THE OFFICIAL TRUTH SQUAD -- (House of Representatives - July 23, 2007)
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Mr. RYAN of Wisconsin. I thank the gentleman for yielding, and I thank the gentleman for his leadership on health care issue, not only the fact that you're practicing physician, but also your leadership here in Congress, and the gentleman from New Jersey as well.
I just listened to this conversation you're having in my office, and I wanted to come down and just add maybe a few facts. I missed part of your debate as I walked over here.
But we're looking at all these various SCHIP bills to renew this program, and we looked at what the other body is doing over in the Senate. They propose a new $35 billion expansion of the program, but what we find in their legislation is that, not only do they provide a $35 billion expansion, they provide another $35 billion expansion after that in 5 years. Then to contort their budgets to make it all work, they actually say that we will cut off 4.5 million children off of SCHIP insurance to make their numbers work, meaning they have a budget gimmick.
The budget gimmick is, they're going to put as much money into this program as possible, but to fit in their contorted budget window, they will just assume that in about 9 years everybody's knocked off of health insurance.
Both you and I know that that's not going to happen, but what we have over here in this body is an even larger SCHIP expansion, a $50 billion SCHIP expansion which translates into $100 billion SCHIP expansion if their full 10-year ambitions are realized.
And what does that mean? What they're talking about is having all families at 400 percent of poverty, a family of four earning $80,000, being on government health care. What they're talking about is the largest expansion of Washington-controlled bureaucratic health care we have seen in decades, and this expansion of Washington-controlled bureaucratic health care is not the recipe for America.
All of us know from the fact that we represent Americans that the cost to health care and the cost of health insurance is an enormous crisis in America today. Finding good quality, affordable health care is a big problem.
And so what the majority is doing is, rather than attacking the root cause of health care inflation, rather than looking at what is producing these high costs, they're simply saying we will just pay for more of that from the government. They simply want to take more control in Washington and go down the same path, the same path where, today, we spend two-and-a-half times per person on health care of any other industrialized world; yet, today, we have 46 million people who have no health insurance.
We have a system today where all the fiscal experts in Washington and across America from the left and the right are telling us health care's unsustainable, the entitlements in this country are bankrupting America, that our children and grandchildren simply won't be able to pay for the government of tomorrow because of the cost of health care today and the trajectory it's on.
We believe in a different philosophy, a different alternative. We believe we can have affordable, accessible health care that is patient-centered, that is patient-driven and patient-controlled health care.
And so that is why we have a very different vision of this Washington-controlled bureaucratic health care, where the patient and his or her doctor are making the decisions in health care, where we actually go at the root cause of health care inflation and attack those causes so that people get affordable health care at a good price and good quality, and that the patients are the ones who are the drivers of the system.
Today, under the third party payment system we have today, either an HMO bureaucrat or a government bureaucrat's making the decisions, and we as consumers really don't care what things cost because someone else is paying the bills. We can't shop around based on quality and price because we don't know what quality and price is or we're told who and where we've got to go to by our closed network. That's a system that's unsustainable. That's a system that we have today, but this is the system that the majority wants to not only expand, but they want to turn more of it over to Washington, more of it over to government bureaucrats making our health care decisions which will cost us even more money, $50 billion to be specific, in this bill that's going through the Ways and Means Committee and Commerce Committee this week.
But the key here is that we have 16 percent of the GDP, 16 percent of the economic output of this country is dedicated to just health care. The Democrats want that to grow and grow and grow. What's ironic about this is the other 84 percent of health care doesn't work like the 16 percent of GDP that health care consumes, because the other 84 percent of our economy operates on the basic free market premise of competition, competition on price, competition on quality. If you don't do a good job, you don't get more business. If you're not price competitive, people aren't going to buy your product.
Unfortunately, that is not how health care works today, and those are the reforms that we want to inject into health care so that people can get affordable, accessible health insurance coverage, health care that is very high quality and that doesn't grow at 6, 10, 20, 18 percent of price increases every single year.
So we have two different philosophies, two different visions of where we want to go to with health care. We very much believe in putting the patient at the center of the equation, giving the patient and their physician control over the health care system so health care providers, rather than oligopolistic pricing, rather than just raising prices on everybody, will compete again for our business on price and quality.
What the majority wants to do is continue this system, where providers continue to raise prices over and over and over, third parties make the decision whether it's a bureaucrat at an insurance company or a bureaucrat in Washington, and they simply want to raise more taxes to pay for more of this.
In this particular bill, they want to cut Medicare patients. They want to raise taxes on low-income individuals in order to pay for this unprecedented expansion of Washington-controlled bureaucratic health care. To me, that's not the right way to go. It's not the right priorities, and what it will do will be to get more difficult for small businesses, individuals, families and even large businesses to be able to afford health insurance.
That's not the path to take. That's the way that's going to bankrupt this country. That's going to raise our taxes and that's going to take health care decisions away from individuals and families.
That's the approach that we want to go, and I just am pleased to see that my colleague from Georgia and New Jersey have joined in this debate on the floor because it's a very important debate. I would argue that the cost and affordability and accessibility of health care is the largest domestic crisis facing America today, and it's high time we do something about this.
I just want to thank the gentleman for including me in this debate.
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Mr. RYAN of Wisconsin. All I would say is I think most Americans realize, if you're spending someone else's money, you are not going to be judicious with that money like you are with your own, and that is what we do here in government.
And in health care, by asking Washington to spend our taxpayer dollars, they are not spending it like it's their own money. Think of what's happening in health care. In health care, they're spending someone else's money, our money, and they're spending it in a very irrational way, and it's giving us high health care costs. That is the basis of this third party payment system.
And so by simply saying we're going to raise taxes to spend more money in Washington on health care in a system that takes control of health care out of the hands of the patient, him- or herself, is just wrong.
I can't think of a more intimate and personal decision you experience in your life than making a decision over your own health care. Yet, they want more bureaucrats to make that decision than individuals. They want Washington to control this system. They want HMO bureaucrats to control this system and not the patient and their doctor.
That is the real core of the issue here, who you trust. Do you trust Washington with your money to make personal decisions for you or do you trust individuals to make them for themselves?
I would argue, and I think the evidence is clear, that when individuals make the decisions for themselves, when they're spending their own money, when they're talking to their doctor and making decisions on their own treatments, with affordable insurance, that the system's going to be far better, people are going to be much more satisfied, and we're going to save a lot more money and we'll have healthier outcomes.
So it's a real difference in philosophy, and where we see competition working, prices go down and quality goes up, even in health care.
I will just give one final conclusion. I used to have really bad eyes. I had 8.5 in this eye and 8.0 in this eye, which means you have really bad eyes, about 2800 vision. In the year 2000 after years and years of wearing contacts, I decided I'm going to get this LASIK surgery, and that LASIK surgery cost me $2,000 an eye for a total of $4,000 out-of-pocket discretionary spending in elective surgery. They used this Excimer Laser at the time, and it went very well. I can see your charts extremely well. I can even see the detail on your tie. You're standing about 20 feet away me, and the LASIK worked well.
Well, what is LASIK procedure now in the year 2007 where it was in the year 2000? It costs $800 an eye at the same place, and they've revolutionized this procedure, revolutionized this Excimer Laser they use four times over. So the procedure is much better in quality, it's much better in recovery, and it costs $800 an eye instead of $2,000 an eye. $1,600 instead of $4,000 seven years ago. Better quality, lower price, because of competition.
So, even in health care, with complicated things like eye surgery, you can see where competition is allowed to work, is allowed to flourish, that good results can occur, and that is the way out of this. That is the way forward, and that is the lesson that we need to learn as we go through this, instead of raising taxes on Americans and having more Washington-controlled bureaucratic health care, which has given us this double digit inflation on health care.
And with that, I'd be happy to just yield back to the gentleman, and I thank him for including me this time debate.
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Mr. PRICE of Georgia. I thank the gentleman for pointing out the shortfall of Federal Government rules, because they can't ever catch up.
My State, Georgia, was one of those States that spent too much. It spent too much, we would argue, in Georgia, because we were too efficient at signing up children in the program.
Because the formula wasn't flexible, wasn't nimble enough, couldn't accommodate for a State that overperformed, if you will, then it wasn't able to be able to get the match that it was promised. Whether or not that should have happened in the first place is a different question. But the fundamental challenge that we see in all of this is that the Federal Government can't respond, and it can't respond in so many different ways.
But what we see with this chart here that my colleagues know very, very well, and that is that there are all sorts of children out there right now across our Nation that are covered by private insurance. What happens when the Federal Government and the States get involved and they say, let's put this carrot in front of you; let's entice you to come and join government-run health care? What happens?
The fact of the matter is that there is a crowd-out phenomenon, that individual families who currently have private insurance, either they or their employer looks at the program and they say, well, we could save that money by having you enroll your children in government-run health care.
Mr. RYAN of Wisconsin. So what the gentleman is saying is because you have so many families and children with private health insurance, with this new expansion, taxpayers will be replacing that private health insurance and paying for families who already have health insurance?
Mr. PRICE of Georgia. That's exactly right. That's what we saw with the previous program. It happens every time when you have a government program that potentially can supplant the private program.
In 1998, 28 percent of the children in our Nation were covered by some sort of government-run health insurance. In 2005, 45 percent. This is a combination of SCHIP and Medicaid.
Now, the problem is that when you look at the number of children that are covered by private health insurance in our Nation, up to 200 percent, 50 percent of them are already covered by private health insurance. If you go up to 300 percent, which is what the Senate proposes, 70 percent of the children in America whose families have incomes less than 300 percent have some form of private health insurance.
Mr. RYAN of Wisconsin. At 400 percent?
Mr. PRICE of Georgia. At 400 percent it's nearly 90 percent.
Mr. RYAN of Wisconsin. So in the bill that's coming to the House which takes SCHIP to have government, Washington-controlled, bureaucratic health care, for all children at 400 percent poverty, those families, 89 percent of those family already have health insurance. We are talking about having the government step in, raising taxes on taxpayers, and having the government take over the provision of health care for a group of families, 89 percent of whom right now have private health insurance?
Mr. PRICE of Georgia. That's exactly right. That is the crux of the matter. If everything else were equal in the system, if it were to allow for the same kind of ability for patients and families and doctors to make decisions, that might be one thing. But as we have talked about, and as everybody across this Nation knows, that's not the case.
When you have government get involved in the provision of health care, government is going to make decisions about where you can be treated, who can treat you and what kind of treatment you can have. That's where the personal health care decisions go away from the individual. I don't believe, and I know you don't believe, that that's what the American people want. It's up to you.
Mr. RYAN of Wisconsin. So just to expand on this point a little bit further, we have here a situation where 89 percent of the children in these families are already covered by private health insurance that their parents had purchased, that their parents and employers probably had provided them. So what we are proposing here in this bill is that we raise taxes on the American taxpayers, and that we pay for government-controlled health care to replace that health insurance that they already have.
Mr. PRICE of Georgia. Yes.
Mr. RYAN of Wisconsin. So we are going to pay for a system that we already have coverage of so that we can raise taxes and have the government control their health care system. That is a system, that is a sense of priorities that just doesn't square with the American people that I know. That is not what people in Wisconsin sent me to Congress to do.
I don't believe the American people, if they really know the truth and the facts surrounding this issue, want to see their taxes raised so that Washington controls the health care for all of these families, for all of these children, especially when they already have health care provided to them.
I think people understand that if we truly have uninsured poor children, that they ought to get health insurance. I think there is no disagreement here about making sure that uninsured low-income children receive health insurance.
But talking about providing government-controlled health care to families that already have health insurance and raising taxes to do that, that just doesn't jive with the priorities of the American people and the American taxpayer, in my opinion.
Mr. PRICE of Georgia. No, it doesn't make any sense at all. It lays bare the true motive and the true philosophy, which, on the other side of the aisle, at least the true leadership who are pushing this legislation, their belief is that government knows better how to spend people's money than the people themselves. This stretches all the way into the area of health care, which, as you mentioned, are very personal, personal, health care decisions.
Mr. GARRETT of New Jersey. I know that the gentleman from Wisconsin would be able to elaborate on this in much more detail, but in the best case scenario, would that the Federal Government be awash with cash right now, and would that we had no mandatory spending problem going on in the Federal Government right now, maybe some people would want to sit down right now and say, how can we spend our extra dollars around the country?
But as the gentleman can elaborate in much detail, and we have seen in the Budget Committee for the first months of this year, testimony after testimony after testimony, expert after expert after expert from all spectrums of authority, we are now in that situation where we find ourselves with the Federal Government and mandatory spending going out of control. There are legitimate groups within that that the American public would agree with, or those that we should be targeting, to make sure that they do.
The aged, the poor, the infirm, who desperately need medical care and are not able to cover it by themselves and are not fortunate enough to be able to work any longer, and who are not working now and covered by an employer plan, and did not unfortunately work for a company that provides for a company-sponsored plan after their termination at work, those are the people that the American public would ask that's where our focus would be.
But do we find ourselves in our situation right now where we can say that we have all the other mandatory spending under control that we can address this now?
Mr. RYAN of Wisconsin. All three entitlement programs that are in place today, Medicare, Medicaid Social Security, all go bankrupt in about 10 years. It's because we are doubling the amount of retirees in this country at a time where we were only increasing those taxpayers into the program by 17 percent.
So we are seeing a 100 percent increase of the consumers of those three entitlements, while only experiencing a 17 percent increase of the taxpayers in these entitlements. That's why these three programs are going bankrupt. That's why these three programs will consume 100 percent of our budget by about 2030. By about the year 2040, when my kids are my age, they will have to pay twice the level of taxes we pay today just to keep today's Federal Government going at that time.
We have run this Federal Government remarkably constant at about 18 percent of GDP. We have had to tax the U.S. economy at about 18 percent of the output of the economy just to run the Federal Government for about the last 40 years. And what we are on the trajectory today because of the aging of America and way the entitlement programs are designed and the baby boomers retiring, my children will have to pay 40 percent of GDP just to keep today's Federal Government going when they are at my age group. You can't have a strong growing economy, a high standard of living.
So what we are in the middle of doing here, we are deciding whether or not we are going to sever that American legacy to our children and grandchildren. And the American legacy that I was taught by my parents was that you leave the country better off for the next generation than when you received it. You leave a standard of living better off for your children and grandchildren than that which you received from your parents. We are at risk of severing that legacy for our children and grandchildren if we are going to confound them to a system to where they will literally have to pay twice the amount of taxes to just the Federal Government than we do today.
At a time when we are in tough competition and globalization with China and India, it is impossible to pretend that we are going to be able to enjoy this kind of standard of living if we are requiring our kids and our grandkids to pay double the amount of taxes they pay today to Washington when they are in our age bracket. It will just be fundamentally irresponsible if this is the future we would confine them to, yet that is exactly the trajectory we are on today.
Mr. PRICE of Georgia. You are absolutely right. And to give some credibility to that from a pie chart standpoint, these are the mandatory spending programs, and all of what you said happens unless we act. Unless we act as a Congress, all of these things happen.
In 1995, those three programs were this yellow portion, about percent 48.7 percent of Federal spending. In 2005, about 53.4 percent. In relatively short order, 2017, 62.2 percent. And, as you mentioned, in 2030 the yellow portion of that will be the entire pie.
Mr. RYAN of Wisconsin. And if the gentleman will yield, so the blue portion, which is what we call discretionary, that is national defense, the Department of Education, the Department of Commerce, the Department of Energy, Transportation, roads, bridges, the Pentagon, all of those things are the blue portion. There won't be any money left for those, Will there?
Mr. PRICE of Georgia. You are absolutely right. And that is why you mentioned the significant increase in taxes that would be required, and that is if we don't do anything. That is why it is so imperative that we act, which is why it was so astounding to me that this new majority that came in with this ``new direction'' that they were going to take us on for our Nation. You know what happened when they had the opportunity to bring about some entitlement reform.
What happened with the bill that they passed this year in their budget was no entitlement reform, in spite of the fact that we worked as diligently as we could back in 1997 with the Balanced Budget Act, about $130 billion of entitlement reform, and fought like the dickens, as you remember, in 2005 with the Deficit Reduction Act to get about $40 billion in entitlement reform.
But this new majority comes in with the previous chart that we saw, increases in Social Security spending, increases in Medicare spending, increases in Medicaid spending, the prospect of another $100 billion entitlement with the SCHIP program if they have their way, and no reform. Can you imagine what that is going to do to our economy?
Mr. GARRETT of New Jersey. If the gentleman would yield, And lest anyone following this get confused when we talk about the tax increases, the gentleman from Wisconsin set it out and you followed up with quite some detail, as far as the tax increase necessary in order to pay for those entitlement expansions over time. That would be in addition to what we have already seen has occurred during this first 6 months in office.
In other words, we have already seen the largest tax increase in U.S. history. And the current tax increase means that 115 million taxpayers are going to see a $1,716 increase in their tax bill in just a couple years; 84 million women would see their taxes go up by $1,970; 42 million families with children, which is what we are down here talking on the floor about right now, those children, trying to be sure they have health insurance. Those 42 million families with children will see an increase of over $2,000 in their taxes already this year because of what the Democrats have done. And what you are speaking of is going to be in addition to and on top of that.
In trying to just throw some numbers to the percentages that you were throwing out there before as far as this expansion of children that will come under this program now, those children who may be just living across the street from us who their dads or moms work for a company right now that provides them insurance, all of a sudden those companies don't provide it anymore because now the government, we are going to pay for it.
Or those children who have parents who have retiree benefits and are getting insurance for them now, they will no longer have to get it from their retirement pension programs; the government, meaning taxpayers, will pay for it.
The CBO just came out with some numbers on this, and real numbers means that for the first, just the expansion of the program as far as additional dollars means 600,000 new children who used to yesterday have coverage under the private sector will now look to the taxpayer to pay for it; and another 600,000 children yesterday who had insurance, whether through pensions or their parents' employers, will now look to the Federal taxpayers. So 1.2 million children. Now, that is under the House version. That number, I haven't gotten a CBO estimate yet, would be even greater under the Senate version as far as children expanded into this program who are already covered.
Mr. PRICE of Georgia. I appreciate your pointing out the issue of taxes, because there has also been work that has laid out the tax increase for the average citizen in every State across this Nation. And in Georgia, that average increase is $2,700 average tax increase when those tax increases go into effect if they are not changed. They were included in this budget that included no entitlement reform. In Wisconsin, the average number was $2,964. And New Jersey is a big winner, average increase $3,779.
Mr. GARRETT of New Jersey. We are number one in a number of things, in the number of taxes that we pay and the number of taxes that the Democrats are going to make us pay in the future as well.
Mr. PRICE of Georgia. I want to thank you all for joining us tonight. I do want to close on a positive note, and that is that there is an alternative. And the alternative, as we talk about, is patient-centered health care. And patient-centered health care, as you know, puts the opportunity and the right and the privilege and the responsibility for decisionmaking among patients and their doctors, among families and their doctors. And the way to do that is to structure a tax system that allows individuals, incentivizes individuals to purchase health insurance, through whether it is tax deductions or tax credits, or advanceable refundable tax credits, through high-risk pools, through risk pools that allow people to pool together, making certain that individuals have the same kind of tax treatment for the purchase of health insurance as employers do now, as businesses do now, all sorts of wonderful ways to bring about the opportunity for folks to purchase health insurance.
So it is not whether or not you have the current system or whether you march down the road to more Washington-controlled bureaucratic medicine. There is another way. And I know my good friend from Wisconsin has worked on this extensively on Ways and Means, and I would be pleased to hear your comments.
Mr. RYAN of Wisconsin. I just think that we have a different vision, and that vision is that we believe we can provide a system that gives us universal access to affordable health insurance for all Americans, where they and their physicians are the nucleus of the medical system. What the majority is offering is a bankrupting entitlement system, massive tax increases unprecedented, in addition to the largest tax increase in American history that they have already passed here on the floor this year, and more Washington-controlled bureaucratic health care, where bureaucrats, either HMO bureaucrats or government bureaucrats make the decisions in health care rather than patients and their physicians. We can come up with a system that is patient centered, where every American has access to affordable health insurance, where we have universal access to affordable health insurance throughout America. Or that person who has a risky health care profile, may be overweight and has diabetes, has a history of cancer in the family, we can come up with a system where that person, too, can get affordable health insurance and get access to it without having the government run the entire system, without have to go through a government or an HMO bureaucrat to make decisions on how you get your care. You ought to be able to go to your doctor and come up with a good treatment plan that works for you, and that is where the decisions ought to be made.
And more important to that, all the health care providers, the hospitals, the physicians, all those who are in charge of providing care in the health care system will compete against each other for the consumers and the patients' business. That is the vision we see, where everybody has access to affordable health care and it is a patient-centered system, not a government-driven, government-run, bureaucratically controlled system. And I just thank the gentleman from Georgia and the gentleman from New Jersey for taking this time to address this incredibly important issue.
Mr. PRICE of Georgia. I appreciate the gentleman's comments from Wisconsin. And this is what we believe, patient-centered health care, and we going to work on putting some limbs and leaves on the tree of this over the next number of weeks and number of months, and make certain that the American people understand, Madam Speaker, that there is an alternative and it is a positive alternative. Because we live in a wondrous and a grand Nation, and a Nation where when individuals are allowed to encourage their own visions and their own dreams and their own entrepreneurship and their own work, that they can decide what is best for themselves, not government.
Nobody across this Nation I believe is truly interested in having Washington-controlled bureaucratic medicine, yet that is the road that we are about to march down if this new majority has their way. Our alternative is patient-centered, patient-centered health care and allows individuals to make decisions with their families and with their physicians and with their health care providers.
I look forward to working with colleagues on both sides of the aisle to make certain that as we move forward on this issue, that we move forward in a way that ensures that those decisions, those very personal decisions are able to be made in a very personal way without the government limiting care, without the government determining where you can be seen and who can see you and what kind of treatment you would receive.
Madam Speaker, on that positive note and looking forward to patient-centered health care across this Nation, I want to once again thank the leadership for allowing us to spend this time on the floor.
I yield back the balance of my time.