Healthcare and Small Business: Real Options For Colorado Businesses

HEALTHCARE AND SMALL BUSINESS: REAL
OPTIONS FOR COLORADO BUSINESSES
FIELD HEARING
BEFORE THE
SUBCOMMITTEE ON WORKFORCE, EMPOWERMENT

& GOVERNMENT PROGRAMS
OF THE
COMMITTEE ON SMALL BUSINESS

HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
WASHINGTON, DC, AUGUST 10, 2006
Serial No. 10963

Printed for the use of the Committee on Small Business
(
Available via the World Wide Web: http://www.access.gpo.gov/congress/house
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2006
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MIKE

DONALD A. MANZULLO, Illinois, Chairman
ZQUEZ, New York
ROSCOE BARTLETT, Maryland, Vice
NYDIA VELA
Chairman
JUANITA MILLENDER-MCDONALD,
California
SUE KELLY, New York
TOM UDALL, New Mexico
STEVE CHABOT, Ohio
DANIEL LIPINSKI, Illinois
SAM GRAVES, Missouri
ENI FALEOMAVAEGA, American Samoa
TODD AKIN, Missouri
DONNA CHRISTENSEN, Virgin Islands
BILL SHUSTER, Pennsylvania
DANNY DAVIS, Illinois
MARILYN MUSGRAVE, Colorado
ED CASE, Hawaii
JEB BRADLEY, New Hampshire
MADELEINE BORDALLO, Guam
STEVE KING, Iowa
L GRIJALVA, Arizona
RAU
THADDEUS MCCOTTER, Michigan
RIC KELLER, Florida
MICHAEL MICHAUD, Maine
NCHEZ, California
TED POE, Texas
LINDA SA
MICHAEL SODREL, Indiana
JOHN BARROW, Georgia
JEFF FORTENBERRY, Nebraska
MELISSA BEAN, Illinois
MICHAEL FITZPATRICK, Pennsylvania
GWEN MOORE, Wisconsin
LYNN WESTMORELAND, Georgia
LOUIE GOHMERT, Texas
J. MATTHEW SZYMANSKI, Chief of Staff
PHIL ESKELAND, Deputy Chief of Staff/Policy Director
MICHAEL DAY, Minority Staff Director
SUBCOMMITTEE ON WORKFORCE, EMPOWERMENT AND GOVERNMENT

PROGRAMS
MARILYN MUSGRAVE, Colorado Chairman
ROSCOE BARTLETT, Maryland
BILL SHUSTER, Pennsylvania
MICHAEL FITZPATRICK, Pennsylvania
LYNN WESTMORELAND, Georgia
THADDEUS MCCOTTER, Michigan
JEB BRADLEY, New Hampshire
DANIEL LIPINSKI, Illinois

TOM UDALL, New Mexico
DANNY DAVIS, Illinois
L GRIJALVA, Arizona
RAU
MELISSA BEAN, Illinois
GWEN MOORE, Wisconsin
JOE HARTZ, Professional Staff
(II)
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CONTENTS
WITNESSES
Page
Fries, Mr. Matt, President & CEO, Professional Document Management .........
Roberts, Mr. Dale, Chairman, Loveland Chamber of Commerce ........................
Boesch, Ms. Chris, Exodus Moving & Storage ......................................................
Liske, Mr. Fred, General Manager, American Eagle Distributing Company .....
Hillman, Mr. Mark, Former State Senator ...........................................................
Cletcher, Dr. Jack ....................................................................................................
Tamlin, Ms. Deb, Broker, ZTI Group .....................................................................
Jensen, Mr. R. Allan, National Association of Health Underwriters ..................
Snyder, Ms. Gail, Snyder Insurance Agency .........................................................
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APPENDIX
Opening statements:
Musgrave, Hon. Marilyn ..................................................................................
Prepared statements:
Fries, Mr. Matt, President & CEO, Professional Document Management ..
Hillman, Mr. Mark, Former State Senator ....................................................
Cletcher, Dr. Jack .............................................................................................
Jensen, Mr. R. Allan, National Association of Health Underwriters ...........
Snyder, Ms. Gail, Snyder Insurance Agency ..................................................
(III)
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HEALTHCARE AND SMALL BUSINESS: REAL

OPTIONS FOR COLORADO BUSINESSES
THURSDAY, AUGUST 10, 2006
HOUSE OF REPRESENTATIVES
WORKFORCE, EMPOWERMENT, AND
GOVERNMENT PROGRAMS
Washington, DC
The Subcommittee met, pursuant to call, at 1:00 p.m., in
Loveland City Council Chambers, 500 East 3rd Street, Loveland,
Colorado, Hon. Marilyn Musgrave [Chairman of the Subcommittee]
presiding.
Present: Representative Musgrave.
Also Present: Representative Shadegg.
Chairman MUSGRAVE. The hearing on the Subcommittee on
Workforce, Empowerment, and Government Programs will come to
order. Thank you all for being here today. We appreciate that so
very much. We are going to examine healthcare choices for Americas small businesses, their employees, and working families.
Before I begin, I would like to thank my friend and very respected colleague for joining me here today, John Shadegg. Of all
days to be flying, John. This has been a most interesting one and
I am glad it went well. I want to thank you very much for making
the effort to be here.
Mr. SHADEGG. My pleasure.
Chairman MUSGRAVE. John was first elected in 1994 and he
quickly established a reputation in Congress as a leading advocate
for reduced government spending, federal tax relief, and the re-establishment of state and individual rights. He has proven to be a
leader on healthcare issues.
From 2000 to 2002 he was the Chairman of the Republican
Study Committee, the largest conservative organization in the
House of Representatives. Under his leadership there was dramatic
growth from 40 to more than 70 members and it has become the
most influential and respected force in the U.S. House shaping conservative policy for the country.
In 2005 John was elected by his peers to serve as Chairman of
the House Republican Policy Committee, the fifth ranking position
in the House leadership from 2005 to 2006. At the time he was the
only member of the Republican class of 1994 serving in House leadership. Again, I just want to thank you for being here as we address this important topic today.
SUBCOMMITTEE
ON
(1)
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All Americans want reliable, high-quality, and reasonably-priced
healthcare that will be there when they need it. One of the most
stressing statistics we hear each year is the rising number of
Americans who live without health insurance currently estimated
at 45 million people. Of those without health insurance about 60
percent are small business owners, employees of small businesses,
and their families.
As healthcare costs continue to rise, fewer employees and working families will be able to afford coverage. In Congress we must
look at this pressing problem and find solutions that will create an
environment so that those who need health insurance cannot only
find the coverage they need but, more importantly, afford it. We
need to be working towards the healthcare delivery system method
that works best, not just what we have always done.
A simple look at the current health landscape shows that the
system is not working. The thing that we will focus on today will
be four proposals that this Congress has begun to work on to help
Americans get the coverage they need at a price they can afford.
These proposals are the establishment of Association Health
Plans, as we call them AHPs, increasing the availability, use, and
ease of Health Savings Accounts, we call those HSAs, reforming
the medical liability system, and examining Congressman John
Shadeggs common sense legislation H.R. 2355. He will tell us all
about that, the Healthcare Choice Act.
On July 26, 2005, the House of Representatives passed H.R. 525,
the Small Business Health Fairness Act of 2005. That was legislation that would establish federally regulated Association Health
Plans with a strong bipartisan vote. That was the 7th time the
House had passed such legislation. I am confident, though, that
real progress on this legislation will be made in the Senate this
year.
AHPs would allow small businesses to band together across state
lines through their membership in an association to purchase more
affordable health insurance. Unions and large corporations already
have the ability to do this so it makes sense to me that we should
allow small businesses to have the same opportunity.
Health savings accounts are a new way that people can pay for
a medical expense not covered by insurance or other reimbursements. Eligible individuals can establish and fund those accounts
when they have a qualifying high-deductible health plan and no
other health insurance with some exceptions. These accounts have
significant tax advantages. The contributions are deductible. Withdrawals used for medical expenses are not taxed, and account earnings are tax exempt and unused balances can accumulate without
any limit.
President Bush has proposed several improvements to HSAs
such as allowing Americans who HSA qualified insurance policies
on their own to have the same tax advantages as people who obtain
health insurance through their employers and eliminating all the
taxes on out-of-pocket spending through HSAs.
An additional area that Congress and the President have worked
on together is tort reform for the medical community. American patients are losing access to healthcare because of the nations out-
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of-control legal system enforcing physicians in some areas to retire
early.
I was an elected to Congress with three doctors and some of the
most poignant testimony you will hear are from doctors that come
from states that have enormous problems with the tort system.
Right now it is estimated that we have 21 states that are in a
full-blown medical liability crisis and in 2002 there were 12 so we
see the growth. In these crisis states patients continue to lose access to care. The rural areas of the 4th District, like many other
districts around the nation, people have to drive over long distances, especially in the area of OB/Gyn when women have babies
having to drive 200 miles to see a doctor it gets very burdensome.
Meanwhile, the high-risk specialists no longer can provide trauma care or perform complicated surgical procedures. This excessive
litigation and high medical malpractice rates have added to employers healthcare costs and have spurred some providers to err on
the side of caution that comes at the expense of both health plan
dollars and patients receiving unnecessary service.
This issue isnt just about physicians. It cuts across the
healhcare sector. Hospitals need physicians to admit patients.
Companies that manufacture medical devices and pharmaceuticals
need physicians to use and prescribe their products. Similar to the
AHP legislation, the House passed more healthcare related issues
in H.R. 5 that help efficient accessible low-cost timely healthcare,
or Help Act of 2005, and that happened in July of 2005. The Senate
is continuing to debate this critical legislation.
Another proposal to help Americans find and afford healthcare is
legislation introduced by my colleague, John Shadegg, H.R. 2355.
Again, that is the Healthcare Choice Act of 2005. Under this legislation consumers would no longer be limited to purchasing policies
dictated by their states regulations and mandated benefits. Instead
they can pick from a variety of insurance policies qualified in one
state but offered for sale in multiple states.
When I served in the Senate with Mark Hillman we dealt with
many mandates in committees and we saw the policies in Colorado
loaded up. This would be a solution to that problem that drives up
the cost of the policy. We know, there is not one solution to a problem that is as complicated and as complex as what we are facing
with 45 million Americans without health insurance.
Small businesses and their employees are in a critical situation
with finding new ways to increase health insurance coverage and
we will look at many proposals today that have been offered. I am
eager to hear from our witnesses today. I thank you very much for
being here.
Our first witness is Mr. Matt Fries. He is President and CEO of
the Professional Document Management from Fort Collins, Colorado. I think I will just introduce all of you, if I may, Mr. Fries.
Excuse me. You know what I forgot? My Congressman from Arizona that came to be with us. Ill introduce the witnesses in a moment. Forgive me, Mr. Shadegg.
[Chairman Musgraves opening statement may be found in the
appendix.]
Mr. SHADEGG. The order doesnt really make much of a difference.
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Thank you very much, Madam Chairman. I want to commend
you and the Full Committee Chairman, Mr. Manzullo, for your
focus on healthcare. This is a critical issue that faces our entire nation. I have a written opening statement which, with your permission, I will put in the record and just briefly kind of summarize a
few comments.
Both you and Chairman Manzullo have been leaders on the issue
of healthcare reform. I have a passion for healthcare reform because it is affecting so many American businesses and it is damaging our economy. Indeed, as I think you will recall, just before
we left Washington for the August district work period, the Chairman of the Committee, Mr. Manzullo, made an impassioned plea
for America to deal with the problems confronting small businesses
and, in particular, the rising cost of healthcare. He talked about a
personal story. His brother, who is in the restaurant business, was
forced out of business by rising healthcare costs. I want to commend you as a leader in this field.
As you mentioned in your opening statement, there is no one answer to this problem. The four bills that you have picked for this
hearing, I think, are key parts of the solution to this problem. I
would like to thank all the witnesses for being here. I would like
to thank the people in the audience who are paying attention and
looking at this issue.
Association Health Plans are an idea whose time has come and
we simply, as you pointed out, need to get the Senate to reflect the
will of the American people. It is a device by which small employers could get together and buy insurance by pooling together and
getting the larger purchasing mechanisms thereby bringing down
the cost of their health insurance and making them more competitive.
Health Savings Accounts, I think, go to the heart of one part of
the problem which is we have told the American people that they
are not personally responsible for their own healthcare and for the
cost of that healthcare. HSAs put them back in the drivers seat
which is a key part of what I hope to do in healthcare reform.
There are many pieces to this puzzle. Liability reform, as you
mentioned, is a huge one. Unfortunately, we have tried and tried
again to address the problem of liability reform in Washington
again with no success, kind of steadfast opposition from those who
believe the current tort system is serving the interest of the American people. I am one of those who believes that an injured patient
should be able to recover, but I also believe that we have an outof-control tort system. I might note you kindly did not mention my
prior occupation. I call myself a recovering lawyer, though I did not
practice tort law.
I will just briefly try to, if I could, mention the Healthcare Choice
Act. It is an idea that not many people are familiar with. I will
take a couple of minutes to describe its advantages and strengths.
I would suspect that it having gotten very little attention in the national media, probably many members of even your panel havent
heard of this notion or the idea behind it. If I could, I will try to
just briefly summarize how it would work.
The insurance market, and I think everyone knows, is divided
into different segments. Most Americans get their insurance
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through their employer. In addition, many Americans get their insurance or their healthcare through government programs, either
Medicaid or Medicare. But there is a segment of our population
that buys their health insurance in what is called the individual
market. That means they dont get it from their employer and they
have to go out and buy it individually.
Right now that is the segment of the market that is still regulated by the states. I guess as a states rights person and someone
who believes that the federal government located as it is far away
in Washington, D.C. isnt the best regulator. When looking at the
healthcare reform issue I decided we ought not move more of
healthcare reform regulation or healthcare regulation to Washington, D.C. Lets try to lead it with the states.
At the same time, as you pointed out, the current system for individual health insurance sales is overburdened by state regulatory
practices and by mandates. Just a handful of years ago there were
across America some 50 to 200 mandates, benefit mandates. Things
like you must cover podiatry or you must cover various types of
care, emergency room care, cancer screening, those kinds of things.
As you pointed out, the state legislatures have been inundated
with demands for more and more mandated benefits. I doubt if
many people realize that, for example, today podiatry is required
to be covered by any insurance policy sold in the state of New York.
Acupuncture must be covered in any policy sold in 11 different
states, California, Florida, Montana, and on.
Massage therapy is a mandated benefit in the policies sold in five
different states. Everyone might say it is a good idea to cover these
kinds of services but the problem is every time you mandate an additional benefit that must be covered by an insurance policy, you
raise the cost of that policy.
The other issue is that because in the current individual market
an insurance policy must be filed with and qualified for each states
laws, any insurance company that wants to sell a policy in all 50
states has to write that policy, has to write a policy that meets the
state laws of any state they want to sell in. If they want to sell
in my home state of Arizona, they have to write a policy that meets
Arizona law. If they want to sell in Colorado, they must write a
policy that meets Colorado law.
That means a huge regulatory burden of meeting the laws of all
50 different states. The concept behind the Healthcare Choice Act
is pretty simple and straightforward. Given that most states insurance laws are relatively similar, it says that an insurance company
can take a policy, bring it to Colorado, for example, qualify it for
sale under Colorado law, and then take that policy to any one of
the remaining 49 states, simply file with the insurance commissioner in that state and then offer that policy for sale.
There is a huge regulatory burden that is lifted. But being interested in having consumers protected by local enforcement or local
regulatory protection, we then said that if a policy was written to
comply with Colorado law and then taken and filed in Arizona and
sold in Arizona, the Arizona insurance commissioner could enforce
the terms of the policy on behalf of Arizona consumers.
What this would really mean is that the regulatory burden for
getting a policy in the market would come down dramatically. The
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number of mandates included in a basic policy would go down quite
dramatically lowering the cost of health insurance and, yet, consumers would remain protected because their own insurance commissioner could protect them.
In most states, and I believe this is true of Colorado, the number
of insurance companies selling policies on the individual market is
a handful, three to five. There is virtually no competition. Were you
to enact the Healthcare Choice Act, which I hope we will get a vote
yet this year in Congress, and has passed the Commerce Committee on which I serve, there would be literally dozens more policies for sale here in your congressional district because it would be
so much easier to bring a policy to the market and, therefore, more
competition hopefully producing lower cost.
That gives people a little bit of an idea what the Healthcare
Choice Act does. It did clear the Energy and Commerce Subcommittee and it is waiting for further action so we are anxious.
I want to thank you for continuing to support healthcare reform so
that Americans can get high-quality healthcare at an affordable
price.
Chairman MUSGRAVE. Thank you. I remember when you came
into my office to ask me to co-sponsor that legislation. You got a
little bit out of your mouth and I said, Does it get us out from
under all the mandates? You said, Yes. That is what I wanted
to hear right away. Thank you for being here.
I would like to introduce the witnesses and then we will start
with Matt. Again, the first one is Mr. Matt Fries, President and
CEO, Professional Document Management from Fort Collins. Then
we have Chris Boesch, Exodus Moving and Storage from Fort Collins. There you are. Thank you.
Next up is Mark Hillman. I served with Mark in the state legislature. It is very good to see you and I know that you were very
knowledgeable and worked very hard on bringing down the cost of
healthcare. I appreciate those efforts.
Deb Tamlin. It is good to see you. I thank you for being here
today, a broker from ZTI Group in Fort Collins. Gail Snyder down
there on the end, Snyder Insurance Agency, Loveland, Colorado.
Dale Roberts from the Loveland Chamber, Loveland, Colorado.
Fred Liske, General Manager, American Eagle Distributing Co. It
is very good to see you. Dr. Jack Cletcher. We are happy to have
you here today from Berthoud, Colorado. And Allan Jensen, Colorado Association of Health Underwriters.
I think we will just actually go in the order that you are seated.
That will be fine. Matt, we will start with you. We will adhere to
the clock so Mr. Shadegg can get off to DIA and fight the good fight
to get back to Arizona. Thank you.
STATEMENT OF MATT FRIES, PROFESSIONAL DOCUMENT
MANAGEMENT
Mr. FRIES. Very good. Good afternoon Chairman Musgrave. It is

a pleasure to see you. Welcome to Northern Colorado Congressmen
Shadegg. Thank you for holding this hearing and for your leadership to find ways to make health care coverage affordable to small
businesses.
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My name is Matt Fries, and I am the owner of Professional Document Management located in Fort Collins. My company is in the
paper and electronic records storage and destruction business, and
we employ 13 people, 10 full-time and three part-time.
Like most small, independent business people, I dont typically
look to Washington, D.C. to solve my problems. Most of us generally operate from the point of view that less government is the
best government. And when it comes to affordable healthcare, government provided healthcare known as universal care is absolutely
not the answer.
Yet, the current health care coverage system isnt working all
that well, especially for small businesses. My company is pretty
typical. The people employed at PDM work very hard and do a
great job. They care about our customers and serve them well and
for their success, they deserve to have access to first rate health
and medical care when they need it.
However, due to the high cost of health insurance premiums,
that is extremely difficult for me, if not financially impossible. Currently, we are unable to provide any level of health care insurance
for our employees.There is a direct relationship between the increase in health care and the cost of health care coverage. New
medical technologies and new procedures can lead to increases;
however, from where I sit there appear to be two major cost-drivers. One is litigation and the other is state mandates.
Because my business serves the medical community, I know a lot
of physicians, and they struggle with crushing malpractice insurance rates. Excessive litigation and consequent high medical malpractice insurance rates cost all of us. Caps on non-economic damages and punitive damages would go a long way to stem rising
costs. This is beyond the scope of H.R. 2355 but deserves your further attention.
Regarding mandates, they are a major cost factor. For decades
states have micro-managed the health insurance industry. State
legislators require insurance companies or health plans to cover
specific services and by doing so they drive up costs for all of us.
The worst offender is Minnesota with over 60 mandates. We are
fortunate in Colorado to only have 19. According to the Council
for Affordable Health Insurance, state mandates add between 20
and 50 percent to the cost of health insurance.
This leads to another cost-driver: lack of competition. Price and
competition are inextricably tied together. A few large insurance
companies dominate the state markets meaning that there is very
little real competition in thehealthcare insurance coverage marketplace. Where little competition exists in any industry, there is no
incentive to keep prices down. I think H.R. 2355 could have the effect of creating a national health insurance market. New competition will drive down costs.
Another issue is lack of flexibility in the health insurance marketplace. Even in my small company employee needs vary widely.
The younger employees tend not to care much about health and
medical insurance, while middle-aged and older workers do. It is
difficult for us to qualify as a group when the young workers
dont want to pay to participate in an expensive one-size-fits-all
plan with features they dont want.
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Also, consumer-driven options like Health Savings Accounts,
while a huge step in the right direction, need to be detached from
employer-provided policies. HSA purchasers should be allowed to
purchase any type of health plan and get a tax credit for doing so.
The concept in H.R. 2355 concerning small business health
plans is excellent. By allowing small employers to purchase coverage through bona fide associations, small guys like me will have
the same advantages that unions and big employers have. By banding together, small businesses will realize economies of scale, increased bargaining power, savings from administrative efficiencies
due to having just one set of rules, flexibility in the design of the
coverage and increased competition in the health insurance markets.
Small firms and their employees will see lower insurance premiums as risks are spread across a larger pool of people. Small
Business Health Plans would give the little guys the same preemption from costly state mandates now enjoyed by the big guys under
the Employee Retirement Income Security Act (ERISA).
I am convinced that fostering interstate commerce in the health
insurance market will increase competition and improve consumer
choices just like interstate banking has done.
In summary, small employers like me want to provide health insurance to our employees without the cost and inflexibility of expensive state mandates. We want to encourage further development of consumer-driven health plans like Health Savings Accounts. We want to see choices for our employees in terms of coverage they want rather than being forced to buy one-sized-fits-all
coverage.
Chairman MUSGRAVE. If you could just wrap up.
Mr. FRIES. You bet. In closing, as a small employer, as stated
earlier, I dont look to Washington, D.C. to solve my problems. I
dont look to you for handouts. Congress can help, however, by improving the health care market. H.R. 2355 is a big step in the right
direction. Thank you again for your leadership on this issue and for
listening to my testimony.
[Mr. Friess testimony may be found in the appendix.]
Chairman MUSGRAVE. Thank you for your good testimony.
Now we will hear from Mr. Roberts representing the Chamber of
Commerce from Loveland.
STATEMENT OF DALE ROBERTS, LOVELAND CHAMBER OF
COMMERCE
Mr. ROBERTS. Yes. Thank you all for taking your time to be with
us today. My name is Dale Roberts. I am Executive Vice President
of Front Range Bank. Today my hat being worn is the Chairman
of the Chamber of Commerce here in Loveland.
Chairman MUSGRAVE. Could I ask you to pull your microphone
a little closer if that is possible?
Mr. ROBERTS. Okay. Is that better?
Chairman MUSGRAVE. Thank you.
Mr. ROBERTS. Okay. My speech wont be five minutes. I just
wanted to share with you the issues that our Chamber is involved
with and the things we have been trying to do possibly looking to
you to give us some other guidance and leadership.
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The Loveland Chamber actually has become a bona fide association as spoken to a little bit by Matt. We are currently working
with local healthcare providers to try to get something going with
them to provide insurance coverage for small businesses.
As a matter of fact, it is kind of frightening in some ways.
Loveland seems to be a big city. However, of our 850 members in
the Loveland Chamber of Commerce, 85 percent of those are four
employees or less. We are concerned because we have a lot of those
companies who are frankly running uninsured We dont currently
know any other way than try to make the Chamber, if you will, a
bona fide association tying our Chamber membership into some
kind of a healthcare program. Hopefully with state laws and others
we will be able to solve that problem and use our association to
help that very small businessman.
Again, thank you for my testimony and thank you for being here.
Now we will go to Ms. Chris Boesch from Exodus Moving and
Storage, Fort Collins. Thank you for being here before the Committee today.
STATEMENT OF CHRIS BOESCH, EXODUS MOVING & STORAGE
Ms. BOESCH. Thank you. I want to also thank you all for being
here and having this very important discussion. We have 60 employees. We do not provide health insurance. We do provide dental
for $11 per month per employee which is fabulous. We give our
guys a few dollars a month towards preventive maintenance such
as vitamins, to go to a gym, that sort of thing.
The profit margin in our industry is four percent. The lowest
healthcare that is available out there, Anthem recently went from
$100 to $50 as a minimum that an employer can contribute to an
employee. You can have a 60 percent amount of employee participation instead of 75 percent. That is supposed to be good news.
Unfortunately, it is not good news. The reason being that with
60 employees $50 a month you are looking at $3,000 a month and
that is if it doesnt go up next year and the year after that. That
is over one percent of my income and I have a four percent margin.
Not to mention that it is about $200 a month per employee and
there is no way that my guys that make between $9 and $16 an
hour are going to be able to afford $150 a month. It is a very difficult situation. They would like healthcare even though they are
young for both them and their families.
I am just going to throw out kind of an ad question that I dont
expect you to respond to right now, but how is it that healthcare
became the responsibility of businesses.
Chairman MUSGRAVE. That is a good question.
Ms. BOESCH. Okay. I think if we could go back to that basic and
talk from that point of view, I think that would be very important.
Secondly, I am going to offer kind of a pie in the sky resolution.
I believe in pie in the sky ideas because I think if you dont reach,
you can never attain. One of the things we all know that in addition to water, food, shelter, and education everyone should have access to a doctor. We also know that our European counterparts
have managed to do that for their citizens. We are a richer country
and we dont seem to have that which is really, I think, sad.
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I think there is no reason why Colorado cant be a pioneer. One
of the things that I would suggest is that health insurance companies, like many companies, are there to make money. I dont think
they are necessarily there to help patients or help hospitals. The
local hospital here 60 to 70 percent of their income comes from the
foundation from Medicare and from Government subsidies.
Thirty to 40 percent comes from healthcare insurance and
healthcare insurance and healthcare insurance companies dont
tend to pay the full price of the services that the hospitals provide
so the hospitals get short-cutted when working with health and insurance companies, not mentioning all the different types of people
that everyone has to go through to make that happen.
What about the idea of getting rid of the middleman? I am going
to the concept of a partnership between businesses, residences, and
the hospital. Perhaps there is a monthly fee that is charged to
every resident based on their income that is a percentage base.
Also health tax could be connected to a property tax so that, again,
you are looking at a fairness factor, if you will.
But not to be completely ignorant in that if we have a huge train
wreck or some big horrible catastrophe, somehow the cities or the
state would have to be covered for something massive so have a
huge umbrella policy through an insurance company along those
lines. That is just kind of my pie in the sky idea that I wanted to
throw out.
I think that is all I have to share. Thank you very much.
Chairman MUSGRAVE. Thank you very much. We discussed that
we might talk about tax rates in those European countries, too, because somebody does pay for it.
Fred, I am glad to have you here today and we are looking forward to hearing from you.
STATEMENT OF FRED LISKE, AMERICAN EAGLE
DISTRIBUTING COMPANY
Mr. LISKE. Thank you. My name is Fred Liske and I am General

Manager of American Eagle Distributing. I am honored to be here
today because this is a very timely topic for our company and everybody on the panels company. We just came off of renewing coverage for our employees so we are fresh off the fax.
I am going to tell you a little bit about our business to start with,
the industry that we participate in, and then we will just kind of
move forward from there.
American Eagle Distributing has been around a long time. It is
about a 30-plus-year business in the community. We are one of
1,900 American beer distributors across this country. American
beer distributors are generally family-owned, independent companies, relatively small business, generally 50 employees, about $14
million a year revenue. We have a million dollar payroll.
We are a little bit bigger here than the average wholesaler. We
have about 120 employees, $50 million a year in annual revenue,
and about $4.7 million in payroll. Ironically we are a member of
the National Beer Wholesalers Association and one of the hot topics of discussion right now is healthcare for our employees. It is absolutely crushing us when we take a look at the cost. We just recently, like I said, renewed our policy.
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What I want to do is take you through real quickly a little bit
about us as a company. We havent had an issue with getting insurance for our employees. We have been around a long time and
we have been pretty good at that but we are having an issue as
far as cost. We have to contain those costs and they have gone up
substantially year over year.
As we just renewed our healthcare benefits, some of the things
that we looked at were the benefits and costs of multiple insurance
products, the availability of in-network providers, the deductibles
and the maximum amount for our employees, co-pays, specific stop
loss maximums, allocation of premiums for commissions, fees, and
administration expenses.
I will speak up a little. Anyway, as general manager I got to kind
of see everything and I think like most small businesses we have
a handful of staff or executive members that have to do everything.
That is a lot of things that we have to review. We are not experts
in all these and a lot of issues that we have to deal with in communicating insurance to the employees.
Moving on, prior to shopping, bargaining and increasing our insurance we had to increase our stop loss amounts this years. We
did that also last year. What I specifically mean by that is we are
partially self-insured. That means as a company we continue to
take more and more of the risk.
Now, what we are hedging on is that we dont have a calamity
or a series of employees that have serious illnesses or injuries because that will definitely impact our bottom line. The reason we
chose to do that as a company, it was the only way of keeping our
insurance costs in line for our employees to afford.
To give you an example, the increase in the cost of our insurance
from 2002 to 2006 was basically 9.7 percent. We kept that in the
6 percent range as a company by again being partially self-insured
and raising the stop loss protection for our employees. In 2005 our
healthcare benefits represented 10 percent of our overall payroll
cost. If you figure about $4.7 million in payroll, $470,000 for
healthcare costs for the employees.
We feel that again we work, just as Chris alluded to, on a very
slim margin. Extremely slim. We continue to see margins going
down in our industry. As we do that, we look at the $460,000 as
being obviously an extreme cost of doing business.
There is something else that we want to bring up that we found
is very interesting, and that is while we offer insurance we know
a lot of small employers dont. Something that we found, especially
with our younger employees, they dont understand the benefit of
the insurance that we offer. As a company and working with other
beer wholesalers we have to educate.
We have a lot of young employees, as you can imagine, that are
putting the beer away doing that type of stuff and they will literally jump ship for 50 cents an hour to another competitor that
doesnt offer insurance benefits. Again, when they get a little bit
older and they actually use the benefits, they see the value but
that is just something that we thought we would bring up because
it is something we deal with in the company every single day.
I thought I would bring up just a couple things also in closing.
We try to stay pretty active in the community and we got some sta-
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tistics which we included in our packet for NCMC, Northern Colorado Medical Center. The interesting thing that we brought up,
and I want to read this. For 2005 their bad debt was 9.7 percent
of their total operating revenue. Basically what they are telling us
is 20 percent of the people that walk in their door to the emergency
room have insurance.
If we as a companyand remember we are a $50 million company. If we as a company had bad debt of 9.7 percent of our operating revenue, we would be out of business. Doors would be closed
and we would be gone. Again, something to bring up also as a
point.
Kind of in closing I wanted to bring up that we think that the
interstate commerce and health plans and the potential larger pooling would be absolutely phenomenal for us because what we look
at is obviously we think it would reduce the insurance administrative cost. We think it would add more value focused in a network
of providers. Obviously increases competition. We might be able to
have more like companies such as beer distributors within a pool.
We feel that in the long run that may help keep costs within the
realm.
Anyway, that is what we had in closing and then in the packet
we include some backup data. Thank you.
Chairman MUSGRAVE. We will submit all of that to the record.
Thank you.
Mark Hillman, we are very glad to have to have you with us
today. We look forward to hearing your testimony.
STATEMENT OF MARK HILLMAN, FORMER STATE SENATOR
Mr. HILLMAN. Thank you, Madam Chairman, and Congressman

Shadegg from Colorado. My name is Mark Hillman. I am the owner
and operator of Hillman Farms at Burlington and former Colorado
Congressman.
It has been said that insanity is doing the same thing over and
over again and expecting different results. That maxim could certainly apply to attempts by lawmakers and regulators to fix the
health insurance market. If I could wave a magic wand and compel
Congress do absolutely anything to the health insurance market, I
would simply ask them to undo everything Congress has done to
the health insurance market.
In fact, apart from licensing insurers to require financial stability, even most state level regulations simply replace old problems in the marketplace with well-intended but politically-driven
marketplacedistortions. These distortions replace old problems that
could be affected and corrected by the choices of millions of consumers and erect political obstacles that are exceedingly difficult to
correct.
Colorados small group market for health insurance has been
struggling for many years. In 1994, 84 carriers offered small group
coverage in Colorado. Today, 10 carriers constitute 96 percent of
our market. From 2000 to 2005, the number of lives covered in the
small group market declined from 538,000 to 358,000 and the number of employer groups enrolled in small group plans fell from
70,000 to 46,000.
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Much of this decline finds its roots in so-called reforms of the
past beginning with: Community rating. Prior to enactment of
community rating in Colorado premiums were directly related to
the health of each consumer. Legislators enacted community rating
in order to protect small business from wildly fluctuating premiums
and to keep insurance affordable for consumers with pre-existing
health problems. Unfortunately, this replaced wildly-fluctuating
costs with rapidly-increasing costs and disproportionately shifted
costs to healthy consumers, causing many of them to simply leave
the market.
Look at it this way. If you and I go to lunch everyday and we
both pay $10 and I get an $18 steak and you get a $2 cheese sandwich, how long are you going to like to subsidize my steak and be
satisfied with your cheese sandwich? That is exactly what the community rating does.
It gets worse, because when healthy consumers leave the market,
the high-risk consumers who remain now must bear an even higher
cost. In 2003, Colorado took a modest step toward restoring market
based premiums by allowing insurers to offer discounts of up to 25
percent to employer groups, thereby making premiums more affordable for health groups. As the sponsor of that legislation, however,
I will tell you that we need to give insurance carriers even greater
flexibility, perhaps up to 50 percent, in order to allow them or require them to compete for consumers business and to attract
healthy consumers back into the market.
The second distortion is guaranteed issue. Congress compounded
the problems associated with state-level community rating by mandating guaranteed issue to anyone whose employer provides
group health insurance. The rationale for this was simple, that no
one should be denied health insurance coverage because of preexisting conditions.
The distortion this created is that employees can now decide to
forego health insurance coverage until they actually need health
care. For young people it makes perfect sense for them to drop
their health insurance until they have an outstanding need.
Lastly, mandated coverage. Everyone who purchases health insurance through the small group market in Colorado is required to
pay for, by some counts, 17 and by others as much as 24 mandated
coverages, regardless of whether they want or need them.
My favorite example is that by law everyone, that is everyone,
men, women who plan not to have children, and women who are
beyond child-bearing age have to purchase pregnancy and maternity coverage. Incidentally, pregnancy and maternity coverage for
an ordinary pregnancy with no complications is now mandated by
federal case law so consumers cannot choose to pay for this out of
pocket.
This illustrates perhaps the biggest problem with mandated coverage. Most mandates require coverage for things like prostate or
breast examinations. From a preventative standpoint, those precautions are certainly wise. However, the purpose of insurance is
not to be a compulsory savings plan for medical expenses that can
be anticipated. The purpose is to share the risk for insurable
events costs that are unanticipated, unavoidable and difficult or
impossible to budget. Mandating coverage for preventative mainte-
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nance simply requires us to use the middle man which increases
those costs.
Lastly, if I were to make a few suggestions, I would suggest that
we make health insurance premiums fully tax deductible for everyone. Most business owners or managers do not want to be in the
position of choosing benefits for their employees. The only reason
they have to do that is because of the uneven treatment by the Internal Revenue Service code. This is manipulative, not to mention
economically insane because it removes the ability to make choices
about cost and coverage from the very people to whom the market
should respond.
I think a refundable tax credit would be even a better step. Lastly I would suggest that you leave regulation of health insurance to
the states. Although I am intrigued by the prospect of congressional legislation to allow consumers to purchase health insurance
from carriers in any state, the one concern I do have is that Congress will then be unable to resist the temptation to meddle in this
new national market and instead impose costly mandates and burdensome regulations at the national level which then will be virtually impossible to reform. Thank you.
[Senator Hillmans testimony may be found in the appendix.]
Chairman MUSGRAVE. Thank you, Mark.
Now we will hear from Dr. Jack Cletcher. Thank you for being
here today.
STATEMENT OF DR. JACK CLETCHER
Dr. CLETCHER. Thank you very much. It is a great honor to be

here, Congressman Musgrave and Congressman Shadegg. It is a
great pleasure to have the opportunity to talk to you. That is basically what I am going to do. I have written my testimony. It is in
here. I chose to testify on my own behalf from my own experience.
I do have, however, a great background in some of these issues
having been a member of the House of Delegates, the American
Medical Association for several years.
I have been integral in the development of the physician and patient advocacy of the Colorado Medical Society. I have served various positions in the State Medical Society and the County Medical
Society. I am also an representative of the American Academy of
Orthopedic Surgeons at the AMA and on various other councils
serving on their ethics committee for a long time. All of these
things are very familiar to me. Actually, my testimony as written
is somewhat moot because of Congresswoman Musgraves excellent
summary of the problem covering most of the issues that I think
are contributory to the cost of healthcare. I will focus my testimony
again as an individual on the issue that I was asked to do which
is the contribution of the cost of medical liability to the increase in
the cost of medical care in the United States.
Briefly, it is a well-documented fact that the cost of medical liability insurance has risen exponentially in the past 20 years. It affects everybody involved in the healthcare production. Equipment
manufacturers, doctors, nurses, hospitals, any provider has experience an enormous increased in their cost of liability insurance at
all levels. People dont realize the cost to them.
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For example, the cost of a total hip charged to the patient is
$6,000 or $8,000 for just the piece of iron that they put in there.
The liability on the manufacturer of that product is undisclosed.
You cant get any of the manufacturers to really tell you how much
it is but I know from private conversations it is probably close to
40 percent of that cost purely for liability issues.
Who pays for this? Well, it is YOU, the patient. You pay for it.
Any care that you get and any service that you get, materials that
you receive in the healthcare industry through the health insurance that you buy and everything you ultimately pay for whether
it is out of your pocket or perhaps your employer would have been
able to pay you a great deal more money had they not had the
mandate before issuing insurance.
It is a benefit that is not exactly calculated in cost but it is there.
How big is the problem? It is enormous. Anyway, in physician
services the dramatic costs of liability are malpractice insurance,
speaking of that specifically, on healthcare cost is a matter of crisis. I will just say that. You have already said it.
Colorado has very good tort reform laws. They have helped keep
healthcare costs down in comparison to many other states by limiting liability awards with caps on non-economic damages such
as pain and suffering and other subjective claims that are difficult
if not impossible to document.
This is not the case in many other states whose legislatures have
refused to pass tort reform laws similar to Colorado and California.
For example, in Nevada, malpractice premiums rose to levels
where the Las Vegas Hospitals had to close their Emergency
Rooms because there were no doctors who could afford the insurance required to staff them. Big time change.
Obstetricians in many parts of the Country are giving up delivering babies because of the cost of malpractice insurance. In some
cases the premium was higher than their previous years gross income so what choice did they have? Surgeons in some areas are refusing to do high-risk procedures. Doctors are leaving practice or
moving to other States because of the malpractice climate.
Neurosurgeons, already in short supply, are leaving areas where
premiums and claims are notoriously high.
There was a sign at the north end of Mississippi at one time that
said, Please drive carefully. The next neurosurgeon is 500 miles
away.
The result is not only are cost of health care increased by high
law suit awards and the resultant increased liability insurance premiums, but access to quality health care is dramatically affected.
I have only scratched the surface. Much needs to be done. There
are many causes for the alarming increasing costs of healthcare, as
we have heard by the previous testimony, in the United States and
in other countries, too. It is very hard to control. The contribution
of this one can be slowed if not totally controlled by appropriate
and prompt tort reform laws as has been shown in California and
Colorado. This is one thing we have a little control over.
Federal legislation to establish parameters for tort reform has
been passed in the House of Representatives, I have in my records,
nine times and the Senate has failed to confirm the wisdom of the
House in each and every case. States have been slow to face the
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problems through legislation or good legislation has been passed
only to be overturned by the courts. The voters in Texas were so
frustrated that they passed a Constitutional Amendment to establish caps on non-economic damages with the result of sharp decreases in insurance costs.
Other measures are necessary to approach this ever-worsening
problem. Because many regard a malpractice claim as a Gold
Mine many non-meritorious claims are filed in hopes that a settlement will be made to avoid the cost of fighting a claim. In Colorado
over six million dollars a year is spent by one malpractice insurance carrier to fight non-meritorious claims. A non-meritorious
claim is one which was either thrown out of court, was dropped by
the plaintiff, or was agreed in some way to not be worth pursuing.
Chairman MUSGRAVE. I will ask you to just wrap up now. Thank
you.
Dr. CLETCHER. Okay. The Medical Profession feels strongly that
a patient who has been injured should be compensated fairly. The
fact is that the actual amount the patient receives is so often much
less than the actual award because of the legal fees and other costs
of obtaining a judgment.
In summary, we are faces with a problem that can be greatly improved. The problem is the significant increase in healthcare costs
due to large liability judgments and the attendant increase in insurance premiums across the board for healthcare providers and
industry at all levels.
It can be improved by enacting fair and effective tort reform laws
in each state or, in their absence, by the federal government; reducing the number of non-meritorious lawsuits by the use of Blue
Ribbon panels or Healthcare Courts; by placing more healthcare
decisions in the hands of the patient and their physician; by the
use of Health Savings Accounts and establishing a good doctor/patient relationship with more comfortable insurance environments;
and by removing the legal roadblocks that prevent the truly injured
patient from receiving fair compensation.
[Dr. Cletchers testimony may be found in the appendix.]
Chairman MUSGRAVE. Thank you very much.
Deb Tamlin, you are up next. Thank you for being here today.
STATEMENT OF DEB TAMLIN, ZTI GROUP
Ms. TAMLIN. Thank you. Chairman Musgrave, Congressman

Shadegg, I want to personally thank you for your work on this. I
know both of you have been real committed the last several sessions to pass something and we hope that the Senate will agree one
day.
My name is Debbie Tamlin and I am a realtor in Fort Collins
and I own my own real estate company. I am speaking on behalf
of more than a million members of the National Association of Realtors. NAR is the largest trade association in the United States.
We have members that are engaged in every type of real estate
profession. I do commercial real estate myself personally. We have
a lot of residential members.
I appreciate the opportunity to share thoughts on the challenges
that face small businesses and the smallest of the small business,
the self-employed in finding affordable health insurance coverage.
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Unlike other issues that NAR has testified in the past, NARs
members interest in this is personal. It is not one for the consumer
and a lot of the other issues professionally that we work on. Real
estate sales is the prototypical small business. I am a small business person. I have five employees and I do offer healthcare coverage for each of them.
It is tough sometimes to sit down and try to be evenhanded with
it when you have older people that require higher expensive insurance as opposed to the young people starting. I try real hard to be
evenhanded with how we give out our benefits.
Real estate agents are independent contractors. They are not employees of firms of which they are affiliated but, in fact, usually a
firm of one. Our shareholders are our families. We are not large
businesses. As a consequence, real estate agents are typically
forced into the individual insurance market, a market that is basically a take it or leave it proposition. There is no leverage and
there is no negotiation.
Today 28 percent of realtors, more than one in four of our nations 1.2 million to do have any health insurance. In seven years
the percentage of uninsured NAR members more than doubled
going from roughly 13 percent of the members in 96 to 28 percent
in 2004. By comparison the percentage of the U.S. population without health insurance coverage was estimated to be 15.7 percent in
2004. The percentage of uninsured realtors is almost double that
of the nation.
Twenty-eight percent of our membership are individual members. If each of these individuals is uninsured, it is likely that the
other 1.6 persons are spouses and children and an average realtor
householder also uninsured. Therefore, we could expect that as
many as 873,000 members and their dependents are uninsured, as
well as all of our employees. I was uninsured for seven years. It
is a tough place to be and I thank heaven that I have health insurance.
When asked why they are uninsured 74 percent site the cost. We
publicly support and will do what we can wholeheartedly to help
you pass the Healthcare Choice Act. Thank you Congressman
Shadegg very much. I think we have been there trying to push
back in D.C. In fact, the last time I saw Congresswoman Musgrave
we were working on that very issue.
Madam Chair, NAR members believe that powers granted to
trade organizations should be the equivalent granted to large employers or trade unions when it comes to negotiating for quality
and uniform national health plans for the constituents regardless
of where they live. As a result, NAR members strongly support the
small business plan including House Bill 525, Senate Bill 406, and
more recently Senate Bill 1955.
Small business health plans are by no means the silver bullet
that will solve the nations health insurance problems. It is important that we all sit down and work together to have a solution. We
are heartened by the fact that this is exactly the approach that
Senators Enzi and Nelson have set down and tried to put opponents and proponents together.
This addresses most of the concerns that traditionally have been
raised including state regulatory oversight mandates and fiscal in-
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solvency. NAR is committed to working to advance what we believe
can be very effective insurance delivery systems. If SBHPs are approved, we will be one of the first to be in the discussions with insurers to craft a quality health insurance package for our realtors
members nationwide.
Once again, thank you for giving NAR the opportunity and myself a place at the table. Thank you.
Chairman MUSGRAVE. Happy to have you here today.
Now we will hear from Allan Jensen from the Health Underwriters. Welcome to this hearing today.
STATEMENT OF R. ALLAN JENSEN, NATIONAL ASSOCIATION
OF HEALTH UNDERWRITERS
Mr. JENSEN. Thank you, maam, and Congressman Shadegg.

Good afternoon. As a sidebar, Congresswoman Musgrave, I would
like to thank you and your staff for entertaining our group in
Washington at the end of March. We had a nice chat with your
staff. Unfortunately, you werent there. We were watching you on
the TV down on the floor.
Chairman MUSGRAVE. At least I have an excused absence. Thank
you.
Mr. JENSEN. Again, my name is Allan Jensen. I am an independent broker of health, life and senior insurance products. In my
health insurance practice I specialize in individual and small group
insurance sales. I have been a licensed health insurance agent in
Colorado for 15 years.
My colleagues and I deal directly on a daily basis with thousands
of consumers of health insurance and the carriers that provide
those products. In fact, we also deal with providers often in their
roles as consumers of health insurance. All together we get to hear
and discuss first hand the needs and desires of American consumers probably more than any other organization. We are the integrators and educators within the health insurance industry.
I will bracket my remarks by noting that healthcare is not expensive because of the cost of health insurance, rather it is health
insurance that is expensive because of the cost of healthcare, and
not coincidentally because of the costs of mandates placed upon
these products.
The Colorado State Association and the National Association of
Health Underwriters seek to address these questions of cost while
also striving to maintain consumer choice and the viability of a vigorous private market of health insurance products.
I will take a page from Mark Hillmans testimony because, as
you will see in the written remarks, everything that he said is
going to be in there, too, so I will skip down a few pages on the
market reform issue.
I will bring up the fact that beginning September 1st as one example of market reform a major national carrier here in Colorado
is introducing an entirely new set of plan designs for the small
group market very competitively priced to secure major market
share. There are a host of other examples.
New and innovative concepts in the design of health insurance
products will also help improve competition and buttress the overall strength of the small group marketplace. One such innovation
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was proposed in this past Colorado legislative session where a simple two-word modification of existing statute allows carriers to
alter the participation and contribution requirements. In less than
four months we have seen the introduction of improved choice options from multiple carriers with lower price points.
Vigorous competition, new and creative plan design, and consumer choice are working together to improve and stabilize the
small group market. Our association is always welcoming of greater competition and would like nothing better than to see more carriers enter our market. Without such competition, healthcare costs
would surely rise more rapidly.
A key element in promoting healthy markets and competition is
the availability of easily accessible information regarding price and
quality. The lack of good information in these areas plagues the
consumers of healthcare. In the last legislative session in Colorado
a bill was passed requiring hospitals to post an annual report card.
This is one good step but more needs to be done to make pricing
and performance data broadly transparent. Many insurance carriers are voluntarily beginning to post cost data on their websites.
Some efforts at the federal level in both Medicare and Medicaid
show promise and other proposals before Congress need to be advanced in this regard. This will all play into the business of consumerism.
Regarding Association Health Plans, not all health coverage
ideas are good for the market or useful to consumers. NAHU specifically opposes proposals to create Association Health Plans that
are exempt from health insurance benefit mandates and state rating laws, or are exempt from fully insured requirements. We are
concerned because unregulated AHPs would have a pricing advantage over the fully insured small group markets already operating
in the states, thus creating a distorted playing field.
One unintended consequence from unregulated AHPs might well
lead to the reduction of choice for consumers by driving fully insured carriers from the market. Two specific areas of concern with
AHPs would be the elimination of requirements at the state level
for capital reserve requirements as well as claim reserve requirements. NAHU does not have a formal position on H.R. 2355 as our
membership is split nationally on the idea of allowing the sale of
individual health insurance products across state lines.
This attempt to provide relief for states primarily in the Northeast where individual markets are hampered by both guarantee
issue and community ratings doesnt necessarily help in other
states. There are a number of significant issues that cannot be
overlooked, not the least of which is the state oversight of insurance.
The bill attempts to ensure the integrity of this oversight, but
the problem of complaint resolution for people in one state appealing to another states insurance oversight authorities is highly
problematic. Though a particular state might be a good place to
domicile for business purposes, could or would that state be willing
to oversee consumer complaints from other states in a manner that
is as consumer-friendly as in the local model.
In Colorado individual health insurance products are not required to be sold on a guaranteed issue basis and medical under-
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writing and exclusion riders are allowed. In tandem with this we
have a high-risk insurance pool in the form of CoverColorado to
provide guaranteed access to individual health insurance coverage
for people who are uninsurable in the private marketplace.
Recent improvements passed by this years legislature allows
greater rating flexibility in CoverColorado which should lead to
lower rates promising guaranteed coverage to a much larger pool
of uninsureds.
Another positive development in the arena of health insurance
products has been the advent of Medical Savings Accounts in the
late 1990s and now with the improved benefits offered with Health
Savings Account qualified plans. These insurance products
Chairman MUSGRAVE. If you could wrap up, please.
Mr. JENSEN. are an important product for consumers. I will reiterate what Dr. Cletcher said about medical liability reform. That
is kind of a word-for-word conclusion here. We would like to thank
you for this opportunity to talk to you today and I will stand to answer any questions you might have. Thanks.
[Mr. Jensens testimony may be found in the appendix.]
Chairman MUSGRAVE. Thank you. To all the witnesses, all of
your testimony will be in the written record if you didnt get to give
it all.
We will hear from Gail Snyder now. Thank you for being here.
STATEMENT OF GAIL SNYDER, SNYDER INSURANCE AGENCY
Ms. SNYDER. Thank you so much. Allow me to introduce myself.

I am Gail Snyder and I have the pleasure and honor of working
for my husband, Bob Snyder, through his farmers agency as a specialist in life and health insurance primarily working with individuals and small business.
The three areas that I would like to touch on are the Health Savings Accounts, Association Health Plans, and the Healthcare
Choice Act. Since the introduction of Health Savings Accounts,
HSAs, the health insurance industry has undergone several
changes as has the insured community. The industry is seeing a
tremendous increase in the number of businesses and individuals
purchasing these qualifying high deductible health plans and an increase in the opening and funding of these accounts.
Employers are saving between 20 and 40 percent off their monthly premiums and many are passing some of that savings on to their
employees by assisting in funding the employees accounts. For employers who are already offering health insurance to their employees as a benefit this has become a viable cost containing effort. I
commend the creativity and foresight that brought these to the industry. Thanks. It is becoming a very useful tool.
Regarding Association Health Plans, the Association Health
Plans that I would like to speak directly to are small associations,
something along the size of our local chamber. At first glance they
can be appealing. However, once the plan is in place there is a high
probability of rapidly increasing costs and diminished participants.
Individuals wanting health insurance are typically better served
through individual policies where there are fewer mandates in coverage and, therefore, lower premiums.
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If these individuals are unable to obtain insurance on their own
due to pre-existing medical conditions, they seek alternatives such
as Group Insurance. When evaluating the cost of Group Insurance,
small business owners oftentimes see the premiums as
unaffordable and cry out for an Association Health Plan, under the
misconception that there will be lower premiums.
These types of plans need to be entered into with tremendous
caution. The benefit Group Insurance has over an Association
Health Plan is the risk pool is much larger. There again, I am
speaking towards the smaller associations. An insurance carrier
can offer a group plan to a state-wide audience of tens of thousands, whereas an Association Health Plan may be offered to only
a few hundred. The rates are based upon participation and claims.
A single catastrophic health condition, such as a premature baby,
can be tolerated much better at the group level than it can for an
Association Health Plan. A single shock claim could raise the Association Health Plan premiums to the degree that participation
would rapidly decrease. This leaves an even smaller risk pool behind to bear the cost of healthcare. It becomes a death spiral for
this plan.
Any type of national Association Health Plan could create a guaranteed issue coverage similar to the Business Groups of One here
in Colorado. It has proven to be disastrous. When Business Groups
of One came in, as Mr. Hillman stated, we had 84 carriers. Business Groups of One guaranteed issue we now have 10. It has proven disastrous. Other states that have tried guaranteed issue insurance find that part of the problem here is adverse selection and
fraud.
Allow Business Groups of One to purchase Association Health
Plan coverage would prove equally problematic increasing the likelihood of plan failure and resulting in significant cost increases for
all the state small group market participants.
A potential alternative would be for professional business associations to be considered a group such as the local chamber if we
use that size as an example if they are considered a group for the
purpose of purchasing health insurance. I dont recommend this either, though. The association would then bear the responsibility as
an employer rather than an association having all of the liabilities
put upon the association which those liabilities could then cause
the association itself to default.
Under that evidence there is no specific evidence that states Association Health Plans would have lower premiums. I would not
encourage that action. I would also caution, however, that nationwide large corporate insurance plans, such as what you are recommending, could be offered. But what would make them greater as
an offering than what the unions or our larger retail chains are offering their employees? What specifics will those plans contain that
make them a viable plan?
The last point would be healthcare choice, H.R. 2355. It is my
understanding that this legislation is being considered for the purpose of allowing individuals to purchase health insurance across
state lines. There are several states that have passed overburdening legislation for the health insurance industry and have
caused crisis situations for their respective states.
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This legislation has been conceived as a mechanism to bail them
out of their own mire. I do not believe this is the solution. We get
back to the magic wand. If we could raise that wand and undo the
things that have created those crisis in those states, they then can
solve their problems. Each of these states needs to recognize the
situation they have put themselves into and attempt to reverse
those misconceived health insurance initiatives.
Chairman MUSGRAVE. If you could just wrap up, please.
Ms. SNYDER. To every legislator who believes he or she has a
new very important mandate to add to the insurance industry,
mandates come with a cost and that has been said multiple times.
For the consumer this particular legislation has even greater potential problem. In order for it to be successful each insurance carrier must have access to a nationwide network or go back to a reasonable and customary so that you are not seeing someone out of
network because your state insurance happens to be through Arkansas while you live in Colorado.
The other issue with this is insurance licensing. In order for me
as an insurance agent to sell into a state plan that is not a Colorado state plan, do I then need to be licensed in all 50 states, or
does there become a national insurance broker producer licensing
system. Thank you so much.
[Ms. Snyders testimony may be found in the appendix.]
Chairman MUSGRAVE. Thank you very much.
As you can tell, the witnesses here have differing opinions and
I think that is very good that we bring our ideas to the table.
Congressman Shadegg, I know you have just been ready to question here so go ahead. You go first.
Mr. SHADEGG. You are going to let me go first.
Chairman MUSGRAVE. Yes.
Mr. SHADEGG. Okay. Well, I will simply start by saying I think
you have an extremely well-informed and knowledgeable panel. I
appreciate the testimony of all of them. Quite frankly, I am not certain how many questions I have. I may have a series of comments.
Let me just go through some that occur to me immediately.
I think Chris Boesch raises a great question. That is, how is it
that we decided as a nation that it is the employers function to
provide health insurance or provide healthcare. I have been answering the question for a long time, or looking at the answer to
that question for a long time.
Before I give the answer, however, of how we got there, let me
talk about how anomalous it is. I would bet there is not a person
in this room who is provided by their employer, or if there is there
is only one, their auto insurance policy. You dont typically go into
your job and say, I want to apply for a job. Oh, by the way, if I
get a job here what are you going to provide me in auto insurance?
Same is true for homeowners insurance. You dont go to your employer and say, Now, if I take a job here, how are you going to
cover my home? We have decided that the American people can
buy auto insurance on their own. They can buy homeowners insurance on their own. They can buy disability insurance on their own.
How is it that we have decided that they cannot buy or should not
buy health insurance on their own?
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I believe there is consensus on this point. There are disagreements on some of the other issues in healthcare reform but there
is consensus on this point. The reason that most health insurance
in America is employer based is an historical anomaly. It comes out
of War World II. At a point during War World II the federal government stepped in and imposed wage and price controls. They
said to all American businesses, You may not give wage increases
and you may not have price increases on your products without
going to the federal government and asking for approval.
American business being ingenious as it is, particularly small
business, but all American business being entrepreneurial in nature, went to the government and said, Well, wait a minute. How
are we going to attract and retain the best and the brightest in our
business? What if we decided instead of giving them wage increases we instead gave them a benefits package?
The federal government mulled this over and came back and
said, Yes, you may give them benefit packages and you may do
that without government approval. Suddenly American business
was told, If you want to give your employees a thousand dollar a
month or a thousand dollar a year increase, the government has
got to sign off on that. If you want to give them a benefit package
(and at this time if was any kind of benefit, but healthcare rapidly
became the most attractive benefit in America) you do not have to
go to the government for approval to give that benefit package.
The second thing is that employers then immediately went to the
IRS and there is an IRS ruling which I can provide to you which
answers this question and said, If we do decide to give our employees $1,000 a year healthcare benefit package, are you going to
tax that? The federal government in an IRS ruling that is still on
the books today came back and said, You know what? We wont
tax that. The cost of that benefit package will be an expense to
your company deductible as any other expense, but it will not be
income to your employee.
It didnt take American business very long to figure out, Oh, my
gosh. If I hand my employeeafter World Ward II they could give
out wage increases. If I give them a thousand dollar salary increase, the government is going to tax that and it is going to take
at least a third of it. In some instances we all know it is twothirds of it. But if I give them $1,000 in healthcare benefits, the
government is going to tax zero of it.
Not only did American businesses quickly figure out, This is a
great idea. We will hand out benefits, but American employees figured out and American unions figured out, If we negotiate for an
extra $1,000 for our employees, they will get maybe $700. If we negotiate for an extra $1,000 in healthcare benefits, they will get
$1,000 in healthcare benefits. That is how we got to the situation
where healthcare in America is the responsibility of employers.
I strongly believe, and there is not time here to go into it, that
we need to challenge that concept. We have raised the belief in
America that the only appropriate pooling mechanism, and we
have had some discussion here about pooling mechanisms and the
dangers of having a too small pool or a pool that was created without careful thought of who could get into that pool, and somebody
used the phrase death spiral which is a term used to describe a
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pool that becomes too small and is populated only by the sick and
the healthy leave it, we have created this notion that the only pooling mechanism can be employers. I suggest that is something that
in this debate we ought to reexamine.
I guess the next point I want to make is I want to go, Mark, to
your point about refundable tax credits or about deductibility. It is
outrageously unfair in America that we treat big business different
than small business. It simply is unjustifiable. You heard some testimony here about people who say, Yes, there are ideas that would
put small business on the same playing field with big business
when it comes to health insurance. Association health plans is an
idea to do that.
Two witnesses criticized Association Health Plans because they
think that might be a mechanism to try to place small businesses
on the same playing field as big businesses and those criticisms
could be valid. I, for example, agree that moving more regulation
of the healthcare market to the federal government, which Association Health Plans does, is a bad idea.
It is an aspect of AHPs I dont happen to like. But it is really
unfair to say if you are General Motors or you are Honeywell or
you are Intel, you can offer a fantastic plan to your employees no
matter where they are in all 50 states. You heard a couple of people say when we do that, we are taking them out from under state
regulation. I have a flash. Every big employer who offers
healthcare benefits to their employees in Colorado is regulated by
the State of Colorado Insurance Commissioner to the extent of
zero.
If you work for General Motors in Colorado or Delco or General
Electric or you pick any other large national employer and you
have a problem with your healthcare plan, dont waste your time
driving down to the Colorado Sate Health Commissioner because
he will tell you, It is not my problem. Federal government took
this one away a long time ago under a law that I believe you mentioned, or somebody mentioned, ERISA.
But it is simply outrageously unfair to say the big guys get a
break, little guys dont. Think about this one. We say as a nation
to every American, You really should be insured. There was a discussion here about, I think it was your comment, Mark, the Northern Colorado Medical Center has ano, I am sorry. This was the
gentleman from the beer industryhas a bad debt ratio of 9.7 percent. You know what? It is not that they are bad at collecting bills.
It is that the United States Congress has said to them, Anybody
that shows up in your emergency room gets free healthcare period.
Now, let me see if we understand this. We dont want people to
go to the emergency room for free care. We want them to buy
health insurance but for everyone in this room who cant pay their
employees health insurance, cant provide healthcare coverage, we
say to them, Here is what a good deal the federal government is
going to do for you.
The guy next door, this woman that has just five employees and
she gives her employees healthcare, that is paid for with pre-tax
dollars. That is, the cost of the healthcare that she gives to her employees is paid out before she pays taxes so you dont pay tax on
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that. But anybody here whose employees dont get employer based
healthcare, they have to pay it after tax dollars.
That means it is at least a third more expensive. It is outrageously unfair. I personally have a bill called the Patients
Healthcare Choice Act which would go at many of the comments
that were made here today.
It is different than the Healthcare Choice Act which goes at an
interstate market for healthcare but this instead talks about giving
a refundable tax credit to every American to purchase healthcare
so we would no longer have the anomalous situation where if you
are lucky enough to work for a big employer, your healthcare is
paid for with pre-tax dollars.
If you are unlucky enough not to work for an employer who provides you healthcare, you have to use post-tax dollars which need
to cost at least a third more. I guess in a way I am just kind of
going left to right following through my notes.
Dr. Cletcher, you mentioned a number of things that can deal
with the extreme cost of litigation on the system. You talked about
the point of non meritorious claims. You did mention that Colorado
has passed some good tort reform. One of the reforms I advocate
looks at the issue of non meritorious claims. The vast majority, for
example, of medical malpractice cases are dismissed outright. Either they are dismissed before they go to jury or the jury finds for
the defense making the point that they were non meritorious
claims.
Arizona, unfortunately, has not enacted healthcare reform, litigation reform in the healthcare arena, or any other arena because our
constitution complicates that and would require a constitutional
amendment for us to enact caps or any other reform that would go
at litigation cost. Do you know if the State of Colorado looked at
the issue of loser pays?
Dr. CLETCHER. Yes, they have. One of the best ways to avoid non
meritorious claims is to have a firm doctor/patient relationship. If
I have a doctor for 20 years and something adverse happens, usually the doctor says, Look, this happened. Lets talk about it. The
patient will probably not elect to initiate a claim. I think that is
what has happened to the system is we dont have that relationship
anymore when managed cares organizations and other entities will
dictate the choice of physician to a patient.
Corporate insurance is more or less what you would call a captive insurance company for malpractice claims in the State of Colorado. They have looked at loser claims but they have a better program, I think, right now in that anytime an adverse occurrence occurs the physician will notify the insurance company and the insurance company with that physician will contact the patient and try
to work out the most comfortable solution for that patient.
In other words, if they are missing work rather than take that
penalty which is a non litigated penalty, they will assist them with
living expenses and other assistance to work it through. They will
readily make a settlement in a claim where there is clear malpractice so it does not enter into that. Even in spite of that we still
have $6 million worth of litigation expense to handle non meritorious claims.
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This isnt exactly an answer to your question about loser pays.
It has been suggested and, I think, Mark, you might know more
about that. There have been, I think, bills that have been introduced into legislature that to my knowledge has never gone anywhere. It is kind of considered not fair game. The Lawyers Association dont like that too well. That is basically it. We can go on and
on with it but that is it essentially.
California was the one that introduced the first microlaw which
is the one that limited the caps on noneconomic damages and
things like that and was so successful there that other states have
tried to emulate it. Fortunately, Colorado is probably pretty close
to next in line on the whole thing.
The tragedy is that a lot of states have enacted some really good
laws, or at least in part, trying to solve this problem and then the
State Supreme Court will come along and set it aside as being not
constitutional in that state. That battle goes on. Well, I wont reiterate it. I have a lot more information on this.
Mr. SHADEGG. Actually, for anybody on the panel, it sounds to
me like at least if Colorado has that kind of structure where the
insurance company and the doctor then contact the patient who
has alleged an injury, it sounds to me like there must be something
like an Im sorry provision. Arizona does not have an Im sorry
provision. Anybody here have knowledge of what you have on that
issue?
Mr. HILLMAN. Colorado in the same year that we closed a couple
of loopholes created by our Supreme Court actually passed an Im
sorry provision to allow a doctor to have that conversation with
the patient and it not be used against him later in a proceeding.
Mr. SHADEGG. I think it makes a lot of sense. I have supported
it in Washington. It is kind of anomalous, it seems to me.
I do agree, doctor, that the destruction of the physician/patient
relationship, which you have spoken about already, I think does encourage lawsuits as the first mechanism to address a grievance. I
think the absence of an Im sorry provision does that as well. Lots
of times people if they simply understood that the doctor felt badly
about something that may have gone wrong, humans are humans
and they are going to make errors, you can go a long way towards
solving this problem.
Yet, the tort system, for example, in my state where we have no
Im sorry provision makes that near impossible. A doctor cant
even think about stepping forward directly or through his lawyer
and saying, We regret that this happened and we are sorry that
you are suffering, because that immediately would come into
court.
Dr. CLETCHER. As regards to doctor/patient relationship, it is
pretty hard to sue somebody that you have known for 10 years and
trust. When you dont even know that person, when a patient really has been treated by a doctor that maybe saw him once or twice,
never saw him again and cant even remember his name, it is
amazing how many people dont remember the name of the doctor
that took care of them. It is pretty easy to see somebody like that
because they dont really exist. They are just an abstract figure.
Mr. SHADEGG. I dont know what my time limit is but just a
quick comment on that point. As you and I have privately dis-
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cussed, I personally believe that employer-based healthcare, at
least where it is not an indemnity plan, your employer picks the
plan and assigns you to the plan, the plan picks the doctor and assigns the doctor to the plan and the doctor you get is not as a result of your choice and on any given day you can be told, Im sorry.
The doctor you have been going to for the last three years you may
no longer go to, I think has done immense damage to the physician/patient relationship and encouraged this kind of litigation.
Dr. CLETCHER. I will be honest with you. That is the key. That
is the secret. That is the touchstone that has destroyed the
healthcare system in the United States right there.
Mr. SHADEGG. The legislation I have tried to introduce tries to
go toward consumer choice and patient choice and put people back
in the position where they can pick their own doctor. One of the
bills that I introduced that might be of interest to a number of you,
somebody on the panel said workers dont appreciate the value of
the insurance.
The broader legislation that I introduced called the Patient
Healthcare Choice Act would say to all employers in America once
a year when you are renewing your insurance policy, or at some
point in the calendar year, you would go to your employees and you
would say to them, We are spending this amount on your health
insurance, and you base that calculation on their age, their sex,
and their geographical location because those are the major factors
in the cost of health insurance policy.
You would be obligated to say to the employee, This is the
amount we are spending on your health insurance. You have 90
days to go look for a policy. If you choose, you can take that
amount of money and you can go buy your own policy with it and
not take our insurance plan out of the company. If you decide after
that 90 day expiration period that you cant find a better insurance
policy, of course, then you will remain when we renew it in our
plan.
One of the advantages I see in that is that lots of employees have
no appreciation for how much health insurance cost, how much you
are spending on health insurance. A lot of people say to me, Look,
Congressman, in todays health insurance market nobody is going
to be able to go out and get a better policy than they can get
through their employer.
I dont personally believe that is true. I believe that if we gave
them that possibility many of them would find more attractive policies. Let us assume it is true. Can you imagine if all your employees came back to you at the end of that period and said, My gosh,
you are giving me the greatest deal in the world. I couldnt get anything close to it.
I dont know how we are doing on time and I dont want to abuse
my privileges. Let me just conclude with a couple of quick comments. I would be happy to discuss in detail some of the issues
raised here about the Healthcare Choice Act. A lot of people do call
it interstate health insurance purchase and it really is not. That
is a mischaracterization of the policy. The policy would be filed in
the state where it is to be sold.
It does under the bill have to be governed by a great deal of the
provisions of that states law. For example, the consumer fraud pro-
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tections of the Colorado policy would apply in whole exactly as they
are. The Colorado law would apply to the policy no matter where
the policy had been originally qualified. The notion that those consumer protection laws wouldnt apply is incorrect.
In addition, the remedy, just to answer another question that
was raised, the remedy is with the insurance commissioner of the
state where the consumer lives. Let us say the Goodwill Insurance
Company filed a policy in, we will say, Illinois and qualified it
under Illinois law, they then bring it to Colorado and they have to
file it with the Colorado insurance commissioner.
The Colorado insurance commissioner gets to look at it and make
sure that it satisfies those pieces of Colorado law it has to satisfy
and it satisfies the Illinois law. Then a consumer buys that policy.
They buy it here in Colorado. The answer to the last question, they
can only buy it from a licensed Colorado insurance salesman so
there would be no national licensing of insurance salesmen.
You would sell that policy in the state under Colorado licensing
practices and continue to be governed by Colorado licensing practices. Then the regulation if there were a problem with the policy
would be by the Colorado insurance commissioner. It is, in fact, a
completely new idea. It is a way to try to bridge that point that
was brought up a little bit earlier about, Do you want federal regulation of health insurance or do you want state regulation of
health insurance?
In every respect where we could we tried to leave state regulation in place, in part because of the point that both of you make
about association health plans. ERISA took all this large employer
health insurance out from under. People say, Oh, my gosh, Congressman. If Colorado had a benefit mandate for acupuncture and
an Illinois qualified policy were brought here and sold and it didnt
offer acupuncture, then you would be saying to people in Colorado
that they could buy a policy that didnt cover acupuncture and they
would be getting out from under a Colorado state mandate.
I have a flash for them. Everybody that gets their health insurance from a large employer, General Electric, General Motors, governed by ERISA, no Colorado benefit mandate is covered under
those policies. I guess I will conclude, Madam Chairman, by saying
that I actually share Marks biggest concern about the concept of
allowing an insurance policy to be brought here and sold here and
that is once you let the federal government into like you let the federal government into ERISA, there is the danger that sudden
wheels start mucking around and saying, We didnt cover as a
mandated benefit X when we first passed it back in 2006 but now
we think we really should have a federal benefit mandate for whatever that is.
Chairman MUSGRAVE. Thank you very much. I would just like to
say to Debbie Tamlin, you kind of put a face on realtors that most
people dont think about. I dont want to show anything preferential here but, quite frankly, they see a Remax sign or Century
21 and I dont thinkI believe you said you had five employees.
They dont think about a small business owner facing the obstacle
of trying to come up with enough money to provide health insurance for your employees. Could you elaborate on that a little how
it affects you when you are out there as a small business owner?
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Ms. TAMLIN. I compete for my employees with HP and Bush and
these guys at Fort Collins so the larger companies can provide benefits as a package. To get the quality employees that I want to
work with me, I want to be on a level playing field with the larger
employers so I work real hard to do that. Most all of us are commission based. I took six weeks off from my company when I had
my neck fused and that meant there was six weeks nobody was
producing income from my company.
I had put the surgery off for 11 years, a long time until I couldnt
do it any longer because you are shutting down the income producing function for your company. It is a huge thing because my
company is commission based. The income is not regular and, yet,
I have payroll to meet and I have benefit packages that I want to
compete with so I have the quality real estate company that I do
have. It is important.
Dr. Cletcher, I recently talked to other orthopedic surgeons and,
you know, now you hear a lot about hip replacements and knee replacements. When we talk about these prosthetic devices whether
you have anchors in a shoulder when you have rotator cup surgery
or knee replacement, I dont think a lot of people think about the
liability associated just even with the prothesis much less your actions as a surgeon. Could you speak about that a little bit?
Dr. CLETCHER. Let me put it very simply. Suppose I come up
with a new design for a hip replacement and it works pretty good.
Then somewhere down the line after having put in about 4,000 or
5,000 of them, they find that there is a design defect which after
five years has caused several of these to fail, maybe as many as
20 percent or 25 percent. Now, these devices are scrutinized to the
ultimate. They are x-rayed.
They are put under stress. They are put in testing machines.
There is an enormous amount of effort that goes into developing
these devices to try to prevent this very thing from happening. Say
if you put in 6,000 of them and 30 percent of them have failure
rates of some degree may not be entirely due to the prothesis itself.
It may be to some other problem that has arisen that has shown
up in this number of cases.
Not only is the physician sued, the hospital is sued, but the manufacturer is sued with settlements from the manufacturer maybe
in terms of lets say many, many thousands of dollars. I am not
going to say a million dollars because in some states that is exactly
what happens, $1, $2, $5, $10 million and that sort of thing. Add
that times 2,000, what have you got in claims that can rise just
from this one thing?
This is what I say about medical devices. Pacemakers, another
very, very precarious market where there has to be a lot of insurance against the unforeseen happenings. Remember in malpractice
and in device failure it may not be through anybodys fault other
than the fact that there is a statistical rate of failure in almost any
medical procedure or intervention.
If those are classified due to negligence or to some manufacturing defect, that is one thing, but many times awards are given
in these cases because the jury feels sorry for the person who has
been unfortunate enough to have one of these unforeseen unavoid-
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able events. This is just another bunch of beans that are poured
in the pot and have to be mixed up, you know, before you can get
it all done.
Chairman MUSGRAVE. Well, Mr. Shadegg, do you have any closing remarks that you would like to make?
Mr. SHADEGG. Just, again, I think this is an extremely knowledgeable panel. You could wish that everyones comments were covered because I think it was a very good debate. All Americans need
to learn these issues. I think it was a very informed debate and a
good discussion of how we address these concerns. I am very impressed with the panel and with your work to try to address this
problem which confronts every American and every American small
business.
Chairman MUSGRAVE. Yes. We know the small business is where
most job creation takes place. Having been a small business owner
myself, I can identify with many of these issues. I believe that Congress can come up with solutions to these problems. My main concern is that we better come up with them quickly with the input
of people around the nation before we move to a nationalized
healthcare system.
Many of the problems that we talk about, patient choice, and I
really believe, Dr. Cletcher, it is a call on your life when you go
into medicine. We were even talking about your father earlier
today. I said did your father burn out and you said no, you really
dont get burned out but you do get tired. I want doctors to be able
to practice medicine and I want patients to have choices. All the
problems that we have now in that area I believe would only be
magnified many times over if we went to a national system.
Go ahead.
Mr. SHADEGG. I did think of one last thought, a point I meant
to make earlier. The media would have you believe and the trial
lawyers would have you believe that the rule in America where
each side bears its own cost regardless of the outcome of the lawsuit so you can bring a lawsuit, you can sue somebody.
The lawsuit can prove to have been meritless, yet the defendant,
who has spent a lot of money, maybe the producer of one of those
manufacturing devices or a doctor defending themselves against
the meritless claim have to pay their own cost and, therefore, there
is the ability to extort a settlement. The Trial Lawyers Association
would have you believe that the American rule is the rule in most
of the world.
The English have this notion of loser pay. I think most American
consumers dont know that is wrong. The reality is almost the entire world has the concept of lower pay and the provision that each
side must bear its own cost is the exception around the world.
The other point I want to make is a lot of us are looking at losing
lawyer pays. We all know lawyers share the recovery. The point
was paid earlier lots of time there is a large recovery but the injured patient doesnt get near compensated because so much went
away in attorneys fees. I think we should be looking at and a number of us are talking about it in Washington. Not just loser pays
but more importantly a losing lawyer pays.
Nobody wants to punish the genuinely injured for bringing a
claim. If you have a lawyer who consistently brings meritless
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claims to extort settlements, there has to be a remedy to that. I
have talked to some very, very good tort lawyers who say, Those
of us that are good at this wont take a meritless case and we have
no problem with that kind of remedy.
Chairman MUSGRAVE. Good. That would be kind of a relief, I believe, when we bash lawyers all the time to hear that some would
even go for that. I thank you for your testimony today. I appreciate
the diverse opinions that we have heard from our panel but all
very well founded. I wish we had more time. I wish we could talk
to orthopedic surgeons and talk about how when theyI dont
know, would $18,000 be right for a knee replacement or something?
Dr. CLETCHER. Are you talking about my knee replacement?
Chairman MUSGRAVE. I didnt know you had a knee replacement.
Dr. CLETCHER. Oh, I do, yes. $40,000 is probably right at the actual cost factors. Managed care will bargain it down to probably
half that. Of course, the hospital is working on a very thin margin.
Medicare works on a different scale and so their reimbursement
would be much less than the actual cost if you went out and bought
one yourself.
Chairman MUSGRAVE. It is amazing when you think about probably what the cost of the prothesis and all of the other factors figured in, I guess, what the doctor would actually earn performing
one of those. Some on the panel have mentioned, you know, why
health insurance is so high. It is because our healthcare is expensive. Also we would be remiss today if we didnt say that it is expensive because it is the best healthcare in the world.
I can see the doctor just has to say something. Go ahead.
Dr. CLETCHER. I do because you talk about what the doctor gets
out of it. I can tell you it is about a third of about what the prothesis cost.
Chairman MUSGRAVE. See, those kinds of things would be important for the American public to know. We need to know what our
healthcare cost and have that broken down so people can have an
understanding of why premiums are what they are. Of course, we
in Congress will do what we can to address these issues. Thank
you for being here with us today. I appreciate each and every one
of you.
Again, thank you Congressman Shadegg.
Mr. SHADEGG. Thank you.
Chairman MUSGRAVE. I would also like to thank the staff that
worked on this, Joe Hartz, Small Business Committee, and Kristen
Glenn from my staff. We appreciate you. We couldnt do it without
you. Thank you. The meeting is adjourned.
[At 2:50 p.m. the Subcommittee was adjourned.]
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Healthcare and Small Business: Real Options For Colorado Businesses

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HEALTHCARE AND SMALL BUSINESS: REAL

OPTIONS FOR COLORADO BUSINESSES

SUBCOMMITTEE ON WORKFORCE, EMPOWERMENT

COMMITTEE ON SMALL BUSINESS

WASHINGTON, DC, AUGUST 10, 2006

Serial No. 10963

U.S. GOVERNMENT PRINTING OFFICE

For sale by the Superintendent of Documents, U.S. Government Printing Office

VerDate 0ct 09 2002

00:59 Nov 22, 2006

COMMITTEE ON SMALL BUSINESS

SUBCOMMITTEE ON WORKFORCE, EMPOWERMENT AND GOVERNMENT

DANIEL LIPINSKI, Illinois

JOE HARTZ, Professional Staff

VerDate 0ct 09 2002

00:59 Nov 22, 2006

VerDate 0ct 09 2002

00:59 Nov 22, 2006

VerDate 0ct 09 2002

00:59 Nov 22, 2006