[Congressional Record Volume 153, Number 176 (Wednesday, November 14, 2007)]
[House]
[Pages H13952-H13956]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      AMERICAN HEALTH CARE SYSTEM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentleman from Texas (Mr. Burgess) is recognized 
for the remaining time until midnight as the designee of the minority 
leader.
  Mr. BURGESS. I thank the Speaker. The hour is late, the time is 
short. I do want to talk a little bit about health care this evening. 
Maybe, Mr. Speaker, in order to clear the air from the last 40 minutes, 
let's start off with a Bible verse. Let's start off reading from the 
Old Testament from the book of Habakkuk, Chapter 2. ``I will stand upon 
my watch, and I will set me upon the tower, and I will watch to see 
what he will say to me, and what I shall answer. And the Lord answered, 
Write the vision, make it plain upon tables, that he may run that 
readeth it. For the vision is yet for an appointed time, but at the end 
it shall speak and not lie. Wait for

[[Page H13953]]

it, because it will surely come. It will not tarry.''
  Mr. Speaker, I think those are important words. We are going to talk 
a little bit about the vision for health care, the future of health 
care in America. Sometimes we will have to wait for it, but it will 
come. It's a universal problem in this country. Some people think it 
has a universal solution; others disagree with that. But those two 
philosophies of health care, that that can be solved by the government 
or that that is better solved by individuals, those two competing 
philosophies are really going to be played out front and center over 
the next 18 to 24 months, both in this Congress and on the national 
stage in Presidential elections.
  I may be oversimplifying the issue a little bit, but it underscores 
the basic arrangements. We sometimes appear to discuss health care only 
in the realm of insurance, government systems, third-party systems. In 
fact, Mr. Speaker, if you recall back in 1993, when the attempt was 
made with the Clinton health care plan, a lot of us who worked in 
health care at the time were perplexed, we were concerned because at 
the time the plan seemed to be less about health care and more about 
the transactions involving health care, that is, more about insurance 
than actual health care.
  You know, back not too terribly long ago health care meant you called 
your doctor, you saw your doctor, you paid your doctor on the spot. 
Now, we have this convoluted system of third-party payers, government 
payers, private employee and self-pay. It's a complicated plan. It 
works. Hardly can be described as efficient. But it does work.
  Mr. Speaker, we have got to ask ourselves: Is our goal in reforming 
health care, is our goal indeed in transforming health care to protect 
our patients or are we here to protect that third-party system of 
payment? Is our goal to provide Americans with a reasonable way to 
obtain health care, a reasonable way to communicate with their 
physician, with their doctor, with their nurse?
  We really need to proceed carefully because the consequences of any 
poor choices we make over these next 18 to 24 months, the consequences 
of those poor choices will reverberate for decades. Not just in our 
lifetime, but in our children's lifetimes.
  Mr. Speaker, I often stress that the fundamental unit of production 
of this great and grand American medical machine, the fundamental unit 
of production is the interaction that takes place between the doctor 
and the patient in the treatment room. It is that fundamental unit of 
production which we must protect, we must preserve, we must defend. 
Indeed, anything we do to try to transform or reform the health care 
system in this country, first off, we need to ask: Is it going to bring 
value to that fundamental unit of production of the American health 
care machine?
  The test before us is do we protect people or do we protect the 
special interest groups. Do we protect big government or do we protect 
individuals? Do we believe in the supremacy of the State or do we 
believe in the sanctity of the individual? An educated consumer makes 
for a better health care system. We need to make health care reform 
about patients.
  Let me just spend a little time talking about what are some of the 
predominant plans that we hear talked about, some of those placed 
forward by the Presidential candidates, something that we hear talked 
about on the other side of the aisle here in this House. It's often 
referred to as a single-payer system or universal health care coverage. 
It's got a nice ring to it. It's almost seductive. Why shouldn't the 
world's strongest and best economy, the world's strongest and best 
health care system provide free health care to all? Well, perhaps the 
words of P.J. O'Rourke penned back in 1993 in the Liberty Manifesto, 
when he stated, If you think health care is expensive now, wait and see 
what it costs when it's free.
  Mr. Speaker, the American health care system has no shortage of 
critics at home or abroad. But, Mr. Speaker, it is the American health 
care system that stands at the forefront of innovation, the forefront 
of new technology. These are precisely the types of systemwide changes 
that are going to be necessary to efficiently and effectively provide 
care for Americans in the future. There's no way we can pay for all the 
care we are going to need to buy if we rely entirely on today's systems 
and solutions. There have to be new systems and solutions developed for 
the future, and they will deliver on that promise. The price will come 
down, but only if we give the system the freedom to act and develop 
those measures.
  Now, the New York Times, not something that I normally read, but just 
a little over a year ago the New York Times, renowned for its liberal 
leanings, published October 5, 2006, an article by Tyler Cowan, who 
wrote at the time, ``When it comes to medical innovation, the United 
States is the world's leader.'' Continuing to quote, ``In the past 10 
years, for instance, 12 Nobel prizes in medicine have gone to American-
born scientists working in the United States, three have gone to 
foreign-born scientists working in the United States, and seven have 
gone to researchers outside of this country.'' He goes on to point out 
that five of the six most important medical innovations of the past 25 
years have been developed within and because of the American system.
  Now, Mr. Speaker, comparisons with other countries may be useful, but 
it is important to remember that the American system is always 
reinventing itself and it's always seeking improvement. It is precisely 
because of the tension inherent in this hybrid public-private system 
that creates that tension and creates that impetus for change. A system 
that is completely and fully funded by a payroll tax or some other 
policy has no reason to seek improvement. Its funding and its funding 
stream is going to be reliable and predictable, occurring day after 
day. There's no reason to try to improve a system like that. It's 
always in complete balance, complete equilibrium, and faces stagnation. 
But if there does become a need in such a system to balance payments or 
control costs, where is that going to come from? We have already seen 
from our experience within our own Medicare system that is going to 
come at the expense of the provider. It always has, it always will.

                              {time}  2330

  The difficulties faced by providers within the Medicare system on an 
ongoing basis are truly staggering.
  Mr. Speaker, the fact is the United States is not Europe. American 
patients are accustomed to wide choices when it comes to hospitals, 
physicians and pharmaceuticals. Because our experience is unique and 
because our experience is different from other countries, this 
difference should be acknowledged and embraced, maybe even celebrated. 
But certainly when reform, either public or private, is discussed in 
this country, we need to be cognizant of that difference.
  That is one of the many reasons why a universal health care system, 
or a single payer system, translate that to ``the government,'' to me 
seems almost inadvisable, and certainly doesn't seem sustainable over 
time as an option. So let's think about some of the principles that 
really should be involved when we talk about changes and improvements 
to our health care system.
  Three principles that I focus on, and I think really form the crux of 
the basis of all activities regarding health care reform or 
transformation of the health care system, are affordability, 
accountability and advancements. Three things fairly easy to remember, 
almost an iteration when you put them right together.
  Under affordability, one of the things I think we oftentimes forget 
is what does it really cost to deliver the care? How do we assign those 
costs? How do we allocate those costs? The pricing for health care 
services really ought to be based on what is indicated by the market. 
But that isn't always the case. Oftentimes it is what is assumed by 
administrators, and consumers and even physicians are completely 
insulated, completely anesthetized as to what the care costs or what it 
costs to deliver the care.
  Now, an article or an op-ed from the Wall Street Journal earlier this 
year by Robert Swerlick, a dermatologist from Emory University, the 
title of his column was ``Our Soviet Health System.'' He laments the 
difficulty in finding a pediatric endocrinologist, but in turn it seems 
so easy to find a veterinarian who specializes in orthopedics for his 
Labrador Retriever. So he can't

[[Page H13954]]

find a doctor for his child, but he has no trouble finding one for his 
canine acquaintance.
  Now, the reason for that is the administrative pricing system that 
really is dictated by our Medicare system. And I think Dr. Swerlick 
really hits the nail on the head. He says, ``The roots of this problem 
lie in the use of an administrative pricing structure in medicine. The 
way prices are set in health care already distort the appropriate 
allocation of efforts and resources in health care today. 
Unfortunately,'' he goes on to say, ``many of the suggested reforms in 
our health care system, including various plans for universal care or 
universal insurance or a single-payer system that various policymakers 
espouse, rest on the same unsound foundations and will produce more of 
the same.''
  He goes on to say, ``The essential problem is this: The pricing of 
medical care in this country is either directly or indirectly dictated 
by Medicare.'' We have a system of Federal price controls in medicine 
in this country.
  Again, continuing to quote, ``Rather than independently calculate 
prices, private insurers in this country almost universally use 
Medicare prices as a framework to negotiate payments, generally setting 
payments for services as a percentage of the Medicare fee schedule.''
  This is an extremely important point, Mr. Speaker, and one that I 
don't think Members of this body truly grasp. It is so important, we 
are going to revisit it again in a minute when we talk about Medicare 
pricing and what is happening in the physician realm. But remember 
that, because that is an extremely important point.
  Medicare administrators set the prices. Private insurance companies 
in this country tend to follow suit. So when you say we have got a 
market-based economy in health care, really nothing could be further 
from the truth.
  ``And,'' as Dr. Swerlick goes on to say, ``unlike prices set on 
market conditions, the errors created are not self-correcting. Markets 
may not get the prices exactly correct all of the time, but they are 
capable of self-correction, a capacity that has yet to be demonstrated 
by administrative pricing.''
  Again, he goes on to associate this with the system that was in place 
in the old Soviet Union, and in fact correctly relates some of the 
problems in the old Soviet economy to the reason the old Soviet Union 
is not with us any longer. So we really need to pay careful attention 
to that.
  Transparency, I think that is something that we talk about a lot, but 
we don't spend nearly the time focusing on the issue as we should. 
Transparency between pricing for physicians and hospitals is essential. 
We want to go to a system where there is more consumer-directed health 
care, where consumers are more informed. But in order for consumers to 
be informed, they have to have the ability to go and get the data.
  Right now, the opacity built into the pricing structure between 
physicians and hospitals is significant, and, as a consequence, it 
becomes very, very difficult for the patient, the health care consumer, 
to be able to make those determinations.
  The other aspect that enters into it, of course, is the issue of 
physician quality. Sometimes that is an intangible. Sometimes that is 
something that is difficult to know just from visiting a Web site or 
checking data that may be available, and that may be the word of mouth 
type of information that is delivered from one patient to another. A 
wait time, for example, in one office that is much longer than in 
another office, you might be willing to pay a little bit more to wait a 
little bit less time, or you might be willing to wait a little bit more 
time if the care delivered in that office is truly exemplary.
  Now, Texas has taken some steps to make this more of a reality. I 
think people would like the ability for comparison. In fact, they would 
like to be able to go on-line for that comparison. I think Travelocity 
For Health Care, wouldn't that be a powerful tool to put into people's 
hands.
  An example in Texas is what is called Texas Price Point. There is a 
Web site, www.txpricepoint.org, which was created to provide basic 
demographic quality and charge information on Texas hospitals and to 
promote additional or ready access to consumer and hospital information 
and the appropriate interaction that could occur as a result of that.
  The program is very new. The data sometimes is a little too sparse, 
but it is a program that will build on itself over time and one that 
will I think provide significant utility to patients in Texas. And I 
believe other States have other programs. I think Florida has a program 
that is up and running. These are going to be critical. Some insurance 
companies have developed their own programs, and that will provide a 
critical knowledge base for patients who are covered by those insurance 
companies.
  One of the things that is going to affect affordability, even 
accessibility as far as physicians are concerned, is what I alluded to 
earlier with the Medicare pricing.
  Mr. Speaker, we had reported to us from the Center for Medicare and 
Medicaid Services the first of this month, not even 2 weeks ago, that 
the proposed physician payment cuts for next year will be just a little 
bit over 10 percent for doctors across-the-board in this country. That 
is untenable. Doctors cannot be expected to sustain that type of 
reduction.

  There is no telling what it does to a physician's ability to plan. A 
physician's office, after all, is a small business, and if they are 
going to be facing this type of price reduction, it is very difficult 
to plan. Do you hire a new nurse, do you purchase a new piece of 
equipment, do you take on a new partner, when year over year the 
Medicare system visits this type of travesty upon physicians? And this 
Congress, through both Republican majorities and now Democratic 
majorities, and Democratic majorities that preceded 1994, have refused 
to deal with this issue in a way that corrects it once and for all and 
gets us past the problem.
  The difficulty is that year over year, the physician pricing is set 
by a formula called the sustainable growth rate formula, and year over 
year for the past 5 years and projected for 10 years into the future, 
every year there is a cut to physician reimbursement.
  Now, you might say that doctors earn enough money and it is the 
Medicare system, so what harm is there in that? Let's go back for just 
a moment to Dr. Swerlick's article about administrative pricing.
  ``Again,'' he said, ``the essential problem is this. The pricing of 
medical care in this country is either directly or indirectly dictated 
by Medicare, and Medicare uses an administrative formula, the 
sustainable growth rate formula, which calculates appropriate prices 
based upon imperfect estimates and fudge factors. Rather than 
independently calculate prices, private insurers in this country almost 
universally use Medicare prices as a framework to negotiate payments, 
generally setting payments for services as a percentage of the Medicare 
fee structure.''
  So, let's think about that, Mr. Speaker. What happens on January 1 if 
this House does not take some action to prevent that 10 percent 
reduction in physician payments? What happens on January 1 is all of 
those insurance contracts that peg to Medicare reimbursement rates, all 
of those are going to be reduced by a factor of about 10 percent, or in 
some cases a little bit more. If a plan pays 120 percent of Medicare 
and Medicare is reduced 10 percent, that plan will reduce a concomitant 
amount, which will be a little bit in excess of 10 percent for their 
pricing on their physician services.
  Again, it has ripples and effects far beyond, far beyond what it 
would be affected just by the Medicare system. And it leads to a 
problem, it leads to a problem of what happens with the physician 
workforce.
  Now, just a little over 2 years ago, when Alan Greenspan, the former 
Chairman of the Federal Reserve Board here in Washington, DC, was 
retiring and sort of made a tour around the Capitol, sort of a one last 
victory lap around the Capitol, and came and met with a group of us one 
morning, the question was inevitably asked, what do we do about 
Medicare? What do we do about the liabilities, the future liabilities 
in Medicare? How are we going to meet those obligations?
  The chairman thought about it for a moment and then said, you know, I 
think when the time comes, Congress will take the action necessary and 
that the Medicare system will endure, will

[[Page H13955]]

be preserved. There may be some difficult choices and trade-offs that 
have to be made, but Congress at the correct time will make those 
choices.
  He stopped for a moment and then went on to say, what concerns me 
more, is will there be anyone there to deliver the services when you 
require them?
  And that really comes to the crux of the matter here. If we have a 
system within our Medicare reimbursement schedule for physicians where 
within the whole Medicare system itself, parts A, B, C and D, if only 
part B is affected by this, part A, which is the hospitals, they have a 
cost of living adjustment, part C, which is HMOs, they have a cost of 
living adjustment, part D, which is prescription drugs, they have a 
cost of living adjustment, if the only ones living under this onerous 
formula are the physicians, what happens over time?
  Well, what happens is people will retire early, people will restrict 
their practices so they no longer see Medicare patients, physicians 
will restrict the procedures that they offer Medicare patients, perhaps 
preferring office procedures to surgical procedures that tend to be 
more labor intensive and time intensive.
  It certainly has an effect on the law of supply and demand, if you 
will, as far as physician services are concerned within the Medicare 
system itself. For that reason, for that reason, it has a significantly 
pernicious effect on the physician workforce.
  Remember, I started out this talk and I said we always want to focus 
on are we delivering value to that doctor-patient interaction in the 
treatment room? Well, I will submit if you don't have a doctor there 
for that doctor-patient interaction in the treatment room, it is 
impossible to deliver value of any sort, if you don't have the 
physician there in the first place.
  So that is a critical part. A critical part of establishing and 
creating value for the patient is ensuring that there is indeed a 
capable and trained and caring physician there for that patient in the 
treatment room. And I worry that what we are providing for physician 
compensation within the Medicare system, which has ramifications 
throughout the entire private pay structure through the health care 
system, I do worry if that is a condition that can indeed be sustained.
  Now, one of the other things that I think we oftentime lose sight of 
when we talk about affordability, we always talk about the number of 
uninsured that exist in this country. Sure enough, it is too big a 
number. The number varies, depending upon who you read.
  But if we talk about the number today, we are probably going to talk 
about a number of around 47 million uninsured. And we always stop there 
and say, well, we have to do something about the 47 million who are 
uninsured, as if that was one homogenous population and one solution 
would work for everyone who is caught up in that category.
  But the reality is, one of the large insurance companies in this 
country did a little investigating to see who makes up, who is involved 
in this population, this universe of people who are uninsured.

                              {time}  2345

  It turns out 10 percent are university students. If you say we have 
47 or 48 million people uninsured, 10 percent of that is 4.8 million, 
nearly 5 million, are university students. Students who may arguably 
have health coverage available through their university or college. But 
even if they don't, this is a group of people that is pretty easy to 
insure. It is pretty inexpensive to insure.
  So a solution for that group would be vastly different than some of 
the other groups identified. Twenty percent of that population is 
already eligible for Medicaid or the State Children's Health Insurance 
Program. Why States with outreach efforts have not identified those 
individuals, I don't know. Perhaps we ought to make it incumbent for 
States to do that work.
  If we are providing Federal funds at all sorts of levels, maybe we 
ought to make it incumbent on States to do that outreach work so those 
individuals are enrolled in Federal programs to provide that. Again, 
think about it: 20 percent of 47 or 48 million people, that is almost 
10 million people that could be taken off the rolls of the uninsured 
tomorrow because the programs already exist to take care of them. You 
don't need to create a new program or do something different from what 
you are doing right now. Current Medicaid, current SCHIP will cover 20 
percent of that population.
  And 20 percent earn almost $80,000 a year. That is not a huge sum of 
money, but certainly a group of people that might be considered to be 
able to provide something toward their own health care. I am not a fan 
of mandates. I don't think you get anywhere by telling people what they 
have to do. But if we allow insurance companies some freedom to create 
the types of programs that would be of value to that segment of the 
population, that would be affordable to that segment of the population, 
if we would perhaps remove some restrictions, maybe remove some 
mandates, or decide what are those things that are going to comprise a 
basic package of benefits so we can make it affordable and marketable 
to that group of individuals who arguably have some disposable income 
that they could use towards their health care rather than creating a 
huge, new Federal structure to bring them in. Maybe that is a tactic 
that could be taken.
  Mr. Speaker, we don't like to focus a lot of time and energy on this, 
but we have to talk about it, and that is 20 percent of the people who 
fall into the category of the universe of uninsured people in this 
country are individuals who are in the country without the benefit of a 
Social Security number. Again, that is something that we as a country 
and we as a Congress do need to deal with. Whether that is increased 
efforts at controlling who is coming into our country and increased 
efforts at controlling our borders, but this is part of the problem 
that we as a Congress have yet to really face and deal with.
  We made some efforts, to be sure, in the current State Children's 
Health Insurance Program. One of the recent legislative proposals that 
came through Congress and was passed by Congress that is still tied up 
in negotiations wanted to relax the verification required for someone 
being able to document or verify that they are in this country legally. 
I don't know. I think this body needs to decide what direction it wants 
to go on this. I don't know that is a terribly useful activity from my 
perspective. It might engender more people wanting to come into this 
country to get benefits, but that is something that this Congress has 
to take up and face no matter how difficult it is.
  Mr. Speaker, we have talked about 10 percent university students, 20 
percent already eligible for Medicaid or SCHIP, 20 percent who earn 
nearly $80,000 a year and 20 percent who are noncitizens. If we add 
those all together, that is approximately, 10, 20, 30, plus 5, so 35 
million out of 47 million uninsured. We may have some solutions that 
are really just at our fingertips if we would expend a little bit of 
effort. And this is very frustrating to me. We never seem to want to do 
the effort to break down who is included in the population.
  We are all too content to take the number 47 million uninsured and 
use it as a political bludgeon to beat each other over the head, but we 
are never willing to do the work that a private insurance company did 
in a relatively short period of time. We never seem to be willing to do 
the work. With all of our Federal agencies and bureaus that count 
numbers and people, we never seem to be able or willing to do the work 
to get this number, break it down into the smaller subsets, the smaller 
populations where, in fact, we may be able to provide some significant 
benefit.
  Now, one of the things that I think we do need to talk about is on 
the aspect of accountability. First off, in any system that we talk 
about devising or implementing, we surely have to keep freedom of 
choice. We want to see the doctors we want to see when we want to see 
them. When hospitalization is required, freedom of choice has to remain 
central.
  One of the things that oftentimes gets lost in the discussion when 
you look at the breakdown of how health care expenditures occurs in 
this country, approximately half is paid for by the Federal Government. 
When you look at the Medicare and Medicaid programs, we heard some 
discussion of the

[[Page H13956]]

HHS appropriations bill, $680 billion, almost $700 billion spent by 
this country every year by Medicaid and Medicare. Add to that the money 
spent in the veterans health service and add to that the money spent in 
the Indian health service and add to that the money spent in the 
Federal prison system, and you come pretty close to 50 cents out of 
every health care dollar that is spent in this country has its origin 
here on the floor of this Congress. So that is a pretty big chunk that 
comes from the Federal Government already.
  The other half is not entirely private insurance, but certainly there 
is a large portion accounted by private or commercial insurance in this 
country. A portion, a portion is paid for by the patient out of their 
pocket.
  I would include the growing number of people who are covered by 
health savings accounts in this group. Health savings accounts being a 
high-deductible insurance policy where a person is able to accumulate 
dollars, pre-tax dollars in a savings account dedicated to their health 
care. Those dollars are owned by the individual. They are dollars that 
would, if something happened to the individual, they would stay in the 
family. They don't go back to the Federal Government like Social 
Security. These are dollars that would stay around and be there to help 
your family. They would be there to help someone when they transition 
into the Medicare system.
  Mr. Speaker, I had a medical savings account back in the 1990s when I 
was in the private practice of medicine back in Texas. I thought it was 
a great thing, not so much because of the money I was accumulating in 
this medical IRA. I thought it was a great thing because that was the 
time when HMOs were making big inroads into our medical practice in 
north Texas, and I liked the idea of being in charge of my health care 
decisions because I owned my own health insurance policy. As an 
individual policy, I felt I had much more power over what decisions 
were made for my health care and my family's health care.
  So the whole concept of ownership, owning that medical IRA and being 
allowed to accumulate those savings to offset future medical expenses, 
that is a fundamental desire of many Americans. And I think that is a 
desire that should be encouraged and embellished. Why not be able to 
accumulate a few dollars dedicated toward your future health care 
needs? That is a pretty powerful tool to put into people's hands.
  Again, for me the issue was being able to be in charge of my own 
health care, that individual freedom that comes with increased 
sovereignty. That was critical for me when I went out and looked for a 
medical savings account when they were first offered back in 1996 or 
1997.
  Certainly, Mr. Speaker, whenever we talk about accountability within 
the health care system, independence of the patient, the patient as an 
independent agent is something that must be preserved. That 
preservation of autonomy for the patient or the patient's designee if a 
medical power of attorney is exercised, but that is who should be 
responsible for the care, to be able to accept care, to be able to 
decline care if a particular medical intervention is either sought or 
someone wishes to not participate in the medical intervention that is 
offered. That is a fundamental right that we really should not take 
away from people.
  Advancements within the system. Again, the science of our medicine 
here in the United States is superior to that anywhere else in the 
world. You might say that our system of allocation or delivery system 
needs work, but no one can argue about the science that is present in 
the medical system in this country.
  So, high standards. We want to keep those high standards. The 
underpinnings of the American medical system has always been that we 
have high standards and we enforce standards of excellence, and nothing 
in the future should change that or undermine that. In fact, pathways 
to facilitate future growth in excellence should be encouraged.
  When you talk about expanding the role of the Federal Government in 
health care, you look at some other places where the Federal Government 
has a really big footprint, like our Social Security system, or the 
IRS. Are those systems administered with the highest standard? Or is it 
lowest common denominator? That is certainly a question worth asking 
before we increase that segment that is taken over by the Federal 
Government.
  As far as innovative approaches, American medicine has always been 
characterized by embracing innovation, developing new technologies and 
treatments. The transformational times we have had in medicine in the 
last century, development of anesthesia and blood banking in the 1910-
1920 time frame, development of large-scale production of antibiotics 
and anti-inflammatory agents in the 1940s, the development of 
antipsychotic and antidepressant medications in the 1960s, development 
of newer hypertensive agents in the 1960s, the beginning of the 
development of medicines or the recognition that elevated cholesterol 
levels could lead to disease, and the beginning of medicines that would 
begin to impact that in the 1960s, all of those transformational 
events. And during those same times, in the 1910 to 1920 time frame, 
you had a congressional investigation or commission to investigate the 
vast discrepancy between curricula in medical schools in one part of 
the country versus another, and the standardization of medical school 
curricula which was so critical for establishing that knowledge base of 
science that was going to carry us forward through the last century.
  In the 1940s, you are the introduction of employer-based insurance 
because of a reaction to wage and price controls that were in existence 
in the 1940s. And finally in the 1960s, you had the interjection of 
Medicare and Medicaid, for the first time the Federal Government having 
a big footprint in paying for health care.
  So all of those transformational times were where the science changed 
rapidly and the public policy changed rapidly. I think we are on the 
cusp of such a time right now. Things are going to be changing in the 
realm of the whole arena of personalized medicine. The threshold of 
that stretches just before us.
  The whole concept of far earlier prevention than anyone has thought 
possible. We have all heard that an ounce of prevention is worth a 
pound of cure. Well, we are going to get to use those ounces of 
prevention because of the studies and work that has gone on with 
studying the human genome and the whole phenomenon of genomic medicine. 
We are going to be able to get that ounce of prevention administered so 
much earlier. So we will get the equity from that pound of cure in so 
many ways that really we can't even fathom them at this point.
  What is critical is that this Congress not get caught up in the 
transactional, not always get caught up in the insurance and the 
Medicaid and the Medicare. Don't be so caught up in the transactional 
that you block the transformational because that is the real tragedy. 
That is the real difficulty. That is the real danger to the generations 
for a decade from now, two decades from now, three decades from now.
  That is why this Congress needs to be so focused on this issue. That 
is why all of us on both sides of the aisle need to make ourselves 
students of health care policy. We need to find out as much as we 
possibly can about it. We need to come to this floor every day and 
every night prepared to debate this on the merits and science. Leave 
the politics on the side. This is one of those issues that is too 
important to leave to politics.

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