democratic majority side. they were very articulate and well spoken, but i think very wrong in some of the ideas that they have in regard to a government default plan. and we'll talk about this during the hour. i have been joined by a couple of my colleagues, dr. john freeman -- the dr. from louisiana, dr. paul broun from georgia and i would like to refer to my colleague from louisiana to yield time to him at this point. mr. fleming: thank you to my friend and fellow physician and colleague, dr. gingrey. you know, you made reference to the 30-something democrats. and i watched that debate, that discussion with great interest, because to be honest with you,

32 years of medical practice and also owning businesses for nearly as long, when i hear this discussion about how a public plan can work, i really try to view that and try to understand that, but always come out totally mystified with how this sort of thing could ever work. and to clarify the debate, basically congress right now is looking at three different options. one is a total single heyer nationalized health care system, medicare for all. one would be a private system for all, which is what we on the republican side back. and the other is a public and private system that are competing with one another. . i really watch with great interest to my colleagues on the other side talk about how this

could be a great deal, a great success, where you have a public system that's competing with a private system and somehow that's going to drive costs and prices down and we're going to get a dividend from that. well, what i would do is point out to my colleagues, let's look at medicare today and medicaid as well. both government-run systems. both of them are running out of money rapidly. the budgets are exploding and expanding and they are living off the fat of the private system. today we know, in fact a recent survey, a study came out showing that the average subscriber to private insurance spends an extra $1,000 a year to support the medicare and medicaid system. we also know that a lot of that support comes by way of the uninsured who are routed through the emergency room, who don't have any coverage, and if you

think that the medicare recipients pay for that, forget it. that's not happening. who is paying for that is the taxpayer and those who subscribe to private plans. so right now the systems that exist, medicare and medicaid, are for the most part supported not by premiums and not even fully by the taxpayers, but are supported by those who pay premiums into private plans. so if you expand medicare to where everyone is eligible for a medicare-type plan, who in their right mind is going to stay on private insurance when they know that they're going to have to pay increasing sized premiums in order to get the same level of care that those on medicare who are largely supported by taxes are going to get? and so what ends up happening is you lose that critical mass of

those under private insurance and so private insurance then becomes only an after thought, a sliver of the economy and so what you're left with is a giant public system, a medicare that's much bigger than we have today and incidentally i'll remind those that today as it stands, medicare will run out of money within 10 years, as it is. it's unsustainable as it is. now, if we grow it into a much bigger system, where are those cost savings going to come from? and so i'll yield back in a moment, but i just want to bring out the fact that no one has ever been able to show that a government-run system, particularly a health care system, but any government-run system in which the economy is being controlled in some way has ever controlled cost. and even today we know that health care costs are going up twice the rate of inflation.

and with that i'll yield back and look forward to further discussion. mr. gingrey: i thank the gentleman for yielding back and i want to apologize for the gentleman. i referred to him as dr. john friedman. actually it's dr. john fleming from the great state of louisiana, a family practitioner. and it reminds me, the reason did i that, madam speaker, dr. john friedman was one of my classmates in medical school and also one of my co-residents in my ob-gyn training back in georgia. i think dr. john friedman practiced his entire career in boone, north carolina, and i hope dr. john, wherever he is, is doing well if he happens to be tuning into c-span tonight. i wanted to say before referring to and yielding time to my colleague from georgia, a fellow physician, dr. paul broun, also a family practitioner from athens and augusta area, there was a letter sent within the last couple of days addressed to

our leaders, to our leadership in the house, to speaker nancy pelosi, and our minority leader, john boehner, also to majority leader of the senate, harry reid and senate minority reeder, mitch mcconnell, the national coalition on benefits, madam speaker, talking about the opposition to a public plan. the strong opposition to a public plan. i don't have time to stand here and read the names, madam speakerings, of all of these firm -- madam speaker, of all of these firms, but just to mention a few, wal-mart stores, xerox corporation, well point incorporated, wire howser company, national restaurant association, bank of america, national association of health underwriters, signa corporation, chrysler l.l.c., nike.

i could go on and on. that's just maybe 5% of the number of companies that are part of this national coalition on benefits that are so opposed to this idea of a public plan which our colleagues at the 30-something group just an hour ago touted so strongly. at this point i would like to creeled to my good friend and colleague from georgia, dr. paul broun. mr. broun: i thank, dr. gingrey, for yielding -- i thank you, dr. gingrey, for yielding. i think the american people need to look at what president obama said as a candidate and go back to what dr. fleming was talking about just a few minutes ago about the options. republicans are are offering options because certainly we need to do something about health care financing. people are hurting health care expenses have gotten too high. medicine's too high in the drug store, doctor bills are too high. doctors are actually earning less money today. when i was practicing full time

prior to coming to congress i was making in real dollars less money than i did 20 years ago and seeing as many or more patients and we've seen the whole health care system being strained tremendously. but candidate obama talked about giving the american public options, a public versus private option. he said if you like your current insurance, fine, stay there. but as dr. fleming was talking about just a few minutes ago, what president obama's actually offering us is a reduced-price health care financing system that's going to take away people's choices. it's going to take away their ability to choose their doctor. it's going to take away their ability to choose the hospital, what medicines that they have. it's going to delay them being able to get needed procedures, surgeries, delayed in getting

x-rays that are needed, ordered by their doctor. it's going to take the choices away from the patient and it's going to put those choices in the hands of a washington bureaucrat. and i don't think the american people want that. i'm not sure that they understand yet what we're talking about tonight in our second opinion, that government-run health care is not going to give them the choices that they're used to today, they're not going to be able to stay in their private plans because they're going to be priced out of the market, they're going to have to go to that government-sponsored plan that is going to markedly narrow their choices and what it's going to do is the going to kill people because we saw in the stimulus bill a new program set up in the federal government to look at cost effectiveness and comparative effectiveness,

comparing the effectiveness of health care decisions and age is going to be one of those measures of how those decisions are going to be made. and we already see this happening in canada. we already see it happening in all the socialized health care systems around the world. when people have celebrated a few birthdays and get in what grown up in down in georgia folks talked about long in the tooth, a little white-haired, as i'm turning to be, then what happens in those government-run health care systems is they just deny the procedures, deny the tests, deny the care that the people need to stay alive. and people just die. now, in canada the system that many tout, many on the other side in the democratic party tout the canadian system and others, if you are a certain age

and need a kidney transplant, you just don't get it. if you need by pass surgery, if you're a -- bypass surgery, if you're a certain age, you get on a list but you never get off the list, you just die. if you need medications, you're denied those. if you need cancer treatment, you just don't get those. we in this country, with the health care that we as physicians can give, we've made marked strides since i graduated from the medical college of georgia in how people survive various forms of cancers. back, in fact i think dr. roe will talk about breast cancer, because he talks about that frequently, but our breast cancer survival rates in this country are extremely good. in other countries where they have socialized medicine, people die of that disease.

heart disease, diabetes, you go down the list of all these chronic diseases. in socialized health care systems, as this administration and the leadership in this house, in the senate across the way, want to take us, it's going to take away people's choices. they're not going to be able to get the care that they desperately need to stay alive and it's just the wrong thing to do and dr. beginning --, -- and, dr. gingrey, i appreciate your being one of the co-chairmen of the doctors' caucus and helping the american people to understand the direction that we're being led by this leadership, the liberal leadership in this house and this senate because the not going to be in the best interest of the american public and it's actually going to create a financial collapse as dr. fleming was talking about.

it's going to be exasperated -- exacerbated and people are going to be exacerbated because of this rationing of care, taking away their choices and some federal government bureaucrat in washington, d.c., is going to make those health decisions for them and it's not going to be their doctor, it's not going to be their family, it's not going to be the patient and the wrong thing to do and i thank you for yielding. mr. gingrey: reclaiming my time and i thank the gentleman before yielding to our colleague from tennessee, dr. roe, fellow ob-gyn physician, just want to say to my colleagues on both sides of the aisle, mr. speaker, madam speaker, that what we are about is trying to work in a cooperative way on both sides of the aisle and offer our expertise to say to our colleagues and there's some

health care practitioners on the majority side as well and we have reached out to them and made ourselves available. we want to be at the table. unfortunately, madam speaker, we are not at the table, we haven't been enjoined, if you will, but we still hope, we still have hope that that can occur because we do have some ideas, i think some very good ideas in regard to bringing down the cost of health care, making it more accessible, making it more portable, making it available to everybody and that would include people who are currently considered high-risk, maybe even considered uninsurable or if they can get insurance, it's because they can afford to pay three or four times the normal standard rate, which many, many cannot. so we want to talk about some of those things tonight and we'll

get back to that. at this point i yield to my colleague from tennessee, representative roe. mr. roe: thank you, dr. gingrey, and also, madam speaker. it's good to be here tonight to discuss a very important and, i believe, dr. gingrey, and madam speaker, probably from a social standpoint, the most important issue that we'll discuss and probably this health care debate's the most important one since the mid 1960's when medicare was voted on of the judgment to give -- just to give you a little bit background, i'm a native tennessean. i practiced in johnson, tennessee, and saw a tremendous change in the health care delivery system from 1970 when i graduated from medical school until the current and i really marvel myself at the miracles that have occurred. i recall when i was in medical school when st. jude's children hospital had just opened, hadn't been there long and the death rate among childhood cancers was

80%-plus and today over 80% of those children survive and live. . and thrive. . we are having a debate and i will share with you some things we learned in tennessee about a public and a private system. what i hear when i'm out talking to people is that number one, they're worried about the cost of care. they are worried about the availability of it. and there is another whole discussion we haven't had which is accessibility. as we age, as the medical population ages, there is going to be a huge problem of accessibility in this country and we are seeing in our own communities. where in the next seven years, we need one million registered nurses. next eight to 10 years, there will be more physicians retiring and dying. you cannot maintain the quality of care that we have grown to expect and the medical advances we have grown to expect without

practitioners. and that is an entirely different issue which is part of this debate. in tennessee, about 14, 15 years ago, we had medicaid. we got a waiver to try a managed care system back in the 1980's and 1990's. managed care is how we were going to control the escalating costs. it was a wonderful idea to provide coverage to as low a cost as we could. we put a plan together, as we're doing right here in this congress. we are going to put -- the most astounding thing i ever heard of, in less than 60 days, we're going to vote on a health care plan that affects every american citizen, 300 million of us. and your health care choices are very personal choices. they're between you, your physician and your family. so the plan was a managed care plan and it was a very roots

plan. it provided care for not much money, and for some people, no money. and what happened was -- and people made very logical choices. about 45% of the people ended up on tenncare and had private health insurance and dropped it. why did they do that? this tenncare provided more coverage and people made a conscious decision. the problem with the plan is it dos not pay the cost of the care. that cost has been shifted over to the private sector. when you look at your health insurance costs going up each year, you're paying a tax on your private health insurance premiums caused by the increased useage of the public plan. in tennessee, the tenncare covered about 60% of the cost in

actually providing the plan. medicare and another plan that we had, pays about 90% of the cost and uninsured pays somewhere in between. what i think will happen with this public plan is that once again, because politicians are involved in designing the plan, what will happen is, more and more things will be promised about what will be covered in the plan. but when it comes to paying for it and if we have time, we can discuss the massachusetts plan a little bit, what will happen is you will have a medicaid plan that doesn't pay the cost. you will he a medicare plan that doesn't pay the cost and you will have a public-funded, quote, competitive plan that is subsidized by government, but doesn't pay the full cost of the care, meaning more and more costs will be shifted onto the private payers.

what will happen over time, i think, is that again, individuals, small businesses, 20, 30, 40 people in the business will say we can't afford this private escalating costs and what will happen more will be shifted over to the public plan and you will ended up with a single-payer system. so what? what's wrong with that? we have the government-run health care, one-payer system. everybody has coverage. everybody has a health insurance card, but that doesn't mean you can get health care. don't confuse a plastic card that says you have coverage with actually getting care. what do i mean by that? let me give you an example. when president clinton had his heart attack. he went to the hospital, had a heart attack. he was operated on several days later and probably the reason in my opinion, he got a blood thinner that took a few days to get out of his system and he was

operated on and went home. had he had that heart attack in canada, they would have said, mr. clinton, you can go home and in 117 days, that's the average amount of time to get a bypass operation in canada, you can come back and get your operation. two weeks ago, i was talking to a physician who was canadian. his father began to have chess pain. i won't go through all the problems as to how long it took him to get to a treadmill or cardiologyist. he got his coronary6 c1 cardiologyist. he got his coronary area that was 90% block. he finally survived and got a bypass operation. i do not believe the american people are going to put up with that health care system. the other thing that is astonishing to me and i know dr. gingrey and dr. fleming and dr. broun also, the medical advances. when i graduated from medical

school, we had one antibiotic. there were about five high blood pressure medicines, three of which caused severe side effects. it was almost better to have the high blood pressure. people do so much better. there are a lot of reasons and i'm going to yield back some time to dr. gingrey and dr. fleming for comments and i have some other comments about a single-payer system. it's a good idea, as you pointed out, to try to cover as many people as we can as inexpensively as we can. and i yield back. mr. gingrey: before yielding back to dr. fleming, i wanted to say to my colleagues, madam speaker, that we are the party of a second opinion.

and of course, tonight, we are talking about health care reform, but it could be an energy bill, a comprehensive all of the above approach to solving our energy problems and any other issue, but none really at this point in time is more important than solving this health care problem. and the bottom line is to, again, to lower the cost of health care, to make it accessible to everyone within their fi accessible to everyone within their financial reach and there are so many things that we can do short of, madam speaker, turning this over to the federal government, to run what -- amtrak, the post office or indeed the medicare program. and i don't think that's what people really want and expect. we can do better than that. and there are a number of issues in particular that we can talk about in detail if we had more than just an hour, madam

speaker. but clearly, this idea of electronic medical records, i think, is a way of trying to save money. i think the money we put in the stimulus package, $19 billion to provide grants. i've got a piece of legislation that would help physicians purchase hardware and software and a maintenance program that is specialty specific, whether it was my specialty of ob-gyn or general practice or surgery program produced by a company in my district called greenway, where you have as part of that electronic medical record program, you have all the things set up of best practices that are developed not by a government bureaucrat, madam speaker, but by that very specialty group, those men and

women, those leaders of that specialty society that want to do what is best and they want the best outcome at the lowest possible cost. they want to get paid a fair amount for their services, of course. and in fact, with an electronic medical records system, they are more likely, especially under the medicare program where you have something called an he valuation and management code and intensity that you bring, doctors tend to undercode, because, madam speaker, they are petrified that an inspector general is going to come along and demand to see charts and knit pick and find where they overcoded and maybe they aren't participating in the medicare program and facing a jail

sentence. i don't know how much money it would save, but i know it would lead to a better practice of medicine based on best principles. we wouldn't need to have some comparative if he cantiveness institute, kind of like the federal reserve board telling doctors what they should do and not do when it's time to operate, what medication to prescribe. we would have those best practices as part of the electronic medical records system. we would cut down on duplication of medical testing and people could be in timbucktoo. and they could take the card and they don't speak the language and be comatose, you reach in their pocket and pull out that card, swipe it and there's the entire record.

we know what medications they are allergic to, the past medical history and give them the best and safest medical care. mr. roe: you were making the point of why you don't want the federal government to come between a patient and a doctor. a veteran can go to the emergency room, have an electronic medical record at the v.a. and show up in an emergency room in our area. we have a v.a. hospital in johnson city. he shows up there and the doctor in the emergency room at mountain city does not have access to his v.a. record, to his electronic record that they have at the v.a. now i think we can do better than that. and that's going on right now. that veteran -- maybe he is a world war ii veteran with a complicated medical history, that emergency room doctor is

flying by the seat of his or her pants. i think we can do better. again, the health care decisions should be made between a patient and a doctor. and i don't want to let the private insurers off the hook. you and i know this and dr. fleming also, one of the last cases i did in practice, i spent almost as much time on the phone and a private insurer trying to get the case approved than actually doing a major surgical procedure. that's the ridiculous item of the day when you do that and you're not providing care to someone and arguing with a bureaucrat at the private health insurer. mr. gingrey: those stories are just all too familiar. and it's a shame that that time is wasted when it can be better spent with the patient. i wanted to mention, too, madam speaker, the issue of medical liability reform. now, for a number of years, i

have been here seven and this is my fourth term, and every year introduced medical liability or tort reform modeled after the system that was adopted by back in the late 1970's in california. the acronym for that bill is micra. but it has worked and stabilized the medical malpractice premiums in that state. they have gone up because of inflation. states, they don't have tn. but because of other states, they don't have that reform where there is a limitation on a claim, a judgment for pain and suffering, non-economic. and where there is the elimination of this joint and several liability and there is collateral source disclosure and i can go into some of the weeds of it, but obviously, we have not been able to pass that. when we republicans had the