national debt

Jan 23, 2010

Mr. AKIN. Good afternoon. Once again, we find ourselves here on the floor of the U.S. Congress and the subject before us, in spite of various events that have been of great interest to people yesterday--I'm thinking of the election of Massachusetts--still remains the question of health care. [Page: H249]

There is discussion with the new political realignments that it may be that the House will take up and just pass the bill that was passed by the Senate. That is one possibility, which then of course would require the bill not to have to go back to the Senate.

And so we come back to this question of health care in America, something that has a lot of people's attention. It's not the top priority I think for many people. I think many people are worried about unemployment, they're worried about the economy, they're worried about excessive government spending, they're worried about terrorism and national security. But underneath those, perhaps, there is still some concern about health care, but particularly a fear that in an attempt to try to solve a
problem we may make a bad situation worse. Indeed, when government does too much, we have found that we sometimes get some very bad side effects--inferior quality, inefficient allocation of goods, bureaucratic rationing, and of course excessive expenses.

Now, if health care is expensive now, just wait until it's free, some have said. We were promised by our President, Here's what you need to know: First, I will not sign a plan that adds one dime to our deficits either now or in the future. Sounds pretty definitive. It sounds like he says, hey, I understand about the deficit, I understand about the debt, I understand about excessive spending, and I am not going to add one dime to our deficit.

Well, the bill that's being proposed does not add a dime, so I guess technically this statement is correct. It adds, rather, either one or several trillion dollars. That may be a whole lot worse than the dime. So this particular statement, along with some others that we've heard, is not really precise in terms of what has been proposed, particularly the Senate and the House versions that we have seen.

In order to try to put a package together, there have been some compromises made, as tends to happen when you're writing large and complex pieces of legislation. This protects insurance companies in kind of an odd way. The legislation that is being considered in the Senate preserves the legal immunity of large insurance companies in the event of negligence or any other wrongful action even if their action results in injury or death of a patient.

Now, this is the language that's in the bill. What does that really mean? What it means is something that I think most Americans consider to be very undesirable, and that is, you walk in and you feel sick and you go see your doctor. You trust your doctor, you've known your doctor for some period of time, and so you have the doctor take a look. He runs some tests and he says, well, now, Congressman Akin, this is the news: You've got this, this, and this, and I recommend we do this. And
you check with him, ask a bunch of questions and say good, that seems like a good course of action.

Now, here's where the train comes off the tracks. Your insurance company says, but we don't really think that's necessary, we're not that concerned about you, Congressman Akin. And your doctor, well, you know, he's probably being pretty cautious, but he's also being pretty expensive. And so we're going to say you really don't need to go to the hospital for this, we're going to recommend you just stay home for a while and take some aspirin and see what develops. Now, that's what we call
something or somebody getting in the way of the doctor-patient relationship.

In this country, we have gotten spoiled. We have enjoyed contact with our doctors. We have enjoyed the process of getting to know the doctors and trusting them and soliciting their opinion. At times, we get multiple opinions from different doctors just to make sure. But we don't want some insurance company coming between the patient and the doctor; that's pretty bad when that happens. What's worse is when the government comes between you and your doctor. That's what a full-born socialized medicine
bill will do.

This bill here says that these insurance companies can basically second-guess the doctors, and if things go wrong, guess what? They have no liability. Is that what we want in health care reform? I don't think so. Doctors can be sued if they make a bad diagnosis, but not insurance companies, even when they get in between the patient and the doctor. Is that something we want in a health care bill? I don't think so. And that's one of the reasons why a lot of Americans don't want this massive government
takeover to pass, because it has these little loopholes like this in it. I don't think many of you would have known that that was in the bill, and yet it is.

There are also some other problems. We have a bill, when you start to get thousands of pages of legislation, there is a lot of room for mistakes and an awful lot of creation of bureaucracy. I don't know what the latest version of this is because a lot of this is negotiated behind closed doors, but we're talking about close to a 2,000-page bill passed with I don't know how many hours of public review--72 hours would be nice, I'm not so sure we'll have that. We have not had that on other major
pieces of legislation.

This particular bill creates 118 new boards--that sounds like some bureaucracy, doesn't it--commissions and programs full of new mandates. One of the things in legislation that people who are legislators pay attention to is how many ``you musts'' and ``you shalls'' and ``you've got to's'' there are in a bill. This one contains the word ``shall'' 3,425 times. Obviously somebody has very strong opinions about what other Americans ought to do, and they're going to mandate it. And so you have here
quite a large bill, many, many pages, 3,425 ``shalls,'' 118 new boards.

We tried to draw a picture of what that would look like. Now, you know they say a picture is worth a thousand words. I don't know if this picture is worth 1,000 or 2,000 pages, but this is an attempt at drawing a picture of what we've got. And the more you look at it, the more you look at all these colored boxes, which are some of the new agencies and all, it starts to look more and more like some sort of a maze. And you kind of wonder whether what's going on is, the consumers or people who are
sick are somehow trying to get across this maze to find their doctor. It's almost like something you would be given at a restaurant with a Crayon, and you're supposed to plot the path, if you're a patient, to somehow get over to see the doctor. But this is the kind of complexity that is being created by what has been proposed over the last 7 or 8 months by the Democrats.

The reason this is so complicated is because of the overall strategic approach that health care started, and that was the idea that we're going to take what we have and pretty much pitch it, and we're going to redesign the whole thing and put the government in charge of it. So

we're not going to go in and fix this or that that's broken; we're going to basically scrap it and start over.

Consequently, the result is a very complicated piece of legislation for the government to try to take over what is essentially close to one-fifth of the U.S. economy.

So that's one of the things that people are concerned with and one of the reasons why, not so much based on political party, but just based on good old American commonsense, there is a concern for the complexity and of course the cost associated with that complexity.

We don't like mandates a whole lot. Americans tend to be a little bit freewheeling, and they're not too much into following all the dots and tittles and all the little nuances of laws and rules. Americans like to have some freedom, a little bit of elbow room, a little flexibility. So when we're talking about the mandate, we're saying, here, there's mandates in this bill. All those ``shalls'' come into things that restrict your freedom. One of the mandates is that employers must offer a qualified
health care plan to full- and part-time employees.

So we're saying to companies, we don't care what you think is good for your employees, and we don't really care what your employees think is good for them; what we're going to do is tell you how it's got to be. And so we are going to write what your health care plan has to look like, and then, Mr. Employer, you have to offer what we're writing up for you to your employees.

[Time: 17:15]

That is an interesting approach. We think of it in terms of the idea of a top-down, Big Government solution because the government is going to tell you what you need. Whether you think you know what you need doesn't make any difference. It's going to be a top-down status mandate, and you will pay for 65 to 72 percent of the cost of the plan.

So we're going to tell you what kind of plan you're going to offer. By the way, you're going to pay for it, and if you don't pay for it, we're going to penalize you, and we're going to hit you with a tax of up to 8 percent of your payroll costs. So whoever you are, even fairly small businesses, you know, in terms of what the cutoff is in this, you're going to get hit with 8 percent of your payroll taxes. In fact, if you have 100 employees, if 99 of them want this qualified plan and one does not,
the way the bill is written is that you're going to end up paying this 8 percent because everybody has to agree to what the government has mandated.

So there are some mandates in here which, from a small business point of view, are considered fairly onerous. It's another thing which makes the bill offensive and not popular.

Now, one of the concerns is, when the government takes something over, it tends to cost money. The President said it's not going to cost a dime. I suppose that's true. It's supposed to cost over $1 trillion, but there are a lot of hidden costs. You see, you bury the costs of some things that you don't want to show. Trying to keep it under $1 trillion was a tough thing to do; $1 trillion is a fair amount of money. Even for the U.S. Federal Government, $1 trillion is a lot of money.

We spent about $1.4 trillion last year. That was about what our level of debt was, $1.4 trillion. The highest debt that we'd had before that was under President Bush in 2008. During the Pelosi Congress here in 2008, we had just south of $500 billion in deficit spending that year. So, if deficit spending of 400 and--whatever it is--50 or 60 billion was a lot, $1.4 trillion in deficit spending was a considerable amount. So our deficit in '09 tripled from '08, and it was a $1 trillion-plus, $1.5

Well, here is $1 trillion for this little plan. This is not small if you're worried about Federal spending. The estimate here is it's going to raise taxes $729 billion. If we got away with that few in tax increases, we might be doing well. It increases the long-term cost of medical care by $289 billion. Again, I think those are conservative estimates. It creates shortages, higher costs, more regulations, more patients, and a fixed supply of medical professionals.

This is part of the CMS Report. CMS is a group of staffers who are not connected with a political party. They take a look at legislation, and they try to come up with what the costs are and how it's going to work. Of course, there's a lot of argument about what they count and about what they don't count; but things like creating shortages and also considerable amounts of unemployment are expected to come from this because, if you mandate that businesses spend a lot of money, what happens is it
means their employees are going to cost more. If their employees are going to cost more, there's an incentive for them to get rid of some employees and to run the employees they have for longer hours. That reduces their costs, which of course increases unemployment.

So this bill will affect unemployment, which is another reason people are not very pleased with it and are disappointed in the bill. There is an inefficiency and an expense here which is quite considerable.

There is another mandate. This is one on individuals. It says that individuals must buy acceptable health insurance coverage. Now, guess who defines what health insurance coverage is acceptable if you're an individual citizen of the United States?

Is it the individual citizen? Is it the 22-year-old who says, I can't afford health insurance right now, and I'm very healthy and I'm making the decision not to get health insurance? Is he the one who decides what acceptable health insurance coverage is?

Of course, the answer is ``no.'' The answer is that the Federal Government knows what you need better than you do, so the Federal Government is going to mandate that you have this coverage, and they're going to tell you what kind of coverage it is, and you've got to buy it.

Now, this raises kind of an interesting legal point, which is, if the government mandates that you have something or that you buy something, is that not really, essentially, a tax increase? When you mandate that somebody has to buy a particular product, is that something that the Federal Government should be doing in this particular area? Is it even constitutional? When it is a mandate, is it not just essentially a tax increase? Or pay an additional 2.5 of your income in taxes. So now you're
going to have a choice. You can either buy the insurance that we know is best for you--Big Brother government--or you can pay a fine or face criminal penalties, including jail time and severe fines if you don't get in line with what we know is best for you.

Who is ``we''? Oh, we just saw a picture of the ``we,'' didn't we? Here is the ``we.'' We know what's best for you. All of this matrix of bureaucracy, this matrix run by the Federal Government, really knows what's good for you, and so we're going to tell you what it is that you have to buy. You've got to buy the insurance we tell you you've got to buy. Otherwise, you'll face criminal penalties, including jail time.

How do you think that goes over with a lot of freedom-loving Americans? Well, not very good.

I think some of the election results that we've seen in the last number of months reflect the fact that people are not that comfortable with Washington, D.C.--Big Government--playing God in everybody's lives. That's one of the concerns and why this is not particularly popular.

I notice that we have joining us this evening a doctor, somebody who has spent years in the health care profession and who has really been in the middle of it as to providing that doctor-patient relationship. He knows the subject far better than this poor, old engineer does, and I would like to yield some time to my good friend who has just joined me on this health care topic. I was just running through some of the reasons why people aren't that excited about this Big Government takeover of health
care and why you're seeing a lot of people voting, saying, I'm not sure we're on the right track with this.

I yield to the gentleman from Tennessee.

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