Phil Roe

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Yes, that is correct. That is correct. The reason that I--it was about 10 years ago. I have never had service in the State government or Federal Government before. I really wanted to take this time just to serve my country as I did my patients over the years. So I was asked to be on the city commission and ran and was fortunate enough to win, and then became mayor of Johnson City after my second win. I brought a very simple philosophy to government, and that is: Spend less than you take in. It's not complicated. Well, how do we do with that philosophy? Well, we had 6 years ago in our city of 60,000 people, we had $2 million, approximately $2 million in reserve. When I last came to Congress, we had $24 million in reserve. We have not raised taxes, and our bond rating went up during 2008 when everybody else's had gone off a cliff. The city has a great management, has a great commission. They're going to balance this budget. And every single budget we passed had a surplus. Now, the philosophy in Washington, D.C., I found, is you borrow more than you take in. You spend that and what you take in also. That's what we've done here this year. As you probably have mentioned, we start our fiscal year on 1 October. And by the 26th of April of this year, we had spent all the money that the taxpayers had sent us for the year. So everything we're running on now is borrowed money. The folks back home, as they have you all, ask you what is your biggest frustration or surprise or whatever. A lot of them think it's the workload. It's not that. To me, it's the partisanship and, second, it's the spending. I just can't get over the staggering amount of money that we spend up here. And to give you an example, in our local city, we've put $120-plus million in water and sewer improvements. Didn't raise taxes. We were able to do that. We paid for it. We didn't have the Federal Government pay for it. We paid for it locally.

Mr. ROE of Tennessee. Just a couple of things that Congressman Thompson talked about. One, is accessibility to care, and that is the crisis of personnel. If you look in the next 20 years, over half of our registered nurses can and will retire. We'll need a million new registered nurses in the next 8 years. In the next 10 to 12 years there will be more physicians retiring and dying in this country than we're producing in this country. We are not investing in the medical infrastructure to increase the class size, and I don't know where that anybody thinks who's going to provide this care. So that is very correct. It is a huge issue. The challenge here is affordable health care, and that's accessible to people. It's not going to be easy. I've dealt with this for over 30 years, and this is going to be very, very complicated to do. We do not need to do this fast. We need to do it right. And I think that's one of the worries that I have is that we're going to go and have this arbitrary deadline of 60 days from now. Who says 60 days from now we should have this right, have it done? We need to get it right. If it takes 6 months we need to get it right because it affects every American. Let me just give you a couple of little examples. In this country, we have 47 million people that are uninsured. That's about 15 percent of our population. In the State of Tennessee several years ago, about 15, 16 years ago, we had a Medicaid waiver. And for those out there that understand what Medicaid is for the uninsured and poor in this country, and Medicare is for our citizens over 65, this was a Medicaid waiver to form a managed care plan called TennCare. And what it did was, it was a very rich blended plan that provided a lot of care for not much money. And what we found in the State was that 45 percent of the people who got on TennCare had private health insurance but dropped it. Well, then I asked the providers, what percent of your costs does TennCare actually pay in our district, in our area? And I went to several different hospital systems. About 60 percent. And Medicare pays about 90 percent. And as you pointed out very clearly, and then the uninsured pay somewhere in between. And what you pointed out very clearly was that what happens is that cost is shifted and more cost, so your private health insurance goes up each year, part of it not because of what you do, but because of what the government has done, which is not pay the freight. And my concern is, when we get a public plan that's ``competitive'', it also will offer a lot of benefits but won't pay the costs of the services, once again, causing a shift to the private health insurer, meaning they will be crowded out. And over time, I'm afraid you'll end up with a single- payer system. And a single-payer system is not what the American people, I think, want. And certainly that's something that's going to be discussed in great detail in the future.

Mr. ROE of Tennessee. The gentlelady will remember our first weekend or two here when we, both the freshman Democrats and Republicans--and I might add that I think there are 33 new Democrats and 22 Republicans, I believe, is that correct? We have them outnumbered finally. I will point that out. You remember, we went there, and the economists told us, if we don't spend this money rapidly, the earth's going to end? I remember saying, Well, that sounds counterintuitive to me to spend your way to wealth. Well, guess what, the economy is beginning to turn around, thank goodness, I think, for a lot of people. The signs are feeble, but it looks like the economy may have bottomed out; and the same people are telling us in the third and fourth quarter that the economy probably will show some growth. We've spent less than 10 percent of the stimulus package. The economy did that on its own without the stimulus package. I think the target is what we were talking about earlier; and if we truly had done this, if we truly had looked at infrastructure. For example, the State of Tennessee is going to get $55 million in water and sewer projects, and the small city of 60,000 people I am from is already putting $100 million in the ground. So it was a spending bill that had some little bit of stimulus in it. Look at energy, for instance. If we had invested $100 billion, $200 billion in nuclear power how much further along would we be to energy independence. We chose not to do that. In 2 years the money will be spent, and I don't think we will have much to show for it.

Mr. ROE of Tennessee. Thank you. It's great to be here tonight. I, too, echo Congressman Paulsen. We do have a very, very fine, diverse freshman class. I think we add a lot to the debate. I guess many of the speakers tonight sort of mentioned why they ran for Congress. I do have one distinct advantage. I delivered a lot of my own voters. So that's a huge advantage when you're out on the trail and you deliver babies. I ran, really, to serve my country. I have had a very successful medical career in Johnson City, Tennessee, which is where I'm from. And for those of you who don't know, so you can remember, it's the only congressional district in America that's had two Presidents, Andrew Jackson, Andrew Johnson, and Davy Crockett served in this body as a Congressman. Andrew Jackson was the first person to sit in this seat, so it's a very historic seat in northeast Tennessee.

Mr. ROE of Tennessee. Well, we just spent less than what we took in. It wasn't complicated. In the city where we were, we have one of the lowest tax rates in the State of Tennessee. So smaller government, less people working. We had fewer employees than we had 8 years ago. And lean government. They reward you. The taxpayers like that and they reward you for that kind of work. The other thing we did was we could see--and all of you all dealt with this in State governments--the new ozone levels that the EPA came down with when they lowered that from 80 to 75 parts per billion, a lot of people around don't understand what that means. Well, if you go into nonattainment, meaning you don't attain those standards, the EPA has a right to freeze all building permits, so you cannot grow your community. And we understood where we were. If you had the infrastructure, the roads, water, sewer, and schools, you could grow and business would want to come there. As Erik pointed out, you want an environment where business can flourish. And we looked at the challenge we had with energy and said, Okay, how do we manage this energy problem we're having? Did we look at raising taxes on power? No. What we did was this. We had a landfill, as you've mentioned, and we looked at this as an opportunity. And we went into a private-public partnership with a private company, zero tax dollars, and formed this partnership where we went to our landfill, we capped the landfill, drilled wells into it, sent a pipe 4 miles over to our VA, which is a hundred-acre VA, the Quillen College of Medicine, named after Congressman Quillen who served here for 34 years. Huge campus. They heat and cool that campus with the gas, the methane gas, which is the second largest greenhouse gas outside of carbon dioxide. You, the Federal taxpayer, get a 15 percent discount on your bill. We, the local taxpayer, make money off royalties--about half a million- plus per year--and the private company created jobs and made money. That's the way you do it. We cut our consumption from a million gallons of fuel a year to 850,000 gallons. And when gas was $4 a gallon, that's very, very significant. To give you another example about what you could do: around the country, we did some simple things like just change the lights in a stoplight from the 150-watt bulb to an LED bulb. In every intersection over the period of that lighting, you can save almost $800 per intersection. Multiply that across the country. It's the carrot versus the stick that we're seeing now. You all may have talked about this before I got here, but within days of getting here, we were faced with the stimulus package, which arrived as a 450-page document that went to the Senate and came back as 750 pages. It then came back at conference at 1,071. I carry it around in the trunk of my car and show people how big it is. We had 4 hours or 5 hours to read it here on the House floor. We got it, I think, at 9 o'clock on Friday morning and put it on at 2 o'clock that afternoon. Then we were faced with the omnibus spending bill. The 110th Congress had 12 appropriations in the bill, and we have them every year. Only three had been passed. Every local government, every business, every State in the Union tightens their belts when their revenue is down. So what did we do? We went up 8 percent. We passed an 8 percent increase. I felt like I was in the twilight zone. Then we got the next budget after we got a $1.8 trillion deficit. Guess what? We raised that 8 percent. Then there is this year's budget that's coming along, and that's $3.9 trillion. People back home--I'm talking about Democrats, Republicans, Independents, and apolitical people--do not understand that, and I don't understand that kind of spending. It is not sustainable. Now we've got two big issues that we're going to be facing that are coming up ahead of us: our health care--and I'm really glad to be in the middle of that discussion--and the carbon tax. I yield back.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, I urge support for H. Res. 421 and congratulate the Great Smoky Mountains National Park on turning 75. What an amazing success story! This Park--the most visited in the United States--serves as a source of pride for residents of our entire region and we celebrate the vision of our ancestors who had the foresight to preserve this amazing area for all future generations to enjoy. As an avid outdoorsman myself, I am particularly grateful for this natural wonder. Two weeks from yesterday, the Park will officially turn 75 with activities planned all summer to commemorate this accomplishment. I hope all Americans will join in the celebration and come visit what is truly one of our nation's finest examples of scenic beauty. I also want to congratulate the National Park Service for its diligent management of the Park. Without its leadership, the Great Smoky Mountains National Park would not be what it is today. I hope all members of Congress will join me in supporting H. Res. 421.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Chair, I rise in support of the amendment offered by my friend from Minnesota. As a veteran I support the underlying goal of this legislation to create opportunities for veteran-operated small businesses. It is important in this global economy to train and provide guidance in business administration for our veterans. Veteran Business Centers and grant assistance should expand the economic playing field for these businesses. However, if the Congress authorizes these programs it is our duty to the taxpayer to oversee their progress. This amendment calls for the Government Accountability Office to study and report on the effectiveness of these programs. We need to ask the question: ``Is money spent on veteran owned small businesses helping these businesses?'' ``How can these programs be improved?'' I look forward to having those answers and thank the Gentleman from Minnesota for offering this amendment. I encourage my colleagues to support its adoption and yield back.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, Americans are tired of watching our manufacturing sector move overseas. We need to implement policies that encourage companies to invest here in America and that make the cost of doing business less expensive. Lowering corporate tax rates, creating tax incentives for purchasing new plant equipment and increasing depreciation allowances all would be helpful in expanding investment here. Unfortunately, House Democrats are advancing cap-and-tax legislation that has many theoretical benefits but one absolute consequence--the loss of millions of American manufacturing jobs. The Democrats' response to global warming is to tax coal, of which we have hundreds of years of reserves, and to tax oil so that Americans will start using other power sources. Employers who are in globally competitive industries and who can't simply raise the cost of their goods will be forced to lay off even more people, as their factories close, to pay for a program that may or may not be necessary to reverse climate change. I, for one, am not willing to sacrifice two American manufacturing jobs for every one green job. I hope all Americans will let their legislators know they don't want to pay higher taxes on energy while watching their jobs disappear.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Dr. Broun, thank you for your comments. And just to summarize and sum up. I think our time is just about gone. This is just the beginning of this debate. It is a very important debate for the American people. We just got through a few of the principles tonight. We will continue those at another time. But I thank Dr. Broun for being here, and I thank the Speaker. I yield back the balance of my time.

Mr. ROE of Tennessee. Thank you, Dr. Gingrey. Thank you for those comments. I think one of the things that has concerned me the more I have watched this system and have watched this debate go on is, since I've been here, I've had one of the health care think tanks in my office about every week or so to discuss this issue, and it is incredibly complicated. That's why we cannot do it rapidly, because it is so complicated. I'll now recognize my colleague from Georgia, Dr. Paul Broun. Dr. Broun.

Mr. ROE of Tennessee. Will the gentleman yield for a moment?

Mr. ROE of Tennessee. Thank you, Mr. Speaker. We're here this evening to begin and continue a very important debate in American society. I think it's probably one of the most important social debates we've had in the last 40 years in this Nation since the debate on Medicare in 1965. We're here tonight as a Physicians Caucus to discuss health care reform. My background, I spent 31 years practicing medicine in Johnson City, Tennessee, in the First Congressional District. As I've watched our health care system change over the past 30 years, it really spurred me to run for Congress, to come here and be part of this great debate that will affect every American citizen. I recall when I made my decision to go to medical school, I wanted to be a family practitioner. Somewhere along the way, I discovered I had a great knack and a love of delivering babies. I have delivered almost 5,000 of them, many of whom are now grown. One of the great advantages you have as an obstetrician when you run for Congress is that you can deliver your own voters. There is some advantage to that. We have a health care problem in America. Some call it a crisis. For some, it is. For others, it's cost. Certainly we know that there are great concerns about the cost of health care. In the next hour we're going to discuss how we're going to address this health care crisis. We can ensure that every American can get the care they need, protect individuals from costs that can bankrupt them and make health insurance portable so that you don't lose your coverage just because you change jobs or move from one State to another. We can also take the profits out of health care by reforming the health insurance industry to bring about a patient-centered approach to providing health care. Enacting a public plan will not bring about this type of change, and I'm going to go into that in some detail from the experiences we've had in the State of Tennessee with our Tennessee Medicaid system called TennCare. If you think you won't be affected by a public plan, consider this: A recent analysis of this plan by the respected independent firm Lewin Group estimated that 70 percent of individuals who have health care coverage through their employer would lose those benefits in favor of a public plan. Now this plan could very easily become a Medicaid-type plan. When supporters of a public plan say they want the public plan to compete with private plans, the facts show that what they're really saying is that they want Washington bureaucrats to take over the health care decision-making. I want to talk for a while or speak to you a little while about the principles that House Republicans have put forward to start the debate over how to bring about patient-centered health care. I want to mention a couple things before we start. Health care affects all of us, whether we're Democrats, Republicans, Independents, or whether we're totally apolitical. At some point in time in your life, you're going to have to make decisions about how I receive and get health care for myself or my family. We're going to start this evening by giving another opinion or another view of the health care plan and how it is to be administered and obtained. The principles that we're going to talk about for health care reform are, number one, make quality health care coverage affordable and accessible for every American regardless of preexisting conditions. In a country that spends 16 percent of its GDP, over $2 trillion a year, on health care, I think there's no question that we can provide a basic health care plan for each American. Now what I mean by basic health care, it's not a plan where you can get hair transplants or face-lifts or all this. But if you are out there injured in an automobile wreck or have a heart attack or have a gallbladder that goes bad, you can get basic health coverage and care. I think this is something that all Americans believe in. I think we now have crossed that bridge and believe we can do that. I think the differences we're going to have in this great debate that we're going to have are, how are we going to accomplish this very noble task? In a few minutes I will go through how we tried this in Tennessee, and how it was not successful. But I think it can be. Most Americans also fear, I think rightly so, that a basic health problem--it may be leukemia or a cancer of some type--can bankrupt the family. Certainly we don't want a situation where a family, through no fault of their own, develops a disease process, and then you use up all the family resources you've saved in a lifetime to provide care for your family. The second principle we'll talk about is not a government-run health care plan. This eliminates coverage for more than 100 million people who receive insurance from an employer, and it restricts patient choice of doctors and treatments and results in the Federal Government takeover of health care. Let me sort of explain how this worked in Tennessee. In the early nineties and mid-nineties, the big debate in this country came along about controlling health care costs or managed care. We were going to control costs through deciding who and what care was appropriate and so on. Well, that didn't work. Health care costs have continued to escalate in spite of managed care, and managed care basically has moved the pay to providers over to the third-party payers. In Tennessee we had a very noble plan. We wanted to cover everyone in our State, and we're not a wealthy State, so it was a noble goal. Right now in the State of Tennessee we have TennCare, which is our Medicaid plan. We have the uninsured, we have Medicare, and then we also have the private health insurance coverage. About 60-plus percent of Americans are covered by private health insurance coverage. In Tennessee when we applied the TennCare solution, which was a managed care solution with multiple third-party payers at that time, the plan was not fully vetted and thought out well. One of the things I've said the entire time I've been here, Let's do this health care plan right. Let's not do it fast. I think one of the mistakes we made in Tennessee was going too rapidly with this plan. So we instituted this plan, and what we found out was that 45 percent of the people who applied for TennCare and were granted it had private health insurance coverage. Well, I went to the providers recently, hospitals and other providers, and I said, What percent of your costs does Medicaid or TennCare pay in your particular facility? And the resounding answer was, about 60 percent. So you have a significant percentage of people now who have given up their private health insurance and have gotten on the public plan, which only pays about 60 percent of the provider costs. You also have the uninsured who pay some percentage of their own costs, and Medicare pays about 90 percent of the costs. So as you shifted more people from the private plans to the TennCare plan, you forced the private health insurers to charge more for their plan. That's what happened. What I can see happening in the public plan is exactly this. It's going to be described, we're going to have a plan that's competitive. It will be very rich in benefits. And what happened was, in Tennessee the actual TennCare plan was richer in benefits than I could afford to provide my own office staff and myself because of the costs. When you have politicians deciding what goes into a basic plan, it will become richer and richer and richer. What will happen in the public plan--and you'll hear the buzzwords. It will be competitive. If you like your own health insurance coverage, you can keep it. You don't have to give it up. Just keep what you have. Well, what will happen is this: Businesses will make a perfectly logical decision. What they will do is--and this is small business because in businesses in this country with over 200 employees, 99 percent of those have health insurance coverage. So this is what will happen. You have the public option plan, the government-run bureaucratic plan that will have a lot of benefits, except it won't pay the cost of care. And when that happens, the cost of private insurance once again will be forced up, causing more and more and more businesses to do away with their private health insurance plans and put it on the public plan. And really over time--and I think a very short period of time--you will see the public plan, along with Medicaid and Medicare, become the only options available. Now why do we think that this is not a good idea? Well, we've looked at public plans, and I have studied these extensively in foreign countries. In England, Canada, Sweden, Norway, Germany, France, Italy, other major European industrialized nations. And this is what you would find. The way costs are controlled are by rationing care. In other words, when you have used up all the public dollars that you have dedicated for health care, you have to create ways. An example is in Tennessee. What we did was we simply shrank the rolls. We realized if so many people got on the public plan, the TennCare plan, that the State no longer could afford to budget for it. Our health care costs were more than education in the State. So what the Governor did, along with the legislature, is just cut the number of people off the TennCare rolls. Well, for instance, in Canada, if you have a heart attack, your average time to go to the operating room is 117 days. They simply ration their care in Canada. And they have great physicians there. As a matter of fact, in the last decade, 11 percent of the Canadian physicians have moved to the United States. I have several very close friends who are Canadian physicians and colleagues. And they do a wonderful job. The president of the Canadian Medical Association once stated that a dog in Canada could get a hip operation within 1 week, and a patient there, it took between 2 and 3 years, simply because of lack of government funds to provide all of the benefits that the government had promised. So in this particular plan, the one thing that I want as a physician, that I have utilized for years, is that you want to maintain the patient-physician relationship. The one thing that is absolutely mandatory, in my mind, is that the decisionmaking between patient and physician is paramount. Doctors and patients should be making health care decisions. Some government bureaucrat should not be deciding whether you get your hip replaced or your aging parents get the care they need. I'm going to stop at this point in the principles, and there are lots to talk about tonight. And I see my colleague, Dr. Fleming from Louisiana, is here. And I would like to yield him as much time as he feels is necessary.

Mr. ROE of Tennessee. We used to say, ``Smoke a long cigar.''

Mr. ROE of Tennessee. Thank you, Dr. Fleming, and thank you for those great comments. For the public, we have had, for the last several weeks and months, a physician's caucus that has met now sometimes one and two times a week to discuss this ongoing health care debate. With us tonight here is one of the leaders in that caucus, Dr. Phil Gingrey, who happens to just have the same specialty as I do, and he has been very heavily involved in the health care debate over the past several years, so I will yield now to Dr. Phil Gingrey from Georgia.

Mr. ROE of Tennessee. Here just a minute ago, we heard a debate on the floor about how we are going to have to redo Medicaid and Medicare. And we have a system already that has promised up to as much as a $70 trillion promise that we have unfunded, a government system that we don't have the money to pay for now, and we are thinking about starting another one, another government system. And you mentioned rationing of care. It brings to me the thought of breast cancer. As a physician in our practice, we average seeing one newly diagnosed breast cancer per week. And when I began my practice over 30 years ago, half the women, approximately half the women, died in 5 years after being diagnosed with breast cancer. It was a terrible, and still is, a terrible diagnosis. And one of the great miracles of medicine is we haven't cured that disease, but we have improved the life expectancy for a woman diagnosed early to a 5-year survival rate of 98 percent. It is a wonderful story to tell. When a patient comes to my office, and she says, Dr. Roe, how am I going to do? I can say, look, you're going to have some tough times. It's going to be hard. This therapy is going to be difficult and tough. But you're going to make it. And you're going to live. And you're going to get through it. And I'm going to be through it with you. What has happened in England is that the best results they had ever was a 78 percent 5-year survival rate. And they quit doing routine screening mammograms in England. And the reason they quit doing that is because there is a false positive rate. That means the test says you have something wrong, you go and have a more sophisticated biopsy. It is called a ``wire-guided biopsy.'' It requires a radiologist. It is a fairly sophisticated, as you all know, procedure. But what happens is that that costs more than the screening mammogram. So now they just wait until you develop a lump that you can feel. And as most physicians know, that is about 2 centimeters or three-quarters of an inch. I don't think the American people are going to tolerate that for their families. I know I won't tolerate that for my family. I don't want a government decision based on the amount of money whether my wife or my daughter can have a mammogram. I yield back.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, on that I demand the yeas and nays.

Mr. ROE of Tennessee. Mr. Speaker, I rise in support of House Resolution 360, urging all Americans and people of all nationalities to visit the national cemeteries, memorials, and markers this Memorial Day. Following a tradition begun in 1868, our Nation will pause this Monday in remembrance of those who have sacrificed their lives in defense of our free Republic. Fond mourners and friends will set flowers and flags on the graves of the fallen. Our flag, flown at half staff since sunrise, will at noon be raised high and those gathered will be called to pledge allegiance. A bugle will sound Taps, and we will make another pledge: to aid the widows, widowers, and orphans of our heroic dead, and our disabled veterans. There is no central location for this observance. Our servicemembers' final resting places are in all our towns and communities. The National Cemetery Administration of the Department of Veterans Affairs maintains 128 national cemeteries in 39 States and Puerto Rico. One of those cemeteries is in my hometown of Johnson City, Tennessee. The Department of the Army maintains Arlington National Cemetery and the U.S. Soldiers' and Airmen's Home National Cemetery. Americans have died defending liberty around the globe and have been laid to rest far from home. The American Battle Monuments Commission oversees 24 military cemeteries abroad where 125,000 of our war dead remain. The freedoms we enjoy today, the freedoms enjoyed by a civilized Europe, and those free from despots rising to national power are the proof these men and women did not die in vain. This sacrifice should be celebrated, and never forgotten. Not all who serve perish fulfilling their duty. They return to us as veterans and deserve our thanks and a commitment to serve them. We erect monuments and markers and make pilgrimages there to honor them. That is this resolution's call. Congress should urge Americans to visit these cemeteries, these monuments and memorials, and I as a veteran encourage my colleagues to support this resolution.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Speaker, this week the House Democrats on the Energy and Commerce Committee are marking up a more aggressive cap- and-tax bill than what even the President had proposed. On the campaign trail last year, the President said his plan would cause electric rates to skyrocket, and the bill being considered this week will cause electric utilities even more disruption than what the President proposed. Individuals and businesses everywhere need to start paying attention to the threat this bill poses. The nonpartisan Congressional Budget Office estimated such a plan would increase the average household's electric bill by $1,600 per year. Since the bill requires no concessions from developing countries, businesses like Eastman in Kingsport, Tennessee, who are engaged in a tooth-and-nail competition with China, can't pass increased energy costs on to consumers and maintain their market share, which means that employees could lose their jobs if this bill passes. I urge those on the other side of the aisle not to sacrifice two good-paying American manufacturing jobs to create one ``green'' job.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Mr. Chairman, I urge adoption of my amendment. I yield back the balance of my time.

Mr. ROE of Tennessee. I yield myself as much time as I may consume. Mr. Chairman, the amendment is simple, straightforward and hopefully noncontroversial. It adds a bit of accountability to this legislation by requiring the Institute of Education Sciences within the Department of Education to study the impact the Federal school construction dollars have on the institutions that are receiving the funds. I know proponents of this legislation will say that school construction does impact performance, and they may be correct. I am skeptical of the claim. So I am asking for the opportunity to study the effects of school construction on student performance. This amendment would require the institute to issue a report a year after the schools have issued construction funding and report the impact the funding has. I am hopeful that such a report could provide valuable insights into the best use of taxpayer dollars. I know Mr. Cuellar wanted to be here today to speak in favor. It's nice to have bipartisan support for accountability. I urge adoption of the amendment. I reserve the balance of my time.

Mr. ROE of Tennessee. I rise today in opposition to the legislation. School construction is being billed as something that can dramatically improve student performance and, while it will have an effect, I would guess it would impact the performance less than parental involvement, less than having a quality teacher, and less than having good textbooks and curricula. Since arriving in Washington, all I've heard is that programs are dramatically underfunded, so I question why we would add a new program to fund that could divert more resources from these other programs. I was personally educated in a two-room country school with no running water, no indoor plumbing. I think my parents placing a high value on education had far more to do with my success in the classroom than the condition of my school did. In our debate yesterday before the Rules Committee, we were discussing the merits of Federal involvement in school construction. The point was made that State and local officials are being forced to cut back on school construction because they're required to balance their budgets, so we at the Federal level should start funding this construction to make up for their shortfalls. At home, where I was a mayor, I had a very simple philosophy: Spend less than you take in. Here in Washington, we have a different philosophy: Borrow more than we take, then spend it. At a time of record deficits, I believe the Federal Government should act more like our State and local officials, many of whom are setting priorities and trying to fund programs to get the most bang to their buck. Some communities, like Johnson City, Tennessee, where I was mayor before coming to Washington, are investing their own resources in school construction. We were just able to fund $50 million worth of improvements because we acted in a fiscally responsible manner balancing budgets--and we now have a surplus. Other communities have chosen to put off these needs while they weather this economic crisis. I think it speaks volumes when communities collectively decide that other programs are more of a priority to student achievement than school construction, yet we at the Federal level are making just the opposite determination. It seems to me that if we want to do something that will really help students, we'd be better off with funding the IDEA and No Child Left Behind programs, which are proven to boost student achievement. I appreciate what both sides are doing--and everyone wants to improve the education level. I urge a ``no'' vote on this legislation.

Mr. ROE of Tennessee. Mr. Chairman, I have an amendment at the desk.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Thank you very much for yielding. I think, just to kind of emphasize what Dr. Broun said, if you like the way the government managed AIG, you are going to fall in love with a government-run health care system. I think there are a few principles that we all ought to abide by, and I think we have, and we have discussed this tonight. One is, above all, do no harm. Eighty-five percent of people have health insurance now. We have to help control the cost. Again, as Dr. Broun was talking, physicians and patients should be making decisions. And every American needs access to quality, affordable health care. I think we all agree on that, and we have brought up some ideas tonight about how to do this. An illness should not bankrupt you; you shouldn't go bankrupt because you get cancer or another serious illness, and today it does. It should be portable. We have got several ways--and we can talk about this in the future. It shouldn't just be tied to your job. And the COBRA payments now, you have to be Bill Gates to pay for it. You would have to have an affordable way to do that. And lastly, every single person ought to make an investment, ought to have some investment. Let me give you a very quick example. Let's say a patient on the Medicaid/TennCare system in Tennessee would come to my office to be treated for a cold, as he was talking about; a perfectly rational decision because it costs nothing to do that. If you go down to the local pharmacy to get some medicine, it might cost you $15 or $20 to be treated for the same cold. With this system right here we are talking about, exactly what happened in that graph, Dr. Gingrey, is what is going to happen to the national system; you are going to push people out of a higher quality private system into the public system that we have seen. I had patients who had to go to Knoxville--which is 100 miles from where I live--to see an orthopedist because no one would take the Medicaid-type insurance. And I can go on and on. And we will discuss this further, obviously, as this debate goes on. I yield back my time, Mr. Scalise.

Mr. ROE of Tennessee. Thank you, Mr. Scalise or Dr. Scalise, whatever it is tonight. I am going to share with you some of the experiences that--we've already done this experiment in the State of Tennessee. And as a physician from Tennessee and who has delivered babies in that State for over 30 years, we've seen our health care system change dramatically. Remember back in the 1980s, early 1990s when managed care was going to be the be-all, save-all for us and obviously didn't slow the health care costs at all. And none of us here tonight, not a single person-- there is well over 100 years' experience in this room tonight discussing this--defend the status quo. Not any of us do. Many of us have a tremendous program, I think, and we're here tonight to share these experiences, what is positive and negative about the system. Let me turn the clock back about 15 or 16 years to a very noble cause in the State of Tennessee--not a wealthy State--to cover all of our citizens, and we went into a managed care plan. We got a Medicaid waiver called TennCare, and what happened was this was a very rich plan that was offered by the State to compete with other plans. And businesses made a perfectly logical decision: 45 percent of the people who ended up on TennCare had private health insurance but dropped their private health insurance to go on the State plan. And I went to several of the hospital administrators, the providers there locally, and I said what percent of your cost did TennCare pay in your hospital system? It was about 60 percent. And Medicare, at least in our area--it varies in different areas--pays about 90 percent of the costs. And then you have the costs of the uninsured which pays somewhere in between, leaving a cost shifting to the private payers. Well, what is going to happen--and this is so predictable because we've already done this experiment--we're going to have a plan that's going to be set forward--again, a noble plan--to cover everyone. If we have time tonight, I will go over some principles that I feel are important in the health care debate. What will happen is there will be a plan brought forth to compete with the private sector that will be subsidized by the taxpayers, that when you go to provide the care, it will pay less than the cost of care. And once again, businesses will make a perfectly logical decision to drop that, and over time, you'll end up with a single-payer system. That's how exactly it's going to work. And what happened in Tennessee was this: In the State of Tennessee, you had a choice. In Tennessee, we can't borrow money. It's against the State Constitution, so we have to balance the budget. When the TennCare rolls got so big, the legislature and our Governor--who is a Democrat, different party--made a decision. We had to pare the rolls. So they rationed care by basically cutting the number of people on the system. What happens in a system like in Canada and in England, what happens when you've spent all the health care dollars? The only other option you have is to create waits, and that's exactly what happened. Let me share with you another statistic that hits me right in my heart, because when I started my medical practice, as did Dr. Gingrey, the 5-year survival rate of breast cancer was approximately 50 percent for women in America. Today, it's 98 percent. One of the great stories. So when a patient comes to me or the physicians in this room, they can tell that patient, You're going to have a 98 percent survival rate. In 2003, the 5-year survival rate of breast cancer in England was 78 percent. Now, in England, which is a single-payer system--and in that system, they quit doing routine mammography, and the reason for that was cost. The mammogram comes along and says the woman has a problem in her breast. You do a biopsy, and it shows up that it's negative. She doesn't have cancer, and that is a wonderful thing to be able to tell a patient. But these wire-guided needle biopsies are more expensive than the routine mammogram is, so they quit doing those, and they wait now until a patient develops a mass in her breast which is approximately 2 centimeters, about three- quarters of an inch, of which a certain percentage of those women will have spread to a lymph node. We're not going to do that in this country. I cannot believe we're going to do that. The survival rates of colon cancer are less in England than in this country, and the reason is because the screening takes place at a much later time. I, myself, had a screening colonoscopy at age 50. I had a lesion discovered, clipped out. I've had absolutely no problem whatsoever. If I had waited later in my life, I most likely would have had colon cancer. So just from a personal testimonial here, those health care decisions, Mr. Speaker, should be made between a patient and the doctor, mutual decision made between both of them. That's where the health care decisionmaking should be made. And I will yield back my time. I have some other things to talk about, Mr. Scalise, and I appreciate the honorable gentleman for giving me this time to express my opinion.

Mr. ROE of Tennessee

Mr. ROE of Tennessee. Madam Speaker, I rise today to congratulate Mr. and Mrs. James Ailshie, who are celebrating their 79th year of marriage. James Ailshie was born in 1912, and his lovely wife, Dussie, in 1914. The two are proud parents of six wonderful children, all of whom are residents of East Tennessee. When asked how they have maintained such an incredible marriage, the couple always responds with, ``The secret of a long life together is a four letter word, love.'' In my opinion, the Ailshie marriage is a living testimony of what love truly is. Let theirs serve as an example to all of us, that love and dedication can truly last a lifetime. However, their marriage is more than simply an affirmation of love. Across the years they have witnessed times of joy and times of hardship, yet their commitment has endured. The qualities of character that have enabled them to sustain their union and build their family are the same qualities that are fundamental to the strength of our Nation. May we continue to be blessed with Americans who cherish the values of our traditions. Married in 1930, the Ailshies have shared many yesterdays together. It has been said that, ``An anniversary is a time to celebrate the joys of today, the memories of yesterday, and the hopes of tomorrow.'' It is my hope that they will go on and see many, many more tomorrows together. Madam Speaker, I rise also today to congratulate Jessi, Jedediah, Josiah, and Josephine Smith, better known as ``J4,'' who were declared the winner of the CBS Early Show's Singing Family Face Off this week. The competition began months ago when roughly 700 videos of family bands performing were submitted by Early Show viewers. The ``J4'' siblings performed the Mary Mary's song ``Shackles,'' on the Early Show, which advanced them to the finals. CBS said they were chosen as the winner based on votes through the network's Web site. ``J4'' is made up of four siblings, aged 7 to 15, all with names beginning with the letter ``J'' from the Smith family in Bluff City, Tennessee. The oldest two have played for a couple of years for services at the church across the street from their home where their dad, Mark, is pastor. The Smith kids are the children of Mark and Lori Smith. They're home- schooled and very involved in music, including piano and violin. Congratulations again to ``J4.'' They make East Tennessee proud.