Tim Ryan

Mr. RYAN of Ohio

Mr. RYAN of Ohio. Keep talking.

Mr. RYAN of Ohio. Exactly. And right now we spend four cents of every health care dollar on prevention when we know that's the big saver. But there's a point that we all need to remember. We are fighting for the public option and whatever. Some people are for it, some aren't. I don't know if it will be in. Who knows. But we have to remember that if we have everybody covered and everybody is going to be covered by primarily private insurance, then the whole dynamic of the system changes. So we say to the insurance companies, as you said, and I like that analogy that we set the ground rules basically. And States regulate insurance now, so we're going to say, Here's the goal line. Here's the end zone. Here are the goalposts. Here are the rules. And the rules that we want to change are that you can't be denied because you have a preexisting condition. If you have diabetes, heart disease, the insurance company has still got to cover you. There will be a cap on how much you can spend a year so you're not going to go bankrupt over a health care crisis. But the dynamic that changes when every single person can have health care insurance and the insurance companies have to cover you where they can't shake you any more, because now the insurance companies are spending money saying let me see what you've got, and I shouldn't have called somebody a jerk because they are just trying to make a living, and so I apologize for that. But you call up and the game now is the insurance company tells you, sorry, you have a preexisting condition. They spend money hiring bureaucrats within their organization to deny people coverage. But this all changes if now I am the insurance company and I have to cover you. So now all of a sudden it is in my interest to make you well. So I'm going to spend money and time and energy and effort working with your employer, creating incentives for you to go work out, stop smoking, do things that are going to reduce your stress level, because I know stress is a killer. I am going to do things from an insurance company perspective to make you healthier. That is something that we have failed to talk about. Once everybody is covered and we all get married to our insurance company and they can't get rid of us, their incentive changes from denying you coverage and getting rid of you to making you healthy. That is part of this whole preventive thing that you are talking about.

Mr. RYAN of Ohio. Part of this prevention component is training our physicians in a way, first and foremost, having policies, and part of the rules of the game need to be making sure that physicians don't have to practice defensive medicine. That is one thing. Another is to make sure that our physicians are trained. The average physicians spends 7 minutes with a patient. I think there are a lot of ways in which physicians can stop spending a lot of money on things that maybe they see as an opportunity that they need to cover their own rear ends, but also to spend some time and figure out that people have life-style issues that need to be changed. And that doctor and that patient should both be rewarded for improving their health. That is in this bill to make sure that you are not just getting rewarded for the tests that you run and paid for the tests that you run, but you are getting paid for making sure that the patient is healthier, comes less often, and doesn't come back to the hospital. All of these are incentives built into the system. But let's look at energy and health care in America in 2009. I think it is important for us to recognize that it may be easy to go over, Mr. Speaker, and bury our heads in the sand; and if you look at what our friends did when they were in control here, they basically continued to subsidize Big Oil to the tune of a couple of years ago $117 billion to protect Persian Gulf ships coming in and out of the Persian Gulf. So our carriers and our battleships are protecting these oil ships coming in and out of the Persian Gulf. Our money. So let's look at this. If we want to be competitive in the 21st century, we need to get that investment, that $750 billion that is going to these oil-producing countries, and get it back invested into coal, nuclear, drilling in America, oil shale, algae, the whole nine yards. Instead of the investment being somewhere else, we want the investment here. Instead of hiring oil workers in Saudi Arabia, we want them hiring coal workers in Ohio. And the technology in Ohio, the scrubbers and everything else getting manufactured in Ohio. So you take the energy investment back into the United States. You take all of the venture capitalists that sit in my office and say that they want to put money into this and that, private money, you take the energy money, $180 billion that we are putting into coal in the energy bill that passed here, along with a health care bill that will reduce costs for small businesses and allow them to reinvest back into their business, you have the recipe and the strategy for long-term economic growth. I know that may be hard to believe; but some of our friends, who will remain nameless, supported policies that said if we cut taxes for the top 1 percent, that that will lead to long-term economic growth. That if we deregulate Wall Street, that will lead to long-term economic growth. And all those things did was lead to an economic collapse that if we didn't have the social programs from the Great Depression in place, that would have led to the Great Depression, the second Great Depression in the United States. So, fortunately, we have moved off that track into a track of responsibility, sound fiscal policy, sound investments in the future, and a strategy to let businesses grow as we reduce their health care cost burden.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. It may sound good to say if we just fix this or fix that, fix this and fix that, we will be okay. The problem we have now is we have this patchwork system that we just have been constantly patching up, and it is not addressing one of the main problems, and that is we have got all of these uninsured people. Some people say it is 10 million, some people say 15 million, so it is probably somewhere in between. But the bottom line is, Mr. Meek, all these people are going to the emergency room. That makes no sense to anybody. So you go in with your insurance card, you are paying for the person who is walking in there. What we are asking people to do in this reform package is for people who are now using the emergency room as their primary care doctor, that they will have to pay something now. They will have skin in the game. They will have a copay, they will have a premium. You are going to get something out of them. That is how we are going to help build this new system, is by having people who are now getting something for nothing will have to pay and have skin in the game and take money out of their own pocket, Mr. Meek, and pay for their health care, and that will help everybody.

Mr. RYAN of Ohio. I appreciate it. One of the things--we have got a little old school thing going here too that I ought to mention. But one of the things that I think is very important that everyone I talked to in August, Canfield Fair, St. Mathias, Slovak Festival, Irish plans, Italian-American Festival, every single time people were understanding the fact that they are paying for all of these uninsured people right now. They get it. They know this $1,800 a year increase they are going to get next year is because there are going to be another 50 million people going to the emergency rooms. Doesn't make any sense. But I think one of the things too that we need to remember when we were talking to seniors about Medicare is that we have this population, especially, I think, in the industrial Midwest where people are 55, 60 years old, have lost their jobs, lost their insurance. Maybe they are still working, but the insurance company or their employer is not going to pay for their insurance anymore. We have a very unhealthy segment of our population going into the Medicare program. And so if you are living in northeast Ohio, and if you are 55 or 60 years old, you lose your health care, a lot of people are saying to themselves, I am going to wait until I get into Medicare to get my heart surgery. I am going to wait until I get into Medicare to get my hip surgery. Or I am going to wait until I get into Medicare for you name it. And so from 60 to Medicare age, a lot of things go wrong that you probably could have managed better. So we have this very unhealthy population going into the Medicare program. So what our seniors need to know because our friends on the other side who don't want any kind of health care reform at all are saying, well, they are going to cut Medicare. Well, it's nice to see a few Republicans stand up and actually have some concern about Medicare because Newt Gingrich and Grover Norquist and these guys are talking about letting it wither on the vine and those kinds of things. But it's going to save Medicare money if we have this 50-, 55-, 60- year-old population getting the kind of preventive, manageable care so that they don't all of a sudden say, I am going to wait until I get into Medicare. And then you go into Medicare and you need something that costs hundreds of thousands of dollars more. That's what is hurting our Medicare system more. So we need to bring some of those costs down.

Mr. RYAN of Ohio. I want to say two things and then I will be done for the night, too. There was this interesting article in Newsweek this week. It was about a book about William F. Buckley and about the battle between the extreme right wing of the Republican Party and the William F. Buckley National Review kind of wing, and there was this little battle post-New Deal. But it's interesting to note that right after Roosevelt got in, there was this extreme reaction, very similar to what we're seeing where every critique of what Roosevelt was doing was socialism, communism, and all of these fancy names. But there were also these vigilante minutemen who would show up at these events carrying their guns, and it was amazing, because that's exactly what we're dealing with here. There's no solution. There are just these critiques of how the train is moving down the track. The American people want to go in another direction. But I wanted to share this story because I think this is what we're all talking about. I ran into this woman at the Canfield Fair. I stood outside the Democratic Party tent. This is one of the biggest fairs in Ohio over Labor Day. I stood there for 4 hours, 4 hours, just south of Youngstown, Ohio. I had two people out of all the entire time come up to me and say, What are you doing with this socialist--and they're also against the energy bill, so it was totally the right wing talk radio crowd that was like inundating them with this stuff. Two people came up against this. But what this one woman said, she's 35 years old, married, kid. Husband just lost a job. They made about $58,000 a year when he worked. They now make $32,000 a year. She is working. He, after he lost his job, is going back to school. No income, trying to better their life. The daughter was in the stroller there. This woman is telling me this story. She has a condition. She's got to take medication. It's very expensive. She can't afford it. Now they're paying out of pocket. She makes $32,000 a year, down from $58,000 because the husband lost the job. And she said, Do you want me to go on welfare and go on Medicaid? Because that's what I'm forced to do. Now, if there's any value we respect here in America, it's somebody that wants to work. She wants to work. She wants to provide for her kids, her husband. She wants to have a nice family. She wants to have the dignity of work. And the system now is set up that that really may be the best decision for her and her family is to go on Medicaid and take welfare benefits. That's not what we want. And what we're saying is why should this woman who's working her rear end off, her husband is going back to school to get retrained, those are the people we want to help. That's what this whole thing, the whole thousand pages that everyone keeps talking about, that's what this whole thing is about. It's about helping that woman, her husband, and that kid. And that's why, Debbie, as you said, the stakes are high. Kendrick, the stakes are high, and we need to pass this thing.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. Madam Speaker, I rise this evening in recognition of Mr. Ralph J. Infante of Niles, Ohio. Mr. Infante passed away May 26, 2009. Mr. Infante was a life-long resident of the Mahoning Valley. He leaves his wife, Angeline Ragozine Infante, whom he was married to for 60 years. He also leaves 4 sons, 2 daughters, a sister, 2 brothers, 14 grandchildren, 5 great-grandchildren, and many friends from around the valley. Mr. Infante worked for many years in the Mahoning Valley. He graduated from Niles McKinley High School in 1947 after serving in World War II. Mr. Infante was a Veteran of the United States Navy, who served in the South Pacific Theater during World War II. He received an Honorable Discharge from the Naval Service of the United States of America on the 29th day of April, 1946 at the U.S. Naval Personnel Separation Center, Great Lakes, Illinois. He served with honor and distinction during his time of service in the U.S. Navy. Mr. Infante was employed as a die setter at Faull and Son Tool and Die Co. for 26 years. He was also employed for the City of Niles as a Municipal Court Bailiff and worked for the waste water treatment plant for 15 years, retiring in 1990. He was also very active in local politics, serving as Niles 3rd Ward Councilman for 5 years. Mr. Infante was truly a great part of the community. He was an honorary lifetime member of the Niles Men's Democratic Club and the Italian Fraternal Home of Girard. He was a charter member of the Italian American War Veterans Post 39 in Girard and The Bagnoli Irpino Club, as well as a lifelong member of Our Lady of Mt. Carmel Catholic Church in Niles. Mr. Infante was an avid Cleveland Browns fan and enthusiast of The Ohio State University. Although his beloved wife, Angeline, was a Cleveland Indians fan his beloved team was the New York Yankees. His six children would be split down the middle (3 New York Yankee fans and 3 Cleveland Indian fans) which made for interesting family dinner conversations and game day exchanges. Some of their biggest disagreements came when the Yankees and the Indians played each other. Mr. Infante will always be remembered, as his high school yearbook proclaimed, ``Never Failed a Friend and Never Feared a Foe.''

Mr. RYAN of Ohio

Mr. RYAN of Ohio. That's exactly the point, that if we do nothing-- which is what our friends on the other side of the aisle want us to do is nothing. We know that over the last 8 years, $1,100 increase in energy costs. So keep doing that, you know what you're going to get. What we're saying is we can't afford to keep doing nothing. We have to do something. And what we're doing is reducing our dependency. Give us control over what we're doing. We have no control in many ways when we're depending on sheiks in the Middle East. So, to your point, we've got to take control of this issue. We're Americans, for God's sake. And you know what? When have we started in this country to be afraid of doing big things? Let's wrap our arms around this energy issue and take control of it and take it under the umbrella of the United States of America and stop all of these problems. You're exactly right. If gas is $4 a gallon this summer, we would be getting calls from our constituents, What are you doing? And you know what? If it wasn't for the recession, it probably would be. So next year, there will be $4-a-gallon gas, and hopefully we're moving along to fix this problem.

Mr. RYAN of Ohio. Thank you, Mr. Boccieri. I was reading an article--and I was telling the Congressman from Virginia this. There was an article in The New York Times today, because a lot of people in our districts are like, Well, you know, China is not going to abide by this, and India is not going to have to deal with this, and we're out on our own here, and we've got to compete against these people. There are actually provisions in the bill on steel and paper and some other things that do control imports coming from these other countries; but today in The New York Times, there was an article about this town in China where there was a big factory that was poisoning the people who lived within the area of this factory, and these people were going to the hospital. They were sick. They were nauseous. It was a bad scene. It was because of the pollution that was coming out of this factory; 400,000 people a year die in China because of air pollution. And at some point, based on China's long history, they have these uprisings among the people, the government squelches it and tries to fix the problem. So if you have 400,000 people a year dying in China, at some point those people are going to want clean air. At some point. I say this. Let China sleep for a couple of years. Let us get ahead of the curve. Let us make these investments and then produce these products, and finally we can export products to China that they're going to want because their people are demanding it. So I wanted to come down and join this chorus because I think this is an opportunity for places like Youngstown, Ohio; Akron, Ohio; Canton, Ohio; northeast Ohio, where we have a manufacturing base in Virginia or New York or wherever the case may be to finally export things. Eight thousand component parts to a windmill, four hundred tons of steel. Solar panels have all of these complex components. We can do this. This is opportunity. Let's see it like it is. And I tell folks back in our district, we have a Lordstown plant, a Lordstown General Motors plant, that is going to make this new car, Chevy Cruze. Why are they putting it at Lordstown? Why are they building the Chevy Cruze? Forty miles to the gallon. That's why. It's a green car. Let's read the tea leaves here. This is where the country is going. This is where we need to be. We can finally be at a point, Mr. Boccieri, where we export products to China and we make money and create jobs here. That's what this is about. And we can talk about clean air and climate change, and I believe in all of that and I think it's great, but the bottom line is this means jobs for northeast Ohio. And I think the more we talk about that, the more we recognize that, the more we plug our businesses in. Mr. Boccieri got a $30 billion amendment in to help the auto industry convert over to alternative energy. Those are the things we need to do, and those are the things that are in this bill. So I yield back, but I think this is opportunity, and if we see it as opportunity, it will work for us.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. Mr. Speaker, we are here to discuss the health care reform proposal that is now being discussed in Washington, D.C., and really throughout the country. We are going to use tonight's hour of our 30-Something Working Group to talk a little bit about what is in the bill--what is actually in the bill, not what is being said on talk radio or from some Internet site that is basing their comments and their critiques of this bill on really things that don't exist. And we want to do that. It is interesting that tonight the 30-Something Working Group will be articulating this, and then over the course of the rest of the week and into the fall, to discuss this critical piece of legislation for the American people because one of the previous speakers was talking a little bit, and it reminded me, as I heard some of the rhetoric, they were talking about health care savings plans and all of these accounts, a couple of things came to mind. The origination of this 30-Something Working Group was the creation of then-Minority Leader Pelosi to discuss Social Security privatization. That is how this whole thing originated 4 or 5 years ago with Congressman Meek, and then Congresswoman Wasserman Schultz and I, and then later on Chris Murphy from Connecticut. And we were discussing all of these issues, but one of the issues was Social Security privatization. So before we get into this bill, I think it is critical for us to remember that our friends on the other side who are now so critical of what we're trying to do here were in charge of the House, of the Senate, of the White House. They had President Bush, they controlled the Senate, they had this Chamber--Tom DeLay was running the show--and they didn't do anything for health care costs. So I think it's important that that's out there. And if they wanted to pass some kind of comprehensive health care reform, they should have done it because we are still dealing with the problems that they failed to solve when they were in. And this is a problem facing millions of Americans, millions of small businesses that we need to help address. So that's why, as we talk today, this needs to be in context. The Social Security privatization, I mention that because, let's imagine where our country would be today if our friends on the other side had their wish and privatized Social Security. Can you imagine where this country would be today if President Bush and Tom DeLay got their wish and privatized Social Security? I know in my district we're dealing with all kinds of pension issues--Delphi salary, Delphi hourly, UAW, steelworkers have all lost their jobs, their pensions in many cases are in jeopardy. Thank God for the PBGC to help cushion the blow. But can you imagine the cost to this country if the Republicans had been able to fully implement their economic agenda? They did the tax cuts, they did most of their economic agenda, but fortunately we were able to prevent privatized Social Security. So it's important for us to realize that as we begin to debunk some of these myths. I would just like to suggest, Mr. Speaker, as we go through this, and I have encouraged my constituents and would encourage all Members of Congress within an earshot to base their critiques on what's actually in the legislation. Don't we at least owe that to the American people? This is big. This is comprehensive. This is complex, multidimensional. Every chip you move moves another chip on the table. But we owe it to the American people to have an honest, mature discussion. The rhetoric that is being fed to the American people is outrageous. I want to start with one, and I will go through some others and we will talk about the bill a little bit. But one of the commercials about how much it will cost--and my friend from Texas mentioned it a few minutes ago, and I would love to talk about that and the CBO scoring. But one of the things that I'm hearing from people who listen to Fox News or listen to talk radio is this plan is going to cover illegal immigrants. How dare you drive up my health care costs. I have to lose my pension, but you're going to spend the American tax dollars covering illegal immigrants. It is clear, right here in section 246, ``No Federal payment for undocumented aliens.'' ``Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.'' Black and white. Can we move on? Can we now move on and talk about how much health care is costing our country, that it may bankrupt our country? Section 246, ``No Federal payment for undocumented aliens.'' Right here. So now let's have an honest discussion about what's in this bill as we start to knock down some of these. First, the cost of doing nothing, which has happened over the last 13 or 14 years. We haven't done anything since President Clinton tried to move health insurance reform in the early nineties. We know that if we do nothing, that there will be an $1,800 increase for a family of four every single year. That's what happens if we do nothing. There has been a 4 percent increase in property insurance and an 11 percent increase in health insurance year in, year out; year in and year out. We can pull out boards and say it's going to cost you this and cost you that, but the biggest expense is the cost of doing nothing. Look at this system. It's atrocious. To even call it a health care system is ridiculous because it's not. Why would you possibly be okay with a system that doesn't try to prevent sickness? Why would you be okay with a system that waits--we don't want to prevent you from getting sick, but gosh, once you do, come right into the emergency room, we'll take care of you because we're a compassionate country. And we are a compassionate country, but let's be a smart country. Let's be a wise country. And true compassion would be not waiting until someone gets deathly sick and shows up at the emergency room. God gave us a brain, too, and he wants us to use that brain. And we are all in agreement here, as we use the gift that God has given us to use logic and process information, that if we take some of this money that we are spending in the system, and instead of waiting and being reactive and rescuing people, we spend a fraction of that money on the front end and we make sure that everyone has some preventative coverage. This is not a Democratic idea, it's common sense. Talk to the CEOs of hospitals. I've got one in my district. He is a Republican CEO. He says, Please, Tim, whatever you do, give me the opportunity to give this person a $20 prescription instead of having this person show up in my emergency room and costing me $100,000. This is not brain surgery that we're trying to perform here. And the fear tactics and the fear tactics and the fear tactics that are coming from Members of Congress, they're coming from talk radio, they're coming from Fox News about illegal immigrants are going to be covered under this plan. And as I read earlier in section 246, they're not. They're not. Section 246, ``No Federal payment for undocumented aliens.'' ``Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.'' I'm going to say that to every single person I meet who brings it up because this debate has more to do with the well-being of all of our citizens than to try to be demagogued and try to alienate people. You look at our plan, and it covers 97 percent. Why doesn't it cover 100 percent? Well, for the reason I just said. And it is already in law where illegal immigrants can't be covered under SCHIP, they can't be covered under Medicare, they can't be covered under Medicaid. And from the employer-based system that we already have, an employer is not allowed to hire an illegal immigrant, so how could you cover them under this plan, if you're under an employer-based system, when an employer is not allowed to hire an undocumented worker? So let's put this aside and let's have this discussion. The American people want us to have a mature discussion here. Small business owners want us to have a mature discussion. I got a call today in my office. I periodically pick up the phone and chat with my constituents who call, and the concern was about seniors on Medicare being hurt by this plan. It's important for our seniors to recognize--our friend said, it's $9,200 a family. And I'm happy to pay my share because I remember when my grandparents were in their last months, weeks, years of their life, they had health care because of the Medicare program. So all of these folks who want to not have the government involved in health care, you know, tell your parents and your grandparents to give back their Medicare. Give it back. You don't want it. The government's involved in that. Give it back. No Medicare. Of course you're not going to say that. Of course you're not. And to have this discussion--honestly, we would say we could save money in Medicare. We should. Not on the backs of our seniors, but there are a lot of overpayments, in Medicare Advantage, for example, that we can squeeze out of the system. One of the costs to Medicare is the fact that there is no previous care for a lot of people. So if you're 60 or 61 or 59, you see the date coming where you're going to be Medicare eligible and you don't have health insurance coverage or you don't have a good plan or you have a preexisting condition in which you can't get health insurance, you have heart disease or you have cancer and it has not been in remission long enough--I had this woman come to a round table I had the other day. She had cancer. She got kicked off her plan, got cancer, and then could not get on any other health insurance plan because she had this preexisting condition. Her cancer wasn't gone for 10 years, so until it was gone for 10 years no one would pick her up. Tragic in the United States of America. But a lot of people do that. And so they wait. Instead of getting health insurance, they think, I'll be on Medicare in a few years, so I will just wait this out. And that leads to some chronic issues, chronic disease issues. That leads to, again, not preventing things from happening. Maybe cancer is spreading, maybe breast cancer, maybe cervical cancer because they failed to go and get preventative care. So they get into the Medicare program, and costs blow up because they've waited. So part of squeezing some of the fat out of Medicare is adding this element of prevention. And this is what our grandparents told us growing up. An ounce of prevention is worth a pound of cure. Don't get yourself into trouble. You get in a fight, well, I was right, he was wrong. You should have not gotten in the fight, then you wouldn't have all these series of events that happened that you now have to deal with. Prevent yourself from getting in these situations. That's what we're trying to do with this legislation. It makes a great deal of sense. Another myth that has been forwarded by our friends on the other side is the cost that CBO gave a week or two ago in their analysis that the trillion dollars that we are saying needs to be spent in this plan is actually $2 trillion or $3 trillion. I don't know exactly what the exact number is from the Congressional Budget Office. Now, this is the point I want to make. The Congressional Budget Office is nonpartisan, so they deal a blow to the Democrats and then they deal a blow to the Republicans, but, you know, we have an opportunity--they're not partisan. They've slammed everybody. But what we want to say, and what needs to be highlighted is, in the CBO analysis of the health care plan, when they factor in the cost and they try to do the long-term costs and the long-term analysis, they do not factor in prevention. So as I mentioned with the CEO of the hospital the other day, you know, if you're not factoring in this person who shows up at the emergency room with late stage cancer, when you maybe could have given them access to an OB/GYN or a mammogram or regular prostate checks, I mean, these are the kind of things that will prevent that. So if you're just adding what if this person doesn't have health care and shows up in the emergency room and the long-term cost of that person, without factoring in the preventive side, that cost would balloon. But common sense will tell you that the prevention will lower the costs. And that's what CBO has not factored in. So this prevention can save the system a heck of a lot of money. Now, the CBO, one of the other myths is that the CBO, or our friends are saying, Well, this is going to dry up the employer health care plan or the employer-based system. And it's going to put--everyone's going to go into the public option and they're not going to stick with their employers. And so CBO did an analysis of this. So, as I said a couple of minutes ago, CBO blasted the Democrats. We have a response to that, saying that they failed to factor in the preventative aspects of our bill. And so the next myth is that our friends are saying that this is going to destroy the employer-based system. So I'd like to read an excerpt from the CBO letter analyzing this. Over the weekend they did this. It says there will be an increase in employer-sponsored insurance coverage. This is a quote, We estimate that about 12 million people who would not be enrolled in an employment-based plan under current law would be covered by one in 2016 largely because the mandate for individuals to be insured would increase workers' demand for insurance coverage through their employer. So they're saying that 12 million people who would not be enrolled now would be covered by one in 2016. So an increase of the employer- based system in 2016 by 12 million, largely, because employers want to give their folks a benefit. And under this plan, they will be negotiating with millions of other people, as opposed to, in the instance of a small business, just being out there on their own with five, 10, 15, 20 people trying to piece this whole thing together. And we'll go through the cost of doing nothing for small businesses. It's incredible. So they see this as a real opportunity to leverage their business with others and therefore, increase the amount of people who will be covered under the employer plan. Third-party validator, Congressional Budget Office, not always in agreement with the Democrats, says that that's just false; Medicaid coverage does not crowd out private health insurance. CBO does not anticipate a substantial shift from private insurance to Medicaid. Specifically, we estimate that about 1 million people who would otherwise have employment-based insurance or individually purchased coverage would end up enrolling in Medicaid in 2016. So very small numbers. One of the things, too, there's been this Lewin Group's analysis about the public option and people going into the public option. CBO knocks that down. And it's good to know, I think, I'm trying to remember, I think it was United Health who, yep, the Lewin Group, who did this analysis saying everybody's going to leave employer and go to this public option. That study was funded by United Health Care and requested by the rightwing Heritage Foundation. It's been widely discredited for its flawed review of the House legislation. So it's important, again, that we base our analysis on what the facts are and what's actually in the bill. So the CBO refuted this Lewin group estimate, quote, For several reasons, we anticipate that our estimate of the number of enrollees in the public plan would be substantially smaller than the Lewin Group's, even if we assume that all employers would have that option. So CBO's projecting 10 to 11 million people would maybe go into the public option, a very, very small number. And it's important for us to remember that. So, again, another myth, that there's going to be a decrease in employer-based health care. Not true, CBO, nonpartisan, actually an increase of 12 million people by 2016. Also, stated by our friends on the right, that this is going to drive people to this public option. CBO, again, nonpartisan, saying that's just not true; that that just won't happen. One of the other things that I think's important to remember, again, doing nothing costs, will cost you or your family next year $1,800 for a family of four, a $1,800 increase. And that is not just next year and then it ends. As people know, it keeps going. And so there's a business in my district, I was talking to the gentleman who owns the business. He happens to be on both sides of the insurance industry. He's a provider, but he also has 150 people who he employs. And over the course of the last 5 years, he's had an increase, aggregate increase of, I think, 42 percent in his health care costs for his company. And then he's on the provider side, so he gets paid by insurance companies, and with a 42 percent increase on health care for his folks, but yet, he got no increase for the services that he was providing to the insurance company. So you see again that we need reform in the system where you can't just continue to increase costs, not pay your provider, and deny coverage. And that was really one of the messages that was hammered home in our townhall--it wasn't a townhall, it was a roundtable that we had this weekend in Niles, Ohio, at Vernon's Cafe, that a lot of people are very, very concerned about this preexisting, being denied for a preexisting condition. And with all the money that we have in this system, for us, as a country, to say, Oh, no, you have cancer. You're on your own. You're not eligible for Medicare yet. You're not poor enough to be on Medicaid yet. And you've got to go out and try to get COBRA coverage or something else is completely outrageous and needs to be dealt with in this country. And I feel like this is a moral issue for our country, for people to have to have that level of suffering that is unnecessary. There's enough suffering already with the cancer or with the issues that, the health issues that people are dealing with. We don't need to add to it. There should be a level of security within the system that we know everybody will get taken care of. One of the issues that we have to deal with and tried to be helpful with, is this issue of cost. Now, this is a chart of our expenditures up to 2006. As you can see, the United States is in red. France, Canada, Germany and the United Kingdom are in a shade of blue. And this line here is life expectancy. So you can see that we're all pretty much in the same realm of life expectancy, give or take a year and a half, 2 years, which, if it's you, that's a very important distinction. But on the average, we're pretty much around the late seventies, early eighties. And the cost, as you can see, of health care for Americans goes through the roof. Goes through the roof. So you can see how much we are paying per individual in 2006. It's close to almost $7,000 a person, when France is spending a little over $4,000 a person. And we all have the same life expectancy. What's wrong with this picture here? So, to say that we're going to let this continue, that for a family of four, $1,800 increase next year, $1,800 increase in 2011, another 18, these are compounding on top of one another. Play it out. We bankrupt the country. You want to talk about small businesses being innovative, being able to compete against China, India, and all of these other countries, which is a whole other issue, but we've got to make these folks cost- competitive. And small businesses? A 129 percent increase for health insurance since 2000. Want to just keep going down that road? We know how it ends. It don't end pretty. We can just keep going. And that's what many people on the other side of the aisle want to do, they want to say ``no.'' They want to nitpick and make things up to try to put the kibosh on this because they know, as has been stated in a memo from a top Republican consultant, that if they destroy health care they knock the legs out and they kneecap President Obama. This is a political issue for some people, and it shouldn't be, because the people that I met with at Vernon's Cafe want change. An independent small business person was sitting right next to me, Neil. He had to close his lawn and garden business because he couldn't withstand the health care bills that he was getting. And he was supportive of Barack Obama's plan because he couldn't sustain his business. 129 percent increase since 2000? You want to talk about a tax increase on a small business? You know what? We're going to do it again next year. We're going to put more on next year, another couple of thousand next year per employee, another couple of thousand the next year and the next year and the next year as your energy costs go up, as your health care costs go up, as manufacturing continues to decline in the United States because we don't make anything anymore. On and on and on and on. And you know what? This is about leadership, Mr. Speaker. This is about leadership. And sometimes some people just aren't going to like you. And sometimes people are going to try to use and score political points to try to prevent progress from happening. We need to do something, Mr. Speaker. We need to do it for the people who are out there suffering. We need to do it for the people whose costs keep going up. We need to do it for small businesses who recognize that this can put them right out of business in every single way. These small businesses, I tell you, have really gotten the shaft in this whole health care deal. They don't have much bargaining power. And I think part of the magic of this approach that we've been working on and will continue to work on over the course of the next days and weeks is to allow small businesses who now have to go out into the market and try to find something on their own, will now be playing with millions of other people, and that ability to use the buying power, the partnerships through this exchange that's being created, will reduce costs for them. I mean that's common sense. If you're a small business and if you have 10 people and if you've got to go to a major insurance company and try to strike some kind of deal because you want to provide health insurance for your employees, then you're on your own. What we're saying is let's pool everybody together and give you an opportunity to go into these different plans, but if you like the plan you've got, you can keep that, too, and that will help drive down costs for these small businesses. It will finally put them on a level playing field. So there has been a 129 percent increase for small businesses since 2000. Their premiums are 18 percent higher for a small business than they are for a big business. So they get it on that end, too. The percent of premiums that deal with administrative costs are higher for small businesses--25 percent as opposed to 10 percent. Yes, it does make sense. They're a small business. This is a bigger business. There are going to be more administrative costs. Yet, if we allow them to join together, to pool together, then they will begin to reduce some of those costs. This is a winner for small businesses that are already covering their employees, because they're not going to see that 8, 9, 10, 12-- sometimes higher--percent increase. What's great about this plan is that there are limits. We've talked a bit about preexisting conditions. So you get into the plan, and you may be sick, and you may have cancer or heart disease or a variety of other illnesses. What this plan does is it limits and caps for catastrophic coverage. So, if you're an individual, you can't pay more than $5,000 a year for catastrophic coverage. If you're a family, the number now is about $10,000 a year for catastrophic coverage. That's still a lot of money, but the bottom line is it's not going to bankrupt most people. When you look at what is happening today in the United States, half of our bankruptcies, Mr. Speaker--half--are caused by health care, by a health care crisis. Imagine this: In 2009, in the United States of America, you could have a health care crisis in your family, and you might have to file bankruptcy. Is that incredible? Are we okay with that as a country? I'm not, and I think there are millions of other people who aren't either. This is a problem that we need to solve, to share together and say, hey, wait a minute. What are the values we have in this country? Liberty and freedom. You know, there are a lot of different phrases and words we have, but what do we really believe? Our actions and our policies should be in line with those values that we have. What we're saying is that that is unacceptable. So our friends on the other side, who had control of the House, of the Senate and of the White House, didn't do anything about it. You want to take the small piecemeal steps? You could have taken that one. In fact, you passed a bankruptcy bill that made it worse. They passed a bankruptcy bill that made it worse. Fifty percent of bankruptcies are health care-related. Unacceptable. If our friends on the other side found it necessary and found it in line with their values to end denial for insurance coverage due to preexisting conditions, it could have happened. They had control of the House. They had control of the Senate. They had control of the White House, but it didn't happen. So now we've got some Johnny-come-latelies with a piecemeal plan here or there which doesn't solve the overall problem. We've got to bend the cost curve here. We've got to bend it. You don't do that with piecemeal actions. You do that with bold actions that will help bend the cost curve. Ultimately, that's what we're trying to do here. Also, there is the preventative side here. There are no copays for prevention, so there will be an incentive for us to be assured that people will go to the greatest extent possible to get preventative care. Let me add this: We can only do so much with the system. People, average Americans, need to do a better job of keeping themselves healthy, too. It's not all us. The government is not going to do that. The insurance industry is not going to do that. Yet, if we tilt the system towards prevention, if we tilt the system to create incentives for it with doctors--and there is a component in here that gives more say to the doctors and to the patients to keep that relationship sacred between those two to make sure that the doctors get rewarded and paid based on quality, not quantity--then there will be an incentive in the system to make sure that our docs are able and willing to provide the most quality care, not having to worry about a variety of other issues. They will deal with the patient. It will be patient-centered. Barack was at the Cleveland Clinic, which is just about an hour north of my district in Cleveland. He was at the Mayo Clinic. You hear what these top hospitals do. Every time you hear what they're doing successfully, it's patient-based, not insurance-based. You know, it's not ``Some doctor has got to call somebody at the head office and ask, `Is it okay for me to do this for the patient? Is it paid for? Is it not paid for?' '' That's ridiculous. We're going to weed that out of the system and let the doctor make these decisions, not the insurance companies. This brings me to another point--again to our friends and to right- wing talk radio, you know, which is at this point pure entertainment because I find very few facts issued out of the right-wing talk radio station as of late. It's the issue of rationing. People are saying, ``Oh, my God. This big, you know, socialist system is going to be in place.'' It's not true at all. This is not Canada. This is a blend of what works here in America to make sure that we can bend that cost curve. This is going to be very uniquely American, which it should be. It maintains competition. It gives choice. You can keep what you've got, but you also have these other options which you may want to choose, including a public option, which should be there, I think, to keep people honest as a component of this whole system. You're able to shop around and to get what you want or to keep what you have and have choice and help contain costs. What our friends keep saying is the government is going to come in and ration health care. If you don't think health care is being rationed right now, you have not talked to anybody who has been breathing for the last decade. The insurance companies are rationing health care right now. As a nurse said, who was at our town hall meeting this week, The government couldn't possibly ration more than the insurance companies are. We deal with it all the time. A person will call his Congressman or Congresswoman, and say, Hey, can you help me? My God, this insurance company denied me. I thought it was in my policy. They wouldn't let the doctor do this or that. They're not going to reimburse. They're not going to pay for this. The insurance companies are rationing right now. They've been hiring people to knock people off the rolls. Their employment has gone up. Their coverage has gone down because of rationing by insurance companies. What we're saying is you can't do things like deny someone coverage for a preexisting condition. There will be a basic plan. Ninety-five percent of employer plans right now already meet the standard for the basic level, but there will be a basic plan on which people will be covered. Ultimately, as I've said before, this is going to save us a lot of money, and it's going to help bend that cost curve. Ultimately, by doing that, which we fail to, I think, sometimes incorporate into this discussion, when you insure and assure people that they will have coverage and that they will have preventative coverage and that their kids will have coverage, there will be a level of anxiety that obviously goes away, which is very helpful. This is going to increase the level of productivity in the United States because people will be healthier. There is a tremendous investment here to make sure that our docs and our nurses have the proper incentives for student loans to go to high-risk areas and practice and make some money so that their loans don't keep them from, maybe, wanting to be helpful in a community that they want to be helpful in. We need to make sure that we deal with the nursing shortage. It's all of these things. It will increase the level of productivity that we have because we're going to have more people who are healthy who are participating in this economy and who are contributing. There was a story a couple of weeks back--I think it was in the Wall Street Journal--in which there was a kid--not a kid. He was probably in his twenties or early thirties. He wanted to go out and start his own business--I think it was a computer technology business--but he couldn't because the job that he held had insurance. His wife was sick with cancer, I think, but he knew, if he left and tried to get insurance for his wife, that she wouldn't be able to qualify because she would have had a preexisting condition. How many stories are like that all across the country where you want to leave and want to start a small business and want to create value and grow your business but can't because someone in your family may be sick? So you don't because you have to stay put. How many times does that happen? We have, really, the gem of Youngstown, Ohio. In the Mahoney Valley, we have the business incubator, the Youngstown business incubator--a great place. Our district office is actually located on the third floor of the business incubator. Last week or 2 weeks ago, Entrepreneur Magazine said that Youngstown, Ohio, was one of the top 10 places in the country to start a business. It was really cool. They had the cover. It read, ``Top 10 Places to Start a Business.'' In parentheses underneath, it read, ``Youngstown, Ohio, anyone?'' So here we are in Youngstown, trying to convert our economy over from manufacturing steel and, just down the road in Akron, rubber. Communities like ours have started this incubator where we have all of these business-to-business software companies that are incredible companies as is the level of talent that works in this incubator. There are, I think, 300 people who work for the company. The average wage is $58,000 a year. Companies from around the country now want to move there. You can begin to see why we need to do this, because you want these young, bright, intelligent, creative people to feel like they can take a risk, can take a chance, can start a business without having to worry about the burden of health care. This is going to unleash a generation full of young, smart, creative people to get out in the marketplace and to create wealth for us and to hire people. And especially with the green revolution coming, we're not really sure what's going to happen. There are so many nuances to green technology with solar panels and windmills and biodiesel plants and batteries, and we don't know. But wouldn't you want, wouldn't it be smart to say, Don't worry about health care. You're going to have to pay some. This is not going to be a free ride. There is going to be shared responsibility here. Everyone's got to do their fair share. No one's going to get on board for free. There is going to be a ticket price here and everybody is going to have to pay something. But wouldn't you want these young people to feel secure to be able to create the next generation wealth? I know we need it. I know when you're looking at places in the Midwest like Youngstown, we need these young people to feel unleashed and let their creative juices flow as they come out of engineering schools and they want to take a chance and be in an incubator and grow a company or start a company. That's what we need here. This is what America needs right now. And we're trying to compete, Mr. Speaker, in the United States of America with 1.3 billion people in China, 1.2 billion or 1.3 billion people in India, and we only have 300 million people. So we're spending all this money on health care, and we're not getting anything out of it. Let's spend this wisely. Half of the money to pay for it gets squeezed out of the current system; $500 billion of the trillion gets squeezed out of the current system. And that's young people and the Youngstown business incubator and incubators like it all over the country and young people like them all over the country. Let's fuel that fire. Let's throw some coal on it. Let's get it nice and hot. Let's let it burn. Because we don't have the same luxury that the Chinese have where if 300 million or 400 million people fall off the side of a cliff, they still have got a lot of people to contribute. We don't have that luxury. So what we need to do is take the wealth that we have, invest it strategically in this country. And one of the biggest burdens for people to be creative and to start new businesses or for small businesses to grow is the cost of health care. So our friends on the other side who say they're pro-business are going to allow an $1,800 tax go on the backs of a family of four next year through inaction. There are acts of commission and acts of omission. And there are taxes of commission and taxes of omission. And through inaction, there will be an $1,800 tax put on the backs of families next year and small businesses next year. How can you say you're for small business development when your inaction allowed health care costs to balloon 129 percent since the year 2000? That is strangling small businesses. Let's let them compete and pool their resources and get into the exchange, bend the cost curve. Let's have a uniquely American health care system. I mean, not what we got now. This is ridiculous. We're going to keep this system that we got? It stinks. It's not working. We're not okay with keeping it like it is. We want it to change. We want something different. We want it to work for the people. We want it to represent our values. We want it to unleash the creativity that the American people have. The artists in this country in many ways are small business people. They take risks. They take chances. They go out in the public and they sell their products. They make it happen. That's an art form, and it takes a lot of courage. Let's help them. Let's not sit and turn our head, bury our head in the sand and hope problems go away. That's not what the people voted for. They didn't vote for us to stand by and watch. We're not on the sidelines. We're players in this game. We're supposed to do things. And inaction--and you can argue, Mr. Speaker, they can continue to argue inaction. Keep the government out. Don't do this, don't do that. That's bad. That's bad. No, no, no, no. That's all we've been getting here, and the American people don't want it. We've got to go out and explain this to the American people. We've got people running around--they're so afraid of this happening, the only argument they think they have, which isn't even true, that oh my God, this is going to cover undocumented illegal immigrants. That's your health care debate in 2009 in America. That's what you're telling your small business people? That's what you're telling this country? We can't do it because it's going to cover illegal immigrants, when in section 246 it says, No Federal payment for undocumented aliens? That's all you got? That's it? 2009 in the United States of America in Congress and on right-wing talk radio, all you've got is this is going to cover illegal immigrants, when it's not even in the bill? Come on. American people deserve better than that. This is not what they signed up for. Running ads. We've got politicians running ads about how this is going to cover illegal immigrants. What are you talking about? Stop it. American people don't want to hear that. I mean, it's continuing--it's very consistent with what President Bush started off fear-mongering to the American people: if we can't beat them, we scare people. If we can't beat them on the merits, we try to scare people. And it's just-- it's not right. And so over the course of the next few days, weeks and months, we're going to go out and we're going to talk to the Americans. But we want to hear what they think this is, what they want, their concerns. But I can guarantee you one thing right now. I can guarantee you one thing right now, Mr. Speaker, that there is not any level of fear that can come out of right-wing talk radio, that can come out of FOX News, that can come out of the Republican conference, that can come out of the Republican Senate conference, that can come from Karl Rove and Newt Gingrich and everyone else. There's not a level of fear that they could manufacture that will meet or be able to compete with the level of fear the American people feel under the current health care system. They can't meet it, and we are going to try to the best of our ability to alleviate that fear for the American people. And our friends on the other side have not produced an alternative plan. Now, as we're wrapping up here--and I'm almost done--but the Republicans have not produced an alternative. They have not produced a plan. Because their sole goal is to destroy this one. And so, Mr. Speaker, I think it's important that we continue to ask the American people to look at the facts, look at what's in the bill. If you have questions, that's legitimate. This is a big deal. We should have a conversation about this, about what's actually in here. What's the subsidy level? What are the tax rates? Who's getting taxed in this whole deal and who is not? Who's going to get coverage, and what level of subsidy are they going to get? What's Medicaid going to look like? What's Medicare going to look like? This bill, through the savings that we have here, fills the doughnut hole in Medicare. It fills the doughnut hole through the savings that we squeezed out of the system here. We filled the doughnut hole for the Medicare prescription drug bill so that seniors won't drop off after a certain level and not get covered again until their bill goes up to $5,000 or so a year. That's what we're doing here. So, Mr. Speaker, it's important that we all ask the American people during the course of this discussion to remember that our friends on the other side who had their opportunity for health care reform, had their opportunity for energy reform, controlled the House, Senate, White House, didn't do anything. Now they're coming to us saying that we're doing it wrong. But it's important to remember that their top Republican strategists issued a memorandum to the Republicans in the House of Representatives that they have to be against health care because if they defeat health care, they defeat Barack Obama and they bring him down. Now, when you're listening to the debate on the issues, when you hear unsubstantiated rumors, Mr. Speaker, it's important that the American people hear that and see that within the context of this memo in which the Republicans have been instructed to march down the line of destroying Barack Obama's health care plan, you can keep the plan you have. You will have more choice. This will bend the cost curve, be uniquely American, save us money that we can reinvest so that our small businesses can compete. Doing nothing will continue the cost curve on small business up 129 percent since the year 2000. If we do nothing, a family of four will see an $1,800 increase in their health care bill next year, if that. And if we do nothing, people will still be denied by insurance companies who will say to them, We won't cover you because you have cancer. We won't cover you because you have heart disease. Those days need to be over. And let's muster up the courage to communicate to the American people, to have a mature, adult discussion about health care in 2009 in the United States of America. Since when did Americans get afraid to do big things? This is what we do. We've built transcontinental railroads, we built the interstate highway system, we make sure we lift millions of seniors out of poverty with the Medicare program. We do civil rights. We do big things in America. And this is the next great challenge for us. And we've got to meet this challenge. Not for the sake of me going home and saying, hey, we met this challenge or Speaker Pelosi saying it or anyone else, but because this is what the American people want. This is what they want us to do. So the next few days and weeks are going to be talking about this quality, affordable health care, health insurance reform, and we're going to do this. This is going to happen, and this is going to be another landmark achievement in the history of the United States.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. Mr. Speaker, I move that the House do now adjourn.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. There is $256 million for helping start up 1,300 new charter schools; there are investments into the NIH for cancer research. These are the investments that we need to make. This is the situation we've been given, and these are the cards we've been dealt. I think this bill goes a long way in trying to clean up this mess. It's not going to happen overnight. It took 10 years of Republican leadership to get us in the worst economic situation we've been in since the Great Depression. It's going to take a few years for us to get out. The current system cannot continue. This bill, the energy bill and the health care reform are all opportunities for us to change the direction in which we're going.

Mr. RYAN of Ohio. I thank the gentleman. Mr. Chairman, there have been a lot of people saying: Why are we rushing? Why aren't there more amendments? Why isn't there more debate? We have an obligation to the American people to get these budgets done. The fiscal year starts at the end of October, and we need to get our job done. I want to commend Chairman Obey for making sure that we are going to get all of these House bills done before we leave in August. Given all of the tactics that our friends on the other side have used, I think it's going to be quite an accomplishment. It's important for us to remember that our friends on the other side had control of the House, had control of the Senate, had control of the White House, had control of the Supreme Court, had a chance to implement their health care policy, their energy policy and their overall economic policy. That's the world that we're living in right now. They had control of everything, and we're trying to fix it. The $1,100 increase in gas prices per family over the course of the last 10 years and the increase in health care, going up 120-some percent over the last decade for small businesses--that's a tax. We're trying to fix it. If we do nothing, gas prices are going to continue to go up; energy costs are going to continue to go up; health care costs are going to continue to go up. We are trying to rein this in, and we are trying to fix it. I think this bill does a lot of what we need to do. This eliminates 28 programs; it cuts $1.3 billion out of the bill; it funds community health clinics so that 17 million patients can have some access to health care; it increases the Pell Grants since Democrats have had an opportunity to move in; there is a $1,500 increase, a 37 percent increase, in charter schools.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. Well, we have in Youngstown, Ohio, we have a Youngstown business incubator, and we've had some debates on this floor about a variety of issues, earmarks, different things. And one of the issues that I have been pushing, and I know a lot of Members, is reinvestment back into communities in the Midwest that were once steel or rubber or industrial cities to invest in new technologies. And we have been doing that in Youngstown, Ohio. We have a great business-to-business software incubator there. And recently in the latest edition or latest issue of Entrepreneur magazine, you may or may not be able to read, the 10 best cities to start a business, and down here in parenthesis: Youngstown, Ohio, Anyone? So we're in there with some major metropolitan areas across the country who have been doing great things, but in Youngstown, Ohio, in the Mahoning Valley we're emerging, I think, from years and years of steel-making into advanced manufacturing and business-to-business. It's great. To the gentleman from Connecticut and the gentlelady from Maryland, this is the best issue of Entrepreneur magazine they've ever put out. And I commend to you this issue and read with great excitement, as we have. And we have a local convention center there that's doing great and has made money for the first time in the second quarter and they're doing tremendous. We have got a lot of great shows. We've got downtown living. Anyway, it's happening like a lot of cities in Connecticut, I think, that have made comebacks. So I wanted to just plug our local business incubator, thank Jim Costner who runs the incubator; Michael Brokerage who ran the company that was highlighted in here and look forward to our health care discussion as well, so that these small businesses can prosper in the future because we have a sane health care policy going here in the United States.

Mr. RYAN of Ohio. Absolutely. Whatever you need, it's all in here.

Mr. RYAN of Ohio. This is ``the'' issue. In fact, they may just wrap it up and say we're never going to have a better issue than the one we just issued so we're done.

Mr. RYAN of Ohio. We do have a chart of the Republican health care plan. You may be able to see it from where you are. But it is a series of question marks with arrows pointing in all kinds of different directions because they've had no plan. So it becomes very easy to come down here and be critical and scare people about what the Democrats want to do. But the one key statistic that everyone needs to remember is from 1995 to 2006, per person, there was a $3,000 increase in health care spending per individual in the United States of America. An 85 percent increase under the do-nothing plan. Our people did not elect us to come down here and just continue to let problems compound and compound and compound. We're trying to do something. We all know the problems. We all have the uninsured in our communities. We all have the underinsured in our communities. In my district almost 1,600 families go bankrupt just because of health care. How do you go back and say, Well, you know, we couldn't really get the political muscle to push something through? How do you tell this to these families in America today? And with all the changes going on in the economy--and earlier I showed communities converting from industry to high-tech businesses. There's a lot of unseemly transition going on here from people who have worked in the auto industry and steel industry that eventually will get retrained and may eventually work their way into a newer part of the economy--hopefully the green economy that we tried to deal with a couple weeks ago. But shouldn't we say in America that you at least have some basic level of health care, you at least don't have to worry about that as you go about getting retrained or your kids are in college or your kids are in school? When you look at what we would save--we went back and we did a little research--if we spent on health care at the level that France spends, we would save $805 billion a year. That's how much we would save. And we could take a portion of that savings--which is what we want to do, which is how we're paying for half of this to begin with, savings in Medicaid and Medicare--and put it on the front end so we have preventive care. That's why these other countries are saving money, because people don't end up in an emergency room, costing us hundreds of thousands of dollars. They have some card so they can go or some plan so they can go and get a prescription. That is common sense. That is basic common sense. Our plan is very uniquely American. It takes the best of what happens around our States and our communities, blends them together, and makes them work by driving down costs, focusing on prevention, and making sure if something happens to you and you have heart disease and you lose your coverage and then try to go to another insurance company or another plan, who say, Whoa, you've got heart disease. Sorry, you can't come in here. Oh, you have got diabetes? Sorry, you can't come in here. Cancer? Sorry. Too bad. You can't come in. That's not right. So what we're saying is, everyone will be covered. Everyone. And we have a lot of the money within the current system that we have now to do it. When you look at the statistics in all of our own districts with the doughnut hole and a lot of other things, this bill is going to be in the best interest at the end of the day for businesses in the United States of America. They're going to have a more healthy, more productive workforce and, quite frankly, when you talk to some of these--and I just want to share one story. I was at a wedding last week and was talking to someone who employs about 150 people, but he was also a provider. He does equipment and different services, so he sees this from both sides. His insurance rates went up over the past 5 years 42 percent. So the insurance companies were making more money off him. But on the provider side, he got the goose egg for any increase. So he felt the insurance companies raise his rates on his 150 employees; but they didn't say, Okay, we're raising your rates, but here's a little bit more reimbursement for you. That's not how it works. They squeeze the providers; they increase your rates; they make a lot of money at the expense and on the backs of a lot of the American people. I yield to my friend from Maryland

Mr. RYAN of Ohio. Will the gentleman yield? I want to accentuate that point a little bit. We tried to provide 10 million kids health care coverage through the State Children's Health Insurance Program, and President Bush vetoed it twice, with the support of a lot of people who come to this floor tonight and are fabricating things about this bill, talking about we're going to cover illegal aliens and this is a government-run operation that we're trying to promote here, that we're trying to drive small business out. This bill doesn't even start until 2013. What we pass, no matter what it is, doesn't even get implemented until 2013. And there's no coverage for illegal immigrants in this bill. That's why it doesn't cover everyone. It only covers 97 percent of folks here, and there may be an argument about that. But the fact of the matter is there is institutional support to undermine and sabotage health care reform, and someone's going to win and someone's going to lose. And who's been winning have been the big insurance companies, the people who like the system just the way it is, and the people who have been losing are the men and women and children that the gentlelady from Maryland was speaking about a few minutes ago. So, yes, this is a big fight. This is a pretty big deal that we're having. But the scare tactics--and it's funny, because our friends on the other side of the aisle, they're like a stable full of one-trick ponies, man. If there's not fear coming out to scare you, to make you so afraid of what is happening, but the problem they have now is everyone's already afraid. Everyone's already scared. Everyone's already anxious about their kid and the middle of the night, if something happens, they've got to go to the emergency room because they don't have the kind of coverage that we want to provide here. So they can keep coming with the fear, but what we want to do is provide a little bit of hope for the American people and some sanity, and this chart, itself, shows it. We pay twice as much per person for health care in the United States than they do in France and Germany and in Canada. We have a lower life expectancy. We continue to spend more and more and more and more and not reap the benefits of it because we don't spend the money in the right areas. We need to put the money in the front end so that we have prevention and we stop a lot of these problems from happening in the first place. If you look in the United States from 1995 to 2006, we had an 83 percent increase in health care spending. Public, private, all health care all together, 83.64 percent increase in health care spending; that is not sustainable. It goes on the backs of the small businesses. It goes on the backs of the individuals. We just can't continue to do it.

Mr. RYAN of Ohio. I think it's important to know that one of the major endorsements is the AMA. The American Medical Association has endorsed this bill. If you go back 40-50 years when we tried to do something, they'd put the kibosh on it. You talk about health care reform in the early 1990s. The docs did not want anything to do with it. They have endorsed this bill. It has gotten that bad. I would yield to my friend.

Mr. RYAN of Ohio. If the gentlelady would yield.

Mr. RYAN of Ohio. We hear a lot about this--run your government like a business. That's exactly what we're trying to do here, which is to make a decision as we look at the facts as they're presented to us, as we look at the costs that have gone up 84 percent over the last, you know, 10 or 12 years. A businessperson looking at this would say, Hmm, we wait until someone gets really, really sick. Then we provide universal health care as opposed to saying, As a businessperson, if I just spent a little bit of money up here on the front end, we would save all of this money on the back end. Look at all of these hospitals, whether they're in the cities or whether they're in the rural communities, that spend enormous amounts on charity care. Somebody is paying for that. We're paying for that. Taxpayers are paying for that already, and that's the problem here. Everyone says, Well, why are you asking the rich to pay for it? It's the top 1 percent that we're going to ask to pay a surcharge. The rich are already paying for it. They're already paying. These people don't have health care, so they show up in the emergency rooms, and they get public money to help the hospitals so that the hospitals don't go belly up. So what we're trying to say with the business mind is let's put a little bit of money up here and give these people preventative care, and let's make sure that they get prescriptions instead of ending up in the emergency rooms a week later and costing everybody $100,000 or $200,000. Let's make sure you have a mammogram instead of ending up, you know, in the hospital after being diagnosed with breast cancer. Let's make sure you have a cervical screening so you don't end up with cancer weeks or months later because you don't have preventative care. This is common sense, and I think that's what frustrates the American people. It's like get your act together, and get this done. We can do this. As you said, there will be more choice with a public option, and the public option will then, as it competes, drive costs down. When there's a public option hanging out there, Blue Cross-Blue Shield will not be able to get away with a 32 percent increase. It just will not happen. People will flock somewhere else. So, inherently, this public option will drive down the costs of health care. Again, the idea of doing nothing, which basically has been the case over the past 10 or 15 years, and of saying we hope this all just goes away and that we hope the free market works, has led to an 85 percent increase from 1995-2006 per person, almost a $3,000 increase. We can't sustain it. We are going to build the political coalition here and exercise the political muscle necessary to make sure that our small businesses that can thrive under this plan get the kind of benefits that they deserve, and the people and the increase in productivity will increase, too, in the United States.

Mr. RYAN of Ohio. I would be happy to yield.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. If I could add one thing. So the American people, every time our friends on the other side sold something to the American people when they were in charge, it was fear- based. You know, it was fear. We have to implement this policy. Here's the fear, we have to implement this policy. Here's the fear, we have to implement this policy. And so the only play in their playbook they have is to try to scare the American people. And now they're trying to do it again. Big government-run health care plan. Not true. You're going to lose your choice. Not true. You are going to have more choices. Everyone is going to be forced, 100 million people forced into this public option. That's not true. Even the CBO, which is nonpartison, says maybe 10 million people will access the public option. There will be an increase in the employer-based. All of these things aren't true. So I think it's important, as we close out, to say when you hear the fear, you know some bad policy is tracking right behind it.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. I want to thank the gentlemen from the Pittsburgh area. This is a great investment for our community to pull these two, Cleveland-Youngstown-Pittsburgh corridor together. And I would just like to remind the gentleman from Arizona, as I have before and will continue on every amendment, his congressional district, Mr. Chairman, wouldn't even exist. You in Arizona, it's a desert. All of the water lines, all the sewer lines, the $7 billion Central Arizona Project was paid for by the taxes of the steelworkers in Pittsburgh. We helped build the West, our area, and now we're saying we need to retool our economy. And I think it is imperative for everybody in this House to know, we're all Americans here. And so to take investment during the 1950s and 1960s to build the West and then have a Member of Congress come before us here living in the largesse, spreading water into the desert so they can have nice golf courses, and come tell two Members of Congress from Pittsburgh, Pennsylvania, that are trying to retool their economy that somehow this is a bad use of Federal money, I have an answer for this. Why don't we send the State of Arizona a bill for the $7 billion that built the Central Arizona Project, that sent all of these water lines and sewer lines and public investment out there. Maybe we should ask for that money back and put it towards deficit reduction.

Mr. RYAN of Ohio

Mr. RYAN of Ohio. I would just like to say, I don't think anybody here is anti-nuclear. I think we all recognize how important this is as a part of our portfolio. There is no one here who is against coal. We represent Virginia and Ohio and think it's a good way to do it. That's why there's $180 billion in here to figure out how to make it clean and make it work for us. We're not saying that there's only one specific way to do this. We recognize you may need to drill a little bit, you may need to take advantage of nuclear and coal and all this. But look at the advantage. We have $700 billion going to these other countries that could be coming here, revitalizing the United States of America, and I think that's important for us to remember. And lastly, because I think we're winding down, and I want these guys who are a lot smarter than me to be able to talk, our friends on the other side, who have been so critical, had control of this government, had control of the House, had control of the Senate, had control of the White House. Their energy policy was nonexistent. It was more subsidies for oil companies, more subsidies for the big power companies, and got us to where we are today. Which means over the last 8 years, an increase of $1,100 just in gas prices for the average family. And the same group of people who thought that cutting taxes for the top 1 percent was somehow going to be to the benefit of all hasn't worked. We've got two wars going on, and a war our friend has served in here. That's $1 trillion dollars, $3 trillion when you factor in the costs of the veterans' health care. That's not a good energy policy of us having to go over, getting into the middle of the desert and getting ourselves in this sticky web of politics in the Middle East. Why are we doing that? We don't have to do that anymore. And that is what is at the heart of this bill, and I think that is the magic of this bill, rely on the innovation, the spirit of the American people and reduce our dependency on all those other countries.