Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Just a very short comment. This weekend, Dr. Gingrey, Mr. Speaker, I had three friends, people I know, diagnosed with some very serious illnesses. It just happened. These three men that I know extremely well, all of them, are getting the highest quality care anywhere in the world, and they don't have to go far from home to get it. I think one of the things that the American health care system has brought to us are new innovations, lengthening of our life span, and the procedures that are done today to extend and improve the quality of life. I am glad to hear no longer, and I heard it for a year, and it was very bothersome and troublesome to me, to hear the other side talk about how bad health care was in America. We certainly have a problem getting health care at an affordable price to all of our citizens, there is no question that is true, but the care that everyone gets is good care. I can tell you that I have done it myself for people who couldn't pay. And I would stand here and hear people talk, and I am one of the few people on this House floor who had to get up and go to the emergency room at 3 in the morning and see a patient who doesn't have health insurance and try to work him through a system and get them care. It isn't easy. We can do better, and we sure can do better than this bill right here.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, today I rise to commend Coach Dave Loos, the head basketball coach at my alma mater, Austin Peay University. He has dedicated the majority of his life to coaching basketball. The year 2009 marked Coach Loos' 20th season as head coach at Austin Pea, where he is also athletic director. During this time, he welcomed his 400th overall head-coaching victory on December 3, 2009. Austin Peay is a member of the Ohio Valley Conference, and this year, Coach Loos became the winningest coach in OVC history. It has been a privilege to watch Coach Loos interact with his young athletes, recruiting and encouraging them, both as a mentor and as a coach. As Rick Pitino once said, ``The key to coaching is not what you do, but the way you do it. The intangibles, the motivational parts of the game are the most important facets of it.'' A successful coach not only prepares his team for victory but motivates them along the way. Coach Loos accomplishes this each time he sets a foot on the court and has great concern and appreciation for each of his players, and that is an invaluable trait as a successful coach. However, his proudest accomplishment is being a dedicated husband to Phyllis, a father, and grandfather. I encourage my colleagues to join me in commending Coach Loos for his service to Austin Peay University.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I will just continue with that thought for a moment. When I began my practice--and, yes, we practiced like it takes us a while to get it all right, and I am still working on it after 30 years trying to get it right--but when I began my practice in medicine, the survival rate of breast cancer in this Nation was about 50 percent for 5 years. If a patient came to me and said, Dr. Roe, I have breast cancer. What are my chances of living? About 50 percent had 5 years. Fast forward to now. We get a stage I breast cancer now, which we are finding almost all of them at early detection because of early mammograms; it is over 95 percent. It is one of the great stories. You can tell a patient, no matter how ill you get, no matter how sick you are, you are going to make it. You are going to be fine. In England what they did was they were doing mammograms, and they discovered and there will be a false positive where the test says you have something and you don't. Well, let me tell you, one of the best days you will ever have is calling a patient up and tell them, You don't have cancer. I have never had a problem with that. But what they found out was that the biopsies, it is a fairly sophisticated biopsy. It requires a radiologist and an X-ray and so forth. That was costing more than providing the mammograms. So what they have done is now they don't do routine screening mammograms. They just wait until you get a cancer, until you can feel a lump, and then biopsy it. The highest survival rate I have been able to find in English literature is 78 percent. I can promise you, if you follow that pathway, it is going to go right back down to 50 because you will find them too late after the disease has already spread. So this stuff is occurring. This is not fairytale stuff. It is occurring right now. I will give--and back to your first point a moment ago, I will give Senator Nelson from Nebraska kudos. I have to say, because in our State, in Tennessee, we have a budget shortfall. As a matter of fact, we can't even fund--we have no capital projects at the university this year. We're not building a library, a dormitory, nothing. We have 50 less highway patrolmen than we had 30 years ago and we've got 2 million more people. That's how dire our budget is. So what happens with this new bill we're talking about, adding Medicaid, is that you're going to add almost a billion dollars to Tennessee's budget that we don't have, and it's a tax on States. In other words, what you're doing when you add all these people, as you pointed out, is somebody's got to pay for it. And there's a State match. Senator Nelson understood that and he just exempted his State from that match. So that's why it's important for the viewers to understand that you at home will get not only a tax, an individual mandate tax, you're also going to get a tax. And what the government has done is an unfunded mandate. We see that all the time around here, where bills are passed and local municipalities or States are left to pay the bills. So I think it's important that the folks understand that. I yield back.

Mr. ROE of Tennessee. We have a Democratic Governor in the State of Tennessee, and he and the legislature are right now in session beginning on this very difficult process of balancing the budget. Our Governor in the State of Tennessee said this was the mother of all unfunded mandates. He wants no part of it. He feels like it's bad, just as the Governor of Nebraska and other Governors are realizing; that it's just another huge government entitlement that's going to cost the States and local taxpayers. Like I said a minute ago, what are we supposed to do? Do away with our highway patrol if the Federal Government passes this? Are we supposed to not do anything for education in the State of Tennessee? I don't know what the Federal Government expects us to do, but I guess they expect us not to build colleges, not to add to our schools. I don't know. Right now, the legislature is working very hard not to cut money from education. We hear and I've heard all the time about how our side, the Republican side, doesn't have any ideas about health care. Well, it would have been nice to share that with somebody. We have 10 physicians in our caucus on the Republican side. Not one of us was asked about this 2,000-page health care bill. I found that astonishing when I've spent my career in health care and not one person asked my opinion about what I thought of this bill. I found that amazing to me. And so when I go home and tell people in Tennessee--as a matter of fact, all over the State of Tennessee--when I go, they can't believe it. It is sort of hard to believe. I yield back.

Mr. ROE of Tennessee. I would like to add to that. I agree with you 100 percent. If you haven't figured out that eating out of a vending machine is not healthy for you, you are not smart enough to be here in the U.S. Congress.

Mr. ROE of Tennessee. The other little thing that I thought was fascinating about this health care bill was a mention for carbon credits for black liquor. And most people don't know what black liquor is, but I happen to have a paper factory in my district. It's a paper byproduct. Why in the world was that in there? Why was a sewer system on Indian reservations? Why was the calorie content of a doughnut--I don't even eat doughnuts. I started eating a dozen of them because it's not government's business to be telling you that. I want to mention something about--you talked about how they took the money and then provided the service 3 years later. Well, typically you see those furniture store ads on Saturday morning, what they typically give you is zero interest; you don't pay anything, and you get the product. This is just the opposite. I find it fascinating. Let someone try to sell you a couch doing that. The cost is another thing I wanted to bring up, the government estimates of cost--I think this, to me, was the most amazing thing in the world. Medicare came online in 1965. It was a $3 billion program. The estimate from the government was that 25 years later, that program would be a $15 billion program. In 1990, 25 years later, it was a $90 billion program. Today it's over $400 billion. In Tennessee, we started in 1993 a program called TennCare to save money, to manage care and save money. It was a $2.6 billion program. Ten budget years later, it had tripled to an $8 billion program. It took up every new--almost every new dollar the State took in. So when you see these cost estimates of $1 trillion or $1.2 trillion, it's a fairy tale. I mean, every single government program that I have ever heard of, with the exception of Medicare Part D, went over budget.

Mr. ROE of Tennessee. Well, I think it brings the point. It is getting harder and harder to pass legislation that people don't want, for sure. And I think, just very quickly, to let people know of a few basic ideas that we have that will help solve this problem. I mentioned to you a moment ago cost and affordability are what people worry about, and preexisting conditions. How do you deal with those things? One of the things you can do is allow health insurance companies to go across State lines like any other insurance companies. Form association health plans. Preexisting conditions are only a problem for individual markets, if I'm going out to try to buy it, or small businesses, like I ran. But if you are spreading those risks among hundreds of thousands or millions of people, it's not a problem. Number three is tort reform. We haven't touched on that. Certainly malpractice reform is a major cost bender in this.

Mr. ROE of Tennessee. I could not agree more. And I certainly agree with my colleague from Michigan, Congressman McCotter, about the high plans, the so-called wealthy plans. We don't need to be increasing taxes on--Americans can't stand another tax right now. The other thing you can do in the State is subsidize at a nominal amount of money high-risk pools so that people who do have preexisting conditions--that's another way you can deal with that very simply. And those four or five things we talked about we could all agree on. We could get this done this 90 days or less, right here in the House in a bipartisan fashion. If the President is ready to work with us, I know our side is. I am. I yield back.

Mr. ROE of Tennessee. I thank the gentleman for yielding. I will point out also, just to continue your point, when you take this $500 billion out, what is going to happen in 2011 is the first wave of our baby boomers hit at 3 million to 3.5 million people per year. Which means in the next 10 years when you take half a trillion dollars out, you are going to add 30 million to 35 million people. Three things happen when that occurs. Number one, you decrease access. Seniors get it. Number two, if you can't get in to see your doctor, the quality of your care goes down. And, number three, to get the care you need, you are going to have to pay more money. You are going to have to pay a higher supplemental to get in. So those three things are absolutely guaranteed. Our seniors understand it very well. Back to the point that you were making a moment ago and I think is very important for comparative effectiveness research: I practiced medicine for over 30 years, and there is nothing wrong with finding out what the best treatment for something is. We do that and we do research on that. The problem comes when you make the next move and say: okay, this person is 80 years old. Their life expectancy is three, four years. Am I going to do an expensive knee replacement? People will say that won't happen. It is already happening. In England right now, they have an acronym called NICE, which is really an ugly word for that. I have a good friend, a physician in my hometown, whose sister-in-law is English. She was recently treated for chronic lymphocytic anemia and her treatment in England was a blood transfusion. People in this country don't die of that disease. Whatever your age is, you are offered treatment and you are treated. So this is being used already around in England. Many medications are not allowed because it ``costs too much.'' You will get to take the red pill or the blue pill, and it may not be the best pill. So what you said is absolutely true. If people don't think it will happen in this country, it will. And I could not agree more. I agree with the President. I think the President would have served himself and the country well to sit down with both sides and find the common denominator on the 80 percent of the things that we agree on and then fix them. It is not that hard to do. An example I will give you: the Senate bill is going to cover 30 million people, I think, at a cost of $1 trillion. You can do two things, one of which is in this bill which I like. Two things: One is if your adult-age children graduate from high school or college and don't have insurance, which three of mine didn't when they got their first job, you simply allow them to stay on their parents' health care plan. You can cover 7 million young people by doing that. Number two, we already have a State Children's Health Insurance Plan and Medicaid. It is already out there, and so that doesn't require another bureaucracy. If you sign the people up who currently are eligible, you will cover another 10 million to 12 million people. You get to almost two-thirds of what the Senate bill wants to do in one page, not 2,500 pages of incomprehensible gibberish. So I would suggest that we do that now. We have a great opportunity to get this right. As I have said as a physician for years, first of all, patients and their families and their doctors ought to be making the health care decisions, not insurance companies, not the government. And after looking at this bill--and I have read, as probably you have, this entire 2,032-page bill. And some of it is almost incomprehensible. It takes two or three other manuals, the HHS manual and the IRS manual and so on, to even read it to fully understand what you are getting. So we need to go back and do something that is simple and fixable so that the American people can understand and a doctor can understand. My physician friends are asking me, Phil, what does all this stuff mean? That is basically what we are dealing with. If the doctors don't understand it, I doubt if the general public does.

Mr. ROE of Tennessee. I thank the gentleman for yielding. The point was made twice that the American people are the fairest people on this Earth, and we live in a place where we have fought a Revolutionary War, established a Constitution that stated that everyone had that right--has a right to be treated equally and under the U.S. Constitution. This does not do that. It absolutely voids those rights for people in certain States and gives more rights to people in other States. I can tell you, the American people will do a lot of hard things if you're honest with them and you're fair and they feel like the people in California and the people in Ohio and Tennessee and Michigan and Nebraska are all being treated the same. I might add that the people in Nebraska feel the same way. I have seen them and I've seen the people in Florida speak and I've seen the people in other States who got these sweetheart deals. And Louisiana, they're not happy about that either. They're fair people. I want to point that out. It's not the people of those States. They're very fair people. I yield back.

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, as an obstetrician and gynecologist, I've delivered close to 5,000 babies and I strongly support the sanctity of life. Using technology like the 3-D ultrasound has given us windows to the womb that show unborn children as living, breathing, feeling human beings. I have looked through that window with my own eyes. I have seen human development occur from the earliest stages of human development all the way through birth, which strengthens my conviction in the right to life. Life is a precious miracle from God that begins at conception. It's our responsibility and privilege as legislators to protect those who do not have a voice. I will always fight for the right to life because it is my conviction that we are all unique creations of a God who knows us and loves us before we are even conceived. Tomorrow, we will mark one of the most tragic, misguided Supreme Court cases in our nation's history, Roe versus Wade. Since 1973, more than 50 million babies have been denied the right to life. We must make our laws consistent with our science and restore full legal protections to all who are waiting to be born. If government has any legitimate function at all, it is to protect the most innocent among us. Congress has prevented taxpayer funded abortions for over 30 years, and the healthcare reform bill has reopened the door to change this effort. As we debate the proposed healthcare legislation, we must fight to prevent it from becoming the largest expansion since the pivotal Roe versus Wade decision, and work to ensure that the door to taxpayer funded abortions remains closed. I am glad to be fighting for the rights of the unborn. General Leave

Mr. ROE of Tennessee

Mr. ROE of Tennessee. I think probably we haven't educated our public as much as we should have. I was surprised in my own practice about how many chose to do that once they understood it. When you are faced with paying $3,000, that is kind of scary to do that when you normally have a small copay or deductible. But once you understand how it works, that you get to keep the money, not the insurance company--and while we are on insurance companies, I have got a problem. I know one of the things that I did in practice that really frustrated me to no end was to have insurance companies deny needed care for patients, and I think certainly they are culpable. I know I have spent as much time on the phone sometimes getting a case approved for a patient to get needed care as I did actually doing the procedure I was trying to get approved. That is very frustrating. So the insurance company is culpable out there, and we do need some reform.

Mr. ROE of Tennessee. Health care should not be a partisan issue. In 30-plus years, I never saw a Republican or Democrat heart attack. I never operated on a Republican or Democrat cancer, just a people problem. We need to get together in this body and not have a partisan solution. There needs to be a bipartisan solution that is simple and addresses problems that we have laid out here today so that patients, their families and doctors can make health care decisions.

Mr. ROE of Tennessee. It has been a whale of a ride. I woke up on the 23rd of December and told my wife that I was actually embarrassed to be in this House because of the deals that were cut. And who ultimately paid for them are the patients and taxpayers. And that's wrong. It really embarrassed me when you saw this deal in Louisiana and the different deal in Florida.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. There is not one of us standing here now that wouldn't agree with that 100 percent. And Congressman Gohmert makes a good point about the mandate. Let's give some practical experience about what's happening to the mandate. Mandate means you have to purchase something, and in Massachusetts it's health insurance. It also says that you cannot be denied because of a preexisting condition. So the Harvard Pilgrim health care plan, beginning in March of 2008 until this year, 2009, 1 year, they found this, that almost half the people who got their health insurance through the Harvard Pilgrim plan kept it for an average of 5 months. You couldn't turn them down, so they waited until they got sick, and when they got well, they dropped it. If you were in that 5-month period of time, that plan spent over $2,000 a month on those folks. For the other folks, like me, who just bought it for the year, they averaged then about $300 a month. So people scammed the system. They paid the tax until they got sick because it was cheaper than buying the health insurance. Then they bought the health insurance and kept it until they got well. It's the same thing as using Congressman Gohmert's example of a car wreck. Well, you have your car wreck, and then you buy the best car insurance policy you can, and when your car is fixed, you drop it.

Mr. ROE of Tennessee. I think you're absolutely right. I mean, it's the ``do unto others, except don't do it to me.''

Mr. ROE of Tennessee. What the gentlelady from Minnesota has said is absolutely true. Just in our area, at Vanderbilt University in Nashville, Tennessee, the largest employer in the county, 14,000 people--these are jobs that don't go overseas, they're not exported, these people are doing great work--new innovations, new treatments that may go away with this system--they're afraid to hire anybody. In my local town, our medical center, 9,000 employees in their system. The adjoining city has a medical system of 6,000. That's 15,000 people that work in health care in two cities with a little over 100,000 combined population bringing quality care to the people of Appalachia. What I am worried about is if that's going to go away. Those jobs will dry up--and those are great jobs that are not exported anywhere, they are jobs for Americans with health insurance, with retirement plans, great benefits, and we may be tanking that also. I want to just reminisce for a moment when I graduated from medical school and think back as the gentlelady from Minnesota, Congresswoman Bachmann, was talking about. When I graduated from medical school there were five high blood pressure medications, three of them made you sicker than the high blood pressure did. Now we have over 50 wonderful medications to provide for people. Antibiotics, a plethora of antibiotics; we had one or two at the time I graduated. Ultrasounds, MRIs, PET scans, survival rates of cancer. The research is just astonishing that's going on in America. We are the leader in the world; the world looks to us for medical innovation. With this right here I'm afraid it will stymie that innovation. I think back--and we were talking about this a moment ago--one of my good friends and a colleague, a medical colleague whose wife is English, his sister-in-law lived in England. She died of chronic lymphocytic leukemia. That's a disease that Americans just don't die of any longer. We live with that disease. It's treatable. She was treated with a blood transfusion. We could have done that 50 years ago. That's all the treatment. And she got that treatment because she was too old to be treated. We don't do that in this country. And I'm afraid we're heading down that path. I yield back.

Mr. ROE of Tennessee. Would the gentleman yield?

Mr. ROE of Tennessee. You can call a polecat a skunk, but it is still a polecat or a skunk, whatever you name it. I yield back.

Mr. ROE of Tennessee. Will the gentleman yield?

Mr. ROE of Tennessee. If the gentleman would yield for just a second, there is a great book out by Milton Friedman, Free to Choose. And he makes a statement in that book, if you want more of something, you subsidize it. If you want less, you tax it. And it is a very simple principle you can apply to health care or anything else. If you have government programs that are subsidized by the taxpayers, you will create more people who use those programs. We have seen it over and over and over again. I will give you a brief example before I yield to my colleague from Georgia. In this country we talk about, and I heard many times about how--and we do have failings in our health care system. It is not perfect. But when President Clinton had a heart attack, he was taken to an emergency room to the hospital, where he had a heart cath and discovered that he had blockages in his arteries and needed a bypass operation for it to save his heart. He got a bypass operation. It was delayed a couple, 3 days I am sure because of a blood thinner they gave him. I don't know that, but I am pretty sure that is what happened or they would have done it immediately. Let's say you are in small town Johnson City, Tennessee, and you don't have any insurance or anything at all, and you have a heart attack and you come to the emergency room, what is going to happen to you is you are going to get a heart cath and you are going to get a bypass operation, and then we will figure out how to pay for it. In Canada if you have that heart attack, what they will tell you is there is a list that you get on that you can get a catheterization, where they put the dye in your heart and see if you have a blockage. You will get on a list. And when your name comes up, you will get the cath. And then you will get put on the list to see if you get a bypass operation. That is the difference and the delay in the care. And I have seen it happen. I know people that that has happened to in Canada. They have wonderful physicians in Canada, I want to point out also. I know many of them, have worked with some that have moved to our community. Well trained, excellent doctors. So when you get the care, I think, in Canada, it is good care. I really believe that. When it is available, I think it is excellent care because of the experience I have had with Canadian-trained physicians. Some of my colleagues I worked with every day were well-trained physicians. That is the rationing of care that we speak of that we don't want to have happen in our country. And we have enough of that as it is. People will tell you that insurance companies ration care. And they do. And I think certainly they are to be held culpable also.

Mr. ROE of Tennessee. If the gentleman would yield, let's just talk about, for a minute, we have this very complex, over 2,000-page bill which I have read. The Senate bill is over 2,500 pages, which I will admit I have not read. I have seen the synopsis of it. We have 118 new agencies in this very complex schematic that you have down there in front of you. We should, on both sides of the aisle, be able to agree on a few things. One is that we agree that the cost of care is rising too fast and we have the uninsured out there that we need to cover. Those are the two basic premises that spurred this entire debate. How can you best solve those problems? It is not that complicated. You can do several things. One, as you point out, let's just look at five things that we can do on 25 pages, not a complicated 2,000 pages. You can let people buy insurance just like you do your auto insurance or your life insurance. We see advertisements every night on television with a little gecko running around, those cute ads they have. Let people buy health insurance across State lines. Let young people who don't have health insurance stay on their parents' plan, if they don't have a job that provides it, until they are 26 or 27 years old. Pick your number. You can cover 7 million people by doing that at zero cost to the Federal Government. You pointed out very eloquently liability reform. You save billions of dollars doing that. You simply sign up the people right now who are eligible for government programs without creating another new one. You cover 19 million people by doing that. You are not creating another agency and 118 new bureaucracies. Expand the health savings account. I will give you personal experience. I have had one for 2 years. I put $5,000 a year in. Instead of the insurance company keeping my $10,000, I have spent about $2,000. My wife and I are both healthy, fortunately. We have $8,000 in our health savings account that we can use how we choose, not the insurance company. I think for someone who owned an individual policy, you can treat them like a big corporation. Let them deduct their premiums just like General Motors gets to do, like the big unions do, and so forth. And then I think the last thing you have to do is you have to put some individual responsibility for each of us, so that everybody, no matter what care they get, needs to pay something for the care. It shouldn't be totally free. We saw that in Tennessee, when our costs just skyrocketed because of the very generous plan we had there where there were no costs to the patients and it was overutilized. So those are five or six things that every one of us in this room, in this auditorium, ought to be able to agree on and take care of. And it wouldn't be hard to do. It is an easy solution. We should be able to pass that in no time at all. And the President ought to listen to that. He really should. These are simple, real-world solutions.

Mr. ROE of Tennessee. If the gentleman would yield, let me give a practical example of what you are saying there. Let's say years ago if I were working in the emergency room and a patient came in with right-sided pain, I might be concerned about whether they had an appendicitis. I would get a blood count. It was at that time probably a $15, $20 test. It is probably a $50 test now. You do a physical examination, take their vital signs, their blood pressure, their pulse and temperature and do a physical exam, and you would say, I don't think there is a chance that you have an appendicitis, but let's let you go home and if you get worse, start to have more pain, come right back and we will reevaluate you. That is not going to happen anymore because part of the legal system now, you know if you do that and you don't get a CT scan, a very expensive test on that patient and you go out and you happen to have an appendicitis, the one in 500 times that might happen, you will be held liable. So all 499 people are going to come out of the emergency room glowing in the dark, just about, because of all the X-rays that they have had to protect the doctor from a potential lawsuit of the one in 500. That is the problem that you get into with the tests that are not needed basically to protect the physician. And why wouldn't the doctor order those tests? You don't want to put up everything you have earned in your entire life for the risk of that one in a thousand, that jackpot that somebody might have. The thing you also brought up is people are genuinely injured in the system. We don't have any way to adequately compensate the injured parties without the attorneys getting their hands on a significant amount of the settlements.

Mr. ROE of Tennessee. I thank the gentleman for yielding. Mr. Speaker, I think last night, watching what happened in Massachusetts, was really, in the many years I have watched politics, was really astounding. The people there I think--it was more than just health care. We have a country now that's not in trouble. We're America, and we know how to avoid trouble in this country. But we have a lot of our citizens who are hurting now. They need jobs, and they need employment. Certainly in our district and around our area where unemployment is over 10 percent, that's the talk in the barber shops and the restaurants: What's the economy doing? What business are we going to lose overseas next? What manufacturing job is going to be gone? I think the people there looked at more than just health care. I think they looked at a stimulus package of almost $800 billion that I don't believe has worked. It certainly has provided some one-time jobs. But you know and I know as a former mayor that you don't take one-time money and turn that into a long-time job. How you do that is you incentivize the people who are creating jobs in this country. That is small business. In this country, 70 percent of the businesses are small business that create the jobs. And how do you help them? You make the cost of capital, the cost of money, the cost of creating a job less. How do you do that? Well, you cut capital gains taxes. You can cut individual income tax rates. You can accelerate depreciation for plant equipment that they buy. So we have a country now that has put itself in debt that my great grandchildren will not be able to pay off. We looked last year, and it is staggering to me how much a trillion dollars is. I get almost overwhelmed, and I made it through calculus in college, and I have a tough time getting my arms around how much money that really is. We have a budget that went up 8 percent last year. We added 8 percent. In the State of Tennessee where I live, we had to live on less money than the year before. That is what we had to do in our State. That is what California is having to do. That is what every State in this Union is having to do. I don't know if the people here in Washington get out, as I have, and talk to our Governors and our State legislators, but our States are in trouble. We need our economy to pick up. If our economy was doing well, I don't think that our health care issue would be as big of an issue as it is. As people lose their jobs, they lose their health benefits. The people of Massachusetts got their arms around the bigger problem, and I think they looked at this entire country and the direction it is going and said, Whoa, wait a minute, we don't like the direction that the country is going. They put the brakes on this. They said let's stop and take a slow, measured look at what we are doing.