majority in this house, we would pass it eefer year in the house. but so many attorneys who are members of the united states senate would block that. well, why can't we come together again in a bipartisan way and say, look, we can agree that part of the cost of medicine, cost of health insurance is the fact that medical practitioners order so many unnecessary and in some cases, madam speaker, harmful tests, draw too much blood, an m.r.i. and ct scan the next day and standard x-ray the next day, because they are trying to cover the possibility that someone would say, well, why didn't you order this or why didn't you order that? we have gotten to the point where everybody who shows up in the emergency department anywhere across these great 50

states with a headache is going to get a $1,200 ct scan instead of a blood pressure check and aspirin and come back to my office in the morning. this is an area in which we could clearly come together in a bipartisan way and hash out, well, if the california version of tort reform is not acceptable, how about a medical tribunal, a group of independent people looking at the claim and saying whether or not it has merit? there are so many things we could do. and i have a few more ideas, madam speaker, that i want to talk on, but i want to refer back to dr. fleming and hear from him, because i know he has a number of things he wants to share with us. i yield time to dr. fleming. . mr. fleming: i thank the gentleman from georgia. i wanted to come down on the debate a little bit more.

we heard the 30-something group democrats talk about the debate earlier and one said something very interesting, really caught my ear. he said that the debate is basically democrats want health care reform, republicans do not want reality care reform. now, i have spoken on this floor as you know, dr. gingrey, and dr. roe as well, and i've heard you speak many times, many members of our conversation have spoken, i've spoken a number -- conference have spoken, i've spoken a number of times throughout the district, i've listened to everyone, i've yet to hear one republican say that he is against health care reform. so i want to remind my colleagues on the other side of the aisle that the only way we're ever going to solve our health care problems, which makes up about 20% of our economy, we must have an honest debate and framing the other side into a position that really doesn't exist is not going to get us there.

in fact, i would say that we really agree, from what i can understand, on 90% of the discussion. we all agree that we should do away with pre-existing illness, we all agree that we should have affordability, we agree there should be 100% access to care, we all agree that we should lower the cost of care. i mean, i can just, i can draw you a great list. there's really, when you get down to it, only one thing we disagree with and that is, we feel that a private system, private industry, even if it's paid for by the federal government in many cases, does a much better job in terms of quality of care and customer service and a much better job of controlling cost. this is proven time after time. compare our economy with a socialistic economy and you see every time that we provide much better products and services at a much better price than those country does. so really, the only disagreement is, who is actually controlling

the care? and of course i submit to you that a government-run system is a real problem. i'll tell you where i learned this. when i was in the navy as a physician i noticed in the first year that the commanding officer of the hospital sent out a call and said this is budget time of the year and if there is anything that you think we could ever want in this hospital, wink, wink, meaning think of something, dream of things, put it on a list because if we don't preserve that budget the way it is then our budget will be cut next year. and that, mie friends, is the way government works -- my friends, is the way government works. if you don't force it in the budget, in you don't make sure and protect -- if you don't make sure and protect your tertry, it won't be there next -- territory, it won't be there next year. somebody will cut into it. that's wait government works.

i'll give you a real-life example of how we will never be able to get rid of waste, fraud and abuse from our health care system if it's run by the government. think about this. we have to throw out a wide net which is very expensive, we may capture a few offenders out there, because it would have to be a criminal act, we would have to prove that they really did it on purpose and then at the end of the day we would have to prosecute them with a lot of dollars and then we may get one person and we may get a few dollars. that's the way you get rid of fraud and abuse in a government system. in a private system, much different. you have a physician or some other provider in a health care organization that's privately run and if his practices are not the best practices and if he's not practicing in a cost-effective way, that shows up on a graph. and then, of course, you go to that provider and you re-educate and you have him work with colleagues and you get him back to the protocols.

and if that doesn't work, then you fire him. easy problem to solve. it doesn't require all of that, there's no crime involved and so you can work in the most effective way possible. mr. gingrey: reclaiming my time. i think that the gentleman has certainly hit the nail right on the head in regard to this and we could go back to why don't -- what we were talking about earlier in regard to electronic medical records which would be specialty-specific -- specialty specific. the information, of course, would be available for any provider who is seeing a patient. but in regard to best practices, as the gentleman was talking, thesal got rhythms. doctors are busy, they're operating, they're delivering babies, they don't have time nor can they afford to run all over the country every four months going to continuing medical education course, a lot of times they have to do that online and it is hard to keep up. but with electronic medical

roared -- records, this would help them keep up. it would absolutely help them order the right test, given the best outcomes and as dr. fleming pointed out, if they're within a group, say a single specialty group of eight general surgeons and one in the group is not getting the results that the others are getting, that information is available internally and externaly. but you kind of police your own. i wanted to give, i think you just asked for one minute, the gentleman from california, my good friend, dana row balker, is going to be on the floor in the next hour on a very important subject. but he asked for a minute. i yield to him at this time. mr. rohrabacher: thank you very much. as we are making fundamental decisions about things such as health care, which are so important to our country and important to each and every citizen, we should keep in mind the fundamental differences that you are bringing up tonight between a government-controlled health care system and an

individual-controlled health care system. where the individual basically controls a great deal of the resources that he or she depends upon for his or her health or the health of their family. as compared to having those resources totally at the command of the government. and the one word that comes to mind is politicalization of what's happening and what could that possibly mean in health care? let me give a little suggestion that if we have government-controlled health care we're going to have illegal immigrants involved in the system. our democratic colleagues, good-hearted as they are, cannot get themselves to say no to providing health care benefits to illegal immigrants. if we provide the type of operations that we want for our own people, heart operations and various things that are very expensive propositions for health care, to be granted to illegal aliens, you can expect

that it will, number one, bankrupt the system, but number two, we will have illegal aliens coming here from every part of the world and in fact one of the problems right now is that we already provide too much health care for illegal immigrants. that issue alone should be a red bell for everyone out there saying, do i really want the government -- do i want the government to control health care and make the decision and give part of the money to an illegal immigrant? mr. gingrey: reclaiming my time and i thank the gentleman for his contribution in regard to that, when you look at that number of 47 million who do not have health insurance, according to the census bureau, madam speaker, probably as many as 10 million of them are illegal immigrants. now, they're not entitled, so to speak, to health insurance. that's not to say that you might not have a situation of extreme compassion if an illegal immigrant is admitted through

one of our emergency departments and they're absolutely in the throes of a fatal illness. maybe it's a young, healthy person, otherwise healthy person, with congestive heart failure or con genital malformation that's resulted in an inability to sustain their blood pressure and their on the verger of death, they would can get the care in that hospital and any hospital i think across the united states. mr. rohrabacher: no one argues with that. mr. gingrey: yes, of course not. they would get that care, it to save a life, of course we would. but the gentleman brings up a good point and i did want to point out that the segue into that number of 47 million. it's estimated that maybe 18 million of those 47 million, 18 million are making more than $50,000 a year and many of them just choose of their own

volition, maybe they're 10 feet tall and bulletproof, 20-somethings, 30-somethings have a gene and don't spend much money on health care and they just elect not to put $200 a month payroll detection or whatever it is and maybe they have their own escrow account for their own health savings account. i think it's a bad decision, i think it's a bad bet. but a lot of people do that. and you can't really force them, i don't think, unfortunately in this democratic plan, madam speaker, and what the president is talking about, is to have a mandate on the employer. if they are above a certain number of employees and if they don't provide health insurance for their employees and they have to pay a tax or pay a percentage of their payroll into this connecter and the individual is absolutely required to sign up for health

insurance or if not they have to pay a tax, i mean, that's not the american system. we want to encourage people, young, healthy people, to get health insurance. and i want to make one point before i yield back to either one of my two colleagues. the insurance industry can help in a great way by looking at this. let's say, take an example, a 22-year-old young man, newly married, or newly employed, is not really convinced that paying for health insurance on a monthly basis is to his advantage, but he does it anyway. and he puts in whatever the cost for a family premium and his portion of that payment month after month, year after year, with the same company, maybe 15

or 20 years. during the course of that time, madam speaker, envision this, that individual develops high blood pressure or maybe in addition to that high blood pressure develops type 2 diabetes. maybe the diabetes comes first and then the high blood pressure. and then ar that develops coronary artery disease and then all of a sudden the company goes out of business. and that individual is out of work, out of insurance and desperately needs it. but because of these pre-existing conditions, once cobra runs out, how are they going to get health insurance? how are they going to afford, struggling maybe to find a new job, but how are they going to be able to go out with no tax deduct -- deductibility and purchase a health insurance plap that's three and four times the amount of a standard plan for

everybody else? what i would say, madam speaker, to the association of health insurance plans, why don't you grant those individuals credible coverage just like we did in medicare part d, the prescription drug benefit? if you have a credible insurance plan that covers prescription drugs, say on a supplemental plan, and then you lose that after four or five years, then you shouldn't be penalized when you get into part d and indeed the law says you won't be penalized. why should the insurance company penalize these people who in good faith all those years have put that money, that premium that the insurance industry has an invested and had a good return on their investment, when these people all of a sudden are in a high-risk situation? i think they should get a community rating. i would be very curious to know how my colleagues feel about that.

i yield to the doctor. mr. fleming: i appreciate you yielding. i want to take a moment to follow up on what you said and mr. rohrabacher. we have 47 million uninsured, 10 million of course are illegal aliens and of course that's a solvable problem by only allowing legal aliens and requiring them to pay taxes and insurance like anyone else and those who are here illegally should not be here. so that's not really a health care problem, at least not primarily, that is an immigration problem. we also have, as you point out, at least half that 47 million who are insurable people and very cost effectively, but they choose not to and that really hurts the risk pool and we should do things to incentivize them. the real problem is the 10 million or 15 million people who are either business owners or they work for small businesses and they can't get cost

effective insurance and they're the once that delay care, they're the ones that don't go to their primary doctor, they're the ones that end up going to the emergency room, getting carat the time when the outcomes are the worst and the cost is the highest. . polls show that 75% of people are happy with what they have. it's that 25% that can't get affordable care, that's where the problem is and that's where the focus needs to be. and if we do that, we get cost-effective coverage for them and we have to get into the weeds to determine 1 cost-effective coverage for them and we have to get into the weeds to determine that. we would really have this problem under much better control. if we blow this thing out with a single-payer system, we will have exploding budgets as far as the eye can see and i don't see an end to that. mr. gingrey: i yield to the the

gentleman from tennessee. mr. roe: my colleague from california makes great points and i will ask you to discuss this medicare part d. but he is correct, when we created the tenncare plan in tennessee, we were surrounded by eight states. we had a plan much richer than the other states. guess what happened? people came into the states. all you had to have was a post office box. and the way the governor handled that and remember that government-run plans and i want people to understand, in tennessee when the plan was about to break the state, our governor, along with the legislature, made some very tough decisions. they cut the rolls and they cut the number of people on the tenncare plan.

in other single-pair -- single payer plans, you cut rates. they said you could get your dog's hip replaced in a week than it takes for a person to get their hip replaced in canada. mr. gingrey: we did talk about that this morning and it was canadian testimony, was it not? mr. roe: and i think the discussion as i recall, and dr. fleming is absolutely right. there aren't that many disagreements. it is who is controlling these health care decisions. is it the bureaucrat or the patient and the doctor. as i recall when the medicare part d discussion came up, that the problem was going to be -- the argument i heard the other side make is that without this public option that there

wouldn't be enough competition and therefore the prices would go up. but what happened in part d and i'm not saying that part d is perfect, it's not -- but what happened was with the competitive market out there, that actually came in lower without the public option. when you have the private option competing in the open market, and i believe the discussion was among democrats, without the public option, that wouldn't happen. but the opposite happened. i can assure you, it will be a plan that promises more than it can deliver with the funds that are available and there will be two options and you now what the optionsr long waits -- and i know i'm not interested in that. mr. gingrey: reclaiming my time. the only way to solve the cost overruns which would no doubt occur -- and i do believe as our

friend from california suggested that if the government was running the whole show and eventually, if we approve this government-default plan, that's just a giant step and a baby step towards a single-payer system. and if you get into that situation, i can almost assure you, madam speaker, that under current leadership, you would have any and all, come one, come all, just like they did in tennessee and dr. roe was describing the tenncare plans. and the only way you could pay for it would be is to start cutting reimbursement to the health care providers, to the physicians, to the primary-care doctors that we so desperately need to be focusing and to be running our medical homes and to make sure that people are taking their medications.

the emphasis on wellness and keeping people healthy, keeping them out of the doctors' office, out of the emergency room and hospitals and at the end of life, out of nursing homes and in their own homes. that's why i think it's a mistake to even go in that direction of government-run health care. i clearly feel and i know my colleagues on the floor tonight agree with me, madam speaker, that the private market place works and when we were here, my two colleagues that are with me tonight weren't in the house back in 2003, but i know they were following the debate very carefully and closely and maybe even felt that medicare part d was something we couldn't afford and certainly it added cost. if you crunch the numbers to the medicare annual payments,

medicare part d did. but in the long run, in the long run, if people can then afford because of that program, they can afford to take medications for some of the diseases i mentioned earlier, high blood pressure, cholesterol, diabetes beat east, keep these things under control, clearly what happens is you shift cost from part a, the hospital part of medicare and from part b, the doctor part, the surgeon part, the amputation part, the renal transplant part. and then also in part d, keeping folks from having a massive stroke hopefully by controlling their blood pressure and you spend less on the skilled nursing home part. so i think that's a pretty good bargain and a pretty compassionate way of a --

approaching things. but our democratic colleagues stood up here and said, well -- some of them tore up their aarp cards because that senior organization had the audacity to support a republican bill. and then of course they said, well why can't we have a government default plan and why can't the government come in and set the price and say, ok, you know, this is the price, this is the monthly premium for part b, the prescription drug part. and these me-market thieves will not be able to run up the price. and they even suggested that we set the monthly premium at $42 a month. fortunately, my colleagues, that amendment was defeated. and when the premium first came

in from the prescription drug plans, the private plans competing with one another for this business, they came in at an average at $24 a month. three years later that has gone up a bit because of inflation, but it's nowhere near $42 a month. so if we don't learn from our history, we're going to repeat the same old mistakes and looks like the democrats with this idea of letting the government come in and run everything and saying that we can't trust the free market, i guess that's what they want to do with government motors -- excuse me, general motors. and i'm very anxious to see how that one turns out. mr. roe: the good points about the private versus the public sector. the private sector will always be more efficient and more responsive. and you heard this story before,

but when i began practice and when you did, dr. gingrey, and dr. fleming also, when a patient came to me and i took care of nothing but women, when they came to me with breast cancer, which i saw way too much of. and i diagnosed about a case a week, it was that common. and we just had the relay this weekend. and what -- in 1977 or so, patient came to me. the five-year survival rate was about 50%. and the big argument came, if you do a disfiguring operation, because the survival rates were the same. what's happened over that time, a patient can come to any of our colleagues and tell them that because of early detection, because of mammography. that is a wonderful story to tell.

you can look at the patient and say you're going to be ok. they quit doing them. screening mammograms aren't done anymore. why? it costs more than the biopsy. sometimes tests will tell us a false positive. the phone call i love to make to my patients is that you do not have cancer. this is one where they quit doing that, because the cost of the biopsies was more than screening. and the best rates they had was 78% survifles. i yield back. mr. gingrey: as we get close to that witching hour of 11:00. i know we have a few minutes left. can you tell us how much time we actually have left? the speaker pro tempore: 1 1/2.

mr. gingrey: i better draw than faster than a draw. my mom, hellen gingrey who lives in a retirement community, my mom had her 91st birthday on february 8 of this year. when she was 90, about five or six months ago, she had a knee replacement. and mom had gotten to the point where she could barely walk and in constant pain on the verge of falling and breaking a hip at any moment. and now, she is enjoying life and enjoying being with her friends and maybe she will live another 10 or 15 years. but do you think in canada or u.k. or one of these countries that they rashion care she would be able to have that knee replacement? absolutely not.

i would like to see equal treatment of health care benefit for individuals who have to go out in the market on their own and don't get it from their employer. why should they not get a tax advantage health care plan like everybody else? i have not heard the democrats in the house, the democrats in the senate or president obama talk about that and talk about fairness and want to be equitable. let's hear more about it. i want to thank my colleagues, dr. roe, dr. fleming and my good friend from california, dana rohrabacher. with that, we yield back the balance of our time. the gentleman yields back. under the speaker's announced policy of january 6, 2009, the chair recognizes -- mr. rohrabacher: i would like to address the house for one hour. the speaker pro tempore: under the speaker's announced policy of january 6, the chair

recognizes the gentleman from california, mr. rohrabacher, for 60 minutes. mr. rohrabacher: thank you very much. a thought came across me about two days ago. i was out on the water surfings off of san clemente, california. i was sitting on my board and the pelicans were getting fish and the dolphins were swimming by and i couldn't help but remember, many years ago when i was a young reporter, one of my first assignments to cover a speech given by jacques kousteau and i relished having gone out and interviewing him. after the speech, i found that