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tv   Today in Washington  CSPAN  July 31, 2009 2:00am-6:00am EDT

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committee to look at the texas experience and reject it. >> will the gentleman yield? will the gentleman yield? >> i yield to him. >> i thank the chairman. you know, we've heard all of these arguments in the late 1980's and early 1990's, and they passed some of the most draconian laws, and we even had a lot where if they pass a drug, and you could not sue, and in michigan,a doctors are claiming that we have to leave michigan, everything is too expensive, we cannot afford to practice here. what we need is a registry of where they are so they cannot go from state to state, hospital to hospital and commit it. let's put some transparency into this. there are very few doctors. but do not limit the rights of the american people with all of these fears of "we are going to leave." be malpractice rates and
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michigan, are some of the highest. -- the malpractice rates. we should reject it. we should stick up for the people who are truly injured in this country. >> will the gentleman yield? >> thank you. i just want to add on to what he was saying. study after study shows that putting caps on non economic damages does not reduce the cost of malpractice insurance for doctors, and it does not solve the problem. . economic damages does not reduce the cost of malpractice insurance for doctors and it does not solve the problem. there are a lot of creative thing that states have done to try to use dispute resolution with doctors and patients. but using a blunt instrument like this just is simply not going to solve a problem and what it will do is take away what it will do is take away legit empty that legitimate patients might have. so this is not a solution.
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i support finding ways of reducing medical cost. i support finding ways to reduce medical practice frankly but study after study has shown this system doesn't work, even in states like bart's or mine other states that have passed caps on noneconomic damages. i will yield back. >> my time is up, mr. chairman, i yield back. >> all time has expired. the vote now owe on the burgess amendment. all those in favor say eight. opposed, no. the nos have it. >> request the roll on this. >> let's go to roll call vote. [ roll called ] >> mr. waxman? >> no. >> mr. waxman oat votes no. mr. dingell. mr. marquee. mr. voucher. mr. pallone? mr. pallone votes no. mr. gordon. >> no. >> mr. gordon, no.
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mr. rush? ms. eschew? ms. eschew no. mr. stupak? >> no. >> mr. stupak, no. mr. engel? mr. green? >> no. >> mr. green, no. ms. deget? >> no. >> ms. deget, no. >> mrs. caps? >> no. >> mrs. caps no. >> mr. doyle? >> no. >> mr. doyle, no. ms. harmon? >> no. >> ms. harmon no. ms. by cow ski? >> no. >> ms. by could you ski no. mr. gonzalez? >> no. >> mr. gonzalez no. >> mr. enly? >> no. >> mr. enly no ms. baldwin? >> no. >> ms. baldwin, no mr. ross? mr. wiener? >> no. >> mr. wiener, no. >> mr. matheson? mr. butter field? >> no. >> mr. butter field no mr.
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mallson? >> no. >> mr. mallson no mr. barrow? >> no. >> mr. barrow votes no mr. hill? mr. hill, no. ms. matsui? ms. matsui no ms. christensen? no. mrs. castor? ms. castor no. mr. sarbanes? no. mr. sarbanes no mr. murphy of connecticut? mr. murphy, no. mr. space? mr. space, no. mr. mcnortherny? mr. mcnortherny, no. mr. braillely? i'm sore. i apologize. ms. sutton? >> no. >> ms. sutton, no. mr. brayly? mr. brayly votes. no mr. welsh? mr. welsh no. mr. barton? mr. barton eight. mr. hall? mr. hall, eight. mr. upton? mr. upton, eight.
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mr. stern? mr. stern, aye. mr. deal? mr. deal aye. mr. whitfield? mr. whitfield aye. mr. ship cuss? mr. shattuck. mr. status aye. mr. blunt? mr. blunt, aye. mr. boyer? mr. boyer, aye. mr. rod dan know vich? mr. rad done know vich, aye. mr. pitts? mr. pitts, eye. ms. bono max? ms. bono max aye a. mr. walden? >> aye. >> mr. walden, aye. mr. terry? mr. rogers? >> aye. >> mr. rogers, aye. mrs. my rick? mrs. my rick aye. mr. sullivan? mr. sullivan aye. mr. murphy of pennsylvania? aye. mr. murphy, aye. mr. burgess? aye. mr. burgess aye.
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ms. blackburn? mrs. blackburn aye. mr. beginningry aye. mr. scully? >> aye. >> mr. scully, aye. mr. voucher? mr. voucher rotes no. mr. goran? [ inaudible ] mr. goran, aye? mr. marquee? >> no. >> mr. marquee, no. mr. matheson? >> aye. >> mr. matheson, aye. mr. rush? >> no. >> mr. rush votes no. mr. ross? >> no. >> mr. ross votes no.
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>> all members responded to the call of the roll? any member wish to change his or her vote? now the clerk will report the te. >> mr. chairman, on that vote there were 23@dxvz2> he offered the amendment as a way to get members on the record on the issue of a public plan. this is 30 minutes. >> this amendment seeks to clarify one of the great
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mysteries in the debate about health care. that is where my republican friends stand on government-run health care. that is where my republican friends stand on the issue of government-run health care. now on one level it's very clear, quotes throughout the debate have seemed to imply that they are against it. mr. sterns of florida said if the government runs, it it will be bureaucratic inefficient and many cases won't cover the people who want it. mr. terry of nebraska, government-run health care will lead to rationing and eliminate the sacred doctor-patient relationship and mr. blunt the marketplace is the only known mechanism available to deliver what people want. now i raise this subject because today is the 44th anniversary of president johnson signing the medicare act into law. now the medicare act is all of my colleagues know is not only government-run health care but it's remarkably good government-run health care. now i was criticized earlier for having shoddy charts so i got a
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little fancy. on this chart you see that not only is medicare public health care but also we have dod, veterans affairs and indian health service. now this is not only government-run health care but it's remarkably efficient. 3% overhead in medicare compared to about 30% in the combination of overhead and profit by the health insurance companies. remarkable satisfaction on the part of the contractors in the last national scoring that they did of this contractor. it got a 4.1 on a six-point scale and frankly we know it works. we know that when medicare before medicaid was passed we had a poverty rate of seniors of about 30%. now it's about 10%. we know also that the private insurance companies take about $600 billion a year and put it
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in their pockets, not into health care. now some people have held up this chart, this byzantine chart that talks about how they think the bill works. well, i've got my own chart. this is medicare, three boxes. the patients, the doctors and the one single payer so this amendment is simple. it gives my republican friends the chance they have been waiting for, to vote against government-sponsored, government-run, government-administered health care. it's your dream amendment unless, of course, you're going to continue to do this civil impression when it comes to medicare. first you like it and then you don't like it and then you like it and then you run against tfrmt the fact of the matter is that medicare is a pretty darn good model of what a public plan might look like. now it's not perfect.
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there are reimbursement rates in some case that i think need to be higher. i think we incentivize too much to go into hospitals and not enough on the other side. some of the things that are being done in this bill, but this is your opportunity once and for all with my amendment to vote to eliminate the medicare act, once and for all stamp out the scourge of public government-run, government-administered single-payer health care. this is your chance, and you know what? for all of the talk about how much you hate such programs i think you'd welcome this opportunity. now i'm going to vote no and i'll tell you why, because i think the medicare program works pretty darn well. i think it's administered efficiently. i think that you ask seniors, if you tell someone tomorrow who is 55 years old you're going to get medicare, that we're going to start covering people 55 to 65 and then maybe 45 and then 35 and then who knows medicare for everyone, you'd have a lot of people who would be pretty happy. there have been a lot of elements of this debate that
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have been hard to follow. i admit that, but one of the hardest that's been is the utter hypocrisy and contradiction inherent in the argument of many of my friends on the other side. this is put up or shut up side. if you don't like national health care, if you don't like government-run health care, this is your amendment. i dare you. i double dare you. vote yes on this, and then go home and explain to your constituents how you're so philosophically opposed to publicly funded health care that you voted to eliminate medicare on its 44th anniversary and let me just say since i only have 27 seconds left. there is one member here who voted in favor of medicare when it was created and who was present when it was signed 44 years ago, and on behalf of all of us i want to say publicly, i want to thank him for being there for us 44 years ago when it was signed and god willing he will be here to watch this be signed where we extend another
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example of efficient, sound publicly funded publicly administered health care and i yield back my time. >> the gentleman's time has expired. >> mr. barton? >> parliamentary inquiry. >> the gentleman will state his -- >> is there a requirement that a sponsor of an amendment has to vote for it? >> that's the usual practice in my experience. >> okay. >> then i will double dog dare the author of the amendment to put his vote where his mouth has been for the last five minutes and vote for it. it ought to get one vote. >> may i be heard on the inquiry. >> because my guess is it's going to get zero. >> the gentleman has made a parliamentary inquiry and now you're making a speech. >> i also want to speak on my own time. >> did you wish a parliamentary -- >> i'd be happy to hear before the chairman rules on the parliamentary inquiry, i wish to be heard.
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>> well, the chairman is certainly not going to rule on it. the chair does not know of any rule that requires the author of amendment to vote for it. let me recognize mr. barton, but if you'll allow me in celebration of the fact is it 44th anniversary of medicare becoming law. >> and the first medicare card went to president truman. >> we have pizza in the back for both the democrats and the republicans to celebrate this occasion, and just want the members to know that because you see people eating you'll know why they are eating but we'll continue the markup. >> mr. chairman, may i ask a procedural question >> we are. we have not started the 5 minute rule. >> thank you. >> mr. barkin, your five minutes. >> i rise in opposition to this amendment.
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there is a distinction, and i'm going to treat the men and seriously. there is a distinction between a government mandate and a government run plan. medicare is a government mandate. there are numerous government mandates and government entitlements. having said that, congress sets the requirements of medicare. it sets -- the executive branch issues regulations and implements requirements. to my knowledge, at least in my part of the country, medicare is operated by private companies under contracts to the federal government. we have never on the republican side of the aisle said that we oppose -- at least in this congress -- that we oppose medicare.
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my mother would not be alive today if it were not for medicare. she had a heart condition several years ago that was very difficult to treat. she went to houston to the hermann hospital heart center and underwent a two-part surgical provision that basically replaced her aorta. it is very complicated. it cost over $100,000. she paid out of pocket less than $500 because of medicare. you are never going to hear the ranking member say that we are opposing medicare. what we have tried to do when we are in the majority, we try to use a market system within medicare for thei. use a market system within medicare, medicare part "d," the prescription drug benefit,
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depends upon market competition that numerous private sector drug insurance plans offer their services and senior citizens choose which, if any, of those plans that they want to get their prescription drug coverage for. we use a market orientation to implement a government mandate. that is a far cry, a far cry from saying that we oppose medicare because it is a government mandate, so with all due respect to my friend mr. new york, you know, if he wants to eliminate medicare and he wants to eliminate part "a," "b" and "c" and "d why the "he can vote for the amendment. >> if the public plan under the initiative that we're considering today looked like medicare, would you support it? >> i didn't hear -- >> if the public plan, the public plan that's being contemplated in this bill looked like medicare, would you support it? >> we are working on several
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options of co-ops and pooling arrangements, one mr. shadeg sg offering, mr. boucher is working on a plan, if we could get something like that, we very might well support it. >> i want to yield to the vice ranking chairman. >> i thank the gentleman for yielding. i thought the ranking member's point was well made, that the difference in this debate is medicare is a mandated program that everybody goes to without options, without competition. if medicare -- a medicare-like plan that paid on average 80% of what is supposed to be the cost of health care was out there, certainly it would be appealing because it's not paying the entire bill. why -- you know, there are many doctors that won't take medicare patients. we'd like to see a system, i'd like to see a system where we assisted everybody into health care coverage, and i don't want everybody to be -- to have doctors they can't go to. you know the ranking member made a point about in trying to
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expand the benefits of medicare to part "d" as i said earlier for the first time ever, instead of trying to operate the system, we put a system together there where marketplace forces did work. it's cheaper than anybody thought it would be by 40%. it's a voluntary plan that 90% of the people that could be in the plan are in the plan. 90% of them think it's either good or excellent and 100% of them can change their provider sometime in the next 12 months. those would be good things available to people in health care whether they were on medicare or not. i said the other day i mentioned that medicare had not been particularly good at helping people prevent health care problems from developing, and in fact until 2005 or '06 when the medicare reforms were initiated, no medicare patient from 1965 until then had ever seen a doctor unless they were sick, had ever seen a doctor unless they were sick or they thought
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they were sick and got to the doctor consistently. it was our reforms to medicare that created the welcome to medicare physical where for the first time ever in the entire history of the program people saw a doctor when they entered the program and they got their blood pressure, they got all of those things created a baseline that helped them be well longer in a more effective way. we have not only supported the program, we have worked to improve the program and will continue to do that, and i think our time is expired. >> the gentleman's five minutes has expired. >> who seeks recognition for the second five minutes? are we ready for the vote? well, democratic time. mr. butterfield is recognized for five minutes >> i strike the last word, mr. chairman. i ask to strike the last word. >> will the gentleman yield? >> the gentleman is recognized for five minutes. >> mr. weiner. >> i guess the failure to answer
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my question speaks volume. the fact of the matter is you like medicare, right, because it's efficient, not bureaucratic? it's efficient. no one disputes that, okay. you like medicare. now the whole idea of medicare is that it is government-run health care. it's socialized medicine, that's what it is, and you know what? it works. one of the reasons it works is the $6 hundred billion of profits that we put in goes not to checkups, not to indigent people, goes to profits for the health care companies, so much so that the administrative overhead combined with their profit is 30% compared to 3% for medicare, so you like it. you're not going to vote for this amendment because you like medicare. you go home to your constituents and brag about how you fought to save medicare. that's socialized medicine. i just want to stop the hypocrisy of having you all stand up as frequently as you do
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and lament socialized medicine, bureaucrats coming between you and your doctor. can i tell you something, do you think there are no hmo bureaucrats, nine shurns company bureaucrats? >> will the gentleman yield? >> will the gentleman yield? >> let me just -- i don't control the time, but when i said what if the public plan looked like medicare, i didn't hear an answer. you like it, well, maybe the public plan in here is going to look kind of like medicare. >> would the gentleman yield? >> hold on a second. let me just finish this thought because if it is, it's going to be more efficient. now you have said repeatedly we have to careful because you're going -- if you let that be an option the private plans won't be able to compete. now that's a strange thing to say. do you mean that the public may choose something like medicare over your friends in the insurance industry? yeah. they might. you know why? medicare does a better job. people like it, so when you stand up and say socialized medicine, government-run medicine is bad, impolice i had
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in that is medicare, the va and vod health care which are government-run health care plans, so when you think about the public plan and you go home and say how bad it is, you're essentially saying you don't like medicare. >> reclaiming my time, i yield to the gentleman from missouri. >> i thank the gentleman for yielding, and you actually did hear an answer. the answer was when we talked to our health care providers where we live they say that medicare does not pay the bill and that has to be either by charitable donations or by other plans has to be supplemented. that's one of the reasons that the reimbursement rate from the private plans is higher than the medicare plan. that's one of the reasons they cost more. that's one of the reasons that the more people that go into a government-like plan the harder it is for those plans to compete, and when we talked to our hospitals and doctors i think the nationwide average is that the medicare reimbursement rate is right at 80% of what health care providers say is cost of service.
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>> would the gentleman yield for a moment? >> the point being made here is not whether or not medicare is perfect, i know that it's not. the point is the language of criticizing government-run health care is -- >> i believe i still -- >> is hypocritical and dishonest. you can't have it both ways. >> i think i still have mr. butterfield's time. >> the gentleman from missouri has the time. the gentleman from missouri has the time. >> i thank the gentleman for yielding and i will just try to answer the question and get the time back to your side. the point is if you have more people in a system that doesn't reimburse the cost of care, who does reimburse? and i'd yield. >> the gentleman -- the answer is the 15% that goes to profit goes back to reducing costs. >> well, i don't know -- >> i'm curious. you know, the idea that the health insurance companies are keeping prices at a certain level out of altruism, no, they are making profits. why are we putting profits into
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insurance companies rather than the practice of medicine? medicare doesn't do that. that's why medicare is such a success and that's why you wouldn't to criticize that as being government-run health care. you like it. you think it's good. it's better in many cases. have you a 30% combined overhead, 15% of it is profits. by the way, how much profit? about -- i'll tell you how much profit. $600 billion -- approximately $600 billion and that's on the rise so the question is why don't we capture some of that money and put it towards health care. you like medicare. you like socialized medicine. you like government-run health care and you are just afraid to admit it. >> will the gentleman yield? i can -- >> reclaiming my time, mr. chairman. i yield back. >> mr. chairman, the gentleman yields back the balance of his time. >> mr. murphy? >> thank you, mr. chairman. this is not the place to have sweeping prejudicial statements about whether people are hypocritical or dishonest. let's stick with some facts. new york presbyterian hospital of 93 internists affiliated with
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that hospital, 37 won't accept medicare. a medpac survey in 2008 said 29% of patients on medicare have trouble finding a primary care doct doctor. that's up 5% from the year before. in the last congress there were 452 bills introduced by members of congress. 13,000 co-sponsors of those saying we have problems with medicare and medicaid. let's fix them. only 12 were signed into law but it takes an act of congress to change government-run health care. there are lots of good things with medicare, no doubt about it but let me give you examples where you have procedures that require an act of congress. in order to get intravenous drugs patients must enter a hospital though therapy can be given at home. it will take an act of congress to change that. you have situations where medicare might not pay for a power wheelchair for an individual with sere arthritis who can walk a short distance but who may need a power wheelchair for longer distance and a private insurer may pay
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for that. some may not take part in clinical trials because medicare doesn't cover costs. >> would the gentleman yield? >> no, not yet. i don't want to be hypocrite camp i want to give you facts. there's also issues where you have situations where some patients require very expensive over-the-counter medications but it's cheaper than prescription drugs, but they can't get reimbursements for it. my point is this. the concern is not -- let's not create this straw man of sweeping generalizations that we don't like medicare or government-run programs. the problem is, it's between your doctor and you, it's congress. and what we have -- what we see in these things is many, many inefficient things that over the years -- now, what i would suggest we do is recognize, there -- just a mist -- there's a lot of great things happening in medicare.
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but it really needs to be reformed. 44 years ago it was made. it hasn't gone through reform since then. i think one great thing this committee can do is really spend time going through that. i would love if the president would appoint a blue ribbon panel and say let's find all the good things in this program, take out the other things, so you have efficiencies -- >> will the gentleman yield? >> i would yield -- >> i'd just like to make this point. it doesn't happen very often, but every once in a while, i guess as members we get to vote on amendments that are truly a political farce. and that's what this amendment is. it's unfortunate, because the author of the amendment is not going to vote for it himself. one thing i would like to note is that when, as you celebrate this anniversary of medicare, please note the numbers i'm about to give, i also gave when republicans created medicare part d and you were making these
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allegations even back then that republicans, how could be doing this, you don't even like medicare. so i'm going to repeat them today. when the bill passed the senate, when medicare was created, the vote was 77-21. and in the house, to pass medicare, the vote was 355-59. so please, it was passed by a democrat-controlled -- sir? well, i tell you what, mr. weiner, i would love to have conversations with you. but i don't have the patience for you to an are you going to vote for this amendment? >> i am going to yield back to dr. murphy. >> can yield for a question? >> you can beat up on insurance
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companies all day. some people may make a career out of that. you should not be up on senior citizens. so many seniors are concerned about the government takeover because of this bill cuts over $500 billion out of medicare. you can talk about how the medicare is. a lot of us think medicare has a lot of good component. you should not go and cut 5 under billion dollars of the medicare like this bill does. -- $500 billion of medicare like this bill does. it cannot sell this bill on its own merit, do not try to hide behind senior citizens. >> the boat now comes on the amendment. those in fiber -- favorite say aye.
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>> i request a roll-call vote. >> called the roll. >> mr. waxman? >> mr. waxman and boats in know. >> mr. dingell? n votes no. mr. ding el? mr. ding el no. mr. markey? mr. boucher? mr. pallone? mr. pallone, no. mr. gordon? mr. rush? miss eshoo. no. mr. stupak. mr. stupak no. mr. engel? mr. engel no. mr. green? ms. degette? no. mrs. capps? mrs. capps no.
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mr. doyle? mr. doyle, no. ms. harman? ms. harman no. ms. schakowsky no. mr. gonzalez? mr. gonzalez no. mr. inslee. mr. inslee no. ms. baldwin? ms. baldwin no. mr. ross? mr. weiner? no. mr. weiner, no. mr. butterfield? mr. butterfield, no. mr. melancon? mr. melancon, no. mr. barrow? mr. barrow no. mr. hill? ms. matsui? ms. matsui, no. ms. castor, no.
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mr. murphy? mr. murphy no. mr. mcearney no. mr. braley no. mr. welsh? mr. welsh no. mr. bart? mr. barton votes no. mr. hall? mr. upton? mr. upton, no. mr. stearns? mr. stearns no. mr. deal? mr. deal no. mr. whitfield? mr. whitfield no. mr. shimkus? mr. shimkus no. mr. shaddock? mr. shaddock no.
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mr. blunt? mr. blunt no. mr. williams no. mr. radanovich no. mr. pitts no. miss bono mack no. mr. walden? mr. walden no. mr. terry? mr. terry no. mr. rogers? mr. rogers no. ms. myrick? [ applause ] myrick no. mr. sullivan? mr. sullivan? mr. sullivan no. mr. murphy of pennsylvania? mr. murphy no. mr. burgess? mr. burgess no. mrs. blackburn? mrs. blackburn no? mr. gainbridge no. mr. doany? mr. doany no.
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mr. boucher? mr. boucher no. mr. murphy? mr. murphy no. mr. rush? mr. rush no. mr. hill? mr. hill no. mr. matheson? mr. matheson no. mr. green? mr. green no. mr. gordon? mr. gordon votes no. >> have all the members responded to the vote? >> is that everybody? >> any member wish to change? his or her vote?
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all right. when the clerk's ready, we'll get a report of the vote. >> mr. chairman, on that amendment, there were zero ayes and 57 nos. >> zero ayes, 57d(@ act as a progress, they considered another amendment by michael burgess that would eliminate the public health option from the bill. this is a little less than a half hour. >> without objection the amendment will be considered as read. the gentleman from texas is recognized. >> mr. chairman the recent article in the "dallas morning news" that, highlighted the troubles that a young girl had who was covered by medicaid. she had difficulty finding a doctor to treat her stating due
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to the lack of medicaid doctors, medication patients often grow sicker. there are of course similar stories out there every day outlining the difficulties that patients with government health care phase on a day-by-day basis. this is not rhetoric. this is reality and it will be reality for millions more americans who inevitably will be pushed onto the rolls of government-run health care if the public plan is part of the health care reform bill. a government plan would not compete fairly with private plans. it is like the umpire being on the home team and it does not work. so, the amendment is fairly simple. it strikes all language pertaining to the public plan and specifies in the bill that no federal funds may be used to invest in, establish or operate a government-run health care plan. now mr. chairman i'm committed to helping millions of americans who want coverage into lowering costs for everyone.
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i will not, however, allowed that coverage to come in a slow but inevitable takeover of our health care system and that is precisely what the creation of a public option, which is probably more properly referred to as government insurance, will do. let me be clear, i am not, i was not, i have not nor will i ever be an advocate on behalf of private health insurance companies. but i do believe the role of the government is to play that role of referee or umpire ensuring performance standards are met and that everyone is treated fairly but then it should get out of the way. and let american hard work in ingenuity and american know how do what it does best. that is why think it is so important for this amendment to pass. we do not need more government involvement in health care. we do not need a government-run health care option. it is often quoted the american medical association's in is in
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favor of h.r. 3200. let me just say from the perspective of my physician colleagues in texas, this is not a popular notion, so i would encourage members to think of their physicians back home, think of their patients back home. let's do the right thing by creating the right kind of system and reject the public option. i will be happy to yield to my friend from michigan. >> thank you doctor. henry ford was a great industrialist there and he said you can have any color car you want as long as it is black and that is all he sold where black cars. this is exactly where you are going with this notion on a government-run plan and you know i thought the tirade from my friend from new york was entertaining but the more listen to him that maury really understood that that is the philosophy where we are going. private plans are inherently bad and can't work for america and we should show everybody on to a government plan. as a matter that the lewin study
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over 100 million americans will lose the health care as they know it today, 100 million. as a matter of fact they said we are willing to use the weight of government to do great things to medicare, cut it $400 billion cut out of medicare. hospice, home nursing, hospitals , $400 billion. why? because that is the only way the government can control costs, by denying access or rationing care. that is it. look at candidate, look at the united kingdom. and systems that have it, that is the only way they can control costs and you are going to take all of these 100 million people come up with the monta a government plan that tells doctors, we will not pay you what it costs to see that patients. if you don't think that is trouble brewing, look at the
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health systems in the european system. they are dying under the weight of their system and as a matter of fact the fastest-growing part of their system are people who are escaping it in getting their own private health care insurance. americans deserve better. people like the states of michigan who built the middle class, who built this notion that you could work really hard and by the way you get great health care is part of your employment is destroyed by this system. if you are a cancer survivor, look out. if you are somebody who has a serious ailment that takes very complicated treatment, look out because you are going to have to call up a bureaucrat in hope to god his calculator is more compassionate and smarter than your doctor and i would yield back my time. >> reclaiming my time and i thank the gentleman is fashion. our subcommittee on health, his medicaid patient population grew to 70% of her practice, she was sparling from retirement fund to
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keep your doors open. >> the gentleman's time has expired. >> can i ask for an additional 15 seconds? >> without objection. >> if we take away the private sector the public sector cannot afford what it is going to be required to pay and doctors across the country are going to inevitably be borrowing for operational expenses and as the business model for those of you in the room who have run your own business you know that is not a model for survival. i urge an affirmative vote for this amendment and i would feel that the additional time and i thank the chairman for his indulgence. >> who seeks recognition? the gentleman from connecticut, mr. murphy. >> i thank the chairman. i understand the public plan has become the bogeyman in a lot of this conversation. i think it is a lot harder to present the argument if you really are reading of this is laid out in the bill. there is nothing to be scared of here because this ultimately
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gets at the issue that a lot of republicans have run on and talked about on the house floor and that is choice. that his choice for our constituents, for our patience. the fact is, there is no one that is going to be forced into the public option. it is going to be every individual's choice as to whether they want to stay in private insurance or they want to choose public insurance. if you guys are right, and the government can't run an efficient product, can't put something competitive on the market then it is going to lose out because this bill requires the public option finance itself completely with its own premium so it can do a good job of running its own show, then no one is going to buy into. seconded is not going to eliminate private insurance. we have the cbo as much as those this clearly that not only are there only by their estimate going to be 10 million people to take the public option which by my count is 3% of total patients across the country but we are
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actually going to see more people as a result of this bill, not let's go to private insurance, so contrary to the arguments we have heard those they are going to be about 3% of people in the public option, actually more people will be in private insurance, not less. lastly this methodology that is out there that people have a choice today is not rooted in fact. 50% of the states in this country have one ensure that controls more than 50% of the market. in some areas especially rural areas in this country, there is one ensure that controls 70% of the market. that is no choice for individuals who are trying to go out there to find a more affordable product. this bill with the public option gives people the choice and it is not just their choice. it is dr. choice as well. nil physician will be forced into this. it will be their choice as to whether the rate is enough to bring them in, so i think this is the essential to try to
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inject competitiveness into the health care market by giving our constituents patience in the system of choice they have been longing for. >> would the gentleman yield? >> i would be happy to yield to ms. spaulding. >> i want to underscore a you have just heard him talk about places with few choices to begin with. the public choice will make meaningful the idea of choice. i also this and stating the obvious. our private option is for profit. the public auction will not have the motivating force. it did get the ceo's salary of the top seven private insurance companies, on average is 9.7 million. that is an average. some are much higher. that is enough to cover 648
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families with health insurance for a year. that is what that is. the ceo of the public plan is going to earn a high government salary, under two and a thousand dollars. -- under $200,000. somewhere around $150,000. the last one i want to make, and i realize i have made this point many times before, is to draw your attention to the wisconsin example in medicare part d. in all your states, and all people have is private options. we happen to be fortunate in wisconsin as we have a public option. it is called senior care and it exists by waiver of the department of health and human services. this is a very successful program, very popular among seniors. the cost per enrollee is one-third the cost of private plans.
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but for all of those of you who are out there saying that inserting a public option will stifle private competition, we have more private sector choices in medicare part d in wisconsin than most other states. this has been a singular success to have a public option competing side-by-side the private option and i will tell you that every member of our congressional delegation, a democrat and republican when that waiver was up wrote the secretary saying please, please give us our waiver to continue our public option and when jim sensenbrenner and i can agree on something, dino you have got a good thing. so, we have got to keep a public option. >> ides is one their constituents to have this choice. wonder constituents to be able to decide whether they want to stick with their private plan or they want something kind of like we have as members of congress. i think that is okay to allow for our constituents to have that choice. i don't think there's so dumb as to not be able to figure out
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what is best for them and that is why i support. >> the gentleman's time has expired. >> mr. chairman? >> the gentleman will be recognized for five minutes for the last five minutes of debate on the republican side. i hope you won't take it and maybe go to the vote earlier. the gentleman is recognized. >> i won't make promises to take it because i think this is important. there is indeed a heated debate as to whether not a public plan will destroy private insurance. indeed there is debate in the minds of some members of congress because some members of congress have said flat out that the goal behind the public option is a single-payer care. indeed barney frank said that in a reported statement now being published all over the internet right now. he said the way we get to a single-payer system is to start with a public option. let's talk about choice but the republicans desperately want choice. we believe in choice but what is stopping choice in america today
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is not the absence of a public option. what is stopping choice in america today is that tax code says if your employer visor health care he days before tax dollars but if you buy your health care you have to pay with after-tax dollars. that makes it impossible for the average american to go buy health care on their own so they have to take health care that is controlled by a third party. if you want to give choice to the american people, then let every single american buy their health care with pretax dollars. if they like their employer's plan, fine, take that plan but if they don't, let them buy it with their own money. republicans would give them a tax credit to do it and give them a refundable and danceable tax credit to do it. democrats say that a public option will set a level playing field. it can't set a level playing field. n.t. there will be no property tax imposed on the federal government health care plan. there will be no financial solvency requirements.
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we were just told there would be no high salaries paid so we are favoring the public plan and the public plan will drive out of existence the private plans. it is just a matter of time. mr. frank is very blunt about saying there are members of this committee that it said that. talking little bit about what is the notion behind a robust option. do we need a robust public option for ottawa insurance? no we don't because we let people buy their own auto insurance on the same basis as businesses. do we have a public option, are you proposing a public option for life insurance? why should we be able to go to a public food vendor and get private competition and profit out of the food sales business? the reality is that a public option is not needed to promote competition. what is needed to promote competition and bring down the cost of health care in america is to empower individual americans and let them buy their
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own care. take their employers, if they choose or go by their own care with money that we give to them if they can't otherwise afford care. that is real choice. that is the choice republicans have been talking about, not some government plan. as for the choice that is given in medicare part d i believe you are repealing that in this deal so i don't know how, if that is the great modeled you can also seek to repeal it in this bill. there will be no fair competition by the private sector if you have a public choice option. we will subsidize it like we currently subsidize other public health care. i would be happy to yield to the lady from tennessee. >> i thank the gentleman from arizona for yielding and i find it so interesting as we have this debate, what we have seen in tennessee is what actually happens when you have a government plan, a government-run plan in competition with private
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insurance. our plan was put in place in 94. it was a test case for hillary clinton's health care plan. it was the public option plan that you can look at now with 15 years of data behind it and say, it did not work. look at what happened. when it comes to choice and individual choice, is limited and restricted that choice. people work for their private insurance plans onto a government plan and then to get cost back under control, guess what the governor had to do a couple of years ago? remove nearly 200,000 of them. guess what is getting ready to happen now? there are over 100,000 people there going to be removed. lack of competitiveness is what you see. you do not see more competitiveness. it is a plan that does not work. it has been described in our state as a disaster. >> plan quadrupled and costs and
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consumes 36% of the state budget and it ended up restricting access and driving costs through the roof and the yield back to the gentleman from arizona. >> i thank the gentlelady. we have offered the idea of choice on this committee in the past. i propose legislation that would let you drive-- buy insurance that was qualified in a separate state. that would address the problem the gentleman spoke about which is there aren't enough plans offering insurance in the state's on the market. but a public plan will solve this problem. >> the gentleman's time has expired. do we need more debate or be ready for a vote? okay. the clerk will call the roll. [roll call]
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[roll call] [roll call] [roll call]
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[roll call] [roll call] >> any other members wish to record their votes?
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the clerk will report the tally. this they look at teddy roosevelt. it is two hours saturday at 6:00 p.m. eastern. this week as expected, the senate judiciary committee voted to recommend the confirmation of sonia sotomayor . what is saturday at 7 eastern. next week, her confirmation as to the senate floor. live coverage of the full senate debate on c-span2. coming in october, tour the home to america's highest court, the supreme court.
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>> you are watching public affairs programming on c-span, created by americus cable-tv companies, offered as a public service. over the next several hours, we will show you some of thursday's congressional discussions of health care legislation, including comments from house speaker nancy pelosi, the progressive caucus, and john boehner. later in debates in the house energy and commerce committee which is marking up its version of a health-care bill.
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to as the beer summit. house speaker nancy pelosi says that the health care bill that eventually comes to the floor will be supported by both liberal and as -- and
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conservative democrats. she spoke with reporters for about 15 minutes. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> as a mother and grandmother, i'm very excited but the food safety bill that will pass the house later this afternoon. so important, so long overdue and now we will have a president to help sign the bill. today is also a day of celebration. -- for another reason. 40 years ago today, president johnson signed the medicare bill. just think of all the good that has done for our country and for our seniors. we now find ourselves in a similar place to be able to move forward with universal health insurance for all americans.
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quality, affordable, accessible health care for all. it is pretty exciting, i have to say. it is historic and is a big challenge. as members go home, they're sending them with a card. i do not have it here. it talks about what is in it for the american people. i think it is important for people to know because this is a kitchen table -- these are kitchen table issues. people's economic security is affected by their health security. under this legislation, no discrimination for pre-existing conditions, no dropping of your coverage because you are sick, no refusal to renew your coverage if you have paid in full. no more job losses or job decisions makinbeing made on the
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basis of who has health insurance. no excess of out of pocket expenses, the deductible or co pay, you're the caps on what you pay, but no cap on your benefits. very exciting. these are initiatives that are very important this legislation and they are to correct what the insurance companies have done to america and to the health of our people over the years. it is very clear that what a strong public auction in the legislation. insurance companies are out there in full force, corporate bond in shock and doc against the public option. so much so that when you ask about the plan, they're on certain of it until they tell you what is in it. -- until you tell them what is
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in it. but when you tell them what is in the plan that changes in 56 in favor. we have great diversity in our caucus, geographic and otherwise, that will be reflected in the legislation. the education and labor committee has reported out its bill and now we're waiting on the energy and commerce committee to put out their bill. these will be posted -- two of them have been posted on the internet for awhile. the third one is reported our, it will be. and the american people will have a chance to see what is in it for them and our members will have a chance to discuss this with their constituents and when they come back into deborah, it
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will take up the legislation and make it another historic decision for the american people similar to the legislation that lyndon johnson signed 44 years ago. i will be pleased to take any questions. >> [unintelligible] a lot of liberal members in your caucus, some of them now indicating they will not vote for the reform if it looks like this. what are you telling them and how are you going to reconcile these two different wings of your party that seems so far apart right now? >> first, let me say i do not see it that way. i do not see us as different means. i do not think there was any deal with chairman waxman the proposals made by some in our caucus and who served in our
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committee was to be a reflection of what they thought would work for their district and i respect that. çbut this is one piece of a try committee process -- a tri- committee process. at the end of the day, i tell my members that we have to have universal, quality affordable health care for all americans, and we will do that. we will do so working together. >> if you could please give me a yes or no answer on whether or not you personally support expressly prohibiting the funding of abortion through the federally subsidized health care.
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today, energy and commerce, tomorrow as their work on that bill, may be addressing that issue. >> a congressman says we are opposing our leadership on the health care bill. how're you going to solve this? >> i'm sorry, i did not hear his statement. he is a valued member of our caucus, a serious member of the energy and commerce committee. he has worked hard to have all views reflected in the bill that will come out of our committee. >> if the agreement with the blue dogs holds up in the final bill, how will the public option insurance be able to compete if it has to negotiate reimbursement rates? >> i am for the strongest possible public option because the president said that is the way you keep the private sector
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honest, it is how you have true competition as you achieve universal quality, accessible health care for all americans. the language that is in the proposal by the blue dogs is the exact same language as the bill in the senate. i think there is plenty of common ground as we move forward on this for people who share a common goal and are supportive of common goaloption. >> [unintelligible] does that meet your test of a robust public option? >> senator kennedy's bill is one that i think would be ok. it is not my preference. my preference is a stronger
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bill. it meets the test of having an effective public option. we're talking about one committee year and another here and we have to other committees that have a stronger haveoption in them. as the members go home and the public makes their voice heard, then we will see where we go from there. i have enormous respect for senator kennedy. i know he has a lot of support for a public option. i would prefer the language in the ways and means committee or the education and labor committee. >> it was suggested that it might not have been a good idea to set a deadline. do you think a deadline, in retrospect, was a good idea? >> it does not matter.
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we have worked toward the deadline. if we did not have a deadline, we would not be as far along as we are now with two committees on the verge of doing so. we're waiting to see what the senate will do. that had some impact on our ability to move forward. and we're still waiting to hear what that is. you have a number of things to do by the time a bill gets to the president's desk. you can be very prepared by the time you vote to go to conference, having a clear understanding of what the other body has to say about it.
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a lot can be achieved by having a day preparing us to move forward. >> [inaudible] will they be allowed to charge higher premiums? and if so, will there be a cat? ç>> the competition is an important part as well and thank you for the question because it points to why we need this legislation certainly, for all the reasons that i mentioned and many more, but unless we have this legislation, the upward spiral of health care in our country would not only harm our families and the competitiveness of our businesses, harm the vitality of our economy, but also increase the cost of entitlements. the idea was to have stiffer competition for the insurance companies.
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>> no discrimination against people with pre-existing conditions. >> there have been objections to the public's option, but they're also talking about what they think is a disproportionate amount of influence by the blue dogs. do not agree with them that they have had a disproportionate clout in this process? but this happens to be a proposal of four people who happen to be members of the blue dog coalition. the blue dog coalition has not put this proposal forward. these are four individuals of the committee who have said, this is how the bill would work better for me in my district. the treatment of public'soption and its
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provision works better in certain districts. this is about health care reform that will work. i do not think there is any disproportionate influence when members speak out in favor of their own constituents. we are not a rubber-stamp congress and we are not able numbers -- a rubber-stamp caucus. nor would i want to be among the leadership of such a caucus. we have tremendous ginettdiversd all of these forces come to bear. it is a great kaleidoscope some days, this half of the room is working these evita's half of the room, some gates it is the back of the room to the front of the room. we are all the resources to each other.
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every one of our members is valued. everyone of our constituents has our right to be heard as we develop this legislation. it is pretty exciting. i have been meaning to tell you this for a while, i have a great but that a friend of mine gave me. it has, you might call it a dictionary, but it has big descriptions of how words came into being, or phrases. and one of the phrases is called "thank you, ma'am." franklin roosevelt' use it when they hit a bump in the road. it is just a bump in the road. power became a "thank you, ma'am" is that it probably came from the fact that when a young man was courting a young woman and they were driving down the
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road and they would hit a bump in the road and she would fall toward him and he would say, thank you, ma'am. so, a bump in the road became equated with "thank you, ma'am. so, we have a few of those going on around here when we are dealing with a bill of this size. this is all in a day's work. the legislative process, are democrats will be together to vote on comprehensive health care for all americans. it is very exciting. and today will be exciting as the committee moves forward. but do not forget as you go home tonight, food safety, very important. very important to moms and grandparents and dads, too, i'm sure. this is historic. it is about health, as was the regulation of tobacco. it is about health. tomorrow, we'll be talking about the accomplishments in his first
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seven months of the year and that will be part of how we have advanced not only health care, but the good health of the american people. thank you all very much. >> thank you, ma'am. ç>> [laughter] >> more about health care legislation from a news conference with a house of liberal democrats from the progressive caucus. the loss a year from the chairs of the black, hispanic, and asian caucus, also known as the tri-caucus. >> hello, everybody, and thank
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you for being here, tri-caucus and progressive caucus members hanging very strong for reform that takes care of all americans. we have one major announcement today. we have a letter to the leadership and to the three committee chairs that will during this break -- we will pull the three committees together and all the bills together. >> we have gathered here today to demand that the final health care reform legislation has a robust public option. [applause] cantu gah we will vote against it if it does not.
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[cheers and applause] the insurance companies have at the gates to provide the kind of compromise that we need. they have shown that they cannot or will not do it. and 46 million americans do not have insurance. another 25 million are underinsured. costs are skyrocketing. over the last decade, health care costs on average more -- have risen on average more than four times faster than the average worker's wages. in the current medicare provider network and infrastructure and rates -- through the current medicare provider network an industry trend rates will be able to change this. it will provide much-needed competition and it will force the jurors to control the costs. using the medicare provider network we will reduce our costs by $75 billion and ensure the
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public plan can begin when the new health care exchange is set and ready to go. many of us favor a single payer system standing up here today. [applause] but we have compromised. we have rallied because we want a plan with a meaningful public option and we can compromise no more. [applause] when leaders of the house meet in august to consider the three bills and produce a final one, we expect that it will retain a row -- a robust public option. if it does not, we will vote against it. [applause] we're gonna have all of the chairs of the caucasus speak today and that we will have a few other members who want to say a few words and then
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questioned for of long as you choose. barbara lee, chair of the progress of black caucus. [applause] >> thank you very much and thank you for being here. i am from the nine congressional this trick of california. chair of the congressional black caucus, 42 members strong. for many years, members of the congressional black caucus and our members here have been leading the charge on comprehensive and for comprehensive and health care reform. today, we're closer to providing quality health care to all americans than ever before, but the fight is not over. we must continue to reject these claims that the cost of reforming health care in america is something that our nation cannot afford. we reject that. the money is there to pay for coverage for all americans. to the contrary, if we act -- and if we fail to act now, we do so at the peril of the american
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people the american taxpayer will continue to suffer from the economic consequences of observing health care costs that are spiraling out of control. we must act because the quality of life for millions of americansç and the health of or economy hangs in the balance. but to understand all of this, the cornerstone of comprehensive health care reform is a robust public health plan option similar to medicare. medicare has worked. let me be clear, there are many of us who will continue to fight any efforts to water down a robust public health plan option like medicare. we will fight this with every bit of our strength that we have now and until we come together with this three-prongea bill in the timber. -- in september. [applause] the benefits of a public health plan are obvious.
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they will guarantee coverage regardless of pre-existing conditions. a public health plan would give patients a choice of doctors and hospitals. and it will build in incentives for private insurers to lower health-care costs. that is what we want, lower health-care costs. and that is why public health care plan is extremely important. when it comes to the public plan, we know that the congressional black caucus, congressional and hispanic caucus, the congressional asian american pacific caucus speak with one voice. [applause] health care should not be a privilege, as it has been in the past. it is a basic human right and should be a basic human right. that is what we're saying, it should be. [applause] in the wealthiest and most powerful country in the world. i give you know my colleague who chairs the congressional
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hispanic caucus, the congresswoman from new york. greg thank you, thank you so much. -- >> thank you, thank you so much. for working families in america, the message is clear, the american public expects for us to pass comprehensive health care reform, one that really provides access to quality health care to every american, especially those working families and the most vulnerable. it is amazing in the richest, most powerful country in the world, 47 million americans every day goes by without access to health insurance. we are here to say we cannot support any deal that short changes in working families and the most vulnerable in our country. i stand here and say that, you know, business as usual is not
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going to work. it will not be able to support nothing less than a real comprehensive health care. taos is strong -- that has a strong, robust ,optpublic optio. the only way we can do this is by providing competition and the on the weekend provide competition is by having a public option. [laughter] [applause] we must ask in all of this, where is the accountability for the insurance companies. how do we insure that they are held to higher standards. i know that we're going to go home and i will ask the public to visit members of congress and to share with us is strong commitment and a strong desire to do what is right for all americans. we cannot achieve anything less, nothing less how that will not
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cover the working poor and the malls to vulnerable. thank you. [applause] >> mike honda, where are you? from the asian american caucus, come up here. >> thank you, congresswoman. i'm always behind you. first, i want to thank the media for being here because it is true that we will be able to get our stories out. we stand here to support the progressive colleagues in the energy and commerce committee and in the house of representatives to firmly state my unequivocal support for a robust public option. i have listened to the so-called compromise being pushed by the four members of the house. the reason compromise will, one, cost more than the original bill, two, and pose a greater burden on working families, and three, get the public plan, eliminating access to subsidies
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for families between 300% and 400% of poverty. the people in my district are relying on us to bring to reform to our district and this is not it. every day, i received calls and the mails to preserve a pop -- a strong publicç option that woud drive down the cost of care and allow more families the protection of health coverage. the private insurance companies have decades -- have had decades to provide meaningful reform to our system. they have failed and congress must now act boldly in order to save lives. at 11% of my constituents in my district, better known as silicon valley, are left without health care coverage completely and more are underinsured. they need a meaningful subsidy structure. my constituents and into joyous across this country will continue to struggle with the high cost of private care.
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in my district, families below 400% of poverty are barely at the median income level and struggle to buy homes, make rent, pay for food and gas. a strong public option is necessary to truly reform our health care system and i will not vote for reform without one. let me close with this one thing. a lot of us have come to congress and a lot of us are in office right now because people wanted to change -- wanted a change. we said in the last campaign, "we can do with." now we have to fulfill that word. thank you. [applause] >> thank you very much. i represent the seven districts -- the seventh district in arizona and i am co-chair of the congressional hispanic caucus. all of us know how important -- those of us that are here -- we
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are at a crossroads in this country. we are at a point where there is no retreat and we can and must hold the line. what are we holding the line on? we are holding the line on the fact that we come from the beginning, have been promoting single pair and an absence of that -- and that is what happened. we all have to be honest with each other. we are now saying that we must have a mustoption that is -- must have a public option that is meaningful, that has medicare as it provider network, that has medicare plus five as it's great, that we do not negotiate with private insurance companies for the raid on the public option. and this will not be paid off. this will not be paid off the backs of small businesses, working people and poor families. [applause] we are supporting what happened
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out of ways and means. we are supporting what happened out of education and labor and refined what is happening in energy and commerce unacceptable. we are not obstructionist. we are advocates. we are here to advocate for the simple right of every person and every american to have an opportunity to have quality health care and equality live in this country. we are not obstructionists. we are not here to divide or embarrass our party. but we are here to remind our party that has democrats, we have some basic values and one t@ @ @ @ @ @ @ @ @ #mbá @ @ @ @
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>> we took the seven members that our energy and commerce that are part of the blue dog
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coalition and looked at their districts collectively. in their districts there were 671,000 people that are uninsured. 6500 families lose their homes and their businesses because of bankruptcy, because of health care costs. we had over 3200 people, almost 40,000 people trapped in that medicare don't hold that with the public auction would not be there. that will cost almost $1 billion or more of compensation for their facilities in their providers. there 99000 small districts -- small businesses that would receive a tax credit. that is part of the strategy. sometimes we play too much chess and do not talk enough with the public. i think the public are going to talk to those same members and say, give us a break, too. right now is about insurance companies and what they need.
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this is about communicating the general public in saying this is what is in it for you. we have to put that kind of political pressure on. >> i am curious as to, it allows them to negotiate within a range. >> it detracts from having a strong public auction. >> the problem with the deal that has been struck is that when you negotiate from medicare rates upwards to where the private insurers are, that is sending the cost value up. the goal of a public plan, in addition to all of that coverage we talked about, is to lower costs for all americans. those of us who have health insurance and all americans. the only way that you do that is
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to have a set rate, medicare plus five, and then you have a competition that is real. and not understand what the insurers are afraid of. they are afraid of the competition. what i say is that we have a medicare plus 5% set rate that will ensure that we bring the cost curve down. it will insure that we bring people into the system, and will provide quality care. if the insurers believe in the market, we believe in the market. it is important to compete downward on cost and not upward on cost. >> have any of the progressive caucus members signed that letter, and if not, have they given you any indication whether they will support or oppose the deal? >> it would not be appropriate for them to sign the letter. they are in marked right now.
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-- they are in a mark up right now. we do expect the bill to get out of committee. >> in the month of august, those who are opposed to various forms of health care reform are going to unleash an onslaught -- that would make it difficult for almost anything to pass. >> there will be a lot of ads. we stand here for americans. we want to save lives. we want a bill that can save lives and reduce costs and is competitive with private insurance. the deal they set out yesterday set a limit on what a public plan would be, and said that private companies can raise their premiums as much as they want. we want an insurance bill that will cover most of americans that is fair, that lowers costs, and you all know the pre- existing conditions and all that is in there.
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write a good story. 53 boats, and we do not believe we are born to get any republican votes in this bill. -- 70% of americans want a strong, robust public plan. >> you said you cannot support the bill as it stands without a public auction. are each of the chairman of the various caucuses saying they will not vote as a group unless it has an option? >> we have a letter signed by 53 members saying they will not vote for a plan that does not have a public option. >> the speaker said today that she was for the kennedy public option. is that enough to satiate
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everyone? >> there is a great deal of affection and love for senator kennedy and the work that he is doing and has done. but i also know the pathway that senator kennedy family's has walked in. they have walked against the odds and stood for those who could not stand for themselves. i will stand here in the name of senator kennedy, and i believe that in standing in that name, we are standing for those -- i think the numbers are as high as 83% who want a public option because they know that $1,800 are being lost by families every year. do we want to take the flesh of the working people of america by $100 billion on the plan that is being proposed by the blue dogs by cutting the subsidies so that these low income families cannot have a public auction? -- a public option.
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i stand with the nurses, doctors, health workers, the sick and the downtrodden, the children, i stand with the victims of h1n1 who have not been able to get into the hospitals today because there is no public option. i will close on this, because i think senator kennedy will understand this. i said this before, and people a quizzical when i say it. i am here today because of the voting rights act of 1965. if we could not unify or push to do the right thing, it could have been a voting rights act that said let's do a study as to whether african-americans need the right to vote. i am not going to support that. we want a vigorous wantoption. -- a vigorous public option. >> what do you think pelosi and reid should do right now to get
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the needed votes? >> votes on what? >> to be able to pass the health care? >> they have a ways to go. the next step is to take the three committees and put those bills together. they need a bill that has a robust public option, and then they will have the votes that they need. >> in education and labor their state amendment that passed that did not cost a single vote in the committee that would allow states to do single payer. are you all going to fight to keep that language in the bill? >> i am, and i will let somebody else speak to that. >> absolutely, we will fight to keep the state's right to single paper -- single payer.
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we are born to vote against a bill that does not have a robust robustoption. we made it very clear. we are wrong to stick together, and most of all, we want the american people to get out there and let the government know that they want a robust public option. >> wasn't it a mistake not to draw a line in the sand on single payer? >> in terms of a strong option, we understand some are saying no more than one trillion dollars and have added $100 billion. the costs have been added while the expenses for this proposal have been reduced. we are saying, on whose backs does this $100 billion lie. we are insisting that included
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in a strong and robust public plan, we have to have the resources to pay for that, and prevention is a large part of that. we are not going to accept the most vulnerable, the working poor to pay for the insurance industry and the profits that they will make if, in fact, this works the way this latest proposal is presented. >> thank you very much. thank you all for coming. >> health care legislation was also one of the toppings at a briefing with house minority leader john boehner. >> good morning, everyone. in february, i said that the era of big government is back, and democrats expected to pay for
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it. that is exactly what has happened this year. if we look at what has happened , they passed 81 trillion dollars in stimulus package that no one read, and has not created the jobs the democrats said that it would. as a matter of fact, we have lost some 3 million jobs this year already. in the house passed a national energy tax that will kill jobs by driving up costs for families and small businesses. now they are cutting deals on a government takeover of health care that will raise costs, drive up the deficits, and destroy jobs in america. on health care, it is clear that the more americans hear about the president's health- care plan, the less they like it. in a new npr poll, it shows that more americans oppose the plan and support it. a new gallup poll was out also
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indicating that the more americans hear about it, the less support it has. the majority of americans are opposed to their plan. higher health-care costs are the key issue for most americans. they like the coverage they have, but they want lower cost. they do not want to expand government. there is nothing in the democratic proposal that will reduce costs of health insurance for the average american. none of the committee chairmen who are writing this bill have any private sector experience, and for that matter, neither does the president. they have never met a payroll that was not provided by the taxpayer. they have never negotiated a package of benefits or health care package with their employees. nor have they ever had to make a decision about whether to hire an employee or how to handle an increase in insurance premiums. the bill they are writing, i
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think, reflects that. it is going to raise costs of doing business is for smaller firms, forcing them to make tough decisions like cutting jobs or cutting benefits. i think the deal cut by some of the blue dogs really does not make it any better. it still includes a job killing small business tax and a health care mandate for those small businesses. it still cuts medicare and choices for seniors, and it still puts the government is are in charge of personal medical decisions that only patients and their doctors ought to be making. it is the same plan that democrats have been trying to ram down americans throats all year. clearly, the american people did not want the government involved in delivering their health care. the one real reforms a drive down costs for themselves and their families. democrats appear ready to leave town for the august recess with
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a so-called deal in hand. i think it is safe to say that over the august recess, as more americans learn more about their plan, they are likely to have a very hot summer. with that, i will be happy to take your questions. @@@@@@@ @ @
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that should be under way this fall and it will be interesting to see how many programs are eliminated or cost savings are found as they move their bill, which inevitably is going to lead to higher taxes. >> it is pretty clear that the big government run program they want is eventually going to crowd out the private sector. in their bill it says that after five years, you cannot buy a health insurance policy on your own. you have to go to one of the government exchanges to buy a plan designed by the government. it is right there in the bill. all you have to do is read it.
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it is pretty clear that we will have a big, government run system that will eventually drive out the private sector plans we have today. it also says that after five years, every employer sponsored health-care benefit has to be approved by the department of labor and the new health choices czar to make sure that it meets federal standards. it is pretty clear the government is going to design the health insurance policies that will be out there. >> [inaudible] >> i think the comments are a bit bizarre, but i believe the
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management of this to the president. >> [inaudible] >> there are hundreds of health insurance companies out there today that provide a service. they certainly are not lily white in this fight, but most americans like the health insurance they have. they think it costs too much, and i understand that, but there is nothing in their proposal to drive down costs. at the end of day, that is what the american people expect. >> [inaudible]
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>> i have a lot of things on my plate, like making sure that our economy gets rolling again, making sure that we get jobs growing in america, trying to stop their national energy tax, trying to stop the government take over of health insurance. i have a lot of things i focus my efforts on. i cannot focus my efforts on everything that happens. >> [inaudible] >> i think the polls are saying clearly that the american people --
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>> republicans are not out there criticizing medicare. >> if you look at both of the plans, they are both going bankrupt at a very fast pace. one of the concerns i have with regard to medicare is that they are going to cut medicare advantage and limit the choices that seniors have today. in my district i have tens of thousands of seniors who are enrolled in a medicare advantage program that they like. it will be severely cut, if not eliminated in their proposal. if you look at their medicaid expansion, they will expect the states to put up tens and tens
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of billions of dollars more. this is not the direction the american people what. at the end of the day, finding a way to put these programs on a financially sound basis will probably be the most important thing we can do. >> [inaudible] >> this is not about republicans. this is the american people oppose the opposition that is growing. you see it in the polling. i walked airports. i go to home depot. i have people who stop me nonstop to voice their concerns
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and their outrage. i spend time traveling around the country. there is a lot about rage out there. >> are you worried there will be a blue dog deal? >> [inaudible] >> do you think the private sector is divided?
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>> from most of the private sector associations i have talked to in town, they have serious concerns about the house democrats' proposal. most of these people have been involved in conversations with the white house. i think they continue to be in conversations in the white house. we have seen muted opposition from a lot of these groups, because they basically have a foot in each camp. these companies and these associations understand that the american people want us to deal with health care reform. both republicans and democrats on capitol hill want to deal with health reform, but we want to do it in a responsible way. throwing the current system under the bus and replacing it with a giant bureaucracy is not what the american people want. we could make the current system work better for more americans at lower-cost, but that has to
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be the focus, not having 53 new agencies, boards, commissions, and programs, as we see outlined in their bill. >> [inaudible] >> i have tried to make sure i understand what is in every bill. while i may not have read every word in every bill, the fact is when you file an 1100 page bill at 2:00 a.m. in the morning and you are passing it that day, it is pretty clear no one had read it. when you file a 316-page amendment to the energy bill in the middle of the night, it is pretty clear that no one had read it. yesterday, when you file three different versions of a food safety bill, the morning of the
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day you are going to pass the bill, it is just not the way legislation should be considered. i was the majority leader at one point. i understand what the responsibility is. i do not remember an instance, not one instance where we did not make sure that the bill laid over for a least 24 hours so members had a chance to read it. the american people expect us to know what we are voting on. i think it is our obligation and responsibility as members to know what it is we are going on. thank you.
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mr. chairman.
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>> mr. green. >> could i just ask the staff or counsel does anything in this bill change any of the requirements that are placed in 2005 or under current law on documenting whether someone is undocumented or not for medicaid purposes. do we amend the previous law to eliminate any of those restrictions in this legislation. >> i don't believe so. okay. >> mr. chairman, the concern i have is that from counsel, i want to make sure we weren't touching whatever previous law was in place under the new legislation on medicaid. the state already has enforced the restrictions on noncitizens not being eligible for medicaid. i can't sit here and say somebody doesn't sneak through with a fake social security card -- >> gentleman yield to me.
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>> as i understand this amendment, it would require people to show they are citizens. the law is if you're an undocumented alien, you're not eligible for services under medicaid, period. that's not being changed. but this would require people to come and establish whether they are citizens. the people that get hurt are u.s. citizens who don't have a passport or can't find their birth certificate and go to the hospital and trying to get medical care and not going to be able to get medical care unless they can show they are u.s. citizens. this amendment we know has done a lot of harm. it got to the point where it was being enforced in some areas where children who were born in the united states at the hospital were not being eligible for services as u.s. citizens
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unless they could prove their citizenship. so this is an amendment that is very substantive and harmful to u.s. citizens. if you're an undocumented alien, you're not eligible, unless it's an emergency. and if you get brought into an emergency room, i would like counsel to respond to this, as i understand this amendment, if yore brought into an emergency room, you have to establish whether you're a u.s. citizen. is that an accurate statement? >> or if you are a qualified alien. >> well, counsel said if you're going to an emergency room to get medical care after an auto accident or whatever, you have to be able to establish that you are a u.s. citizen or a legal alien. >> i would imagine someone would bleed to death before you can get the documentation. i would certainly oppose the amendment. i yield time back to the
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gentleman from texas, mr. green who still has time available. >> mr. green? >> i'll be glad to yield. you raised the same questions i have and i've yield to the chairman of the subcommittee. >> mr. chairman, just following up on what you said, the problem is right now the references that are in here to section 1903. those provisions about establishing citizenship and what you do, those were all things that were included at the request of the republicans before and they are in -- they are the law now. and what's happening is as you've said, a lot of people who are citizens are not getting care because of these requirements and there's no evidence that people who are illegal are getting the care. i don't need point of adding another burden when the evidence suggests that illegal can't get the care and citizens are having a hard time getting the care and we've -- we're operating under republican provisions as how you
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establish your citizenship already. this just adds another layer, maybe, which is not necessary and is going to make it more of a burden for people who are citizens to get care. doesn't add anything at all. i don't see the point. i would oppose it. i yield back. >> gentleman? >> from texas, yield to me on this 45 seconds. i thank you very much for yielding. the point is that the law now requires, if you go in for medical care under medicaid, you have to show you're a citizen or you have to show you're a legal alien. that's the law. what this amendment would do, any time you go into any institution any any circumstances, even in an emergency room, you of would have to establish either citizenship or you're right to be in the united states. and the people who have been harmed by the existing law have been u.s. citizens, often times from poor rural areas where they don't have the birth certificate
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or passport and people are -- if you're anticipating going in for medical care, can you get that f you're not anticipating it, you could be in deep trouble. >> mr. chairman, i rise in support of the amendment. i want to just try to focus the committee's attention on the real world. we put citizenship verification provisions into the deficit reduction act of 2005. those went into effect in 2006. there was a great cry that people had lost their birth certificate or born before there were birth certificates and wouldn't be able to prove. we added by regulation a volumous way of identification besides the birth certificate issued by county -- or a state. well in the medicaid s chip
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debate last year, the verification procedure was suspended. and now for s chip children just have their parents have to affirm that they are here in this country legally. it's personal affirmation. that's the standard. personal affirmation. we still have for adults on medicaid the citizenship verification that we put into place back in 2005. having said that, section 1802 of this bill says that the state shall accept without further determination the enrollment under the medicaid program of an individual determined by the commissioner to be a nontraditional medicaid eligible individual. the states are going to automatically enroll millions of people automatically. and what the deal amendment says is before those millions are automatically enrolled, that we use the verification procedure
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to make sure that they are eligible. that's all it says. now, people bleeding to death in emergency rooms and all of that, that's not happening in my public hospital in tar rant county, texas in john peter smith hospital, it's somewhat anecdotal but i believe it to be true, 70% of the births last year were to undocumented residents of tar rant county, 70% because jps has chosen, that if you come into that hospital and you're about to have a baby, they are going to deliver that ba baby. people are not being turned away if they don't walk in with the birth certificate. what we should do, if we're going to expand medicaid eligible for child with adults and all of these new, as you put it in the bill, nontraditional
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medicaid eligible individuals, it makes sense to insist that the verification procedures that are on the books be used for these automatic enrollees. that's all this amendment does. >> gentleman, yield. >> yield to mr. shimkus. >> allowing states to use records such as dmv, we know california providesimmigrants, they can use those to say they are a citizen. this is a clear amendment to say if you want taxpayer funds to go in this health system for illegal immigrants than vote no. if you want the taxpayer on the hook of paying health care for illegal immigrants than vote against this amendment. it's really simple much and the fact is states are allowed to waive verification requirements by a statement by a family
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member. so the choice is clear and i would yield back to the ranking member. >> thank you, mr. chairman. real quickly. oregon was the only state that allowed for an audit to be done on this issue of medicaid enrollment, when it was done in 2005, the state found 3% were illegal aliens and that the 2005 report by the inspector general at hhs found 46 states in the zringt of columbia to allow self-de self-declaration and this is a real issue if you're paying the bill. we're trying to get people to take care of people who are here legally. i yield back. >> thank you, just to add some local flavor in omaha, my sister was a social worker who signed
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up people into the system. and she brought a group of her co-employees to me seval years ago and said they aren't even allowed to ask about citizenship. they knew therapeuty were signia lot of those undocuments. we're talking about taking it to the level where they are allowed to ask for verification. >> gentlemen, it's time -- i yield back. >> the chair recognizes. mr. barton and i had a discussion, right now the verification is in effect. but what i'm concerned about and express concern about, is emergency room. and he thought that was, if i could repeat our private conversation, the emergency room is an exceptional situation. and when we passed the chip bill, we made a modification for
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children. i would like to question that unanimous consent that we limit this amendment -- let me put it this way, that the amendment be changed to make an exception for emergency rooms and care and for care for children. >> mr. chairman, reserving the right to object? >> i would like to make an inquiry of counsel in that regard. is there anything in this amendment that in any way repeals the statute which requires emergency rooms to treat individuals regardless of their status, regardless of whether or not they have insurance or regardless of any other circumstances, is there anything in this amendment that would repeal the requirements that currently apply to emergency room snz. >> no. >> gentleman yield to me. >> it won't eliminate the requirement for the emergency
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room to treat somebody in the emergency but it will eliminate the hospital from getting reimbursed mr medicaid for having given that care. the hospital is not going to be able to verify in an emergency that the person is eligible or not ineligible. >> reserving the right to object. >> be recognized. >> mr. chairman, i don't know there's any reimbursement question here. if you're not covered by medicaid and you go to an emergency room, the hospital still doesn't get reimbursed. that's not an issue. you get the care and you're not reimbursed if you're not covered by medicaid and private insurance and other people make up that gap. that's part of the whole problem of eliminating the private system. nobody is left to fill the gap of people that the emergency@@@@ å@ @ @ @ @ @ @ , h
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so i would suggest that the amendment that is -- i think it's a friendly amendment being offered and might bring us a place to vote for, it's a service that can be offered to anyone who can't show documents. someone hit by a car, doesn't bring their wallet, doesn't have a family member, would have to wait until the service was provided. >> mr. chairman, if i still control the time, i would like to say, that question has been asked and answered. there's nothing here that repeals the access to emergency care. this is about a question of coverage and taxpayer funded reimbursement at some future time. the gentleman's amendment would just require documentation to be part of a covered program. >> gentlemen, i disagree with you and hear what you're saying.
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i'll withdraw my unanimous consent and urge members to pass the amendment. i was recognized for five minutes. so i want to -- want to further debate this matter. i just think this is going to be a bureaucratic nightmare for people at emergency rooms of hospitals to try to decide when somebody is brought in unconscious, whether they have their birth certificate to show they are a u.s. citizen. and i think the people that are going to be hurt are u.s. citizens who are going to be denied coverage. now, there may be a requirement for the hospital to give them care, but i think we're putting the hospitals in a very precarious situation. and i don't think it's necessary, existing law requires that there be a documentation when you sign up in medicaid.
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you have to show it. you have time to do it under those circumstances. you don't have time in an emergency room. >> will the gentleman yield? >> who's asking me to yield? >> i guess on your time with your yield, i would like to ask counsel again, it provides that everyone that shows up at an emergency room is entitled to care and entitled to care before their ability to pay can be verified. if that is not repealed and i thought i heard counsel say nothing in that was reappealpea about mr. deal's amendment. is there anything that repeals the requirement that care be provided? >> no, but he brings up the language online 15 and 16 which deal with eligible for an item or service. but the intent of this appears
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to be deal with eligibility for medical assistance which is the payment for it. i guess the ambiguity would be, is there any intent in the first sentence -- >> what you're saying is his point might result in an issue of who pays for the service. but the chairman's point you might not get the service is not accurate but it is not repealed. there are big issues about payment for services rendered right now. many of us believe those costs are shifted to people who pay for insurance. i don't think we're dealing with the cost issue. the concern of the chairman was are people going to be denied care as they are sitting there bleeding in the emergency room and the answer is they will not be denied the care. >> reclaiming my time. i am concerned that hospitals all over the country are closing emergency rooms because they cannot deal with the
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uncompensated care they give. they have to give it. we agree to that. a lot of them are trying to become specialty hospitals or don't have emergency rooms open. that just means that when people go to the emergency rooms that are open, there are such congestion of people coming in for all sorts of reasons that it would be a bureaucratic nightmare for them not to know whether they are going to get reimbursed if somebody is a u.s. citizen, would appear to be on medicaid. and they make the judgment that that's the situation. i just think that pointed out, i'll yield to him further on the issue, figured out a flaw that is a serious one. perhaps we didn't provide emergency care to -- to people who may be undocumented.
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that's may be all to the good but that's not the law. they have to get the emergency care. hospitals have to give it and we're having unintended consequences which are foreseeable because it's a reality. we're getting fewer and fewer places available for anybody and most of the people who need it are u.s. citizens to get the care and have the institution get the payment for the care. >> mr. baldwin, you want me to yield to you on that? >> i want to add, when wisconsin was implementing the current law, they took very close track of the problems they encountered. there were 19,000 people, the vast majority of them u.s. citizens who are unable to secure a passport or a birth certificate, maybe don't live in the same state or county that therapeut they were born in. had to seek that documentation. 19,000 u.s. citizens in wisconsin turned away for care
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in various settings as that paperwork was being assembled and put together. this has -- i would hope you agree, unintended consequences that injure the health of u.s. citizens and i would therefore strongly urge my colleagues to oppose this amendment. >> my time has expired. are we ready for a vote. let's go to a roll call vote. >> mr. waxman. >> no. >> mr. marky. >> no. >> mr. dingell. >> no. >> mr. boucher. >> mr. palone. no. >> mr. gordon. mr. gordon votes no. mr. rush.
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miss eshu. no. mr. stupack. no. mr. engle. mr. green, no. mr. gets no. mr. doyle? mr. doyle, no. miss harmon. no. miss schakowsky no. mr. gonzalez no. mr. ensly no. mrs. baldwin. no. mr. ross? mr. ross votes aye. mr. wean er, no.
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mr. mathson. aye. mr. butterfield? mr. butter field votes no. mr. barrow? mr. barrow, aye. mr. hill? mrs. mat suey, no. christianson no. mr. murphy of connecticut? no. mr. space? mr. mcnernny. mrs. sutton.
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no. mr. braley. no mr. welch, no. mr. barton, aye. mr. hall? mr. hall, aye. mr. upton. mr. upton aye. mr. stern? aye. mr. deal. aye. mr. whitfield, aye. mr. shimkus? mr. shimkus, aye. aye. mr. blunt? mr. blunt, aye. mr. boyer? mr. ra don vich, aye.
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mr. pipp, aye. mrs. bono mack, aye. mr. terry. aye. mrs. myruck. aye. mr. sullivan, aye. mr. murphy of pennsylvania. aye. mr. burgess. aye. ms. blackburn, aye. mr. gin gri, aye. aye.
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>> mr. rush? >> he is not recorded. mr. rush, no. mrs. capp, no. mr. mcnerny, no. mr. boyer? mr. boyer, aye. mr. space? mr. space votes no. >> mr. who? >> mr. hill, aye.
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>> will the clerk call the roll of those who have not responded to the vote? call the names of those who have not been recorded? >> mr. boucher, mr. engle. >> the clerk will call them. >> thank you, mr. chairman. i believe that's everyone, mr. chairman. >> any member wish to respond to the vote who has not voted?
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any member wish to change his or her vote? the clerk will tally the vote and report it. >> mr. chairman there were 28 ñ
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your bill all plans must comply with the government. >> i note the language does say by the federal government. you said to assume to comply with the government. >> the answer is yes? >> the private insurance company couldn't use this information either. >> great. >> gentleman will yield back. >> gentleman yield back. >> recognition to strike the requisite number of words. >> the gentleman is recognized. >> i would like the attention of the author of the amendment because this is friendly comment but as always when we're considering amendments, the devil is in the details.
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now, the amendment would prevent the search by comparative effectiveness research being used to design or ration care. i appreciate the concerns of the gentleman and i don't want this research misused and my feelings on that are the same as his. i want to note not all denials are a misuse of research. i would like to give the gentleman a couple of concerns he should share with me. first, it was a it was a study that showed that vioxx caused heart attacks, there we really want to limit that use of science? another study, fen-fen actually caused heart valve damage. do we want to limit that kind of science and that kind of use of
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science? >> now, fortunately, these kinds of research findings are rare but if a study shows that a treatment it dangerous, should we be denying ourselves the ability to deny that treatment? so i understand what my good friend from michigan is trying to do and i'm -- i share his concerns. but i also many concerned that it is a bit too broad. and i'm wondering if my friend would be willing to strike the word to deny. that would enable us to support the amendment because it would say that research that says that an amendment -- that a particular treatment or particular kind of pharmaceutical is in fact dangerous, would probably be precluded under the amendment. i yield -- >> does the gentleman yield,
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thank you for your time. i respect the gentleman greatly. couldn't agree more with the interpretation of the language. the fda stepped in and this would not prohibit that at all from happening. and more importantly, it protects the doctor/patient relationship. if a doctor knows fen fen is a problem, they are not going to use that in the treatment of their patient. i wouldn't take my word for it. if you'll yield to the doctor, ke give you a doctor's perspective as well. >> i'm sorry the gentleman and i disagree on the interpretation of his language but i just -- i think if the gentleman could accord with me on removing the words denied, we could support the amendment. otherwise, i have to oppose it. i'm sure night colleagmy collea join me in opposition. it has a great deal of merit if it has that changed.
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i want to support it both as his friends and i'm convinced it is a sound amendment. >> would the chairman yield? >> i'm glad to yield. >> my comment is this, you mentioned in fact several drugs that were approved after market after fda approval to be harmful to patients and of course, the fda moved pretty darn quickly to take those drugs off the market and in fact, that's the whole purpose of the fda, to make sure that products that have been approved that are found to be harming patients and in fact in some cases even calls them their death, that these products are removed. and the other thing, of course, you might say self-policing. physicians, you know, every
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physician is practicing under the hypocritic only in first place, do no harm and clearly is not going to be prescribing medications that would harm them. >> i can't yield further to the gentleman and with respect i would observe physicians are deceived like everybody else is. and when we have research that says that certain practices are dangerous, or certain pharmaceuticals are dangerous, we ought to permit that research to be communicated to the doctors so that they can put it to work and so that they can achieve the help of research. remember doctor's major function is the application of scientific research and new learning in the area of science with regard to the profession of which they are very important and valuable part. i yield back the balance of my time. >> further discussion?
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ms. baldwin. >> the chair would yield to himself to see -- because i've been listening to this discussion and see if we could come to terms on this. mr. rogers? >> yes, sir, mr. chairman. >> the examples that mr. dingell pointed out were fda examples. your amendment says that the research could not be used by the federal government to deny or ration care and i think he was pointing out that there are sometimes information where we ought to deny care when we find it's harmful. one way to resolve this is to strike the word deny and say be used by the federal government to ration care. then we won't have that problem. is that something that you could accept? >> no, sir, just an absolute philosophical difference that we run into. in the cases that i gave you and
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the wise the n.i.c.e. board operates, they denied pap smears when she asked for it three different times. comparative effectiveness research can be made available and the doctor can take that in the course of his practice. but for the government to deny coverage based on the effectiveness research board, you can't, 19-year-old cancer recipient, you're statistically you shouldn't get that treatment, we're not going to do it. they do it in the united kingdom and canada. we won't agree on this fill sofally. >> you're saying we shouldn't deny care to ration or to use this information in a way that would give care that people need. but deny care when we find out that a procedure is harmful is something that we would want the
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federal government to do. i don't think we have a philosophical difference -- >> that's not denying care, that's the practice of good care. you are don't do more harm to your patient. you wouldn't give a treatment that you know is harmful. >> if you do what you suggestside being done elsewhere, that is bad medicine as well. >> let me take another stab, what you described is rationing, didn't see no pap smears, they said not for this person, they'll give it to this person. i think the offer being made by mr. dingell gets to where you want to go. prevents them from making a decision that they are not going to allow something that's haful but still allows them to say, that prevents them from saying, you get it or you don't. it does get there by -- rationing would be left in, which would say they can't do what you described. one more thrust of trying to get there.
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>> would the gentleman yield. >> i disagree they were denied access because the research says statistically it's not very likely to happen. therefore, we're going to ugs the calculator and not the doctor's determination -- >> let me reclaim my time. >> i feel passionate about it as a cancer survivor myself. >> why don't we say, government deny care that may be harmful or rationed care. because you want a mixture that we're not denying care that's beneficial. >> again, mr. chairman, i don't read the amendment the same way you do, again, as somebody who would have fit the criteria to be denied care, i feel extremely passionate about this. >> you're not interested -- >> i apologize on this one as somebody who would have been in this boat, would have been denied care under the system, i passionately believe we should
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send a clear signal. >> you would have been denied helpful care not harmful care. >> mr. chairman, i object to the amendment based on the fact that the comparative effectiveness research is designed -- those treatments that are most effective and in no way dictate to physicians or providers which treatment they should or should not use. and the same way that a harmful treatment being made known to a provider would enable them to make a decision not to use that medicine, favorable treatment, effective treatment being made known to comparative
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effectiveness research, would allow to use the medication, but there's no place in there that would cause a denial or rationing. remember, we're not operating under the british system where -- we're not creating a single payer here. it's atmosphere to insurance coverage. we will create an amendment that we would ask our colleague to consider supporting, which may address some of his issues. and i yield to mr. wienor if he wants to be recognized. >> i thank the gentle lady for yielding i think our concern about this amendment, on its face, it seems pretty straight forward and intuitive. and in the context in which you
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placed it, it has some attraction i guess. but i'm concerned about the way it could be interpreted. you heard one expression of concern about the interpretation. it could be made with respect to this amendment that might prevent you from taking steps with respect to harmful care. i can envision a scenario whereas a result of research kind of flowing through the system, determination would be made that there's now a more effective kind of treatment that should be paid for because the research shows that it's getting very good results. and it becomes a kind of new treatment to replace an old treatment. but, replacing the old treatment with the new replacing the old treatment with something more effective under these -- under this language could be interpreted as denying care, now
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maybe you're not going to reward for that old treatment any more. and so you're stopping what was progress in terms -- >> would the gentleman yield? >> you have just hit on my biggest concern. because that old treatment may apply if a doctor looks at that particular case and says, you know what, this is the right course of action, not the new treatment. and a one size fits all is the most dangerous way you can practice medicine. it's dangerous. people will die and that's why if you look at cancer rates in canada and the united kingdom and compare them to the united states, they die a lot more frequently than we do on certain cancers because they say, we have a new treatment, old treatment can't do it. even though the doctor may say, this is the right treatment for my patient. that's why i feel strongly and you have hit on the one reason we ought to be -- >> reclaiming my time. if you take your perspective to the logical extreme, you can
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never do anything to improve the sort of con stelation of treatments out there and make judgments about the kinds of treatment that ought to be supported versus something else. and that's the interpretation that concerns me here. and that's why i would oppose it. i yield back. >> gentle lady yields back her time. mr. rogers you want to close? >> mr. chairman. >> the problem is that we had more than ten minutes on the democrat side and to the unanimous consent we're supposed to have ten minutes on each side. are you ready to vote? all those in favor of the rogers amendment will say aye. >> aye. >> oppose, no. >> no.ññ1çnó'tkññ.ç@
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>> it is to this title and it has been available the appropriate amount. >> without action the barton amendment will be considered as read and the gentleman from texas is recognized for five minutes. >> before i begin, let me recognize the distinguished chairman of the ways and means committee, mr. rangel, who is in the room, since this amendment relates to the jurisdiction, it is agreed he would be in attendance when i discuss it. mr. chairman, under the pending bill, there is a tax on american citizens depending on their income status if this bill goes into effect, there would be an immediate tax on -- sur tax on incomes of citizens who make
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between 350 and $500,000 per year, a 1% tax. for citizens who make between $500,000 and $1 million, there would be a 1.5% tax and citizens who make over a million, there would be a 5.4% surtax. those taxes on the lower two income brackets would double in the year 2013 if there is a study by the omv that determines that certain savings have not occurred. what the barton amendment does, is direct the study to find that regardless of the savings that the taxes on the lower two income brackets, the tax increases do not go into effect. so the effect of the barton amendment, if adopted, would be
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the beginning in 2013, only those citizens who make over $1 million would have their increased by the surtax. the reason that we don't just repeal the tax increase, and that's why i'm glad the chairman of the ways and means committee is here, is that we don't have the jurisdiction to repeal but we have jurisdiction over studies. so we use the study as a hook to at least save those citizens who make more than the -- who make less than $1 million to try to save them some money beginning in the year 2013 been so this is the $1 million taxpayer protection amendment, those that make less than $1 million. >> mr. chairman. >> the gentleman yields back his time? >> i would yield to mr. walters. >> i just have to speak up on this in support of it.
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if you look at the chart that is being held up here, my home state of oregon would have the second highest income tax rate in the world. and we already have the second -- i think the highest income tax marginal tax rate in the united states of any state, which is a great benefit for mr. emsley's state because we're having to build a whole new bridge so people can move to washington state. you would think our tax policy was written by the vancouver chamber of commerce. this adds to that pressure and i think is one of the reasons why oregon is second to michigan in unemployment. and so i will be supporting the gentleman's amendment. >> and seeing no hands on my side, i would yield back. >> the gentleman yields back his time. >> thank you, mr. chairman. i'm not sure i know exactly how mr. barton is trying to create jurisdiction over this issue,
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you know, and this committee. i really don't think it belongs here. but the basic problem that i see is that, you know, he's doing some kind of gimmick to undercut the work done by the revenue committee and it is sort of interesting that the chairman, mr. rangel is here. what i want to point out and i and the reason i oppose this amendment is that from the very beginning of this debate -- when president obama talked about the need for health care reform, he pointed out that a good need of the cost of this was going to be from cuts in existing programs, medicare in particular. but at the same time, there was going to be a need for new revenue. and the reason there was a need for new revenue was in order to cover more people and provide assistance to middle income families to a subsidy that at least up front in the beginning,
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a certain amount of money was going to have to be available. down the road as the health reform bill kicks in, we save more and more money as time goes on. but at least initially, there would have to be a certain amount of money provided and that figure was about $1 trillion and part of it would be paid for through program cuts and part of it through new revenue. and i think that we would be kidding ourselves if we didn't realize or acknowledge that some revenue source is needed. now, if you look at a revenue source, i think what the ways and means committee came up with is probably the most responsible way of doing this that i can imagine. if you look at this surcharge, it only applies to the top 1.2% of all households in the united states. it would have no effect on 98.8% of all households in the united states. now, of those families making between $350,000 and $1 million,
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they would contribute less than 1% of their annual income to help provide access to affordable health care for all americans. i don't think that's much of a contribution when you're going to cover all these people who have no insurance plus a significant number of people who would get a subsidy to help their -- help them pay and make noorp insurance affordable to them. we're a community. everyone should help to a certain extent. and i think that this is the least offensive way of doing it. i know it's not before our committee. maybe we shouldn't be talking about it today. but of all the proposals we've seen out there, this is the least offensive. and if you think you're not going to be able to do this you would be kidding yourself. i don't represent a poor district. i have a lot of people who would be impacted by this. but i still think it's important to recognize that this is a good way of doing it and that something has to be done. this is not all going to be paid for through program cuts. i yield to the gentleman. >> and the gentleman fails to
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point out one other thing. american citizens' taxes are going to go down as a result of this bill. and let me explain why. because right yao your states are paying too much for health care. >> the republicans are acting like british parliamentarians. >> so long as they don't start acting like south koreans ones, i'll be fine. the cost so citizens will go down because the costs they're paying for their products won't have the same costs. the amounts of uninsured are going to go down so more efficient care will be provided. the amounts for cities like mine and states that have shares of medicaid are going to go down. so overall, tax expenditures are going to go down, down, down, and so are nontax expenditures. the way americans should look at this effort is will their overall cost of life be reduced
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or go up, health care is on the track to double in the next five years, to double. if we don't fix that, everything we have is going to go up in cost. so the question is not what column is going to go up. some may go up a little. but everything is going to go down appreciably a lot. so i welcome the chance to study this. now, you can write in an amendment that says here is what the conclusion of the study shall be. shall be. >> will the gentleman yield? he fact is that health care costs are driving everything in this country to be too expensive. when you buy a car, you're paying a tax. when you're buying food, you're paying a tax. when you go into the office, you're paying a tax. you want those taxes to stay in place. we say no, that's not a good policy and we're trying to change it and what this amendment refers to is the effort to make -- >> will the gentleman yield? >> i don't control the time, but bring it on. >> all right. i thank the gentleman for yielding and i thank the gentleman -- >> the gentleman's time has expired. >> mr. chairman? >> let me go to mr. blonton.
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perhaps he can yield to you on the last five minutes of debate. >> i'll yield time to my colleagues after i mistake a couple of comments. one is that there is no study that i'm aware of that indicates that there is anything that saves money or bends the cost curve. we heard the cbo testify with conclusively that the cost curve does not go down, the gentleman's suggestion that somehow this is guaranteed to contain costs is not supported by any information i'm aware of and the tax year we're talking about is a tax that absolutely falls on most of the small businesses in america that get beyond that two or $300 that you say level and their tax will be impacted by this dramatically. the job creating engine of the country, i think the former chairman's amendment, the ranking member's amendment just simply up here is going to be this tax, tries to move it into an area where it doesn't impact the job-creating aspects of small businesses that have --
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that do have income that might xooet exceed $250,000 or $300,000. we had a meeting with a number of those people this week about the 8% surcharge that was in the bill, if you didn't provide @@á i would yield the gentleman from georgia. >> and i think the gentleman for yielding. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] the amendment says that if this tax on those making less than $1 million a year, many of whom, may be one-third are small businessmen and women, if this is found by a study in 2012 that more than enough taxes have been raised to pay for this health care reform act, then we should not continue to tax these individuals. the speaker was asked the same
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question, on a sunday morning talk show about one week ago. her response was, we would use the money to pay down the deficit. ow, we would use that excess money to pay down the deficit. well, goodness gracious, it would seem to me that we would reef that money in the pockets of the small business men and women so they can continue to create jobs and we have more and more revenue coming in so this is a pretty straightforward amendment. >> will the gentleman yield? >> and let me also say that you've got these same people, the democratic majority are going to go after these same people to pay for other things so you better save some for later. >> i'd yield to the gentleman from florida. >> i thank my colleague. mr. weaner says we're going to lower health care costs with this bill. now, this is a study by the
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joint economic committee, senator brownback is the ranking member on the republican bipartisan. mr. weaner should probably look at this graph. sth a small graph, but it shows that, in fact, under this health care bill, health care costs are going up almost exponentially. you're welcome to get a copy. i don't think there's any evidence to support your idea that this bill here will bring down health care costs. in fact, it's going to increase it dramatically and so i think, you know, when you look at what the president said, that he wouldn't support any health care bill that did not bring health care costs down, i don't know how, in fact, he could support this bill based on what the joint economic has published in this very thorough analysis showing health care costs going up. >> i'd yield to the gentleman from louisiana and if there's time, the gentleman from illinois. >> i appreciate the time. for anybody suggesting taxes will go down, i suggest they go and read the bill. if you look right here in section 401, it's called tax on
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individuals without acceptable health care coverage. so that means if this new health care czar that's being created doesn't deem your plan acceptable, they can impose a 2.5% tax on your income. it's such a large tax that the congressional budget office actually said here in this room unfortunately the public was kicked out of the meeting. it was not a meeting that was open to the public, but i was there and the congressional budget office said that one second alone is going to add $29 billion in new taxes on to the backs of people who are uninsured today. and most of those people are people making well below $50,000 a year. if you look at the congressional budget office's own testimony, maybe some radical blog is telling you you're not going to pay more taxes. the congressional budget office has said you'll pay backside 800 billion in new dollars if this pass he not to mention the rationing of care. >> i'd yield to the gentleman from illinois. >> and i want to follow up.
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the cbo director said that obama's cost savings are an illusion. and that is a nonpartisan congressional budget office, an illusion. so i wouldn't allude to savings. >> the gentleman's time is expired. the chair recognizes himself for the last five minutes of debate on this amendment. this is a very confusing amendment. one would think that we shouldn't be in the jergz of this committee. but the parliamentarian said it was crafted in a way that allowed it to be germane. i don't know if that's why the ways and means committee is here or not, but this is strange. the bill said that if we don't achieve the savings that we need to achieve, then we would look to revenues. now, this amendment says if we do a study, we're going to
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determine that if the savings -- if we do achieve savings, that we're going to reduce the revenues. well, the whole bill that we have is paid for at a programmatic savings of cuts of medicare and medicaid and since that's not enough, new revenues. well, this amendment would reduce the revenues. well, if we make a reduce in the revenue side, then we have to look to see whether we're going to get the savings. if we don't get the savings, this amendment would cost us several hundred billion dollars. if it worked. and there's a lot of confusion whether it works. so i think this is a message amendment and i don't even understand the message. but the impact of this amendment would be very destructive of the bill that we have before us. and if the study shows that we
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didn't achieve this saving and if we did achieve the savings, we would then make a decision or redelegate this decision as to how much money would be available. and then we would have to go make additional cuts in medicare and medicaid. that may or may not be possible. so i just think that we -- i urge members to oppose this aempt. it's what we call gimmicky. it says it's doing something. it says the omv would find at least $700 billion in savings had been generated, and if they did, we change the surtax and individuals making less than $1 million would never face a tax. well, i don't know what the revenue provisions will be once we get to the house floor. no one wants to raise revenues.
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we would rather get program cuts, but we're not going to get enough program cuts. >> will the gentleman yield? >> i will in a second. this gentleman says if we don't get the program cuts, reduce the revenues, and if it turns out that that is inaccurate, we have to reduce revenues even more. who is asking you? >> the gentleman. >> thank you. >> you know, the committee, the majority committee provided members with a description of what this bill does for the district. including talking about the surtax. and i would suggest that your side do the same thing. for example, in -- i've got a whole bunch of them here. it tells a number of small businesses that would receive tax credits. every one of these that i'm holding is more -- is about $12,000 plus. small businesses that helped. how many seniors would avoid the doughnut hole in medicare part c? that's thousands. how many families would escape bankruptcy? that's in the hundreds.
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and how many uninsured people in the district that will get coverage and in all cases, it's over 100,000 and in every single case, 99% plus people in the district will not pay the surcharge. we're talking about a tiny number compared to the hundreds of thousands of people that we'll help because finally they'll get insurance. you ought to look at this description so that you can take a good look at how your district will be helped by this bill and i -- >> well, i would just say that under this amendment, after you get some analysis, the first priority would be to reduce taxes rather than make sure we keep those promises. and if we can't keep those promises, then we have to look at further reductions in medicare and medicaid. this is going to cost us hundreds of billions of dollars and not make the plan work. now, i suppose that's the goal. mr. weaner -- >> well, i just want to point
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out one tax that the minority side refuses to point out. we have a $2. 2 trillion in 2007 for health care. that's going to go up unless we do something to $3.1 trillion by 2012. i have this high tech chart here to demonstrate it. doerchbt forget, if you don't act on legislation to get health care under control, that tax will be passed on. i say to my colleague from louisiana, yes, you can find charges in this bill, but you have to balance it, again, close to $1 trillion of taxes that you seem to want to -- >> will the gentleman -- the time has expired and we've complete today debate time. we'll now proceed to vote. mr. barton informs me he would like a roll call vote. the clerk will call the roll. >> mr. waxman. >> no. >> mr. waxman votes know. no. mr. dingal.
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mr. did i ngal votes no. mr. markey. no. mr. boucher. mr. balone. though. mr. gordon. mr. brush. miss essue. votes no. mrs. supak. mr. stupak, no. mr. angle. mr. angle, no. mr. green. mr. green no. ms. degett. mrs. cap. mrs. cap, no. mr. doyle. mr. doyle no.
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ms. shakowski, no. mr. gonzales. mr. ensley. no. ms. baldwin. ms. baldwin, no. mr. ross. mr. ross no. bl weaner? mr. weaner, no. mr. mathison. mr. butterfield. mr. butterfield no. mr. malazon, aye. mr. barrow, mr. barrow aye. mr. hill. mr. hill no. ms. matsui. ms. matsui, no. mrs. christianson. mrs. christianson no.
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ms. caster. ms. caster, no. mr. sarbain. mr. sarbain no. mr. murphy of connecticut. mr. murphy no. mr. space. mr. space no. mr. mcnurney. mr. mcnurney no. ms. sutton. ms. sutton, no. mr. braillely. mr. braillely no. mr. welsh, mr. welsh no. mr. barton. mr. barton votes aye. mr. hall. mr. hall aye. mr. upton. mr. upton aye. mr. sterns. mr. sterns votes aye. mr. deal. mr. deal aye. mr. whitfield. mr. whitfield aye. mr. shimkus, mr. shimkus aye. mr. shatti gb. mr. blunt.
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mr. blunt aye. mr. bowyer. mr. bowyer aye. mr. radovonich. mr. hadovonich, aye. mr. walden, mr. walden aye. mr. terry. mr. terry aye. mr. rogers. mr. rogers aye. mrs. myrick, mrs. myrikk aye. mr. murphy of pennsylvania. mr. murphy aye. mr. burgess. mr. bernlgess aye. ms. blackburn. ms. blackburn votes aye. mr. gingrey, aye. mr. skulley. aye. ms. degettz.
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degettz votes no. mr. gonzalez. no. mr. mattheyson, no. mr. rush. mr. rush votes no. mr. shaddik. mr. shaddik, aye. >> have all members responded at the call of the roll? >> mr. gordon. >> any member wish to change his -- >> mr. gordon. mr. gordon votes no. >> the clerk will tally the votes and report. yes? >> on that vote,ç?ñkumwgñíñwig
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>> michael burgess offered a bill that would limit lawsuits against doctors and hospitals to no more than $25,000. >> i think the chairman for yielding. remembering the first amendment, this was the offer of an amendment that would affect medical liability in the practice of medicine, and this was ruled not germane, and we were allowed an opportunity to rework the amendment, and that is what this amendment represents. the principal difference is that the protections provided for each subsection shall apply in the case of the health-care
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provider with respect to the treatments for which a provider seeks reimbursement under medicare, under title 18 of the social security act, or title 19. to recapitulate the issues that were brought up a few weeks ago, many doctors are forced to protect -- forced to use defensive medicine, and seasoned medical protections -- season medical professionals are retiring early, further contributing to the manpower shortage. the national change in the budget system would increase health care by less than the threat of lawsuits, and respect -- specifically this would cap the damages and $250,000 for a nursing home or a second
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hospital, and a wrongful death awards would be 1.4 million. and this may only be provided by actively practicing physicians. by actively practicing physicians. payment of future damages on a periodic or a basis, limitations on liability for good samaritans providing emergency health care. mr. chairman this is patterned after legislation that was adopted in my home state of texas it has increased charity care rended by texas hospitals, which rose 24% following the enactment of this legislation. texas has licensed over 14,000, nearly 15,000 new physicians in the first five years after enacting this legislation. 33 rural counties have seen a net gain of e.r. doctors, including 26 counties that previously did not have that emergency room physician. a vote for this amendment will tell america's physicians that we are committed to putting in place reforms that will allow them to do their job free of
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government and special interest intervention a vote for this amendment will tell america's patients that access to high-quality affordable health care is, indeed, our goal. and i thank the chairman for consideration allowing us to reworked amendment and reoffer that. with that, i will yield back the balance of my time. >> thank you. would any other member like to be heard on this amendment? mr. -- gentleman from -- >> thank you. i strongly oppose this amendment. we all know the most significant way to reduce the cost of medical malpractice is to emphasize patient safety by reducing the number of preventible medical errors. according to the institute of medicine in its seminal report preventing medication errors, this other report, to err is human, building a safer health system and other report, patient saving, achieving a new standard of care, americans should be able to count on receiving health care that is safe.
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to achieve this, a new health care delivery system is needed. a system that both prevents errors and learns from them when they occur. this requires, first, a commitment by all stake holders to a culture of safety, and second, needed improved information systems. according to the institutes of medicine, every year, preventible medical errors kill as many as 98,000 americans. the center for disease control, if it included preventible medical errors, would be the sixth leading cause of death in america. the number of americans injured each year by preventible medical errors is much larger. the institute for health care improvement estimates that 15 million incidents of medical harm occur each year. according to the institutes of medicine, every day, tens if not hundreds of thousands to errors occur in the u.s. health care system. to address this problem, its institutes of medicine concluded patient safety is indistinguishable from the delivery of quality care and it
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recommended that a new delivery system must be built to achieve substantial improvement in patient safety. drug errors are the most common error of all. the institute of medicine estimates that on average, every hospital patient in america is subject to one medication error each day they are in the hospital. these are called a verse drug events and the institute of medicine estimates that each year, at least 1.5 million preventible adverse drug events occur in u.s. hospitals that add nearly $5,000 to the cost of each admission of. the defensive medicine claim that is constantly being made by my friends on the other side has been researched thoroughly by the gao and cbo and the institutes of medicine. they have questioned the validity of the defensive medicine claim. cbo noted in its 2008 report that the evidence on defensive medicine is not conclusive and whether it limits malpractice torts have an impact on the
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practice of medicine has been subject to some debate. gao issued a similar statement in its report earlier this decade, noting the overall prevalence and cost of defensive medicine have not been reliably measured. researchers from the dartmouth atlas project reached similar conclusions this year, noting that fear of malpractice suits is reported by many physicians to influence their practice, but differences in the malpractice environment explain only 10% of state variation in spending. one of the other things that's often claimed is that the number of physicians is declining because of this problem. when reality, using the ama's own physician characteristic and distribution data, these conclusions are undisputed. one, the number of doctors is increasing and has been increasing every year in the past decade. the number of doctors is increasing faster than population growth. the number has climbed steadily for decades and is twice the number of doctors per 100,000 in
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the 1960s. the number of doctors is increasing in every state. the ratio of doctors to population is higher in states without caps on damages in medical negligence case. in states that have caps on damages, the number of doctors per 100,000 population is 319, while states with caps on damages have a lower ratio of 283. another known fact is that rising insurance premiums are related to market conditions and not to any claimed benefit from tort reform. how do we know this? well, mr. burgess has cited the tort reform efforts in texas. after that tort reform legislation was passed in 2003, the dallas morning news did an investigation and found that while hospitals and medical malpractice insurance carriers made millions of dollars over the next few years, no hospital or doctor cut the prices they charged patients or health insurers to reflect any savings
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from tort reform. and finally, the national practitioner data bank, which collects statistics on medical errors and case settlements has shown that there has been a steady decline in the number of payouts between 2002 and 2006. from the number in 2002, which is 14,391 to 2006, when those payouts were down to 11,759. so mr. chairman this is a problem that has much effort being devoted to it but it is a problem that is not in need of a solution. we need a safer patient safety system and that's what we should be focusing on. >> gentleman's time has expired. mr. chairman. >> mr. burgess recognized. >> mr. chairman, if i can just have a minute to respond to a few of the things that were just said. the institute of medicine study to err is human was published, when, 1998, 1999, relied on data collected in two hospitals, one in 1984, one in 1992.
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they collected data in two hospitals over that period of time. they extrapolated to the rest of the country, doubled it, made sure that they hadn't missed anything and the fact is the institute of medicine has not seen fit to do another study in the ten years since that one was released. they were relying on data that was collected in 1984. i to would submit to you the practice of medicine has changed significantly since 1984 and if you don't believe me, i encourage you to believe the health care facilities in your district and get to know them. i would further submit that if you think that medical lie bill sit not an issue for your physicians in your district to have a visit with your county medical societies and get their tack on this. i know that this bill before us has been endorsed by the american medical association, but i would submit to you that doctors across this country want us to face and fix this problem. they are tired of waiting and they should make their voices heard to members onhis committee.
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and i will yield back. >> gentleman yields back his time? why don't you yield to mr. gingrich. the last five minutes. >> mr. chairman, thank you. and i thank the gentleman from texas, my fellow physician, fellow ob/gyn for yielding. the gentleman from iowa i just heard the end of his remarks and he said that there is no evidence that doctors lowered their charges to patients in states where, such as texas, such as georgia, such as florida, where the states had meaningful medical liability reform. but you know it is kind of like the situation with all these jobs going to be grown by the economic stimulus package. now, the majority and the president says, well, we are going to have a growth and preserve the ones that we've go i submit to the gentleman from
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iowa that not necessarily by cutting fees to patients but just keeping them level, the lowering of the malpractice premium is very important. but the most important point is to cut down on the amount of testing that is unnecessary and in some cases, downright harmful and risky to patients and clearly, doctors, those of us who spent 30 or more years practicing medicine know this all too well. you order tests and you know they are not necessary, but you do that in a defensive way. the president went to the ama in chicago and spoke to them and when that issue was raised by the ama leadership, the president admitted, yes, we do need meaningful liability reform. he made no specific promises but this is the opportunity for this committee to change this, add to hr 3200 and improve it based to
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on what the president said to the ama. so i thank the gentleman for yielding, i yield back. i support -- >> yield a minute to mr. boyd. >> thank you, dr. burgess, for yielding. in the state of indiana in 1975, we became the first state of the union to enact comprehensive malpractice reforms it is called the indiana compensation act for patients it became a model for other states as it balanced the need for physicians for affordable liability insurance premiums with the need for patients for good access to all kinds of care. our law contains components very effective for three decades. our statute of limitations limits on recovery, patients compensation fund, a medical review panel and the limit on attorneys' fees. when you balance indiana's success, the state of indiana contiguous is very expense is city of practice medicine, meaning people who live in indiana have greater access to health care. now, when you think about the trends and jury awards and
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settlements, overall, 74% of the medical liability claims in 2004 were closed without payments to the plaintiff. the plaintiff lost a majority of the cases that went to the jury. of the 6% of the claims that went to a jury in 2004 to a jury verdict in 2004, the defendant won 91% of the time. so, when the gentleman from iowa was talking about that there suspect a problem here that needs in search to of a solution, i think it is completely false. we all know that doctors are having to practice defensive medicine because of very aggressive plaintiff [ inaudible ]. >> i want to add it is not just defensive medicine it is the doctors on the won't show and care. last week, i spoke with a doctor in phoenix who was an e.r. doc answered explained to me that in their emergency room, they could not get many specialists they could not get hand surgery specialists they can could not get in some instances neurologists they can could not get many doctors to show in the
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emergency room to handle cases in the emergency room because they did not want to expose themselves to liability of presenting themselves there and indeed, people were getting hurt as a result of those. people who needed a hand surgeon in an emergency room needed one. people who had a stroke and needed a neurologist in an emergency room couldn't get one. this goes beyond the issue of defensive medicine and cost it goes to the issue of people not getting health care services. >> gentleman's time has expired. for the last five minutes, mr. gonzalez. >> thank you very much, mr. chairman. first of all, let's get straight what we are talking about we are talking about meritorious lawsuits were there is negligence and talking about capping damages. we are not talking about trying to stem some imaginary prices for frivolous lawsuits. we are talking about defensive medicine. we can talk about that. and so what are these great savings that we are going to realize if we impose these kinds of restrictions for the right of people to seek redress from negligent acts? well, i'm from texas also.
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and the beauty of that law that we passed in 2003 is truly in the eyes of the beholder, mr. one would expect that if this was so successful, that costs would be brought down and health care insurance would be available at reasonable prices, premiums would go down, all of that would be the outcome. but this goes into effect in 2003. texas health care insurance increased 83.8%. the average insurance policy when to $12,403. because of these tremendous savings, we have been able to understand that this law -- let me give you the experience.
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if this is what you expired to, go to it. 4.2 million people in the state of texas did not have insurance. 21% of people do not have coverage -- of children do not have been cut in the coverage. this is a great experiment that did not work. go ahead. the sad thing is that this shift the responsibility and the liability from the negligent party to the innocent parties, not just the victim of all of those will have to incur the cost to pay it -- to care for that bentham, to compensate the victim for the injury. the negligent, call will party is set free, without truly paying for the negligent act.
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when do you want to reward people and not hold them accountable? to me, the exposure to liability is what instils accountability. i would ask the members of this committee to look at the experience in the state of texas and reject this. >> high-yield. -- i.e. yield -- i yield. in the late '80s, early '90s in michigan. michigan passed the most -- law, the fda approved drug that you can't sue. only state in the union has it we have every reform you wanted. the doctors are now claiming we have to leave michigan, everything is too expensive, can't afford to practice here what we really need, very few doctors have malpractice, but what we need is a registry of where they are so they can't go
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from state to state, hospital to hospital to ton commit it let's have some transparency into these lawsuits and see who is committing it. very few doctors. but don't limit the rights of american people with all these fears that we are going to leave, you can't have this and that. michigan malpractice rates are one of the highest in the nation. we passed everything you asked for, and then some t doesn't work it is a false argument. we should reject it and stick up for the people truly injured in had this country. >> will had the gentleman yield? >> mr. gonzalez controls my time. probably give to mr. get. >> mr. get. >> add an to what mr. stupak was saying. study after study shows that putting caps on noneconomic damages does not reduce the cost of malpractice insurance for doctors and it does not solve the problem. there are a lot of creative thing that states have done to try to use dispute resolution with doctors and patients. but using a blunt instrument
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like this just is simply not going to solve a problem and what it will do is take away legit empty lawsuits that legitimate patients might have. so this is not a solution. i support finding ways of reducing medical cost. i support finding ways to reduce medical practice frankly but study after study has shown this system doesn't work, even in states like bart's or mine other states that have passed caps on noneconomic damages. i will yield back. >> my time is up, mr. chairman, i yield back. >> all time has expired. the vote now owe on the burgess amendment. all those in favor say eight. opposed, no. the nos have it. >> request the roll on this. >> let's go to roll call vote. [ roll called ] >> mr. waxman? >> no. >> mr. waxman oat votes no.
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mr. dingell. mr. marquee. mr. voucher. mr. pallone? mr. pallone votes no. mr. gordon. >> no. >> mr. gordon, no. mr. rush? ms. eschew? ms. eschew no. mr. stupak? >> no. >> mr. stupak, no. mr. engel? mr. green? >> no. >> mr. green, no. ms. deget? >> no. >> ms. deget, no. >> mrs. caps? >> no. >> mrs. caps no. >> mr. doyle? >> no. >> mr. doyle, no. ms. harmon? >> no. >> ms. harmon no. ms. by cow ski? >> no. >> ms. by could you ski no. mr. gonzalez? >> no. >> mr. gonzalez no. >> mr. enly? >> no. >> mr. enly no ms. baldwin? >> no. >> ms. baldwin, no mr. ross?
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mr. wiener? >> no. >> mr. wiener, no. >> mr. matheson? mr. butter field? >> no. >> mr. butter field no mr. mallson? >> no. >> mr. mallson no mr. barrow? >> no. >> mr. barrow votes no mr. hill? mr. hill, no. ms. matsui? ms. matsui no ms. christensen? no. mrs. castor? ms. castor no. mr. sarbanes? no. mr. sarbanes no mr. murphy of connecticut? mr. murphy, no. mr. space? mr. space, no. mr. mcnortherny? mr. mcnortherny, no. mr. braillely? i'm sore. i apologize. ms. sutton? >> no. >> ms. sutton, no. mr. brayly? mr. brayly votes.
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no mr. welsh? mr. welsh no. mr. barton? mr. barton eight. mr. hall? mr. hall, eight. mr. upton? mr. upton, eight. mr. stern? mr. stern, aye. mr. deal? mr. deal aye. mr. whitfield? mr. whitfield aye. mr. ship cuss? mr. shattuck. mr. status aye. mr. blunt? mr. blunt, aye. mr. boyer? mr. boyer, aye. mr. rod dan know vich? mr. rad done know vich, aye. mr. pitts? mr. pitts, eye. ms. bono max? ms. bono max aye a. mr. walden? >> aye. >> mr. walden, aye. mr. terry? mr. rogers? >> aye. >> mr. rogers, aye. mrs. my rick?
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mrs. my rick aye. mr. sullivan? mr. sullivan aye. mr. murphy of pennsylvania? aye. mr. murphy, aye. mr. burgess? aye. mr. burgess aye. ms. blackburn? mrs. blackburn aye. mr. beginningry aye. mr. scully? >> aye. >> mr. scully, aye. mr. voucher? mr. voucher rotes no. mr. goran? [ inaudible ] mr. goran, aye? mr. marquee? >> no. >> mr. marquee, no. mr. matheson? >> aye. >> mr. matheson, aye. mr. rush? >> no. >> mr. rush votes no. mr. ross? >> no. >> mr. ross votes no.
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have all members responded to the roll call? do any members wish to change their vote? if not the clerk will report to vote. >> there were 23 ayes, 32 nays. >> the amendment is not agreed two. >> later on thursday evening, they looked into an offer by anthony wiener that would
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eliminate medicare. he also spoke about the issue of a public plan. this is a half hour. read and the gentleman from new york is recognized to offer his amendment. >> thank you, mr. chairman. this amendment seeks to clarify one of the great enduring mysteries of the debate about health care, and that is where my republican friends stand on the issue of government-run health care. now on one level it's very clear, quotes throughout the debate have seemed to imply that they are against it. mr. sterns of florida said if the government runs, it it will be bureaucratic inefficient and many cases won't cover the people who want it. mr. terry of nebraska, government-run health care will lead to rationing and eliminate the sacred doctor-patient relationship and mr. blunt the marketplace is the only known mechanism available to deliver what people want. now i raise this subject because today is the 44th anniversary of president johnson signing the
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medicare act into law. now the medicare act is all of my colleagues know is not only government-run health care but it's remarkably good government-run health care. now i was criticized earlier for having shoddy charts so i got a little fancy. on this chart you see that not only is medicare public health care but also we have dod, veterans affairs and indian health service. now this is not only government-run health care but it's remarkably efficient. 3% overhead in medicare compared to about 30% in the combination of overhead and profit by the health insurance companies. remarkable satisfaction on the part of the contractors in the last national scoring that they did of this contractor. it got a 4.1 on a six-point scale and frankly we know it
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works. we know that when medicare before medicaid was passed we had a poverty rate of seniors of about 30%. now it's about 10%. we know also that the private insurance companies take about $600 billion a year and put it in their pockets, not into health care. now some people have held up this chart, this byzantine chart that talks about how they think the bill works. well, i've got my own chart. this is medicare, three boxes. the patients, the doctors and the one single payer so this amendment is simple. it gives my republican friends the chance they have been waiting for, to vote against government-sponsored, government-run, government-administered health care. it's your dream amendment unless, of course, you're going to continue to do this civil impression when it comes to
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medicare. first you like it and then you don't like it and then you like it and then you run against tfrmt the fact of the matter is that medicare is a pretty darn good model of what a public plan might look like. now it's not perfect. there are reimbursement rates in some case that i think need to be higher. i think we incentivize too much to go into hospitals and not enough on the other side. some of the things that are being done in this bill, but this is your opportunity once and for all with my amendment to vote to eliminate the medicare act, once and for all stamp out the scourge of public government-run, government-administered single-payer health care. this is your chance, and you know what? for all of the talk about how much you hate such programs i think you'd welcome this opportunity. now i'm going to vote no and i'll tell you why, because i think the medicare program works pretty darn well. i think it's administered efficiently. i think that you ask seniors, if you tell someone tomorrow who is
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55 years old you're going to get medicare, that we're going to start covering people 55 to 65 and then maybe 45 and then 35 and then who knows medicare for everyone, you'd have a lot of people who would be pretty happy. there have been a lot of elements of this debate that have been hard to follow. i admit that, but one of the hardest that's been is the utter hypocrisy and contradiction inherent in the argument of many of my friends on the other side. this is put up or shut up side. if you don't like national health care, if you don't like government-run health care, this is your amendment. i dare you. i double dare you. vote yes on this, and then go home and explain to your constituents how you're so philosophically opposed to publicly funded health care that you voted to eliminate medicare on its 44th anniversary and let me just say since i only have 27 seconds left. there is one member here who voted in favor of medicare when it was created and who was
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present when it was signed 44 years ago, and on behalf of all of us i want to say publicly, i want to thank him for being there for us 44 years ago when it was signed and god willing he will be here to watch this be signed where we extend another páample of efficient,oh@@ the gentleman's time has expired. >> is there a requirement that the response that the author of the amendment has to vote for this? >> that is the usual practice in my experience. >> and i will their the author of the amendment to put his vote where his mouth has been for the last five minutes and to vote for this. >> my id heard on the inquiry? >> the gentleman has made a parliamentary inquiry about a
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speech. >> before he rules on the inquiry -- >> i'd be happy to hear before the chairman rules on the parliamentary inquiry, i wish to be heard. >> well, the chairman is certainly not going to rule on it. the chair does not know of any rule that requires the author of amendment to vote for it. let me recognize mr. barton, but if you'll allow me in celebration of the fact is it 44th anniversary of medicare becoming law. >> and the first medicare card went to president truman. >> we have pizza in the back for both the democrats and the republicans to celebrate this occasion, and just want the members to know that because you see people eating you'll know why they are eating but we'll continue the markup. >> mr. chairman, may i ask a procedural question? >> procedural question.
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you have to teeth with your fingers. >> are we still operating on the rule of five minutes on each side? >> we are. >> we haven't started the five minutes. >> five, five, five, five. >> yes. >> okay. >> mr. barton, for your five minutes? >> i rise in opposition to this particular amendment. there is a distinction, and i'm going to treat the amendment seriously, okay. there is a distinction between a government mandate and a government-run plan. medicare is a government mandate. there are numerous government mandates and government entitlements. having said that, the congress sets the requirements of medicare and sets -- and then the executive branch issues regulations to implement those requirements.
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to my knowledge, at least in my part of the country, medicare is operated by private companies under contract to the federal government. we have never on the republican side of the aisle said that we -- at least in this congress, in this committee, that we oppose medicare. my mother would not be alive today if it weren't for medicare. she had a heart condition several years ago that was very difficult to treat. she went to houston to the herman hospital heart center and underwent a two-part surgical provision that basically replaced her aorta, and it was very complicated. it cost over $100,000. she paid out of pocket less than $500 because of medicare. you're never going to hear the
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ranking member say that he opposes medicare, but what we have tried to do when we were in in the majority we have tried to use a market system within medicare, medicare part "d," the prescription drug benefit, depends upon market competition that numerous private sector drug insurance plans offer their services and senior citizens choose which, if any, of those plans that they want to get their prescription drug coverage for. we use a market orientation to implement a government mandate. that is a far cry, a far cry from saying that we oppose medicare because it is a government mandate, so with all due respect to my friend mr. new york, you know, if he wants to eliminate medicare and he wants to eliminate part "a," "b" and "c" and "d why the "he can vote
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for the amendment. >> if the public plan under the initiative that we're considering today looked like medicare, would you support it? >> i didn't hear -- >> if the public plan, the public plan that's being contemplated in this bill looked like medicare, would you support it? >> we are working on several options of co-ops and pooling arrangements, one mr. shadeg sg offering, mr. boucher is working on a plan, if we could get something like that, we very might well support it. >> i want to yield to the vice ranking chairman. >> i thank the gentleman for yielding. i thought the ranking member's point was well made, that the difference in this debate is medicare is a mandated program that everybody goes to without options, without competition. if medicare -- a medicare-like plan that paid on average 80% of what is supposed to be the cost of health care was out there, certainly it would be appealing because it's not paying the entire bill. why -- you know, there are many
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doctors that won't take medicare patients. we'd like to see a system, i'd like to see a system where we assisted everybody into health care coverage, and i don't want everybody to be -- to have doctors they can't go to. you know the ranking member made a point about in trying to expand the benefits of medicare to part "d" as i said earlier for the first time ever, instead of trying to operate the system, we put a system together there where marketplace force did work. it's cheaper than anybody thought it would be by 40%. it's a voluntary plan that 90% of the people that could be in the plan are in the plan. 90% of them think it's either good or excellent and 100% of them can change their provider sometime in the next 12 months. those would be good things available to people in health care whether they were on medicare or not. i said the other day i mentioned that medicare had not been particularly good at helping people prevent health care problems from developing, and in
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fact until 2005 or '06 when the medicare reforms were initiated, no medicare patient from 1965 until then had ever seen a doctor unless they were sick, had ever seen a doctor unless they were sick or they thought they were sick and got to the doctor consistently. it was our reforms to medicare that created the welcome to medicare physical where for the first time ever in the entire history of the program people saw a doctor when they entered the program and they got their blood pressure, they got all of those things created a baseline that helped them be well longer in a more effective way. we have not only supported the program, we have worked to improve the program and will continue to do that, and i think our time is expired. >> the gentleman's five minutes has expired. >> who seeks recognition for the second five minutes? are we ready for the vote? well, democratic time.
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mr. butterfield is recognized for five minutes >> i strike the last word, mr. chairman. i ask to strike the last word. >> will the gentleman yield? >> the gentleman is recognized for five minutes. >> mr. weiner. >> i guess the failure to answer my question speaks volume. the fact of the matter is you like medicare, right, because it's efficient, not bureaucratic? it's efficient. no one disputes that, okay. you like medicare. now the whole idea of medicare is that it is government-run health care. it's socialized medicine, that's what it is, and you know what? it works. one of the reasons it works is the $6 hundred billion of profits that we put in goes not to checkups, not to indigent people, goes to profits for the health care companies, so much so that the administrative overhead combined with their profit is 30% compared to 3% for
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medicare, so you like it. you're not going to vote for this amendment because you like medicare. you go home to your constituents and brag about how you fought to save medicare. that's socialized medicine. i just want to stop the hypocrisy of having you all stand up as frequently as you do and lament socialized medicine, bureaucrats coming between you and your doctor. can i tell you something, do you think there are no hmo bureaucrats, nine shurns company bureaucrats? >> will the gentleman yield? >> will the gentleman yield? >> let me just -- i don't control the time, but when i said what if the public plan looked like medicare, i didn't hear an answer. you like it, well, maybe the public plan in here is going to look kind of like medicare. >> would the gentleman yield? >> hold on a second. let me just finish this thought because if it is, it's going to be more efficient. now you have said repeatedly we have to be careful because you're going -- if you let that be an option the private plans won't be able to compete. now that's a strange thing to
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say. do you mean that the public may choose something like medicare over your friends in the insurance industry? yeah. they might. you know why? medicare does a better job. people like it, so when you stand up and say socialized medicine, government-run medicine is bad, impolice i had in that is medicare, the va and vod health care which are government-run health care plans, so when you think about the public plan and you go home and say how bad it is, you're essentially saying you don't like medicare. >> reclaiming my time, i yield to the gentleman from missouri. >> i thank the gentleman for yielding, and you actually did hear an answer. the answer was when we talked to our health care providers where we live they say that medicare does not pay the bill and that has to be either by charitable donations or by other plans has to be supplemented. that's one of the reasons that the reimbursement rate from the private plans is higher than the medicare plan. that's one of the reasons they cost more. that's one of the reasons that the more people that go into a
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government-like plan the harder it is for those plans to compete, and when we talked to our hospitals and doctors i think the nationwide average is that the medicare reimbursement rate is right at 80% of what health care providers say is cost of service. >> would the gentleman yield for a moment? >> the point being made here is not whether or not medicare is perfect, i know that it's not. the point is the language of criticizing government-run health care is -- >> i believe i still -- >> is hypocritical and dishonest. u can't have it both ways. >> i think i still have mr. butterfield's time. >> the gentleman from missouri has the time. the gentleman from missouri has the time. >> i thank the gentleman for yielding and i will just try to answer the question and get the time back to your side. the point is if you have more people in a system that doesn't reimburse the cost of care, who does reimburse? and i'd yield. >> the gentleman -- the answer is the 15% that goes to profit
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goes back to reducing costs. >> well, i don't know -- >> i'm curious. you know, the idea that the health insurance companies are keeping prices at a certain level out of altruism, no, they are making profits. why are we putting profits into insurance companies rather than the practice of medicine? medicare doesn't do that. that's why medicare is such a success and that's why you wouldn't to criticize that as being government-run health care. you like it. you think it's good. it's better in many cases. have you a 30% combined overhead, 15% of it is profits. by the way, how much profit? about -- i'll tell you how much profit. $600 billion -- approximately $600 billion and that's on the rise so the question is why don't we capture some of that money and put it towards health care. you like medicare. you like socialized medicine. you like government-run health care and you are just afraid to admit it. >> will the gentleman yield? i can -- >> reclaiming my time, mr. chairman. i yield back. >> mr. chairman, the gentleman yields back the balance of his
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time. >> mr. murphy? >> thank you, mr. chairman. this is not the place to have sweeping prejudicial statements about whether people are hypocritical or dishonest. let's stick with some facts. new york presbyterian hospital of 93 internists affiliated with that hospital, 37 won't accept medicare. a medpac survey in 2008 said 29% of patients on medicare have trouble finding a primary care doct doctor. that's up 5% from the year before. in the last congress there were 452 bills introduced by members of congress. 13,000 co-sponsors of those saying we have problems with medicare and medicaid. let's fix them. only 12 were signed into law but it takes an act of congress to change government-run health care. there are lots of good things with medicare, no doubt about it but let me give you examples where you have procedures that require an act of congress. in order to get intravenous drugs patients must enter a hospital though therapy can be
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given at home. it will take an act of congress to change that. you have situations where medicare might not pay for a power wheelchair for an individual with severe arthritis who can walk a short distance but who may need a power wheelchair for longer distance and a private insurer may pay for that. some may not take part in clinical trials because medicare doesn't cover costs. >> would the gentleman yield? >> no, not yet. i don't want to be hypocrite camp i want to it is cheaper than prescription drugs. but they cannot get reimbursement. the concern is not -- let's not create this straw man of sweeping generalizations that we do not like medicare. the problem is that this is between your doctor and you, this is congress. and what w

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