gingrey, my fellow colleague from Georgia, for his leadership and his wisdom in bringing this issue forward. It is extremely important. I also want to commend our own Cobb County Medical Society for their leadership and their persistence in maintaining attention on this vital matter. We all take for granted the fact that we make these personal medical decisions, and most often we are able to make those decisions ourselves. But occasionally we are not conscious or competent to make these decisions, and sometimes that happens in a split second. As an orthopedic surgeon, I would often treat patients or folks who were involved in automobile accidents, and sometimes they would arrive in the emergency in a coma, unable to participate in decisions about how they would want their care to proceed. Very important life and death decisions. And without advance directives, then their families had no guidance on the direction of these decisions. That is why advance directives are so remarkably important. They allow people to make decisions about the care that they would want to receive if they happen to become unable to speak or act for themselves. The term ``advance directives,'' as has been noted, really encompasses two types of legal documents for each individual. They answer the questions what and who. What would individuals want to be done? That is through a living will. And who would make those decisions for them if they were unable to make themselves? That is the medical power of attorney or health care proxy. I also think it is interesting to note that although these are legal documents, they do not require an attorney to execute, which may be good news for folks. So I would encourage, as the others have, to make certain that they give the time and effort to this activity and make certain that they proceed with fulfilling the obligation, actually the responsibility that they have to their loved ones. So I want to commend Congressman Gingrey once again and I want to mention really it is our desire to ask people to be prepared. Be prepared, as the resolution states, to avoid any legal or medical confusion due to the emotions involved in end-of-life decisions. It is in the best interest of all Americans that each individual over the age of 18 communicate his or her wishes by creating an advance directive. So it is wholly important that this House of Representatives supports the goals and ideals of Plan Ahead with an Advance Directive Week; that we encourage each individual to fulfill their responsibility for those forms and we encourage medical, civic, educational, religious, and other nonprofit organizations to ask their members as well to fulfill their obligation for a living will and a medical durable power of attorney. I want to encourage all my colleagues to support this resolution.

Mr. PRICE of Georgia

Mr. PRICE of Georgia. Mr. Speaker, I thank Congressman Boustany so much and appreciate your perspective and the stories that you told and the statistics you brought to us because it really puts a face on it. When we have the kind of divisive conversations that oftentimes occur on the floor of the House, it is not helpful, does not help patients all across this Nation. So I appreciate you bringing that perspective. You mentioned again many of the ripples that occur when these kinds of decisions are made here. What happens in terms of access to care is maybe the most important thing, but what also happens is it ripples down the line of what bright young men and women across this country choose as a profession. Are they choosing to go into medicine; are they choosing to go into some of the more difficult subspecialties that many of us will require the care from over our lifetime? And what is indeed happening is that they are not choosing those things. They are not choosing to go into medicine in the numbers that they have in the past. So the ripple effect is huge. All of it boils down to a decreasing access to care that patients have across this Nation and a decreasing access to quality care across this Nation. I am so humbled by the participation of many of our physician colleagues in this hour on the floor of the House today. And Congressman Burgess from Texas has joined us, an individual who has great expertise in the health care arena, a preeminent member of the Energy and Commerce Committee, and has a wonderful perspective and has talked about this issue since his arrival in Congress and has put on the table specific solutions. So I welcome him today and thank you for your comments.

Mr. PRICE of Georgia. Thank you so much for your perspective and for your wisdom in this area. It is extremely helpful and positive and productive for the debate that we are having or the discussion that we are having. I think you point out a very important aspect, and that is, this voluntary reporting requirement that might come soon for physicians is an increase in the regulation. And as you so appropriately point out, it ought not be punitive in nature, because if it is, what we will see in addition to the challenges that we have with levels of reimbursement, decreasing access that patients have to care, we will see further decrease in physicians in the community, and that will significantly harm the ability of patients to see physicians and get the care that they so appropriately deserve and require. Sometimes you will hear folks say in this debate or this discussion, well, there really is not an access problem. And in having some discussions with the folks at the Center for Medicare Medicaid Services, the high-level individuals in the department who are charged with making certain that physicians are there to take care of patients from a Federal Government perspective, I had a specific conversation with one of them. I said it is imperative that you not continue to decrease the reimbursement to physicians because they will no longer be able to cover the costs of providing that care and they will decrease the number of Medicare patients, if not end seeing Medicare patients all together. The response from that individual was chilling, Mr. Speaker. What that person said was, well, we have not seen it yet, and until we do, we have not cut them enough. Mr. Speaker, that is not the kind of collegial activity that we know to be productive in health care. It also takes incredible advantage of the Hippocratic oath that all physicians take in this Nation. I have come to a conclusion that has been very difficult over the past decade, and it is more so true now, I believe, than ever before, and that is, that our health care system is held together today by many things but not the least of which is the altruism of the physicians involved in caring for patients who understand and appreciate the importance of that care and also respect and recognize that the oath that they took to care for patients, oftentimes regardless of the reimbursement, is the most important thing, but that takes advantage of the goodwill of so many men and women who are highly trained and educated across this Nation and who each of us rely on for high-quality health care. Because all of us are patients at some point, every single one of us. So it is imperative that we do the right thing here as a Congress and make certain that we address this issue. Sometimes you will hear folks say there is not an access problem, like the fellow at CMS who made that statement. Let me point out, Mr. Speaker, a couple items. A recent survey, a recent study by the Medicare Payment Advisory Commission charged with looking into these things found that even before these cuts that we are talking about today might go into effect, 25 percent, fully one-quarter of Medicare patients looking for a new primary care physician are having difficulty finding one. One out of every four new Medicare patients is having difficulty finding a primary care physician, and that is all the more important as we mentioned before, Mr. Speaker, that our population is aging. The demographics are making it such that we are seeing a graying of our population. So more and more Medicare patients will be coming online. The congressionally created Council on Graduate Medical Education, which is the body charged with making certain that we have high quality physicians trained in this Nation, have reported existing or looming physician shortages. In fact, they are predicting that as again the baby boomers enter Medicare and more seniors are requiring health care, that the country will experience a shortage of 100,000 physicians over the next 15 years. 100,000 physicians over the next 15 years. And that is an important time frame to talk about because that is about the time that it takes to train a physician. From undergraduate school to medical school and through residency, it is somewhere between 10, 12, 15 years, sometimes even longer. Mr. Speaker, it is appropriate that we are discussing this. It is urgent, it is urgent that we correct this remarkable, remarkable challenge that we have to make certain that all patients across this Nation have the opportunity to see and be seen and cared for by a caring, high quality physician. In closing, Mr. Speaker, let me just say that you have heard much discussion about the problem, you have heard some discussion about the solution. I would point out that I think there is a short-term solution and a long-term solution. A short-term solution is to make certain that the cuts that have been envisioned and are on the books right now and will take place on January 1 if the Congress does not act, to make certain that those decreasing reimbursements don't occur. It is imperative that we make certain that those don't occur so that we maintain the opportunity for patients all across this Nation to see their physicians. In the long term, it requires either a fix of the formula or truly changing the system that we have in place that provides for reimbursement of physicians so that we can ensure into generations to come that we have a system in place that respects individuals who are caring for patients and, more importantly, respects patients' opportunity to receive access to the highest quality health care that is available. And the system that we currently have will not provide for that. It will not deliver that kind of health care system not only today but into the future. And so I challenge and ask my colleagues on both sides of the aisle, we have so much opportunity to do good in this institution, this is one of those instances that ought not be a Republican challenge or a Democrat challenge. It is an American challenge, and we need to come together to make certain that we address this in a way that allows patients all across this Nation to continue to have access or to regain access to the highest quality health care that is available. I thank once again the leadership for allowing me to organize this hour. I thank my colleagues who participated and brought so much wisdom and light to this issue. I appreciate the leadership for allowing me this time, and I thank you, Mr. Speaker.

Mr. PRICE of Georgia. Mr. Speaker, I want to thank you so very much for allowing me to come to the floor. I want to thank the leadership for allowing me to come and talk about an issue that is extremely, extremely important and timely right now as we complete congressional business this week. I would like to talk a bit about health care and health care expenditures and how the current system is set up that will, I believe, and many people believe, adversely affect how patients are treated across our Nation. And it has to do with the Medicare program, and it has to do with something called a sustainable growth rate, or SGR, which is currently the way in which it is determined on the part of the government how physicians are compensated for caring for Medicare patients. Now, before I came to Congress, Mr. Speaker, as you know, and others, I was a physician, orthopedic surgeon; practiced over 20 years in private practice of orthopedic surgery on the north side of Atlanta. And there are probably another 10 or 12 physician Members of the United States House of Representatives, and each of us knows and appreciates and understands that the manner in which the government has decided reimbursement for physicians over the past number of years has resulted in, in many cases, in many cases across this Nation, a disincentive for physicians to be able to see patients. And that is an important point that we need to think about, Mr. Speaker, because as that disincentive has increased over a period of time, and I, and many others would argue that it continues to increase. In fact, it is getting much, much worse. There is a decrease in the access that patients have to quality care all across this Nation, and we are seeing it in numbers that we will talk about today, time and time again, especially in many of the specialties, subspecialties. So what has happened with the manner in which the government makes decisions regarding reimbursement, regarding how much physicians are paid for services, oftentimes what has happened is that patients can no longer find doctors, having difficulty finding doctors. So what we would like to do for the next few moments is to chat about, to discuss this issue of physician reimbursement as it relates to patient access to care and to talk about this SGR, sustainable growth rate. I joke back home about how the SGR really is not a sustainable growth rate; it is an unsustainable reduction rate, URR, and we will have some numbers that will back that up. Oftentimes when we think about the expenditure of health care dollars in this Nation, we think, well, every single dollar is obviously going to doctors to take care of patients. In fact, that is not what happens. And this chart is a great example of that. This is national health care expenditures in the year 2004, the most recent for which this kind of data is available. The total in 2004 was $1.88 trillion, Mr. Speaker, $1.88 trillion of money being spent on health care. And I always, whenever I present this kind of information in a forum where individuals can ask questions, they are always surprised to find that a relatively small portion of that health care dollar goes to their doctors. In fact, on this pie chart, only 21 percent goes for what are called clinical services; that has physician/ clinical services, which means what it takes to take care of patients, ordering tests and prescription drugs and the like. In fact, the amount of money going to physicians out of a given health care dollar is in the low teens, 12, 13, 14 percent on the dollar, which means that it really is pennies out of the health care dollar that we are spending in this Nation that goes to the individuals who are providing the vast majority of the care. Now, that is not to say that these other things aren't important; but it is important to appreciate, Mr. Speaker, that the amount of compensation, the reimbursement, the providing of the cost for the services that are being provided by physicians is a relatively small portion of the health care dollar. And that is important, because what we have seen over the past number of years is that the way in which the Federal Government is reaching their targets as to how much they spend on health care is to decrease the reimbursement for physicians, and therein lies the significant problem. So how did we end up in this boat? Well, in 1965, middle '60s, Medicare was passed. And at that time, the manner in which it was determined how much physicians should be paid and therefore what kind of access patients had to physician care was that each individual physician would bill Medicare for certain services, and then the amount of difference between the amount that Medicare paid and what they had billed, the physicians were then allowed to then what's called balance bill or bill the patient. And initially this program compensated the physicians, as I mentioned, on the basis of their charges, and allowed them to balance bill. What happened over a period of time, for a variety of reasons, and I would suggest, not necessarily physician related, but in 1975 the Medicare payments were continued to be linked to physicians. But the annual increase in cost, the annual increase in fees began to be limited by what was called and is called the Medicare economic index or MEI. And because the changes were not enough to prevent the total payments from rising more than were desired at that time, from 1984 through 1991, the yearly change in fees was determined specifically by legislation. So between 1984 and 1991, instead of allowing physicians to bill for certain procedures and certain activities that they would perform in taking care of patients, what happened is that Congress decided, between 1984 and 1991, what physicians in the Medicare program would be compensated for those procedures or that activity. And then starting in 1992, this charge-based system was replaced by what was called a physician fee schedule. And this fee schedule bases payment for individual services on measures of the relative resources provided to them. Now, this is extremely important because in 1992 was the time when the Federal Government, and we as a Nation, decided, in essence, we will determine at the beginning of the year, January 1, how much money we will spend for health care for the entire year to come. Without regard to how many patients there were to be seen, what kind of health challenges and problems they had, we were going to set this finite pot of money as a Nation and say, this is what we will spend on health care. It doesn't make a whole lot of sense when you think about it, because those kinds of things are not necessarily predictable. Now, at that time it was stated that that schedule, this physician fee schedule, was not intended to control spending; but it was designed to redistribute the spending among various physician specialties, so if it was determined by the Federal Government that thoracic surgeons were gaining too much of this small portion of the pie, then they would shift that money to another specialty, remembering that when those monies are shifted, what happens is that many patients oftentimes lose access to the care of a quality physician. Now, the schedule was updated at that time, in 1992, using a combination of the Medicare economic index that I mentioned before and an adjustment factor that was designed to counteract changes in volume of services being delivered per beneficiary. That adjustment factor was known as the volume performance standard. And over a period of time, relatively short period of time, that led to significant variability in the amount of payment rates. And Congress then replaced, in 1998, all of this system with what is currently in place, which is called the sustainable growth rate. Now, the sustainable growth rate is something that has come under significant scrutiny, because in fact it hasn't been a growth rate; it has been, as I mentioned before, a reduction rate. It hasn't answered the true question of how we are going to provide services as a Nation, how the physicians of this Nation are going to provide appropriate health care services to patients all across the Nation and what kind of compensation they should receive. Many people, when I talk about this at home to folks and talk in health care conferences, many people really don't appreciate and understand that, in fact, the Federal Government is setting reimbursement rates for physicians all across this Nation, the kind of price-fixing that we have as a Nation said, no, it doesn't work in any other industry. But, in fact, that is the way we do it in health care. The reason that it is important and not just related to Medicare is that the vast majority, Mr. Speaker, the vast majority of insurance companies tie their reimbursement rates of physicians to what the reimbursement rate is for Medicare. So what happens is that an individual insurance company will impose reimbursement for physicians of a certain percentage, 100 percent of Medicare, 90 percent of Medicare, 110 percent of Medicare. The result is that, de facto, the Federal Government is setting the reimbursement rates for physicians all across this country, and it hasn't worked well. It hasn't worked well. The SGR mechanism aims to control spending on physician services provided under Part B of Medicare, which is where the physician block is, but it is also where other services are. It does so by setting, once again, an overall target amount of spending on certain types of goods and services, as well as payments that Medicare makes for certain items. As I mentioned, there are other things besides physician payment in this portion of this pie; for instance, laboratory tests and X-rays, imaging services and many of the physician-administered drugs. Now, the Congress had two main goals in mind when it adopted the SGR mechanism: the sustainable growth rate mechanism, ensuring adequate access to physician services and controlling Federal spending on those services in a much more predictable way than that volume performance standard did. The problem is that the SGR accomplishes neither well. We find ourselves now over the past few years in a very, very difficult situation. Since 2002, the spending measured by the SGR method has consistently been above targets established by the formula. As a result, the SGR mechanism under current law will substantially reduce payment rates for physician services over the next several years. Payment rates would decline by a total of somewhere between 25 and 40 percent, 40 percent, over that period of time. I have got some charts that will demonstrate a few other matters as they relate to physician reimbursement and access to care and quality care. This is a chart that compares the payments for varying aspects of our health care delivery system, and each of these bars, there are four bars, for Medicare Advantage which is part of the Medicare program, hospitals, nursing homes and then physicians on the far right portion of the chart. It is important to keep in mind that the physician portion of this was slated for a decrease in all of these years, but these are the actual payments that have gone out, increases in payments or decreases in payments over the past 4 years. The portion of the Medicare program Medicare Advantage has seen decreases in the 5 to 7 percent range over the past 4 years. Hospitals, appropriately, they do it, they perform a wonderful service in our health care systems. What they have seen is increases in the range of 3, 3\1/2\ percent over the last 4 years. Nursing homes, a comparable level. It is important that when we have this discussion that we get across the point that nobody, nobody is saying that these numbers necessarily ought to decrease, because hospitals and Medicare Advantage, nursing homes, all of them are providing an absolutely vital and imperative service. The problem comes, I and many others would suggest, in the final group of numbers, which is where the physicians have been over the last 4 years, remembering that the physicians were slated for a decrease every year. What that means is when physician reimbursement goes down, physicians who have been contemplating retirement say, well, it is just not going to cover my costs anymore; I am not going to be able to practice, too many headaches from the Federal Government. And many of them retire prematurely. I am a third-generation physician. My grandfather saw patients until he was 94 years old. I guess there are some that would argue that he ought not to have been seeing patients at that time, but physicians routinely, over the last 30 to 100 years of the history of our Nation, routinely retired at a much later date than the general population. They oftentimes practiced into their seventies and eighties. That whole trend, that whole trend has changed completely, so that now we see physicians retiring, if not at the rate of their peers in other businesses and other endeavors, in fact, many physicians are retiring at a much younger age because of a combination of factors: litigation problems, reimbursement problems, aspects of governmental intervention, regulation kinds of things. But what that means is that when physicians retire is that patients have a decreasing likelihood of having access to care, and that is where the concern lies. When you see this chart here and the past 4 years as it relates to physician reimbursement, what has happened is that physician increase in 2004 and 2005 was in about the 1.5 percent range last year. It was absolutely flat. So the proposal for this next year, a 5.1 percent decrease that will take effect, Mr. Speaker, in less than 30 days, in less than 30 days unless this Congress acts, unless this Congress acts, and there are incredible surveys and statistics and information we have on what the consequences, what will be the consequences to American health care if that 5.1 percent decrease takes effect. As I mentioned a little bit ago, that decrease is slated to be year after year after year for the next 6 to 8 years. So it is not that a 5.1 percent decrease in fiscal year 2007 would result in a significant increase in 2008 or 2009 or 2010 so that folks could plan their future in terms of their practice and caring for their patients; that would be followed by a 5 percent decrease in 2008, a 5 percent decrease in 2009, a 5 percent decrease in 2010 and so on and so on. The challenges are huge, because what will happen if we allow this to occur is that patients, many patients across this Nation will have continuing and increasing difficulty in finding a physician to care for them. The information on the amount of the number of physicians who would see these decreases, because it isn't absolutely even 5 percent across the board for every single physician, is that the vast majority of physicians would see more than a 5 percent, a 1 to 5 percent cut. In fact, some physicians would seek decreases in their reimbursement of 16 to 20 percent, 13 percent of those would see decreases up to 15 percent. So you see where the nationwide effect would be. Sometimes you will hear folks from the Center from Medicare and Medicaid Services saying, yes, but some folks would be getting increases. I think that is arguable. However, even if that were true, it is only in the 6 percent range, and it is not among the primary care folks, the internists, family medicine specialists, family practitioners, those individuals all would be seeing a decrease. Remember, Mr. Speaker, the consequence of a decrease in physician reimbursement rate in Medicare means that there is a ripple effect throughout the entire system, so that insurance companies reimburse physicians at a decreased rate, and consequently what happens is that patients, patients lose their ability to see physicians all across this Nation. Now, any of that might be okay if, if there were decreases in the costs of providing the services. But you and I both know, Mr. Speaker, that when you go to your doctor, there are more tests that are oftentimes taken now, because the technology is available. I know when I go it oftentimes seems to me that there are more people in the office itself, and most often they are individuals who are not necessarily involved in the actual care, they are individuals who are involved in the administrative side of a medical practice; so they are filling out the paperwork for the insurance company or filling out the paperwork for the government. So the costs continue to increase. This chart here is titled ``The Gap Between Cost Increases and Payment Updates,'' and this goes from 2001 through 2007, so the past 6 or 7 years. If you take zero percent at 2001 as the baseline, what has happened to physician practice costs over that period of time is that the annual increase has bumped up each and every year. Each and every year the costs of providing the service to patients in any practice has increased, and that is just like anything else in our economy, by and large. Now what has happened to physician payments or physician reimbursement over that period of time, and you see, Mr. Speaker, where the challenge is, because this line is not even flat, it is a continual, continual decrease over a period of time. Again, the problem, the consequence of this, is that patients are not able to see the physicians that they desire oftentimes or they are not able to find a physician to take care of them. It has been estimated that fully a quarter of patients out there who are trying to find a primary care physician who will accept Medicare cannot do it. They cannot do it right now. When you talk with physician groups about what are the consequences, again this kind of decrease in 2007, what is going to happen? Nearly half of the physicians who say if that decrease goes into effect, then what will happen is that they, their practice, will no longer be able to take new Medicare patients. Mr. Speaker, you and I both know that as members of the baby-boom generation that we are demographically an aging population in this Nation, and there are more and more individuals who are reaching Medicare age. Now, if there are more and more individuals reaching Medicare age, and fewer and fewer physicians or physician practices who are able to take new Medicare patients into their practice, then, as you see, Mr. Speaker, it means that access to care is limited and consequently quality health care in this Nation will suffer. That is the magnitude of the challenge that we are talking about. As I mentioned before, there are a dozen or so physicians in the United States Congress, and I am pleased to have, hopefully, many of them join us today, this evening, to talk about this issue. I am so pleased to have my good colleague and friend from Georgia, Congressman Phil Gingrey, who is a fellow physician and obstetrician/gynecologist. Both he and I served in the Georgia State senate together, and we are both privileged to serve here in the United States House of Representatives. I thank you so much for coming today and sharing some words about what is truly, truly a matter that we must address as a Congress this week.

Mr. PRICE of Georgia. Mr. Speaker, I thank my colleague for coming and joining us today and pointing out the importance of this, but also pointing out very clearly the urgency of this matter. As I mentioned before, if this Congress doesn't act, then what happens on January 1, less than 30 days away, is that patients will have less access to high quality health care than they do today; patients all across this Nation, not just Medicare patients, patients all across this Nation, from birth to their last days. It is extremely important that we as a Congress address this. Again, it is not just Medicare. It ripples into all sorts of other insurance company reimbursement to physicians all across this Nation. I think that is important to appreciate, because with the election results on November 7 of this year, what has happened is that the party in power will shift after the first of the year, and there are some on the other side of the aisle, some of my friends on the other side of the aisle believe we ought to move toward a Medicare system for all, for all people across this Nation. I personally believe that would be an absolute disaster in terms of the level of quality care available to patients all across this Nation. I believe that for a variety of reasons, not the least of which is this kind of issue. What we see is a Congress that has been for years, not just 2, 3, 4, 5 years, for years, decades, has struggled with how to fashion reimbursement for health care across this Nation. I believe that as we continue to move in the direction of greater control at the level of the Federal Government, that what happens is that we actually decrease the access of patients to care and decrease the quality of care that is provided. So I thank my colleague from Georgia so very, very much for doing this and for pointing out the urgency of this, the importance of acting while we are here this week. There are a number of proposals that are available in order to allow us to solve this problem, and I urge my colleagues on both sides of the aisle to embrace one of these and try to make certain that we do so before we head home. I am so pleased to be joined by a new Member of the United States Congress, another physician Member, Dr. Shelley Sekula Gibbs from Texas, a practicing dermatologist before she came to Congress, who has great experience in the community back in Texas and served on the local city council and has struggled as well, I know, with the kind of ability to deliver high quality health care to her patients. We appreciate you coming today and look forward to your insights and perspective as it relates to patient access to care and the sustainable growth rates.